Years spent as an intern, resident, or fellow are euphemistically labeled Graduate Medical Education. During GME a young physician must cram as much knowledge and experience as possible during this training opportunity. Oh, before I forget, GME physicians are a very inexpensive labor force. Large hospitals could not function without these housestaff members.
Here’s an example: an ophthalmologist specializing in corneal surgery completes a one-year internship, a three-year residency, plus another year as a fellow.
Every hour asleep is an hour of missed training. At least that’s how sage medical educators used to think. We used to love to tell stories about we were forced to work 40-48 hours or longer without a break. It was a savage system. Well-documented studies have demonstrated how this draconian approach led to a marked increase in serious medical mistakes as well as a rise in personal health risks to these young doctors.
Here’s how it works. The Accreditation Council for Graduate Medical Education (ACGME) introduced work-hour limits for all first-year residents training in U.S. hospitals. Under these standards, interns are limited to a maximum of 30 consecutive work hours (known as the 30-hour rule), which includes time used for sign-out, teaching, and continuity of care. Interns also are prohibited from working more than 80 hours per week (the 80-hour rule), averaged over 4 weeks, and must be free of all duties for 1 day in 7 (the 7-day rule). In the year following implementation of the standards, mandatory reports submitted to the ACGME by residency programs concluded that only 5 percent of residency programs did not comply, and that only 3 percent of residents reported any violations of the 80-hour rule.
Interns and residents who pull an “all-nighter” are not supposed to be working the following day. They need to go home and rest. In our hospital we hired more residents to accommodate these welcome changes.
Hospitals who disregard the ACGME rules could jeopardize the accreditation of their training programs. That would be a disaster for the trainees as well as the institution. If you encounter a young physician who appears exceedingly drowsy – or – who admits to having been on duty for over 24 hours, report the incident to the clinic supervisor or hospital administrator.
Wake-up and smell the coffee! It is a proven fact that well-rested physicians provide more efficient, more compassionate, and far more safe care to their patients.