Patient Safety and Quality

Work hour limitations may improve resident quality of life, but other effects are unknown

The negative effects of sleep deprivation on residents was one factor behind the mandatory 80-hour work week restrictions instituted by the Accreditation Council for Graduate Medical Education (ACGME) in 2003. Studies suggest that residents' quality of life may improve with work hour limitations. However, studies on the topic thus far have used suboptimal study design and nonvalidated instruments. The long-term impact of reducing resident work hours on medical education and patient outcomes remains unknown, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS11540).

The researchers state that more studies are needed to rigorously evaluate the link between resident working hours and their quality of life, burnout, quality of medical education, and quality of patient care. They reviewed the research literature on the effect of interventions to reduce resident work hours on residents' education and quality of life. Interventions used to decrease resident work hours varied from use of night and day float teams to providing extra cross-coverage and use of physician extenders. Interventions (most made before the ACGME restrictions) generally improved residents' quality of life (such as their amount of sleep and sense of well-being), but had mixed effects on both residents' operative experience and on perceived educational quality (that is, operative experience, test scores, and satisfaction).

Some educators argue that reduced hours for residents may necessitate additional years of training. The benefit of fewer hours on reduced fatigue may be worthwhile if operative experience evens out over the course of training. However, reduced hours may be problematic if residents have less experience in their final year before leaving training, as was found in one study.

See "Effects of work hour reduction on residents' lives: A systematic review," by Kathlyn E. Fletcher, M.D., M.A., Willie Underwood III, M.D., M.S., M.P.H., Steven Q. Davis, M.D., and others, in the September 7, 2005, Journal of the American Medical Association 294(9), pp. 1088-1100.

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