In response to many national calls to enhance patient safety, the Accreditation Council for Graduate Medical Education (ACGME) mandated a maximum 80-hour workweek for all residents beginning in 2003. Traditionally, surgical programs have been the most grueling residencies, incorporating workweeks that often reached 100 to 120 hours. Because otolaryngology-head and neck surgery is both an operative and office-based specialty, the 80-hour workweek may have a different impact than in other surgical specialties, such as neurosurgery and cardiac surgery. But the impact on all residency training is important to consider.
Explore this issue:November 2008
Background of Work Hour Regulations
The concept of work-hour restriction has been rapidly developing in the medical education community over the past two decades, but a big jolt forward resulted as a response to a particular legal case in New York State when a grand jury investigation, launched after the death of 18-year-old Libby Zion, determined that the long hours of often unsupervised interns and residents was a contributing factor. In 2003, after much internal dialog and review, the ACGME introduced explicit regulations for residency training, designed to ensure that residents were sufficiently rested when caring for patients (see sidebar, page 8).1 These guidelines include criteria that are monitored by the ACGME, and violations bring risk for institutions’ loss of their residency program accreditation.
Advantages of Regulations
Prior to the mandate for restriction, there were no compelling data showing that decreasing work hours would result in greater patient safety and better care. Since 2004, a variety of studies conducted at several large academic health centers have generally shown no worsening of patient outcomes, some possible improvements, and mixed results on any mortality benefit associated with duty-hour restrictions.2-10 However, it is difficult to predict whether these results will endure and be similar across all institutions and in all settings. This underscores the need for further investigation.