Resident Restructure: Attendings adjust to new work-hour rules

The new duty hour regulation from the Accreditation Council for Graduate Medical Education (ACGME) that limits first-year residents to 16-hour shifts has drawn a conflicted chorus of reactions from attendings, who have only seven months before the stipulation goes into effect.

Some otolaryngologists view the move ambivalently, seeing it as a natural extension of the landmark 2003 rules that capped most resident workweeks at 80 hours and required one day off in seven from all education and clinical activities. Others view it as yet another rule that chips away at how well prepared the next generation of residents will be.

Regardless of viewpoint, residency program directors have little time to prepare for the changes, which were formally adopted in late September and go into effect July 1. Because otolaryngology residents typically spend one to three months of their first year in the otolaryngology service, several program directors have said that the effect of the duty hour modification for post-graduate year one (PGY-1) residents may be muted on the physical ENT rotation. It could cause scheduling issues with other rotations the resident is on in that year, however, including anesthesiology and general surgery.

“Our PGY-1 otolaryngology residents who are rotating on the general surgery services? Those general surgery services are going to have more difficulty in staying in compliance,” said Bradley Kesser, MD, associate professor and program director of otolaryngology-head and neck surgery at the University of Virginia Health System in Charlottesville.

Dr. Kesser co-authored a report, “Four years of accreditation council of graduate medical education duty hour regulations: Have they made a difference?” which stated that the 2003 rules “did not improve patient care as measured by the 30-day readmission rate, in-hospital mortality, and patient’s length of stay” (Laryngoscope. 2009;119(4):635-639). The study, a retrospective review of an otolaryngology residency program’s resident duty hours violations and Otolaryngology Training Examination (OTE) scores, noted that residents’ performance on the OTE also showed no significant change. It suggested more research to determine whether the rules have had a statistically significant impact on either patient care or how well residents were trained.

Dr. Kesser said the rules will benefit upper level residents because the ACGME has added language that allows them to exceed previous duty hour limits in prescribed situations. Particularly noteworthy to Dr. Kesser is language that recognizes that “residents in the final years of education (as defined by the Review Committee) must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods.”