A panel at the Institute of Medicine recommended that medical and surgical residents in hospitals work no more than 16 hours without taking a mandatory five-hour sleep break, along with other work rules. The panel also advised that residents should have greater supervision, and interns, who are in their first year of training after medical school, should have in-house supervisors rather than ones available only over the phone. Medical residencies last from three to seven years, depending on the specialty. These rules are more restrictive than rules implemented in 2003, which are heavily violated.
"[T]he science clearly shows that fatigue increases the chances of errors, and residents often work long hours without rest and regular time off," said the leader of the panel, Michael M.E. Johns, a physician and the chancellor of Emory University.
The maximum hours residents may work in a week is currently set at 80 hours, with shifts of 30 hours or less. Residents are also required to take at least four days a month off, but there is no restriction on when those days are taken. The requirements are set by the Accreditation Council for Graduate Medical Education, which oversees residency programs.
These restrictions, however, are widely violated. A survey of about 4,000 interns found that in the first year those rules were in effect, 84 percent reported working shifts that violated them at least one month of the year. Forty-three percent said they worked more than 80 hours per week. In 2005, a survey at Vanderbilt University Medical Center found that 85 percent of medical and surgical residents reported violating the 30-hour shift limit.
While fatigue causes a risk to patient harm, it also increases the risk of car accidents and depression for the residents themselves. A 1996 study found that pediatric residents who slept less than three hours a night when they were on call were twice as likely to be in car accidents as faculty members, who did not report sleep-deprived nights.
The panel made their new recommendations, but recognized that implementing the recommendations could make things worse because more patient handoffs would be required. Handoffs require passing information about patients to a receiving physician that has probably never seen or examined the patient, and are a known source of medical error. However, researchers "believe it is a fixable problem," said David F. Dinges, a sleep researcher at the University of Pennsylvania.