Critical Timing

Teaching future ICU doctors.

Art by Randall Nelson

Medical school residents often used to work 24 hours straight. But fears about overworked residents making errors prompted new guidelines from the national Accreditation Council for Graduate Medical Education. They now work no more than 80 hours weekly, with shifts no longer than 16 hours, plus 10 hours off between shifts. Medical schools can lose accreditation if they do not abide.

For residents in intensive care rotations, where care continuity is life and death, the new rule creates challenges. “The tradeoff is the inevitable handoff of the care of a patient,” says Michele LeClaire, an assistant professor of medicine at Hennepin County Medical Center. Without continuity of care, residents sometimes lose the opportunity to see firsthand the results of their actions.

It’s also unclear whether the new guidelines protect patients. A paper in April’s JAMA Internal Medicine noted that the percentage of residents reporting harmful errors actually went up slightly when work hours went down. Another 2007 study showed no statistical difference in patient mortality under hour restrictions, though residents’ hours were likely underreported. Other studies have shown slight or moderate reductions in errors when hours are reduced.

The squeeze is on for ICU docs who are teaching, like LeClaire. “Our primary responsibility is to provide excellent medical care to the patient,” she says. “As the residents have a little less continuity with them, it’s our job to provide that overview.” That means residents spend more time sharing cases, debriefing at handoffs, and following up with each other on what went well and what could improve.

Once med students leave residency, they will have no work-hour restrictions. “In practicing physicians there is a burnout rate that exceeds 40 percent,” LeClaire says. “The supposition is that learning how to take time away from the hospital to recharge is important for all physicians.” Hopefully, it’s important for the patients, too.

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