OGDEN -- When Dr. Emily Poff was a first-year medical resident at McKay-Dee Hospital, she was on call for 24 hours. When her shift was over, she spent an additional two to six hours making patient rounds. The family medicine resident, now in her second year, knew what she was getting into. Long hours, stress, little sleep and a rigorous, demanding schedule have been part of the training of young doctors for decades. But under proposed regulations, doctors like Poff may be working shorter shifts under closer supervision.
The Accreditation Council for Graduate Medical Education last month recommended cutting the maximum time per shift for first-year residents from 24 hours to 16. The goal is to reduce errors caused by lack of sleep and to enhance patient safety.
On the ACGME website, Dr. Thomas Nasca, CEO and vice chairman of the Task Force on Quality Care and Professionalism, said patient safety and an excellent, humanistic learning environment are the ACGME's twin prime objectives.
"We want first-year residents to have the resources and supervision they need to learn and provide excellent patient care while also assuring that residents near the end of their training are prepared to leave the program and practice independently," Nasca said.
Those recommendations concern Poff.
"I believe that the rigorous hours that are a part of residency are an important part of resident training," she said.
"In our program, we are front-loaded with more inpatient hours in the beginning of residency. Working so many long hours helped to build my stamina and confidence to know that I could handle difficult patient situations even under suboptimal physical conditions, which is something practicing physicians must be able to do."
Poff believes that seeing many patients is essential to building an experience base that will help residents gain confidence and handle situations on their own once they are finished with residency.
"The more resident hours are restricted, the fewer cases they will see, which will limit their education and experience," Poff said.
"I am concerned that patient care may not improve with the work hour restrictions and even may suffer. With shorter shifts, there are more pass-offs of patient information between residents. Lack of continuity of care could adversely affect patient care and may offset any gains in patient safety under the proposed changes."
Residency programs provide rigorous on-the-job training for medical schools' newest graduates. By the time they are finished with residency, they are fully competent for independent practice, said Dr. Anne Hutchinson.
"The residency program at McKay-Dee has 18 residents. It is a family medicine program," Hutchinson said. "Family medicine residencies typically are three years long, so we have six first-year residents, six second-years and six third-years."
New residents start every July 1, and the third-years graduate every June 30. They come from medical schools around the country and end up at McKay-Dee via a national matching program in which both they and the hospital submit a preference list.
During their three years at McKay-Dee, the residents complete a curriculum specific to each year of training. Some of the training occurs in specialists' offices, some in their own clinic at McKay-Dee, some at the Community Health Center and some on the inpatient wards in the hospital, Hutchinson said.
"The resident hours vary depending on their rotation. For the last several years, the ACGME has set work hour restrictions including a limit of 80 hours per week, averaged over a four-week period, with certain amounts of time off during that time required," Hutchinson said.
"The residency program must comply with these time restrictions in order to maintain accreditation by the ACGME."
On some rotations, the residents are on call every fourth day, meaning they stay overnight in the hospital and care for patients as needed throughout the night. When this occurs, they are required to finish their duties and leave the hospital by 1 p.m. the next day.
"Other situations can arise where they would work longer than a usual work day, such as when attending to an obstetrical patient during labor and delivery of a baby," Hutchinson said.
Under the regulations, patients must be informed when they are being treated by new doctors. The accrediting group is seeking public comment on the new regulations on its website, www.acgme.org, through Aug. 9.
The new regulations are now scheduled to become effective July 2011.
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