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Monitoring Medical Residents

Groups petition government for work cap

SATURDAY, June 2, 2001 (HealthDayNews) -- The federal government has to limit the number of hours worked by medical residents to protect their health and the safety of their patients, says a petition filed with the U.S. Occupational Safety and Health Administration.

"Residents [doctors in training after medical school] can regularly work anywhere from 95 to 140 hours per week. This is out of 168 hours in one week. Working this amount of time represents a danger to both patients, in the form of medical error, and to the residents themselves," says Anandev Gurjala, a spokesman and health researcher for Public Citizen, a national consumer advocacy organization.

Public Citizen filed the petition together with the Committee of Interns and Residents, a union representing more than 11,000 medical residents, and the American Medical Student Association, which represents more than 30,000 medical students.

The petition seeks a work cap of 80 hours a week, with shifts not to exceed 24 hours. It also asks that on-call shifts be limited to every third night. And it asks that there be a minimum of 10 hours between shifts, with at least one 24-hour period of off-duty time per week.

There are no existing legislated national work-hour limits for medical residents. The closest thing to a set of national standards are work-hour guidelines issued by the Accreditation Council for Graduate Medical Education (ACGME), the body that accredits more than 7,700 residency programs in 110 medical specialties and subspecialties.

But the ACGME work-hour guidelines vary by medical specialty, and hospital compliance is voluntary.

Gurjala, who is also a second-year medical student, says a comprehensive review of studies demonstrates the risk to the health and safety of sleep-deprived medical residents. For example, the residents are at increased risk for auto accidents, depression, and pregnancy complications.

There's also the issue of their ability to treat patients, he says.

"There have been a multitude of studies showing that residents have decreased performance in certain medical procedures, including reading of EKGs and anesthesia-monitoring tasks. And there have also been studies showing there are decreases in performance of cognitive tasks, including memory recall and learning," Gurjala says.

One study cited in the petition was published in 1991 in the Journal of the American Medical Association. The study found that 41 percent of 114 medical residents who reported mistakes said fatigue was the cause of their most serious error. And in almost one-third of the cases, the patient died as a result of the error.

While the American Medical Association (AMA) says it's concerned about the impact of excessive work hours on the health of residents and on patient safety, it doesn't agree with calls for government intervention.

The AMA favors working with the ACGME to develop and enforce better work-hour standards, Dr. Liana Puscas, the AMA's resident trustee, says in a written statement.

The AMA wants to address the issue in various ways, she says. These include: developing recommendations based on existing research on the relationship between sleep deprivation and fatigue and physician performance and education; working with the ACGME and other groups to develop better work-hour guidelines and ensure effective monitoring and enforcement of current guidelines; and reducing the amount of non-educational work burdens placed on residents.

"Medical students play a vital role in our nation's health-care system. Their needs must be addressed. The ACGME must continue to define the requirements of graduate medical education programs, but additional measures may be needed to ensure resident well-being, quality physician training, and patient safety," Puscas says.

What To Do

To learn more about admission to the nation's medical schools, try the Association of American Medical Colleges.

For the latest, if controversial, list of the country's top medical programs, check out U.S. News & World Report.

This HealthDay story looks at declining enrollments at U.S. medical schools.

SOURCES: Interview with Anandev Gurjala, health researcher, spokesman, Public Citizen, Washington, D.C.; written statement from Liana Puscas, M.D., resident trustee, American Medical Association, Chicago
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