Since 2011, the Accreditation Council for Graduate Medical Education (ACGME) have limited how long first-year medical residents can work continuously without a break - 16 hours. The rules were implemented due to studies finding that sleep deprivation leads to medical errors and potentially threaten patients' safety.

Studies conducted on sleep-deprived residents showed that they are more likely to injure themselves even while performing simple procedure such as drawing blood, inserting intravenous lines or suturing wounds, leading to viral infections such as hepatitis and HIV. Tired residents also tend to have an overall lower morale with a higher likelihood of psychological issues and this raises concerns with patient safety.

However, the ACGME is proposing to increase the number of consecutive hours to 28 hours. This reverts its former argument by saying that restricting first-year resident work hours to shorter shifts was not a prodigal proposal, but rather, it could hurt patient care and quality of doctor training. ACGME wants to avoid "the disruption of team-based care and to facilitate seamless continuity of care."

Doctors say that the medical residents would most probably not experience a 24-hour shift. Dr. Tomas Nasca, ACGME's CEO said that not even half of medical specialties "ever come close to" 80 hours of residency work in a week or "working 24 consecutive hours."

Training for when round-the-clock care is needed

It is only for instances where round-the-clock care is needed so residents need to experience what it is like, medical educators say. Most of the mistakes occur at the critical point when residents have to hand off their patients to other doctors due to a rigid schedule which forces them to handover at a specific time. The change in doctors would result in a lower quality of patient care as well, as the "new" doctor does not know the patient as well.

Specialties such as neurosurgery and other medical disciplines where the seriousness of a patient's injury or illness requires a physician to attend beyond 16 hours, such as surgeries or post-operative care, are usually affected. Nasca said that at some point in a physician's clinical practice, they would need to put in these lengths of hours, therefore residents should be trained for it.

Insufficient sleep and an overwhelming workload is something that housemen (HOs) inevitably encounter when they undergo training especially in the government settings where the ratio of doctors to patients are below average. Discounting regular working hours where life and death decisions may need to be made, they are expected to be on call through the night, forcing them to work more than 30 hours at a stretch, therefore the transition should not be difficult.

Programs can still configure clinical schedules to 16-hour increments

The ACGME is expected to make a decision this month after seeking public comment, with hope that recommendations on work-hours and other new residency training requirements will be ready for implementation in medical schools and teaching hospitals for the 2017-2018 academic year.

"It is important to note that the absence of a common 16-hour limit does not imply that programs may no longer configure their clinical schedules in 16-hour increments if that is the preferred option for a given setting or clinical context," Nasca said.

The 24-consecutive-hour cap has been the standard for all second to tenth year residents, therefore it should not be a stretch for first-year residents. MIMS

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