Duty hour rules ripple across medical education
A simple rule to give residents more sleep has kept educators up at night. The rule limits residents' duty to 80 hours per week. Its fallout has bumped some medical students' work hours to 100 per week and left educators scratching their heads about ensuring the educational quality of the medical students' experience.
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"Residents are
some of the main teachers for students, and when the residents go home, the
teaching stops." |
Family medicine has felt less pain than its surgery counterparts, but family medicine programs do feel the pinch, said Edward Bope, M.D., director of the Riverside Family Practice Residency of Columbus, Ohio, and former president of the Association of Family Practice Residency Directors.
"The issue comes up when other resident duty hours are imposed on us," he said, referring to rotations such as surgery. In other situations, family medicine residents may have moderate duty hours and may fill in for residents who've reached the 80-hour quota. "The other specialties are finding that the FP resident is a help in meeting call demand. That increases the quality of the experience for our residents," said Bope.
However, enforcing duty hour restrictions may limit medical students' access to resident supervisors.
Effect on medical students
Implications of the new rule from the Accreditation Council for Graduate Medical Education have rippled across medical schools. Some students say they're working harder; others say their educational opportunities have shrunk.
"The students' work increased to over 100 hours a week on average for the group in my clerkship, and remained that way until two months ago," said William Walsh, a student at Indiana University School of Medicine, Indianapolis, and student representative to the AMA Council on Medical Education. "The longest shift I put in was 44 hours consecutively."
Longer hours resulted partly from expectations that students would complete the nonmedical tasks formerly performed by residents, he added.
"After the ACGME program requirements came into effect, the medical student leadership started receiving reports from our fellow students," Walsh recalled. "I received over 100 complaints myself."
The problem was sporadic and depended on the rotation, said Danny Lewis of East Tennessee State University College of Medicine, Hampton, Tenn., student delegate to the AAFP Congress of Delegates.
"On a couple of rotations, the residents were allowed to go home at noon following call nights, while the students on call were required to continue clinical assignments and lectures until the midafternoon," Lewis said. "On another rotation, however, the student was treated as the resident and went home when the resident did post call.
"As a whole, we savored the opportunity to learn. As long as our duties contributed to learning, then we didn't seem to worry about it."
Walsh responded to concerns by writing a resolution urging the Liaison Committee on Medical Education to address the issue.
Adopted by the AMA Medical Student Section and House of Delegates, the resolution resulted in an LCME amendment to medical school standards. "In general, medical students should not be required to work longer hours than residents," the LCME amendment concludes.
Educational implications
Although one issue is being resolved, a second continues, said Bope.
"Many are concerned that cutting down hours will cut down the educational experience," he said.
Joe McDonald of the University of Kansas School of Medicine, Kansas City, chair of the AMA-MSS Governing Council, agreed.
"I've been hearing from students who've said they aren't learning as much, or some work fewer hours" as schools implement duty hours restrictions, he said. "Residents are some of the main teachers for students, and when the residents go home, the teaching stops."
ACGME is reviewing these issues and may tweak the rules during its September meeting, said Ingrid Philibert, ACGME vice president of field operations. Bope applauds the effort. "During this first year, we're trying to see where the truth is in all that we're hearing," he said. "We are learning how to better teach, how to make better use of residents' time. It's really a redesign of medical education. There's no quick answer. This is an evolving system."
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
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Copyright © 2004 by
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