Family Medicine Resident Says Duty Hour Changes Can Promote Teamwork

October 06, 2010 05:30 pm Barbara Bein

Ben Schneider, M.D., is a third-year resident at the Oregon Health & Science University Family Medicine Residency in Portland, Ore. He's also the resident representative to the Association of Family Medicine Residency Directors Board of Directors.

AAFP News Now asked Schneider for his thoughts about the resident duty hour changes just released by the Accreditation Council for Graduate Medical Education, or ACGME. Those changes include, among other things, a 16-hour work limit for first-year residents, along with stricter supervision requirements.

Q: What do you think of the new duty hour changes imposed by the ACGME?

A: I believe the increase in supervision can have a huge, positive impact on resident education, as well as on patient safety, so long as senior residents and faculty still allow first-year residents to think and make decisions on their own. Just because faculty now need to be close geographically doesn't mean that they need to micromanage.

However, I am coming from the perspective of a large, academic program. I am concerned about how these changes will affect smaller, community programs. Given that there will be no incoming funds to pay for this mandated change, I worry how small programs will be able to quickly adapt to meet the requirements. If good, but small, residency programs are forced to close, it will be a devastating blow to family medicine graduate medical education as a whole.

Q: First-year residents can't work more than 16 hours per shift. In your experience, will it hurt their education?

A: It is clear that after 16 hours of continuous work, mental clarity begins to wane and the number of mistakes we make begins to rise. Why, then, would we want our trainees to spend more than one-third of their shifts living in this gray zone?

Many will make the argument that residency training requires these long shifts to prepare young physicians for the rigors of their careers when 30-or-more-hour shifts will be a reality. I have yet to see any data showing that training in a sleep-deprived state makes you any better at working under those conditions.

Q: Although the AAFP and other groups have focused on the added costs of incorporating these changes in a time of economic uncertainty, as well as on the potential for lost educational opportunities, do you see anything good about these revisions?

A: Many feel that these requirements are an unfunded mandate that will cripple many programs and reduce opportunities for education. I would argue that while difficult, these changes offer an opportunity for improving graduate medical education and patient care.

Family medicine residency programs across the county are grappling with the idea of who we are as a specialty and how to best train residents to be the family doctors of tomorrow. The new common requirements will likely force big changes in how the family medicine service is run.

Now is the time for us as a specialty to better define and standardize our training. Now is the time to implement innovative ideas into residency training such as the patient-centered medical home, evidence-based practice and continuous improvement.

If the solution to the new requirements is to create a new schedule where residents are still pushed to (work) as close to 80 hours a week (as they can) without going over, I think education will suffer. We already try to do too much with too little time and too few resources. Instead, this should be used as an opportunity to expand the team model of care and allow everyone to work to the top of their degrees.

That will be the future of medicine, so shouldn't our training look that way?