Residency training programs across the nation have undergone significant changes in residents’ duty hours to comply with new accreditation standards.
As of July 1, residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) are generally required to limit resident duty to 80 hours per week, schedule residents for call no more than every third night, and give residents one 24-hour day off per week free of patient care and educational obligations. Residents are medical school graduates receiving further training in specific disciplines such as family medicine, surgery or anesthesiology, for example.
These standards are averaged over four weeks. The standards also limit continuous duty to 24 hours, but allow for up to six hours additional time for continuity of care and for education. Residents must also have at least 10 hours rest between duty periods.
The minimum standards apply to residency programs in all 118 ACGME-accredited specialties and subspecialties. The duty hour standards attempt to address health-care environment changes, to promote quality training and patient care, and to protect patient safety.
The ACGME will monitor compliance with duty-hour standards by confidential Internet resident surveys and interviews during accreditation site visits.
UW Medicine has been implementing solutions to meet the new standards throughout the system. In December of 2002, residency program directors assessed their programs and developed plans to bring each program into compliance with the new standards. Among the concerns expressed about the new duty standards were decreased continuity of patient care, increased faculty workload, and missed training opportunities.
A UW steering committee reviewed the residency program plans. The committee, headed by Dr. John Coombs, associate vice president and associate dean for regional affairs and graduate medical education, was composed of the medical directors of UW Medical Center and Harborview Medical Center, representative residents, the director of graduate medical education, residency program directors, the MEDEX Northwest director, and others.
Most programs were already meeting the new standards. Changes were required in 10 departments. The types of changes include the addition of new residents and in-hospital physicians, increasing the patient care responsibilities of nurse practitioners and physician assistants, and improving the work flow on the affected clinical units.
UW Medicine is improving other aspects of graduate medical education to foster excellence and efficiency, flexibility to meet future clinical service demands, and integration of general competency requirements into duty-hour limitations.
Program directors hope the new standards will reduce residents’ fatigue, improve quality of residents’ lives, and enhance patient safety.