Background:
A task force of the Accreditation Council for Graduate Medical Education (ACGME) has proposed removing the current requirement limiting first-year residents to 16 hours on shift and raising the limit to 24 hours on-task plus 4 hours to manage transitions of care. Residents may also remain past the time limit for educational or research purposes in unusual circumstances. The additional time is still counted toward the 80-hour weekly limit. Residency programs are free to keep 16-hour shift schedules and that specialty review committees will still be permitted and expected to add greater restrictions, such as how internal medicine currently does not permit averaging of the frequency of overnight call. The proposed changes are open for review and comment online until December 19, 2016. See ACP’s detailed comments. After the comment period, the final proposed requirements will be submitted to the ACGME Board of Directors for approval, with implementation planned for the 2017-18 academic year.
ACP statement attributable to:
Nitin S. Damle, MD, MS, MACP
President, Â鶹ֱ²¥app (ACP)
December 19, 2016
As we noted in our detailed comments, the Â鶹ֱ²¥app approves and commends ACGME for explicitly addressing well-being in the Common Program Requirements. ACP supports the tracking and reporting of resident well-being and its incorporation into the Common requirements.
ACP agrees in principle with ACGME that work from home such as using an electronic health record and taking calls must be included in the weekly 80-hour work limit.
We strongly recommend that the standard for duty-free days must stipulate two days off in any 14-day period. This would prevent resident abuse by programs scheduling residents for 24 straight days of work followed by four days off.
ACP strongly opposes the change to include an additional four hours in addition to the already generous four-hour extension to 24 hours on call (’24 +’). We believe that the 24 + rule adequately addresses all clinical and educational needs. The new standard places residents at risk for 28 consecutive hours of duty.
ACP supports ACGME’s revision of mandating residents having at least 14 hours free of duty, clinical work and education after 24 hours of in-house duty call as a means of protecting resident quality of life and patient safety.
We support ACGME in removing the standard limiting duty hours for PGY-1 residents to no more than 16-hours. By mandating different hours for PGY-residents and more senior residents, the old standard disrupted the continuity of the resident team and resulted in considerable unintended consequences without commensurate improvement in patient safety or educational outcomes.
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