CHICAGO, Oct. 28, 2004 - Two studies published in the Oct. 28, 2004 issue of the New England Journal of Medicine support the Accreditation Council for Graduate Medical Education's decision to implement duty hour standards for residents.

"These studies are very helpful and help validate that the ACGME is moving in the right direction in its regulation of duty hour standards," said ACGME Executive Director David C. Leach, MD. "It also makes clear that continuing efforts to further refine the standards are needed. Hard data like this is very helpful in the refinement process."

The two studies examined the impact of extended duty hour shifts on medical errors, attentional failures and sleep among first-year residents on rotations in the intensive care unit at Brigham and Women's Hospital in Boston. One study "Effect of Reducing Interns Work Hours on Serious Medical Errors in Intensive Care Units" by Christopher P. Landrigan, MD, PhD, et al. concluded that eliminating extended duty hour shifts can reduce serious medical errors in the ICU. The other study - "Effect of Reducing Interns Weekly Work Hours on Sleep and Attentional Failures" by Steven W. Lockley, PhD, et al. concluded that first-year residents who were on duty less than 80 hours per week got more sleep and had less than half the rate of attentional failures while working during on-call nights as compared to those first-year residents who were on duty more than 80 hours per week.

One unknown factor, however, is if the combined impact of inexperience and fatigue on medical errors is the same as the impact of fatigue on more experienced residents, noted Dr. Leach. In addition, because duty hours are only one piece of the residents' overall learning environment, the ACGME has created a standing committee on innovations in resident learning.

"The number of hours worked is an important variable, but not the only one in the learning environment," said Dr. Leach. "Working fewer hours may reduce fatigue, but the numbers of patients seen and their acuity also contribute to medical errors, especially with inexperienced first-year residents. It may be inappropriate for a first-year resident to ever care for patients in an intensive care setting."

The ACGME implemented common duty hour standards for residents in all ACGME-accredited programs on July 1, 2003. The standards limit duty hours to no more than 80 hours per week, averaged over four weeks; limit continuous duty shifts to no more than 24 hours plus up to six additional hours for patient hand-offs and educational activities; require one day in seven free from patient care and educational obligations, averaged over four weeks; limit in-house call to no more than once every three nights, averaged over four weeks; and require rest periods that should be at least 10 hours between duty shifts.

Programs can request an increase of up to eight hours per week above the 80-hour limit, on a case-by-case basis, if this benefits resident education and is approved by the sponsoring institution and the ACGME residency review committee for that particular specialty. Seventy-four programs out of 8,000 ACGME-accredited programs have been granted the increase, most of which are in the specialty of neurological surgery.

The ACGME monitors compliance with the duty hour standards through accreditation site visits, interviews with faculty and residents, review of documentation tracking duty hours, and confidential Internet resident surveys. So far, the ACGME has surveyed 25,176 residents in 1,489 programs. Among the respondents, 3.3% of residents (834) reported working more than 80 hours a week during the previous four weeks.

Programs that violate the duty hour standards are subject to adverse accreditation actions, including withdrawal of accreditation. Loss of accreditation is serious because residency programs must be ACGME-accredited in order to be eligible for federal graduate medical education funding, and residents must complete an accredited program in order to take their board certification examinations.

More information on the ACGME's duty hour standards is available on the ACGME's Web site, www.acgme.org. The studies are available on the New England Journal of Medicine's Web site, www.nejm.org.