Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a fifth-year Harvard medical student. E-mail her at firstname.lastname@example.org.
The latest tweak on duty hour restrictions, approved by the Accreditation Council for Graduate Medical Education (ACGME)'s board on Tuesday, will take effect when my classmates and I start residency next June. Though I am a big fan of patient safety, and of sleep, I'm not so sure about 80-hour work weeks with a 16-hour shift cap for interns (first-year residents). For starters, it is a nightmarish logistical challenge for residency directors.
My gut reaction? As a medical student eager to start the next, all-consuming phase of my training, I feel slightly cheated out of this formative experience. And if we're talking about quality of life, I'd rather work hard for 24 or more hours at a time and get "post-call" days of rest than work in shorter increments followed by unsatisfyingly short respites.
I worry that these mandated interruptions in patient care will make it harder for me to know my patients well, to make effective decisions for them, and to learn from those experiences. We can earn exceptions to the 16-hour limit, if we document why we want to stay longer and submit the requests to our program director. But somehow, extra paperwork seems counter to the goals of the regulation.
After just the one-week transition into second year of residency, we will be deemed able to handle an additional eight hours per shift, which seems both jarring and arbitrary. This is also unfortunate for those of us who looked forward to more family-friendly schedules after we paid our intern year dues and advanced in our training.
Programs are asked to implement "alertness management strategies" and encourage "strategic napping" for residents. I'm curious to know what these entail. At the same time, my experience as a sub-intern makes me skeptical about their execution.
The conversations I've had with classmates and faculty members at Harvard and elsewhere tell me that I'm not alone in these concerns.
I'll grant that it's much easier to gripe about the standards than to come up with them. And I'll be the first to note that the changes are based upon solid principles -- there are good data supporting the dangers of fatigue on patients and providers alike, and the ACGME also addresses the need for more effective interdisciplinary teamwork and better supervision in this go-around.
We'll have to wait and see whether the measures have their intended effect, and whether the outcomes justify the hassle.
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