Resident duty hours reform: are we there yet?

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented resident duty hours restrictions to address growing concerns about medical errors and resident well-being. Many anticipated that resident duty hours restrictions would improve the quality and safety of care by minimizing the detrimental effects of fatigue on resident performance. Others were concerned that the fundamental clinical and educational principle of continuity of care would be lost or at least eroded, and that more frequent "hand-offs" might result in more clinical errors. Some lamented the loss of the total-emersion residency experience that serves as a forging process to temper the mind and body to create a finely honed clinician. The author draws from the literature to examine the effects of the ACGME resident duty hours restrictions three years after their implementation. From the perspectives of resident perceptions, attending perceptions, organizational approaches, and unintended consequences, the author concludes that far more than simple control of duty hours will be required to achieve the goals of clinical excellence, educational excellence, resident well-being, and professionalism.