Making residency work hour rules work.

Area of Science:

• Medical Education
• Healthcare Policy
• Patient Safety

Background:

• The Accreditation Council for Graduate Medical Education (ACGME) established new work hour limits in July 2011.
• Interns are limited to 16 consecutive work hours, while residents PGY-2 and above can work up to 28 consecutive hours.
• Debate continues regarding the adequacy of these ACGME work hour standards.

Purpose of the Study:

• To address the effective enforcement of established ACGME work hour limits.
• To identify optimal national strategies for ensuring compliance with resident physician work hour regulations.
• To mitigate harm to residents, patients, and others resulting from sleep deprivation in resident physicians.

Main Methods:

• Analysis of three potential national enforcement approaches.
• Focus on strategies rooted in funding mechanisms.
• Examination of approaches based on disclosure requirements.
• Consideration of strategies involving tort law.

Main Results:

• The ACGME has faced challenges in effectively enforcing its own work hour limits.
• Three distinct national enforcement models are proposed: funding-based, disclosure-based, and tort law-based.
• Each model offers a potential pathway to improve adherence to resident work hour regulations.

Conclusions:

• Effective enforcement is critical to realizing the intended benefits of ACGME work hour policies.
• National strategies involving funding, disclosure, or tort law may be necessary to ensure compliance.
• Improved enforcement can enhance resident well-being and patient safety by reducing risks associated with physician fatigue.