Although internal medicine programs instituted an 80-hour weekly work limit in 1989, the “80-hour” duty hour limit was formally implemented by the ACGME is 2003. The purpose of the limit was to ensure patient safety and reduce medical errors while protecting the safety of residents by preventing burnout and psychological distress. While there is conflicting data with respect to whether the duty-hour limits have resulted in improved patient safety and decreased medical errors, the duty-hour limit has been blamed for numerous deficiencies in resident education.1 The responsibility for this is often placed on the residents by older generations of surgeons. The residents are explicitly told, or it is not so subtlety implied, that they are “weak” for abiding by the duty-hour regulations. Residents are chastised for losing continuity of care and for “choosing shift work” instead of choosing to take care of their patients. Many surgeons feel that there has been an erosion of the surgical skills and clinical acumen of trainees and that these deficiencies are rooted in residents spending less time in the hospital and performing fewer surgeries with less independence.
Even if the 80-hour duty limit has not improved patient safety or reduced medical errors, it is my belief that the regulations are attracting a higher quality applicant into medicine. The days of first year trainees being “interned” in the hospital and living on the grounds for an entire year are long gone. While some may mourn the fact that today’s medical students see their career as part of their life and not their entire life, these students have varied interests and talents that would not have been a fit in medicine 50 years ago. Their different perspectives and values will hopefully allow for innovative solutions to our most challenging problems.
We must adapt our teaching techniques to optimize surgical education in this new era. The 80-hour duty limit is not inherently good or bad, it is just different. Instead of lamenting the lack of hours that residents are in the hospital, we need to make the most of those hours and stop insisting that the education of the pre-80 hour duty limit era is unquestionably superior to education of the post-80-hour duty limit era. Given the exponential growth of medical knowledge and surgical techniques, it is no longer enough that residents and fellows “learn by osmosis,” simply by being present in the hospital and watching senior mentors perform surgeries. Medical and surgical education in the post-80-hour era must be more efficient. Many programs have already instituted bioskills labs, and our understanding of how to measure surgical competence continues to evolve. It is my plea that we stop “lamenting” the 80-hour rule but rather rise to the challenge of improving how we teach the future generations of student, residents and fellows.
- Philibert I, Nasca T, Brigham T, Shapiro J. Duty-hour limits and patient care and resident outcomes: can high-quality studies offer insight into complex relationships? Annu Rev Med. 2013;64:467-483.