Challenges with Duty Hour Reforms: A Survey of Residency Program Directors

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) enacted duty hour limitations in response to public concern over excessive resident work hours and patient safety. In Dec 2008, the Institute of Medicine (IOM) recommended further duty hour limitations, including 16-hour shift limits, a 5-hour protected nap during 30-hour shifts, increased minimum time off after extended shifts, 5 days off per month, 48 hours off after 3 or 4 nights of consecutive duty, and inclusion of moonlighting in 80-hour work week limits. After evaluating the impact of the 2003 requirements, and in response to IOM recommendations, ACGME announced proposed duty hour limitations in Jun 2010. Although they closely resembled IOM recommendations in areas such as moonlighting, key modifications included a maximum 16-hour consecutive duty for postgraduate year 1 residents only. Likewise, strategic napping was encouraged, not required, during extended shifts for upper level residents. Here, Willett et al discusses the results of the Association of Program Directors in Internal Medicine survey regarding the internal medicine program directors' perspectives on the proposed duty hour limitations.