ACGME reveals plans for duty-hour reform

Residency Program Insider, February 24, 2009

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The ACGME published an open letter from CEO Thomas Nasca, MD, MACP, describing the steps the organization will take to review and revise duty hour standards over the next 18 months. The ACGME’s Board of Directors approved this plan late last year.

In the letter, Nasca says the decision to review duty hour standards now stems from a promise the ACGME made in 2003 to review the regulations five years after implementation. Although the timing aligns, the Institute of Medicine’s (IOM) recent report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, is not the reason for the review, according to the ACGME letter. However, Nasca says the IOM report will be considered throughout the process.

The first step of the ACGME’s review will occur during International Symposium on Resident Duty Hours and the Learning Environment. During this workshop, conducted on Mach 4–5, experts will discuss duty hour standards, review current literature, and address the IOM report.

Next, the ACGME will collect data, which will inform future decisions. The data-gathering phase will consist of the following activities:

  • The ACGME sent a survey to ascertain the opinions of designated institutional officials, program directors, faculty, and residents on current standards and the IOM recommendations
  • This month, the ACGME requested that member and constituent organizations submit position statements by April 15. The ACGME will summarize these statements for the ACGME’s Board of Directors and Council on Review Committee and review before potential revisions made to the standards
  • The GME community will discuss potential new standards during a session at the Annual ACGME Educational meeting
  • Throughout the spring, the ACGME will conduct a formal review of the literature; senior leadership will summarize the findings and present it to the ACGME Board of Directors and Council of Review Committees
  • As the ACGME reviews duty hour data, the organization will also look into the ethical issues raised; the accreditor will discuss principles for ethical decision-making to avoid and settle divisive issues


The ACGME’s data gathering phase will conclude in June 2009 at the Congress on Standards for Resident Duty Hours, Patient Safety, and the Learning Environment Standards in Chicago. During the invitation-only event, speakers will present their positions and findings to the ACGME Board of Directors and Council of Review Committees.

The ACGME will also create task forces, which will present their recommendations on duty hour standards Board of Directors and Council of Review Committees during their February 2010 meetings. After that, revised standards will undergo the approval process outlined in the ACGME’s policies and procedures.

In the letter, Nasca does not state a specific date in which new standards will be approved. However, he does state that GME programs will have sufficient time to adjust and implement any new standards.

Additionally, Nasca does address the IOM’s recommendation that a payer of medical services oversee sponsoring institutions’ compliance with duty hour standards. Nasca states that such oversight is unnecessary, and in response, the ACGME Board of Directors has approved a tiered assessment of duty hour compliance. The evaluation includes an annual assessment at the institutional level. However, Nasca does not give any more details about how such assessments will be carried out.

Read the full letter regarding duty hour revisions.

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