One size doesn't fit all

Residency Program Insider, April 4, 2014

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Limiting residents to 16-hour shifts appears to have led to negative consequences for surgery patients and trainees, a recent review published in the Annals of Surgery suggests.
A team of reviewers, led by Najma Ahmed, MD, of the Department of Surgery at the University of Toronto, drew their conclusions from an analysis of 57 studies examining resident duty hours.
Limiting work hours to shifts of less than 24 hours hasn’t led to significant improvements in resident wellness, but has “potentially deleterious consequences for patient and training outcomes,” the reviewers wrote.
They found no evidence that patient safety overall had improved under duty hour restrictions and noted that some research has suggested seriously ill patients have suffered more complications.
In some medical specialties, certification exam scores have declined since the introduction of duty hour restrictions, the authors wrote. They called the trend of poorer performance on American Board of Surgery certification exams “concerning.”

“It is clear that a ‘one-size ?ts all,’ solution to the issue of [resident duty hour] restrictions is not appropriate for all medical disciplines,” the authors wrote. “A more tailored and discipline speci?c approach is required such that training objectives and patient outcomes are protected.”


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