ACGME proposes change to duty hour restrictions

An ACGME task force recently issued recommendations regarding changes to its Common Program Requirements regarding duty hours. A public comment period is now underway. A key part of the recommendations propose greater flexibility in resident work hours as generally tested in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, including allowing first-year residents to increase their shifts from 16 hours to 24 hours, which is allowed for all other residents.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted duty hour restrictions which stated how many consecutive hours/days a resident could work. The ACGME argued that when residents worked too many hours, patienty satefy was at risk, along with resident wellbeing.

Earlier results from The FIRST Trial found that easing current restrictions on surgical residents’ schedules did not worsen patient outcomes among general surgical patients and did not adversely affect overall resident well-being. In fact, most residents expressed greater stress over having to leave the hospital during a surgery or handover patient care.

During the FIRST Trial, 59 general surgery residency programs adhered to standard duty hour policies, while the other 58 programs tested a flexible policy that waived certain ACGME rules on maximum shift lengths and mandatory time off between shifts, to allow the residents the flexibility to stay longer when needed to provide patient care or for educational opportunities. However, both groups were limited to an 80-hour workweek averaged over four weeks.

Results of the FIRST Trial find that general surgery residents at all levels favor flexible duty hours. Eighty-six percent of the surveyed trainees preferred a flexible duty hour policy over the current policy limiting them to an 80-hour workweek.

The researchers also found that as residents assume more patient care responsibilities, their desire for more flexibility generally increases. Of the FIRST Trial participants, nearly 85% of first year residents preferred the flexible hours, compared to 89% of senior residents.  

Source: The American College of Surgeons