The Journal of Pediatrics
Volume 154, Issue 5 , Pages 631-632.e1 , May 2009

Resident Duty Hour Restrictions: Is Less Really More?⁎

  • Luc P. Brion, MD

      Affiliations

    • University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Josef Neu, MD

      Affiliations

    • University of Florida College of Medicine, Gainesville, FL
    • Corresponding Author InformationReprint requests: Josef Neu, MD, 1600 SW Archer Rd, Department of Pediatrics, University of Florida College of Medicine, Academic Research Building Room RG130, Gainesville, FL 32610
    • ,
  • David Adamkin, MD

      Affiliations

    • University of Louisville, Louisville, KY
    • ,
  • Eduardo Bancalari, MD

      Affiliations

    • University of Miami, Miami, FL
    • ,
  • James Cummings, MD

      Affiliations

    • East Carolina University, Greenville, NC
    • ,
  • Susan Guttentag, MD

      Affiliations

    • Children's Hospital of Philadelphia, Philadelphia, PA
    • ,
  • Sandra Juul, MD, PhD

      Affiliations

    • University of Washington, Seattle, WA
    • ,
  • Victoria F. Norwood, MD

      Affiliations

    • University of Virginia Children's Hospital, Charlottesville, VA
    • ,
  • Rita M. Ryan, MD

      Affiliations

    • University at Buffalo, State University of New York; Women & Children's Hospital of Buffalo, Buffalo, NY

References 

  1. Ulmer Cheryl, Wolman Dianne Miller, Johns Michael ME. Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. Editors, Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety, National Research Council. Institute of Medicine of the National Academies. The National Academies Series, Washington DC 2008;
  2. Whang EE, Mello MM, Ashley SW, Zinner MJ. Implementing Resident Work Hour Limitations (Lessons from the New York State Experience). Ann Surgery. 2003;237:449–455
  3. Holzman IR, Barnett SH. The Bell Commission: Ethical Implications for the Training of Physicians. Mt Sinai J Med. 2000;67:136–139
  4. Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg. 2006;243:864–871discussion 871-5
  5. Chudgar SM, Cox CE, Que LG, Andolsek K, Knudsen NW, Clay AS. Current teaching and evaluation methods in critical care medicine: Has the Accreditation Council for Graduate Medical Education affected how we practice and teach in the intensive care unit?. Crit Care Med. 2008;Nov 28. [Epub ahead of print] PMID: 19050627
  6. Gaies MG, Landrigan CP, Hafler JP, Sandora TJ. Assessing procedural skills training in pediatric residency programs. Pediatrics. 2007;120:715–722
  7. Leone TA, Rich W, Finer NN. Neonatal intubation: success of pediatric trainees. J Pediatrics. 2005;146:638–641
  8. Falck AJ, Escobedo MB, Baillargeon JG, Villard LG, Gunkel JH. Proficiency of pediatric residents in performing neonatal endotracheal intubation. Pediatrics. 2003;112:1242–1247
  9. Steinbrook R. Medical student debt—is there a limit?. NEJM. 2008;359:2629–2633
  10. Gitterman DP, Hay WW. That sinking feeling, again? (The state of National Institutes of Health pediatric research funding, fiscal year 1992-2010). Pediatr Res. 2008;64:462–469
  11. Iglehart JK. Revisiting duty-hour limits—OM recommendations for patient safety and resident education. NEJM. 2008;359(25):2633–2635
  12. NANN Board of Directors. Neonatal Advanced Practice Nurses Shift Length, Fatigue, and Impact on Patient Safety (Position Statement #3043. NANNP Council, August 2007). http://www.nann.org/pdf/0810apn.pdfaccessed 12/11/08
  13. Mayer ML. Are we there yet? (Distance to care and relative supply among pediatric medical subspecialties). Pediatrics. 2006;118:2313–2321
  14. Jewett EA, Anderson MR, Gilchrist GS. The pediatric subspecialty workforce: public policy and forces for change. Pediatrics. 2005;116:1192–1202
  15. Gruskin A, Williams R, McCabe E, et al. Final report of the FOPE II Pediatric Subspecialists of the Future Workgroup. Pediatrics. 2000;106:1224–1244
  16. Schulman M, Lucchese KR, Sullivan AC. Transition from housestaff to nonphysicians as neonatal intensive care providers: cost, impact on revenue, and quality of care. Am J Perinatol. 1995;12:442–446
  17. Weinstein A, Reidy K, Norwood VF, Mahan JD. Factors influencing pediatric nephrology trainee entry into the workforce. Submitted to the Pediatric Academic Societies December 2008;
  18. Woodrow SI, Segouin C, Armbruster J, Hamstra SJ, Hodges B. Duty hours reforms in the United States, France, and Canada: is it time to refocus our attention on education?. Acad Med. 2006;81:1045–1051
  19. Philibert I. Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep. 2005;28:1392–1402
  20. Stickgold R. Sleep-dependent memory consolidation. Nature. 2005;437:1272–1278
  21. Jagsi R, Weinstein DF, Shapiro J, Kitch BT, Dorer D, Weissman JS. The Accreditation Council for Graduate Medical Education's limits on residents' work hours and patient safety: a study of resident experiences and perceptions before and after hours reductions. Arch Intern Med. 2008;168:493–500
  22. Fletcher KE, Underwood W, Davis SQ, Mangrulkar RS, McMahon LF, Saint S. Effects of work hour reduction on residents' lives: a systematic review. JAMA. 2005;294:1088–1100
  23. Fletcher KE, Davis SQ, Underwood W, Mangrulkar RS, McMahon LF, Saint S. Systematic review: effects of resident work hours on patient safety. Ann Intern Med. 2004;141:851–857
  24. Landrigan CP, Fahrenkopf AM, Lewin D, Sharek PJ, Barger LK, Eisner M, et al. Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. Pediatrics. 2008;122:250–258
  25. Kairys JC, McGuire K, Crawford AG, Yeo CJ. Cumulative operative experience is decreasing during general surgery residency: a worrisome trend for surgical trainees?. J Am Coll Surg. 2008;206:804–811discussion 811-3
  26. Shin S, Britt R, Britt LD. Effect of the 80-hour work week on resident case coverage: corrected article. J Am Coll Surg. 2008;207:148–150
  27. McElearney ST, Saalwachter AR, Hedrick TL, Pruett TL, Sanfey HA, Sawyer RG. Effect of the 80-hour work week on cases performed by general surgery residents. Am Surg. 2005;71:552–555discussion 555-6
  28. Ferguson CM, Kellogg KC, Hutter MM, Warshaw AL. Effect of work-hour reforms on operative case volume of surgical residents. Curr Surg. 2005;62:535–538
  29. Landrigan CP, Barger LK, Cade BE, Ayas NT, Czeisler CA. Interns' compliance with accreditation council for graduate medical education work-hour limits. JAMA. 2006;296:1063–1070
  30. Petersen LA, Orav EJ, Teich JM, O'Neil AC. Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv. 1998;24:77–87
  31. Lobato RD, Fernández-Alén J, Alday R. The impact of resident work hour limitations on medical student clerkships in Spain. Neurocirugía. 2008;19:213–217
  32. Bowhay AR. An investigation into how the European Working Time Directive has affected anaesthetic training. BMC Med Educ. 2008;8:41

PII: S0022-3476(09)00123-1

doi: 10.1016/j.jpeds.2009.02.004

The Journal of Pediatrics
Volume 154, Issue 5 , Pages 631-632.e1 , May 2009

Article Tools