The Accreditation Council for Graduate Medical Education (ACGME) Board of Directors has approved a set of requirements that are a comprehensive approach to patient care, quality improvement, supervision, professionalism, transitions in care, and resident well-being. Included are graduated standards for duty hours for the nation’s 111,000 residents training in ACGME accredited teaching institutions.
The standards are based on recommendations made by the Institute of Medicine (IOM) in 2008, evidence collected during a 16-month review of the scientific literature on sleep issues, patient safety and resident training. The standards retain the current duty hour limit of 80 hours per week, averaged over four weeks, but specify more detailed directives for levels of supervision necessary for a first-year resident (PGY-1). The standards also reduce duty periods of first-year residents to no more than 16 hours a day (down from 24 hours) and set stricter requirements including “strategic napping.”
But according to The Associated Press, some residents are still not satisfied. “The American Medical Student Association had sought substantial across-the-board work-hour reductions and argues that there’s no reason to give first-year residents a break but not others. The medical student group, joined by other advocacy groups, earlier this month asked the government’s Occupational Safety & Health Administration” to further investigate.
The board also approved changes establishing new categories of standards and by setting higher requirements for teamwork, clinical responsibilities, communication, professionalism, personal responsibility and transitions of care. Other items the new requirements address include:
- establishing graduated requirements for minimum time off between scheduled duty periods;
- expanding program and institutional requirements regarding handovers of patient care;
- setting more specific requirements for alertness management and fatigue mitigation strategies designed to ensure both continuity of patient care and resident safety.