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In This Issue:
Lisa Bellini (at left) with Maria Yialamas, BWH Internal Medicine Residency associate program director
As the Department of Medicine's 10th annual Gretchen S. and Edward A. Fish Visiting Scholar in Medical Education, Lisa Bellini, MD, guided Medical Grand Rounds attendees through a contentious topic familiar to all working in medicine: resident duty hour reform.
In her April 18 talk, "Duty Hours: The Saga Continues," Bellini, of the University of Pennsylvania's Raymond and Ruth Perelman School of Medicine, shared the complex history of duty hours during the past 30 years.
She included the Libby Zion Law, which capped the number of hours that medical residents in New York could work to roughly 80 hours per week, following the 1984 death of an 18-year-old woman believed to be under the care of overworked residents and interns. Bellini also detailed the 1987 Bell Commission, which evaluated the training and supervision of physicians in New York and developed recommendations to the state, including the same 80-hour-per-week restriction and shifts no longer than 24 hours.
"This was the first time that the government was regulating duty hours for medicine," she said.
Bellini took attendees through Duty Hour Reform I, in which the Accreditation Council for Graduate Medical Education (ACGME) adopted the same 80-hour guidelines for all accredited U.S. residency programs as of July 2003. She also discussed Duty Hour Reform II, which began in 2010 and recommends interns' shifts do not exceed 16 hours. It also encourages short, strategic napping.
In addition to sharing how we got to where we are today, Bellini explained the positive and negative impacts of the changes-from increases in residents' quality of life and amount of sleep, to reduced continuity of care, increased handoffs and less time for education and care at the bedside.
Bellini pointed out that duty hour reform does not decrease workload along with work hours, but has increased work intensity by consolidating the same amount of work into less time. In an attempt to solve this problem, she and her colleagues are working on a two-year study called iCompare, which will randomly assign 40 ACGME-accredited internal medicine training programs to one of two duty-hour regimens: 16-hour shifts for year one, followed by 28-hour shifts with four hours of protected sleep time per shift for year two, and the opposite.
"The ACGME understands that we're in a bad place," she said. "We hope iCompare can answer some of the questions we have and help create a duty-hour standard that works well for the environment it serves. It can't be one size fits all."