ACGME recommends restricting first-years to 16 duty hours per day

The Accreditation Council for Graduate Medical Education (ACGME) recommended that first-year residents' duty hours be capped at 16 per day. Citing differences in capabilities and the need for more supervision, the Council said first-years work longer and that fatigue among them leads to more errors.

The draft standards propose significant changes to first-year resident training, including more detailed directives for supervision and stricter requirements for duty hour exceptions. The group published its statement online June 23 in the New England Journal of Medicine.

The group received position statements from more than 100 medical organizations, heard personal testimony, and discussed the issue with the Institute of Medicine, patient advocates, sleep physiologists, patient safety experts and educators. While the same standards are applied to different specialties and levels of training, educators wanted more flexibility.

ACGME wrote, "As residents mature in knowledge, experience and clinical judgment, the standards permit them to gradually move from a structured, directly supervised, time-limited setting to more advanced training, then to the independent practice of medicine, in which the structure of work and the allotment of time are dictated by patients' needs and physician professionalism. This progression logically begins with a more highly controlled first year of residency."

The standards will be available for comment until August 9 on the ACGME website. The new proposed restrictions follow ACGME's original limitations placed in 2003. The organization had said at that time it would revisit the issue in five years. If adopted by ACGME, the restrictions would take effect July 2011.

The American Medical Student Association said it supported the move and called for 16-hour shifts for second- and third-year residents.