Longer shifts proposed for first-year residents
A task force of the Accreditation Council for Graduate Medical Education has removed the current requirement limiting first-year residents to 16 hours on shift, and has proposed limiting the shift to 24 hours on-task plus 4 hours to manage transitions of care.
An increase in the allowed shift length for first-year residents was among the changes recently proposed in a public letter from the CEO of the Accreditation Council for Graduate Medical Education (ACGME).
A task force of the ACGME has removed the current requirement limiting first-year residents to 16 hours on shift, the letter said. The task force proposed limiting the shift to 24 hours on-task plus 4 hours to manage transitions of care. “Residents, in unusual circumstance and of their own accord, after signing out the care of their patients, may remain to care for a single patient, and the prior onerous documentation burden for this activity was removed,” wrote Thomas J. Nasca, MD, MACP, in the letter. “This promotes professionalism, empathy, and commitment.”
Residents may also remain past the time limit for educational or research purposes in unusual circumstances, the letter said. The additional time is still counted toward the 80-hour weekly limit. The letter also said that residency programs are free to keep 16-hour shift schedules and that specialty review committees will still be permitted and expected to add greater restrictions, such as how internal medicine currently does not permit averaging of the frequency of overnight call.
Other proposed changes to ACGME requirements mentioned in the letter focus on greater attention to patient safety and quality improvement and resident and faculty well-being. Residents will be expected to compare their patients' care to quality metrics and benchmark data and to work with teams to identify and improve patient safety issues. The letter also said that faculty members should model and teach the importance of clinician well-being, as well as make sure that residents have a manageable workload and are not overburdened with clerical work.
The proposed changes are open for review and comment online until Dec. 19. After the comment period, the final proposed requirements will be submitted to the ACGME Board of Directors for approval, with implementation planned for the 2017-2018 academic year.