Internal medicine faculty heavily involved in residency programs believe that resident duty-hour limitations negatively affect aspects of residents’ patient care, education and professionalism, but improve residents’ well-being, according to a report in the July 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Residency duty-hour restrictions were put into place in 2003 to reduce the risk of negative events resulting from sleep deprivation and to improve residents’ well-being. “Before implementation of duty-hour regulations, some cautioned that reductions in duty hours may have unanticipated negative effects on patient care, resident education and professionalism,” according to background information in the article. Some also feared that reducing residents’ duty hours would increase clinical faculty workload.
Darcy A. Reed, M.D., M.P.H., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues surveyed 154 key clinical faculty from 39 internal medicine residency programs affiliated with U.S. medical schools in 2005 to obtain their views on the effect of residents’ duty-hour limitations. Key clinical faculty consists of faculty members who dedicate at least 15 hours per week to the residency program and provide clinical teaching and supervision of residents.
Of the 154 faculty members targeted, 111 (72 percent) responded. Three-fourths of them had five or more years teaching residents and one-third had more than 15 years of experience.
Key clinical faculty reported they believe resident duty-hour restrictions:
- Worsen the continuity of patient care provided by residents (87 percent), residents’ communication with patients and families (66 percent) and overall quality of patient care (60 percent)
- Decrease opportunities for didactic [instructive] (69 percent) and bedside (73 percent) teaching, decrease opportunities for residents to perform clinical procedures (57 percent), decrease conference attendance (51 percent) and worsen residents’ autonomy (57 percent)
- Worsen residents’ professionalism (51 percent), accountability to patients (73 percent) and ability to place patient needs above self-interests (57 percent)
- Improve residents’ well being and level of fatigue (85 percent) and personal-professional life balance (81 percent)
- Decrease resident burnout (approximately 50 percent)
- Increase time spent by faculty attending on inpatient teaching services directly providing patient care without residents (47 percent)
- Impair faculty ability to accurately evaluate residents (49 percent) and develop mentoring relationships with residents (40 percent)
- Decrease faculty’s overall satisfaction with teaching residents (56 percent)
“One-third of the key clinical faculty reported a decrease in overall satisfaction with their careers as a result of duty-hour limitations for residents,” the authors write.
“These faculty, who have the most contact with residents, believe that duty-hour limitations have adversely affected important aspects of residents’ patient care, education and professionalism, as well as the workload and satisfaction of faculty teachers,” they conclude. “Residency programs should continue to look for ways to optimize experiences for residents and faculty within the confines of the duty-hour limitations.”
(Arch Intern Med. 2007;167(14):1487-1492. Available pre-embargo to the media at www.jamamedia.org.)
Editor’s Note: This study was supported by a grant from The Johns Hopkins University School of Medicine. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Teaching Faculty Faced With More Responsibilities
“Clearly, internal medicine programs have been dealing with limited duty hours for more than 15 years, yet the gravity of complaints about change in resident behavior and change in faculty member workload are only now coming to active discussion,” writes Barbara Schuster, M.D., of Wright State University, Dayton, Ohio, in an accompanying editorial.
“This change has had less to do with duty-hour restrictions and more to do with patient safety and hospital quality measures,” Dr. Schuster writes. “The faculty is increasingly held fully responsible for patient length of stay on the service, cost of care per discharge and accuracy of resident dictation.”
“The increased demand for clinical service personally delivered by faculty members presently interferes with teaching responsibilities. The duty-hour restrictions have improved the well-being of the residents but may be worsening the well-being of faculty members,” she concludes.
(Arch Intern Med. 2007;167(14):1453-1455. Available pre-embargo to the media at www.jamamedia.org.)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org. To contact editorialist Barbara Schuster, M.D., call Judi Engle at 937-775-2951.
Journal
Archives of Internal Medicine