Paper by Rhode Island Hospital physician selected among best of 2010 by JACR

PROVIDENCE, R.I. – A paper on resident duty hour limits from Rhode Island Hospital has been selected as the best education paper of 2010 by the Journal of the American College of Radiology (JACR). In the paper, lead author Martha Mainiero, M.D., explains the history behind the current resident duty hour requirements, the proposed changes, and the response from national radiology organizations regarding the proposed changes.

Mainiero, the director of the residency program in diagnostic radiology at Rhode Island Hospital, explains that national restrictions were first introduced in 2003 to limit the hours residents could be on duty. At the time, the Accreditation Council for Graduate Medical Education (ACGME) cited increasing acuity and intensity of medical care in teaching institutions, as well as scientific evidence of the negative effect of sleep deprivation on performance, as reasons for instituting restrictions. Those limits were not to exceed 80 hours in a week or more than 24 consecutive hours.

In December 2008, the Institute of Medicine (IOM) issued a report recommending further action be taken to reduce resident fatigue and ensure patient safety within 24 months of the report. In their paper, Mainiero and her colleagues state, "The IOM committee did not recommend a change from the maximum of 80 hours per week, averaged over four weeks, but instead recommends decreasing the maximum length of shifts, increasing the time off between shifts and mandating sleep period during longer shifts."

In response to the ACGME's request for input to the proposed changes, Mainiero and her co-authors summarized the input provided by the American College of Radiology and a number of other radiologic institutions. Mainiero wrote, "Radiology supports the current requirements, but recognizes that there has been inadequate study of the outcomes of the current duty hour regulations and there continue to be issues with compliance with those regulations." Their recommendation was to have more rigorous monitoring of duty hours before implementing new duty hour recommendations

Mainiero also reported that the radiology community found no convincing evidence that the proposed recommendations for further duty hour limits would have a significant impact on reducing resident fatigue. In fact, there is concern that further restricting duty hours may take away from important educational activities that are essential to resident training, but Mainiero and her co-authors recognized that ACGME would have little choice but to take further actions and make additional restrictions to guide the training of residents. Subsequent to the publication of the article, the ACGME did indeed issue further restrictions on resident duty hours, which will take effect in July 2011.

On being recognized as one of the top papers of the year by the JACR, Mainiero says, "We appreciate this recognition from the JACR and hope that it will open the door to further discussions on the important issue of resident duty hour requirements. As an academic medical center, we are committed to teaching the physicians of tomorrow, and we hope the new guidelines will help us be effective in our mission."

Other authors of the paper with Mainiero are Lawrence P. Davis, M.D. of Long Island Jewish Medical Center in New York and Jocelyn D. Chertoff, M.D., of Dartmouth-Hitchcock Medical Center of New Hampshire.

About Rhode Island Hospital

Founded in 1863, Rhode Island Hospital (www.rhodeislandhospital.org) in Providence, RI, is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital receives nearly $50 million each year in external research funding. It is a founding member of the Lifespan health system.

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