As we’ve reported before, July is the most dangerous month to visit a hospital due to the influx of brand-new residents. A new proposal from the Accreditation Council for Graduate Medical Education aims to cut this danger with changes to rookie residents’ hours and oversight.

The proposal suggests that first-year medical residents work shorter shifts under closer supervision. Additionally, patients would be told they were being treated by a rookie doctor and that their supervisors would make final decisions regarding care.

ACGME is the the accrediting body for more than 8,800 medical residency programs and is charged with setting and enforcing standards for supervision and resident duty hours. The organization drafted the new regulations to increase overall patient safety and decrease the chance of medical errors.

Medical residencies, which last three to seven years, provide new doctors with essential on-the-job training. However, medical residents and interns often work for long hours during elongated work weeks. The subsequent sleep deprivation associated with these residencies is believed to lead to an increase in medical errors.  For example, a study by ABC News found that the number of hospital medication errors “spiked by 10 percent in July in counties with a high number of teaching hospitals.” July, of course, is the month when students graduate from medical school and start their first-year residencies.

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ACGME’s new proposal would attempt to reduce potential problems by cutting the maximum duration of a first-year resident’s shift to 16 hours. (Currently, maximum shift length is 24 hours.) The maximum length of a resident’s work week would remain at 80 hours. Once residents enter their second year, they will be permitted to work a 24-hour shift.

The last time ACGME amended its regulations was in 2003. Since then, concerns have been raised over how well hospitals have enforced duty-hour limits.
“The ACGME independently identified the difficulty of enforcement as a problem, along with the inherent challenges of enhancing the frequency and intensity of duty-hour surveillance at the program level, given the nearly 9,000 accredited programs,” ACGME’s Task Force told the New England Journal of Medicine. “Recognition of the need for enhanced measures to promote compliance has led to a new program of annual site visits to sponsoring institutions, focusing on duty-hour compliance, supervision and provision of a safe and effective environment for care and learning.”

The draft regulations will remain on the ACGME Web site until Aug. 9. During this time, the public and the educational community are welcome to comment.  ACGME will consider modifications based on these responses and the final proposal will be put into effect in July 2011, just before a new batch of residents take their posts.

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