New research published in the New England Journal of Medicine suggests that surgical residents who were allowed to work longer shifts did not experience an increased likelihood of harming the patient.
The debate over working hours during the residency portion of a surgeon’s training has long since been debated in the medical community. Some people are in favor of placing restrictions on workloads to ensure residents aren’t overworked and overstressed, which they believe could lead to more medical mistakes and put the patient in jeopardy. Others believe the restrictions actually serve to hurt the resident, because they abruptly force interns to stop during the middle of treatment or prior to surgery, and they make it harder for residents to follow their patients through the care cycle. Many who believe in fewer work-hour restrictions believe the findings present new evidence for relaxing the work limits.
“We believe the trial results say it’s safe to provide some flexibility in duty hours,” said Dr. Karl Bilimoria, the main author and a professor of surgery at the Feinberg School of Medicine at Northwestern University in Chicago.
Work-Hour Restriction Study
For their study, researchers decided to track patient outcomes after relaxing certain work-hour restrictions in 58 surgical residency programs across the nation. They they compared the data to 59 residency programs that stuck to the enhanced work-hour restrictions. After looking at the results, researchers found that there were no differences in patient deaths or complication rates between the two groups. Doctors also noted no differences in reported levels of morale between the two groups. Other findings from the study painted a picture of the current state of the work-hour restrictions:
- 7 percent of residents exempted from duty limitations said they left during an operation at least once a month, compared to 13 percent in the work-hour restriction group.
- 30 percent of the lax work-hour group said they missed an operation at least once a month, compared to 42 percent in the work-hour restriction group.
- 1/3 of residents in the lax work-hour restriction group said they handed a patient over to another doctor, while about half of the control group reported doing the same.
The study came under scrutiny from a few large medical groups, including the American Medical Student Association, which still believes that work-hour restrictions keep patients safer despite the findings.
“Research on the deleterious effects of chronic sleep deprivation is just overwhelming,” said Dr. Deborah Hall, president of the medical student association. “I’m concerned we’re going to walk away from a lot of progress that’s been made without overwhelming data [showing] that residents aren’t subject to the ordinary limits of human neurobiology.”
Dr. Maya Babu, a neurological surgery resident at the Mayo Clinic and president of the Resident and Associate Society of the American College of Surgeons disagreed with Hall, saying that the lax work-hour restrictions actually provided the surgical resident with more flexibility to provide the patient with the best care.
“We’re very encouraged by the findings,” said Dr. Babu. “We feel very strongly that flexibility is important to provide opportunities to learn and to have patient ownership, to see patients from the time they’re admitted through surgery the next day.”