CHICAGO ― Surgery patients fared just as well when junior doctors worked longer than mandated hours in the first major rigorous test of regulations many physicians say hurt medical education.
Nationwide limits on work hours were established more than a decade ago because of concerns that sleep-deprived medical residents were a threat to themselves and their patients. To test that, researchers randomly assigned more than 4,000 surgery residents to regulation hours or a more flexible schedule that allowed them to continue with a case after their shifts ended. That sometimes meant working for more than 28 hours at a time.
The study looked at how many patients died or had serious complications in the month after surgery and found the same low rate – about 9 percent ― in both groups. Residents’ self-rated dissatisfaction with their education and with their well-being were similarly low ― 11 percent and roughly 13 percent respectively in each group.
It’s a landmark study, testing “a hot button, controversial issue in health care,” said lead author Dr. Karl Bilimoria, director of surgical outcomes and quality improvement at Northwestern University’s Feinberg medical school. Without flexibility, rookie doctors often have to end their shifts in the middle of caring for patients, handing them off to another medical resident. That can happen at critical times, disrupting the doctor-patient relationship, Bilimoria said.
“Our hope would be that the evidence would be used … to change policies fairly soon and allow flexibility back into surgical residency,” he said.
Residents’ work limits were first set in 2003 by the Accreditation Council for Graduate Medical Education, and revised in 2011. The rules include 80-hour maximum work weeks.
The group said it will consider the results as part of an ongoing review of residents’ work hour standards. The council, the American College of Surgeons and the American Board of Surgery paid for the study, which was published Tuesday by the New England Journal of Medicine.
