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A New Era in Medical Education

With tighter resident-hour limits starting in July, Peter L. Slavin and David F. Torchiana discuss the challenges ahead to train physicians in the confines of a 16-hour workday.

Spring 2011
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ambulance

Courtesy of MGH

MGH's first ambulance, bought in 1873

The transformation from medical school graduate to confident, capable physician is a journey like no other. While emotionally and physically draining, the residency years also can offer the most intellectually stimulating, rewarding and humbling of experiences. Doctors-in-training not only witness what it takes to preserve health and restore the body but also learn firsthand about the strength and vulnerability of the human spirit and the precious bond between patient and caregiver.

During the past decade, medical training has undergone the most significant—and most controversial—revolution since formal residency programs began in the late 1800s. Residency traditionally has been a rite of passage, testing the mettle of rookie doctors during marathon shifts in the hospital day after night after day after night. Now such grueling training years are becoming a thing of the past.

Since 2003 the nation’s teaching hospitals have had to restrict residents to 80-hour workweeks. And beginning this July, first-year residents will be limited to 16-hour shifts, down from the usual 30, and more experienced residents kept to 24-hour shifts. The logic is understandable—lack of sleep leads to fatigue and impaired judgment that can harm patients or these young physicians themselves.

But mandated limits also mean less continuity of care and more handoffs among caregivers, increasing the chances of miscommunication and mistakes. Less time in the hospital reduces residents’ opportunities to observe and treat, and may produce doctors ill-prepared to function independently, think critically and manage nuanced situations. Interns sent home after 16 hours may not fully absorb the sense of duty to their patients.

In our cover story, we examine this confounding issue. From the Libby Zion case to inconclusive data about errors, hours and continuity of care, we sort through the challenges of finding a formula that works.

Only time will tell if it has been wise to embrace a more prescriptive approach to training. Even as we adjust to the new realities, we must continue to instill the sense of personal responsibility among doctors—whether well-rested or dog-tired—to do whatever it takes to pull a patient through a crisis. The goal of residency is to offer new doctors complete, enriching training while delivering safe, high-quality care. Being a good physician means embracing practice shaped and guided by the needs of patients, not by the hands of a clock—a vital lesson we must preserve and pass along.

Peter L. Slavin, M.D.
President
Massachusetts General Hospital
David F. Torchiana, M.D.
CEO and Chairman
Massachusetts General Physicians
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Residency Hour Limits: On the Clock

Female resident adjust stethescope

If residents’ long shifts endanger patients, lightening the load should reduce the risk. Trouble is, there’s no evidence it does.

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