(Repeats to add reporting credit)
Nov 5 (Reuters) – Orthopedic surgeons-in-training said they
were tired less often after rules regulating how much they could
work went into place, according to a U.S. survey.
But the results published in the Annals of Surgery found the
trainee doctors didn’t actually get any more sleep under the
limited work hours policy, and also said they felt less prepared
as doctors and were less satisfied with their education.
In July 2003, the U.S. Accreditation Council for Graduate
Medical Education implemented new policy limiting the on-duty
hours of notoriously sleep-deprived residents to 80 per week,
with a minimum of ten hours off between shifts. Those changes
were further updated in 2011.
The main goal was to ease young doctors’ fatigue and
fatigue-related medical errors.
The work limits seem to have been somewhat successful, but
they also come at a cost, according to Debra Weinstein from
Massachusetts General Hospital and Brigham and Women’s Hospital
in Boston, who worked on the study.
“The extent to which we restrict residents’ time in the
hospital does risk (affecting) their skill and sense of
preparedness,” she said.
“Continuing to further limit duty hours may not be the best
way to address the goals of patient safety, resident well-being
and excellent medical education.”
Some past studies have suggested that work limits improve
quality of life for residents, but have a negative impact on
their education. One survey published last year found that the
majority of surgery residents worked more hours than the current
regulations allowed.
In the new study, researchers analyzed surveys completed by
a total of 216 residents at the Harvard Orthopedic Combined
Residency Program between 2003 and 2009.
Compared to pre-2003 residents, orthopedic trainees in 2009
reported working fewer hours per week, about 66 hours versus 75.
But they didn’t get any more sleep. Throughout the study period,
they reported sleeping for about five hours every night, on
average.
Residents rated their own preparedness to make clinical
decisions under stress and their ability to perform the range of
skills expected of them slightly lower in later years, the
researchers said.
After the work-hour policies went into place, residents did
say they spent fewer days feeling very tired, and a smaller
proportion of them said their fatigue had a negative impact on
patient care and safety.
Forty-six percent of residents said their fatigue affected
the quality of care they provided in 2003, compared to 26
percent on the 2004 through 2009 surveys.
“There’s a general assumption that reducing work hours will
result in more sleep for tired residents, and clearly out
findings challenge that,” Weinstein said.
However, it’s possible that having more time to decompress
and relieve psychological stress may improve residents’ sense of
well-being, even if they’re not getting more sleep, she added.
Weinstein and her colleagues noted that their study didn’t
include objective measures of residents’ performance, so they
couldn’t tell whether they actually did better or worse on
exams, or made more or fewer errors.
SOURCE: http://bit.ly/TcFx66
(Reporting from New York by Genevra Pittman; editing by Elaine
Lies)
