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  • NEJM Survey: Work Hours Working?

    It has been almost two years since the Accreditation Council on Graduate Medical Education (ACGME) duty hour standards were released. The recommendation - note: not regulation - limits first year resident physicians to 16-hour shifts, a decrease from 24 hours.

    AMSA continues to say that the recommendations, which permit intermediate-level and senior residents to work 24-hour shifts, are not strong enough and we continue to urge the Occupational Safety and Health Administration, which is tasked with enforcing safety and health legislation, to address resident work hours.

    In last week's New England Journal of Medicine, results of a national survey conducted between December 2011 and February 2012, found that residents reported no improvement in education, total number of hours worked, or the amount of rest they were getting. In fact, many participants described the changes as detrimental, with the majority feeling less prepared to take on more-senior roles. Only quality of life for first-year residents was identified as having improved. The frequency of handoffs and workload for senior residents were both noted to have increased, whereas patient safety was deemed to be unchanged. Overall, only 22.9% of residents reported approval of the 2011 regulations. Read more here.

    What do ...

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  • One Year After ACGME Regulations Implemented, Further Adjustments Needed

    This week marks the one-year anniversary of the Accreditation Council on Graduate Medical Education (ACGME) duty hour standards that limit first year resident physicians to 16-hour shifts, a decrease from 24 hours.

    But the recommendations, which permit intermediate-level and senior residents to work 24-hour shifts, are not strong enough, says the American Medical Student Association (AMSA), the nation’s oldest and largest, independent association for physicians-in-training. AMSA continues to urge the Occupational Safety and Health Administration, which is tasked with enforcing safety and health legislation, to address resident work hours.

    “AMSA would like to see the 16-hour shift applied to all residents, not just first year interns,” says AMSA National President Dr. Elizabeth Wiley, JD, MPH. “Our hope is that policymakers will recognize that providing Americans with access to quality health care includes duty hour restrictions to keep America’s patients and resident doctors safe.”

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  • Work-Life Balance of Residents

    Aliye Runyan
    Chair, AMSA Medical Education Team
    The University of Miami Miller School of Medicine

    I was recently talking to friend, who is an intern. She told me she didn't remember the last time she'd had a bite to eat. She'd been up for 16 hours. We talked about an article written by a classmate, also an intern, about the stress of his days. A fellow resident commented on it, something to the effect of "don't be weak, you haven't seen anything yet.”

    To some extent, this is the normalization/desensitization process that all residents must go through, in order to make it through the tough years of training, to be able to handle a full schedule with emergencies popping up at a moment's notice. This is understandable, it's what we go to med school for; it's what we train for.

    What is not understandable is how this aspect of the culture of medicine permeates to the very health and sanity of the physicians it trains. There is no honor in losing a grip on your own mental and physical well-being in the process of caring for your patients (which, as a resident, is less of that and more dealing with ...

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  • Changing great expectations

    Andrea Knittel
    AMSA Member
    6th Year MSTP
    University of Michigan

    Post #4 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations. 

    When I started medical school, there was substantial debate swirling about changing residency work hours, particularly for interns who were putting in untold hours at the hospital clearly to the detriment of their personal wellbeing, and potentially to the detriment of patient care.  These arguments sparked discussions of the best way to train physicians to work independently, how to maintain continuity of care without endless work hours, and even how to measure progress on these issues.  Ultimately, resident work hours were limited to 80 hours per week and shifts limited to 30 hours.  AMSA helped to draft the legislation that implemented these first changes, and continues to advocate for better conditions for residents and students. 

    As I’m preparing to return to the wards, the controversy has flared again, though this time regulations have already passed.  The 80 hour work week remains in place, but first year residents (interns) may only work 16 consecutive hours.  (In addition, as detailed in news articles here and here, stricter ...

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  • Do you think the ACGME work hour recommendations are strong enough?

    This week, the Accreditation Council on Graduate Medical Education (ACGME) released resident work hour recommendations. If you haven't seen them, you can check them out here. What do you think of the recommendations - right on the money? or not enough?

    If you want to read AMSA's response to the recommendations, click here. Basically, AMSA thinks that they are a good step toward establishing evidence-based work hour scheduling for resident physicians HOWEVER, they would be stronger if the 16-hour shift applied to all residents. AMSA also hopes that the ACGME continues to monitor, enforce and update work hour regulations so that U.S. medical schools can maintain the highest standards of learning and self-care.

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