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1 Background and Overview
Pages 27-46

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From page 27...
... . This chap ter gives a brief history and overview of graduate medical training in the United States, with a focus on resident duty hours.
From page 28...
... Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety.
From page 29...
... The subcommittee had been investigating preventable medical errors and asked if the duty hours of physicians and residents are among the most serious threats to patient safety (Dingell et al., 2007)
From page 30...
... , residency, internship, fatigue, sleep, sleep disorders, burnout, mood, depression, work schedule(s) , work hours, 80-hour workweek, adverse events, medical errors, job satisfaction, handoffs, handovers, transitions, mortality, patient outcomes, patient safety, quality of care, medical education, graduate medical education, workload, and performance.
From page 31...
... Residency training has periods during which prolonged duty hours are perceived as necessary to achieve the educational goals -- this is more the case for some specialties than others. Trainees spend years preparing for the opportunity to train as resident physicians -- through 4 years of a premedical curriculum in college and 4 more years of challenging medical school study and testing.
From page 32...
... Training Programs Nearly 105,000 graduate medical trainees were at various stages of their residency training in the 2007-2008 academic year. Residents work in public and private, teaching and community hospitals across the country, affiliated with more than 8,500 distinct accredited residency programs.
From page 33...
... 7,651 251 Anesthesiology 4,970 131 Obstetrics and gynecology 4,739 250 Psychiatry 4,613 181 Emergency medicine 4,379 140 Radiology, diagnostic 4,368 188 Orthopedic surgery 3,187 152 Pathology 2,310 150 Neurology 1,507 122 Otolaryngology 1,292 104 Ophthalmology 1,225 117 Physical medicine and rehabilitation 1,167 79 Dermatology 1,069 112 Urology 992 118 Neurological surgery 881 97 Plastic surgery 609 89 Radiation oncology 556 79 Preventive medicine 285 74 Surgery (thoracic) 282 85 Allergy and immunology 274 71 Nuclear medicine 143 61 Medical genetics 77 47 Surgery (colon and rectal)
From page 34...
... DUTY HOUR DEMANDS IN THE MEDICAL PROFESSION Graduate medical training programs have a tradition of requiring long hours. In 1998-1999, residents in surgical specialties were still regularly clocking more than 100 hours per week in their PGY-1 and PGY-2 training years.
From page 35...
... According to the U.S. Bureau of Labor Statistics, many physicians work long and unpredictable hours around the clock once they finish their graduate medical training -- longer hours than most other workers in the United States.
From page 36...
... The major topic areas raised included the following: • Current duty hours and adherence to them • Educational needs • Resident safety and well-being • Patient safety • Economic implications The committee heard from diverse speakers: patient advocates; an ethicist; residents in training; resident and medical school student representatives; residency program directors of several specialties; administrators in charge of all graduate medical training programs at their institution; hospital executives and financial officers from institutions with residents; scientists who study sleep, fatigue, and human performance; physician specialty societies; the president of the Royal College of Surgeons; representatives of national organizations involved in GME, including matching medical school graduates to residencies, and accreditation of programs; major funders of GME; and the Joint Commission. The presentations of the speakers that appeared before the committee are available on the project website, www.iom.edu/residenthours (see Appendix F for the public agenda for committee meetings)
From page 37...
... Further, it briefly examines the duty hour limits set for other safety-sensitive industries such as aviation and trucking and the efforts at regulation in those work environments. Appendix C draws lessons from the experiences of other countries that have mandated significantly reduced resident duty hours (e.g., by 2009, Europe will reduce duty hours to 48 hours per week)
From page 38...
... . Therefore, the challenge to the committee was, on the one hand, to suggest ways to minimize any risks of extended duty hours for patients and residents, while, on the other hand, suggesting ways to maximize the presumed educational and patient safety benefits of uninterrupted continuity of resident involvement (especially early in the course of illness or immediately after surgery)
From page 39...
... Patient Safety The committee appreciates that a complex set of issues is associated with considering the short- and long-term safety implications of making any adjustments to resident duty hours (Cohn, 2008)
From page 40...
... A set of interrelated studies on resident hours of work and sleep are examined in depth to determine what lessons might be learned about resident error and patient safety. Chapter 7 covers what is known about preventing acute or chronic sleep loss and its effects on making errors and what the implications would be for the redesign of resident duty hours and schedules, and the chapter includes the committee's recommendations
From page 41...
... The chapter includes a summary of an economic analysis commissioned by the committee to estimate the order of magnitude of costs for substituting current resident duty hours with those of other personnel or additional residents according to various scenarios for changes in the duty hour and workload requirements of residents. Finally, the committee is aware of the possibility that even wellc ­ onsidered recommendations might have unintended consequences, some of which will be discovered only after they are implemented.
From page 42...
... Presentation by Debra Weinstein to the Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety, May 8, 2008, Washington, DC.
From page 43...
... Presentation by Sunny Ramchandani to the Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety, December 3, 2007, Washington, DC.
From page 44...
... Presentation to the Committee on Optimizing Graduate Medical Trainee (Resi dent) Hours and Work Schedules to Improve Patient Safety, December 3, 2007, Wash ington, DC.
From page 45...
... Presentation to the Commit tee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety, March 4, 2008, Irvine, CA.


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