USA today posted an article on lack of sleep of medical residents on Monday, August 4, 2008.  In this article they are talking about the 2003 policy change from the Accreditation Council for Graduate Medical Education, which cuts shifts to 24 to 30 hours with a maximum of 80 hours per week.

This study of 220 residents shows only small improvements within the last 5 years:

  • The number of residents working 30 or more consecutive hours changed from 80% of residents before 2003 to 56%.
  • The sleep amount of 7 ½ hours a day stayed the same for residents.
  • The number of mistakes – 1 ½ for every 100 orders given – stayed the same.
  • Needle-sticks and car wreck incidents didn’t improve.
  • Residents burnout decreased from 75% to 57%.

As a result there have been positive changes regarding the residents’ burnout and the number of residents working 30 and more consecutive hours but when it comes to mistakes and accidents, there have been no improvements for the residents.

The article also talks about junior doctors in New Zealand who may not work more than 16 hours straight and 72 total hours a week. And in Europe doctors can work only 13 consecutive hours and 48 to 56 hours a week. Now the article doesn’t say what the medical mistake percentage and car accident rates of residents are in those countries.

Rebecca Sadun, director of student programming at the American Medical Student Associations states that cutting work hours cannot be the only answer. “We need more physicians in training. Without more residents, we can’t give people more rest.”

I am sure that is one of the reasons for this awareness-raising study. What else is missing?

Even though there has been a policy change, it doesn’t mean there has been a paradigm shift. After all, successful and permanent behaviorial change can only happen when it was preceded by a change of thinking. As Albert Einstein said, “The significant problems we face cannot be resolved at the same level of thinking we were at when we created them.”

Why didn’t the number of medical mistakes improve? Interesting questions with several possible answers:

One could be that residents are too tired to concentrate which causes them mistakes. On the other side, if they say that they get about 7 ½ hours a night, that is a fairly good and normal sleep duration. Therefore it is difficult to say whether the concentration is such a major factor.

Another answer could be that residents don’t feel comfortable asking teaching physicians for help or advice. Many residents probably feel intimidated by their mentors to ask questions or admit a mistake so that it gets easily corrected. After all, many of these teaching physicians are not aware how to build trusting relationships with colleagues and staff members.

Rather than just giving residents a policy that the number of work hours gets limited to 80 hours a week, residents need to learn valuable self-management and interpersonal tools to maximize their time in residency such as:

  • How to control stress and limit the energy drains in difficult situations
  • How to communicate most effectively with nurses and teaching physicians
  • How to put your ego to the side and use the collaborative environment
  • How to raise your energy quickly and in a healthy way
  • How to streamline life to leverage time

As long as residents and physicians don’t master these essential skills, no policy will create major improvements. What are your thoughts on that?

Iris Grimm