New Sleep Recommendations for Doctors in Training
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The Institute of Medicine released a report recommending doctors-in-training to work no more than 16-hours per shift without taking a sleep break for at least five hours. The institute found clear evidence tying doctor mistakes to the lack of sleep. The focus was on the training of medical residents and how they often work over 80 hours a week and can work individual shifts over 30 hours long. Research shows the less sleep medical residents get the higher percentage of reported errors. For example, when they average 7 to 8 hours of sleep, 21 percent of residents report errors; on the other hand, when the residents get less than 4 hours of sleep, 45 percent of residents report errors made during their shift. It’s clear that the medical residents’ lack of sleep directly affects patients’ safety.
The report also called for better supervision from the instructing physicians to make sure not only that the students are resting, but also to ensure the patients are receiving the proper care. Having the instructing physicians available could also help the students use their time more effectively. Dr. Kenneth M. Ludmerer, professor medicine and history at Washington University in St. Louis explained,
“One of the problems has been that we limited the hours but didn’t change the work to make it better educationally and in terms of safety. You have to look at what they do during those hours. Is the total experience a learning experience?”
Another issue doctors and students face is “the patient hand-off,” where one physician leaves and another takes over. With the student-doctors working shorter shifts, there could be more of these hand-offs, which if not handled properly could cause errors in the patients’ care.
“The handoff is a risky time for patients, because rushed and fatigued doctors often inadequately brief incoming staff members,” said Dr. Sandeep Jauhar, director of the heart failure program at Long Island Jewish Medical Center and a reviewer of the report.
So how are the training hospitals going to balance the students working shorter shifts with more patient hand-offs in order to make sure the patients are receiving the best possible care? At this point there is no clear answer and many in the medical community are skeptical and frustrated. Mary Carol Jennings, legislative director for the American Medical Student Association asked,
“How is it reasonable for truckers in our country to be more restricted in their work hours than doctors and resident physicians?”
That’s a good question.
Read the Times article on this report.