I read this article with interest. As a Senior Faculty Attending
Physician at one of the leading teaching medical institutions in the
United States, I have had close interactions with the trainees (residents
and fellows). My impression may sound anecdotal but other Attending
Clinicians have also voiced their findings.
Contrary to the authors, I do not believe in any of the results of
the published studies performed in the United States after 2003. The truth
may never come out. The recommendations set forth by the Accreditation
Council for Graduate Medical Education (ACGME) have put us (Faculty
Members) and the trainees in a very difficult position.
We, the trainers, have the moral duties and obligations to train the
trainees to achieve independent practitioner status (either specialists or
primary care providers) after the completion of their residencies. This
aim must be achieved at all costs while maintaining patients' safety and
improving their outcomes. The trainees also have the moral
responsibilities to learn, to train and to take care of patients. Some
specialties, especially surgical specialties, are very demanding. The
ACGME's recommendation not to let first-year resident work more than 16
hours continuously, may not just be practical, for some neurosurgical
procedures take more than 24 hours. Therefore, at the end of the day, many
residents underreport their duty hours to their program directors at many
institutions. They have even created a term "working under the table". On
paper, everything looks alright.
Pilot studies were performed at some teaching institutions to see if
residents were accurately reporting their work hours. MacGregor, et al,
also concluded that surgical residents did not always record their work
hours accurately and many have concerns about further work hour
restrictions and that the majority (52%) under-reported work hours and
felt that further work hour restriction would be detrimental to their
training[1]. Carpenter et al, also concluded that the ACGME work-hour
restriction have created ethical dilemma for residents and that many
residents (49%) felt compelled to exceed work-hour regulations and report
those hours falsely [2]
References:
1.MacGregor JM, Sticca R. General surgery residents' views on work
hour regulations. J Surg Educ 2010;67:376-80. Epub 2010 Nov 5
2.Carpenter RO, Austin MT, Tarpley JL, et al. Work-hour restrictions
as an ethical dilemma for residents. Am J Surg 2006;191:527-32
Competing interests:
I am a Faculty Attending Physician.
26 March 2011
Thein H Oo
Associate Professor of Medicine
The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
Rapid Response:
Many residents underreport their work hours
Dear Sir,
I read this article with interest. As a Senior Faculty Attending
Physician at one of the leading teaching medical institutions in the
United States, I have had close interactions with the trainees (residents
and fellows). My impression may sound anecdotal but other Attending
Clinicians have also voiced their findings.
Contrary to the authors, I do not believe in any of the results of
the published studies performed in the United States after 2003. The truth
may never come out. The recommendations set forth by the Accreditation
Council for Graduate Medical Education (ACGME) have put us (Faculty
Members) and the trainees in a very difficult position.
We, the trainers, have the moral duties and obligations to train the
trainees to achieve independent practitioner status (either specialists or
primary care providers) after the completion of their residencies. This
aim must be achieved at all costs while maintaining patients' safety and
improving their outcomes. The trainees also have the moral
responsibilities to learn, to train and to take care of patients. Some
specialties, especially surgical specialties, are very demanding. The
ACGME's recommendation not to let first-year resident work more than 16
hours continuously, may not just be practical, for some neurosurgical
procedures take more than 24 hours. Therefore, at the end of the day, many
residents underreport their duty hours to their program directors at many
institutions. They have even created a term "working under the table". On
paper, everything looks alright.
Pilot studies were performed at some teaching institutions to see if
residents were accurately reporting their work hours. MacGregor, et al,
also concluded that surgical residents did not always record their work
hours accurately and many have concerns about further work hour
restrictions and that the majority (52%) under-reported work hours and
felt that further work hour restriction would be detrimental to their
training[1]. Carpenter et al, also concluded that the ACGME work-hour
restriction have created ethical dilemma for residents and that many
residents (49%) felt compelled to exceed work-hour regulations and report
those hours falsely [2]
References:
1.MacGregor JM, Sticca R. General surgery residents' views on work
hour regulations. J Surg Educ 2010;67:376-80. Epub 2010 Nov 5
2.Carpenter RO, Austin MT, Tarpley JL, et al. Work-hour restrictions
as an ethical dilemma for residents. Am J Surg 2006;191:527-32
Competing interests: I am a Faculty Attending Physician.