Impact of the ACGME Work Hour Requirements

This survey was undertaken to identify neurology resident and program director opinions as to the early impact of the standards, as well as to identify strategies used to institute and monitor the guidelines in neurology and to promote discussion of these issues.

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) approved new residency program duty hour standards for all medical specialties in June 2002. The rationales for the guidelines were threefold: increased acuity of hospitalized patients resulting in greater demands of residents, growing public opinion that long resident duty hours compromise patient safety, and growing evidence of the negative effects of sleep deprivation on performance.1–3 The ACGME resident work hour requirements were implemented in July 2003, and can be summarized by the following standards: 1) an 80-hour weekly work limit, averaged over 4 weeks; 2) a 24-hour limit of continuous duty with up to 6 additional hours for transfer of care and education; 3) one day off per week, averaged over 4 weeks; 4) in-house call limited to no more than once every three nights, averaged over 4 weeks; 5) a 10-hour rest period between duties. The ACGME resident work hour requirements forced major system changes for some neurology programs in the way that patient care is delivered and residents are educated. Although potential issues such as continuity of care, patient safety, resident education, and shifting responsibilities onto academic staff were identified and justified prior to implementation,2 the impact remains to be seen. This survey was undertaken to identify neurology resident and program director opinions as to the early impact of the standards, as well as to identify strategies used to institute and monitor the guidelines in neurology and to promote discussion of these issues. A total of 24 adult neurology residency programs were selected based on publicly available program director contact information. These programs were evenly distributed in terms of geographic region (East, West, South, Midwest) and program size within each region. All correspondence was via e-mail. The initial contact was through the program director. It included the following …