The Accreditation Council for Graduate Medical Education released Friday proposed revisions to residency training requirements, including a controversial proposal to extend the cap on consecutive hours worked from 16 to 28 hours.
The proposal includes four main changes: expanded requirements for patient safety and quality improvement, guidance on physician well-being, strengthened expectations for team-based care and streamlined resident clinical and educational work hours.
"At the core of the proposed standards is the philosophy that residency education must occur in a learning and working environment that fosters excellence in the safety and quality of care delivered to patients today and in the future," Thomas Nasca, MD, CEO of the ACGME and vice-chair of the task force that drafted the revisions, said in a statement. "We recognize that the well-being of physicians is crucial to their ability to deliver the safest, best possible care to patients, and we've thoughtfully constructed enhancements in this area."
However, one detail of the proposal has already begun to receive backlash for potentially putting patients and residents at risk. The ACGME reviewed available research, evidence and testimony and concluded it should extend the limit of consecutive time on-task first year residents are allowed to work from 16 hours to 24 hours plus four hours to manage care transitions.
"Training to become a practicing physician can be compared to training for a marathon," Dr. Nasca said in a statement. "You must learn how to pace yourself, take care of yourself and recognize your limits. With enough experience comes resilience and the ability to perform under [un]expected, sometimes challenging conditions."
The Public Citizen, a nonprofit, consumer rights advocacy group, issued a statement Friday calling the consecutive time proposal a "dangerous step backward."
"Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients and the public," Michael Carome, MD, director of Public Citizen's Health Research Group, said in a statement. "It's disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health."
The Public Citizen pointed to a 2009 report from the Institute of Medicine — which originally spurred ACGME's 16-hour limit — as evidence consecutive hours should not be extended. The report found tired residents are more likely to cause harm to themselves or their patients, according to Public Citizen.
The ACGME proposal notably does not change the overall number of hours worked per week by residents. This will remain at a maximum of 80 hours per week with at least one day free for every seven days, averaged over four weeks.
The proposed revision is open for comment for 45 days. Review the full proposal and find directions to submit comments here.
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