Skip Navigation Archive: U.S. Department of Health and Human Services www.hhs.gov
Archive: Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner

Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules


This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Remarks by Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality (AHRQ)

Institute of Medicine, Washington, DC
December 3, 2007

Good morning.  I cannot tell you how pleased I am to have such a body of experts coming together to find solutions to one of the preventable causes of errors in health care—the extended shifts worked by graduate medical trainees in teaching hospitals and other health care institutions.

As you know, some of our colleagues continue to believe that there is no correlation between the extended work hours of graduate medical trainees and quality of care. They say the long hours are good for the continuity of care and reducing them would put these trainees at risk of missing valuable learning opportunities.  I think we know better.

My family used to ask me about this all of the time.  I don't come from a family of doctors, and they would ask "How do you not make mistakes when you've been up all night?"  I hated these questions.  I would always talk about adrenaline and people checking on you and other things, but the truth is that I really didn't have an answer.  It probably had more to do with prayer and coffee than anything else.

As for the potential impact of these long hours, the research findings speak for themselves:

  • We know that first-year doctors-in-training who work five extra-long shifts increase their chances of making a potentially deadly error by 300 percent.
  • We know that first-year graduate medical trainees are more likely to injure themselves with sharp instruments when they work for 20 hours straight.
  • We also know that these trainees more than double their risk of car crashes when they drive home after working extended shifts.  I have very vivid recollections of seeing people in casts.

Furthermore, we know that despite rules being put in place in 2003 to govern resident work schedules that the culture and traditions remain very strong.  What we need are some levers—maybe even some financial levers—to make it easier for people to do the right thing.

So, for that reason, my colleagues and I are gratified that Congressmen John Dingell, Joe Barton, and other members of the House Committee on Energy and Commerce view this issue with the high level of importance that we think it deserves. 

The congressional concern gives us an opportunity to make a difference.  Of course, it will up the pressure.

We will have to come up with real solutions, because I don't believe Congress and the public that they represent will have much tolerance for anything less than some thoughtful recommendations from this group.  If we don't give members of Congress some workable leading-edge solutions, they will come up with their own.  I don't think any of us wants to abdicate our responsibility for dealing with an issue of this magnitude, so I want to be very specific in explaining what I hope this committee will consider over the course of your deliberations.

The primary task of this committee will be to focus on four areas:

  • Synthesis of the current evidence base on graduate medical trainees hours and works schedules and their impact on safety.
  • Identification and development of strategies, practices, interventions, and tools that can be used to implement reasonable work hours.
  • Analysis of both the potential benefits and harms of updating work hours and schedules.
  • Short- and long-term recommendations for action by various stakeholders and interim strategies and policies for implementing these recommendations.

I know that this is a lot of work.  But, I think the bottom line is that there must be change. The complacent era of graduate medical trainees being exposed to extended hours for no good reason when there is a clear downside is about to come to a close.

The reasons for keeping these traditions going are not rooted in science. They are based on opinion, traditions, and very strong beliefs which are perceived rather than actual barriers to change.

At some point, we have to acknowledge the fact that a human being can work only so long without sleep deprivation becoming a factor.  Research shows that we do not do well in transitions of care, but limiting these transitions by having work hours that are not compatible with human physiology is not the answer.

It is unsafe and it belies virtually all of the tenets of providing good health care.  How can we profess to provide the best possible quality when we know we have staff members who are firing on fewer than all cylinders at levels of sleep deprivation so severe that they are similar to those of someone who is doing community service for driving under the influence of alcohol?

The problem exists across health care.  AHRQ sponsored an IOM study not long ago that focused on working conditions for nurses.  Their hours, as well as those of other health care professionals, are also a concern.  But in order to have a narrow enough focus, the scope of this effort is specific to graduate medical trainees.

People in the United States are increasingly worried about their health care and the research suggests that they should be.  We know that poor quality care is an issue that really must be addressed.  The real issue is much more personal.  The real issue here is how good is my health care?

At this point, I am not sure we have an answer for most Americans.  And I think that with this committee we have a chance to go beyond providing answers. We can provide solutions.

 We are hoping you can send Congress recommendations that can have an impact on the quality of care across the Nation.

Thank you very much for being a part of this panel.  I am already looking forward to reading your report next year.

Current as of December 2007

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care