Starting July 1 the Accreditation Council for Graduate Medical Education will limit the shifts of first-year residents to no more than 16 hours without sleep. However, ACGME will continue to permit shifts of 28 consecutive hours for more senior residents, including surgical residents.
The ACGME's pace for implementation of the IOM recommendations was singled out for criticism in the report, and by the advocacy groups. Charles Czeisler, MD, a coauthor of the report and chief of the Division of Sleep Medicine at Brigham and Women's Hospital, in Boston said the ACGME has taken a "very limited" approach to the IOM's recommendations, noting that the ACGME's new rules will cover only "a small fraction" of the resident workforce and not get at the root of the problem.
"Extensive research has shown that experience does not overcome the need for sleep," Czeisler said in a media release. "There is no justification for maintaining unsafe work hours, other than that they're a good deal for hospitals. But they endanger patients, and they even endanger residents."
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Czeisler said ACGME enforcement was insufficient because it relies on self-regulation, and lacks external or public accountability.
Attempts to obtain comments from ACGME were unsuccessful.
Christopher Landrigan, MD, a co-author of the Harvard report and lead author of the North Carolina Patient Safety Study, says rates of harm due to medical error have been constant. "Adoption of even the best proven interventions to reduce medical errors – including elimination of shifts exceeding 16 consecutive hours for resident physicians – has been extremely poor," he said.
The Harvard recommendations cover six other areas: workload and supervision; moonlighting; resident physician safety; hand-over practices and training in quality improvement; monitoring and oversight of the ACGME; and funding for reform implementation.