Training Docs Around the Clock
Earlier this month the Accreditation Council for Graduate Medical Education approved guidelines that would allow first-year medical residents in the United States to work hospital shifts of up to 24 hours at a stretch. That’s an eight-hour increase over current rules, which cap the shifts of first-year residents at 16 hours. Critics of the rule change, including the group Public Citizen, have said that the change will lead to errors in care as sleep-deprived residents try to function. Officials at the accreditation agency say that allowing longer continuous hours provides advantages to patients in the form of fewer staff transitions and fewer complications arising from handoffs from one caregiver to the next. The new rules are scheduled to go into effect July 1. Casey Ross, national hospitals correspondent for STAT, joins Ira to talk about the pros and cons of longer hours for medical trainees.
[Would you be on board with a self-driving ambulance?]
Casey Ross is national hospitals writer for STAT News. He’s based in Cleveland, Ohio.
IRA FLATOW: Now it’s time to play Good Thing, Bad Thing. Because every story has a flip side.
Now last week, you may know, was match week around the country when medical students and hospitals get paired up for residencies. And later this year, those new residents may be working longer hours because earlier this month guidelines were approved that would allow first-year medical residents in the US to work hospital shifts of up to 24 hours at a stretch. That’s an eight hour increase over current rules. And the new guidelines are scheduled to go into effect July 1st.
Now, do you want your care being overseen by someone on their 20-something-ith hour awake? There’s got to be some good news about that. And here to talk about the change and the good and the bad is Casey Ross. He’s National Hospital writer for STAT News based near Cleveland, Ohio. Welcome to Science Friday.
CASEY ROSS: Hey, Ira. Happy to be with you.
IRA FLATOW: So tell, what possibly good thing about this. What is a good thing about allowing medical residents to work such long hours?
CASEY ROSS: Well, according to supporters of this move, the gain to be derived from this, principally, is continuity of care. American health care is increasingly delivered by people in teams. And if you have those teams kept together through the duration of somebody’s care, you’re likely to get better care. It decreases the chance of a handoff. Handoffs are basically shift changes in medicine when a person’s care is handed off between teams of people. And during those changes, things get missed and mistakes happen. And so the supporters say this is a good thing because you have that continuity of care and residents who are involved in that care can continue through the course of somebody’s care until the end.
IRA FLATOW: I know. But if you’re on the clock for 16, 24 hours, what about the quality of the care at that point? There’s got to be a bad thing there, right?
CASEY ROSS: Yes, this is a– I mean, having a sleep-deprived resident handle your medical care is fraught with potential drawbacks for sure. In fact, this was all started– the movement to reduce hours, was started in 1984 by the death of a college student in New York state who died under the care of residents. Medication mistakes were cited in that case as well as poor supervision. And so those mistakes do happen. And opponents of this move have pointed to other examples of that. That the lack of sleep, that working these hours can lead to those kinds of errors.
IRA FLATOW: Is there any data? We like to talk about facts. Let’s talk about evidence. Is there any evidence that the effect of the shift length on the medical residents actually changes their performance?
CASEY ROSS: There have been several studies that have looked into this. One recently that actually supported the change back to a longer shift was done by Northwestern University. And that study found out that there can be provisions made to allow residents to work these hours without a detrimental impact on care. So I think there have been studies that have found– come to opposite conclusions on that point over the years. But the science most recently has pointed toward the ability to allow that to happen.
IRA FLATOW: Do hospitals do something now? Are they trying to help sleep-deprived doctors?
CASEY ROSS: Yeah, they’re doing a number of different things. Some hospitals, for example, have quiet rooms that allow doctors just to sort of slip away for a few moments to meditate, to relax, to have a phone conversation they need to handle something outside of work. Those kinds of things. Just allowing normal breaks during the course of shifts to also do those things. Another thing that they’re doing is trying to limit the administrative workload that face doctors. As we probably all are all aware, doctors spend an awful lot of time on computers and doing that kind of work. And that can be stressful because it takes away from other duties and face time with patients that they’d rather have.
IRA FLATOW: All right, Casey. Thank you for taking time to be with us today. Casey Ross, National Hospital’s writer for STAT News. We’re going to come back and talk with my next guest who spent several years interviewing people most directly affected by the Deepwater Horizon explosion in the Gulf of Mexico. And she wrote a play. Yeah, it’s being produced here in New York, Spill. We’ll talk with Leigh Fondakowsi when we come back. Stay with us.
As Science Friday’s director and senior producer, Charles Bergquist channels the chaos of a live production studio into something sounding like a radio program. Favorite topics include planetary sciences, chemistry, materials, and shiny things with blinking lights.