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The mission of the American Medical Student Association (AMSA) is built upon our members’ commitment to advocate for high quality health care, excellence in physician training, and the protection and promotion of the welfare of physicians-in- training and our patients. We are dedicated to excellence in our training and practice and remain in awe of this sacred art and tradition we are fortunate to be a part of. To that end, AMSA fully supports the Accreditation Council for Graduate Medical Education’s (ACGME’s) position that residency training should ultimately be designed to produce competent, autonomous, caring physicians. However, we remain concerned about the safety of patients and ourselves given the current climate of graduate medical education. While we are aware that there are multiple ailments currently affecting both the medical system and graduate education, we still believe that limits on medical resident work hours are an important part of the solution.
There is a continued need for resident duty hour limits as part of our shared obligation to resident well-being and high-quality patient care. We believe that resident duty hour requirements should be based on the most current research on sleep, learning, patient safety and care, and resident well-being. Research has shown that acute and chronic sleep deprivation are detrimental to learning, which is in-fact a primary goal of residency training. We continue to recommend that the number of hours a resident physician may work per week should not exceed an absolute limit of 80 without averaging. We believe that the maximum number of hours worked consecutively per shift should not exceed 16, no matter the stage of training and that residents should have at least 10 hours off between shifts.
It is critical that both robust enforcement and evaluation of resident duty hour limits occur in order to maintain and enhance the quality of resident medical education and the quality of patient care. AMSA is committed to evidence-based training that reflects best practices for both learning and safety. In order to fully realize the benefits of resident duty hour limits or to reliably evaluate the effects, resident duty hours need to be reported accurately, and the duty hour limits need to be enforced consistently. Despite efforts to promote an environment of honest reporting and adherence to the current duty-hour requirements, residents continue to underreport hours to their programs. This occurs for a variety of reasons including fear of retaliation or fear of a negative impact to their program if it were to be penalized by the ACGME.
We ask that the ACGME:
1. Reject any calls to remove the 16-consecutive- hour limit for first-year resident (interns);
2. Apply the 16-hour cap to all residents, and
3. Rescind its waivers that have allowed the iCOMPARE and FIRST trials to continue.
AMSA is dedicated to our profession, to excellence and to adapting medicine and medical education to the present-day world in which we live. There are models currently in place in which learning opportunities exist, but also in which work hour protections are not compromised and neither is the safety or education of residents. We have a responsibility to ensure that we keep patients and trainees from harm, while providing the best care that we can. AMSA is urging the ACGME to ensure that we do no harm, to patients, or to our trainees.
Read AMSA’s comments to the ACGME concerning Section VI of the Commom Program Requirements, The Learning and Working Environment during the recent 45-day open comment period, which closed December 19, 2016.