As everyone who has ever watched a TV medical show knows, medical residents work long, long hours. For at least one group of residents, that's about to change. The Accreditation Council for Graduate Medical Education has reduced the maximum number of hours a first year resident can work per shift from 24 to 16. The goal is to reduce resident fatigue and to prevent medical errors resulting in injury and death of patients.

Second year residents can continue to work up to 24 hours per shift.

The role of fatigue in poor decision making has come under close scrutiny in many professions, including truck drivers, airline pilots and air traffic controllers. While some previous limits were imposed - such as shifting the maximum hours worked per week to 80, in 2003 - residency programs and the accreditation board have not taken other action. In 2010, a national advocacy group, Public Citizen, petitioned OSHA to investigate resident work hours and fatigue.

To people outside the medical field, limiting work hours may seem very reasonable, but this change has caused a great deal of controversy in the field of medical education. Indeed, some very esteemed medical institutions, such as the Mayo Clinic, are concerned that reducing shift hours could hurt patient care.

A Mayo Clinic survey found that 87 percent of medical residency directors felt the shift limit would decrease continuity of care for hospitalized patients, while 65 percent said it would not reduce resident fatigue. Many expressed concern that it would reduce the medical competency of first year residents in several areas. The traditional system of training, with long hours, ensured that doctors in training had a great deal of exposure to certain patients and could follow their progress and treatment.

Also changed is the supervision requirement. First-year residents are to be supervised, directly or indirectly, with more experienced doctors immediately available.

As these new rules are put into place, everyone will be closely monitoring the results to see if, indeed, patient care is improved. "What we're doing is embracing a positive change and saying, 'We're making the system safer,'" said Dr. Joseph Mikhael, vice chairman of the Graduate Education Committee at Mayo Clinic in Scottsdale.

Source: The Arizona Republic, "Limits on first-year medical residency hours will be studied," by Jackie Smith, July 5, 2011.