First-Year Residents Can Work 24-Hour Shifts Again

Starting on July 1, 2017, first-year residents will again be permitted to work shifts as long as 24 hours, per a memo from the Accreditation Council for Graduate Medical Education (ACGME) updating its Common Program Requirements.

The new memo reverses rules from 2011 that set a work limit of 16 hours but maintains other provisions, including the total cap of 80 hours per week.

Explaining the change in policy, the ACGME stated, “the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized.” The memo goes on to note that the 16-hour limit negatively affected patient care, supervisory systems, and residents’ professional education.

The clinically-driven revisions were created by the ACGME’s Phase 1 Task Force, which was charged with creating standards based on research and literature. Support was based on multicenter research trials, position statements from 120 organizations and individuals, including “specialty societies, certifying boards, patient safety organizations, resident unions, and medical student organizations.” Residents commented that they preferred the 24-hour limit as it allowed for continuity of care. In the memo, ACGME referred to the 24-hour shift as “a ceiling, not a floor.”

The ACGME supported two national, large, independent, multicenter trials (one of which is incomplete) to evaluate the effects of the 16-hour work limit. According to the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, which compared 16-hour requirements with more flexible policies, flexibility in the 16-hour work limit ultimately benefited patient care and resident education without interfering with patient outcomes.

Source: ACGME memo, March 10, 2017; New York Times, March 10, 2017.