Virginia Tech expert: Increased caps on hours for medical interns strikes balance to promote patient care

New working hour rules for medical interns released recently by the Accreditation Council for Graduate Medical Education are intended to “find the right balance of reasonable work hours while ensuring we have good patient care and appropriate professional advancement for our trainees,” said Ralph E. Whatley, a professor of internal medicine at the Virginia Tech Carilion School of Medicine and senior vice president for research and education at Carilion Clinic.

The ACGME released its latest work limits for first-year interns on March 10, voting to eliminate a 16-hour working cap and instead allow up to 24 hours. A limit of 80 hours per week for residents at all levels remains in place under the new rules.

The change comes after the organization limited both interns and residents in 2003 to 24 hours per shift. In 2010, after more studies, the council shortened the cap again for first-year interns to 16 hours while strongly recommending “strategic napping.”

Whatley said two concerns rose to the top fairly early after the implementation of the limits in 2010.

“One concern was that the shorter shifts result in more ‘handoffs’ of clinical care between the trainees, which is an opportunity for lapses in the continuity of care and failure to recognize clinical trends such as a condition that is deteriorating,” he said. “Another concern is that the limits on shifts and hours worked per week was limiting the clinical experience of some trainees — especially those training in surgery — whose training requires experience in a certain number of procedures.”

The changes to the rules come after a number of studies that have examined the impact of the rules on safety, patient care, and the impact of the rules on the professional development of residents, Whatley said.

“It’s not about, ‘This is the way we used to do it.’ That was last century’s argument,” he said. “It’s more about trying to find the right balance of reasonable work hours while ensuring we have good patient care and appropriate professional advancement for our trainees.”