Limiting hours of resident shifts improves satisfaction—but not educational outcomes

Limiting medical residents to 16-hour work shifts, instead of allowing for longer stretches on the job, increased satisfaction with training but did not affect overall educational outcomes. Findings were published March 20 in the New England Journal of Medicine.

In the study, researchers examined the difference in resident satisfaction and educational when comparing limited-hour polices and those using a more flexible set of rules requiring an 80-hour work week. A total of 23 trained observers followed the daily routines of 80 interns—44 with flexible hours and 36 with limited hours, from 63 internal medicine residency programs.

When surveying over 1,200 interns from the 63 training programs, those in flexible-hour programs were more than twice as likely to be dissatisfied with their well-being and one and a half times more likely to report dissatisfaction with the overall quality of their education

“There was no significant difference in the proportion of time that medical interns spent on direct patient care and education between programs with standard duty-hour policies and programs with more flexible policies,” concluded Desai and colleagues. “Interns in flexible programs were less satisfied with their educational experience than were their peers in standard programs.” 

Burnout was also similar in both groups, with 79 percent in flexible programs and 72 percent in limited-hour programs scoring moderate or high on the burnout scale

"The effects of limiting trainee duty hours were not known," said first author Sanjay Desai, MD, associate professor of medicine and director of the Osler Medical Training Program at the Johns Hopkins University School of Medicine. "A randomized trial with many institutions and generalizable findings was needed to inform the issue.”

Since 2003, medical residents have been limited to a maximum of 30-hour shifts and an 80-hour workweek. While the decrease in workhours was meant to increase satisfaction and decrease burnout, medical educators worried how such limits affected a resident’s overall education.

"Many educators have worried that the shift work created by limited duty hours will undermine the training and socialization of young physicians," said the study's principal investigator David Asch, MD, at the Perelman School of Medicine at the University of Pennsylvania. "Educating young physicians is critically important to health care, but it isn't the only thing that matters. We didn't find important differences in education outcomes, but we still await results about the sleep interns receive and the safety of patients under their care."