Surgical Residents And Patients Benefit From 24-Hour Shifts

By Jane Farrell

Limiting the number of working hours for surgical residents hasn’t improved patient outcomes and may actually have increased patient complications. Additionally, shorter hours seem to lead to higher failure rates on certification exams.

The finding, by researchers from St. Michael’s Hospital in Toronto, was published in the journal Annals of Surgery.

In recent years, the number of hours doctors spent in their residency has come in for some criticism. Physicians in that phase of training have traditionally spent long hours in a hospital, often working around the clock so they could see a wide variety of patients.

Over the last decade, health authorities have started limiting those hours with the aim of, improving patient care as well as doctors’ well-being.

In 2003, the Accreditation Council for Graduate Medical Education in the United States limited residents’ hours to 80 per week. In 2011, the council prohibited first-year residents from working 24 shifts.

Last year a Canadian group, the National Steering Committee on Resident Duty Hours, said shifts of 24 hours or longer without sleep should be avoided.

Dr. Najma Ahmed, a trauma surgeon at St. Michael’s Hospital, who was a member of the national group, said his study found that overly restrictive hours may work for some residents, but not for surgical residents.

“A one-size fits all approach to resident duty hours may not be appropriate for all specialties,” he said.  He noted that the American College of Surgeons Division of education has stated that mastery in surgery requires “extensive and immersive experiences.”

Ahmed, who is also director of the University of Toronto’s General Surgery Program, analyzed 135 articles on the impact of resident duty hours on clinical and educational outcomes in surgery.

“In surgery, recent changes in hours for residents are not consistently associated with improved resident well-being and may have negative impacts on patient outcomes and performance on certification exams,” she said.

Shorter hours for residents, she said, means more shift handovers, which means less continuity of care and more opportunities for information to be overlooked. Shorter shifts may also reduce residents’ ability to observe the natural course of recovery and recognize when a patient starts to experience complications.

“We must remember that the objective of residencies is to train expert clinicians. In the case of surgery, this requires a lot of time in the operating room, under the mentorship of an expert surgeon. Coaching in the operating room specifically requires that mentors observe progress, provide feedback and then look for progress at the next opportunity.”