Percutaneous injuries, with their attendant risk of hepatitis, HIV, and other blood-borne illnesses, are the greatest occupational hazard faced by resident physicians and motor vehicle crashes (MVC) are the leading cause of death in their age group. In our nationwide survey of 2,737 resident physicians in their first postgraduate year (PGY1s) we found that extended duration work shifts (> 24 hours) were associated with a 73% increase in the risk of percutaneous injuries and a 168% increase in motor vehicle crashes (MVCs) on the commute from work. We found that PGY1s were also significantly more likely to report falling asleep while driving when they worked at least one or more extended duration shifts per month. Based on these and similar findings, in 2009, the Institute of Medicine (IOM) recommended and in 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented, a 16-hour limit on the number of consecutive hours that resident physicians may be scheduled to work in their first postgraduate year. In order to determine the effectiveness of the new work hour rule, we propose to conduct a large-scale nationwide survey of interns, similar to that which we conducted from 2002-2007. We will collect work hours and sleep data as well as health and safety outcomes on monthly web-based surveys. We propose to test the hypotheses that sleep will be increased, and the incidence rates of MVCs and percutaneous injuries will be decreased among PGY1 residents working under the new ACGME Common Program Requirements (2011) that limit the duration of work shifts to 16 consecutive hours as compared to data we previously collected from 6,487 PGY1s (47,858 monthly surveys) prior to implementation of this limit. We will also test the hypotheses that sleep will be increased and the incidence rates of MVCs and percutaneous injuries will be decreased among PGY1 residents whose work shifts are limited to 16 consecutive hours as compared to those same residents in their PGY2+ years who are scheduled to work extended duration (>24 hours) shifts. The proposed study could have important public policy implications related to the health and safety of the more than 108,000 medical and surgical residents, who are the principal providers of medical care in academic medical centers throughout the United States.
The Accreditation Council for Graduate Medical Education implemented new work hour standards on July 1, 2011 limiting first year resident physicians work shifts to no more than 16 consecutive hours. There remains considerable debate in the medical community, however, about whether reducing hours will in fact lead to improvements in health and safety. We conduct a large-scale nationwide survey of PGY1 resident physicians to document health and safety outcomes (motor vehicle crashes, near-miss incidents, attentional failures and percutaneous injuries) associated with 16-hour shifts and compare them to data collected using the same methodology prior to the new rule, when extended duration shifts of up to 30 hours in duration were sanctioned. Results from this study will have important public policy implications for postgraduate medical education, providing guidance as to the impact of the new ACGME work-hour regulations on the health and safety of resident physicians.
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