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Medical residents need sleep, docs say

Could more sleep be on the horizon for fatigued medical residents? If not, it should be, says the Institute of Medicine (IOM), which in a report released today recommends shorter shifts and scheduled time for snoozing.

The IOM doesn’t suggest that the docs in training work less than the maximum 80-hour weeks set five years ago by the Accreditation Council for Graduate Medical Education (ACGME), which accredits residency programs. But it says residents shouldn’t be allowed to work for more than 16 hours straight without an uninterrupted sleeping break that's at least five hours long.

The ACGME rules allow residents to work as long as 30 hours without a break, but "adequate time for rest and personal activities must be provided" after that in the form of 10 free hours. Some 43 percent of residents surveyed, however, said they routinely worked longer than the maximum amount.

If it feels like hazing, the 80-hour week has a practical purpose — to familiarize residents with the potentially long hours of medical practice, according to the IOM report. Doctors work an average of 50 to 60 – and some as many as 80 — hours a week, the report says.

But sleep deprivation is more than a lifestyle issue. Residents working without enough rest function as poorly as people who are drunk, and lack of sleep increases the risk of them harming or killing patients, studies have shown.

"The science clearly shows that fatigue increases the chances of errors, and residents often work long hours without rest and regular time off," IOM committee chair Michael Johns said in a statement released with the report. "These recommendations will make a difference only if the limits are being followed. We heard from many sources that violations of current duty hour limits are frequent and they are underreported."

Johns said ACGME should do more frequent and unannounced duty-hour audits to make sure its rules are followed.

The council said in a statement that it "has aggressively enforced the standards and monitored compliance," and will "carefully review the IOM report" when it meets in March to discuss possible changes to the rules.

Image by iStockphoto/Rich Legg

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