A new study from Swiss researchers adds to the ongoing debate over the best method for maintaining the highest educational standards for medical residency programs while also ensuring optimal patient safety. While plenty of research has indicated that exhaustion among medical professionals can lead to more mistakes, critics of rules designed to limit working hours — and encourage more routine sleep — among trainee doctors suggest that long hours are a critical to continuity of care, and quality of training. Yet, in a new analysis of 405 doctors — including 221 residents and 184 attending physicians — researchers found that a recent rule change that limits surgical residents to working 50 hours per week may have a negative impact on both the quality of training and quality of patient care.
The study, conducted by researchers at University Hospital Basel in Switzerland and published this week in the Archives of Surgery, surveyed residents and attending physicians in surgical departments at 52 hospitals one year after new rules were implemented limiting surgical residents to 14 hours per day (including breaks), and requiring a minimum of 11 consecutive hours off per day for rest.
Researchers found that, residents were more likely than attending physicians to say they preferred the 50-hour workweek, but, on average residents said they still continued to work roughly 55 hours per week. A majority of residents (58.4%) and consultants (81.5%) alike said they thought quality of life had improved for residents.
As for how the rules impacted training, roughly two thirds of residents (62.8%) and more than three quarters of attending surgeons (77.2%) said they thought the shorter hours had a negative impact on surgical training. What’s more, 43% of residents and 70.1% of attending physicians said they thought patient care suffered due to the shortened workweek.
As the study authors concluded:
“Most surgical residents and surgical consultants perceive the 50-hour workweek limitation as having a negative effect on surgical training and on quality of patient care. Although residents’ quality of life improved slightly, the work hour limitation for surgical residencies as instituted in Switzerland appears to be a failure. To optimize the present situation, resident paperwork should be reduced or assigned to physician extenders. Furthermore, it is imperative that surgical residents read and study during their time off duty.”