When policy meets physiology: The challenge of reducing resident work hours

Clinical Orthopaedics and Related Research

Volumn 449, Issue , 2006, Pages 116-127

  Lockley, Steven W ^a   Landrigan, Christopher P ^b   Barger, Laura K ^b   Czeisler, Charles A ^b  

^a HARVARD MEDICAL SCHOOL   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ALERTNESS; CIRCADIAN RHYTHM; CONFERENCE PAPER; DIAGNOSTIC ERROR; FATIGUE; HUMAN; JOB PERFORMANCE; LEARNING; ORTHOPEDIC SURGERY; PATIENT CARE; PATIENT SAFETY; PHYSIOLOGY; POLICY; PRIORITY JOURNAL; RESIDENCY EDUCATION; SHIFT WORKER; SLEEP DEPRIVATION; SURGEON; TRAFFIC ACCIDENT; WORK SCHEDULE; MEDICAL EDUCATION; MEDICAL ERROR; ORGANIZATION AND MANAGEMENT; PATHOPHYSIOLOGY; PSYCHOLOGICAL ASPECT; REVIEW; SLEEP; TIME;

ACCIDENTS, TRAFFIC; FATIGUE; HUMANS; INTERNSHIP AND RESIDENCY; MEDICAL ERRORS; ORGANIZATIONAL POLICY; SLEEP; TIME FACTORS; WORK SCHEDULE TOLERANCE;

EID: 33747168522     PISSN: 0009921X     EISSN: 15281132     Source Type: Journal    
DOI: 10.1097/01.blo.0000224057.32367.84     Document Type: Conference Paper

References (88)

1. Accreditation Council for Graduate Medical Education. Common program requirements - duty hour requirements. 2003. Accessed October 4, 2004, at http://www.acgme.org/DutyHours/dutyHoursCommonPR.pdf.
2. Accreditation Council for Graduate Medical Education. The ACGME's approach to limit resident duty hours: A summary of achievements for the second year under the common duty hours standards. 2005. Accessed April 8, 2006, at http://www.acgme.org/acWebsite/dutyHours/dh_achieveSum04-05.pdf
3. Afessa B, Kennedy CC, Klarich KW, Aksamit TR, Kolars JC, Hubmayr RD. Introduction of a 14-hour work shift model for housestaff in the medical ICU. Chest. 2005;128:3910-3915.
4. Akerstedt T, Nilsson PM. Sleep as restitution: an introduction. J Intern Med. 2003;254:6-12.
5. American Medical Association. Medical students and residents work-hour survey. 2005. American Medical Association. Accessed July 14, 2005 at http://www.ama-assn.org/ama1/x-ama/ upload/mm/363/workhours.pdf.
6. Arnedt JT, Owens J, Crouch M, Stahl J, Carskadon MA. Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA. 2005;294:1025-1033.
7. Bailit JL, Blanchard MH. The effect of house staff working hours on the quality of obstetric and gynecologic care. Obstet Gynecol. 2004;103:613-616.
8. Baldwin DC Jr, Daugherty SR. Sleep deprivation and fatigue in residency training: results of a national survey of first-and second-year residents. Sleep. 2004;27:217-223.
9. Barger LK, Cade BE, Ayas NT, Cronin JW, Rosner B, Speizer FE, Czeisler CA. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005;352:125-134.
10. Borbély AA, Achermann P. Sleep homeostasis and models of sleep regulation. J Biol Rhythms. 1999;14:557-568.
11. Brasher AE, Chowdhry S, Hauge LS, Prinz RA. Medical students' perceptions of resident teaching: have duty hours regulations had an impact? Ann Surg. 2005;242:548-553.
12. Cajochen C, Khalsa SBS, Wyatt JK, Czeisler CA, Dijk DJ. EEG and ocular correlates of circadian melatonin phase and human performance decrements during sleep loss. Am J Physiol. 1999;277:R640-R649.
13. Cajochen C, Wyatt JK, Czeisler CA, Bonikowska M, Dijk DJ. Nonlinear interaction between the circadian and homeostatic modulation of slow eye movements during wakefulness in humans. J Sleep Res. 2000;9:58.
14. Committee of Interns and Residents. New medicine schedule caps shifts to 12 hours. CIR SEIU News. September 2005:7.
15. Coverdill JE, Finlay W, Adrales GL, Mellinger JD, Anderson KD, Bonnell BW, Cofer JB, Dorner DB, Haisch C, Harold KL, Termuhlen PM, Webb AL. Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study. Acad Med. 2006;81:50-56.
16. Cull WL, Mulvey HJ, Jewett EAB. Resident fatigue before and after ACGME duty hour limits. American Academy of Pediatrics, 2005. Accessed November 29, 2005 at http://www.aap.org/research/abstracts/05abstract15.htm.
17. Czeisler CA, Weitzman ED, Moore-Ede MC, Zimmerman JC, Knauer RS. Human sleep: Its duration and organization depend on its circadian phase. Science. 1980;210:1264-1267.
18. Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature. 1997;388:235.
19. Dawson D, Zee P. Work hours and reducing fatigue-related risk: Good research vs good policy. JAMA. 2005;294:1104-1106.
20. Department of Transportation. Federal Motor Carrier Safety Administration. Washington, DC: National Archives and Records Administration; 2000: Federal Register 65[85], 25541-25611.
21. Dijk DJ, Czeisler CA. Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans. J Neurosci. 1995;15:3526-3538.
22. Dijk DJ, Lockley SW. Integration of human sleep-wake regulation and circadian rhythmicity. J Appl Physiol. 2002;92:852-862.
23. Dirschl DR, Dahners LE, Adams GL, Crouch JH, Wilson FC. Correlating selection criteria with subsequent performance as residents. Clin Orthop Relat Res. 2002;399:265-271.
24. Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25:117-129.
25. Ellenbogen JM. Cognitive benefits of sleep and their loss due to sleep deprivation. Neurology. 2005;64:E25-E27.
26. Ellman PI, Kron IL, Alvis JS, Tache-Leon C, Maxey TS, Reece TB, Peeler BB, Kern JA, Tribble CG. Acute sleep deprivation in the thoracic surgical resident does not affect operative outcomes. Ann Thorac Surg. 2005;80:60-64.
27. Federal Aviation Administration. Pilot flight time and rest. 2005. Federal Aviation Administration. Accessed August 31, 2005, at http://www.faa.gov/news/fact_sheets/factsheets/2001/factsheets_0110.htm.
28. Federal Motor Carrier Safety Administration. The revised hours of service regulations. 2005. Federal Motor Carrier Safety Administration. Accessed August 31, 2005, at http://www.fmcsa.dot.gov/print.asp?URL=/rules-regulations/truck/ driver/hos/faxsheet.htm.
29. Fischer JE. Surgeons: employees or professionals? Am J Surg. 2005;190:1-3.
30. Fletcher KE, Underwood W III, Davis SQ, Mangrulkar RS, McMahon LF Jr, Saint S. Effects of work hour reduction on residents' lives: a systematic review. JAMA. 2005;294:1088-1100.
31. Folkard S, Tucker P. Shift work, safety and productivity. Occup Med (Lond). 2003;53:95-101.
32. Ford CV, Wentz DK. The internship year: A study of sleep, mood states, and psychophysiologic parameters. South Med J. 1984;77:1435-1442.
33. Friedman RC, Bigger JT, Kornfield DS. The intern and sleep loss. N Engl J Med. 1971;285:201-203.
34. Friedman RC, Kornfeld DS, Bigger TJ. Psychological problems associated with sleep deprivation in interns. J Med Educ. 1973;48:436-441.
35. Gaba DM, Howard SK. Fatigue among clinicians and the safety of patients. N Engl J Med. 2002;347:1249-1255.
36. Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165:2601-2606.
37. Goldman LI, McDonough MT, Rosemond GP. Stresses affecting surgical performance and learning I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes. J Surg Res. 1972;12:83-86.
38. Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595-2600.
39. Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J. Laparoscopic performance after one night on call in a surgical department: prospective study. BMJ. 2001;323:1222-1223.
40. Grunstein RR, Rogers NL. Medical work hours: time for a Maggie's Law for doctoring? Intern Med J. 2005;35:269-271.
41. Huber R, Ghilardi MF, Massimini M, Tononi G. Local sleep and learning. Nature. 2004;430:78-81.
42. Humphries C. HMS hospitals hone plans for deeper cuts in resident hours' Focus Online, Harvard Medical School, 2004. Accessed June 3, 2006 at http://focus.hms.harvard.edu/2004/Dec3_2004/medical_ education.html.
43. Jagsi R, Shapiro J, Weinstein DF. Perceived impact of resident work hour limitations on medical student clerkships: a survey study. Acad Med. 2005;80:752-757.
44. Jewett ME. Models of circadian and homeostatic regulation of human performance and alertness. [PhD Thesis] Cambridge, MA: Harvard University; 1997.
45. Jewett ME, Wyatt JK, Ritz-De Cecco A, Khalsa SB, Dijk DJ, Czeisler CA. Time course of sleep inertia dissipation in human performance and alertness. J Sleep Res. 1999;8:1-8.
46. Joyner BD, Siedel K, Stoll D, Mitchell M. Report of the national survey of Urology Program Directors: attitudes and actions regarding the accreditation council for graduate medical education regulations. J Urol. 2005;174:1961-1968.
47. Keating RJ, LaRusso NF, Kolars JC. Perceived impact of duty hours limits on the fragmentation of patient care: results from an academic health center. Am J Med. 2005;118:788-793.
48. Klingensmith ME, Winslow ER, Hamilton BH, Hall BL. Impact of resident duty-hour reform on faculty clinical productivity. Curr Surg. 2006;63:74-79.
49. Knutsson A. Health disorders of shift workers. Occup Med (Lond). 2003;53:103-108.
50. Landrigan CP. Sliding down the bell curve: effects of 24-hour work shifts on physicians' cognition and performance. Sleep. 2005;28:1351-1353.
51. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838-1848.
52. Lin GA, Beck DC, Garbutt JM. Residents' perceptions of the effects of work hour limitations at a large teaching hospital. Acad Med. 2006;81:63-67.
53. Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP, Rothschild JM, Katz JT, Lilly CM, Stone P, Aeschbach D, Czeisler CA. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Engl J Med. 2004;351:1829-1837.
54. Lund KJ, Teal SB, Alvero R. Resident job satisfaction: one year of duty hours. Am J Obstet Gynecol. 2005;193:1823-1826.
55. Mathis BR, Diers T, Hornung R, Ho M, Rouan GW. Implementing duty-hour restrictions without diminishing patient care or education: can it be done? Acad Med. 2006;81:68-75.
56. Mittal VK, Portenier D. Continuity of care in the 80-hour workweek era? Curr Surg. 2006;63:31-34.
57. Murray A, Pounder R, Mather H, Black DC. Junior doctors' shifts and sleep deprivation. BMJ. 2005;330:1404.
58. Mycyk MB, McDaniel MR, Fotis MA, Regalado J. Hospitalwide adverse drug events before and after limiting weekly work hours of medical residents to 80. Am J Health Syst Pharm. 2005;62:1592-1595.
59. National Highway Traffic Safety Administration. Traffic safety facts 1999: a compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system. Washington, DC: US Department of Transportation-National Center for Statistics and Analysis; 2000.
60. National Sleep Foundation. Executive summary of the 2002 "Sleep in America" poll. Washington, DC: National Sleep Foundation 4-2-2002; 2002: WB&A Market Research 1-43.
61. Naylor RA, Rege RV, Valentine RJ. Do resident duty hour restrictions reduce technical complications of emergency laparoscopic cholecystectomy? J Am Coll Surg. 2005;201:724-731.
62. O'Malley PG, Khandekar JD, Phillips RA. Residency training in the modern era: the pipe dream of less time to learn more, care better, and be more professional. Arch Intern Med. 2005;165:2561-2562.
63. Parks DK, Yetman RJ, McNeese MC, Burau K, Smolensky MH. Day-night pattern in accidental exposures to blood-borne pathogens among medical students and residents. Chronobiol Int. 2000;17:61-70.
64. Pellegrini VD Jr, Peabody T, Dinges DF, Moody J, Fabri PJ. Symposium resident work-hour guidelines. A sentence or an opportunity for orthopaedic education? J Bone Joint Surg Am. 2005;87:2576-2586.
65. Philibert I. Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep. 2005;28:1392-1402.
66. Poulose BK, Ray WA, Arbogast PG, Needleman J, Buerhaus PI, Griffin MR, Abumrad NN, Beauchamp RD, Holzman MD. Resident work hour limits and patient safety. Ann Surg. 2005;241:847-856.
67. Rajaratnam SM, Middleton B, Stone BM, Arendt J, Dijk DJ. Melatonin advances the circadian timing of EEG sleep and directly facilitates sleep without altering its duration in extended sleep opportunities in humans. J Physiol. 2004;561:339-351.
68. Reiner SC. The impact of the new code regulations on postgraduate medical education in New York State. N Y State J Med. 1989;89:457-461.
69. Reiter ER, Wong DR. Impact of duty hour limits on resident training in otolaryngology. Laryngoscope. 2005;115:773-779.
70. Reuben DB. Depressive symptoms in medical house officers. Arch Intern Med. 1985;145:286-288.
71. Ribak J, Ashkenazi IE, Klepfish A, Avgar D, Tall J, Kallner B, Noyman Y. Diurnal rhythmicity and air force flight accidents due to pilot error. Aviat Space Environ Med. 1983;54:1096-1099.
72. Richardson GS, Wyatt JK, Sullivan JP, Orav E, Ward A, Wolf MA, Czeisler CA. Objective assessment of sleep and alertness in medical house-staff and the impact of protected time for sleep. Sleep. 1996;19:718-726.
73. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006;81:82-85.
74. Spiegel K, Knutson K, Leproult R, Tasali E, Van Cauter E. Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol. 2005;99:2008-2019.
75. Steele MT, Ma OJ, Watson WA. Thomas HAJr, Muelleman RL. The occupational risk of motor vehicle collisions for emergency medicine residents. Acad Emerg Med. 1999;6:1050-1053.
76. Stickgold R. Sleep-dependent memory consolidation. Nature. 2005;437:1272-1278.
77. van Dongen HPA, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26:117-126.
78. Van Eaton EG, Horvath KD, Pellegrini CA. Professionalism and the shift mentality: how to reconcile patient ownership with limited work hours. Arch Surg. 2005;140:230-235.
79. Veasey S, Rosen R, Barzansky B, Rosen I, Owens J. Sleep loss and fatigue in residencey training. A Reappraisal. JAMA. 2002;288:1116-1124.
80. Vidyarthi AR, Katz PP, Wall SD, Wachter RM, Auerbach AD. Impact of reduced duty hours on residents' educational satisfaction at the University of California, San Francisco. Acad Med. 2006;81:76-81.
81. Wagner U, Gais S, Haider H, Verleger R, Born J. Sleep inspires insight. Nature. 2004;427:352-355.
82. Walker MP, Brakefield T, Morgan A, Hobson JA, Stickgold R. Practice with sleep makes perfect: Sleep-dependent motor skill learning. Neuron. 2002;35:205-211.
83. Walker MP, Stickgold R. Sleep-dependent learning and memory consolidation. Neuron. 2004;44:121-133.
84. Watson JC. Impact of the ACGME work hour requirements: a neurology resident and program director survey. Neurology. 2005;64:E11-E15.
85. Wehr TA, Moul DE, Barbato G, Giesen HA, Seidel JA, Barker C, Bender C. Conservation of photoperiod-responsive mechanisms in humans. Am J Physiol. 1993;265:R846-R857.
86. White CB, Haftel HM, Purkiss JA, Schigelone AS, Hammoud MM. Multidimensional effects of the 80-hour work week at the University of Michigan Medical School. Acad Med. 2006;81:57-62.
87. Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991;265:2089-2094.
88. Zonia SC, LaBaere RJ, Stommel M, Tomaszewski DD. Resident attitudes regarding the impact of the 80-duty-hours work standards. J Am Osteopath Assoc. 2005;105:307-313.