Showing papers by "Stanley G. Rockson published in 2004"

Benefits of Resident Work Hours Regulation

Abstract: The new regulations for resident work hours are part of a long evolutionary process of change in medical education, representing the most dramatic innovation in recent history to calibrate the work hours for residents. Implementing the requirements has not been easy. Most institutions and departments have experienced serious challenges (1–3). Moreover, many educators are concerned that by focusing on a maximum number of work hours and a “deadline” for leaving the hospital, the regulations threaten both the educational process and the meaning of professional responsibility. Despite these current challenges, we highlight several positive effects of the new regulations. This is not to say that our own initial experience has been universally positive. We have, like others, been challenged to ensure continuity and quality of patient care, protect valued educational experiences, and continue to emphasize collegiality and teamwork. Although data that validate the positive outcomes are scarce, we believe that the changes have had and will continue to have positive effects (Table). SHORT- AND LONG-TERM BENEFITS FOR THE PUBLIC A primary driver in the institution of resident work hour limitations was to improve patient care in training institutions. Such care must include human sensitivity by and for providers, as well as system effectiveness for patients. Fortunately, the regulations are occurring simultaneously with greater attention to system function, assessment of care, and a commitment to improved care. It has become apparent that improved system function with less frequent errors will require more than restricted hours. Evaluation of the effect of New York’s restricting housestaff working hours suggested an increase in delays of test ordering and in complications (4). Other data indicate that increased shift work to accomplish the restrictions may increase errors, possibly as a side effect of more frequent handoffs and cross-coverage of patients (5). Other results show that for the public to experience desired positive effects, the regulations must be coupled with more extensive system revision (6). Thus, in the short term, the regulations should provide patients with providers who are more rested; in the long term, the system analysis brought about by the regulations should provide patients with an improved system of care, going beyond the limitation of physician hours. BENEFITS FOR THE TRAINEE