A nationwide experiment conducted on fatigued, young surgeons found that their tired conditions do not affect patient safety according to a Business Insider report. “This is the first time we have randomized trial data on this controversial topic,” said study leader Dr. Karl Bilimoria. “You would think for such a hot-button issue we would have had randomized trial data, which is sort of the gold standard for research, years ago.”
Due to public concern over the long working conditions of surgeons, the Accreditation Council for Graduate Medical Education (ACGME) rolled-out studies in 2011 of first year residents of hours up to 16 hours and capped the senior staff at 28 hours. These stipulations were applied to medical trainees comprehensively in all fields, not just surgery based on 2003 regulations that limited workers to 80 hours.
Critics thought the long hours affected work performance and the quality of education especially during dangerous surgeries or when patients rely on them most. The trial arbitrarily assigned 117 general surgery resident programs to follow the regulations for one year, from July 2014 to June 2015, or abide by flexible shift lengths, as long as the total number hours didn’t’ exceed the enforced limit.
“The 80-hour workweek was still in place,” said Bilimoria, of the Northwestern University Feinberg School of Medicine in Chicago. Results concluded that nearly 9 percent of patients died or experience an urgent medical problem within 30 days after surgery regardless of following the mandate.
And residents at more lenient programs were found to leave in the middle of surgery half the amount of time, miss a surgery deadline or fob the patient off to another doctor. Residents in both programs were satisfied by their quality of education, but they didn’t like not being able to spend more time with loved ones.
ACGME oversees resident programs in the U.S., and they will consider the findings as an ongoing analysis, said Emily Vasiliou, the organization’s communication manager.”We want to leave the 80-hour workweek in place and some of the other protections, like one day off in seven and (being on-call) no more frequently than every third day,” Bilimoria added.
However, Dr.Michael Carome, of Public Citizen in Washington, D.C. voiced bias in the study to reach predisposed conclusions to Reuters Health. For instance, he said, former research indicated that residents would often flaunt ACGME’s directive, which would minimize the differences between the two control groups. In addition, he feels that the hours would had the most impact on first year residents while more senior staff are indisposed with patient care.”For all these reasons and others, the reported findings of no difference in patient deaths is unsurprising and uninformative,” said Carome.
Carome also added that the trial didn’t test whether the shift mandate protected the residents’ health themselves because the testing didn’t monitor details that would result in fatigue, such as workplace or car accidents, which were found to be side effects of working long shifts.
However, Public Citizen and the American Medical Student Association said the testing was unethical by potentially exposing patients and residents to increased harm (See Reuters Health story of Dec. 30, 2015 here: http://reut.rs/1JVnLnm.). But The Resident and Associate Society of the American College of Surgeons applauded the conclusions. “Based on the trial’s results, the RAS-ACS firmly believes that flexibility in duty hours is not only safely possible, it is essential to provide surgical residents with exposure to the variety and complexity of educational experiences necessary to become fully trained and competent surgeons,” the statement said.