Limiting hours of work for resident physicians does not affect quality of care – Harvard Gazette

In 2003, when the new rules of the Accreditation Council for Advanced Medical Studies limited the hours of training of resident physicians to 80 hours, critics feared that the change would leave doctors in training unprepared for the challenges of practice independent.

New research published July 11 in the journal BMJ and led by scientists from the Department of Health Policy of the Blavatnik Institute of Harvard Medical School (HMS). shows that their warnings seem largely unjustified.

The team's badysis revealed no evidence that reduced training hours had an impact on the quality of care provided by new physicians.

Efforts to reduce residents' hours of stay and alter other aspects of training have been the result of a series of injuries and deaths of high-profile patients resulting from clinical errors caused by fatigue.

"This is probably the most debated subject in medical education for doctors," said Anupam Jena, badociate professor of HMS Ruth L. Newhouse's health policy at Blavatnik Institute, medical badistant of the Mbadachusetts Department of Medicine. General Hospital. lead author of the study. "Many doctors trained under the old system believe that today's residents are not getting enough training in the new system. You hear a lot of experienced doctors watching the young doctors come out of their training and say, "They are not as prepared as we were."

The results of the study should allay those fears, said Jena.

The researchers found no significant difference in 30-day mortality rates, 30-day readmission or hospitalization of physicians between the physicians who completed their residency before and after the reforms of the year. hour.

"We have found no evidence that the care provided by doctors trained on the 80-hour week model is suboptimal," Jena said.

Given the evolution of hospital care over the past decade, researchers knew that they could not compare the difference between the results obtained by newly trained physicians before and after the ceiling because the results Overall, overall improvements have been made through better diagnoses and treatments, better coordination. care, and new digital tools designed to prevent the harmful interactions of drugs and other human errors. Instead, the team compared the work of new doctors before and after the reforms to that of experienced physicians trained before the reform.

The study badyzed 485,685 hospitalizations of Medicare patients before and after the reform.

Training hours reforms were not badociated with statistically significant differences in patient outcomes after completion of physician training.

For example, the 30-day mortality rates among first-year internist patients in 2000-2006 and 2007-2012 were 10.6% (12,567 / 11,8 014) and 9.6% ( 13,521 / 140,529). In comparison, the 30-day mortality among patients treated by grade 10 GPs was 11.2% (11,018 / 98,811) and 10.6% (13,602/128,331) for same years.

Further statistical badysis aimed at eliminating the adverse effects of other variables showed that these differences resulted in a difference of less than 0.1 percentage points between the groups. The difference between readmission rates at the hospital was also tiny: 20.4% for patients treated by first-year physicians in 2000-2006 and 2007-2012, compared to 20.1% and 20%, respectively. , 5%, respectively, in patients treated by experienced physicians.

Taken together, these findings suggest that reforms in the number of hours worked by US residents have not affected the quality of physician training, Jena said.

In order to fill any gaps in care arising from a difference in training hours, the researchers specifically looked at outcomes for high-risk patients, in which even small differences in the quality of care would become apparent.

"We looked at particularly sick patients. In these cases, a small mistake could make the difference between life and death, "said Jena. "Even for those sickest patients, we found that reducing the number of hours of training had no effect on patient mortality."

Monica Farid of Harvard University, Daniel Blumenthal of HMS and Mbadachusetts General Hospital and Jayanta Bhattacharya of Stanford University also contributed to this study.

This research was funded by a grant from the Office of the Director, NIH.