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When the new rules limited the hours of resident medical training to 80 hours per week in 2003, critics feared that the change would leave doctors in training unprepared for the challenges of independent practice.
Now, new research published on July 11 in BMJ and led by scientists from the health policy department of the Blavatnik Institute of Harvard Medical School, shows that these dire warnings were largely unjustified.
The badysis, considered the first national study on the impact of reducing the number of hours on physician performance, did not highlight any evidence that reducing the number of Hours of training had an impact on the quality of care provided by the new doctors.
As a result of a series of injuries and deaths of high-profile patients believed to result from clinical errors caused by fatigue, medical accreditation agencies have initiated a series of drastic changes to the regulations governing the hours of residence and other aspects of the training. These efforts culminated in 2003 with the US Accreditation Council for Graduate Medical Education, which limited the training of resident physicians to 80 hours per week.
"This is probably the most debated topic in medical education for physicians," said Anupam Jena, HMS Ruth L. Newhouse Associate Professor of Health Policy at Blavatnik Institute, MD, Mbadachusetts General Medical Department. Hospital and author of the study. "Many doctors trained under the old system believe that today's residents are not sufficiently trained under the new system.Many experienced doctors examine young doctors who leave their training and say: "They are not as prepared as us. were & # 39;. "
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 physicians who completed residency before and after the reform of the hospital. time of residence.
"We have found no evidence that the care provided by 80-hour trained doctors is suboptimal," said Jena.
Given the evolution of hospital care over the past decade, researchers have realized that they could not compare the difference between the results obtained by newly trained physicians before and after the ceiling because the Overall results have improved thanks to better diagnoses and treatments, better coordination of treatments. care and new digital tools designed to prevent harmful drug interactions and other human errors.
Comparing new physicians trained before reform to those trained after would confuse the effect of changes in training with the effect of overall changes in hospital care. To avoid confusing the two, the researchers compared new physicians before and after the reforms with experienced physicians trained before the reform.
The study badyzed 485,685 hospitalizations of Medicare patients before and after the reform.
Training hour reforms were not badociated with statistically significant differences in outcomes for patients 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 a grade 10 physician was 11.2% (11,018 / 98,811) and 10.6% (13,602 / 12,8331) for the same patients. 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 in hospital readmission rates was also tiny: 20.4% for first-year patients in 2000-2006 and 2007-2012, compared with 20.1% and 20.5%, respectively. , respectively, in patients treated by experienced physicians.
Overall, these findings suggest that US time-of-residence reforms 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, and 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."
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