Residents are doctors in training – recent medical school graduates who famously work long hours training towards their specialties. For many years, residents were required to work 100 hours a week. To many of us (not currently in a trial) a work week that long is nearly unfathomable. The reality is that residents need intensive training to gain exposure to the full breadth of their specialties before they can enter unsupervised practice. For a long time, the accepted thinking was that this meant 100 hour work weeks with 30+ hour shifts.

Reforms by the Accreditation Council for Graduate Medical Education (ACGME) to reduce the long hours of residents, begun nationally around 2003 (but with roots running twenty years earlier) started by capping a work week at 80 hours, with no individual shift running longer than 30 hours. The reforms were implemented in part to address resident errors due to fatigue. A measurable amount of opposition to the reforms, though, was based in concern about whether these doctors were receiving enough training in their residency. In effect, there was concern that newly minted doctors committed errors due to insufficient training. However, a recent study by the BMJ reveals that at large part of that concern has not been met.

The study compared outcomes of patients of doctors trained before the 2003 residency reforms, against those who trained after the 2003 reforms. For the metrics measured – thirty day mortality, thirty day readmission, and inpatient spending – the researchers found no statistically significant difference. Notably, the study focused on internal medicine doctors. Surgeons, for example, may be affected differently because the work restrictions may limit the amount of supervised procedures they perform.
The study was also limited in that it did not evaluate why there was no statistical difference; that is for future researchers to determine. The results of this study, nevertheless, are an important step towards further refining the residency program so that it balances the considerations of extensive, intensive instruction, against the health and fatigue of residents.

Read the report here:

[Association of residency work hour reform with long term quality and costs of care of US physicians: observational study](https://www.bmj.com/content/366/bmj.l4134)