Council on Medical Student Education in Pediatrics


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Shorter medical resident duty hours may not be the answer
Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: A randomized trial. Parshuram CS et al.  CMAJ 2015;187: 321-329.

Reviewed by Giuseppe Latino

What was the study question?
What are the effects of resident schedules in the intensive care unit (ICU) on patient safety, resident well-being, and continuity of care?

How was the study done?

This was a blinded randomized control trial of resident schedules in 2 academic medical-surgical ICUs in Toronto. Residents were assigned to in-house overnight schedules of 12, 16, and 24 hours in 2-month rotation-blocks.  The primary resident outcome was sleepiness, measured using the validated scale.  Secondary resident outcomes included somatic symptoms and burnout. The primary patient outcome was adverse events, defined as any unplanned injury resulting from medical care in the ICU that was associated with morbidity, required treatment, prolonged hospital stay, or resulted in disability at discharge. Secondary patient outcomes included preventable adverse events, death in the ICU, and severity of adverse events. Continuity of care and ICU staff perceptions of residents were assessed using surveys at the end of each ICU block.

What were the results?

The study found no effect of schedule on adverse events or on residents’ sleepiness. Seven of 8 preventable adverse events occurred with the 12-hour schedule and mortality rates were similar across the 3 schedules. Residents’ somatic symptoms were more severe and frequent with the 24-hour schedule, though burnout was similar across the groups. ICU staff reported that residents working the 16-hour schedule were less familiar with their patients and made suboptimal decisions more frequently. Residents working the 12-hour schedule were judged most alert overnight.

What are the implications?
No differences were found between 3 commonly used resident duty schedules in terms of adverse event rates and residents’ sleepiness and burnout. This study does not support the purported advantages of shorter duty hours.  Additional studies are needed to determine if these conclusions are relevant to pediatric centers, as well as undergraduate medical education.   

Editor’s note:  This study makes one wonder what other things we can do to enhance trainee well-being and patient care – this study suggests that shorter duty hours alone are not the way to improve both of these outcomes (SLB).

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