Restricting Medical Resident Work Hours Does Not Affect Average Sleep Time

Institute of Medicine (IOM) guidelines restricting the number of hours medical residents can work may not result in the intended consequences of enhancing sleep and patient safety.

The first study of these 2008 guidelines shows that average sleep time is unaffected and that work-life balance actually worsens.

The Cincinnati Children’s Hospital Medical Center study was presented at 4 p.m. ET Saturday, May 1, at the annual meeting of the Pediatric Academic Societies in Vancouver, Canada.

"Proposed IOM recommendations had no significant effect on average sleep time during any 24 hour period," says Katherine Auger, MD, a physician at Cincinnati Children’s and the study’s main author. "The pattern of sleep, however, did change. Residents had more frequent blocks of consecutive sleep, which may potentially improve fatigue and safety. On the other hand, work-life balance worsened, which may be due to an unanticipated increase in work load intensity." Auger is also an instructor at the University of Cincinnati College of Medicine.

The 2008 IOM report proposed revisions to residents’ duty hours and an increase in their supervision to reduce the chances of fatigue-related medical errors and to enhance the learning environment for doctors in training.

Auger and her colleagues studied first-year residents (interns) on general pediatric inpatient teams at a large children’s hospital over a one-month period. Some of the interns worked a schedule that complied with the 2008 IOM guidelines, including a maximum shift of 12 hours, at least 24 hours off every seven days, and no more than three consecutive night shifts. Other interns worked a 30-hour call schedule every fourth night. All kept sleep logs.

In the pre-IOM group, 67 percent of the interns indicated their work-life balance as good, very good, or excellent, compared to 20 percent in the IOM group. Also, 40 percent of those in the pre-IOM group rated their daily workload intensity as very low, low or neutral, compared to 0 percent of the IOM group.

"Given the contradiction in work-life balance, further work is needed to determine whether and how much increased staffing will prevent detrimental work-load intensity from undermining potential benefits to well-being and less fatigue," says Auger.

Complete survey results are as follows: