The Evolving Educational Challenge: Balancing Patient Numbers, Conference Attendance, Sleep, and Resident Wellness

Abstract

The Accreditation Council on Graduate Medical Education (ACMGE) 2011 guidelines for resident physicians specifically limited interns to 16-hour shifts and forced a paradigm switch from traditional overnight call.1 In “Shift Schedules and Intern Work Hours, Patient Numbers, Conference Attendance, and Sleep at a Single Pediatric Residency Program,”2 we prospectively compared intern work hours, patient numbers, conference attendance, sleep duration, pattern, and quality in 2003 and 2011 ACGME duty hour compliant call schedules at a single pediatric residency program. We concluded that a shift schedule reduced intern work hours and improved sleep duration and pattern. Although intern didactic conference attendance declined significantly during high census months, opportunities for experiential learning in a shift schedule remained robust with unchanged or increased intern patient numbers. Since the publication of our study, the ACGME has removed the 16-hour intern work hour limit, but still requires a maximum 80-hour work week and limits consecutive time on-task to 24 hours, plus 4 hours to transition care.1 Educators aim to provide the best clinical education for residents, while meeting requirements. In this progress report, we consider our study's findings in light of what has been published since October 2016 and discuss innovative scheduling, didactic and experiential resident education, resident sleep, and wellness and areas for future work.