study in the September 10 issue of JAMA, a theme issue on medical
education, says that medical interns who experience an increase in their
on-call workload are more likely to get less sleep while on call, have longer
shift durations and participate less in educational activities.
2003, the Accreditation Council for Graduate Medical Education (ACGME)
restricted resident duty hours in an attempt to reduce resident fatigue and the
likelihood of fatigue-related errors that could harm patients. Further
restrictions in resident duty hours are being considered. "Yet, little
attention has focused on the risks associated with work intensification.
Further limitations on duty hours without any attempt to address work
intensification may result in residents doing the same amount of work in less
time, which could undermine resident welfare and patient safety," the authors
M. Arora, M.D., M.A., of the University of Chicago, and colleagues examined
whether increased on-call intern workload, as measured by the number of new
admissions on-call and the number of previously admitted patients remaining on
the service, was associated with reductions in on-call sleep, increased total
shift duration, and lower likelihood of participation in educational activities
(such as lectures or bedside teaching). The study, conducted from July 2003
through June 2005, included 56 medical interns observed during 1,100 call
researchers found that average sleep duration on-call was 2.8 hours and that
average shift duration was 29.9 hours. Approximately 30 percent of shifts were
deemed noncompliant with duty hours (greater than 30.5 hours). Analysis
indicated that each new on-call admission early in the academic year was
associated with less sleep (-10.5 minutes). A significant association between
admission workload and shift duration also was observed. For each new on-call
admission early in the academic year, shift duration increased by 13.2 minutes.
Call nights during the week and early in the academic year were associated with
the most sleep loss and longest shift durations.
higher number of previously admitted patients remaining on the service was
associated with a lower odds of participation in educational activities.
Interns reported spending 11 percent of their time in educational activities.
findings raise concerns about the possibility of future duty-hour restrictions
in the absence of corresponding limits on workload," the authors write. "Our
study highlights the importance of considering reductions in on-call admissions
as a strategy to alleviate sleep deprivation and ensure compliance with duty
hours for interns early in the academic year in a traditional extended-duty