Medical Residents Need Enhanced Training, Shorter Work Hours

Medical residents should receive expanded training as part of an effort to make America’s healthcare more effective.  Dr. Jay Crosson, senior medical director of the Permanente Foundation at Kaiser Permanente, who served on the Medicare Payment Advisory Commission, announced the initiative.  According to Crosson, medical residents will now receive additional training in office-based care competencies, care coordination, continuity of care; leadership and management skills; providing analysis by identifying needs and priorities; increasing the number of primary-care providers; investing in top-quality training; and placing physicians in under-served areas.  “Which of these can we expect from residency programs, and what is naturally on-the-job training?” Crosson asked.

The advanced training could be funded in part by $320 million in grants authorized by the Patient Protection and Affordable Care Act.  Department of Health and Human Services Secretary Kathleen Sebelius said “Investing in our primary-care workforce will strengthen the role that wellness and prevention play in our healthcare system.  With these grants, Americans from all backgrounds will have new opportunities to enter the healthcare workforce.”  Mary K. Wakefield, Ph.D, R.N. and administrator of the Health Resources and Services Administration (HRSA) says “These grants will provide much-needed support for increasing primary-care capacity by expanding training programs for primary-care providers, vital to our future healthcare workforce.”

In another move that will impact their training, medical residents now work slightly shorter shifts and have tighter supervision in a bid to improve quality. According to Kaiser Health News, “The Accreditation Council for Graduate Medical Education’s (ACGME) board of directors approved new rules for more than 110,000 new physicians being trained at American hospitals.  The goal is to improve patient safety and reduce medical errors caused by junior doctors working extremely long hours.”  Doctors in their first year of residency will be limited to 16 consecutive hours of work with “strategic napping.  The maximum shift length remains 24 hours for residents in their second year of training and beyond.  Also, medical residents are to tell patients they’re being supervised by more experienced physicians, and the hierarchy should be spelled out to patients,” according to the revised rules.

“My body is not made to work 30 hours or more,” said Dan Henderson, a third-year medical student at the University of Connecticut. “If I’m truly going to do no harm as I pledged, I need a system to protect patients against errors caused by my fatigue.”

“Resident physicians working 30-hour shifts make 36 percent more medical errors caring for women in the intensive care unit…including 460 percent more serious diagnostic mistakes than those scheduled to work for 16 hours,” said Chuck Czeisler, M.D., of Harvard and Brigham and Women’s Hospital.  “They are also 73 percent more likely to stab themselves with a scalpel or needle.”

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