The Effect of Reducing Maximum Shift Lengths to 16 Hours on Internal Medicine Interns’ Educational Opportunities

Abstract

Purpose To evaluate educational experiences of internal medicine interns before and after maximum shift lengths were decreased from 30 hours to 16 hours. Method The authors compared educational experiences of internal medicine interns at Vanderbilt University Medical Center before (2010, 47 interns) and after (2011, 50 interns) duty hour restrictions were implemented in July 2011. The authors compared number of inpatient encounters, breadth of concepts in notes, exposure to five common presenting problems, procedural experience, and attendance at teaching conferences. Results Following the duty hour restrictions, interns cared for more unique patients (mean 118 versus 140 patients per intern, P = .005) and wrote more history and physicals (mean 73 versus 88, P = .005). Documentation included more total concepts after the 16-hour maximum shift implementation, with a 14% increase for history and physicals (338 versus 387, P < .001) and a 10% increase for progress notes (316 versus 349, P < .001). There was no difference in the median number of selected procedures performed (6 versus 6, P = .94). Attendance was higher at the weekly chief resident conference (60% versus 68% of expected attendees, P < .001) but unchanged at morning report conferences (79% versus 78%, P = .49). Conclusions Intern clinical exposure did not decrease after implementation of the 16-hour shift length restriction. In fact, interns saw more patients, produced more detailed notes, and attended more conferences following duty hour restrictions.

The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review

“…There were 27 studies included in the final review: 13 (48%) reviewed shift length, [23][24][25][26][27][28][29][30][31][32][33][34][35] 12 (44%) examined Across all of the studies and interventions, the impact of duty hour restrictions most frequently had no impact on patient care (5 of 10, 50%), 23,24,28,41,48 no impact on resident well-being (7 of 17, 41%), 27,34,35,41,44,46,49 and an unfavorable impact on resident education (9 of 14, 64%). 29,30,[33][34][35][36]41,43,46 A minority of studies found a favorable impact on resident well-being (4 of 17, 24%; TABLE 2).…”

“…[23][24][25][26][27][28][29][30][31][32][33][34][35] The length of shifts that were studied ranged from 13 to 36 hours. The populations of interest, and subsequently the study outcomes, were not consistent across all of the studies.…”

Effect of a Handover Tool on Efficiency of Care and Mortality for Interhospital Transfers

“…This was chosen because a significant restructuring of resident duty hours occurred in spring 2011 that had the potential to affect all measures studied. 20,21 Finally, we did not collect data on accuracy of the information provided in the handover tool or end-user utilization and were unable to account for effects of these.…”

Implementation of 2011 Duty Hours Regulations through a Workload Reduction Strategy and Impact on Residency Training

“…Our results are similar to other studies in that reducing census or admitting caps did not substantially change total patient encounters. 23,26 The restructuring changes increased the exposure of residents to an increased number of outpatients, which some educators have made strong arguments in favor of instituting. 27,28 It is important to note that the inpatient WLR approach, by necessitating shifts in overall scheduling, increased patient encounters across a spectrum of care settings (inpatient and ambulatory).…”