About the Discussion

Revisiting Flexible Duty Hours

Since implementing the 80-hour weekly limit in 1989, the Accreditation Council for Graduate Medical Education (ACGME) has created iterations of work-hour restrictions, culminating in the 2011 rules that capped intern and resident in-hospital time to 16 and 24 hours, respectively, with mandatory time off after call. At the time, the evidence supporting this change was weak. In 2016, NEJM published the results of the FIRST trial, which cluster-randomized 117 general surgery residencies to the 2011 rules or a more flexible policy that waived caps on shift lengths and minimal time off between shifts (80-hour weekly limit remained). The results showed no difference in patient outcomes and neutral resident perception of overall quality of education and wellbeing. Subsequently, the ACGME removed the 16-hour limit for interns to minimize disruptions to patient care. In March 2018, NEJM published the highly anticipated results of the iCOMPARE trial, which now compared standard and flexible rules in 63 internal medicine programs. Please join us with the study’s authors for a discussion of the details of the trial and the future of resident work-hour restrictions.