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The 80 hour work week was a result of the Libby Zion case, but the 16 hour shifts for interns was a result of the IOM report based on a small study of 40 interns in the ICU (Lockley SW, Cronin JW, Evans EE, et al., Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures. NEJM 2004 351:1829-37 & Landrigan CP, Rothschild JM, Cronin JW et al., Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units. NEJM 2004 35:1838-48). In this study that started the 16-hour shift craze, the interns in the "16 hour group" worked only 65 hours per week, compared to 85 hours per week in the q3 call group. Given the fact that the FIRST trial failed to show a benefit in terms of patient outcomes in the 16 hour group, and the iCOMPARE trial showed no resident-felt benefit to patient safety with either group, what do you think matters more: how we slice the 80-hour pie? or how many hours are in the pie to begin with, and why?