Surgical residents are those who have finished medical school and are training for five to seven years to become a general surgeon.
Northwestern University reported a national study, led by Northwestern Medicine, that showed surgical residents with flexibility to work longer hours, to stay with their patients until an operation ends or the patient stabilized, did not pose greater patient risks.
The FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial is the first national randomized trial of resident duty hour policies. The American Board of Surgery and the American College of Surgeons funded the FIRST Trial.
The study, published in the New England Journal of Medicine, and presented at the Academic Surgical Congress on February 2, 2016, indicated that when physicians pass their patients to other doctors, there is danger from the loss of critical information, a break in the physician-patient relationship, and patients’ safety.
The Institute of Medicine requested national trials to be performed in its 2008 report, and the FIRST Trial is the first. The study discovered surgical residents reported no worsening in overall well-being and personal safety when they worked longer hours. Flexible duty hours are safe for patients and beneficial for residents.
Before the FIRST trial, smaller studies suggested there may be worse surgical patient outcomes after the duty hour limits were established in 2003. As a result of the small studies, duty hour policies were implemented in 2003 to address concerns unsafe care and residents’ well-being.
The 2003 duty limits limited residents’ work hours to 80 per week, capped shifts to 28 consecutive hours and mandated minimum time off between shifts. The shift length for interns (first-year residents) was limited to 16 consecutive hours and their minimum time off increased after a 24-hour shift.
Two 2004 studies, by the National Institute for Occupational Safety and Health and the Agency for Healthcare Research, addressed surgical interns’ hours and medical errors. In one study, published in October 28, 2004, the rate of serious medical errors committed by first-year doctors in training in two intensive care units at a Boston hospital fell when traditional 30-hour-in-a-row extended work shifts were eliminated and when interns’ continuous work schedule was limited to 16 hours. In the other study, published in the New England Journal of Medicine, interns made 36 percent more serious medical errors on the traditional 30-hours-in-a-row schedule than on the schedule that limited scheduled work shifts to 16 hours and reduced scheduled weekly work from approximately 80 hours to 63.
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