Anyone who teaches and learns internal medicine understands the many challenges faced in accomplishing the enormous agenda required to mold a trainee into an independent practitioner capable of comforting and healing effectively. Perhaps the most recent salient challenge is that imposed by the new Residency Review Committee work-hour restrictions. That is, in the midst of an ever increasingly complex knowledge base and system of care with ever increasing pressures on accountability for both safety and performance, there is now less time to accomplish these burgeoning goals. The 80–hour per week and the 30–hour per shift work-hour restrictions are not based on strong evidence that they will result in better learner- and patient-centered outcomes. They are based on observational data that work hours correlate with medical errors,1,2 a few highly publicized medical malpractice cases implicating work hours as a root cause, and the general face validity for the concept that tired physicians are less effective learners and practitioners of medicine. Some research indicates that the work-hour restrictions decreased serious medical errors in intensive care units and improved sleep and attentional failure rates among trainees.3,4 However, it is still largely unclear what impact this policy is having on the various affected parties (patients, residents, and teachers), and the possibility of unintended consequences is always present even with the best intentions.5
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 6
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.