Residency Training in the Modern Era:  The Pipe Dream of Less Time to Learn More, Care Better, and Be More Professional

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