Charles P. Clayton
At the start of a national dialogue on duty hours, representatives of the Alliance for Academic Internal Medicine (AAIM) urged an Accreditation Council for Graduate Medical Education (ACGME) task force to weigh the following factors in its decision making about new duty hour regulations: the need to develop professionalism, including the ownership of patients, in residents and fellows; the need to maintain faculty as role models and educational leaders; the importance of modeling the duty hour changes within complex care systems before mandating changes; and the need to develop more specific evidence in support of duty hour changes before implementing them.
Speaking on behalf of AAIM and its constituent organizations, David E. Steward, MD, President of the Association of Professors of Medicine, Donald R. Bordley, MD, President of the Association of Program Directors in Internal Medicine, and Linda R. Burns, MD, President of the Association of Specialty Professors, further asked the ACGME task force to provide flexibility at the specialty and individual interaction levels so duty hours reflect the unique needs of medical, surgical, and hospital-based specialties. These leaders also called on ACGME to provide enough flexibility in the requirements and their enforcement so teaching and learning moments, which are not conveniently aligned with schedules for residents and fellows, can be optimized, whether that be in seeing a patient through the last hours of life or in meeting with family to discuss treatment options.
The testimony was provided as part of the ACGME Duty Hours Congress that the accreditation organization convened to engage the educational community in a dialogue about updating duty hour standards. While the Institute of Medicine report on duty hours was one source of input to the task force, ACGME convened the congress as part of its commitment to the community to review duty hour requirements after the fifth anniversary of implementation of common duty hour standards to all residencies and fellowships.
The AAIM testimony to ACGME extended the alliance’s position on duty hour regulation as relayed to the accrediting organization in a letter in early May.
Representatives of the American College of Physicians and Association of Pulmonary and Critical Care Medicine Program Directors also presented testimony at the congress.
In response to the testimony, members of the task force asked questions regarding resident supervision, the current models for progressive responsibility in residencies, and mechanisms for instilling a sense of ownership of patients. Task force members also posed questions about whether caps on inpatients cared for are well received in internal medicine and whether sick patients really want their normal physician, even if fatigued, over a well-rested physician.
After presentations from internal medicine, ACGME heard presentations from representatives of other specialties as well as groups of residents and national organizations involved in graduate medical education. The duty hours congress will conclude Friday, June 12, 2009, after press time. An AAIM summary of the congress will be available at the end of June.