Resident Duty Hours: A Review

Residents are physicians undertaking further training to become independently licensed practitioners. Historically, resident duty hour periods were long and intense. The goal was to maximize learning through high patient volume and to teach doctors how to take responsibility. Recently, concerns over patient and resident safety have led to restricted trainee work hours. The putative justification is to improve resident education, resident well-being, and patient care. In light of this recent shift in the medical culture, resident duty hours have become a controversial topic. Restricted duty hours take many forms. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) mandated junior residents work no longer than 16 consecutive hours, while senior residents could work up to 26 hours.1 In Canada, no nationwide mandate exists and the issue falls within provincial jurisdiction. In Ontario, under the Professional Association of Residents of Ontario agreement, call-periods are no more than 26 consecutive hours in-house, no more than one in four nights in-house, or no more than one in three nights of home-call. After a 2011 Quebec court ruling, resident duty hours were restricted to 16 consecutive hours in that province. This resulted from the court concluding that traditional hours violate the Canadian Charter of Rights and Freedoms. Regardless, the Quebec ruling prompted other Canadian programs to further reduce resident duty hours and consecutive hours on-call. To better understand this complex issue, the following review discusses resident safety, resident performance, resident education, and patient safety. Our goal is to present a balanced, evidence-based discussion, addressing both patient safety and resident fatigue management.