Joseph Scherger, MD, MPH
Throughout my career, I have been in favor of restrictions on resident work hours. After watching how surgery residents worked in the 1970s, I wanted none
of that “prison sentence.” After choosing family medicine, I found a program with “civilized” work hours. I do not think much learning happens after working 80 hours in a week, and patients do get harmed by residents who are too fatigued to care or use good judgment.
I embraced the 2003 ACGME resident work hour restrictions since they had flexibility but limited the on-duty time to 80 hours a week and guaranteed some days off each month. Residents could still sit with patients who were going through a long labor and delivery process or who were in end-of-life care. These long experiences are some of the most memorable for residents and do not occur too often to cause chronic fatigue. They showed the resident how well they can work under occasional extreme circumstances, a skill that would be valuable in a crisis.
The 2011 ACGME work hour restrictions are much more specific and prohibit the time for any “work shift.” First-year residents may no longer work on any given day more than 16 hours. That means that if the resident is with a woman in labor or at the bedside of a critically ill patient they must end their work and turn the care over to another resident. Second- and third-year residents must do the same after 24 hours and must be able to have a “strategic nap” after 16 hours. Is this the continuity of care of a family physician? No family physician in practice would ever consider such an abandonment of their patient! This is how emergency room physicians work, and I wonder if these new work restrictions will transform family medicine into shift workers.
There is evidence that we become less effective in our clinical judgment after 12 hours of continuous work and certainly after 16 hours. With that being so, we should train for teamwork where another physician joins us in the care of the patients after we become less effective. That would reinforce that we are not superman and should ask for help but would not take us away from the very situations where we may be doing the most good and are having a great learning experience.
I hope our leaders in the ACGME will make an effort to revise the resident work restrictions again to allow for both continuity of care and teamwork, so we can balance both clinical experience and patient safety.
Stacy Brungardt, CAE
STFM Executive Director
Psst…want to know a secret? STFM wants to be the authority in innovation and research in medical education. Kind of cool, right?
The problem is, this really isn’t supposed to be a secret. Despite our commitment to research in activities and dollars, STFM can improve on communicating how high a priority this is for the Society. Our interest in research generally remains a secret that is known only to those who sit on our Research Committee and Board of Directors. For the sake of the discipline, STFM needs to be seen as a leader in promoting research activities that have an impact and a place where faculty are inspired and learners are engaged in the generation of new knowledge.
To gain this presence, we need the right combination of scholars and resources, and, yes, communications about what we are doing. We have some brilliant scholars within our membership who work hard to review journal manuscripts, develop skill building research sessions at our conferences, and collaborate with CAFM Educational Research Alliance PIs.
For the resource piece, STFM invested more than $300,000 last year to advance scholarship through the following initiatives:
- Family Medicine – Submissions continue to rise for STFM’s flagship journal.
- Annals of Family Medicine – STFM is third largest financial contributor to Annals.
- Grant Generating Project – STFM is one of three financial partners in the Grant Generating Project.
- CAFM Educational Research Alliance – Currently six manuscripts have already been submitted for publication from CERA, and we anticipate several more within the next 2 months. This is all within the first year of existence of CERA. We’ve only scratched the surface of the potential of this initiative.
- Fifty four podium presentations and 180 posters at our annual meeting – including skill building sessions and educational and clinical research findings. Every year, one of our four plenary slots is reserved for research. We also have dozens of research posters at our other conferences.
- Best Research Paper Award – The list of research leaders on this list is impressive.
- Research Advocacy – This is still in its infancy, but advocacy for increased research funding is now an advocacy priority for the family.
- National Research Network – Our Conference on Practice Improvement is the home for presentations and meetings of the National Research Network. We see a great linkage between practice improvement and the translation of the research coming out of the network.
- Family Medicine Research wiki – The Group on Research in Residency offers a great but relatively unknown resource to help build research capacity. Topics include: Getting Started with Family Medicine Research, Journal Clubs & Critical Appraisal, Scholarly Projects in Residency Training, IRB Issues and Participant Safety, Writing A Research Paper, Reviewing a Manuscript, and more.
- Management Contract with the North American Primary Care Research Group – STFM provides the staff to run NAPCRG. We do this because we believe that NAPCRG can do things that STFM can’t to advance the generation of new knowledge.
There is much more that needs to be done to move forward the scholarship of our discipline. STFM should lead research initiatives that align with our educational mission and collaborate with others to develop our faculty and learners’ skills in educational research and innovation.
Please help us spread the word.