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Are 24-hour shifts for interns a 'dangerous step backward?'

The Accreditation Council for Graduate Medical Education, the organization tasked with setting standards for doctors-in-training, dramatically altered the medical landscape back in 2011 by announcing new work hour restrictions for interns, meaning those in their first year of training post-medical school.

Specifically, the ACGME announced that in recognition of the dangers of fatigue-related medical mistakes, interns would no longer be able to work 24-hour shifts, but rather would be limited to 16-hour shifts.   

The ACGME made something of a shocking about face earlier this month, however, when it announced that it was recommending that 16-hour shifts be dropped in favor of a return to the longstanding norm of 24-hour shifts.

As for the reason behind this surprising move, the ACGME indicated that 24-hour shifts are more reflective of real world conditions, as medical residents -- second- and third-year doctors -- already work these hours. Furthermore, it argues that the move would allow interns to learn more by following patients during their first 36 hours of hospitalization, long understood to be a crucial timeframe from a medical standpoint.

Perhaps most intriguing, the ACGME is arguing that the move back to 24-hour shifts would also serve to improve patient care by limiting the number of handoffs, meaning the transitions of care from one doctor to another doctor that occur during shift changes, which have long been recognized as a major source of medical errors.

Indeed, in order to meet this last objective, the ACGME would allow the 24-hour shift can be extended to a 28-hour shift provided these extra four hours are used to facilitate handoffs.

It's important to note that the ACGME's recommendations would leave certain time restrictions in place for interns, including no more than an average of 80-hour workweeks and no overnight shifts more than once every three days. Furthermore, a day off would continue to be required every seven days.

Not everyone was enthused by the proposal, including the advocacy group Public Citizen, which called the recommendation to go back to 24-hour shifts "a dangerous step backward."

The ACGME's recommendation, which is still open to public comment, will be decided in February. If adopted, it would take effect in U.S. teaching hospitals in July 2017.

Stay tuned for updates …

If you've been seriously injured or lost a loved one because of medical negligence, consider speaking with a skilled legal professional who can help you seek justice as soon as possible.

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