Justin Bright

Focus still on experience as workweek is shortened

Justin Bright, M.D. (‘07), is 14 hours into a 30 hour shift at St. Vincent Mercy Hospital in Toledo, Ohio, a regular work day for a resident in emergency medicine. Two weeks ago he worked a total of 84 hours, and before that, it was 78.

As bad — and as long — as those hours might seem, they represent a huge decrease in the number of hours resident doctors put in for their in–house training. Just five years ago, they worked 100 hours a week, if not more.

In 2003, the Accreditation Council for Graduate Medical Education adopted recommendations from the Institute of Medicine for an 80 hour work week and requiring residents should go no more than 16 hours without a five–hour break or nap.

“The human brain simply does not perform reliably for 24 consecutive hours without sleep,” said Charles A. Czeisler, M.D., Ph.D., at Brigham and Women’s Hospital, who worked on the 2008 study published in the National Academies Press.

Interns and residents who put in more than five 24 to 30 hour shifts in a month were involved in 300 percent more fatal errors than when they did not work extended shifts, Czeisler said.

The study also found that they were more likely to fall asleep during surgery, while examining patients, during hospital rounds and during lectures or seminars.

Sleep deprivation is also putting the residents themselves at harm.

“As soon as I get in my car, I realize how tired I am,” said Bright. “I’ll admit I’ve almost fallen asleep a few times on my way home.”

“But working nights, even long nights, has its benefits,” said Bright, 32.

“There’s a lot of learning that goes on in the middle of the night when you’re alone. Medicine is all about life–and–death decisions, and we need to learn to do that well,” he said.

These decisions happen at night, he said, when you’re alone with a skeleton crew. “You don’t have time to think you’re tired when you’re on.”