As the Accreditation Council for Graduate Medical Education seeks to improve patient care by further limiting the hours worked by medical residents, the Journal of Surgical Research will published a new study online on Monday reporting that outcomes in two common surgeries – appendectomy and laparoscopic cholecystectomy – were similar among residents who had worked less than 16 hours and those who had worked more than 16 hours.
The research team, led by investigators at Los Angeles Biomedical Research Institute (LA BioMed), concluded that requiring a five-hour rest period at night for surgical residents after 16 hours of work is "unlikely to improve the outcomes for these commonly performed operations."
The researchers reviewed 2,908 laparoscopic cholecystectomies, in which the gall bladder is surgically removed through a small incision in the abdomen, and 1,726 appendectomies to remove patients' appendixes that were performed at Harbor-UCLA Medical Center from July 2003 to March 2009. These are the two most common operations performed by residents, and the two surgical procedures are often performed at night when residents are more likely to have worked a long shift.
The researchers compared outcomes in these two operations when they were performed during the day by surgical residents who had worked less than 16 hours and at night by surgical residents who had worked 16 or more hours. The researchers concluded that "appendectomy and cholecystectomy operations performed at night by less rested and possibly sleep-deprived residents have similar good outcomes compared with those performed during the regular work day."
"In terms of the two most commonly performed operations by surgical trainees, the study suggests that limiting resident shifts to 16 hours of work is unlikely to improve surgical outcomes," said corresponding author Christian de Virgilio, MD, a LA BioMed principal investigator. "Training surgeons takes more time than many other medical disciplines because the residents must learn the craft of surgery along with patient care. By reducing the hours per day available for surgical training, residents would miss out on critical aspects of a patient's care. It will also further increase the costs and length of time to train surgeons. It currently takes 10-15 years after graduating from college to competently train surgeons."
The Accreditation Council for Graduate Medical Education is a private, non-profit council that evaluates and accredits more than 8,800 residency programs in 130 specialties and subspecialties in the United States, affecting more than 110,000 residents. Its 16-member task force charged with reassessing resident training program standards recently proposed a set of draft standards for medical resident education that would reduce duty periods of first-year residents to no more than 16 hours per day and would seek more supervision of first-year residents.
As the residents progress through their training, the task force set no specific limits on hours worked per day but encouraged residents to avoid fatigue by napping or resting during their shifts. The task force recommended the maximum weekly hours of resident training stay the same as the current standard of 80 per week averaged over four weeks.
The study published by the Journal of Surgical Research said the proposed changes in residents' duty hours "have the potential to profoundly affect surgical residency training nationally." It pointed out that limited work hours in Europe have resulted in decreased patient interaction, participation in 30% fewer operations per year, decreased ability to learn from more senior professionals, decreased ability to follow patients through their full clinical course and decreased participation in structured training.
"The accrediting agency should closely examine the data to determine if reducing surgical residents' work hours improves outcomes for surgical patients, and it should carefully consider the effect any reduction in duty hours has on the training of surgeons before adopting any further reductions," said Dr. de Virgilio. "The agency may wish to adopt a different standard for surgical residents, who need more hours on duty to ensure they have adequate time to learn the craft of surgery and follow a patient's care from pre-operation to post-operation."
The task force's standards are open for comment at this time, with final approval set for September and implementation scheduled for July 2011.
About LA BioMed
Founded in 1952, LA BioMed is one of the country's leading nonprofit independent biomedical research institutes. It has more than 150 fulltime and part-time researchers conducting studies into improved treatments and cures for cancer, inherited diseases, infectious diseases, illnesses caused by environmental factors and more. It also educates young scientists and provides community services, including immunization and childhood nutrition programs. LA BioMed is academically affiliated with the David Geffen School of Medicine at UCLA and located on the campus of Harbor-UCLA Medical Center.
Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland
Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
24.03.2017 | Materials Sciences
24.03.2017 | Physics and Astronomy
24.03.2017 | Physics and Astronomy