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Resident Schedule Perfection? Not Yet

April 15, 2019

Written by Clay Smith

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A flexible duty hour schedule that kept total weekly hours under 80 but allowed for longer shift length and no fixed mandatory time off between shifts was not inferior to the current standard duty hour regulations when it came to sleep duration or morning alertness.

Why does this matter?
Sleep deprivation may adversely impact the care we give patients.  But learning to effectively manage inevitable fatigue while still functioning at a high level is critical.  What’s the right balance?

Residents, try to stay awake to read this…
Roughly 200 interns from 63 US programs over 2 weeks were randomized to the usual duty-hour restrictions since 2011 or a flexible duty-hour program that maintained an 80 hour week but did not restrict shift length or mandatory time off between shifts.  See below table for the schedules.  They found that sleep duration was 11 minutes longer in the standard group than the flexible group, 7.03 hours vs 6.85 hours, but didn’t reach the predefined non-inferiority margin of -0.5 hour.  Morning alertness was also non-inferior.  A measure of psychomotor vigilance, testing response times, was inferior in the flexible group.

Since both schedules are the same, is it time to make this a matter of resident and program preference?  And what about the impact on patient care?  Stay tuned for tomorrow.

Sleep and Alertness in a Duty-Hour Flexibility Trial in Internal Medicine.  N Engl J Med. 2019 Mar 7;380(10):915-923. doi: 10.1056/NEJMoa1810641.

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Reviewed by Thomas Davis

From cited article, Supplementary Appendix, Table S1

From cited article, Supplementary Appendix, Table S1

What are your thoughts?