Reduced Hours for Trainees Has Had Little Effect in U.S.

Reducing work hours for doctors in training to less than 80 per week has had little impact on patient outcomes or postgraduate training in the United States, according to a literature review published online March 22 in BMJ.

S. Ramani Moonesinghe, M.R.C.P., of the University College Hospital London, and colleagues reviewed 72 studies from the United States and the United Kingdom examining the impact of reduced hours on postgraduate medical training, patient safety, and clinical outcome.

The researchers found that reduction of working hours from more than 80 per week did not adversely affect patient safety and has had minimal effect on postgraduate training. No significant conclusions could be drawn on the impact of working less than 56 or 48 hours per week (in accordance with European legislation) because of a lack of high-quality studies.

In an accompanying editorial, Leora Horwitz, M.D., of the Yale University School of Medicine in New Haven, Conn., points out that, while reduced work hours have not negatively affected patient safety, patient safety has not improved. She offers several possible explanations, including a weak evidence base, inadequate regulation, busier doctors, and discontinuity of care related to trainees working fewer hours.

"Our study, which summarizes a diverse and sometimes methodologically flawed body of literature, has been unable to reach firm conclusions, but we consider that this in itself is an important observation. We have highlighted the need for a more systematic approach to evaluating the impact of legislative changes of duty hours and the challenges of conducting high quality audit and research in this area," the authors write.

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