Residency Duty Hours and Continuity of Care: Patient Perspectives on Medical Education

Background: In response to pressure from the press and politicians over the last decade, the Accreditation Council for Graduate Medical Education (ACGME) has increasingly restricted the amount of hours that medical residents in training are permitted to work. These limitations have centered on decreasing fatigue-related errors in patient care and physician safety. However, the duty hour rules have fostered concern from surveyed residents and program directors that shorter shifts fragment patient care, increasing errors in transitions of care and reducing the amount of educational opportunities. Despite broad media coverage and close examination of physician perception, patient opinions on residency duty hours have been largely unstudied. Objective: To measure patient perceptions of residency duty hours, fatigue, and continuity of care following implementation of the 2011 ACGME Common Program Requirements. Methods: A cross-sectional survey was administered to inpatients at a large academic medical center and an affiliated community hospital. Adult inpatients on teaching medical and surgical services were eligible for inclusion in the study.  Results: A total of 513 of 720 (71.3%) surveys were obtained between June and August 2013. Most respondents (57.1%, 293 of 513) believed that residents should not be assigned to shifts longer than 12 hours, and nearly half (49.7%, 255 of 513) wanted to be notified if a resident caring for them had worked longer than 12 hours. The majority of patients (63.2%, 324 of 513) felt that medical errors commonly occur due to fatigue, and fewer (37.4%,192 of 513; OR, 0.56; P < .01) believed that medical errors commonly occur as a result of transfers of care. Given the choice between a familiar physician who “may be tired from a long shift” or a “fresh” physician who had received sign-out, more patients chose the “fresh” but unfamiliar physician (57.1%, 293 of 513 versus 42.7%, 219 of 513; P< .01). Conclusions: While patient perception of duty hour regulations were attuned to the potential risk of medical errors from fatigue, they were much less concerned regarding the potential risks from transition of care. Although fatigue mitigation strategies are important, many program directors and residents have expressed concerns that duty hour restrictions have resulted in more transitions of care, inadvertently leading to errors and compromising the resident learning experience. This study demonstrates a gap between patient and physician perceptions of duty hour regulations and highlights an opportunity to foster further public education, empowering patients to meaningfully contribute to decision-making on medical education.