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In this randomized trial comparing ACGME duty-hour policies with more flexible policies for surgical residents, the flexible policies resulted in noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. In response to concerns about patient safety and resident well-being, the Accreditation Council for Graduate Medical Education (ACGME) introduced national regulations in 2003 that limited resident duty periods to 80 hours per week, capped overnight shift lengths, and mandated minimum time off between shifts. 1 , 2 Concerns persisted, 3 and in 2011, the ACGME implemented further restrictions to shorten maximum shift lengths for interns and increase time off after overnight on-call duty for residents. 1 , 4 , 5 Although most observers agree that some duty-hour regulation was necessary, critics cite a weak evidence base for the 2003 and 2011 reforms. 3 , 6 , 7 Several retrospective . . .

In this cluster-randomized trial involving 63 internal-medicine residency programs governed by either the 2011 ACGME duty-hour rules or more flexible duty-hour rules, flexible duty-hour policies did not increase 30-day mortality or adversely affect several other patient safety outcomes.

In a cluster-randomized trial involving resident physicians working in pediatric ICUs, resident physicians were randomly assigned to schedules that included shifts of 24 hours or more or to schedules with shifts of 16 hours or less. Contrary to the authors’ hypothesis, resident physicians made fewer serious medical errors when they followed the extended schedule.

U.S. internal-medicine residency programs were randomly assigned to standard duty-hour policies or more flexible policies, which maintained the 80-hour workweek limit but did not require limits on shift length. Sleep duration and morning sleepiness were similar for interns in standard programs and those in flexible programs.

Interns made 36 percent more serious errors when working on a traditional schedule than when on an intervention schedule. In a pioneering study published in the Journal 33 years ago, Friedman and colleagues reported that interns made almost twice as many errors reading electrocardiograms after an extended (24 hours or more) work shift than after a night of sleep. 1 More recent studies have similarly found that surgical residents made up to twice the number of technical errors in the performance of simulated laparoscopic surgical skills after working overnight than after a night of sleep. 2 , 3 Although many prior studies have been methodologically limited by the use of nonvalidated self-reports on the timing of sleep and inadequate accounting for circadian . . .

Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care. Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents’ physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed. We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents’ sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents’ somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents’ knowledge and decision-making worst with the 16-hour schedule. Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents’ symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. Trial registration: ClinicalTrials.gov, no. NCT00679809.

Background: Medical education is rapidly changing where there has been decreased emphasis on passive didactics and increased focus on novel modes of teaching and learning to address the unique needs of millennial learners. As educators, it is challenging to keep up and find active teaching strategies outside of routine small group exercises to engage learners. Although the traditional small group activities, such as cased-based learning, allows for interactive and effective teaching, this modality may require the use of multiple faculty facilitators, which can be a difficult resource to find. The jigsaw learning method is cooperative learning that utilizes peer teaching and promotes collaborative learning, and additionally, only one facilitator is required of this type of learning technique. Objectives: We aimed to assess the effectiveness of the jigsaw method by comparing it to the traditional small group learning method to teach principles of diagnostic reasoning. Design: Residents were assigned to either the traditional small group teaching method or the jigsaw method. We compared pre-test, post-test, one-year follow-up test results between participants, and resident perception of the exercises. Results: A 2 × 3 repeated measures ANOVA indicated statistically significant improvement in tests scores from before to after participation with the jigsaw method compared to the traditional small group method. Post-survey demonstrated higher resident satisfaction with the jigsaw method. Conclusion: Our study demonstrates that a jigsaw cooperative learning approach can be used as an effective method to promote collaborative learning and engagement.

BackgroundAnaesthesiologists work in a high stress, high consequence environment in which missed steps in preparation may lead to medical errors and potential patient harm. The pre-anaesthetic induction period has been identified as a time in which medical errors can occur. The Anesthesia Patient Safety Foundation has developed a Pre-Anesthetic Induction Patient Safety (PIPS) checklist. We conducted this study to test the effectiveness of this checklist, when embedded in our institutional Anesthesia Information Management System (AIMS), on resident performance in a simulated environment.MethodsUsing a randomised, controlled, observer-blinded design, we compared performance of anaesthesiology residents in a simulated operating room under production pressure using a checklist in completing a thorough pre-anaesthetic induction evaluation and setup with that of residents with no checklist. The checklist was embedded in the simulated operating room's electronic medical record.ResultsData for 38 anaesthesiology residents shows a statistically significant difference in performance in pre-anaesthetic setup and evaluation as scored by blinded raters (maximum score 22 points), with the checklist group performing better by 7.8 points (p<0.01). The effects of gender and year of residency on total score were not significant. Simulation duration (time to anaesthetic agent administration) was increased significantly by the use of the checklist.ConclusionRequired use of a pre-induction checklist improves anaesthesiology resident performance in a simulated environment. The PIPS checklist as an integrated part of a departmental AIMS warrant further investigation as a quality measure.

There is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. To improve understanding for the Chinese model, we present a comparative perspective with systems from the UK and USA. To succeed, the 5 + 3 model will need to overcome major challenges of accreditation and certification, alternative education pathways, and China's unique degree and credentialing system. We conclude by reviewing the challenges of clinical competencies in China, especially the complementarity of specialist training and general practitioner training, which are essential for the quality and equity of China's health-care system.

Internal medicine residency programs were randomly assigned to standard duty-hour policies or to flexible policies without limits on shift length and time off. Interns in programs with flexible policies did not have a superior educational experience.