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BACKGROUNDTraining programs have implemented the 2011 ACGME duty hour regulations (DHR) using “workload compression” (WLC) strategies, attempting to fit similar clinical responsibilities into fewer working hours, or workload reduction (WLR) approaches, reducing the number of patient encounters per trainee. Many have expressed concern that these strategies could negatively impact patient care and learner outcomes.OBJECTIVEThis study evaluates the medical knowledge and clinical impact of a WLR intervention in a single institution.DESIGN & PARTICIPANTSNonrandomized intervention study with comparison to a historical control study among 58 PGY-1 internal medicine trainees in the 2 years after duty hour implementation [exposure cohort (EC), 7/1/2011–6/30/2013], compared to 2 years before implementation [comparison cohort (CC), 7/1/2009–6/30/2011].MAIN MEASURESProcess outcomes were average inpatient encounters, average new inpatient admissions, and average scheduled outpatient encounters per PGY-1 year. Performance outcomes included trainee inpatient and outpatient days on service, In-Training Examination (ITE) scores as an objective surrogate of medical knowledge, Case-Mix Index (CMI), and quality of care measures (30-day readmission rate, 30-day mortality rate, and average length of stay).KEY RESULTSBaseline characteristics and average numbers of inpatient encounters per PGY-1 class were similar between the EC and CC. However, the EC experienced fewer new inpatient admissions (157.47 ± 40.47 vs. 181.72 ± 25.45; p < 0.01), more outpatient encounters (64.80 ± 10.85 vs. 56.98 ± 6.59; p < 0.01), and had similar ITE percentiles (p = 0.58). Patients of similar complexity cared for by the EC also had a greater reduction in readmissions (21.21 % to 19.08 %; p < 0.01) than the hospital baseline (12.07 to 11.14 %; p < 0.01).CONCLUSIONSOur WLR resulted in a small decrease in the average number of new inpatient admissions and an increase in outpatient encounters. ITE and care quality outcomes were maintained or improved. While there is theoretical concern that reducing PGY-1 inpatient admissions volumes may negatively impact education and clinical care measures, this study found no evidence of such a trade-off.

Purpose Japan introduced physician work-hour regulations in April 2024. Perceptions of such regulations appear to be influenced by history and culture, and thus vary among stakeholders and countries. Here, we aimed to investigate supervising physicians’ perceptions of physician work-hour regulations in Japan. Methods A nationwide cross-sectional study was conducted from March to April, 2024. We distributed an online anonymous self-administered questionnaire, which included closed questions about expected influence of physician work-hour regulations on various factors and an open-ended question regarding expectations or concerns about the regulations. The data were analyzed using descriptive statistics for the closed questions and inductive content analysis for the open-ended question. To explore whether various factors (sex, postgraduate years, specialty, hospital location, hospital type, and hospital size) were associated with the perceptions of the pariticpants on the implementation of physician work-hour regulations (overall, patient care, resident physician well-being, resident physician education, or supervising physician well-being), we also performed multivariable linear regression analysis. Results We included 144 participants in the analysis. Many of the participants raised concerns about the negative impact of the regulations, particularly on the training of medical residents. About one-fifth of the respondents described their thoughts about the gap between the real medical field and the system. Some participants used the Japanese term jikokensan , which literally means self-improvement but is used to refer to study or research conducted by a physician with the aim of acquiring knowledge or enhancing skills apart from their primary duties, in the context of physician work-hour regulations. In multivariable analyses, several organizational factors showed statistically significant associations with supervisors’ perceptions of physician work-hour regulations. Nevertheless, effect sizes were small, there was no clear dose–dependent relationships, and findings were inconsistent across the five outcome domains; thus, no strong or consistent predictors were identified. Conclusions These results highlight the need to more fully explore supervisor perspectives, which could lead to more discourse in policy-making and an improved system of physician work-hour regulations.

Canadian court decisions and human rights legislation impose strict legal criteria for developing applicant and incumbent physiological employment standards to qualify as a bona fide occupational requirement. These legal criteria compel researchers and employers to ensure that the standards are criterion-based and validly linked to the critical life threatening physically demanding tasks of the occupation, and this has led to the establishment of a systematic research process template to ensure this connection. Validation of job-related physiological employment standards is achieved using both construct and content procedures and reliability is established via test–retest procedures. The 1999 Supreme Court of Canada Meiorin Decision also obliges employers to demonstrate that it is impossible to accommodate an individual applicant or employee who is adversely impacted by lowering the physiological employment standards without imposing undue hardship on the employer. Recent evidence has demonstrated convincingly that familiarization opportunities, motivational feedback/coaching during test performance, and participation in a 6-week job-specific physical fitness training program can overcome the adverse impact of a physiological employment standards on a sub-group of participants, thereby providing “de facto” accommodation. In this article, the authors review the physiological employment standards for prominent Canadian physically demanding public safety occupations; police, correctional officers, nuclear emergency personnel, structural fire fighters, and wildland fire fighters, to illustrate the steps, challenges, and solutions involved in developing and implementing physiological employment standards designed to meet the requirements to qualify as a bona fide occupational requirement.

Context The ACGME-released revisions to the 2003 duty hour standards. Objective To review the impact of the 2003 duty hour reform as it pertains to resident and patient outcomes. Data Sources Medline (1989–May 2010), Embase (1989–June 2010), bibliographies, pertinent reviews, and meeting abstracts. Study Selection We included studies examining the relationship between the pre- and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies. Data Extraction One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality. Results Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Meta-analysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I 2 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies. Limitations Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible. Conclusions Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

To describe the views of residency program directors regarding the effect of the 2010 duty hour recommendations on the 6 core competencies of graduate medical education. US residency program directors in internal medicine, pediatrics, and general surgery were e-mailed a survey from July 8 through July 20, 2010, after the 2010 Accreditation Council for Graduate Medical Education (ACGME) duty hour recommendations were published. Directors were asked to rate the implications of the new recommendations for the 6 ACGME core competencies as well as for continuity of inpatient care and resident fatigue. Of 719 eligible program directors, 464 (65%) responded. Most program directors believe that the new ACGME recommendations will decrease residents' continuity with hospitalized patients (404/464 [87%]) and will not change (303/464 [65%]) or will increase (26/464 [6%]) resident fatigue. Additionally, most program directors (249-363/464 [53%-78%]) believe that the new duty hour restrictions will decrease residents' ability to develop competency in 5 of the 6 core areas. Surgery directors were more likely than internal medicine directors to believe that the ACGME recommendations will decrease residents' competency in patient care (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.5-6.3), medical knowledge (OR, 1.9; 95% CI, 1.2-3.2), practice-based learning and improvement (OR, 2.7; 95% CI, 1.7-4.4), interpersonal and communication skills (OR, 1.9; 95% CI, 1.2-3.0), and professionalism (OR, 2.5; 95% CI, 1.5-4.0). Residency program directors' reactions to ACGME duty hour recommendations demonstrate a marked degree of concern about educating a competent generation of future physicians in the face of increasing duty hour standards and regulation.

The EU established the European Working Time Directive (EWTD) in 2003 to avoid the exploitation of employees, with a limit on the number of working hours, 4 weeks paid annual leave, and mandatory rest periods in every 24-hour shift. When asked whether, in their personal experience, reduced working hours had affected patient outcomes including patient safety, 38% noticed no difference and 20% thought it had a negative effect (\"poor handover practice results in loss of important info\").

What is the future of European legislation enacted in the UK? Abi Rimmer considers what might happen to working time rules if the UK left the EU

GPs accused the government of scapegoating the profession and ignoring the true causes of the pressures across the NHS in England, after practices were warned through a series of inflammatory headlines in the national media that funding for extending their opening hours could be withheld unless they could prove that they were informing their patients of additional appointment slots and offering appointments at convenient times. 1 2 3 May's intervention came as the government came under growing pressure to tackle the growing crisis in hospital emergency departments by reducing the number of patients visiting. 4 But GPs said that the prime minister was attempting to shift the blame away from the government and was wilfully ignoring the underlying pressures facing the NHS and the GP workforce caused by underfunding, soaring demand, and staff shortages. GP leaders also highlighted the evidence from an evaluation of the government's existing pilot schemes for seven day GP access launched under May's predecessor, David Cameron, which found no reduction in emergency department admissions and low demand among patients for GP appointments on Sundays. 5 May also came under fire from her own party, with the Conservative chair of the House of Commons Health Committee and former GP Sarah Wollaston saying that the public and NHS staff \"deserved better than scapegoating, smoke, and mirrors.\"