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Kevin G. Volpp, MD, PhD; Christopher P. Landrigan, MD, MPH

JAMA. 2008;300(10):1197-1199.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In 2003, passage of the Accreditation Council for Graduate Medical Education (ACGME) work hour standards marked the first time that work hours for physicians in training were regulated throughout the United States. Five years later, the medical profession stands at a critical juncture. At the request of Congress, the Agency for Healthcare Research and Quality has sponsored an Institute of Medicine committee to review the evidence on the relationship between residents' work hours and patient safety and to develop recommendations for improvement.¹

There is increasing evidence that resident sleep deprivation endangers patients and residents,^2-5 but studies have not shown consistent benefit from implementation of the current ACGME standards. No changes in mortality were found in national studies of surgical patients.^6-8 Some reductions in mortality were observed for medical patients at Veterans Administration hospitals⁸ and in a cohort of non–Veterans Administration . . . [Full Text of this Article]

Guiding Principles

Rigorously Study Alternatives for Work Hour Reduction

Measure Outcomes Related to Resident Education

Improve "Sign-Out" Procedures

Eliminate or Minimize Situations in Which Residents Work 24 to 30 Continuous Hours

Improve Monitoring of Standards

Increase Flexibility for Implementation and Enforcement

Recognize the Importance of Supervision and Work Intensity

Align Incentives for Payment With Desired Objectives

Author Affiliations: Center for Health Equity Research and Promotion, Veterans Administration Hospital, Philadelphia, and Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia (Dr Volpp); and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Landrigan).

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