Educator Evaluates New Resident Duty Rules

New, less-publicized changes to residency work rules are likely to have a larger impact
on academic medicine than simple hours adjustments, according to a physician expert
at the Jefferson Medical College in Philadelphia. Writing in the College’s Health Policy
Newsletter, Associate Dean John W. Caruso, MD, FACP notes the new residence
training program requirements issued by the Accreditation Council for Graduate
Medical Education and effective July 2011. The new requirements limit intern duty
periods to 16 total hours and resident duty periods to 24 hours, with the proviso that
resident moonlighting activity be counted against the 80 hour per week total limit. While
important, Caruso argues that other rules are more significant. These include requiring
that residents use quality improvement methods to improve practices, participate
in interdisciplinary teams to improve safety, and be guided by explicit performance
measures. Other rules require a more structured approach to sign-outs and handovers
as well as more explicit requirements addressing supervision. “In simple terms,” Caruso
writes, “it will no longer be acceptable for the least experienced team members to make
critical decisions without the input of senior residents and faculty.” Since 2001, IPRO
has conducted external monitoring of resident duty hours on behalf of the New York
State Department of Health. For a copy of the Jefferson Medical College Summer 2011
Newsletter (vol. 24, No. 3), visit the Medical College website at