On June 23, the group that oversees graduate medical education, the ACGME, released updated regulations governing resident work hours and supervision.

From a patient safety standpoint, here are some of our main concerns:

º     Everyone should be limited to 16 hours or less per shift. Currently, resident physicians are allowed to work marathon shifts of 30 hours. The new ACGME rules would limit first-year residents to 16 hours, but would allow others to work up to 28 hours.

º    Time off between shifts should be preserved. Residents used to have at least 10 hours between shifts, and a government-commissioned report called for 10-14 hours depending on the situation. Now the ACGME will only require 8 hours between shifts. Consider commuting time, a chance for a good meal, calling mom, and sleeping. Do you want your doctors back on the job just a few hours after they left?

º    There is no rigorous process for monitoring duty hour regulations. In order to successfully implement these regulations, we need frequent, unannounced review visits and whistle-blower protections for residents who have the courage to report violations. There should be a mechanism for patients to report safety concerns, and a place where patients can easily check to see whether their hospital is in compliance. Even the most positive reforms can’t improve patient safety if they are not openly enforced.

º    What will patients be told about the roles of residents and supervising physicians? While the ACGME says that patients should be informed about the role of residents in patient care, no guidelines are provided as to what information should be included in this disclosure. Explicit information is especially important in surgery, where patients often do not know they are being operated on by residents.