Shift Scheduling for Residents in Medical Critical Care: Benefits and Limitations

Based on the evidence of risk to both patients and residents, the Accreditation Council for Graduate Medical Education (ACGME) made the largest reform to medical training in 2003 when it enforced a limitation in cumulative duty hours for residents.  It has now been over a year since a 2010 revision directed further restrictions and regulations.  These revisions have revolutionized how physicians are trained, inspiring creativity in the pursuit to deliver quality education in less time.  In fact, variability in creation of schedules within the confines of ACGME guidelines is often used as a recruitment tool.  Many programs were forced to dramatically restructure from traditional long call schedules, to shift work requiring increased number of patient handoffs. The change to shifts for residents prompted the legitimate concerns that the decreased continuity would lead to a loss of sense of ownership of patients and that fewer hours would lead to a loss of educational opportunities.  The impact of changing duty hour requirements has posed different challenges to different specialties and at different levels of care.