“At times, the debate has seemed like a shouting contest, rooted in opinion rather than evidence,” Dr Asch and his colleagues commented.
Instead, health policy that has a broad impact on patients — such as rules addressing the education of residents — should be based on evidence, just as drug approvals are based on randomized controlled trials, they argue.
Two of their own randomized controlled trials of surgical and medical residency programs in the US are providing some of that data, the authors say.
The studies compare patient outcomes among residents whose workweeks are structured either by duty-hour rules or by more flexible rules, with no limits on their shift length or the time they are allowed to take off.
One trial revealed no differences in patient outcomes between duty-hour rules and flexible rules. The ACGME used evidence from this trial to craft the new rules, which maintain a cap of 80 hours per week for residents, averaged over four weeks, but also extend shifts from 16 to 24 hours and permit within-shift flexibility. Results from the second trial have yet to be analyzed.
“There are many other questions that can be tested with future studies of the training environment. In the meantime, the ACGME has recognized that far-reaching health policies deserve to be based on the same kind of science as far-reaching health treatments,” the authors conclude.
Asch DA, Bilimoria KY and Desai SV. “Resident Duty Hours and Medical Education Policy — Raising the Evidence Bar.” The New England Journal of Medicine. 2017. doi: 10.1056/NEJMp1703690 [Epub ahead of print]