On September 28, 2010, the Accreditation Council for Graduate Medical Education (ACGME) Board of Directors approved new requirements for residency programs, including updated standards for resident duty hours, education, and supervision. ACGME’s press release states: "The standards are based on recommendations made by the Institute of Medicine (IOM) in 2008 and evidence collected during a 16-month review of the scientific literature on sleep issues, patient safety and resident training." The new standards will be implemented in July 1, 2011.
In line with many of the IOM’s recommendations, the new standards require residency programs to:
- tailor supervision standards for different levels of training, particularly greater supervision for first-year residents;
- ensure competence in structured handover processes;
- incorporate clinical quality improvement and patient safety into resident learning;
- provide safe transportation and/or sleeping facilities for fatigued residents;
- adjust workload according to patient severity and resident training; and
- improve oversight of compliance with duty hour limits.
Following parts of specific duty hour recommendations from the IOM:
- the maximum number of work hours remains at 80 hours per week, averaged over 4 weeks;
- moonlighting, now both internal and external, is counted against the 80-hour weekly limit; and
- duty periods are limited to 16 hours (although only for first-year residents by ACGME).
Following the release of the new standards, Dr. Nasca was quoted in a perspective piece published in the New England Journal of Medicine (September 30, 2010). He highlighted "the important role of the IOM report in ‘solidifying the ground on which GME programs will move forward to adjust duty hours, provide closer supervision to residents, and improve the quality of care by making it safer.'" Dr. Nasca also noted that the connection between sleep and performance should be investigated further—ACGME recommended "strategic napping," finding the IOM committee’s recommendation of an uninterrupted 5-hour sleep period "unworkable."