New ACGME rules for supervision and duty hours: resident commentary.

the recently approved Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements including new Standards for Resident Supervision and Duty Hours will take effect July, 2011. These new requirements revise the initial regulations implemented by the ACGME in 2003 and respond in part to recommendations set forth by the Institute of Medicine (IOM) in 2008. The changes are proposed to ensure three main objectives: patient safety and quality of care in teaching hospitals, patient safety and quality of care provided by current residents in their future independent practice, and maintenance of a “safe and humanistic educational environment” for residents to learn. As residents, we applaud the ACGME’s continued efforts to promote resident education, monitor resident workload, and ensure patient safety. These new standards have drawn attention from both the public media and medical professionals. Yet, despite very admirable goals, the actual impact of many of the changes has been questioned by residents and faculty alike. Our purpose is to summarize the 2011 ACGME Common Program Requirements for resident supervision and resident duty hours and discuss how we believe they may impact resident education and quality of life. The new Common Program Requirements cover 15 headings: (1) Supervision; (2) Clinical Responsibilities; (3) Teamwork; (4) Professionalism, Personal Responsibility, and Patient Safety; (5) Transitions of Care; (6) Alertness Management; (7) Maximum Hours of Work Per Week; (8) Maximum Duty Period Length; (9) Maximum In-Hospital OnCall Frequency; (10) Minimum Time Off between Scheduled Duty Periods; (11) Maximum Frequency of In-Hospital Night Duty; (12) Mandatory Time Off Duty; (13) Moonlighting; (14) Dutyhour exceptions; (15) Home Call. To simplify the proposal we have created a framework for these changes within four headings: Supervision, Duty Hours, Call, and Other. We have chosen to narrow our discussion to the changes we believe will have the most impact on residents: supervision, duty hours, and call.