Today, the National Steering Committee on Resident Duty Hours released Canada’s first comprehensive, collaborative and evidence-based report on the hotly debated issue of fatigue and duty hours for Canada’s approximately 12,000 residents. Funded in part by Health Canada, the Royal College joined eight other health care organizations and experts nationwide to produce Canada’s first cross-jurisdictional effort to find consensus on the critical health and safety issue of resident duty hours.
The result is a series of principles and recommendations to help all provinces and jurisdictions ensure residents are healthy and fit to provide the highest quality of patient care. These findings will also help inform and shape new efforts looking into how our system can better support the health and wellbeing of practicing physicians.
Finding Canadian solutions to an international debate
The debate over reducing resident duty hours is not new. European Union countries have set standards of between 40 and 52.5 duty hours per week, while the United States Accreditation Council for Graduate Medical Education recently set maximum hours at 80 per week. In Canada, multiple jurisdictions have implemented various approaches, but there has been no pan-Canadian approach or standards.
The National Steering Committee came together in 2012 to find a path forward. The committee was formed less than a year after a Quebec arbitrator ruled in June 2011 that 24-hour duty hour (on-call) shifts pose a danger to residents’ health (and therefore violate the Charter of Rights and Freedoms), and that on-call shifts cannot exceed 16 hours. The Quebec ruling created a clear need for all stakeholders to come together and conduct a comprehensive Canadian analysis of the issues.
Key research findings: Duty hours are impacting resident health
As part of this project, the National Steering Committee examined available evidence on the impact of resident duty hours and resident duty hour regulations. This informed a series of key findings and principles, including:
- Canada has a unique landscape as pertains to resident duty hour regulations.
- Traditional call models present risks to the physical, mental, and occupational health of residents.
- Successful efforts to improve education, patient safety and resident fatigue will need to be comprehensive, involving not only the regulation of resident duty hours alone.
- There is evidence suggesting that the regulation of resident duty hours in the surgical disciplines can lead to suboptimal patient care and educational outcomes.
- Duty periods of 24 or more consecutive hours without restorative sleep should be avoided.
To date, there’s no conclusive evidence that tired doctors are more likely to deliver unsafe care, or that restricting duty hours alone has resulted in improved patient safety. To view the research and evidence that shaped these decisions, please review the complete final report.
The way forward: Better fatigue management rather than a “one size fits all” approach
Resident training needs are diverse and variable. Optimizing resident training and patient care requires consideration of a number of unique factors within each rotation. Based on this, the final report does not mandate a “one size fits all” solution for the hours worked by Canadian physicians and surgeons during residency.
Rather, the report outlines a detailed series of recommendations on systems-based changes to address issues pertaining to, and impacted by, resident duty hours in Canada. Furthermore, the National Steering Committee’s report does state that duty periods of 24 or more consecutive hours without restorative sleep should be avoided and should only be undertaken in rare and exceptional circumstances.
Another recommendation calls on all health care jurisdictions to develop comprehensive strategies to minimize fatigue and fatigue-related risks during residency. Changes to accreditation standards, increased simulation use and new pilot projects are also proposed. I invite you to read the full recommendations, methodology, references and research findings.
This will help inform an evidence-based examination of physician duty hours
There is no doubt that the finding of fatigue’s impact on health can also be applied to that of Fellows, most of whom work long, demanding schedules. That is why we have also joined the CMA’s Physician Duty Hours Working Group, which will look at how to best advance physician health and wellbeing in practice, while still ensuring patients receive the highest quality of care.
I’d welcome your thoughts on this report but also how we as an organization and a health care system can better support your health and wellbeing.
Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer