Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review
Open Access
- 22 March 2011
- Vol. 342 (mar22 1), d1580
- https://doi.org/10.1136/bmj.d1580
Abstract
Objectives To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Design Systematic review. Data sources Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. Study selection Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. Results 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. Conclusions Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours’ legislation on objective educational and clinical outcomes.Keywords
This publication has 78 references indexed in Scilit:
- Patient safety and quality of care continue to improve in NHS North West following early implementation of the European Working Time DirectiveQJM: An International Journal of Medicine, 2010
- Impact of Timing of Birth and Resident Duty-Hour Restrictions on Outcomes for Small Preterm InfantsPublished by American Academy of Pediatrics (AAP) ,2010
- Prolonged Hospital Stay and the Resident Duty Hour Rules of 2003Medical Care, 2009
- Variation in Hospital Mortality Associated with Inpatient SurgeryNew England Journal of Medicine, 2009
- Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomesPublished by Wiley ,2009
- Effects of Resident Duty Hour Reform on Surgical and Procedural Patient Safety Indicators Among Hospitalized Veterans Health Administration and Medicare PatientsMedical Care, 2009
- Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparisonQJM: An International Journal of Medicine, 2009
- Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care PhysiciansJAMA, 2007
- The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending SurgeonsAnnals of Surgery, 2006
- Impact of Work-Hour Restrictions on Residents’ Operative Volume on a Subspecialty Surgical ServiceJournal of the American College of Surgeons, 2005