Share this article on:

The Effect of Reducing Maximum Shift Lengths to 16 Hours on Internal Medicine Interns’ Educational Opportunities

Theobald, Cecelia N. MD; Stover, Daniel G. MD; Choma, Neesha N. MD, MPH; Hathaway, Jacob MD, MPH; Green, Jennifer K. MD, MPH; Peterson, Neeraja B. MD, MSc; Sponsler, Kelly C. MD; Vasilevskis, Eduard E. MD; Kripalani, Sunil MD, MSc; Sergent, John MD; Brown, Nancy J. MD; Denny, Joshua C. MD, MS

doi: 10.1097/ACM.0b013e318285800f
Research Reports

Purpose To evaluate educational experiences of internal medicine interns before and after maximum shift lengths were decreased from 30 hours to 16 hours.

Method The authors compared educational experiences of internal medicine interns at Vanderbilt University Medical Center before (2010; 47 interns) and after (2011; 50 interns) duty hours restrictions were implemented in July 2011. The authors compared number of inpatient encounters, breadth of concepts in notes, exposure to five common presenting problems, procedural experience, and attendance at teaching conferences.

Results Following the duty hours restrictions, interns cared for more unique patients (mean 118 versus 140 patients per intern, P = .005) and wrote more history and physicals (mean 73 versus 88, P = .005). Documentation included more total concepts after the 16-hour maximum shift implementation, with a 14% increase for history and physicals (338 versus 387, P < .001) and a 10% increase for progress notes (316 versus 349, P < .001). There was no difference in the median number of selected procedures performed (6 versus 6, P = 0.94). Attendance was higher at the weekly chief resident conference (60% versus 68% of expected attendees, P < .001) but unchanged at morning report conferences (79% versus 78%, P = .49).

Conclusions Intern clinical exposure did not decrease after implementation of the 16-hour shift length restriction. In fact, interns saw more patients, produced more detailed notes, and attended more conferences following duty hours restrictions.

Dr. Theobald is instructor of medicine, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee, and VA Quality Scholars fellow, VA Tennessee Valley Healthcare System, Nashville, Tennessee.

Dr. Stover is fellow in medical oncology, Dana-Farber Cancer Institute and Massachusetts General Hospital Cancer Center, Boston, Massachusetts.

Dr. Choma is executive medical director for quality and patient safety and assistant professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Hathaway is assistant professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee, and chief of primary care service, VA Tennessee Valley Healthcare System, Nashville, Tennessee.

Dr. Green is codirector of the primary care medicine clerkship and assistant professor, Departments of Medicine and Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Peterson is associate director of the internal medicine residency program and assistant professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Sponsler is assistant professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee, and staff physician, VA Tennessee Valley Healthcare System, Nashville, Tennessee.

Dr. Vasilevskis is assistant professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Kripalani is chief of hospital medicine and associate professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Sergent is director, Internal Medicine Residency Program, and professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Brown is chair and professor, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Denny is assistant professor, Departments of Medicine and Biomedical Informatics, School of Medicine, Vanderbilt University, Nashville, Tennessee.

The authors have informed the journal that the research team for this report agrees that both Dr. Theobald and Dr. Stover completed the intellectual and other work typical of the work of the first author.

Correspondence should be sent to Dr. Theobald, VA Tennessee Valley Healthcare System, GRECC, 1310 24th Ave. S., Nashville, TN 37212; telephone: (615) 873-8024; fax: (615) 873-7981; e-mail: cecelia.theobald@vanderbilt.edu.

© 2013 Association of American Medical Colleges