{"id":651,"date":"2011-10-20T12:32:21","date_gmt":"2011-10-20T16:32:21","guid":{"rendered":"http:\/\/blogstemp2.wpengine.com\/?p=651"},"modified":"2015-05-13T08:02:38","modified_gmt":"2015-05-13T12:02:38","slug":"shifting-times","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/","title":{"rendered":"Shifting Times"},"content":{"rendered":"

\"hourglass\"<\/a>Anyone involved in academic medicine probably is aware of the new ACGME duty-hour restrictions that went into effect\u00a0 on 7\/1\/2011. For those of you who aren\u2019t, the new guidelines state that PGY1 residents cannot work for longer than 16 hours straight. If they do work longer, they require strategic uninterrupted naps. The restrictions on PGY2 and PGY3 residents are less stringent, but the total consecutive hours that a PGY2 (and beyond) can work was lowered\u00a0from 30 to 28. One other change is that residents are mandated to have 8 hours off, and recommended to have 10 hours off, between shifts. As one of the chief residents when this change occurred,\u00a0I really want to share my thoughts about it.<\/p>\n

For our program, these new rules have meant a transition to shift work on all days of the week. We have had night float for the past 5 or 6 years, but we had overnight \u201clong\u201d calls during the weekends. I can see both good and bad things about this new call change. We avoid some resident fatigue, because\u00a0interns work only 16 hours maximum. The problem is that, in order to accommodate for the shifts,\u00a0giving interns an entire weekend off is very difficult. The Golden Weekend is becoming somewhat of a myth to our intern class. Transitioning to a shift-based call system also points out major flaws in our handoff process. We have noticed that our \u201ccheckouts\u201d\/handoffs were not relaying the needed information\u00a0and, as a program, we’ve been trying various things to improve this process.<\/p>\n

\"resident<\/a>One thing I ask of\u00a0every resident reading this page\u00a0is — be nice to your chief resident! We didn\u2019t make this rule, nor did we have any input into the decision, but\u00a0we have\u00a0to enforce it. The more restrictions that the ACGME\u00a0puts on\u00a0resident work hours,\u00a0the more complaints I hear from attending physicians about having to pick up the slack. We often do not have the manpower to ensure that every service will have a \u201cfull team\u201d of interns and residents to complete daily work, and we have to rely on staff physicians to fill the service gap.<\/p>\n

Our job to ensure that residents do not work more hours than they are allowed and, thus, avoid citations against our program.\u00a0Problems\u00a0arise mostly when residents who are on weekday call (which ends at 7PM for us) delay\u00a0leaving because of notes, orders, or patient care issues. If a resident does not leave until 9 or 10PM, they cannot come back into the hospital until 7 or 8AM. This means that those residents probably have not seen all of their patients before rounds begin,\u00a0and the responsibility falls\u00a0on other residents or the attending physician. I realize that this issue is a culture shock for some of the older physicians who \u201cused to walk to work in a foot of snow uphill both ways,\u201d but these are the rules, and we all have to live by them. So, please, cut your chief a break!<\/p>\n","protected":false},"excerpt":{"rendered":"

Anyone involved in academic medicine probably is aware of the new ACGME duty-hour restrictions that went into effect\u00a0 on 7\/1\/2011. For those of you who aren\u2019t, the new guidelines state that PGY1 residents cannot work for longer than 16 hours straight. If they do work longer, they require strategic uninterrupted naps. The restrictions on PGY2 […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[31,36,37],"class_list":["post-651","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-patient-care","tag-resident-blog","tag-resident-experience"],"yoast_head":"\nShifting Times - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Shifting Times\" \/>\n<meta property=\"og:description\" content=\"Anyone involved in academic medicine probably is aware of the new ACGME duty-hour restrictions that went into effect\u00a0 on 7\/1\/2011. For those of you who aren\u2019t, the new guidelines state that PGY1 residents cannot work for longer than 16 hours straight. If they do work longer, they require strategic uninterrupted naps. The restrictions on PGY2 […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2011-10-20T16:32:21+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-05-13T12:02:38+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/10\/hourglass-220x300.jpg\" \/>\n<meta name=\"author\" content=\"Gopi Astik, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Gopi Astik, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/\",\"name\":\"Shifting Times - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2011-10-20T16:32:21+00:00\",\"dateModified\":\"2015-05-13T12:02:38+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/f20ecd160f9de6928530ce6ceb8829f8\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Shifting Times\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/f20ecd160f9de6928530ce6ceb8829f8\",\"name\":\"Gopi Astik, MD\",\"description\":\"Dr. Astik grew up in Warrensburg, Missouri, an hour east of Kansas City. She received her Bachelor of Arts\/MD in a 6-year combined program at the University of Missouri-Kansas City. Dr. Astik was an Internal Medicine resident at UMKC from June 2008 to July 2011 and currently is completing an extra year as a Chief Resident. She is planning to apply for a Gastroenterology fellowship in 2012. Dr. Astik is an avid tennis player and has been playing competitively since childhood; she loves to meet and talk with new people.\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/author\/gastik\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Shifting Times - Insights on Residency Training","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/","og_locale":"en_US","og_type":"article","og_title":"Shifting Times","og_description":"Anyone involved in academic medicine probably is aware of the new ACGME duty-hour restrictions that went into effect\u00a0 on 7\/1\/2011. For those of you who aren\u2019t, the new guidelines state that PGY1 residents cannot work for longer than 16 hours straight. If they do work longer, they require strategic uninterrupted naps. The restrictions on PGY2 […]","og_url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/","og_site_name":"Insights on Residency Training","article_published_time":"2011-10-20T16:32:21+00:00","article_modified_time":"2015-05-13T12:02:38+00:00","og_image":[{"url":"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/10\/hourglass-220x300.jpg"}],"author":"Gopi Astik, MD","twitter_misc":{"Written by":"Gopi Astik, MD","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/","url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/","name":"Shifting Times - Insights on Residency Training","isPartOf":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/#website"},"datePublished":"2011-10-20T16:32:21+00:00","dateModified":"2015-05-13T12:02:38+00:00","author":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/f20ecd160f9de6928530ce6ceb8829f8"},"breadcrumb":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/10\/shifting-times\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.nejm.org\/general-medicine\/"},{"@type":"ListItem","position":2,"name":"Shifting Times"}]},{"@type":"WebSite","@id":"https:\/\/blogs.nejm.org\/general-medicine\/#website","url":"https:\/\/blogs.nejm.org\/general-medicine\/","name":"Insights on Residency Training","description":"Observation of residents across diverse medical specialties","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/f20ecd160f9de6928530ce6ceb8829f8","name":"Gopi Astik, MD","description":"Dr. Astik grew up in Warrensburg, Missouri, an hour east of Kansas City. She received her Bachelor of Arts\/MD in a 6-year combined program at the University of Missouri-Kansas City. Dr. Astik was an Internal Medicine resident at UMKC from June 2008 to July 2011 and currently is completing an extra year as a Chief Resident. She is planning to apply for a Gastroenterology fellowship in 2012. Dr. Astik is an avid tennis player and has been playing competitively since childhood; she loves to meet and talk with new people.","url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/author\/gastik\/"}]}},"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts\/651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/comments?post=651"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts\/651\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/media?parent=651"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/categories?post=651"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/tags?post=651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}