Canadian doctors who work shifts of up to 26 hours during their residency training can become so fatigued their performance is inhibited, according to a new report.
The report by the National Steering Committee on Resident Duty Hours said there's no conclusive data that restricting residents' consecutive hours on shift is needed for patient safety, but that all residency education should be required to develop programs to manage fatigue.
"Fatigue is more than how many hours are worked. It's also the type of work being done, the intensity of workload and many other factors," said Dr. Kevin Imrie, the committee's co-chair and physician-in-chief at Sunnybrook Health Sciences Centre in Toronto.
"We need to better manage fatigue, create more effective call schedules and do a better job of designing our training programs in order to create positive, lasting change," he added in a news release today.
The report's authors said the status quo for residents' working hours is not acceptable. Being on duty for 24 or more consecutive hours without "restorative sleep" should be avoided and only occur under rare and exceptional circumstances. Many U.S. and European hospitals place such limits.
Studies suggest lack of sleep inhibits performance and, for example, can increase the risk of needle stick accidents in hospitals.
The committee pointed to ongoing negotiations and legal implications of recent labour arbitration rulings in two provinces.
In 2011, a labour arbitration ruling in Quebec determined residents can't work more than 16 hours consecutively on call. (Regulations on total number of hours per week weren't stipulated.) Since then, the authors said that concerns have been raised about frequently alternating between day and night shifts and frequent handovers during patient care, which may increase the potential for miscommunication and medical errors.
In March, an arbitration ruling in Nova Scotia awarded annual wage increases to medical residents in the Maritimes. The committee said as changes are made to residents' education and schedules, national data could help in evaluating the impacts and comparing jurisdictions.
The report's authors included members who accredit residency programs and participants, including the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada.
The Quebec Medical Association said Thursday it agreed with the conclusions of the report.
"The restriction on resident duty hours obliges us to rethink our ways of doing things. It is our system as a whole that has a workload problem," QMA president Dr. Laurent Marcoux said in a statement.