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December 5, 2012

Professionalism in the Era of Duty HoursTime for a Shift Change?

Author Affiliations

Author Affiliations: Department of Medicine, Sections of General Internal Medicine (Dr Arora) and Hospital Medicine (Dr Farnan), and Pritzker School of Medicine (Drs Arora, Farnan, and Humphrey), University of Chicago, Chicago, Illinois.

JAMA. 2012;308(21):2195-2196. doi:10.1001/jama.2012.14584

Concerns have been raised that the implementation of shorter duty hours for residents may erode the professional allegiance of these physicians to their patients. Those who trained before duty hour regulations often dismiss current physicians in training as lifestyle oriented and not committed to the profession. Even residents who completed their internship training before 2011 have become instant “grandfathers,” sharing in these sentiments.

Yet old values do not simply die in a new system. Despite duty hour restrictions, today's trainees continue to exhibit behaviors consistent with “nostalgic professionalism,”1 defined as consistently placing a patient's or the profession's needs above one's own personal needs. However, at times these behaviors directly conflict with the current system of medical training. This creates a challenge for medical educators: how can the conflict between nostalgic definitions of professionalism and the new model of medical training be reconciled? Answering this question requires a deeper understanding of specific circumstances in modern residency training in which resident actions consistent with nostalgic professionalism conflict with mandated regulation.

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