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—Drs Friedmann and Griffen highlight that many factors aside from working hours are pertinent to any inquiry about quality of care and quality of education in teaching hospitals. Supervision was in full compliance with Code 405 during both study periods, so our study addressed working hours alone. Future efforts should explore the balance between supervision, autonomy, service, and education necessary to achieve high-quality patient care and resident education without one suffering at the expense of the other.Furthermore, while we agree that residency is arduous, we believe that Dr Carmichael has, unfortunately, misinterpreted our conclusions.We did not condemn shortened resident hours. Our study suggests that restricted hours do not guarantee improved quality of care, particularly if achieved via a system of cross-coverage resulting in an increased patient-to-physician ratio and loss of continuity. Training programs can limit hours by numerous strategies. We do not denounce shortened hours, we
Laine C, Goldman L, Soukup JR, Hayes JG. House Staff Work Hours, Supervision, and Quality of Care-Reply. JAMA. 1993;269(23):2987–2988. doi:10.1001/jama.1993.03500230069029