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June 23, 1989

Residents' Work Schedules-Reply

JAMA. 1989;261(24):3549. doi:10.1001/jama.1989.03420240062016

In Reply. —  Drs Gleckel and Walerstein complain about my advocacy of "untested guidelines" such as those promulgated by the Bell Committee. But where are the scientific studies supporting the present residency training system? Despite decades of opportunity, not a single study has shown that 100-hour work weeks or 36-hour shifts improve patient care or result in a better educational experience.I find it hypocritical for those who tolerated an obviously flawed residency system—that lacked any scientific underpining—now to demand studies before making changes. I do support trials of innovative training programs. What I oppose is delaying overdue changes for several more years to acquire data.As I have discussed elsewhere,1 the present system is suboptimal for learning. Although its supposed educational advantages often are used to defend it, according to Wentz and Ford,2 the "evolution of many... characteristics has been determined more by socioeconomic-political issues than by