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Editor's Note
April 22, 2013

Reconciling the Work, the Learning, and the Hours: Comment on “Effects of the 2011 Duty Hour Reforms on Interns and Their Patients” and “Change in Intern Calls at Night After a Work Hour Restriction Process Change”

JAMA Intern Med. 2013;173(8):663. doi:10.1001/jamainternmed.2013.487

Two articles in this issue of the journal highlight continuing problems with implementing the Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions and the impact on several domains of learning and care. There is a need for innovative models of care and teaching that optimize learning, minimize transitions of care, and maximize the safety and quality of care, while also tending to the lifestyle and educational needs of trainees. Unfortunately, the policy was implemented without robust evidence on how best to achieve these outcomes. The ACGME policy on work hours is well intentioned and has been associated with improvement in the quality of life of trainees, but it has also been associated with a decrement in educational effectiveness and perceptions of lower quality of care. Hospital administrators and program directors can do a better job of multicenter collaborating and studying innovative models that can inform best practice implementation. Establishing the infrastructure to do this will not only help implement the current policy but also inform future evidence-based educational policy in residency training programs.