Resident duty hours in Canada: a survey and national statement

Abstract

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n=1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n=1598). Only 52% (830) had received training in handover (n=1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models.

Figure 1

Residents’ view of maximum continuous work hours. In response to the question, “Up to how many continuous hours of work do you feel that you are able to consistently provide safe, high quality patient care,” residents were asked to choose 12, 16, 20, 24, 30, or 36 hours, or “not sure”.

Figure 2

Reported impact of work hours on patient care. Residents were asked how often felt that the quality of the care they provided was compromised by the number of consecutive hours they had worked.

Figure 3

Frequency of training in patient handover. Residents were asked to choose all responses that would describe how they had been trained in skills relating to the handover of patient care. Numbers indicate number of responses (n = 830).