​A national, randomized trial showed no significant statistical difference between less-restrictive duty-hour policies for surgical residents when compared to standard duty-hour policies, said a report in the February 2, 2016, New England Journal of Medicine (NEJM). The Accreditation Council for Graduate Medical Education (ACGME) in 2003 introduced regulations that limited residents to 80 hours per week and mandated minimum time between shifts. The reforms were introduced to reduce fatigue-related errors, but critics argue that mandatory cut-off times could jeopardize patient safety by forcing physicians to leave during critical times. For the flexible-policy group, ACGME waived requirements regarding maximum shift length and minimum time off between shifts. The trial found no significant differences in patient outcomes (the rate of patient death or serious complication was 9.1% under the flexible policy, 9.0% in the standard) or resident satisfaction (11.0% listed "very satisfied" in the flexible policy, 10.7% under the standard). An accompanying editorial in the NEJM noted that because there was no difference in patient outcomes between the two approaches to residency work hours, the notion that more flexibility in these  programs is warranted is not necessarily the best conclusion—rather, hospitals should find safe ways to provide care without relying on overworked residents. An accompanying perspective concluded that the problem with the current medical education system is that trainee physicians do not get the experience of autonomy needed to develop their clinical judgment and therefore more flexible residency programs could be advantageous.

HRC Recommends: Risk managers in facilities that participate in residency training programs should remain aware of the issues of patient safety and risk that have been identified regarding care provided by residents working long shifts and ensure that their facility's risk management program captures errors and near misses related to care provided by residents. Although residents are likely to discuss incidents and adverse events with other trainees or attending supervisors, residents may rarely report incidents through hospital reporting systems. Thus, as residents rotate through hospitals, many near misses, adverse events, and otherwise reportable events involving patient care provided by residents could remain unidentified and evade risk management review.