Two weeks ago, the Accreditation Council for Graduate Medical Education, the organization responsible for accrediting American medical residency programs, issued an open letter that outlined its plans to review, revise and enforce residency duty hours. The letter is part of continuing efforts to improve the way that medical residents, the recent medical graduates who care for patients, are trained in this country.
Five years ago, the organization established an 80-hour cap on resident workweeks, a move spurred in part by the 1984 death of Libby Zion, a young woman who was under the care of residents on call, and by years of legal wrangling. Despite the reforms, the organization came under criticism by a national panel of medical experts that said it had failed to address work hour violations that were "substantial and underreported."
I spoke with Dr. Thomas J. Nasca, the chief executive of the council, and asked him about resident duty hours, patient safety in teaching hospitals and the implications of further duty hour changes to the doctor-patient relationship.