The FIRST trial begins this July and runs until June 2015. Participating hospitals will be randomized to the current restrictions versus more flexible duty hours. All residents (not just interns) in general surgery programs will participate, including off-service residents rotating in surgery. Hospitals in the intervention group will be permitted to eliminate all resident duty hour restrictions except the core limitations of 80 hours per week, minimum of one free day per week, and in-house call no more frequent than every third night. Other than that, anything goes. Presumably, some programs will use consecutive duty periods of 36 hours or more. This could potentially affect emergency medicine residents rotating on a general surgery service during the upcoming academic year. The primary outcome measurements will be patient death or serious morbidity.
It will be several years before we see the results from these studies. However, by permitting these randomized controlled trials to go forward, the ACGME and the medical education community is acknowledging that there may be value in having residents spend more time with their patients and that patients may benefit from improved continuity with hospital providers.
2. Van Dongen HPA, Dinges DF. Circadian rhythm in sleepiness, alertness, and performance. In: Kryger MH, Roth T, Dement WC, eds. Principles and practice of sleep medicine. 4th ed. Philadelphia, Pa: Elsevier; 2005:435-443.
4. Desai SV, Feldman L, Brown L, Dezube R, et al. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med. 2013;173:649-655.
Dr. House is professor of emergency medicine at the University of Iowa and vice chair for education in the Department of Emergency Medicine.
Dr. Mutnick is a resident physician at the University of Iowa.