title: Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review.
abstract: OBJECTIVE
  To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles.
  
  
  METHODS
  Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion.
  
  
  RESULTS
  72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made.
  
  
  CONCLUSIONS
  Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes.
authors.affiliation: University College Hospital, London NW1 6BU, UK. ramani.moonesinghe@uclh.nhs.uk
authors.forename: S R
authors.initials: SR
authors.lastname: Moonesinghe
authors.forename: J
authors.initials: J
authors.lastname: Lowery
authors.forename: N
authors.initials: N
authors.lastname: Shahi
authors.forename: A
authors.initials: A
authors.lastname: Millen
authors.forename: J D
authors.initials: JD
authors.lastname: Beard
mesh_terms: D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004521:Educational Measurement; D006801:Humans; D007318:Inservice Training; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D006113:United Kingdom; D016526:Workload