title: The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review.
abstract: BACKGROUND
  Despite 25 years of implementation and a sizable amount of research, the impact of resident duty hour restrictions on patients and residents still is unclear. Advocates interpret the research as necessitating immediate change; opponents draw competing conclusions.
  
  
  OBJECTIVE
  This study updates a systematic review of the literature on duty hour restrictions conducted 1 year prior to the implementation of the Accreditation Council for Graduate Medical Education's 2011 regulations.
  
  
  METHODS
  The review draws on reports catalogued in MEDLINE and PreMEDLINE from 2010 to 2013. Interventions that dealt with the duty hour restrictions included night float, shortened shifts, and protected time for sleep. Outcomes were patient care, resident well-being, and resident education. Studies were excluded if they were not conducted in patient care settings.
  
  
  RESULTS
  Twenty-seven studies met the inclusion criteria. Most frequently, the studies concluded that the restrictions had no impact on patient care (50%) or resident wellness (47%), and had a negative impact on resident education (64%). Night float was the most frequent means of implementing duty hour restrictions, yet it yielded the highest proportion of unfavorable findings.
  
  
  CONCLUSIONS
  This updated review, including 27 recent applicable studies, demonstrates that focusing on duty hours alone has not resulted in improvements in patient care or resident well-being. The added duty hour restrictions implemented in 2011 appear to have had an unintended negative impact on resident education. New approaches to the issue of physician fatigue and its relationship to patient care and resident education are needed.
authors.forename: Lauren
authors.initials: L
authors.lastname: Bolster
authors.forename: Liam
authors.initials: L
authors.lastname: Rourke
mesh_terms: D004503:Education, Medical, Graduate / Q000379:methods; D005221:Fatigue / Q000517:prevention & control; D006801:Humans; D007396:Internship and Residency; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D010820:Physicians / Q000523:psychology*; D014481:United States; D014940:Work Schedule Tolerance / Q000502:physiology / Q000523:psychology; D016526:Workload / Q000592:standards*