In fact, the perceived negative impact of the 80-hour work week on medical education has no real basis—except perhaps in terms of a decline in patient numbers. I believe that this loss is counterbalanced by the gains made in terms of an increase in the quality of patient care and safety, as well as the strengthening of acquired knowledge because residents will be more alert, make fewer mistakes, and have increased productivity. This viewpoint is not new, and is supported by numerous studies. For example, duration of work hours compared with the duration and quality of sleep, are viewed as factors that influence health-care quality.
9 Similarly, Howard and colleagues
10 reported that resident skill level was negatively affected, and “post-call conditions were near or below levels associated with clinical sleep disorders,” justifying reforms for residents' work and duty hours. In two studies of intensive care units, the Harvard Work Hours and Health Study Group concluded that attention failures decreased with significant increase in sleep during night work hours
11 and there were “substantially more” serious medical errors with frequent 24-hour shifts.
12 Similar results were found in a smaller scale study.
13 Additional studies, all on simulations of laparoscopic surgeries, showed that more errors (ie, limited dexterity, impaired speed, accuracy, economy of motion) occurred as sleep loss increased and after multiple nights on call.
14-17 One of these studies showed that performance decreased after 17 hours,
4 consistent with results reported elsewhere for nurses.
4 In addition, some evidence exists that problems related to sleep-deprivation extend for 2 days beyond a sleepless night.
18 It is my contention that residents with healthier sleep patterns will establish better habits of alertness and mental focus for their individual medical readings and projects, as well as their journal clubs, seminars, and conferences. All of this will benefit residents as future physicians—ultimately benefiting patients.