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Letters to the Editor  |   October 2019
Resident Duty Hour Restrictions
Author Notes
  • St Luke's Hospital Family Medicine Residency, Perrysburg, Ohio 
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   October 2019
Resident Duty Hour Restrictions
The Journal of the American Osteopathic Association, October 2019, Vol. 119, 644. doi:10.7556/jaoa.2019.110
The Journal of the American Osteopathic Association, October 2019, Vol. 119, 644. doi:10.7556/jaoa.2019.110
To the Editor: 
As chief residents of a previous dually accredited program and current Accreditation Council for Graduate Medical Education–accredited program with osteopathic recognition, we have seen how duty hour restrictions affect residents. We appreciate Berry and McClain's update on the transition to the single accreditation system and synopsis of the iCOMPARE (Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education) trial and FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial.1 We second the idea of investigating individualized duty hour policies to promote resident well-being, specifically after reviewing iCOMPARE data. 
The iCOMPARE trial shows evidence of intern well-being negatively correlating with flexible duty hour restrictions in categories such as job satisfaction, career choice satisfaction, work-life balance, and overall well-being. Flexible duty hour restrictions also correlated to higher measures of burnout.2 This trend, on top of the study's perceived “burned out” control group, suggests that individualized duty hours policies may benefit from options with reductions in duty hours. Interestingly, Piotrowski et al3 reported that among 748 medical students who had an understanding of extended residency length and decreased annual salary, more than half of the students preferred a 60-hour work week compared with an 80-hour work week. Additionally, students interested in primary care specialties and women were more likely to prefer reduced duty hour requirements.3 With iCOMPARE data showing pervasive burnout and current medical students’ interest in reduced duty hour options, we hope that individualized duty hour policies are comprehensively and objectively vetted in the future. 
The American Osteopathic Association's Trainee Duty Hours Policy recognizes the need for strict duty hour mandates to aid in preventing poor resident well-being.4 In congruence with this policy, our residency has implemented policies to protect resident well-being. Two successful policies include weekly wellness breaks to promote fun collaboration between residents and faculty and protected time for each resident class. This protected time is in addition to traditional didactic sessions and ensures a personal collaborative network in each cohort. These strategies have been successful for the well-being of our residents, and we believe other residencies should consider adopting similar policies until individualized duty hours become a realistic option. 
References
Berry AC, McClain EK. Resident duty hour restrictions: the implications behind the new data ahead of the single accreditation system. J Am Osteopath Assoc. 2018;118(8):501-503. doi: 10.7556/jaoa.2018.116 [CrossRef] [PubMed]
Desai SV, Asch DA, Bellini L, et al. Education outcomes in a duty-hour flexibility trial in internal medicine. N Engl J Med. 2018;378:1494-1508. doi: 10.1056/NEJMoa1800965 [CrossRef] [PubMed]
Piotrowski M, Stulberg D, Egan M. Medical student interest in flexible residency training options. Fam Med. 2018;50(5):339-344. doi: 10.22454/FamMed.2018.169078 [CrossRef] [PubMed]
Association American Osteopathic. The Basic Documents for Postdoctoral Training. Chicago, IL: American Osteopathic Association. 2018. https://osteopathic.org/wp-content/uploads/2018/03/aoa-basic-document-for-postdoctoral-training.pdf. Accessed January 20, 2019.