Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. Resident Duty Hours provides a timely examination of how those requirements were implemented and their impact on safety, education, and the training institutions. An in-depth review of the evidence on sleep and human performance indicated a need to increase opportunities for sleep during residency training to prevent acute and chronic sleep deprivation and minimize the risk of fatigue-related errors. In addition to recommending opportunities for on-duty sleep during long duty periods and breaks for sleep of appropriate lengths between work periods, the committee also recommends enhancements of supervision, appropriate workload, and changes in the work environment to improve conditions for safety and learning. All residents, medical educators, those involved with academic training institutions, specialty societies, professional groups, and consumer/patient safety organizations will find this book useful to advocate for an improved culture of safety.

Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. Resident Duty Hours provides a timely examination of how those requirements were implemented and their impact on safety, education, and the training institutions. An in-depth review of the evidence on sleep and human performance indicated a need to increase opportunities for sleep during residency training to prevent acute and chronic sleep deprivation and minimize the risk of fatigue-related errors. In addition to recommending opportunities for on-duty sleep during long duty periods and breaks for sleep of appropriate lengths between work periods, the committee also recommends enhancements of supervision, appropriate workload, and changes in the work environment to improve conditions for safety and learning. All residents, medical educators, those involved with academic training institutions, specialty societies, professional groups, and consumer/patient safety organizations will find this book useful to advocate for an improved culture of safety.

This unique and engaging open access title provides a compelling and ground-breaking account of the patient safety movement in the United States, told from the perspective of one of its most prominent leaders, and arguably the movement’s founder, Lucian L. Leape, MD. Covering the growth of the field from the late 1980s to 2015, Dr. Leape details the developments, actors, organizations, research, and policy-making activities that marked the evolution and major advances of patient safety in this time span. In addition, and perhaps most importantly, this book not only comprehensively details how and why human and systems errors too often occur in the process of providing health care, it also promotes an in-depth understanding of the principles and practices of patient safety, including how they were influenced by today’s modern safety sciences and systems theory and design. Indeed, the book emphasizes how the growing awareness of systems-design thinking and the self-education and commitment to improving patient safety, by not only Dr. Leape but a wide range of other clinicians and health executives from both the private and public sectors, all converged to drive forward the patient safety movement in the US. Making Healthcare Safe is divided into four parts: I. In the Beginning describes the research and theory that defined patient safety and the early initiatives to enhance it. II. Institutional Responses tells the stories of the efforts of the major organizations that began to apply the new concepts and make patient safety a reality. Most of these stories have not been previously told, so this account becomes their histories as well. III. Getting to Work provides in-depth analyses of four key issues that cut across disciplinary lines impacting patient safety which required special attention. IV. Creating a Culture of Safety looks to the future, marshalling the best thinking about what it will take to achieve the safe care we all deserve. Captivatingly written with an “insider’s” tone and a major contribution to the clinical literature, this title will be of immense value to health care professionals, to students in a range of academic disciplines, to medical trainees, to health administrators, to policymakers and even to lay readers with an interest in patient safety and in the critical quest to create safe care.

On July 1, 2003, work-hour reforms were enacted nationally for the roughly 129,000 resident physicians in the United States. The reforms limit weekly work hours (a maximum of eighty per week) and in-hospital call (no more than once every three nights), mandate days free of clinical and educational obligations (one day in seven), and regulate other aspects of resident work life. Why Surgeons Struggle with Work-Hour Reforms focuses on general surgeons, a historically long-hour specialty, who fiercely opposed the reforms and are among the least compliant. Why do surgeons struggle with the reforms? Why do they continue to work long hours and view the act of doing so as reasonable if not quintessentially professional? Although the analysis is situated in the growing scientific literature on the consequences of fatigue, the authors do not adjudicate between the claims of surgeons and reform advocates about the effects of long work hours on patient or provider safety. Rather, the aim is to explore and explain how aspects of the occupational culture of surgeons and the social organization of surgical training and practice interlock to impede the reforms.

Patients who are confident of physicians' intellectual and technical abilities are sometimes not convinced of their professional behavior. Systemic and anecdotal cases of physician misconduct, conflict of interest, and self-interest abound. Many have even come to mistrust physicians as patient advocates. How can patients trust the intellectual and technical aspects of medical care, but not the professional? In order to enhance and promote professionalism in medicine, one should expect it, encourage it, and evaluate it. By measuring their own professional behavior, physicians can provide the kind of transparency with which they can regain the trust of patients and society.Not only patients, but also institutions which accredit organizations have demanded accountability of physicians in their professional behavior. While there has been much lament and a few strong proposals for improving professionalism, no single reliable and valid measure of the success of these proposals exists. This book is a theory-to-practice text focused on ways to evaluate professional behavior written by leaders in the field of medical education and assessment.

Graduate medical education (GME) is a continually evolving, highly dynamic area within the complex fabric of the modern health-care environment. Given the rapidly changing regulatory, financial, scientific and technical aspects of GME, many institutions and programs face daily challenges of "keeping up" with the most recent developments within this ever-more-sophisticated operational environment. Organizational excellence is a requirement for the seamless functioning of GME programs, especially when one consider the multiple disciplines and stakeholders involved. The goal of the current book cycle, titled Contemporary Topics in Graduate Medical Education, beginning with this inaugural tome, is to provide GME professionals with a practical and readily applicable set of reference materials. More than 20 distinguished authors from some of the top teaching institutions in the US, touch upon some of the most relevant, contemporary, and at times controversial topics, including provider burnout, gender equality issues, trainee wellness, scholarly activities and requirements, and many other theoretical and practical considerations. We hope that the reader will find this book to be a valuable and high quality resource of a broad range of GME-related topics. It is the Editors' goal to create a multi-tome platform that will become the definitive go-to reference for professionals navigating the complex landscape of modern graduate medical education.

In turn heartbreaking, irreverent, moving—and at times raucously humorous—one of the nation's leading pediatric researchers recounts his first years as a newly minted, stuggling, and insecure doctor at Massachusetts General Hospital in Boston. A graduate of a state university medical school, Scott Rivkees was competing with elite students from some of the most prestigious schools in the country. Nervous and uncertain, he worked unholy hours with patients ranging from indigent street people to celebrity guests drawn to the reputation and care offered by Mass General. Along the way he learned what medical school textbooks don't teach: how to deal with immense pressure, exhaustion, unruly patients, mysterious conditions, the joy of saving a life, and the wrenching suddenness of losing a patient, more often than not a young child. His resident education did not prevent him from losing his sense of irony and humor as he recounts bleary nights on the town, the allure of young nurses, substandard housing, and the value of pricking an inflated ego.