Fatigue, Risk and Excellence:
Towards a Pan-Canadian
Consensus on Resident Duty
Hours
Funded in part by Health Canada, the project ran from March
2012 – May 2013; Public report released on June 27
•Two central goals:
To assemble the available evidence on the issue of resident
duty hours in Canada and similar international contexts (or
duty hours at large)
To facilitate a national consensus-building process to come to
pan-Canadian statements on issues, directions, and best
practices
The final report was developed by the National Steering
Committee on Resident Duty Hours, a diverse group of medical
educators, residents and experts from across Canada, including
nine health care organizations
The project was divided into three key phases,
which together spanned the period from March
2012-May 2013.
Phase 1
Phase 2
(March 2012-August 2012)
(June 2012-January 2013)
Preliminary research and report
development
Analysis and consultations with
Expert Working Groups
Phase 3
(January 2013-May 2013)
Consensus Conference
Final Report
A mixed-method, multi-phased approach was developed to
guide research and analysis throughout the project, including
– Interviews with National Steering Committee members,
– National Survey of Residents, Postgraduate Deans, Program ,
Directors, and a Sample of Hospital Administrators,
– Analysis of Current and Historic Collective Agreements,
– Literature Review,
– Jurisdictional Review outside Canada,
– Six Expert Working Group Commentary Papers, and
– Canadian Consensus Conference on Resident Duty Hours.
A Way Forward for Canada
Key Findings +
5 Central Principles +
5 Recommendations
to Move Forward
• Canada has a unique landscape as pertains to resident duty
hour regulations.
• The environment in Canada is marked by tremendous
historical and geographic variability in the working
environments faced by residents.
1. Traditional duty periods present risks to the physical, mental,
and occupational health of residents.
2. Fatigue impairs cognitive and behavioural performance.
3. A tired doctor is not necessarily an unsafe doctor.
4. There is no conclusive data to show that restrictions on
consecutive resident duty hours are necessary for patient
safety.
5. Successful efforts to improve patient safety and resident
fatigue will need to be comprehensive, involving not only
the regulation of resident duty hours alone.
6.
7.
8.
There is no clear evidence that resident duty hour
regulations have had a significant positive or negative
impact on academic performance.
There is evidence suggesting suboptimal patient care and
educational outcomes in surgery resulting from the
restriction of resident duty hours.
Resident duty hour regulations necessitate
reorganization of health human resources deployment
and care delivery models. These changes have the
potential for impact on the health care system.
1. Residents have inter-related roles as learners and care providers.
2. Residents are vital providers in a health care system that is
collectively responsible for 24/7 patient care coverage
3. Duty periods of twenty-four or more consecutive hours without
restorative sleep should be avoided.
4. Efforts to minimize risk and enhance safety are necessary and
cannot be undertaken by addressing resident duty hours alone.
5. Given the substantial variation in resident training needs, a
tailored and rigorous model for resident duty hours and the
provision of after-hour care is needed.
Recognizing that there are many factors that contribute to
resident fatigue, a comprehensive approach to minimize
fatigue and fatigue-related risks should be developed and
implemented in residency training in all jurisdictions in Canada.
• Residency education programs to develop fatigue risk management
plans
• Create monitoring and enforcement mechanisms at a local level
• Develop a national tool-box of fatigue mitigation strategies and
techniques
Educational approaches should be redesigned to leverage
innovations and new approaches, to ensure appropriate
training and acquisition of competencies in an era of increasing
resident duty hour regulations.
• Encourage and catalogue pilot projects for a range of educational tools
and innovative scheduling systems
• Re-design residency education to maximize teaching and learning
opportunities, and minimize excessive service obligations
• Incorporate simulation experiences into programs as teaching tools
• Curricula to include self-assessment, fatigue management, and handover
skills
• The Three sister colleges to review specialty training requirements to
allow flexibility in training
Accreditation standards must be adapted to support planned
modifications of the content and duration of resident duty,
through the enforcement of fatigue risk management activities.
• Standards to specify that individual institutions must develop, and keep up
to date, fatigue risk management plans (FRMPs)
• Standards should require education in effective self-awareness, handover
and communication skills
An inventory of alternate models of scheduling and after-hours
care provision should be created and disseminated to provide
alternatives and benchmarks of scheduling and service
delivery.
• A national evaluation framework to monitor the impact of changes to
resident duty hours should be created.
An independent, pan-Canadian consortium devoted to the
evaluation of resident duty hours in Canada should be created.
• Enable local decision-making through the provision of resources and
measurement related to resident duty hours
Consortium would have four key roles:
1.
2.
3.
4.
Create and coordinate dissemination of national toolbox of resources
Support the process of Fatigue Risk Management Plan
creation/implementation
Undertake science and evidence-based research on resident duty hours
Knowledge translation and dissemination of scholarly evidence
View the complete report to learn more about
• Project timelines and activities
• Project methodology
• A glossary of resident duty hours terminology
• Key research themes and findings
• Pan-Canadian principles
• Recommendations