Invited Commentary

Commentary on Survey of Internal Medicine Physicians Trained in Three Different Eras: Reflections on Duty-Hour Reform”

Authors: Cathy A. Petti, MD, Bennett W. Pafford, MD, MPH


In this issue of the Southern Medical Journal, Burton and colleagues1 examine physician attitudes toward duty-hour reform at their institution. This topic has received strong physician response from all generations since 2003 when the Accreditation Council for Graduate Medical Education implemented work hour restrictions.2 This study by Burton and colleagues adds to the literature that demonstrates change does not come easily in a portion of the physician community.1 The authors surveyed physicians from three discrete training eras with the intent to capture a wide spectrum of perceptions regarding duty-hour reform.1 The study suggests that among respondents, the older generation of academic physicians believes duty-hour reform may cause residents to be less prepared for future careers and focus attention on patient safety. Previous studies on this topic were challenged for their study design, validity, and lack of generalizability.3 Although this study shares some of the same limitations, we applaud the authors’ effort to explore generational attitudes toward work-hour reform.1

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1. Burton MC, Larsen CM, Issa M, et al. Survey of internal medicine physicians trained in three different eras: reflections on duty-hour reform. South Med J 2014;107:396-401.
2. Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med 2013;173:649-655.
3. Eaton JE, Reed DA, Aboff BM, et al. Update in internal medicine residency education: a review of the literature in 2010 and 2011. J Grad Med Educ 2013;5:203-210.
4. National Transportation Safety Board. NTSB safety recommendations. Accessed February 10, 2014.
5. Federal Aviation Administration. Regulations & policies. Accessed February 10, 2014.
6. Theobald CN, Stover DG, Choma NN, et al. The effect of reducing maximum shift lengths to 16 hours on internal medicine interns’ educational opportunities. Acad Med 2013;88:512-518.