Five key principles: A collective, pan-Canadian response for resident duty hours
1. Residents have inter-related roles as learners and care providers
- Duty hours are training hours and are an integral component of the delivery of patient care in the Canadian health care system
2. Residents are vital providers in a health care system that is collectively responsible for 24/7 patient care coverage
- The Canadian health care system is obligated to provide patient care coverage at all hours of the day, every day. However, it bears recognition and distinction that this is a system-wide responsibility rather than the responsibility of any single health care provider. Residents form an important component of the entire team of providers that has a collective, rather than individual, responsibility to ensure patient care coverage is there when it is needed to guarantee the timely provision of the best care for all Canadians.
3. Duty periods of twenty four or more consecutive hours without restorative sleep should be avoided
- In recognition of the risks posed by such duty periods, we suggest they should only be undertaken in rare and exceptional circumstances
4. Efforts to minimize risk and enhance safety are necessary and cannot be undertaken by addressing resident duty hours alone
- Resident duty hours are only one of a multitude of factors that contribute to resident fatigue. To be effective, efforts to improve safety outcomes will need to include other factors in both education and health service delivery such as the improvement of work processes, supervision, and education.
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.
- Resident training needs exemplify significant diversity across the country, among disciplines, between rotations and training sites, and across stages of training. Optimizing resident training and patient care requires consideration of a number of unique factors within each rotation. There is no single one-size-fits-all approach that will optimize the education, patient safety, and patient care components of Canada’s diverse residency education system