The Institute of Medicine's recommendations to ensure sleepy residents don't make medical mistakes could hurt rad residents' education and be costly, according to some radiologists.

An IOM report published at the end of 2008 suggested making changes to residents' on-duty workload, such as slashing late-night hours, to prevent fatigue-related errors. But in the January edition of the Journal of the American College of Radiology, researchers argue that some of the proposed changes, such as curbing night-shifts to no more than 2 or 3 a week, are "problematic."

The IOM, a respected scientific affairs group currently evaluating the FDA's medical device approval process, got tapped by Congress to find out if the current duty-hour limits set in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), which monitors medical school and residency education, protected patients from the dangers of residents working long hours on little sleep.

The concern is that sleep deprivation could lead to serious, even fatal, medical errors. Although a randomized control study comparing long and shorter shifts mentioned in the December 2008 IOM report failed to turn up a significant difference in error rates, other studies have shown that the grueling long-hour shifts typical of residencies result in more failures of attention and more serious medical errors.

"Studies in residents have been limited," admits David Dinges, Ph.D. Dr. Dinges is a professor of psychology and psychiatry at University of Pennsylvania and an authority on sleep research who was a member of the committee that developed the IOM report. But the "scientific evidence the sleep field has built up over the last 30 years" is immense, he says: sleepy people make more mistakes.

"The overwhelming amount of data from non-medical areas, as well as medical areas, is that there is a risk from inadequate sleep and that needs to be mitigated."

Still, the IOM didn't find much fault with the current ACGME duty-hour guidelines, and didn't recommend federal oversight of the program, something called for by many observers.

Their recommendations, which largely left the ACGME rules untouched and which allow a maximum 80-hour workweek for residents, focused on ensuring residents had blocks of time in which to get adequate sleep and pay off their "sleep debt."

For this to happen, the IOM recommended that residents have at least one day off per week, not one day off per week as averaged out over a whole month, as in the current system. And they said that residents could work the 30-hour maximum shift length (which includes a hefty educational portion) only if there was a protected 5-hour sleep period between 10 p.m. and 8 a.m., and even then the amount of time devoted to direct patient care, as opposed to education, was cut.

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