Why Residencies Should Fly: Towards a Logical Approach to Duty Hour Reform

J Gen Intern Med. 2020 May 29. doi: 10.1007/s11606-020-05894-z. Online ahead of print.

Abstract

Since 2011, aviation has revolutionized their approach to safety. The aviation industry has adopted a multi-faceted approach to improve safety through decreasing duty hour limits and implementing processes to mitigate fatigue-related errors as well as creating cultural shifts in responsibility for safety. These changes have been guided by data generated by quality-improvement methodology. In contrast, duty hour limits in graduate medical education have not yet seen dramatic data-driven reform. Key advancements in aviation fatigue mitigation and implications for residency education are explored in this article. Scientifically based processes to optimize duty hours, quality-improvement strategies to iteratively monitor and reform duty limits, systematic change focusing on a just culture, and financial disincentives and incentives as a catalyst for change are discussed.

Keywords: aviation; duty hours; fatigue; graduate medical education; patient safety; wellness.