The regulation of resident duty hours is a complex and challenging issue, with implications across the health and medical education systems. In Canada, as in many other jurisdictions, physicians in training have a dual role of a learner and a clinical care provider. The balance between each role in Canadian residency programs is currently managed by individual collective agreements in different provincial jurisdictions, with no formal system, standards, or principles, leading to significant variability across the country. Emerging evidence and awareness with respect to issues such as patient safety, preparedness for practice, impact on health service delivery, access to care, professionalism, appropriate work-life balance, emerging evidence regarding chronobiology and sleep science, and evolving models of training, has driven further divergence regarding the ideal balance between education and service provision across the country.
The regulation of resident duty hours has been a source of much national and international debate. In the name of resident and patient safety, trends in the European Union and the United States have focused on two primary duty hour reforms: reducing the total maximum number of hours per week and/or reducing the total maximum consecutive hours. In Canada, the 2011 ruling in Quebec focused on the latter reform, reducing consecutive work hours through the elimination of 24-hour on-call shift by decreasing maximum, in-house on call shift length to 16 hours. Similarly, more recently in Nova Scotia, an arbitration award was made citing lengthy resident duty hours as a key contributor of health and wellness, and patient safety, concerns among resident physicians. However, considering the potential impact of such reform on other Canadian jurisdictions, these changes increased the debate regarding how Canadian health care should move forward given Canada’s significant variability in national standards across the country.
In 2012, a collaborative project entitled Towards a Pan-Canadian Consensus on Resident Duty Hours was launched in March 2012 to undertake two key objectives related to the hours worked by Canadian physicians and surgeons in training: first, to assemble the available evidence on the issue and, second, to produce pan-Canadian standards on the complex issues of resident duty hours.
Collaboration across Canadian medical education
This project was led by the National Steering Committee on Resident Duty Hours, an organization made up of experts from across Canada. Click here to view a complete list of participants in the National Steering Committee on Resident Duty Hours and Expert Working Groups. Also, nine stakeholders from across Canadian health care also participated: