Since the 2011 duty-hour restrictions got underway, I’ve discussed the urgent need to assess their impact on patient safety and resident education. On July 1, 2015, we launched a study with these aims.
Known as iCOMPARE, the study includes 63 programs across the country that have been randomized to the current Accreditation Council for Graduate Medical Education duty-hour standards or to more flexible hours. The primary outcome measure of the trial is patient mortality, which will be assessed alongside additional patient safety metrics. Resident education and experience are also being measured.
As part of this, residents in a subset of programs will be monitored for sleep and fatigue using actigraphy. An additional subset of residents will be followed by observers to record time spent on other activities to shed light on how duty-hour policy affects the time residents spend in direct patient care. Also, every day during the study, hundreds of residents will receive brief surveys asking about the previous 24 hours. These aim to assess educational experiences as well as continuity of care and patient handoffs.
iCOMPARE is unique and meaningful for several reasons. First, it’s the largest randomized trial in graduate medical education for internal medicine. Second, it attempts to address the compelling interests for policymakers, trainees and leaders in graduate medical education. A testament to that mutual interest is that iCOMPARE is funded by the ACGME and by the National Heart, Lung, and Blood Institute.
We are proud to help lead this trial. The Osler Program was randomized to the flexible arm of the study. As such, we’ve implemented new schedules for almost all our rotations that have allowed us to introduce innovative educational initiatives, including a service dedicated to teaching bedside clinical skills. Data collection for iCOMPARE will end in June 2016. Updates to follow.