Adopting work schedules that "account for circadian phase" may be necessary, the authors suggested, as well as including funding for additional clinical staff.
They noted the association between "increased work compression" and "poorer clinical performance and decreased satisfaction among residents."
The trial by Desai et al was limited by its small size -- just 43 participants from an internal medicine training program at one institution -- which raise doubts about the generalizability of its findings. Also, "we could not exclude the possibility that some of the dissatisfaction and perceptions of interns might be a result of unfamiliarity with or prejudice against the new models, as well as reluctance to systematic change," they wrote.
The Intern Health Study was limited by its self-report model and well as the fact that only 58 percent of those invited did participate. Additionally, "our study assessed only the effects of duty hour reforms during the first year of their implementation. Studies should assess changes in interns' sleep and rates of depression and medical errors in future years, after hospital systems have had time to adjust to the new duty hour restrictions."