Duty hours reforms in the United States, France, and Canada: is it time to refocus our attention on education?

Resident duty hours restrictions have now been instituted in many countries worldwide. Such policies have resulted in a broad-based discussion in the medical literature concerning their effects on patient care, resident education, and resident well-being. To better understand the impetuses behind these changes, the authors examine not only the duty hours mandates currently in effect in the United States, Canada, and France, but also the events influencing their independent development in these three countries. In the United States, an 80-hour resident workweek was mandated by the Accreditation Council for Graduate Medical Education out of concern for patient safety. In France, a 52.5-hour workweek was decreed by the government, reflecting the broader European Working Time Directive initiated out of concern for the negative impact of extended work hours on its population. In Canada, resident unions, whose primary interest has been one of resident well-being, have negotiated a series of reduced resident duty hours that approach those mandated in the United States. At the core of these changes are unique differences in these countries' health care and medical education systems. The resulting diversity in the origin and nature of such regulations serves to highlight the lack of evidence that has guided their development and the need to refocus on the educational elements of postgraduate training.