Proposal: Encourage the resident physicians at UIC Medical Center to lead healthier lifestyles by targeting three major areas: nutrition, physical activity, and sleep Expand to a national movement for all teaching hospitals in the U.S.
Background information: Resident physicians are doctors-in-training in specific fields after graduating from medical schools. Length range from 3-7 years Traditionally, residents spend >100 hours per week in the hospital 1 Patient and Physician Safety and Protection Act 2 (H.R. 3236, S. 2614) Limits resident work hours to 80 h/wk or less Introduced to Senate and House, heard in subcommittees but never passed
Background information: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) adopted the policy to limit resident duty hours to an average of 80 hours per week Violations of duty hours are usually underreported, due to fear of losing accreditation 3 In Europe, residents work much less. In UK, residents are limited to 56 hours per week and shifts no longer than 12 hours 4
Life of a resident: Arrive at hospital between 5am to 7am Typically leave hospital after 5pm No official lunch break Overnight call every 3 to 5 nights Average 4 days off in 1 month
Three major concerns: Poor nutrition “ I eat junk. I eat crap because it ’ s like the only happiness in my day right now. ” 5 Vitamin D deficiency. 50% of residents are deficient. 6 (24% in general young adults 7 ) Physical inactivity 65% of the residents exercise less than twice a week 14 94% would work out more if they had more time 14 Sleep deprivation Caffeine dependency 76% of residents feel too tired to drive home after overnight calls 14
Why focus on residents? Physician errors More errors when sleep-deprived 8 Better patient outcome with new regulation 9 Safety – patients and residents Car accidents 10 Accidental needle sticks 11 Role models Residents who lead healthier lives tend to be better counselors to patients 12,13 Improve productivity and efficiency
Nutrition: UIC Medical Center ’ s cafeteria: Garden Caf é opens only from 7am to 7pm no nutritional labels available minimal healthy alternatives Resident survey: 98% of residents feel our cafeteria food is less than nutritious 14 83% would eat at the cafeteria more if there were healthier options 14
Proposal - nutrition: Garden Caf é should provide nutritional information on all food served Strive towards a no trans-fat, low sodium kitchen Healthier options
Physical inactivity: No time for exercise Too tired/burned out to exercise No convenient facility to exercise
Proposal - physical activity: Encourage walking or biking to work Incentive for bikers/walkers More bike racks, safer locations iClimb: program to encourage use of stairs in hospital Swipe ID card to track number of stairs climbed Reward residents who log the most number of stairs Also saves energy by decreasing elevator use
Proposal - physical activity: Provide a room with some exercise equipments treadmill, stationary bike, free weights ping pong table, pool table free access for residents
Sleep-deprivation: 64% of residents feel sleep-deprived more than half of the time 14 Average 1-2 hours of sleep on call
Proposal - sleep: Make ACGME duty hour guidelines a federal regulation separate enforcement body from accreditation Free cab vouchers for post call residents example: Rush University Medical Center Improve environment of call rooms clean sheets, blankets manual temperature control
Potential partners at UIC: Graduate Medical Education Committee (GMEC) Regulates all residency functions Meets once a month Resident representative: Drs. Shikha Jain, Neel Shah, and Daina Alexander Nutrition and Wellness Center Director: Dr. Theodore Mazzone Employee Health Department Started the walking mentor program at UIC Would be a proponent for iClimb
Sponsors at UIC: Dr. Fred Zar Program director of internal medicine residency Great advocate for all residents Dr. Rachel Caskey Associate program director of combined med-peds residency Also a faculty member at UIC School of Public Health Interest in adult preventative medicine
Sponsors at UIC: Dean Joseph Flaherty Dean of medical school Dr. Prakash Desai Medical Director of UIC Medical Center
Other potential sponsors on the local level: Dr. Kenneth Schmidt Member of U of Illinois ’ s Board of Trustee Graduated from UIC medical school Part of University of Illinois President ’ s council Also member of Chicago Medical Society
Other potential sponsors on the local level: Commissioner Robert Steele Represents District 2 of Cook County A member of the Health and Hospitals Public Health committee
Partners on the national level: Committee of Interns and Residents of SEIU Healthcare National President, Dr. Luella Toni Lewis American Medical Student Association National President, Dr. Michael Ehlert
Sponsors on the national level: Congressman John Conyers (MI) Sponsored H.R. 3236, the original Patient and Physician Safety and Protection Act in 2001
Congressman Danny K. Davis (IL) Represents District 7 of IL, including UIC A co-sponosor of H.R. 3236 Sponsors on the national level:
Congressman Frank Pallone (NJ) Heads the House Subcommittee on Health Also a co-sponsor of H.R. 3236
References: 1.Tracey B. Ehlers. "The Patient and Physician Safety and Protection Act: Crucial federal legislation to improve the lives of residents and patients.” Connecticut Public Interest Law Journal. Paper 34, 2004. 2.http://thomas.loc.gov/ 3.Landrigan, et. al. “Interns’ compliance with ACGME work-hour limits.” JAMA. 2006, 296(9). 4.Butterfield, Stacey. “Shorter hours, fewer nights: Life as a British resident.” ACP Hospitalist. Oct 2007. 5.Stoller et al. “Strategies resident-physicians use to manage sleep loss and fatigue.” Med Educ Online. 2005, 10:9.
References: 6.Haney et al. “Vitamin D insufficiency in internal medicine residents.” Calcified Tissue International. 2005, 76:11. 7.Gordon et al. “Prevalence of vitamin D deficiency among healthy adolescents.” Archives of Peds and Adolescent Med. June, 2004, 158(6). 8.Barger et al. “Impact of extended-duration shifts on medical errors, adverse events, and attentional failures.” Public Library of Science Medicine, Dec. 2006 3(12). 9.Volpp, et. al. “Mortality among patients in VA hospitals in the first 2 Years following ACGME resident duty hour reform.” JAMA. 2007, 298(9):984- 992. 10.Barger, et. al. “Extended work shifts and the risk of motor crashes among interns.” NEJM. 2005, 352(2).
References: 11.Ayas, et al. “Extended work duration and the risk of self-reported percutaneous injuries in interns.” JAMA. 2006, 296(9). 12.Abramson S et al. “Personal exercise habits and counseling practices of primary care physicians: a national survey.” Clin J Sport Medicine. 2000, 10(1). 13.Frank E et al. “Exercise counseling and personal exercise habits of US women physicians.” J Am Med Womens Assoc. 2003, 58(3). 14.Residency survey conducted by Amy Huang, MD. Chicago, IL, 2008.