June, 23 2010, 01:33pm EDT

Patient Safety Advocates Give Plan to Reform Medical Residency a Failing Grade
Accreditation Group’s Proposal on Resident Physician Work Hours Do Not Measure Up to Institute of Medicine Recommendations
WASHINGTON
The coalition of public interest and patient safety groups that have
spearheaded the www.WakeUpDoctor.org
campaign issued a "report card" in response to today's proposal by the
Accreditation Council on Graduate Medical Education (ACGME) to
restructure medical residency programs, published in The New England
Journal of Medicine.
Since February, the Wake Up Doctor campaign has been instrumental in
raising awareness about the dangers posed by medical residents working
shifts as long as 30 hours, frequently with limited support or
supervision, leaving them exhausted and prone to mistakes. The
coalition, which includes Public Citizen, Mothers Against Medical Error
and other patient advocates, based their grades on the landmark 2008
report by the Institute of Medicine (IOM), Resident Duty Hours:
Enhancing Sleep, Supervision and Safety. The IOM report made a thorough
review of issues related to residency and listed 10 recommendations for
change, including an increase in supervision of junior residents and a
significant reduction in work hours.
Although ACGME, the group responsible for training physicians in the
United States, demonstrated some progress in reconciling its regulations
with the mounting body of scientific evidence linking acute and chronic
sleep deprivation with preventable medical errors, the coalition judged
that the proposal fails compared to the more comprehensive
recommendations of the IOM report.
*
Common Sense Limits on Resident Duty Hours
Grade: F
The IOM report called for a reduction in resident duty hours from 30
consecutive-hour shifts to continuous shifts lasting no longer than 16
hours. The ACGME's proposal implements that change only for medical
residents in their first year (interns). This change would therefore
only apply to 22 percent of total residents in hospitals throughout the
country. Most medical residents could continue to be scheduled for a
maximum of 24 consecutive hours, a duration rejected by the IOM in late
2008. Ample evidence has shown that marathon shifts in excess of 16
hours can have a detrimental effect on a physician's abilities and
judgment.
Additionally, the IOM made a number of recommendations ranging from
the minimum time off between scheduled duty periods, the maximum number
of consecutive nights a resident may work night duty, adjustments to the
minimum amount of time off per week, and an immediate, urgent
requirement for hospitals to provide safe transportation home for
fatigued residents. Nearly all of these recommendations are left out of
the ACGME's proposal.
"Although it's a positive step for the ACGME to make any
acknowledgement of the evidence linking resident fatigue and medical
error, its proposed solution misses the mark," said Dr. Alex Blum, one
of the authors of the recent study, "US Public Opinion Regarding
Proposed Limits on Resident Physician Work Hours," which was published
in BMC Medicine. "Physicians do not cease to be human beings when they
complete their first year of residency, nor does an additional year of
training make them impervious to the physiological effects of sleep
deprivation. Patients both deserve and expect to be treated by a
well-rested physician. The ACGME's proposal on work hours won't come
close to making that a reality."
Adequate Direct, Onsite Supervision
Grade: B
The IOM report called for first-year residents not to be "on duty
without having immediate access to a residency program-approved
supervisory physician in-house" (Summary, p.13). The ACGME adopts this
measure, but only somewhat vaguely addresses the IOM report's
recommendation for measurable standards of supervision for each level of
residency.
"The ACGME has taken an important step in regard to supervision of
first-year residents and to setting specific standards for different
levels of supervision," said Helen Haskell, founder and president of
Mothers Against Medical Error. "I think the acid test will be in the
details. We need to be sure that residents of all levels have sufficient
backup and reasonable limits on their workloads."
Structured, Institutionalized Handover Processes
Grade: C
The IOM report called for medical residents to be trained to
communicate clearly and accurately when handing over patients after
residents' shifts end, a process known as "handovers" or "signouts." The
ACGME proposal includes this provision, as well as requiring a system
to quickly and accurately communicate to staff and patients the roles
and patient responsibilities of both residents and attending physicians
at any given time.
However, the IOM report also called for dedicated, protected and
overlapping time for patient care teams to conduct these transitions.
The ACGME proposal does not include this solution to reduce errors
related to handovers and improve team communication among providers.
"Without question, the environment in which handovers take place must
be closely monitored to prevent errors and potential harm for our
patients," said Dr. Farbod Raiszadeh, president of the Committee of
Interns and Residents/SEIU Healthcare, the nation's largest union for
housestaff. "However, I can say from experience that part of that
environment is how long the outgoing resident has been working in the
hospital and how fatigued they are at the time of transition. Handovers
are safer, more thorough and less prone to error when they occur in hour
16 than in hour 30 of a shift."
Increased Oversight of Residency Programs
Grade: F
Although the ACGME plans to dramatically increase the number of site
visits, its oversight proposal falls far short of the IOM's standard.
The IOM report called for rigorous oversight on the part of the ACGME,
including unannounced visits to teaching hospitals, strengthened
complaint procedures and confidential, protected reporting of hours by
residents and teaching hospitals - none of which is directly addressed
by the ACGME's proposal. Additionally, the IOM report called for
independent monitoring by the Centers for Medicare and Medicaid Services
and the Joint Commission - a recommendation that is also absent from
the ACGME proposal, thus leaving the major control in the hands of the
non-governmental ACGME instead of increasing the role of the government
in oversight.
"The improvements in the new ACGME guidelines are largely swamped by
the failure to cover the majority of medical residents with the
protection of not having to work more than 16 hours continuously," said
Dr. Sidney Wolfe, director of Public Citizen's Health Research Group.
"This is the second revision of ACGME requirements in the last seven
years and the organization still does not get it right."
*
The coalition will continue to educate the public concerning the
areas where the ACGME proposal fails to meet the standards set by the
2008 IOM report.
To learn more about the issue of resident work hours, supervision and
safety, and to sign the campaign's letter to the ACGME in support of
the IOM recommendations, visit www.WakeUpDoctor.org.
Public Citizen is a nonprofit consumer advocacy organization that champions the public interest in the halls of power. We defend democracy, resist corporate power and work to ensure that government works for the people - not for big corporations. Founded in 1971, we now have 500,000 members and supporters throughout the country.
(202) 588-1000LATEST NEWS
'Authoritarian Theater' Meets 'Pure F*cking Idiocracy' as Trump Plans White House UFC Match
"Americans, you won't have healthcare, Medicaid, public schools, nursing homes, rural hospitals, or SNAP," said one critic. "But, you'll get UFC fights on the White House lawn. America F-Yeah!"
Jul 05, 2025
Critics of President Donald Trump's announcement of a planned Ultimate Fighting Championship event on White House grounds to celebrate the United States Semiquincentennial next year took to social media Friday to call the proposal something "straight out of 'Idiocracy'"—the comedy cult classic about a dumbed-down 26th-century America—and condemn what one detractor called "authoritarian theater."
"Every one of our national park battlefields and historic sites are going to have special events in honor of America 250," Trump said at the Iowa State Fairgrounds Thursday. "We're going to have a UFC fight—think of this—on the grounds of the White House."
Yearning for a time when every new day isn't exponentially dumber than the day before.
[image or embed]
— Dave Vetter (@davidrvetter.bsky.social) July 4, 2025 at 2:57 AM
While Octagon aficionados cheered the prospect of a 1600 Pennsylvania Avenue fight card, critics couldn't help but notice parallels with the plot of Mike Judge's 2006 film "Idiocracy," a satirical skewering of issues including the erosion of White House decorum in a future when everyone is an imbecile and a sports drink corporation owns the country, whose voters elect Dwayne Elizondo Mountain Dew Camacho, "five-time ultimate smackdown champion and porn superstar," as president.
"If anyone defends Trump saying there will be a UFC fight on the White House lawn never listen to them again," former Republican Congressman Adam Kinzinger of Illinois wrote on the social media site X Friday, adding that Trump's announcement was like the "plot to 'Idiocracy' with an equally stupid-ass president."
Another X user fumed: "This is what happens when a failed empire hits rock bottom and throws a party about it. UFC fight on the White House lawn to celebrate 250 years of what used to be a country with brains. This ain't strength, this is pure fucking Idiocracy. Straight out of Rome before it burned, give the mob a fight and some burgers while the world collapses around them.
Yet another social media critic joked that "'Idiocracy' was actually a documentary from the future, sent back in time as a warning to us all."
Some critics noted the decadeslong business ties between Trump and UFC President and CEO Dana White, who has donated at least $1 million to Trump's campaign coffers.
Others noted the "bread and circuses" vibes of Trump's proposed event, which some called a cynical ploy meant to distract from the devastating impact of policies like Friday's signing of a multi-trillion-dollar tax cut that will overwhelmingly benefit the rich and corporations, while ballooning the deficit and leaving millions of Americans without desperately needed health insurance coverage and food assistance.
"Americans, you won't have healthcare, Medicaid, public schools, nursing homes, rural hospitals, or SNAP. But, you'll get UFC fights on the White House lawn," New York Times opinion contributor Wajahat Ali wrote on Bluesky. "America, F-YEAH!"
Writing for The Guardian Saturday, Karim Zidan asserted: "Donald Trump's UFC stunt is more than a circus. It's authoritarian theater."
"It carries shades of fascist Italy under Benito Mussolini, particularly its obsession with masculinity, spectacle, and nationalism—but with a modern, American twist," he wrote. "Fascist Italy used rallies, parades, and sports events to project strength and unity."
"Similarly, Trump has relied on the UFC to project his tough-guy image, and to celebrate his brand of nationalistic masculinity," Zidan continued. "From name-dropping champions who endorse him to suggesting a tournament that would pit UFC fighters against illegal migrants, Trump has repeatedly found ways to make UFC-style machismo a part of his political brand."
"There was once a time when the U.S. could point to the authoritarian pageantry of regimes like Mussolini's Italy and claim at least some moral distance. That line is no longer visible," he added. "What was once soft power borrowed from strongmen is now being proudly performed on America's own front lawn."
Keep ReadingShow Less
As Flood Deaths Rise, Texas Officials Blast Faulty Forecast by DOGE-Gutted National Weather Service
"Experts warned for months that drastic and sudden cuts at the National Weather Service by Trump could impair their forecasting ability and endanger lives during the storm season," said one critic.
Jul 05, 2025
As catastrophic flooding left scores of people dead and missing in Texas Hill Country and President Donald Trump celebrated signing legislation that will eviscerate every aspect of federal efforts to address the climate emergency, officials in the Lone Star State blasted the National Weather Service—one of many agencies gutted by the Department of Government Efficiency—for issuing faulty forecasts that some observers blamed for the flood's high death toll.
The Associated Press reported Saturday that flooding caused by a powerful storm killed at least 27 people, with dozens more—including as many as 25 girls from a summer camp along the Guadalupe River in Kerr County—missing after fast-moving floodwaters rose 26 feet (8 meters) in less than an hour before dawn on Friday, sweeping away people and pets along with homes, vehicles, farm and wild animals, and property.
"Everybody got the forecast from the National Weather Service... It did not predict the amount of rain that we saw."
"The camp was completely destroyed," Elinor Lester, 13, one of hundreds of campers at Camp Mystic, told the AP. "A helicopter landed and started taking people away. It was really scary."
Kerr County Sheriff Larry Leitha said during a press conference in Kerrville late Friday that 24 people were confirmed dead, including children. Other officials said that 240 people had been rescued.
Although the National Weather Service on Thursday issued a broad flood watch for the area, Texas Division of Emergency Management Chief Nim Kidd—noting that the NWS predicted 3-6 inches of rain for the Concho Valley and 4-8 inches for the Hill Country—told reporters during a press conference earlier Friday that "the amount of rain that fell in this specific location was never in any of those forecasts."
After media reports & experts warned for months that drastic & sudden cuts at the Nat Weather Service by Trump could impair their forecasting ability & endanger lives during the storm season, TX officials blame an inaccurate forecast by NWS for the deadly results of the flood.
[image or embed]
— Ron Filipkowski (@ronfilipkowski.bsky.social) July 5, 2025 at 3:19 AM
"Listen, everybody got the forecast from the National Weather Service," Kidd reiterated. "You all got it; you're all in media. You got that forecast. It did not predict the amount of rain that we saw."
Kerrville City Manager Dalton Rice also said during the press conference that the storm "dumped more rain than what was forecasted" into two forks of the Guadalupe River.
Kerr County judge Rob Kelly told CBS News: "We had no reason to believe that this was gonna be anything like what's happened here. None whatsoever."
Since January, the NWS—a branch of the National Oceanic and Atmospheric Administration (NOAA)—has reduced its workforce by nearly 600 people as a direct result of staffing cuts ordered by the Department of Government Efficiency, or DOGE, as part of Trump's mission to eviscerate numerous federal agencies.
This policy is in line with Project 2025, the Heritage Foundation-led blueprint for a far-right overhaul of the federal government that calls for "dismantling" NOAA. Trump has also called for the elimination of the Federal Emergency Management Agency, arguing that states should shoulder most of the burden of extreme weather preparation and response. Shutting down FEMA would require an act of Congress.
Many of the fired NWS staffers were specialized climate scientists and weather forecasters. At the time of the firings, Rep. Jared Huffman (D-Calif.), the ranking member of the House Natural Resources Committee, was among those who warned of the cuts' deadly consequences.
"People nationwide depend on NOAA for free, accurate forecasts, severe weather alerts, and emergency information," Huffman said. "Purging the government of scientists, experts, and career civil servants and slashing fundamental programs will cost lives."
Writing for the Texas Observer, Henry D. Jacoby—co-director of the Massachusetts Institute of Technology Joint Program on the Science and Policy of Global Change—warned that "crucial data gathering systems are at risk."
"Federal ability to warn the public is being degraded," he added, "and it is a public service no state can replace."
On Friday, Trump put presidential pen to congressional Republicans' so-called One Big Beautiful Bill Act, a $4 trillion tax and spending package that effectively erases the landmark climate and clean energy provisions in the Inflation Reduction Act signed by then-President Joe Biden in 2022.
As Inside Climate News noted of the new law:
It stomps out incentives for purchasing electric vehicles and efficient appliances. It phases out tax credits for wind and solar energy. It opens up federal land and water for oil and gas drilling and increases its profitability, while creating new federal support for coal. It ends the historic investment in poor and minority communities that bear a disproportionate pollution burden—money that the Trump administration was already refusing to spend. It wipes out any spending on greening the federal government.
Furthermore, as MeidasNews editor-in-chief Ron Filipkowski noted Saturday, "rural areas hit hardest by catastrophic storms are the same areas now in danger of losing their hospitals after Trump's Medicaid cuts just passed" as part of the budget reconciliation package.
At least one congressional Republican is ready to take action in the face of increasing extreme weather events. Rep. Marjorie Taylor Greene (R-Ga.)—who once attributed California wildfires to Jewish-controlled space lasers—announced Saturday that she is "introducing a bill that prohibits the injection, release, or dispersion of chemicals or substances into the atmosphere for the express purpose of altering weather, temperature, climate, or sunlight intensity."
"It will be a felony offense," she explained. "We must end the dangerous and deadly practice of weather modification and geoengineering."
Keep ReadingShow Less
National Team Member Becomes at Least 265th Palestinian Footballer Killed by Israel in Gaza
Muhannad al-Lili's killing by Israeli airstrike came as the world mourned the death of Portugal and Liverpool star Diogo Jota and his brother André Silva in a car crash in Spain.
Jul 04, 2025
Muhannad Fadl al-Lili, captain of the Al-Maghazi Services Club and a member of Palestine's national football team, died Thursday from injuries suffered during an Israeli airstrike on his family home in the central Gaza Strip earlier this week, making him the latest of hundreds of Palestinian athletes killed since the start of Israel's genocidal onslaught.
Al-Maghazi Services Club announced al-Lili's death in a Facebook tribute offering condolences to "his family, relatives, friends, and colleagues" and asking "Allah to shower him with his mercy."
The Palestine Football Association (PFA) said that "on Monday, a drone fired a missile at Muhannad's room on the third floor of his house, which led to severe bleeding in the skull."
"During the war of extermination against our people, Muhannad tried to travel outside Gaza to catch up with his wife, who left the strip for Norway on a work mission before the outbreak of the war," the association added. "But he failed to do so, and was deprived of seeing his eldest son, who was born outside the Gaza Strip."
According to the PFA, al-Lili is at least the 265th Palestinian footballer and 585th athlete to be killed by Israeli forces since they launched their assault and siege on Gaza following the October 7, 2023 Hamas-led attack on Israel. Sports journalist Leyla Hamed says 439 Palestinian footballers have been killed by Israel.
Overall, Israel's war—which is the subject of an International Court of Justice (ICJ) genocide case—has left more than 206,000 Palestinians dead, maimed, or missing, and around 2 million more forcibly displaced, starved, or sickened, according to Gaza officials.
The Palestine Chronicle contrasted the worldwide press coverage of the car crash deaths of Portuguese footballer Diogo Jota and his brother André Silva with the media's relative silence following al-Lili's killing.
"Jota's death was a tragedy that touched millions," the outlet wrote. "Yet the death of Muhannad al-Lili... was met with near-total silence from global sports media."
Last week, a group of legal experts including two United Nations special rapporteurs appealed to the Fédération Internationale de Football Association, the world football governing body, demanding that its Governance Audit and Compliance Committee take action against the Israel Football Association for violating FIFA rules by playing matches on occupied Palestinian territory.
In July 2024, the ICJ found that Israel's then-57-year occupation of Palestine—including Gaza—is an illegal form of apartheid that should be ended as soon as possible.
During their invasion and occupation of Gaza, Israeli forces have also used sporting facilities including Yarmouk Stadium for the detention of Palestinian men, women, and children—many of whom have reported torture and other abuse at the hands of their captors.
Keep ReadingShow Less
Most Popular