If we can’t stand the heat.

We’ll find a cooler job. This week NEJM published initial results of a massive randomized trial of work hour restrictions among internal medicine residents, and it’s catching fire on social media. For the 2015-2016 academic year, 31 programs were randomized to the standard work hours and 32 to the experimental, yet old school, “flexible” work hours (read: better be flexible to work 30+ hour shifts). We could have given NEJM these results for a lot less time and money, but here’s the official reporting: trainees are significantly more satisfied with shorter shifts while program directors are significantly more satisfied with “flexible” shifts, and the only objective (don’t read: meaningful) measure, in-service exam scores, showed no difference. The reason the study’s catching heat is its design. The primary hypothesis--not yet reported--is to substantiate that “flexible” hours result in non-inferior 30-day patient mortality rates, garnering sharp criticisms for bias towards an inherently worse arm. One man’s clever twitter response to this generation’s resident physicians? “If you can’t stand the heat, get out of the kitchen.” TBL: Stop wasting scarce government research funding to beat a dead-tired work horse. | Desai, N Eng J Med 2018