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In 2011, the Accreditation Council for Graduate Medical Education established duty-hour policies that limited per-shift duty hours for interns to ≤16 and for second-year or higher residents to ≤28; all residents are required to have at least 8 hours off between shifts. Due to concerns about care continuity and patient safety, investigators initiated a cluster-randomized trial of 63 internal medicine residency programs to compare the 2011 duty-hour rules (standard schedule) with more-flexible schedules — determined by programs — without shift-limit restrictions. All programs had weekly maximums of 80 hours, with a minimum of 1 day off weekly and maximum night call of every third night.
Trainees in both groups spent similar small amounts of ti…