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It has been found that the training time of trainee doctors in Korea is longer than in foreign countries. Accordingly, a recent study stressed the need to work out plans to limit the training time of junior doctors while ensuring the quality of training.
Go Dun-sol, an associate research fellow at the Health Policy Research Center at the Korea Institute for Health and Social Affairs (KIHASA), made these and other points in an article titled “Issues of limiting the number of training hours for medical residents and implications of major countries' cases,” published on Monday in its journal, Issues & Focus.
Go Dun-sol, an associate research fellow at the Health Policy Research Center at the Korea Institute for Health and Social Affairs, pointed out in an article titled “Issues of limiting the number of hours for specialty training and implications of cases in major countries” published on Monday in Issues & Focus, that the number of hours for training medical residents in Korea is significantly higher than in other major countries. (Credit: Getty Images)
Go Dun-sol, an associate research fellow at the Health Policy Research Center at the Korea Institute for Health and Social Affairs, pointed out in an article titled “Issues of limiting the number of hours for specialty training and implications of cases in major countries” published on Monday in Issues & Focus, that the number of hours for training medical residents in Korea is significantly higher than in other major countries. (Credit: Getty Images)
Trainee doctors have dual status as trainees receiving training at a training hospital and as wage-earning workers. Therefore, limiting their training hours is cited as one of the most basic requirements to ensure their dual status rights.
Go analyzed the standards for limiting the hours a doctor can practice in Korea and other developed countries, such as the U.S., Canada, Japan, and the U.K.
In Korea, the “Act to Improve the Practice Environment and Status of Trainee Doctors” (often referred to as the Trainee Doctors Act) was enacted in 2015, and the training time limit was mandated by law.
When the act was first implemented in 2017, the maximum weekly practice time was 80 hours, which can be extended by eight hours for educational purposes. The maximum “continuous” practice time is 36 hours, with 40 hours allowed in case of emergency.
Go said that even after the law was enacted, there are still many cases of overtraining.
“The average weekly training time of junior doctors decreased from 92.0 hours per week in 2016 to 79.2 hours in 2018 before the enactment of the Trainee Doctors Act,” Go said. “However, many trainee doctors experience excessive practice, especially those with low seniority and surgical specialties.”
“These junior doctors are also more likely to experience continuous practice for more than 24 hours, and the lower the seniority, the higher the rate of continuous practice,” Go said. “The number of holidays and breaks after on-call have improved since the implementation of the Trainee Doctors Act, but they are still not guaranteed adequate breaks and rest periods.”
Maximum continuous working hours are 28 hours in US and Japan
In the U.S., the Accreditation Council for Graduate Medical Education (ACGME) imposes duty hour limits as an accreditation requirement for junior doctors’ training programs.
In July 2003, the ACGME mandated residency time limits for all specialty training programs. In 2011, the ACGME established new standards based on the recommendations of the Institute of Medicine (IOM).
The maximum number of hours per week was limited to 80 hours, averaged over a four-week period. The maximum number of consecutive hours in the first year was limited to 16 hours, while the maximum number of consecutive hours in the second year was set at 24 hours, with a four-hour extension for teaching or handover purposes. After 16 hours, “strategic rest periods” were recommended.
In Canada, the need to limit practicing hours was first raised in Quebec. In 2009, after medical residents protested against working 24 hours straight, a 2011 ruling limited the province to 16 hours or less of continuous practice.
This prompted Canada to form the National Steering Committee on Resident Duty Hours in 2013 to develop national guidelines and recommendations.
The guidelines set a maximum weekly resident duty time of 60 to 90 hours (depending on the province) and a maximum consecutive duty time of 24 to 26 hours (16 hours in Quebec). They recommend that trainee doctors only practice for more than 24 consecutive hours in exceptional circumstances and that they have a fatigue risk management plan in place.
In the U.K., the European Working Time Directive (EWTD), established in 1993, limits the number of hours doctors can practice. For trainee doctors, it has been in place since 2003. As of 2024, the maximum weekly practice time is no more than 48 hours in 26 weeks, and the maximum continuous practice time is 13 hours in 24 hours.
In Japan, the Work Style Reform Bill, passed in 2018 to prepare for an aging society, limits working hours for all workers. For doctors, it became applicable in April 2024, and the Ministry of Health, Labor and Welfare announced the “Work Style Reform for Doctors” accordingly. According to the Physician Work Style Reform Bill, specialty doctors' maximum weekly training time is 80 hours, and the maximum continuous training time is 28 hours.
‘Korea should shorten training time, improve education and operation manpower methods’
“Korea has relatively high training time standards compared to other countries. The maximum weekly training time can be extended by up to eight hours for educational purposes, reaching 88 hours,” Go said. “The maximum continuous training time is also 36 hours and 40 hours in case of emergency, which is much higher than that of major countries.”
Go emphasized the need to shorten the training period and improve education and manpower management so that the quality of training does not deteriorate.
“Overseas, training programs are being systematized to clarify the competencies to be acquired through the training process and to strengthen the role of supervisory specialists so they can focus on training,” Go said. “Efforts are also being made to resolve the work gap due to the shortening of the training time for medical residents.”
“The government must review the criteria for applying the appropriate number of patients to ease the workload of trainee doctors,” Go said. “To minimize the gap caused by the reduction of training hours, the government must review and support efficient workforce management methods, such as team-based care and the introduction of flexible work systems.”
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Kim Ju-yeon kjy@docdocdoc.co.kr
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