NEED FOR REGULATING WORKING HOURS FOR RESIDENTS IN

GYNAE/OBS
INTRODUCTION.
1. Medical training traditionally requires lengthy hours of their trainees.
Research from Europe and the United States on non-standard working hours
and sleep deprivation found that such long hours are counter-productive,
since sleep deprivation increases rates of medical errors and that late-hour
workers are subject to higher risks of gastrointestinal disorders,
cardiovascular disease, breast cancer, miscarriage, preterm birth, and
low birth weight of their newborns. There are also social effects. Married
fathers in the United States who work fixed night shifts are 6 times more
likely than their counterparts who work days to face divorce; for married
mothers, fixed nights increase the odds by a factor of 3.
WORKING HOUR REULATIONS AROUND THE GLOBE
2. Most countries in the developed world have made great progress in
regulating the working hours. Recent studies supporting a four-day
week have shown that reduced work hours not only increase consumption
and invigorate the economy, but also improve worker's level of education
(due to having extra time to take classes and courses) and worker's health
(less work-related stress and extra time for exercise). The currently
recommended working hours in various countries are given below:
o United States
33 hours/week
o France
35 hours/ week
o Germany
35 hours/ week
o South Korea
40 hours/ week
o Western Europe
48 hours/week
o Mexico
48 hours/week
o Columbia
48 hours/week
o India
66 hours/week

3. The Constitution of Pakistan also contains a range of provisions with regards

to Labor rights. Under the Factories Act, 1934 no adult employee can be
required or permitted to work in any establishment in excess of nine hours a
day and 48 hours a week.
RESIDENT DOCTORS WORKING HOURS
4. Rules specific to resident doctors have also been formulated by most
countries. One of the most comprehensive rules adopted by the American
Osteopathic Association as follows:
a. Rotations in which trainee is assigned to Emergency Department duty
shall ensure that trainees work no longer than 12 HOUR shifts.
b. For duties NOT involving emergency care, the trainee may work upto 24
consecutive hours inclusive of morning and noon educational programs.
Residents may not assume responsibility for a new patient after working
24 hours.
c. For training programmes involving IN HOUSE NIGHT CALLS,
1) The trainee shall not be assigned to work physically on duty in
excess of 80 hours per week.
2) The trainee may not be assigned to call more often than every third
night.
3) Such a routine may NOT exceed 4-WEEK PERIOD
d. The trainee shall have on alternate weeks 48-hour periods off, or at least
one 24-hour period off each week, averaged over a 4-week period.
e. Upon conclusion of a 24-hour duty shift, trainees shall have a minimum
of 10 hours off before being required to be on duty again. Upon
completing a lesser hour duty period, adequate time for rest and personal
activity must be provided.
f. All off-duty time must be TOTALLY FREE from assignment to clinical
or educational activity.
g. In cases where a trainee is engaged in patient responsibility which
cannot be interrupted, additional coverage should be provided as soon as
possible to relieve the resident involved.

RECOMMENDATIONS:
5. In view of the above, it is recommended that a new working hours plan be
devised for trainees in Gynae/Obs as is being followed by trainees in other
major specialties with due regard to the internationally accepted limitations
of human capacity . Such a plan will not only decrease the risk of medical
errors but also allow the trainee to strike a balance between clinical work,
self study and research activities improving the overall standards of training
or in the words of Dr. Richard Corlin, president of the American Medical
Association, who has called for re-evaluation of the training process,
declaring "We need to take a look again at the issue of why is the resident
there."

PROPOSED DUTY ROSTER FOR TRAINEES IN GYNAE/OBS

PLAN 1 (4 TRAINEES)
The 4 trainees may be divided into two groups
2 trainees work on morning shift from 0800hrs-1500hrs
The other two trainees perform the evening (1500 hrs-2100hrs) and night (2100
hrs-0800 hrs) duties on working hours and work in 12 hour shift on
weekends/holidays
After every 1 week, the duties of two groups be interchanged.
The trainees may avail c leave during their day duty week.
PLAN 2 (3 TRAINEES)
If the number of trainees is reduced to three at any time, they may continue to
perform duties in morning, evening and night shifts.
Trainees may be regularly rotated in three shifts on weekly basis
The weekend duty be performed in 12 hour shifts by the two trainees on morning
and evening duties in the previous week.
PLAN 3 (2 TRAINEES)
If at any time, the number of trainees falls to two, the trainees may work in
alternating 24 hour shifts followed by 24 hour off period.

Such a routine may not exceed 1 week during which more trainees be called on
rotation from MH or in extreme deficiency, GDMOs and House officers may be
included in the roster as has been practiced before.