Microbiology: Combo Vector Delivers Blow Against Melanoma Immunology: Shadow Proteins in the Thymus Give Clues to Autoimmunity OB/GYN: Genetic Sonograms May Reduce Need for Amniocentesis Medical Ethics: Panel Probes Cap on Resident Work Hours Letter to the Editor   Repeat-encoding Gene May Drive Brain Size Combing the Genome for Natural Selection Bystander Cells in Animal Model Affected by Radiation   HMS Faculty Council New Appointments to Full Professorships Dana-Farber/Harvard Cancer Center Awarded Third SPORE Grant IOM Recommends Better Protection for Research Subjects Family Van Back in Service New Peabody Associate Masters Named In Memoriam: Catherine Binderup Ronald Malt Honors and Advances News Briefs   Making Cultural Competency a Part of Medical Training   New Division Director Melds Learning, Service Front Page

MEDICAL ETHICS Panel Probes Cap on Resident Work Hours The debate over resident training hours has shifted. Discussions at an Oct. 2 forum addressed whether those shorter hours will be mandated by voluntary accreditation guidelines or by federal legislation and what their impact will be on teaching hospitals, patient safety, and medical training programs. AAMC president Jordan Cohen moderated the ethics forum "Education or Endurance? Ethics and the Debate over Resident Work Hours." (Photo by Liza Green, HMS Media Services) "The debate has been clearly won by those who believe 100 hours a week and 36 hours of consecutive duty raises questions about whether it is the safest thing for patients and residents," said moderator Jordan Cohen, president of the Association of American Medical Colleges. This summer, faced with the threat of federal legislation, the Accreditation Council for Graduate Medical Education (ACGME) proposed new rules for residency work hours. The final standards are due to be approved on Feb. 11, 2003. The rules mandate no more than 80 in-house duty hours a week, no more than every third night on call or 24 hours of consecutive duty, and one day off in seven--all averaged over four weeks--with 10-hour breaks between periods of duty. All panelists but one urged the academic medical community to regulate itself through the ACGME rules. Panelist Ruth Potee, president of the Committee on Interns and Residents of the Service Employees International Union, worried that the proposed rules lack the government's enforcement power. She cited the New York State experience, where new residency-hour rules were flouted by some hospitals until the state funded an inspection and enforcement program. "I don't dispute the need for change," said Andrew Warshaw, the W. Gerald Austen professor of surgery at HMS and surgeon in chief at Massachusetts General Hospital. "I want to guard against unintended consequences." Surgical residents will need some flexibility in the guidelines to attend to the necessary range of cases or they risk extending their program by years, he said. Debra Weinstein, HMS assistant professor of medicine at MGH and vice president for graduate medical education at Partners, pointed out that "resident schedules are dictated to a large extent by service needs of the hospital." Partners has asked residents for suggestions about how to reengineer the training to fit the new rules. The forum was sponsored by the Division of Medical Ethics. --Carol Cruzan Morton