I am seeking an end to mandatory 24 hour call shifts periods for residents, and the adoption of reasonable maximum duty hours, on the grounds that the current model of 24 hour in hospital call shifts violates the Charter of Rights Freedoms. #MedTwitter #onpoli @picardonhealth 1/

What I am seeking is in line with the precedent set in Quebec in 2011. The changes that I am seeking are also consistent with recommendations of the National Steering Committee on Resident Duty Hours in June 2013, as well as guidelines in Europe, Australia, and New Zealand. 2/

The changes that I am seeking can be achieved in a timely and practical way that maintains quality patient care and resident education, as evidenced by the experience of residency training programs in Canada, the United States, and Europe. 3/

During 24 hour call shifts it is not uncommon for residents to receive very little or no sleep, rest, or down-time during these call shifts because of the continuous demands that are placed on residents during these shifts. 4/

This is exacerbated by reduced staffing levels that are available during overnight, weekend, and holiday periods. 5/

Residents will often joke that they personally experience “acute kidney failure” during the performance of their call shifts because they are too busy to drink enough water. This is, unfortunately, not far from the truth... 6/

The physical, cognitive, and mental health consequences of 24 hour call shifts are stark. 7/

Residency wellness and burnout are becoming more urgent issues. It has been noted that rates of mental illness, addiction, and suicide are higher among medical students, residents and physicians than in the general population. 8/

There have been a number of recent suicides of medical students and residents in both Canada and the United States, suggesting that medical students and residents are already particularly vulnerable. 9/

As Dr. Pamela Wible @PamelaWibleMD has stated in response to recent suicides: "Yoga, meditation, and forced wellness modules won't stop...suicide clusters at NYU and Mount Sinai…The medical system must finally take responsibility for perpetuating... toxic working conditions..10

that destabilize our doctors-in-training and lead to these suicides." 11/

There is evidence to show that sleep deprivation decreases performance and threatens health and safety. Risks include obesity, diabetes, heart disease, burnout, lower quality of life, increased risk of being involved in a motor vehicle accidents and needle stick injuries... 12/

(which can lead to exposure to blood-borne diseases). Some of these effects can be persisting. There is also evidence that a sense of a lack of control over working conditions contributes to mental illness and a poor sense of well-being. 13/

"On June 7, 2011 Quebec arbitrator...Lussier ruled that section 12.14 of the collective agreement between La Féderation des médecins résidents du Quebec and Le Ministre de la Santé et des Services sociaux violated section 7 of the Canadian Charter of Rights and Freedoms... 14/

and sections 1 and section 46 of the Quebec Charter of Rights and Freedoms by requiring residents to work 24 hour hour call shifts. He ordered the employer to reduce call shifts to a maximum length of 16 hours, and gave the employer 6 months... 15/

Responding to a lack of national guidelines in Canada and following a review of existing evidence, the National Steering Committee on Resident Duty Hours recommended ... “duty periods of twenty four or more consecutive hours without restorative sleep should be avoided.” 16/

A review of practices in various jurisdictions reveals that quality healthcare and resident education does not require mandatory 24 hour call shifts and lack of reasonable maximum duty hours. 17/

In the United States, the death of Libby Zion, an 18 year old woman who died in 1984 while being cared for by overworked residents in an understaffed New York City hospital, led to much publicity on the issue of resident duty hours. 18/

There was a subsequent grand jury investigation into whether murder charges should be laid. Charges were not laid, but the jury criticized the staffing of the hospital, recommending a limit of residents shifts to 12 hours, with a minimum 8 hour rest period in between shifts. 19/

Subsequent to this, in 1989 the New York state Bell Commission recommended a maximum of 80 hours of weekly work for residents, with no more than 24 consecutive hours. 20/

In 2003 this was later adopted as the national standard by the Accreditation Council for Graduate Medical Education (ACGME). Significantly, many residency programs in the United States responded to the concern about resident duty hours by implementing night float systems...21/

...where residents work only during the overnight period instead of a full 24 hour period. Such night float systems are also in place in certain residency programs in Canada. 22/

Studies comparing traditional...systems to alternatives such as night float..., show that traditional call systems have more harmful and persisting impacts on residents. Night float systems have been...perceived favourably by residents in both the United States and Canada. 23/

Studies examining how to transition from traditional call systems to alternative systems are available.

In Europe, the European Working Time Directive (EWTD) limits weekly duty hours to a maximum of 48 hours, although there is still significant variability. 24/