Alyssa Chang, Contributing Photographer

It is not uncommon for Yale’s Internal Medicine residents to spend more than 24 hours at a time in the hospital on a shift. Now, those full day and night shifts are coming to an end. 

The residency program has three different types of shifts including day shifts, night shifts and overnight shifts — also known as 28-hour shifts. The program announced in December that, starting in July 2024, residents will no longer be assigned 28-hour shifts for the upcoming academic year.

“Back in the day, residents were called ‘residents’ because they spent night and day and really lived at the hospital,” said Matthew Grant, the associate director of the Internal Medicine Residency Program. “They very rarely got to go home.” 

Grant described this shift as a part of the program’s effort to improve resident health, prevent physician burnout and incorporate residents’ feedback. 

Residents and leadership members have long been vocal about reducing extended hours on call, Grant said. Before the announcement that it would end 28-hour shifts, the program had implemented an 80-hour workweek limit. Afterward, the frequency of 28-hour shifts was reduced from once every four days to a limit of once a week. 

After consulting with Melissa Knauert, a sleep medicine expert at the School of Medicine, the program’s leaders concluded that 28-hour shifts are detrimental not only for resident health but also for patient care. 

“I do hope that getting rid of 28-hour shifts and thinking about how to make residency training better for people is important,” said Eric Steinbrook, a first-year resident in the program. “There is a shortage of doctors and getting through medical training is hard enough already.” 

Grant, who is the faculty lead of the program’s Wellness Committee, said that burnout prevention is one of his main focuses for the residency program. As a physician who has personally experienced burnout, he told the News that he encourages all residents to be able to take breaks when they need them. 

Better rested residents, Grant added, can better treat their patients.

“Taking rests, taking breaks, getting sleep — all these things are critically important to have the best chance of minimizing human error,” Grant said.

For the program’s residents, the department’s growing emphasis on physician well-being seems to be paying off. 

Katherine Orr, a third-year resident in the Internal Medicine residency program, became a mother at the end of her first year of residency. After she asked to take 12 weeks of leave, she said, the program welcomed the decision. 

“Nobody made me feel like that was an inappropriate thing to do,” she said. “[The program is] trending towards recognizing that residents have lives outside of work.” 

For Orr, the program’s recent decision to end 28-hour shifts allows her to balance the responsibilities of parenting with her husband. Previously, on the 28-hour overnight shifts, both she and her husband would have had to stay up all night.

“When I’m on nights [shifts], it’s like my husband and I are both on nights [shifts] because he’s the only one at home with our kids,” Orr said. “I think the fact that they’ve figured out how to make the [new] schedules work while still having coverage … is really positive.” 

Orr said that over her time in the residency program, she’s noticed that its administrators have placed a greater emphasis on preventing burnout — and reducing errors from fatigue. 

It’s a shift that Steinbrook, the first-year resident, has also noticed. He said that he believes ending the 28-hour shifts is an important step in the future of residency and he commended the program leaders’ efforts to do so.

“Everyone here, from residents through the directors of our program, cares a lot about resident well-being,” Steinbrook said. “Everyone is working towards creating a workplace that [allows] being able to be happy during residency.” 

Accommodations like Orr’s, Grant said, reflect the internal medicine department’s effort to adopt a culture where medical training is only one aspect of a resident’s life. If a resident is ill, fatigued, or experiencing a family emergency, the program can extend flexibility to residents to take time away from the hospital, he added.

“We have virtually a no-questions-asked policy,” Grant told the News. “If you’re too sick or too tired to work safely, or, God forbid, your parents have a medical crisis, the system is set up so that we 100 percent expect you to jump on a plane and go be with your family if you need to. We want to build a cultural climate where our residents are like family.”

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