As we noted in our paper,1 reduced duty hours may negatively affect the development of competence, which could have an impact on patient safety. This is particularly relevant for procedure-intensive specialties, where increasing evidence suggests that work-hour reforms have deleterious effects on educational outcomes,2–5 including worse scores on licensing examinations. 6 The review by Ahmed and colleagues, 7 which was published after our paper, came to similar conclusions.
We agree with Dr. Allen8 that it will be important for the educational community to consider these findings and others as they evaluate duty-hour reforms.