It was called residency because they literally lived in a hospital facility. And while doctors-in-training today might say that 20th century tradition is still intact, in actuality residents' time-on-task has been restricted since 2003.

The national duty hour guidelines were aimed at keeping patients safer by mandating doctor downtime, but they have perhaps raised more questions than they've answered. And as the discussion continues, some are asking: Is this really the best medicine?

"The goal was to provide rested physicians for the American people," explains John L. Tarpley, M.D., professor of Surgery and program director for General Surgery in the School of Medicine, as he reflects on the rules governing residency programs instituted two years ago by the Accreditation Council for Graduate Medical Education. "We hoped to have a better rested, safer, better read, better balanced physician work corps."

While Tarpley says the duty hour limits have produced some positive changes - a more focused work force and the spin-off of some time-draining clerical tasks, for example - he's nevertheless unsettled by what he calls "unanticipated developments."

These developments, he believes, may call into question the very premise of the ACGME's goal of improving patient safety while also promoting resident learning and well-being. continued..