The whole discussion about work hours, hand-offs, and errors is all kind of silly, because a false premise underlies the whole debate, that residents should be in this precarious position at all.

Limited work hours are required because it is a humane way to treat doctors who are expected to be humane themselves. What excess work hours is really about is saving/making money for the hospital, not training.

To extend the aviation analogy, would you board the plane with a young trainee and no captain? The medical care system can afford to have a fully trained attending physician supervising the care of every patient 24 hours a day, and it should. This is why most hospitals use hospitalists.

Teaching hospitals should drop the dysfunctional culture that says the war mentality trains doctors well. Get off your asses and hire real coverage!