To mandatory nap or not to mandatory nap.

I t's safe to conclude that most people would not take issue with a requirement that they take a nap at some point during their workday. The United States Institute of Medicine even urges that a five-hour snooze should be made mandatory for all medical interns and residents who are putting in 16-hour shifts. The Canadian Association of Interns and Residents, though, isn't convinced of the value of mandatory naps. In fact, Executive Director Cheryl Pellerin says that if naps are added into contracts , they could interfere with a resi-dent's training — he or she might miss a procedure vital to a good education. Mandatory naps are among options being bandied about in response to growing concerns that lengthy shifts for interns and residents compromises the safety of patients. While many jurisdictions are still exploring alternatives, the European Union has adopted a maximum 48-hour workweek as its solution to the problem (CMAJ 2009. DOI:1503 /cmaj.109-3111). The US Institute of Medicine waded into the debate with a recommendation that every resident or intern should be obliged to nap for five hours — at some point between 10 pm and 8 am — for every 16 hours they work. During the nap, there should be no interruptions or pages, the institute says in its report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety (http ://books.nap.edu/openbook .php?record_id=12508). While interns and residents in Europe are now limited to 48 hours of work per week, the situation in the US and Canada is less stringent. In 2003, the Accredita-tion Council for Graduate Medical Education capped the hours a US intern or resident could work at an average of 80 hours per week over four weeks. In Canada, while regulations vary from province to province, an intern or resident generally works no more than 60 to 80 hours per week. Only three provinces have maximum weekly hours built into their legal contracts; Manitoba's regulations are the highest at 79 hours. Mandatory naps would be " kind of difficult to institute, " says Dr. Roona Sinha, past president of the Canadian Association of Interns and Residents. " What matters more is trying to make the person functional the day after. " Shorter shifts and more rest hours after long shifts would be preferable to mandatory naps, Sinha adds. Pellerin concurs, saying that more effective handovers of patients as shifts change would be more significant that midshift …