Medical residents should work no longer than 16 hours in a row without a five-hour break for sleep to reduce risk to patients, according to a new recommendation from the Institute of Medicine. The medical residency, a period designed to educate aspiring doctors in a particular speciality, is characterized by heavy workloads, 80-hour workweeks and sleep deprivation.

The new report, written by a an expert committee convened by the Institute of Medicine at the request of Congress and the Agency for Healthcare Research and Quality, proposed significant changes for training new doctors in America’s hospitals and recommended mandatory sleep breaks to reduce risks to both patients and sleep-deprived trainees. If medical residents have to work more than 16 hours, they should be required to take a five-hour break for sleep. The Institute of Medicine also recommends that any hours spent moonlighting should count against the maximum 80 work hours allowed per week, averaged over four weeks. At the same time, all residents should be granted one full day off every week and two consecutive days off each month, the experts recommended.

The report was written by a 17-member panel, which was led by Michael M.E. Johns, a physician and the chancellor of Emory University, and included sleep researchers and quality-assurance experts.

“Our overarching conclusion is that the science clearly shows that fatigue increases the chances of errors, and residents often work long hours without rest and regular time off,” Dr. Michael M. E Johns, chancellor of Emory University and chairman of the committee that issued the report, told a news conference. Previous studies have shown that fatigue increases the risk of accidents and depression.

The panel also called for better supervision of the doctors-in-training, assigning chores like drawing blood to other hospital workers so residents have more time for patient care, prohibitions against extra jobs, relieving them of tasks that don’t add to their education. The IOM report also recommends that residency programs limit the number of consecutive night shifts that a resident can work.

The goal of these changes is to balance patient safety with ensuring that the medical residents receive adequate training.

The report was requested by Congress to evaluate the effects of the 2003 duty-hour regulations. Back then, the Accreditation Council for Graduate Medical Education (ACGME), which oversees residency programs, has required that residents work no more than 80 hours a week, averaged over four weeks, and no more than 30 hours straight.

The new recommendations would be expensive for hospitals. Hiring additional staff to allow residents to work shorter shifts would cost about $1.7 billion annually, the medical experts said. “We believe that the additional $1.7 billion a year is a necessary investment in patient safety and better healthcare outcomes,” Dr. Michael M.E. Johns was quoted as saying.

Medical experts hope the new recommendations will improve the efficiency in the system, reducing the errors and accidents.