Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education.

The investigators are conducting a cluster randomized trial in a sample of 63 internal medicine (IM) training programs that are randomly assigned to either the current duty hour standards or less restricted flexible duty hour standards. The trial includes a main protocol in which all randomized IM programs participate and two substudies. \"Time and Motion\" and \"Sleep and Alertness\", each conducted at a subset of IM programs and focusing on more detailed data collection at the intern level. The main protocol will examine patient safety and costs as well as quality of education. The \"Time and Motion\" substudy examines additional educational outcomes. The \"Sleep and Alertness\" substudy examines intern sleep time and alertness.