in five opposed any limits on their work hours. These residents cited "additional experience" as the most common reason (69.0%), followed by "opportunity to see rare cases" (46.5%) and "continuity with patients" (31.8%). Towards an 80-hour work week The Libby Zion case, in which an 18-year-old college student died of a drug interaction after being treated by a fatigued intern and resident in a New York hospital, led to the establishment of the Bell Commission in 1987 to address physician training hours. Although the serotonin syndrome was not widely known at the time (neither by the house staff nor the attending physician), the Bell Commission continued to address the house officer sleep deprivation issue. Its recommendations were adopted by the state of New York in 1989, and limited residents to no more than 24 consecutive hours in the hospital, and no more than 80 hours a week with an in-house supervising attending physician present at all times. Though other federal regulatory and legislative attempts to limit medical resident work hours have materialized, none have attained passage. Dr. Richard Corlin, president of the American Medical Association, has called for re-evaluation of the residency training process, declaring "We need to take a look again at the issue of why is the resident there." The U.S. Occupational Safety and Health Administration (OSHA) rejected a petition seeking to restrict medical resident work hours, opting to rely on standards adopted by ACGME, a private trade association that represents and accredits residency programs. On July 1, 2003, the ACGME instituted duty hours requirements for all accredited residency programs, since revised in 2011. The ACGME duty hour standards that went into effect in July 2003 require: An 80-hour weekly limit, averaged over 4 weeks, inclusive of all in-house call activities; A 10-hour rest period between duty periods and after in-house call; A 24-hour limit on continuous duty, with up to 6 additional hours for continuity of care and education; No new patients to be accepted after 24 hours of continuous duty; One day in 7 free from patient care and educational obligations, averaged over 4 weeks, inclusive of call; and In-house call no more than once every 3 nights, averaged over 4 weeks. Following the ACGME's proposed regulation of duty hours the American Osteopathic Association (AOA) followed suit. Below are the requirements adopted by the American Osteopathic association. The trainee shall not be assigned to work physically