OK, now that I've got some more experience on my belt. I gotta say that sign outs really aren't that bad. First, every morning the entire team rounds on every patient on the service, so even though I'm not managing every patient, the fact that I may be responsible for the patient at some other time gives me incentive to pay close attention. The fact that I have that incentive to pay attention has the added benefit of learning about a patients condition without doing all the busy work. The second reason why sign outs aren't that bad is that we're all getting better at effectively presenting patients to each other and writing effective notes. This is a skill that takes some time, but each week it gets better and better. So, now I'm willing to say that shorter hours and more sign outs (in the long run) is better for patients and residents than an overtired resident managing patients. Numerous studies have shown that sleep deprivation severely affects cognitive performance. So, I'd rather have fresh residents who need to spend some time getting to know patients versus an overtired, cognitively impaired one that knows their patient really well.