Principles: 
The Program is committed to and responsible for promoting patient safety and resident well-being and to providing a supportive educational environment

  1. The learning objectives of the program will not be compromised by excessive reliance on residents to fulfill service obligations
  2. Didactic and clinical educational activities will have priority in the allotment of resident’s time and energy
  3. Duty hour assignments will recognize that Faculty and residents collectively have responsibility for the safety and welfare of the patients
  4. Faculty and residents will be reminded periodically of the current ACGME mandated duty hour guidelines.
  5. The program will vigilantly monitor the duty hours on a continuous and real-time basis to maintain compliance with the ACGME mandated requirements
  6. Misreporting of duty hours is considered a breach of professional behavior and will affect the academic performance evaluations.
  7. The residents will be provided several channels of communication with the Program Director, Program Coordinator and Chairman on a regular basis to provide feedback regarding any issues associated with adherence to the duty hours guidelines.
  8. It is emphasized to the residents that adherence to the ACGME mandated duty hour guidelines is mandatory for satisfying the tenets of sound educational rationale and safe patient care. 

Duty hours: 
Duty hours are defined as all clinical and academic activities related to the program, i.e, patient care (both inpatient and outpatient), administrative duties relative to patient care the provision for transfer of patient care, time spent in-house during call activities and scheduled activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

1). Maximum hours of work per week:

  • Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. 

2). Mandatory time free form duty:

  • Residents must be schedules for a minimum of one free day of duty every week (when averaged over four weeks). At home call cannot be assigned on these free days. PGY I cannot do at-home call.

3). Maximum duty period length:  

  • Duty periods of PGY I must not exceed 16 hours in duration.
  • Duty periods of PGY 2 and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. 
  • PGY 2 and above can remain on site for an additional four hours to strictly perform transitional activities only to ensure safe patient care and guide resident education. These four hours cannot be used for any type of non-transitional activities such as operating and clinic activities or accepting any type of new additional clinical or non-clinical assignments.   
  • Residents are encouraged to use alertness management strategies and strategic napping after 16 hours of continuous duty, particularly between 10 pm and 8 am.

4). Minimum time off between scheduled duty periods:

  • PGY I residents should have 10 hours and must have eight hours free of duty between scheduled duty periods
  • PGY II and III (intermediate level residents) should have 10 hours free of duty and must have eight hours between scheduled duty periods. Residents must have at least 14 hours free of duty after 24 hours of in-house duty.
  • PGY IV and beyond (final years of education) should have 8 hours between scheduled duty periods. 

5). Maximum frequency of In-house night float:

  •  Residents must not be scheduled for more than six consecutive nights of night float. Night float rotations must not exceed two months in duration and there can be no more than three months of night float per year. Night float rotations must not exceed two months in duration, four months of night float per PGY level and 15 months for the entire program.

6). Maximum in-house call frequency:

  • PGY 2 residents and above must be scheduled for in-house call no more frequently than every third night (when averaged over a four week period) 

7). At-home call:

  • The time spent in the hospital by residents when on-home call must be counted towards the 80 hour maximum weekly hour limit. The frequency of at-home call is not subject to the every third night limitation or 24 + 4 limitation, but must satisfy the requirement by providing one day in seven free of duty. Home call must not be as frequent or taxing as to preclude rest or reasonable personal time for the residents. Residents are permitted to return to the hospital while on at-home call although each episode will not initiate a new off-duty period. PGY I will not be placed on at –home call.

Supervision of residents: 
The program will ensure that qualified faculty provide appropriate supervision of residents in patient care activities. 

  1. The attending physician has both an ethical and a legal responsibility for the overall care of the individual patient and for the supervision of the resident involved in the care of that patient. 
  2. Although senior residents require less direction than junior residents, even the most senior resident will be supervised. The program will establish a chain of command that emphasizes graded authority and increasing responsibility as experience is gained. 
  3.  The attending surgeon who is ultimately responsible for the patient's care will make judgments on this delegation of responsibility; such judgments shall be based on the attending surgeon's direct observation and knowledge of each resident's skills and ability.
  4.  A fellow may not supervise chief residents. 

Fatigue:
Faculty and residents will be educated to recognize the signs of fatigue and sleep deprivation and will intervene to prevent and counteract its potential negative effects on patient care and learning. Residents that are fatigued and cannot drive home safely will be provided reimbursement for a taxi ride home.

Moonlighting:

  1. Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program.
  2.  Internal moonlighting is considered part of the 80-hour weekly limit on duty hours.
  3. Moonlighting is not permitted except during a research rotation.
  4. A permanent medical license is required to engage in medical practice outside of the University.
  5. The University malpractice insurance will cover personal employment provided such activity is approved by the Program Director and Associate Dean for Graduate Medical Education.

                                                           

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