Resident Duty Hours

Principles

  1. The Program is committed to and responsible for promoting patient safety and resident well-being and to providing a supportive educational environment.
  2. The learning objectives of the program will not be compromised by excessive reliance on residents to fulfill service obligations.
  3. Didactic and clinical education will have priority in the allotment of residents' time and energy
  4. Duty hour assignments will recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
  5. The program will continuously monitor duty hours to maintain compliance with requirements.
  6. Misreporting of duty hours is considered a breach of professional behavior and will affect academic performance evaluations.  

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. 

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. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
  2. Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call
  3. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.  

On Call Activities

  1. In-house call must occur no more frequently than every third night, averaged over a four-week period.
  2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.
  3. No new patients may be accepted after 24 hours of continuous duty.
    1. A new patient is defined as any patient for whom the surgery service or department has not previously provided care. The resident should evaluate the patient before surgery.
  4. At-home call (or pager call)
    1. The frequency of at-home call is not subject to the every-third-night, or 24+6 limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident.
    2. Residents taking at-home call must be provided with one day in seven completely free from all educational and clinical responsibilities, averaged over a four-week period.
    3. When residents are called into the hospital from home, the hours residents spent in-house are counted toward the 80-hour limit.  

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.