Resident and Fellow Policy Manual
Appendix 1 - Institutional Policy on Resident/Fellow Duty Hours:
The following policy is consistent with those outlined by the New York State (NYSDOH) and the Accreditation Council on Graduate Medical Education (ACGME).
The University of Rochester is committed to providing residents with a sound academic and clinical education, which must be carefully planned and balanced with concerns for patient safety and resident well-being. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents' time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
1. Supervision of Residents
a. All patient care must be supervised by qualified faculty. The program director must ensure, direct, and document adequate supervision of residents at all times. Residents must be provided with rapid, reliable systems for communicating with supervising faculty.
b. Faculty schedules must be structured to provide residents with continuous supervision and consultation.
c. Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract its potential negative effects.
2.
Duty Hours
a. Duty hours are defined as all clinical and academic activities related to the residency program, ie, patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
b. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities (NYSDOH has placed an additional limit of 84 hours for any one week.)
c. Residents/fellows must be provided with 1 day in 7 free from all educational and clinical responsibilities, inclusive of in-house and pager call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
d. Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period and must consist of at least an 8 hour time period between all daily duty periods and after in-house call.
e. The NYSDOH requires strict adherence of institutions to its duty hour standards. Because state law supercedes accreditation requirements, all University of Rochester programs will comply with the 80 hour per week maximum. The GMEC will not consider approving a 10% increase in hours as described in ACGME duty hour requirements.
3. On-Call Activities
The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution.
a. In-house call must occur no more frequently than every third night, averaged over a four-week period.
b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 3 additional hours to participate in didactic activities and transfer care of patients.
c. No new patients may be accepted after 24 hours of continuous duty.
d. At-home call (pager call) is defined as call taken from outside the assigned institution.
- The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each trainee. Residents/fellows taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities.
- When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.
- The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.
4.
Moonlighting
a. No resident will be required to engage in moonlighting. Each program may determine if moonlighting activities will be allowed.
b. Because residency education is a full-time endeavor, the program director must monitor moonlighting hours to ensure that moonlighting does not interfere with the ability of the resident to achieve the goals and objectives of the educational program.
c. Each resident/fellow must obtain written permission from his/her program director prior to engaging in any moonlighting activities. The written permission form and record of hours worked will become part of the resident's departmental file.
d. Hours devoted to moonlighting must be added to training program work hours and reported on all work hour surveys. At no time should a trainee exceed work hour regulations through a combination of training program plus moonlighting activities.
e. The program director is responsible for monitoring the effect of these activities upon performance and withdrawing permission to moonlight if necessary. See moonlighting section of this GME manual for additional information.
5. Oversight
a. Each program must have written policies and procedures consistent with the institution's requirements for resident duty hours. These policies must be distributed to the residents/fellows and faculty. Monitoring of duty hours is required with frequency sufficient to ensure appropriate compliance.
b. Faculty and residents must be educated to recognize the signs of fatigue and to apply proactive and operational counter measures. The program director and faculty must monitor residents/fellows for the effects of sleep loss and fatigue and respond in instances when fatigue may be detrimental to resident performance and well being.
c. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.
