USF – College of Medicine

GRADUATE MEDICAL EDUCATION POLICY & PROCEDURE

Policy Statement

The College of Medicine of the University of South Florida is committed to providing the highest quality work environment for physicians in training to master their chosen disciplines.  Residency training involves both a responsibility and a commitment that requires a greater number of hours than the traditional job.  Medicine is a profession, and as such, necessitates commitment to patients that exceeds that of most of modern society. 

As part of the Institutional Requirements, the College of Medicine must ensure that each program has established resident duty hours that provide time for both education and patient care activities.   Duty hours must reflect the fact that responsibilities for continuity of patient care are not discharged only at specified times.  The program must also assure that residents are provided appropriate back-up when patient care activities are especially difficult or prolonged. 

The ACGME Common Accreditation Standards for Duty Hours address three areas:  (1) placing appropriate limits on duty hours; (2) promoting institutional oversight; and (3) fostering high-quality education and safe patient care.  They comprise the following:

Duty Hours

-           Residents must not be scheduled for more than 80 duty hours per week, averaged over a four-week period, with the provision that individual programs may apply to their sponsoring institution's Graduate Medical Education Committee (GMEC) for an increase in this limit of up to 10 percent, if they can provide a sound educational rationale;

-           One day in seven free of patient care responsibilities, averaged over a four-week period;

-           Call no more frequently than every third night, averaged over a four-week period;

-           A 24-hour limit on on-call duty, with an added period of up to 6 hours for continuity and transfer of care, educational debriefing and didactic activities; no new patients may be accepted after 24 hours;

-           A 10-hour minimum rest period should be provided between duty periods; and

-           When residents take call from home and are called into the hospital, the time spent in the hospital must be counted toward the weekly duty hour limit.

Institutional Oversight

-           Monitoring of programs' policies governing resident duty hours by the sponsoring institution;

-                     Requiring a sound educational justification of any increases above the 80-hour limit;

-           An annual report to the sponsoring institution's governing body on duty hour compliance;

-           Institutional policies on patient care activities external to the educational program ("moonlighting"), prospective approval of these activities, and monitoring their effect on performance in the educational program;

-           Counting time spent in patient care activities external to the educational program that occur in the primary program and institution toward the weekly duty hour limit;

-           Requiring programs and their sponsoring institutions to have policies and procedures to monitor and support the physical and emotional well-being of residents;

-           Requiring sponsoring institutions to monitor the demands home call places on residents in all programs, and making adjustments as necessary to address excessive demands and fatigue; and

-           Patient care support services for IV, phlebotomy, and transport activities to reduce resident time spent on these routine activities.

High-Quality Education and Safe and Effective Patient Care

-           Priority of clinical and didactic education in the allotment of residents' time and energies.

-           Schedules for teaching staff structured to provide ready supervision and faculty support/consultation to residents on duty;

-           Duty hour assignments that recognize that faculty and residents collectively have responsibility for patients' safety and welfare;

-           Monitor residents for the effects of sleep loss and fatigue by the Program director and faculty, with appropriate action when it is determined that fatigue might affect safe patient care or learning.

-           Education of faculty and residents in recognizing the signs of fatigue and in applying preventive and operational countermeasures; and

-           Appropriate backup support when patient care responsibilities are difficult and prolonged, and if unexpected needs create resident fatigue sufficient to jeopardize patient care.

The recommendations call for the ACGME-wide program requirements related to duty hours to be placed within the ACGME "Common Program Requirements," and for the standards delineating the sponsoring institution's responsibilities to be incorporated into the Institutional Requirements.  In the case that a specialty believes it cannot conduct its educational activities within the proposed constraints, an exemption beyond the 10 percent increase that can be granted by a sponsoring institution will require the approval of both the ACGME Program Requirements Committee and Board of Directors.  Such exemptions may be granted only if the specialty can demonstrate that there would be a significant detrimental effect on the clinical training and education.  The goal of the proposed approach is to encourage residency programs and sponsoring institutions to collectively implement programs that maintain a balance of education and service, and to collaborate on monitoring their effect on patient safety, learning and resident well-being.

Duty hours must be established for each program and provided to the resident in advance of beginning his/her educational training.

It is understood that residents who agree to participate in the residency training programs at the USF College of Medicine are expected to meet the applicable duty hour requirements.  Absence from clinical duty during anticipated duty hours is considered an unexcused absence and will be addressed.  Individuals with repeat absences during scheduled duty hours may be considered for adverse action.

Procedure

Responsible Party                                             Action

Program Director                                              Determines appropriate duty hours and provides to each assigned resident, addressing on-call time as applicable. 

                                                                        The Program Director may request an increase of up to 10% (8 hours/week for legitimate educational purposes only) by submitting a written request to the GMEC which identifies the educational rationale and justification. 

Resident                                                           Agrees to meet the scheduled duty hours and on-call schedule.

Notifies the Program Director in the event of any absence from scheduled duty hours.

GMEC                                                             Monitors written protocols for duty hours for all programs. 

Reviews duty hour logbook reports and affirmation by program directors.

Reviews request for increase in duty hours for educational purposes:  (a) to determine that the request is for a legitimate educational purpose, (b) that the program will monitor the education value of this increase, and (c) the program will monitor the impact of the additional hours on resident performance.  Notifies Program Director of approval or denial of requested increase.

Program Director                                              Submits request to appropriate RRC with requested documentation.

APPROVED:

Associate Dean, Graduate Medical Education                                                  

Dean, College of Medicine                                                                               

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APPROVED BY GMEC 7/17/02

REVIEWED, REVISED, REISSUED 6/05