Clinical and Educational Work Hours

Clinical and Educational work 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.

• Clinical and Educational work periods for residents must not exceed 24 hours of continuous, scheduled clinical assignments.
• Up to four (4) hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care and/or resident education.
• Resident physicians must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.
• In unusual circumstances, Resident physicians on their own initiative may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. Under those circumstances, the resident must:
  • Appropriately hand over the care of all other patients to the team responsible for their continuing care; and
  • Document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director/DIO.
  • The program director must review each submission of additional service and track both individual resident and program-wide episodes of additional duty.
• Programs must encourage resident physicians to use alertness management strategies in the context of patient care responsibilities.

Resident physicians should have eight (8) hours off between scheduled clinical work and education periods. They must have at least 14 hours free of duty after 24 hours of the in-house call.

Resident physicians must be scheduled for a minimum of one day in seven free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days.

Resident physicians must be scheduled for in-house call no more frequently than every third-night (when averaged over a four-week period).

Resident physicians must not be scheduled for more than six consecutive nights of night float. (The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the Review Committee).

• The Program Director must follow the duty hour exception policy from the ACGME Manual on Policies and Procedures.
• Exceptions that occur or granted are to be reported as a clinical and educational work hour’s exception at the next GMEC meeting.

• Time spent in the hospital by resident physicians while on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every-third-night limitation, and should not exceed every other night, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks.
• At-home call must not be as frequent or taxing as to preclude rest or reasonable personal time for each resident.
• Resident physicians are permitted to return to the hospital while on at-home call to care for new or established patients.  Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new “off-duty period.”