Clinical and Educational Work Hours
The Institutional GMEC ensures that all GME programs are in compliance with the Accreditation
Council for Graduate Medical Education (ACGME) requirements to monitor and limit resident
clinical and educational work hours.
The GMEC recognizes that clinical and educational work hours must be carefully planned
and monitored to ensure academic and clinical education, patient safety, and resident
well-being. The GMEC further ensures that each GME program establishes formal written
policies governing resident clinical and educational work hours.
Maximum hours of work per week
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.
Maximum duty period length
- 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
- 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.
Minimum time off between scheduled duty periods
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.
Mandatory free time off duty
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
Maximum in-house on-call frequency
Resident physicians must be scheduled for in-house call no more frequently than every
third-night (when averaged over a four-week period).
Maximum frequency of in-house night float
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).
Duty hour exceptions
- 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
The GMEC will require all programs to assess compliance to their clinical and educational
work hours policy on a weekly basis. Quarterly, each program will report to the Institutional
GMEC documenting compliance to the clinical and educational work hours policy.
Clinical and Educational Work Hours Violations
PCOM, the Sponsoring Institution, takes the ACGME’s policies very seriously since
infractions could jeopardize patient safety, the institution’s accreditation status,
and ultimately the accreditation status of all their programs. Therefore, any resident
who knowingly violates the clinical and educational work hours policy will be dealt
with by the respective Program Director.
If a resident knowingly continues to violate the Clinical and Educational Work Hours
Policy, the Program Director/DIO can invoke other departmental sanctions and at any
time may bring the issue before the GMEC for review and possible subsequent disciplinary
action up to and including the resident’s dismissal from the program.
Documentation of Clinical and Educational Work Hours
All Residents are required to document their clinical and educational work hours each
week in the E-Value system.
Outside employment is not allowed during the PGY-1 training year. PGY-1 Residents
may participate in private, professional, or clinical practice as it relates to the
structured educational experience to which they are assigned. They shall not receive
compensation for such activities.
Residents may engage in moonlighting opportunities beginning in the PGY-2 year, but
only after the successful completion of their PGY-1 year, which includes the submission
of all paperwork and with permission from their program director.
PCOM will not provide professional liability insurance to residents for any moonlighting
Residents may practice medicine only within the scope of their specialty training,
education and experience.
It is also strongly recommended that an attending physician be present on the premises
at all times while the resident is moonlighting.
If you have any questions regarding this policy, please contact:
- A Resident Application of Approval for Moonlighting form must be filled out. These
forms are available in the Graduate Medical Education (GME) office. The form must
be signed by both the Director of the Residency Program and the DIO.
- Evidence of professional liability insurance coverage must be provided and attached
to the form. This insurance may be provided by the entity for which the resident will
be moonlighting or the resident’s own individual insurance.
- Residents must have an unrestricted license (OS license) to practice medicine in the
state where the moonlighting will occur. A residency training license (OT license)
is NOT a license to practice medicine outside the scope of residency training.