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Resident Clinical Experience and Education - Internal Medicine Resident

DEPT: MEDICAL EDUCATION

POLICY #: 8240.10.1

GOAL

To provide a program statement outlining clinical experience and education requirements (formerly duty hours and the working environment) in accordance with ACGME requirements.

POLICY

1. The Internal Medicine Residency Program will schedule resident assignments in compliance with all applicable ACGME requirements. Faculty members know, honor, and assist in implementing the applicable clinical experience and education expectations. Residents comply with those expectations, accurately report work hours, and cooperate with clinical experience and education monitoring procedures. All involved identify and report sources of potential work hour violations, and collaborate to devise appropriate corrective action. This policy is to be communicated to the residents and faculty annually and applies to all participating sites where residents are trained. On a quarterly basis, residents must log their work hours for a 28-day period. The clinical experience and education report will be submitted to the GMEC for review.

2. Maximum Hours of Clinical and Educational Work per Week: Clinical and educational work hours are limited to no more than 80 hours per week, averaged over a 4-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting (both external and internal). All moonlighting hours are reported as clinical and educational work hours. Note: PGY-1 residents are not permitted to moonlight.

a) Moonlighting must not interfere with resident education.

b) Moonlighting is only permitted with prior written approval of the Program Director (see Resident Moonlighting Policy).

3. Mandatory Time Free of Clinical Work and Education:

a) The program must design an effective program structure that is configured to provide residents with educational opportunities, as well as reasonable opportunities for rest and personal well-being.

b) Residents should have eight hours off between scheduled clinical work and education periods.

i) There may be circumstances when residents choose to stay to care for their patients or return to the hospital with fewer than eight hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements.

c) Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.

d) Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days.

4. Maximum Clinical Work and Education Period Length

a) Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.

(1) Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education.

(a) Additional patient care responsibilities must not be assigned to as resident during this time.

5. Clinical and Educational Work Hour Exceptions

a) In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances:

(1) to continue to provide care to a single severely ill or unstable patient.;

(2) humanistic attention to the needs of a patient or family; or,

(3) to attend unique education events.

b) These additional hours of care or education will be counted toward the 80-hour weekly limit.

6) Night float and cross coverage must occur within the context of the 80-hour and one-day-off-in-seven requirements.

7) Maximum In-House On-Call Frequency: Residents must be scheduled for in-house call no more frequently than every third night.

8) At-Home Call must satisfy the requirement for one-day-in-seven free of clinical work and education, when averaged over four weeks. Time spent on patient care activities by a resident on at-home call must be reported in, and count toward, the 80 hour maximum weekly limit.

a) Return to the hospital for episodic care while on at-home call does not initiate a new “off-duty period.”

b) At-Home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.

DEFINITIONS

Clinical Experience and Education Activities: All clinical and academic activities related to the program. This includes patient care, administrative duties relative to patient care, provision of transfer of patient care, on-call time spent in-house, and scheduled activities such as conferences. Clinical Experience and Education Work hours do not include reading and preparation time spent away from the duty site.

COTTAGE HEALTH POLICY

RECOMMENDED BY: A.Gersoff, M.D. (DIO) DATE: 9/14
ORIGINAL POLICY EFFECTIVE DATE: 4/04
APPROVED BY: E. Wroblewski,M.D (CMO) DATE: 1/18
DATE REVISED: 1/18 
DATE REVIEWED: 9/14