Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. The residency program is committed to ensuring 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. Clinical and Educational work hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
Clinical and Educational Work Hours
These hours are defined as all clinical and academic activities related to the residency program, i.e., 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 activities, such as conferences. These hours do not include studying, reading and preparation time spent away from the work site. Of note, work hours should be counted only for the time spent in a conference/event (travel time, lodging time is not included in the duty hour regulations).
Work hours are limited to 80-hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home and moonlighting.
Residents are provided with at least one (1) day in seven (7), free from all educational and clinical responsibilities, averaged over a four (4) week period, inclusive of call. One (1) day is defined as one (1) continuous 24-hour period free from all clinical, educational, and administrative activities. Residents should review the service call schedule at the beginning of the block rotation in order to assure they have this required time off scheduled. If this requirement is not met, they are to immediately notify the attending or senior resident so that adjustments in the schedule can be made.
Residents should have eight (8) hours off between scheduled clinical work and educational periods. Residents must have at least fourteen (14) hours free of clinical work and education after 24 hours of in-house call. 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 eighty hour and 1 in seven day off requirements. Residents should monitor when they leave the hospital and adjust their return time back to the hospital to meet this requirement. Residents should notify their team (attending or senior resident) of when they will be returning the next day.
Assessment of the compliance with these requirements is done through New Innovations. Work hour violations are discussed with each resident and service chief every 4 week block. In order to ensure that residents are not working beyond the duty hour limits, residents are encouraged to log in their duty hours on a daily basis, and required to log their duty hours on a weekly basis. Residents are also encouraged to log in their duty hours in an honest fashion. The result of work hour reports are analyzed to make appropriate changes that are meant to provide an environment conducive to learning that is well balanced with service. In addition, proactive measures are advised to prevent resident work hour violations and these can be found in Appendix I– Preventing Work Hour Violations
The work hours report from New Innovations is used by the program coordinator to generate resident time sheets. A resident may enter work hours using the NI website or phone "app." Work hours must be updated by 10 am of every Thursday in order to get paid. Hours not logged into New Innovations in a timely fashion may result in a delay of pay. You will be required to use your own leave time to retrieve your check at an offsite place. This is considered unprofessional and will not be tolerated. A pattern of inputting duty hours in a delinquent manner may result in disciplinary action.
In-house call occurs no more frequently than every third night, averaged over a four (4) week period.
For all residents, clinical and educational work periods must not exceed twenty-four (24) hours. Residents may remain on-site for up to an additional four (4) hours in order to facilitate effective transfer of care. Residents must have at least fourteen (14) hours free of duty after twenty-four (24) hours of in-house duty.
Residents must not be scheduled for more than six consecutive night shifts. Residents must be available for obstetrical delivery of their continuity prenatal patients throughout their three (3) years of training. Continuity deliveries, end of life care and other special experiences that result in extended duty hours are considered justifiable duty hour violations. All efforts will be made to accommodate the resident to attend a continuity delivery during other clinical responsibilities.
In rare circumstances after handing off all other responsibilities, a resident on their own initiative may select 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 need of a patient or family
3. To attend a unique educational event
These additional hours of care or education will be counted toward the eighty hour weekly limit.