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These requirements are still evolving. Please check the GME website
for the most up-to-date document. This policy must remain in compliance
with the ACGME requirements. All revisions will be approved by GMEC
prior to posting on the website or including in this booklet.
- UCSF’S HISTORY WITH DUTY HOURS
In June 2002, the Accreditation Council for Graduate Medical Education
(ACGME) granted preliminary approval to new duty hour standards
for residency programs. In July 2003, these standards became a
requirement for all residencies in all specialties to maintain
accredited status. The ACGME standards emphasize the responsibilities
of programs, sponsoring institutions, and the accrediting body
(ACGME) relating to safe patient care and an appropriate learning
environment for residents. The recommended mechanisms to achieve
these goals include the following:
- a set of common requirements that define a minimum standard
that must be met by all accredited programs;
- enhanced requirements for institutional oversight and support;
- and strengthening the system for compliance.
The standards address three areas: (1) placing appropriate
limits on duty hours; (2) promoting institutional oversight;
and (3) fostering high-quality education and safe patient
care. The UCSF Resident Duty Hours Improvement Project (RWHIP)
was approved by vote of the Graduate Medical Education Committee
(GMEC) on March 16, 2001. This followed a year - long effort
that arose from the report of a Taskforce on Resident Duty
Hours. Represented on the Taskforce and on the RWHIP Committee
were residents, students, faculty, program directors, program
coordinators, hospital administration, and the Dean's office.
Both practical and idealistic criteria to seek improvements
in resident duty hours at UCSF: 1) to ensure the highest standards
for delivery of patient care; 2) to enhance the integrity
of resident education; 3) to maintain the competitiveness
of UCSF with respect to other residency programs for outstanding
residents; 4) to satisfy ACGME requirements regarding resident
training hours.
- RESIDENT DUTY HOURS AND THE WORKING ENVIRONMENT (ACGME STANDARDS
FOR INSERTION INTO THE COMMON PROGRAM REQUIREMENTS FOR ALL CORE
AND SUBSPECIALTY PROGRAMS BY JULY 1, 2003)
A program to provide residents with a sound academic and clinical
education must be carefully planned and balanced with concerns
for patient safety and resident well being. UCSF will ensure that
the learning objectives of all residency programs are not compromised
by excessive reliance on residents to fulfill service obligations.
Didactic and clinical education will have priority in the allotment
of residents' time and energies. Duty hour assignments will recognize
that faculty and residents collectively have responsibility for
the safety and welfare of patients.
Resident is defined as an intern, resident, or fellow enrolled
in ACGME-approved training programs at UCSF.
- Duty Hours
- Duty hours are defined as all time in the hospital
and clinics. Specifically, this includes 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
(including sleep), and scheduled academic activities such
as conferences and research activities required by the
RRC. Duty hours do not include reading and preparation
time spent away from the duty site. However, if research
is required by the RRC and if during that research time
clinical work is required, the duty hours policy is applicable
ALL RRC-required activities. These standards apply to
all UCSF training sites including, but not limited to,
the VA, SFGH, Mt. Zion, and Moffitt-Long hospitals. Each
program has program-specific, faculty-developed Duty Hours
Policy. The policy must include a process to educate faculty
and housestaff about fatigue and stress, plans for monitoring,
and procedures to deal with fatigue and stress.
- Duty hours will be limited to 80 hours per week, averaged
over four-week period, inclusive of all in-house call
activities. Note that some RRC’s (e.g., Internal
Medicine) do not allow “averaging” of duty
hours.
- Residents will be provided with 1 day in 7 free from
all educational and clinical responsibilities, averaged
over a four-week period, inclusive of call. One day is
defined as one continuous 24-hour period free from all
clinical, educational, and administrative activities.
Note that some RRC’s (e.g., Internal Medicine) do
not allow “averaging” of duty hours
- A-10 hour time period for rest and personal activities
should be provided between all daily duty periods, and
after in-house call.
- On-Call Activities
The objective of on-call activities is to provide residents
with continuity of patient care experiences throughout a 24-hour
period. In-house call is defined as those duty hours beyond
the normal workday when residents are required to be immediately
available in the assigned institution.
- In-house call will occur no more frequently than every
third night, averaged over a four-week period.
- Continuous on-site duty, including in-house call, will
not exceed 24 consecutive hours. Residents may remain
on duty for up to 6 additional hours to participate in
didactic activities, maintain continuity of medical and
surgical care, transfer care of patients, or conduct outpatient
continuity clinics.
- No new patients may be accepted after 24 hours of continuous
duty. A “new patient” is defined by individual
RRC’s.
- At-home call (pager call) is defined as call taken
from outside the assigned institution.
- The frequency of at-home call is not subject to
the every-third night limitation. However, at-home
call will not be so frequent as to preclude rest and
reasonable personal time for each resident. Residents
taking at-home call will be provided with 1 day in
7 completely free from all educational and clinical
responsibilities, averaged over a 4-week period. Note
that some RRC’s (e.g., Internal Medicine) do
not allow “averaging” of duty hours.
- When residents are called into the hospital from
home, the hours residents spend in-house are counted
toward the 80-hour limit.
- The program director and the faculty will monitor
the demands of at-home call in their programs and
make scheduling adjustments as necessary to mitigate
excessive service demands and/or fatigue.
- Moonlighting (also, see “Moonlighting Policy”)
- The current and long-standing policy at UCSF does not
allow residents (first board trainee) to moonlight. This
is currently under review by a Task Force of the Graduate
Medical Education Committee. Housestaff are invited to
comment. Contact Claire Brett, M.D, Chair of the task
force (brettc@anesthesia.ucsf.edu; 476-9694).
- Clinical Fellows may moonlight under specific guidelines
and with a signed moonlighting agreement from the Chair,
MSO, Program Director, the Clinical Fellow and the Senior
Associate Dean for Graduate Medical Education.* ACGME
Clinical Fellows may only moonlight in areas that are
outside their area of training and only in outpatient
or emergency departments.
- Non-ACGME Clinical Fellows may moonlight in the inpatient
and/or outpatient settings in or beyond their area of
training, and the Department may bill for work done in
or beyond their area of training. The Chair and Program
Director must assure that this effort will not interfere
with the educational experience of the fellow's training
program. If there is evidence of fatigue and stress, the
moonlighting activity must be re-evaluated and, if appropriate,
discontinued.
- Each program director complies with the sponsoring
institution's written policies and procedures regarding
moonlighting, in compliance with the Institutional Requirements.
- Moonlighting that occurs within the fellowship program
and/or the sponsoring institution or the non-hospital
sponsor's primary clinical site(s), i.e., internal moonlighting,
is not counted toward the 80-hour weekly limit on duty
hours; external moonlighting is not.
- Oversight
- Each program has written policies and procedures consistent
with the Institutional and Program Requirements for resident
duty hours and the working environment. These policies
will be distributed to the residents and the faculty.
Monitoring of duty hours is required with frequency sufficient
to ensure an appropriate balance between education and
service. Programs will be monitored with a frequency to
be determined by the UCSF GMEC Executive Committee. This
committee will include the Senior Associate Dean of Graduate
Medical Education, the Resident Duty Hours Compliance
Officer, the vice-chair of the GMEC, and a subset of members
of the GMEC. Each program director will be responsible
for obtaining data on compliance with the Resident Duty
Hours Policy for theiprogram. Each resident will be responsible
for providing accurate and timely data on compliance with
the Resident Duty Hours Policy to her/his program director,
the GME Office, and the ACGME when this information is
requested. Directors of programs that are out of compliance
with the Resident Duty Hours Policy will determine a plan
and timeline to come into compliance and submit this plan
and timeline to the Executive Committee of the GMEC.
- Each program provides back-up-support systems when
patient care responsibilities are unusually difficult
or prolonged, or if unexpected circumstances create resident
fatigue sufficient to jeopardize patient care.
- Duty Hours Exception
An RRC may grant exceptions for up to 10 % of the 80-hour
limit, to individual programs based on a sound educational
rationale. However, prior permission of the Executive Committee
of the GMEC is required.
- UCSF ACGME Fellowship Moonlighting Agreement (within UCSF)
The agreement must define and specify the terms of the clinical
work to be performed by stating the following on a form obtained
from the GME or the GME website:
- the nature and location of the service to be provided
- the UCSF training program in which the Clinical Fellow
is currently enrolled
- the dates of the service to be performed
- the compensation and funding information from the Department
receiving the service
- a statement of who will provide Medical Malpractice
and General Liability coverage
- the dates and type of Departmental Professional Fee
Billing Compliance training the Clinical Fellow received
- the date the Clinical Fellow was licensed in California.
No approval form from the Dean’s office is required
for non-ACGME fellows.
Date GMEC Reviewed & Approved: February 24, 2004
Revised: September 29, 2004 |
