The following guidelines, consistent with the ACGMEs Common Program Requirements, delineate the policy that the University of Chicago Internal Medicine Residency Training Program adheres to, effective July 1, 2011:
Department of Medicine Duty Hours Policy:
Safe / High Quality Care
The Department of Medicine will ensure a culture of professionalism that supports patient safety and personal responsibility. Residents and faculty members must demonstrate an understanding and acceptance of their personal role in the following:
- Assurance of the safety and welfare of patients entrusted to their care;
- Provision of patient- and family-centered care;
- Assurance of their fitness for duty;
- Management of their time before, during, and after clinical assignments;
- Recognition of impairment, including illness and fatigue, in themselves and in their peers
- In the clinical learning environment, each patient must have an identifiable, appropriately-credentialed and privileged attending physician who is ultimately responsible for that patient’s care.
- The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members.
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, educational activities, clinical work done from home, and all extra service pay.
- Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days.
- Duty periods of PGY-1 residents must not exceed 16 hours in duration. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 28 hours of continuous duty (24 hrs admitting + 4 hours transitioning patients) in the hospital. Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.
- Residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods. Residents must have at least 14 hours free of duty after 24 hours of in-house call.
- Our program encourages residents to use alertness management strategies in the context of patient care responsibilities.
- Residents must not be scheduled for more than six consecutive nights of night float.
- PGY-2 residents and above must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).
Policy for Episodes of Remaining on Duty Beyond Scheduled Hours
The policy on episodes of remaining on duty beyond scheduled hours is adapted from the University of Chicago GME Policy.
- After handing off clinical responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site to continue to provide care to a single severely ill or unstable patient, attend to the humanistic needs of a patient or family, or to attend unique educational events.
- In circumstances when residents choose to stay to care for patients or return to the hospital with fewer than eight hours free of clinical experience and education, they must still comply with the 80-hour and one-day-off in seven requirements.
- Under these circumstances, residents must document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director.
- The program director must review each submission of reduced break time, and track both individual resident and program-wide episodes.
- Additional hours of care or education will be counted towards the 80 hour weekly limit.
Every effort will be made by the Program Director, faculty, and trainees to maintain strict compliance with the above guidelines. This policy is disseminated yearly to all program faculty and staff.