Applies to: Residents in the WSU Internal Medicine Residency – Everett program
Date: September 1, 2022
1.0 Policy Statement
It is the Internal Medicine – Everett policy to limited clinical and educational work hours to no more than 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 all moonlighting.
2.0 Definitions
At-Home Call (Pager Call)
Call taken from outside the assigned site. Clinical work done while on at-home call, including time spent in the hospital and work done at home, such as taking calls or entering notes in an electronic health record (EHR), counts against the 80-hour-per-week limit but does not restart the clock for time off between scheduled in- house clinical and educational work periods. The remaining time, free of clinical work, does not count. At-home call may not be scheduled on a resident’s or fellow’s one free day per week (averaged over four weeks).
Attending Physician
The single identifiable physician ultimately responsible and accountable for
an individual patient’s care, who may or may not be responsible for supervising resident or fellows.
Clinical and Education Work Hours
All clinical and academic activities related to the program: patient care (inpatient and outpatient); administrative duties relative to patient care; the provision for transfer of patient care; time spent on in-house call; time spent on clinical work done from home; and other schedule activities, such as conferences. These hours do not include reading, studying, research done from home, and preparation for future cases.
In-House Call
Clinical and educational work hours, beyond the scheduled workday, when residents are required to be immediately available within an assigned site, as needed, for clinical responsibilities. In-house call does not include night float, being on call from home, or regularly scheduled overnight duties.
Moonlighting
Voluntary, compensated, medically-related work performed beyond a resident’s or fellow’s clinical experience and education hours and additional to the work required for successful completion of the program.
Post-Graduate Year (PGY)
The denotation of a post-graduate resident’s or fellow’s progress in his/her/their residency and/or fellowship training; used to stratify responsibility in most programs. The PGY does not necessarily correspond to the resident’s or fellow’s year in an individual program. For example, a fellow who has completed a pediatric residency program and is in the first year of a pediatric endocrinology fellowship program is a pediatric endocrinology 1 level and a PGY-4.
3.0 Responsibilities
Program Director; Program Faculty
4.0 Procedures
All clinical and academic activities related to the program are expected to comply with the clinical and educational work hour standards established by the Accreditation Council for Graduate Medical Education (ACGME).
- Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, in-house night float, clinical work done from home, and all moonlighting.
- Residents should have 8 hours off between scheduled clinical work and education periods.
There may be circumstances when residents choose to stay to care for their patients or return to the hospital with fewer than 8 hours free of clinical experience and education. This must occur within the context of the 80- hour and the 1-day-off-in-7 requirements.
- Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
- Residents must be scheduled for a minimum of 1 day in 7 free of clinical work and required education (when averaged over 4 weeks). At-home call cannot be assigned on these free days.
- Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.
Up to 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. Additional patient care responsibilities must not be assigned to a resident during this time.
Clinical and Educational Work Hour Exceptions
GME (or the ACGME Internal Medicine Review Committee) does not currently allow rotation-specific exceptions for up to 10 percent or a maximum of 88 clinical educational work hours to individual programs. However:
- In rare circumstances, after handing off all other responsibilities, residents, on their own initiative, may elect to remain or return to the clinical site in the following circumstances: to continue to provide care to a single severely unstable patient; humanistic attention to the needs of a patient or family; or to attend unique educational events.
- These additional hours of care or education will be counted toward the 80-hour weekly limit.
Clinical and Educational Work Hour Monitoring
All residents must log into the GME resident management system weekly and enter their clinical and educational work hours. Residents and faculty are responsible for notifying the administration of infractions for any rotation. Per the GME Clinical and Educational Work Hours policy, all programs will be reviewed for violations during GMEC meetings. Clinical and educational work hour violations also will be reviewed at housestaff meetings for suggestions and resolution.
The program director will monitor resident compliance with established work hour guidelines and address any violation within 3 days. Repeated reports of clinical and educational work hour infractions will be taken seriously and responded to accordingly and may result in modification of the rotation hours and/or structure to ensure that clinical and educational work hour requirements are met. The program director and faculty will work with individual residents to help them meet the clinical and educational work hour requirements as appropriate.
Moonlighting
Residents in the Internal Medicine – Everett program are not permitted to moonlight.
5.0 Related Policies
- GME Clinical and Educational Work Hours Policy
- GME Moonlighting Policy