Graduate Medical and Dental Education

Residency Information-Duty Hours Policy

Revised 10/23/03
Introduction

The UT Graduate School of Medicine (GSM) shall implement a policy for all graduate medical education programs that conforms and complies with the ACGME requirements on Resident Duty Hours. The Policy shall consist of two (2) Phases. Phase I shall consist of a monitoring program for actual duty hours for residents in all programs including residency programs in the Department of Dentistry and Oral and Maxillofacial Surgery. Phase II will consist of an education program for faculty and residents on recognition of the signs of fatigue and for potential remedial actions (D.1.c- Common Program Requirements, ACGME).

Phase I

The UT GSM shall adopt the ACGME Resident Duty Hours Language, effective February 2003. Monitoring of Resident Duty Hours will be based on four-week rotations rather than month rotations.

ACGME Final Requirements On Resident Duty Hours
See Appendix A

Duties and Responsibilities

Programs/Departments

It is the sole responsibility of each program to develop and implement a specialty-specific resident duty schedule that allows monitoring of week rotations regardless of rotation sites. This duty schedule must comply with minimum requirements listed in the attached ACGME Final Requirements On Resident Duty Hours (Appendix A). Further, it is recommended that each resident have at least one weekend free of on-call responsibility each consecutive four-week period.

Responsible Coordinators

It is the responsibility of the Program to designate an individual to coordinate distribution to each resident an adequate supply of weekly Resident Physician Duty Hours cards (See Appendix B). These cards are to be obtained from GME and are uniform for all departments.

The Program’s duty hours coordinator shall collect all Duty Hours cards each Monday and from residents who have excused absences as appropriate. In any event, all weekly cards for each resident from the immediate past four weeks should be in the hands of the Duty Hours Coordinator no later that the 5th day of the current month. Departments may elect to assign this duty to a designated resident.

In the event that a rotation begins other than on a Monday, duty hours shall be kept for the period of Monday to Monday.

The Duty Hours Coordinator will use the uniform GME Week-to-Week Duty Hours form (See Appendix C) to record weekly duty hours for each resident. This form is to become a permanent part of the Department’s Duty Hours Files. Further, to prepare for potential audit, the Duty Hours coordinator shall retain all Weekly Duty Hours records for each resident for at least three (3) years.

Using individual resident weekly duty hours report cards, the Duty Hours Coordinator shall provide a Four Week Average Duty Hours Summary for each individual resident (See Appendix D). This report is to be produced in duplicate with one copy to be submitted to the office of GME and one copy kept in the department. It is the responsibility of the Program Director or Department Chair to approve this form prior to submission to GME. The approved Four Week Average Duty Hours Form is to be submitted to GME on or before the 5th of the month. Each department is to maintain the Summary Reports for a period of three (3) years.

Data for the Weekly Report Form and for the Four Week Average Report Form may be entered electronically using the uniform templates (Excel) supplied by GME.

Residents

It is the responsibility of each individual resident to personally record his or her duty hours on the Resident Physician Duty Hours cards (Appendix B) on a daily basis. No assistance from other residents is permitted. Weekly duty hours pertains to the period beginning at 8:00 a.m. on Monday continuously until 8:00 a.m. the following Monday. When multiple sites are assigned within a Monday-to-Monday week, the location sites should be recorded. Thus, The following information must be recorded without exception:

1. Name
2. Department
3. Rotation(s) for the Week
4. Starting date for that week (always a Monday)
5. Sunday ending date
6. Daily Start Time and End Time for each assigned Location. Space is provided for two separate locations for each day. If a third separate location for a single day is assigned, this should be noted in the “Comments” area.
7. Duty hours are to be recorded to the nearest ¼ hour.

Implementation and Monitoring

The process for implementation of this policy is as follows:

Time-line

1. Submission to the GME Committee Meeting in March 2003 for discussion, recommendations and subsequent approval.
2. Submission to the Dean’s Chairs Meeting in April 2003 for discussion, recommendations and subsequent approval.
3. Provisional implementation of the Policies on 01 May 2003. Based on results obtained from the experiences in May and June, implement a revised, if necessary, and “final” policy on 01 July 2003.

Monitoring

1. The Institutional DIO will review all program Duty Hours reports on a monthly basis.
2. The DIO shall provide a quarterly report to each Program Director/Chair vis-à-vis compliance or non-compliance.
3. In the event of non-compliance, it is the responsibility of the Program Director/Chair to submit to the DIO/GME a written plan for correction of non-compliance.
4. The plan for correction of non-compliance must be implemented within the immediate quarter following receipt of the non-compliance notification from the DIO/GME.
5. Non-compliance for two consecutive quarters for any resident (not just the same resident) within the same program will be reported to the Associate Dean for GME.
6. Two or more quarters of non-compliance within a continuous twelve-month period will be reported to the Associate Dean for GME.

Reporting Duty Hours Violations

Phase II

Introduction

Paragraph D.1.c. of the Common Program Requirements on Resident Duty Hours, ACGME, mandates that: “Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.”

Duties and Responsibilities

1. It is the responsibility of the DIO/GME to develop in consultation with GSM and UTMC Sleep Medicine specialists and in concert with national trends, all necessary pamphlets, brochures, videos and, when appropriate, lectures to affect a viable education program on sleep deprivation.
2. It is the responsibility of each Program Director/Chair to implement this educational program for its teaching faculty and residents.

Implementation

1. The educational program on sleep deprivation shall begin on or before 01 October 2003, i.e., one quarter after the official implementation of the Phase I Duty Hours Monitoring Program.
2. The DIO/GME, in consultation with Program Directors/Chairs, shall develop a Resident Survey Instrument to determine if there are signs of recognized as well as unrecognized excess fatigue and sleep deprivation by the resident.
3. The Resident Survey will be administered at a minimum of every six months.
4. The DIO will collate the results of the Resident Surveys for presentation to the GME Committee and department chairs.
5. The DIO/GME will make general recommendations for correction of all problems.
6. It is the responsibility of the Program Director/Chair for final and program specific corrective policies for all problems detected by the Resident Surveys.