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Duty Hours

DEFINITIONS
“Resident” means a physician in an Accreditation Council for Graduate Medical Education (ACGME) accredited Emory Training Program for a clinical specialty.  Unless otherwise specified, “resident” includes fellows in an ACGME accredited Emory Training Program for a clinical subspecialty.  Emory residents or fellows in non-accredited training programs or those accredited by other organizations such as member boards of the American Board of Medical Specialties should be considered included in these policies if their salaries are managed by the Emory Office of Graduate Medical Education or unless specifically excluded by the Emory Graduate Medical Education Committee (GMEC) or Associate or Assistant Dean for GME (the Designated Institutional Officials or “DIO”).

DUTY HOURS POLICY
The GMEC follows guidelines established by the ACGME regarding the clinical learning environment including those related to duty hours for residents in accredited training programs as defined in the ACGME Common Program Requirements (CPR). Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities such as conferences.

General Guidelines

  1. Residents are responsible for accurately reporting their duty hours, including all time spent in Internal and External Moonlighting, per program requirements, and for honestly reporting concerns of non-compliance.
  2. Program Directors are responsible for monitoring and enforcing compliance with duty hour guidelines.
  3. If specialty/subspecialty-specific program requirements for duty hours as defined by an individual ACGME Review Committee (RC) are more restrictive than the CPR, then the duty hour requirements of that RC will apply for residents in that specialty/subspecialty program and will supersede the CPR.
  4. Concerns regarding duty hours may be reported to the Associate or Assistant Dean for GME or through the Confidential Helpline 1-888-594-5874. Concerns may be reported anonymously.

Specific Guidelines

The ACGME duty hour requirements are found within the CPR on the ACGME web site (https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_07012016.pdf, accessed 01/03/2017).   The 2011 ACGME guidelines are summarized in appendix 1 below, but Emory programs are required to follow the most recently approved ACGME version of the CPR.

All programs must have policies for duty hours that at a minimum meet the ACGME's institutional and program requirements. Programs must monitor in-house and from-home duty hours on an ongoing basis in a way that provides accurate data.  The GMEC Duty Hour Subcommittee (“Subcommittee”) has established reporting requirements, one of which is that each monitoring period must be 4 weeks in length, not a moving average or extrapolated from a shorter length of time.  With GMEC oversight, the DIO and the Chair of the Subcommittee will review program data resulting from internal reviews, annual administrative processing sessions, random audits and other times as determined by the DIO, the GMEC or by the Duty Hours Subcommittee.  If a program has received approval from the ACGME to extend the 80-hour weekly duty hour limit, if the program received a duty hour citation or if an internal review reveals a duty hour issue, then these training programs must send reports to the sub-committee at a minimum of every other month. 

Program Directors must monitor call-from-home duty hours in terms of frequency and characteristics to assure that residents and fellows are following basic guidelines established by the ACGME.   

Monitoring

Program Directors must monitor call-from-home duty hours in terms of frequency and characteristics to assure that residents and fellows are following basic guidelines established by the ACGME.    

  1. Residents in core programs are expected to log duty hours daily in New Innovations.
  2. Fellows in subspecialty programs are expected to log duty hours in New Innovations regularly but at minimum quarterly (for a four week period):
    • August
    • November
    • February
    • May

Education

Program Directors must provide information to residents, fellows and faculty members regarding effects of loss of sleep and chronic fatigue.  Currently, the GMEC recommends using the SAFER program available on the GME Website- and asking faculty members of Emory University School of Medicine who have expertise in this area. 

The GMEC Duty Hours Subcommittee will review program duty hours logged in New Innovations. GMEC will notify programs that are not in compliance for follow up.

REPORTING STRUCTURE FOR OFF-SERVICE ROTATIONS

It is the intention of this section of the Duty Hour Policy to establish a process that will address duty hour compliance in a rapid and timely manner when a resident is rotating off service.  Problems regarding compliance with duty hour guidelines should be reported to the Chief Resident of the accepting training program.  If that Chief Resident does not respond to the report of noncompliance, then the resident should report to the Program Director of the sending program.  The Program Directors of the two programs must address the issues that led to the violation of the guidelines.  The resident may notify the GME Office at any time.  The Associate Dean for GME will report to the Chairs of the two training programs and has the option of reporting to the Dean if the issues are not settled on an immediate basis.

The GME office maintains a direct phone line to receive confidential complaints about all issues including duty hours. This phone number 1-888-594-5874 is private and secure.  The Associate Dean and DIO will respond to the recorded messages as appropriate.