Residency Program

Duty Hours

The Department of Rehabilitation Medicine Residency Training Program recognizes that a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being.  Learning objectives of the program must not be compromised by excessive reliance on residents to fulfill service obligations.

Supervision of Residents

All patient care must be supervised by qualified faculty.  Residents in the Department of Rehabilitation Medicine Training Program are provided with rapid, reliable systems for communicating with supervising faculty.  Faculty schedules are structured to provide residents with continuous supervision and consultation.

Recognition of Fatigue and Countermeasures

Faculty and residents are educated annually to recognize the signs of fatigue and to adopt and apply measures to prevent and counteract the potential negative effects of fatigue.

Duty Hours Requirements

The Department of Rehabilitation Medicine Residency Training Program oversees residents' duty hours and working environment.  During all clinical rotations within The Department of Rehabilitation Medicine Residency Training Program, trainees and staff shall conform to existing ACGME, RRC, and institutional duty hour policies.  Duty hours are defined as 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, and scheduled academic activities such as conferences.  Duty hours do not include reading and preparation time spent away from the duty site.

The Program's policies and procedures, including supervision, moonlighting, and duty hours policies, are distributed to the residents and the faculty.

Specific Duty Hour Limitations

Residents will not be scheduled for more than 80 duty hours per week, averaged over a four week period.

Residents will on average (over a four week rotation) have one day (24 hours) in seven free of patient care responsibilities.

In-house call (defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution) will be no more than once every third night averaged over a four week period.

Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours.  Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined by the Department of Rehabilitation Medicine RRC Program Requirements.  No new patients, as defined in the Department of Rehabilitation Medicine RRC Program Requirements, may be accepted after 24 hours of continuous duty.

Adequate time for rest and personal activities must be provided.  This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.

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 reach resident.  Residents taking at-home call will be provided with one day in seven free of all educational and clinical responsibilities averaged over a four week period.  When a resident is called into the hospital from home, the hours that a resident spends in-house are counted toward the 80-hour limit.

The Department of Rehabilitation Medicine Residency Training Program's moonlighting policy delineates the process by which residents may moonlight and how moonlighting hours count toward the duty hours requirements.

Contingency Plan

The Program Director will establish a contingency or backup system that enables patient care to continue safely during periods of heavy use, unexpected resident shortages, or other unexpected circumstances.  The Program Director and supervising faculty will monitor residents for the effects of sleep loss and fatigue and will take appropriate action in instances where overwork or fatigue may be detrimental to residents' performance and the well being of the residents and/or the patients.

The monthly call schedule contains information regarding the residents who are assigned clinics post call.  Faculty physicians may use this guide to modify clinic schedules to accommodate residents who are approaching duty hour limitations.  The Chief residents may also request residents from other Rehabilitation Medicine rotations provide coverage during a busy clinic day.

Duty Hour Policy Compliance Monitoring

The Program Director and faculty will monitor compliance with this policy by the monitoring of call and duty schedules, the direct observation of residents interview/discussions with residents, and the review of residents' evaluations of rotations.  Residents are instructed to notify the Program Director if they or other residents are requested or pressured to work in excess of duty hours limitations.  The Program Director maintains an open-door policy so that any resident with a concern can seek immediate redress.  If problems are suspected, the Program Director will notify the designated institutional official and gather direct duty hour data to clarify and to resolve the problem.  In addition, the GMEC's Duty Hours Subcommittee will confirm program compliance during its quarterly duty hours surveys of all programs.