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Clinical Experience and Education

Policy Purpose:

The ACGME requires that residency programs, in partnership with their sponsoring institutions, must design an effective program structure that is configured to provide residents with educational and clinical experience opportunities, as well as reasonable opportunities for rest and personal activities. Mount Carmel Health System and its residency programs ensure adherence to the ACGME common program requirements on clinical experience and education

Responsible Persons:

Graduate Medical Education Administration

Prodecure:

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 activities, clinical work done from home and all moonlighting.

  • Duty hour exceptions
    • A Review Committee may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale.
      • In preparing a request for an exception the program director must follow the duty hour exception policy from the ACGME Manual on Policies and Procedures.
      • Prior to submitting the request to the Review Committee, the program director must obtain approval of the institution’s GMEC and Director of Medical Education/DIO.

Moonlighting

Moonlighting
  • PGY-1 residents are not permitted to moonlight.
  • According to the ACGME requirement, moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program. Specifically, Medical Education follows the following ACGME guidelines regarding resident physicians’ moonlighting internally and/or outside of the hospital system.
  • Time spent by residents in Internal and External Moonlighting (as defined in the ACGME Glossary of Terms) must be counted towards the 80-hour Maximum Weekly hour Limit. Accordingly, the Program Director may require periodic reports of a resident’s moonlighting hours.
  • Moonlighting is permitted only if a resident physician secures the written approval of his/her Program Director, who may withdraw the permission at any time, if he determines that moonlighting is interfering with the resident’s progress and/or performance.
  • The Program Director must comply with the sponsoring institution’s written policies and procedures regarding moonlighting, in compliance with the ACGME Institutional Requirements.

Mandatory Time Free of Duty

  • 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.

Maximum Duty Period Lengths

  • linical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments
    • Up to four 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.

Minimum Time Free of Clinical Work and Education

  • Residents should have 8 hours off between scheduled clinical 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 eight hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven 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 one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days

In-House Night Float

  • Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements.
  • (The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the Review Committee.)

Maximum In-House On-Call Frequency

  • Residents must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).

At Home Call

  • Time spent in the hospital by residents on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every–third-night limitation, but must satisfy the requirement of one-day-in-seven free of duty, when averaged over four weeks.
    • At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.
  • Residents are permitted to return to the hospital while on at-home-call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum.

Timekeeping
Resident must enter their clinical work and education hours in New Innovations every 48 hours. The Program Director for each residency program will determine the disciplinary actions for non-compliance.

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