Duty Hours and Learning Environment Policy and Procedure for Residents

University of Pittsburgh School of Medicine
Department of Ophthalmology
Policies and Procedures

Title: Duty Hours and Learning Environment Policy and Procedure for Residents

Purpose: The University of Pittsburgh School of Medicine Department of Ophthalmology establishes this policy regarding resident duty hour requirements to ensure program compliance with ACGME resident duty hour regulations and UPSOMGMEP institutional requirements. In addition, this document describes the culture and the academic leadership support to ensure attention to the letter and spirit of these regulations and those regarding the learning environment. Residents/Fellows must be provided a sound academic and clinical education. Their training must be carefully planned and balanced to insure optimal patient care and safety, which requires a diligent commitment to resident well-being. Each program must ensure that the learning objectives of the program are not dependent on residents/fellows to fulfill service obligations. Didactic and clinical education must have priority in the allotment of resident’s time and energies. Clinical assignments must respect that faculty and residents collectively have responsibility for the safety and welfare of patients. The department will join and support GME efforts to comply with this policy which may require that a program request from the Health System additional resources.

Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology

Procedure

I. Supervision of Residents

A. Qualified faculty supervise all patient care as specified in the "Supervision Policy". The program director ensures, directs, and documents supervision and faculty support appropriate for the level of training of residents/fellows at all times. Residents/Fellows are provided with efficient, reliable systems for communicating with supervising faculty.

B. Faculty schedules are structured to provide residents/fellows with continuous supervision and consultation.

C. Faculty and residents/fellows are educated to recognize the signs of fatigue and adopt and apply practices to prevent and counteract the potential negative effects.

II. Duty Hours

A. Duty hours are defined as all clinical and academic 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. All academic or administrative activities that residents are required to attend are counted towards the duty hours standards. This includes required onsite educational activities such as meetings, conferences and research. Duty hours do not include reading and preparation time spent away from the clinical site.

B. Duty hours are averaged over a four-week period, inclusive of all in-house call activities and are limited to 80 hours per week on average.

C. Averaged over a four-week period, inclusive of call, residents are provided with 1 day in 7 free from all educational and clinical responsibilities. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

D. A required 10-hour time period for rest and personal activities is provided between all daily duty periods, and after in-house call as per ACGME guidelines for resident duty hours.

E. The department of Ophthalmology is in full compliance with both the letter and spirit of these and respective specialty duty hour requirements.

III. On-Call Activities

The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal workday when residents are required to be immediately available in the assigned institution.

A. Averaged over a four-week period, in-house call occur no more frequently than every third night.

B. Continuous on-site duty, including in-house call, does not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, maintain continuity of medical and surgical care, transfer care of patients, or conduct outpatient continuity clinics.

C. A new patient is defined as any patient for whom the resident/fellow has not previously provided care. No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity clinics.

D. At-home call is defined as call taken from outside the assigned institution.

i. The frequency of at-home call is not subject to the every third night limitation. However, at-home call is not so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call are provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.
ii. When residents are called into the hospital from home, the hours spent in-house are counted toward the 80-hour limit beginning from the time the resident/fellow arrives at the hospital.

iii. The program director, faculty, and residents monitor the demands of at-home call in this programs and scheduling adjustments are made as necessary to mitigate excessive service demands and/or fatigue.

IV. Moonlighting

A. Moonlighting is defined as any outside activity for which compensation is received, especially when not related to the training program. Because residency education is a full-time endeavor, it is the policy of the department of Ophthalmology that absolutely no moonlighting is permitted.

V. Learning Environment

A. The department of Ophthalmology is committed to providing all medical learners with a safe and positive learning environment which stimulates intellectual, professional, and personal growth.

B. The academic climate in our training program fosters the above in an open and nonthreatening manner. This climate will be concordant with the UPMCMEP policies and procedures outlined in the resident contract as well as the policies on Teacher /Learner Interactions and Harassment.

C. The physical environment of our training programs will also facilitate safety and learning. Components of this include call rooms, lounges, meal services, parking, security, and adequate ancillary patient care services such as patient transport, phlebotomy teams and IV teams. An adequate physical environment is guaranteed in the resident contract.

D. Oversight and monitoring of the Learning Environment is the responsibility of the department and the entire GME system. Programs and the facilities that they reside in have local monitoring that includes trainee involvement. The GMEC will provide oversight and monitoring through the Resident/Fellow Duty Hour and Learning Environment Subcommittee as outlined below and in compliance with the other policies as mentioned above.

VI. Oversight

A. This program must has written policies and procedures consistent with the ACGME/RRC Institutional and Program Requirements for resident duty hours and the learning environment. These policies must be distributed to the residents and the faculty. Duty hours are monitored on an ongoing basis to ensure an appropriate balance between education and service. The department of Ophthlmology is committed to ensuring that programs have adequate support to provide a safe ACGME compliant learning environment as well as the ability to monitor duty hours. Moonlighting activities are strictly forbidden. Failure to comply with this policy may result in disciplinary action up to and/or including dismissal.

The department of Ophthalmology monitors at least monthly duty hours and the overall learning environment. The program directors is required to attest to their review of duty hour reports and their response to violations of the duty hours standards. Trainees have input into this process. The ACGME resident survey is an important component of this monitoring process. The programs ensures a minimum of 70% participation in the survey. Residents are oriented to the survey before completing it. The program uses the survey at annually as an internal monitoring tool.
B. The department of Ophthalmology ensures that back-up support systems are provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.

Residents have mechanisms in place to address concerns without fear of reprisal and are encouraged to contact the GME Office in strictest confidence.

VII. Monitoring & Auditing

A. The department of Ophthalmology maintains an accurate schedule for each resident defining the workday (start and end) and coverage structures including tools to make each resident/fellow's schedule transparent to attendings.

B. The department of Ophthalmology submits verified and accurate resident duty hours information into the automated system-wide tracking (GME ROCS). The program director monitors and responds to the automated duty hours reports.
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