Background
The GMEC approved the Clinical and Educational Work Hours Policy in November 2019, and established the expectation that all GME programs (ACGME accredited and non-ACGME accredited) must develop new clinical and educational work hours monitoring policies by January 2020 with implementation by February 1, 2020. All programs (ACGME accredited and non-ACGME accredited) are expected to ensure that their trainees have adequate rest to be able to perform competently and a mechanism in place to monitor for fatigue.
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. Duty hours do not include reading and preparation time spent away from the duty site. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call. 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.
Clinical and Educational Work Hour Monitoring Policy
Trainees are responsible for reporting their hours worked through this Clinical & Educational Work Hours Survey on a weekly basis. On the first day of the following month, the Program Coordinator will remind trainees to complete their duty hours and will follow-up with those that have not completed five days after the reminder was sent.
On the 6th day of the following month, the Program Coordinator will pull a report of incomplete duty hour submissions as well as duty hour violations and share with the Program Director in order to review and discuss with those individuals that are not in compliance.
Reporting Duty Hour Violations
Trainees that are at risk of violating work hour rules have an obligation to proactively inform program leadership so that coverage can be arranged to avoid violation. Programs must provide alternative coverage for a trainee’s clinical responsibilities if they are found to be too fatigued to continue.
Concerns about continuous work hour violations not adequately addressed by the program can be reported to the Designated Institutional Official at gme@umn.edu. Anonymous reporting of work hour violations can occur via a Qualtrics form.
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