Duty hours are the amount of time resident and fellow physicians spend on clinical experience and education in their specialty or subspecialty after completion of medical school.
“Clinical experience and education” depicts the nature of these hours, which includes all clinical and academic activities related to a program. This includes 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 education site.
The ACGME is committed to a safe learning environment that serves the best interests of patients and residents and fellows. In our efforts to set appropriate duty hours, the ACGME seeks to balance: patient safety in settings where residents and fellows learn and participate in care; and residents’ and fellows’ attainment of clinical skills under supervision, preparing them for practice.
Three guiding principles guide the development of duty hours, as shown below. Specifically, the actions of the ACGME must actualize the profession’s social contract with society and compel Sponsoring Institutions to maintain an educational environment that ensures the:
- integration of residents/fellows into the patient safety and quality improvement programs of the Sponsoring Institution;
- essential responsibility of the institution to ensure safe transitions in care and supervision of residents/fellows appropriate to their level of demonstrated competence; and,
- personal and professional responsibility of faculty members and residents/fellows to ensure they are fit for duty in the care of their patients.
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The ACGME sets standard duty hours, or hours dedicated to clinical experience and education, within the Common Program Requirements that apply to all ACGME-accredited programs.
The duty hours requirements currently in effect encompass the:
The ACGME continually monitors the published research regarding patient safety, supervision, resident and fellow education, and competency development as it relates to working hours, to ensure that the Common Program Requirements reflect the best available evidence.
By conducting a thorough review of the Common Program Requirements in conjunction with the graduate medical education community and other key stakeholders, the ACGME intends to meet both the responsibility of the profession to educate and train the next generation of physicians, and to ensure the safety of patients and residents and fellows involved in the educational process. If any changes or modifications to the accreditation requirements are proposed, the ACGME invites comments during a 45-day public comment period.
Beginning in the fall of 2015, the ACGME undertook a full review of the Common Program Requirements as part of a five-year scheduled review. The review will be completed in two phases. To date for the first phase of this review process, the ACGME has solicited (1) comments from the public on Section VI of the Common Program Requirements, and (2) formal position statements from its member organizations, constituent organizations, and others who have standing in this discussion, including impact analyses, recommendations, and supporting evidence.
Public Comments on Section VI of the Common Program Requirements (March 2016)
Position Statements on Duty Hours and the Learning and Working Environment (January/February 2016)