Home | ACGME Glossary of Terms | Search | Site Map | Application Support | Legal | Contact Us
Accreditation Council for Graduate Medical Education Residents Program Directors & Coordinators Designated Institution Officials General Public ACGME Home








RRC Procedures for Granting Duty Hours Exceptions

Adobe PDF DocumentPrint Document (PDF)

At its September 2002 meeting, the ACGME voted not to consider requests for specialty wide exemptions from the duty hour requirements for at least one year from the implementation date of these requirements. The procedure that follows will be used by RRCs to evaluate requests from individual programs for a maximum 10% increase in the 80 hour limit. An RRC may judge that such a request cannot be considered without a site visit. If approved, the maximum duration of the approval may not exceed the length of time until the program's next review. Each RRC will publicize on its specialty page of the ACGME website either this standard or a statement that it will not consider requests for exceptions to the 80 hours per week limit.

Approval Process
  1. Institutional Endorsement

    1. Prior to initiation of a program's request, the GMEC of the sponsoring institution must have developed written procedures and criteria for endorsing requests for an exception to the duty hour limits.

    2. The institutional GMEC, or its equivalent in single-residency institutions, must review and formally endorse the request for an exception as noted above. The endorsement will be indicated by the signature of the Designated Institutional Official (DIO) or the Chair of the GMEC.

  2. RRC Review

    The RRC will:

    1. formally review such proposals at its regular meetings and will retain documentation of its actions in the program's history;

    2. judge whether the request justifies granting approval of the extension of the maximum weekly number of duty hours from 80 up to 88 hours, averaged over four weeks;

    3. Specify the assignments and level(s) of training to which the proposal applies if the requested exemption is granted; and

    4. Will stipulate the duration of the exception, which will be no longer than the next review.

    5. In the event that the RRC denies a request, the action is not appealable.

  3. Monitoring

    1. At the end of the initial year for the exception, an RRC will monitor and reevaluate the educational purpose for the exception. The form of the monitoring is determined by the RRC, eg, a progress report, a time study, a resident survey, a site visit, or other method.

    2. At the time of each site visit and review, the RRC will reevaluate the patient safety aspects and educational rationale for the exception and may continue, deny, or modify the exception.
Eligibility Criteria

  1. The institutional sponsor must have a Favorable Status from its most recent review by the ACGME Institutional Review Committee (or is a single-residency institution with a favorable accreditation status).

  2. The program must be accredited in good standing, i.e., without a warning or a proposed or confirmed adverse action.
Required Documentation

The program's responsibility is to make a clear showing that the exception is necessary for educational reasons. The proposal from a program to the RRC must include the following documentation:

  1. Patient Safety: Information must be submitted that describes how the program and institution will monitor, evaluate, and ensure patient safety with extended resident work hours.

  2. Educational Rationale: The request must be based on a sound educational rationale which should be described in relation to the program's stated goals and objectives for the particular assignments, rotations, and level(s) of training for which the increase is requested. Blanket exceptions for the entire educational program should be considered the exception, not the rule.

  3. Moonlighting Policy: Specific information regarding the program's moonlighting policies for the periods in question must be included.

  4. Call Schedules: Specific information regarding the resident call schedules during the times specified for the exception must be provided.

  5. Faculty Monitoring: Evidence of faculty development activities regarding the effects of resident fatigue and sleep deprivation must be appended.

  6. Institutional Endorsement: A documented written statement of institutional endorsement of the proposal signed by the Designated Institutional Official (DIO) or the Chair of the Institutional GMEC must be appended. In addition, a copy of the sponsoring institution's written procedures and criteria for endorsing requests for an exception to the duty hours limits must be submitted.

  7. The current accreditation status of the program and of the sponsoring institution should be provided in the formal request.

February 13, 2003