CHICAGO, Feb. 17, 2003 - The Accreditation Council for Graduate Medical Education's Board of Directors has
approved the council's final standards on resident duty hours. The standards, which the board approved Feb. 11 at
the council's winter meeting, culminate 18 months of work by the ACGME to develop common duty hour standards
for residents in all specialties that balance the needs of patient care, resident well-being, and academic and clinical
education. The standards take effect July 1, 2003.
Said David C. Leach, MD, the ACGME's executive director, "Residents are doing more in less time with less help.
These new standards will strengthen both patient care and education. The ACGME is especially grateful for the
extensive input we received from the graduate medical education community, and especially from our public
members."
The ACGME's duty hour standards include provisions on the maximum number of resident duty hours per week, as
well as provisions for rest periods and days free from resident duties. Duty hours are defined as time spent on
educational and clinical activities related to the residency program, including patient care, administrative duties
related to patient care and academic activities. Specific provisions include:
- Residents are limited to a maximum of 80 duty hours per week, including in-house call, averaged over four
weeks. Under limited circumstances, residency programs may be allowed to increase duty hours by 10
percent if doing so is necessary for optimal resident education and patient care.
- Residents must be given one day out of seven free from all clinical and educational responsibilities,
averaged over four weeks.
- Residents cannot be scheduled for in-house call more than once every three nights, averaged over four
weeks.
- Duty periods cannot last for more than 24 consecutive hours, although residents may remain on duty for up
to six additional hours to hand off patients to new teams, maintain continuity of care or participate in
educational activities.
- Adequate time for rest and personal activities must be provided. This should consist of a minimum of a 10-
hour period provided between daily duty periods and after in-house call.
Residency programs that fail to comply with the duty hour standards are subject to adverse accreditation actions,
including probation or withdrawal of accreditation.
The ACGME"s board in September adopted proposed standards based on the recommendations from a council work
group on residency duty hours. The proposed standards were then released for public comment before the board
approved the final standards. The final standards are posted on the ACGME's Web site.
The ACGME's role in developing duty hour standards was affirmed in October by the Occupational Safety and
Health Administration when it recognized the ACGME as the entity best suited to develop and enforce resident duty
hours standards. OSHA rejected a petition filed by Public Citizen, the American Medical Student Assn. and the
Committee on Interns and Residents requesting federal regulation of resident duty hours. In its Oct. 4 letter to Public
Citizen, Assistant Secretary of Labor for OSHA Jim Henshaw stated "the ACGME and other entities are well-suited
to address work-duty restrictions on medical residents and fellows. These entities have extensive experience in
patient health, employee health and medical education and training. They are in a good position to address the issue
in a manner that comports with the complexity of the various interests."
"The ACGME was pleased that OSHA affirmed the ACGME's lead role in developing and regulating duty hour standards," said Dr. Leach. "The ACGME was gratified that its accreditation work was recognized by an agency as
important as OSHA. The medical profession is committed to good learning for good patient care."
The ACGME is a private, non-profit council that accredits about 7,800 medical residency programs in 26 medical
specialties involving nearly 100,000 medical residents. Its mission is to improve the quality of health care in the
United States by ensuring and improving the quality of graduate medical education for physicians in training.
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The ACGME is a private, non-profit council that accredits 7,800 residency programs
in 27 specialties affecting 100,000 residents. Its mission is to improve the quality
of health care in the United States by ensuring and improving the quality of graduate
medical education for physicians in training.
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