Programs and Sponsoring Institutions must design an effective program structure that provides work-life balance, enabling residents to gain requisite educational and clinical experience as well as reasonable opportunities for rest and personal activities. These requirements encompass the baseline priority for institutions and programs to provide a consistent opportunity for residents to experience an interdisciplinary team-based approach to patient care, safety, physician well-being, and education. Based on thorough review of the best available, current evidence, the cornerstone of these requirements, unchanged since the 2003 revision of the Common Program Requirements, remains the 80-hour weekly limit, one day off in seven, and in-house call no more often than every three days, averaged over four weeks. Programs are responsible for ensuring that residents are provided with manageable workloads that can be accomplished during scheduled work hours. This includes that residents have appropriate support from their clinical teams, and that they are not overburdened with clerical work and/or other non-physician responsibilities.
The terms “clinical experience and education,” “clinical and educational work,” and “work hours” replace the terms “duty hours,” “duty periods,” and “duty” in the proposed revision. This change was made to emphasize that residents’ responsibility to the safe care of their patients supersedes any duty to the clock or schedule.
Changes made in this section include:
- Clinical work done from home must be counted toward the 80-hour weekly maximum.
- Clinical work periods for all residents must not exceed 24 hours of continuous scheduled clinical assignments.
- - This change is expected to improve resident education by permitting PGY-1 residents to more fully participate as members of the health care team, with appropriate supervision.
- Clinical work hour exceptions may be granted by the Review Committee to support specialty-specific rotations approved by the institution, for up to a maximum of 88 hours based on sound educational rationale.
- Residents who have appropriately handed off patients following the conclusion of scheduled work periods have the flexibility to voluntarily remain at work in unusual circumstances, if, in their judgment, those circumstances benefit patient care or education. Such additional time must be counted toward the 80-hour limit.
- All residents must have at least 14 hours free of clinical work after 24 hours of clinical assignments. Physicians have a responsibility to return to work rested, and thus are expected to use time away from work to get adequate rest. In support of this goal, residents are encouraged to prioritize sleep over other discretionary activities. Other requirements regarding time off between work periods have been modified to support resident education and patient safety by permitting programs increased flexibility to develop schedules that work best at the local level.