School of Medicine

Duty Hours and Working Environment Policy

Adapted from the WSU/DMC Graduate Medical Education Graduate Trainee Duty Hours and Working Environment Policy, May 2003, and ACGME)

DUTY HOURS

1. Duty hours are defined as all educational activities in clerkships and electives during the third and fourth years of the medical school curriculum, including inpatient and outpatient care, administrative activities related to patient care (charting, discharge planning, transfer planning, etc.), and scheduled educational activities such as conferences, rounds, etc. Duty hours do not include reading and preparation time spent away from the duty site.
   
   
2. Both students and their supervising attending faculty and residents are reminded that medical students are here in an educational capacity. They are not on the floors, clinics, etc. to provide indispensable patient care. Consequently, there may be times when the educational requirements of the program dictate that patient care time be curtailed, in order to allow students to attend scheduled conferences, lectures and other required educational activities. An example of this would be to provide students the opportunity to sleep at night to allow them to attend scheduled required lectures the next day. It is also emphasized that the 24 hour continuous duty rule (see below ‘On-Call Activities’) allows for up to 30 continuous hours of duty as long as 24 are limited to patient care, with the other 6 hours only for educational activities.
   
   
3. Duty hours must be limited to 80 hours per week, averaged over a four week (one month) clerkship or elective. These 80 hours include in-house call activities.
   1. For example, a student may work 90 hours in one week, 60 hours in the next week, and two 75 hour work weeks during a 4 week (one month) clerkship. The average of 75 hours per week satisfies the above rule.
   2. Two 90 hour work weeks and two 70 hour work weeks also satisfy the above rule.
      
      
4. Students must be provided with 1 day off in 7, free from all educational and clinical responsibilities, averaged over a four week (one month) clerkship or elective, inclusive of call.
1. For the purposes of this Policy, four week periods of a clerkship are treated the same as a one month elective.
2. For two month clerkships, the rules stated herein apply to each of the four-week (one month) portions of the clerkship.
3. One day is defined as one continuous 24-hour period free from all clinical, educational and administrative activities.
4. For example, a student is required to work from Monday through the following Friday 12 days and then gets the entire following weekend is off. The two days off that weekend satisfies the requirement that the student has one day off in 7.
   
   
5. 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.

ON-CALL ACTIVITIES

The objective of on-call activities is to provide medical students with continuity of care experiences and additional patient care experience that would not be available during a regular work day. On-Call activities that do not meaningfully provide for this objective should be critically evaluated.

1. In-house call is defined as those duty hours beyond the normal work day when students are required to be immediately available in their assigned institution.
   
   
2. In-house call must occur not more than every third night, averaged over a four-week (one month) clerkship or elective.
   
   
3. Continuous on site duty, including in-house call, must not exceed 24 consecutive hours. Students may remain on duty for up to six (6) additional hours after this 24 hour period to participate in didactic or other educational activities.
   1. No new patients may be assigned after 24 hours of continuous duty.
      
      
4. If students’ educational programs demand that they be available later in the day (eg., lectures that begin in the afternoon), they must have at least four hours of uninterrupted sleep during their call shift. The four hour sleep ‘resets’ the 24 hour clock and allows students to stay through the conclusion of these late afternoon didactic or other educational sessions.

RESPONSIBILITY

The primary responsibility for monitoring and enforcing these regulations rests with the Clerkship Directors and Elective Coordinators/Preceptors. These physicians, in turn, are expected to promulgate these Duty Hours to all faculty and resident physicians who supervise and interact with medical students. At each clinical site, the site coordinators in the clerkship have this responsibility on a day-to-day basis. The Assistant Dean for Clinical Curriculum has ultimate responsibility for all aspects of these regulations.

REQUESTS FOR EXCEPTION

A clerkship or educational program wishing to request an exception to this Policy must submit a written proposal describing the educational rationale for the request to the Assistant Dean for Clinical Education, Wayne State University School of Medicine.

Final Version, September 16, 2005