Section 6.A: Clinical Experience and Educational Work Hours

Definitions
“Resident” means a physician in an Accreditation Council for Graduate Medical Education (ACGME) accredited Emory Training Program for a clinical specialty. Unless otherwise specified, “resident” includes fellows in an ACGME-accredited Emory Training Program for a clinical subspecialty. Emory residents or fellows in non-accredited training programs or those accredited by other organizations such as member boards of the American Board of Medical Specialties should be considered included in these policies if their salaries are managed by the Emory Office of Graduate Medical Education or unless specifically excluded by the Emory Graduate Medical Education Committee (GMEC) or Associate or Assistant Dean for GME (the Designated Institutional Officials or “DIO”).

6.A. Clinical Experience and Educational Work Hours Policy

The GMEC follows guidelines established by the ACGME regarding the clinical learning environment including those related to clinical and educational work hours for residents in accredited training programs as defined in the ACGME Common Program Requirements (CPR). Clinical and educational work hours are defined as all clinical and academic activities related to the program; i.e., 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.

General Guidelines

1. Residents are responsible for accurately reporting their clinical and educational work hours, including all time spent in Internal and External Moonlighting, per program requirements, and for honestly reporting concerns of non-compliance.
2. Program Directors are responsible for monitoring and enforcing compliance with work hour guidelines.
3. If specialty/subspecialty-specific program requirements for clinical and educational work hours as defined by an individual ACGME Review Committee (RC) are more restrictive than the CPR, then the work hour requirements of that RC will apply for residents in that specialty/subspecialty program and will supersede the CPR.
4. Concerns regarding clinical and educational work hours may be reported to the Associate or Assistant Dean for GME confidentially here.

Specific Guidelines
The ACGME work hour requirements are in the ACGME Common Program Requirements (Residency and Fellowship) located on the ACGME site. Emory programs are required to follow the most recently approved ACGME version of the Common Program Requirements.

All programs must have policies for clinical and educational work hours that at a minimum meet the ACGME's institutional and program requirements. Programs must monitor in-house and from-home clinical and educational work hours on an ongoing basis in a way that provides accurate data.  The GMEC Clinical Experience and Education Work Hour Subcommittee (“Subcommittee”) has established reporting requirements, one of which is that each monitoring period must be 4 weeks in length, not a moving average or extrapolated from a shorter length of time. 

With GMEC oversight, the DIO and the Chair of the Subcommittee will review program data resulting from special reviews, annual administrative processing sessions, random audits, and other times as determined by the DIO, the GMEC, or the Subcommittee.  If a program has received approval from the ACGME to extend the 80-hour weekly work hour limit, if the program received a work hour citation, or if an internal review reveals a work hour issue, then these training programs may be required to submit follow-up reports to the subcommittee. 

Monitoring
Program Directors must monitor call-from-home clinical and educational work hours in terms of frequency and characteristics to ensure that residents and fellows are following basic guidelines established by the ACGME.

Monitoring Method
All ACGME programs are expected to use New Innovations to monitor duty hours. Programs may submit in writing a proposal for an alternative tracking method that must be approved by the Clinical Experience and Education Work Hours Committee.

Guidelines for Monitoring

Core/Residency Program Exemptions:
All Core/ Residency Programs are expected to submit a work hour report by September 30^th, but programs may submit in writing a request to be exempt from submitting additional reports for the current academic year to the Subcommittee. This request must be submitted with the September 30^th work hour report.

Delinquent Reporting
Programs that fail to submit their work-hour reports as scheduled will be reported to the Program Oversight Subcommittee and subject to a Special Review.

Education
Program Directors must provide information to residents, fellows, and faculty members regarding effects of loss of sleep and chronic fatigue. Currently, the GMEC recommends using the SAFER program available on the GME Website- and asking faculty members of Emory University School of Medicine who have expertise in this area.

The Subcommittee will review program clinical experience and educational work hours logged in New Innovations. The GMEC will notify programs that are not in compliance to provide an action plan for regaining compliance.

Report a Concern

6.A-01: Transportation Option for Residents Too Fatigued to Return Home Safely
For residents/fellows who may be too fatigued to drive home, the GME Office has arranged for residents/fellows' transportation home with a next-day return trip through Lyft at no expense to residents/fellows. This service must only be used to transport residents/fellows from the hospital to the home with a return to the hospital. All rides will be audited. 

Guidelines and Setup Instructions Lyft

 6.A-02: Clinical Experience and Educational Work Hours Reporting for Residents on Off-Service Rotations
This section of the Clinical Experience and Educational Work Hours Policy aims to establish a process that will address duty hour compliance in a rapid and timely manner when a resident is rotating onto another Emory ACGME training program’s clinical service (off-service rotations).  Problems regarding compliance with duty hour guidelines should be reported to the Chief Resident of the accepting training program.  If the Chief Resident does not respond to the report of noncompliance, then the resident must make a report to the Program Director of the sending program.  The Program Directors of the two programs must address the issues that led to the violation of the guidelines.  The resident may escalate notification to the GME Office at any time, as must the Program Directors if a timely resolution is not established.  When escalated to GME, the Associate Dean for GME will report to the Chairs of the two training programs and has the option of reporting to the Dean if the issues are not settled promptly.

Report a Concern

6.A-03: Clinical Experience and Educational Work Hours Extensions
On occasion, individual programs could determine a need to extend the ACGME’s 80-hour work week requirement rule up to a maximum of 10% above the current limit or a total of 88 hours per week, per  ACGME requirements. This extension must be approved by the Emory GMEC.  If the request to extend work hours has been approved by the GMEC, then Program Directors must petition their specialty RC for permission to extend hours. The letter from the GMEC must be used when communicating with the Review Committee.