Prime target: First-year medical residents

The new rules of the Accreditation Council of Graduate Medical Education (ACGME) focus primarily on first-year residents to reduce fatigue and fatigue-related errors. The limits include:

Residency programs must:

educate faculty members and resident to recognize signs of fatigue and sleep deprivation and on alertness management/fatigue mitigation

provide a process to maintain continuity of care if a resident is unable to perform his or her duties due to excessive fatigue

provide sleep facilities and/or safe transportation for residents who may be too fatigued to safely drive home.

Resident Duty Hours

Duty hours must be limited to 80 hours per week, averaged over a four-week period, including all in-house call activities and all moonlighting.

First-year residents may not moonlight

A Review Committee may grant exceptions for up to 10% or a maximum of 88 hours per week to individual programs based on a sound educational rationale.

All residents must have a minimum of one day off every week, averaged over four weeks. At-home call cannot be assigned on these free days.

The maximum shift length for first-year residents must not exceed 16 hours. Residents in their second year or greater may be scheduled for a maximum of 24 hours of continuous duty. They may then take care of transitional duties for another four hours.

Strategic napping, especially after 16 hours of continuous duty and between the hours of 10 pm and 8 am, is strongly suggested.

In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. They must hand over the care of all other patients and document the reasons for remaining to care for the patient.

Residents may be scheduled for no more than six consecutive nights of night float and second-year residents and above must have in-house call no more than every third night, averaged over four weeks.

Minimum Time Off between Scheduled Duty Periods

First-year residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.

Intermediate-level residents [as defined by the Review Committee] should have 10 hours free of duty, and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty.

Residents in the final years of education [as defined by the Review Committee] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. There may be circumstances [as defined by the Review Committee] when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.