Introduction 

Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents' time and energies. Work hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients. 

Work hours will be established to conform to the ACGME Common Program Requirements for all core and subspecialty programs as of July 1, 2017. The University of Utah Hospitals and Clinics GME Resident Clinical and Educational Work Hours Policy (10.1 Revision Date: November 2017) have been adopted. Portions of this Policy are reproduced below with revisions to include information from the Specialty-specific Program Requirements set forth by the ACGME on July 1, 2017. 

University of Utah Department of Neurosurgery Work Hours Policy

The definitions of work hours and on-call activities as described by the ACGME have been adopted. Compliance with these regulations is monitored on an ongoing basis. Resident work hours are entered into commercially available software and monitored by the GME office. The coordinator and Program Director are notified of any irregularities. The Program Director monitors call schedules to ensure compliance. Particular attention is paid to the at-home call, which is not subject to the one in three restriction. All Department members (faculty and residents) have completed the SAFER Training Program so that they are familiar with the signs and symptoms of fatigue. Should these arise, back up support for clinical care and call responsibilities has been available as needed from residents on research rotations. 

Resident Clinical and Educational Work Hours 

To comply with the Institutional, Common and Subspecialty Program requirements and Clinical Learning Environment Review (CLER) guidelines of the Accreditation Council for Graduate Medical Education (ACGME) regarding institutional oversight of resident clinical and educational work hours. Work hours are defined as time spent on all clinical and educational activities related to the residency or fellowship program. This includes patient care, administrative duties related to patient care, provision for transfer of patient care, time spent in-house during call activities, time spent on patient care activities while on at-home call, moonlighting activities, and scheduled educational activities such as conferences. Work hours do not include reading and preparation time spent away from the duty site.

1. Maximum Hours of Clinical and Educational Work per Week
   1. Clinical and educational work hours must be limited to no more than 80 hours per week, averagedover a four-week period, inclusive of all in-house clinical and educational activities, clinical workdone from home, and all moonlighting.
2. Mandatory Time Free of Clinical Work and Education
   1. Programs must design an effective program structure that is configured to provide residents witheducational opportunities, as well as reasonable opportunities for rest and personal well-being.
   2. Residents should have eight hours off between scheduled clinical work and educational periods.
      1. In certain circumstances, residents may choose to stay to care for their patients or return to the hospital with fewer than eight hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements.
   3. Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
   4. Residents must be scheduled for a minimum of one day in seven free of clinical work and required education, when averaged over four weeks. At-home call cannot be assigned on these free days.
3. Maximum Clinical Work and Education Period Length
   1. Clinical and education work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.
      1. Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. Additional patient care responsibilities must not be assigned to a resident during this time.
4. Clinical and Educational Work Hour Exceptions
   1. After handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances:
      1. To continue to provide care to a single severely ill or unstable patient.
      2. Humanistic attention to the needs of a patient or family, or
      3. To attend unique educational events.
   2. These additional hours of care or education will be counted toward the 80-hour weekly limit.
5. Moonlighting
   Neurosurgery residency training is a rigorous full-time educational experience. It is important that residents have time for adequate rest and personal pursuits. The ACGME has instituted work hour regulations, which require residents to work no more than 80 hours per week when averaged over a four week period. They further require that hours spent moonlighting be counted towards the 80 hours. Residents should not be diverted from their primary responsibilities of patient care and learning by engaging in extramural professional activities. Because the neurosurgery training program is time intensive and it is difficult to meet all the requirements in only 80 hours per week, clinical moonlighting is expressly forbidden and will result in dismissal from the program. Military service or approved University of Utah academic service is not considered moonlighting
6. In-House Night Float
   1. Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements.
   2. Night float should be limited to four months per year and must not exceed six months per year.
7. Maximum In-House On-Call Frequency
   1. Residents must be scheduled for in-house call no more frequently than every third night, when averaged over a four-week period.
8. At-Home Call
   1. Time spent on patient care activities by residents on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks.
      1. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.
   2. Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient care must be included in the 80-hour maximum weekly limit.
9. Institutional Oversight
   1. The Graduate Medical Education Committee (GMEC) provides oversight of program and resident compliance with ACGME work hour requirements. On a quarterly basis, the Office of Graduate Medical Education presents a statistical report to the Graduate Medical Education Committee indicating programs with repeat violations of work hour requirements over the preceding 3-month period.
   2. The GMEC may require a written response from a Program Director or may require a Program Director to report directly to the Committee to discuss the reasons for repeated violations and to assist in developing an action plan for correction.
10. Logging Work Hours for Institutional and Program Level Monitoring
    1. Residents should log their work hours in the MedHub system on a daily basis. When this is not possible, residents should log their hours for the week they are working in. This will reduce the need for trying to remember events and possibly recording hours incorrectly. Residents will be able to log hours during the week they are working in and the week that has just passed. In MedHub weeks are from Sunday to Sunday.
    2. Program Administrators (coordinators/managers) will receive an email when there is a problem with a resident logging work hours. Program Administrators should support residents as needed by reminding them about logging their hours. Administrators can log work hours for residents who have failed to log their hours during the 2-week window for entering work hours (current and previous work week). Administrators have the ability to log hours for two weeks back from the current week. If logging is still not accomplished, the administrator will eventually be locked out and will need to request after the fact logging, from the GME Office.
    3. When logging hours, potential violations are flagged to the resident or administrator logging hours. This flagging will stop when the potential violation is averaged out over a four-week period in MedHub. Potential violations are flagged to help the resident and the administrator to be proactive about violations and to take steps to avoid the violation -- as opposed to responding to the violation after it has been committed. This function of MedHub cannot be disabled.