ACGME Resident Duty Hours
Requirements Take Effect
July 11, 2003 - The Accreditation Council for Graduate
Medical Education (ACGME) board June 24 approved the final
details of the duty hours requirements that went into effect
July 1, 2003. Each Residency Review Committee (RRC) is permitted
to develop its own language to supplement the language of
the common program requirements in three areas: six hours
post call, definition of new patient, and exceptions to 80
hours. Each RRC will post its requirements on its web site.
The common program requirements adopted in February 2003
state "Continuous on-site duty, including in-house call,
must not exceed 24 consecutive hours. Residents may remain
on duty for up to six additional hours to participate in didactic
activities, transfer care of patients, conduct outpatient
clinics, and maintain continuity of medical and surgical care
as defined in Specialty and Subspecialty Program Requirements."
All programs' requirements must include this language. Twelve
RRCs adopted it without addition. Twelve others offered clarifying
language that was approved by the ACGME board.
With regard to the definition of a new patient, the common
program requirements read, "No new patients, as defined
in Specialty and Subspecialty Program Requirements, may be
accepted after 24 hours of continuous duty." RRCs were
permitted to refine the definition of new patient to be consistent
with their specialties' practices. The proposed language of
four surgery RRCs (neurosurgery, general surgery, orthopedic
surgery, and otolaryngology) was revised to define a new patient
as one who is new to the department or service. Language was
added stating that a resident should have reviewed the case
and evaluated the patient before surgery.
In the category of exceptions to the 80 hours rule, the common
program requirements state, "An RRC may grant exceptions
for up to 10 % of the 80-hour limit, to individual programs
based on a sound educational rationale. However, prior permission
of the institution's GMEC is required." Neurosurgery
requested that its limit be 88 hours and that chief residents
be exempt from the requirement altogether. The request was
not approved. The RRCs in emergency medicine, preventive medicine,
anesthesiology, family practice, neurology, nuclear medicine,
pediatrics, and diagnostic radiology proposed added language
stating that no exceptions to the 80-hour limit would be considered.
This language was approved in all cases.
The Subcommittee on Duty Hours, chaired by David Glass, M.D.,
chairman of Anesthesiology at Dartmouth-Hitchcock, recommended
that the overall enforcement of the duty hours requirements
be carried out in the context of the normal accreditation
process. However it also suggested a number of supplemental
activities, including:
- An annual web survey of residents about their duty
hours;
- An annual survey of program directors about their programs'
compliance;
- Oversight and verification of program data by sponsors'
Designated Institutional Officials;
- Follow-up by the RRCs of data that suggests noncompliance;
- Use of consistent questions about duty hours by site
visitors;
- Provision of "whistleblower" mechanism through
the existing ACGME complaint process;
- Communication with residents about the complaint process;
- Conduct of site visits with short notice in the case
of potential "egregious violations"; and
- Devolution of responsibility for monitoring to the
ACGME Monitoring Committee.
The Board accepted the committee's draft report as an information
item and will act on the committee's final recommendations
at the September meeting.
Information:
Sunny Yoder, Director of Resident Affairs
AAMC Health Care Affairs
syoder@aamc.org
(202) 828-0497
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