Duty Hours

This policy and procedure describes resident duty hours for the University of Iowa Department of Neurosurgery.

Graduate Medical Education requires a commitment to the continuity of patient care. As such, residents will participate in all aspects of the preoperative, operative and postoperative care of our designated patient population. However, it is also a priority of the department to train residents in an environment optimal for resident education and patient care.

Duty hours will be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. In-house call will occur no more frequently than every third night, averaged over a four-week period. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, maintain continuity of medical and surgical care, or transfer care of patients. No new patients may be accepted after 24 hours of continuous duty. Residents must have 10 hours off between shifts, and will be provided with 1 day in 7 free from all educational and clinical responsibilities averaged over a four-week period. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. Duty hour rules comply with those set by the ACGME.

All residents are required to keep track of their duty hours on E-Value. Duty hours are reviewed regularly by the residency program director. In accordance with the institutional policy, (GME On-call Dining), residents are provided meals when serving as the Resident on Call (ROC), as well as on-call sleeping quarters. The Chair and program director round on patients, supervises the Morbidity and Mortality conference, and confers with the other staff neurosurgeons and residents on a daily basis. The residents, faculty and support staff are explicitly instructed to inform the program director of any difficulties that may affect resident or patient safety. In the event that any resident experiences fatigue interfering with his/her ability to safely perform his/her duties, he/she is strongly encouraged and obligated to report this to the Chief Resident, or attending neurosurgeon. Appropriate coverage will be arranged as well as any other necessary support. Attending and resident neurosurgeons are instructed to monitor for any signs of excessive stress and/or fatigue. This should be immediately reported to the attending and/or Program Director. The resident will be relieved of his/her duties until the effects of fatigue are no longer present. They will also be provided with any other necessary support.

Neurosurgery residents are not permitted to moonlight while on clinical rotations. Moonlighting is not allowed during other rotations without the approval of the program director.

Resident physicians are eligible for 15 working days and 6 weekend days of paid time off each year, including any time arranged off over holidays.

The residents are directly supervised and monitored by the program director(s). Residents enter their daily work hours onto a web-based system developed for the purpose of tracking duty hours. Program director(s) and neurosurgery administrative staff regularly review the work hours documented by the residents to ensure compliance with duty hour restrictions.

The department head and program director rounds on patients, supervises Morbidity and Mortality conference, and confers with the other staff neurosurgeons and residents on a daily basis. Residents, faculty and support staff are explicitly instructed to come to the program director with any difficulties that affect resident or patient safety. The department head and program director meets with the residents each Saturday morning. During this morning session, he looks for any signs of fatigue or stress among the residents. All faculty and residents receive training on monitoring of fatigue and sleep deprivation.

“Duty Hours” are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as journal club and conferences. Duty hours do not include reading and preparation time spent away from the duty site. These standards applies to all training sites (i.e. UIHC and the VA).

Night Call obligations are equitably divided among junior residents each month. Among their administrative responsibilities, junior staff members are responsible for the optimal organization and implementation of the departmental teaching conferences.