Supervision and Duty Hours

The University of Iowa Hospitals and Clinics ensures that appropriate supervision is provided for all residents, as well as a duty hour schedule and a work environment that optimizes quality patient care, fortifies the educational trajectory of house staff members, and addresses all applicable program requirements. On-call duties are necessary components of clinical care and educational programs; these duties are managed to ensure adequate periods of rest with appropriate levels of supervision to deliver safe, effective patient care.

Supervision

The clinical activities of all residents are supervised by teaching staff and/or more advanced house staff members in such a way as to ensure that residents assume progressively increasing responsibility according to each resident's level of education, ability, and experience. The teaching staff determines the level of responsibility accorded to each resident. On-call schedules for teaching staff and more advanced house staff members are structured to ensure supervision is readily available to those on duty. Call is no more frequent than that approved by the Psychiatry RRC of the ACGME.

Our program demonstrates that the appropriate level of supervision is in place for all patients cared for by all residents. Every psychiatry patient has an attending psychiatry physician assigned who is responsible to assure the excellence of medical care and to supervise and teach psychiatry house staff involved in the care of that patient. Each clinical service is continuously covered by a faculty member who is accessible at any time by means of the pager system. These levels of supervision include:

  • Direct Supervision – The supervising physician is physically present with the resident and patient.
  • Indirect Supervision –
    • i) with direct supervision immediately available – The supervising physician is physically present within the hospital or other site of patient care, and is immediately available to provide direct supervision. 
    • ii) with direct supervision available – The supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide direct supervision.

PGY-1 residents are supervised initially either directly or indirectly with direct supervision immediately available while they acquire basic knowledge and skills specific to the specialty. PGY-1 residents may progress to indirect with direct supervision available following achieving the goals specified by the Psychiatry RRC, which are demonstrated by completing the two assessments of competence (performed by a senior resident while on call and for faculty while on an inpatient unit).

Responsibilities

Residents are responsible for the first contact with the patient. From this, a diagnostic and therapeutic plan will be formulated and presented to the attending physician. The attending physician is responsible for reviewing all resident presentations and approving final diagnostic and therapeutic recommendations. The resident is responsible for completing all documentation regarding the patient’s care and the attending physician is responsible for reviewing this documentation and co-signing medical records. Additionally, residents are responsible for carrying out the orders that are encompassed by the treatment plan that have been finalized by the attending physician.

Duty Hours

Residents work hours are monitored by the program director, associate program director, chief residents, and program coordinator by the means of a work hour record on MedHub that residents are expected to be completed weekly. The work hours for day and night duty on all rotations are designed such that hours worked will fall within the ACGME rules for resident work hours:

PGY-1 Residents:

  • No more than 80 hours per week when averaged over four weeks
  • No more than a maximum of 16 hours of continuous duty
  • At least one day off in seven when averaged over four weeks; a day is defined as 24 consecutive hours
  • At least an 8-hour period, preferably a 10-hour period, free of clinical duty between shifts.

PGY-2 and Above Residents:

  • No more than 80 hours per week when averaged over four weeks
  • No more than a maximum of 24 hours of continuous duty in the hospital with no more than four additional hours used for transitional activities (i.e. transferring patient care, educational sessions)
    • No new patients can be accepted by this resident during this four hour period
  • In-house call must not be scheduled more frequently than every third night when averaged over a four week period
  • In-house night float residents must not be scheduled more than six consecutive nights
  • At least one day off in seven when averaged over four weeks; a day is defined as 24 consecutive hours
  • At least an 8-hour period, preferably a 10-hour period, free of clinical duty between shifts. Must have at least 14 hours free of duty after 24 continuous hours of in-house duty.
    • Final year residents can participate in transition to practice activities when they are preparing to care for patients over irregular or extended periods. It is desirable that these residents have 8 hours free of duty between scheduled duty periods, but there may be circumstances where residents must stay on duty to care for their patients or return to the hospital after shorter intervals.

Home Call

Residents returning to the hospital from home call must count their time spent in the hospital towards the 80-hour maximum weekly hour limit. The frequency of home call is not subject to the every-third-night limitation but must satisfy the requirement for one day in seven free of duty, when averaged over four weeks. Residents are permitted to return to the hospital while on home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new "off-duty period."

Moonlighting

Moonlighting is governed by the Moonlighting Policy and Procedures for House Staff Physicians and Dentists. All requirements of that policy must also be followed, including visa and license requirements.  In order to ensure against any adverse effects on the resident's educational or clinical program, the following departmental policy has been established for psychiatry residents wishing to moonlight:

  • Moonlighting is never required and must not interfere with the ability of the resident to achieve the goals and objectives of the educational program.
  • The resident must obtain permission of his/her program director prior to the beginning of such activities. All approved requests must be filed with the GME Office.
  • Time spent by residents in internal and external moonlighting must be counted toward the 80-hour maximum weekly hour limit. Failure to completely document all time in moonlighting activities will result in suspension of the moonlighting privilege.
  • PGY-1 residents are not permitted to moonlight by the ACGME. Per the Psychiatry Residency Program policy, PGY-2 residents are also not permitted to moonlight.

We'd welcome your feedback!

Please help us improve your experience on our website by completing a brief survey