National Institutes of Health, Office of Education, Office of Intramural Research
Graduate Medical Education Committee (GMEC), July 9, 2003
Deputy Director for Intramural Research, and
Director, Clinical Center, September 2, 2003
Background: To sustain its mission, which includes training the next generation of physician researchers, it is in the best interest of the intramural program of the National Institutes of Health (NIH) to provide a learning environment that will support the needs of its fellows (for the purposes of this policy, the term “fellow” refers to what the ACGME deems a “resident”). NIH sponsors 16 ACGME-accredited fellowship training programs, through the Warren Grant Magnuson Clinical Center. In recognition of the role that NIH plays in biomedical research and in training academic physicians/clinical researchers for the nation, the leadership of NIH and its member Institutes give a high priority to clinical fellowship training. It is the responsibility of the NIH to provide fellows with a sound academic and clinical education with concerns for patient safety and resident well-being. NIH must ensure that the learning objectives of the program are not compromised by excessive reliance on fellows to fulfill service obligations; as a result, a policy must be constructed that reflects the collective responsibility of the faculty and fellows to provide assignments that prioritize the safety and welfare of patients.
Duty hours will be constructed as follows:
- Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
- Residents will be provided with one day (a continuous 24-hour period) in seven free from all educational, clinical, and administrative responsibilities, averaged over a four-week period, inclusive of call.
- Continuous onsite duty is not allowed to exceed 24 consecutive hours; this includes in-house call, which will occur no more frequently than every third night averaged over a four-week period. Between all daily duty periods and after in-house call, a 10-hour time period for rest and personal activities will be provided.
- In addition to the 24 hours, six additional hours are allowed for residents to participate in didactic activities, transfer care of patients, and to maintain continuity of medical and surgical care. However, residents will not be able to accept new patients after 24 hours of continuous duty.
- The program director and faculty will monitor demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.
Oversight will take place as follows:
- The program director will provide documentation that qualified faculty supervises all patient care. Faculty schedules and communication systems will be structured to provide residents with continuous supervision and consultation.
- Backup support systems will be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.
- Faculty and residents will be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.
Pediatric Endocrine Weekend Coverage (PEWC) will be handled as follows:
Outside activities are permitted in accordance with Federal Government and HHS regulations and procedures (form HHS 520 available at http://ethics.od.nih.gov/forms/hhs-520.pdf* and form NIH-2657, Part D, Supplemental Information to HHS-520) and with approval for the activity from the Clinical Director/Department Chief, and the Deputy Ethics Counselor, in addition to the Program Director. Program Directors must be aware of a resident’s outside activities so they can monitor resident well-being and ensure that PEWC does not interfere with the ability of the resident to achieve the goals and objectives of the educational program.
The Resident Agreement, signed annually by each resident, must reflect the individual program’s policy for PEWC, and be in accordance with this official policy on duty hours.
Optional internal clinical coverage will be counted toward the 80-hour weekly limit on duty hours.
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