Policy on Resident Duty Hours
Department of Otolaryngology and Communication Sciences
Medical College of Wisconsin
The Department’s policies are consistent with the policies set by the Medical College of Wisconsin (MCW) and the Medical College of Wisconsin Affiliated Hospitals, Inc. (MCWAH), under guidelines established by the Accreditation Council for Graduate Medical Education (ACGME) and the Otolaryngology Residency Review Committee (RRC).
The otolaryngology program schedules resident assignments to be in compliance with all applicable ACGME requirements. Faculty members know, honor and assist in implementing the applicable duty hour limitations. Residents must comply with limitations, accurately report duty hours and cooperate with duty hour monitoring procedures. All involved are expected to identify and report potential duty hour violations and collaborate to devise appropriate corrective action.
Duty hours are defined as all clinical and academic activities related to and required by the otolaryngology residency program. This includes patient care, administrative duties relative to patient care, provision of transfer of patient care, on-call time spent in-house and scheduled activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
• Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
• Residents must have a minimum of one day (24-hour period) free of duty every week, when averaged over four weeks. At-home call cannot be assigned on these free days.
• Duty periods of PGY-1 residents must not exceed 16 hours in duration.
• PGY-1 residents scheduled as “in-house night float” while rotating on other services must not be scheduled for more than six consecutive nights.
• Duty periods for PGY-2 residents and above are limited to 24 hours of continuous duty in the hospital. Strategic napping, especially after 16 hours of continuous duty, is strongly suggested. Residents may remain on-site up to four (4) additional hours for transition of patient care or to attend an educational conference, but they must not perform additional clinical responsibility after 24 hours of continuous in-house duty.
In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring or humanistic attention to the needs of a patient or family.
Under these circumstance the resident must:
• Appropriately hand over the care of all other patients to the team responsible for the continuing care.
• Document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director, who will review each submission of additional service and track both individual resident and program-wide episodes of additional duty.
• PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.
• PGY-2 and PGY-3 residents (considered intermediate level by the RRC for Otolaryngology) should have 10 hours free of duty and must have eight hours between duty periods. They must have at least 14 hours free of duty after being in-house for 24-hours.
• PGY-4 and PGY-5 residents (considered to be in the final years of education by the RRC for Otolaryngology) must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods.
This must occur within the context of the 80-hour, maximum duty period length and one-day-off-in-seven standards. While it is desirable that PGY-4 and PGY-5 residents have eight hours free of duty between scheduled periods, there may be circumstances (described by the RRC of Otolaryngology as required continuity of care for a severely ill or unstable patient, or a complex patient with whom the resident has been involved; events of exceptional educational value; or, humanistic attention to the needs of a patient or family) where these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.
The program director must be notified of and will monitor all circumstances of return-to-hospital by residents with fewer than eight hours free from duty.
• PGY-2 residents and above must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).
• Any time spent in the hospital by residents on at-home call must count towards the 80-hour maximum weekly hour limit. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time, and the frequency of at-home call 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 at-home call to care for new or established patients. This time spent in the hospital must be included in the 80-hour weekly maximum.
Otolaryngology residents are not permitted to practice medicine and receive financial compensation (moonlight) outside of the residency training program.
Call responsibility varies depending on PGY level. Primary call is covered by the PGY-1-4 residents. Second call is covered by the PGY-5 at Froedtert and the VA. Second call is covered by staff at the Children’s Hospital of Wisconsin.
Weekends call consists of Friday/Sunday or Saturday.
PGY1: Varies depending on rotation. PGY-1's have 3 months of otolaryngology. During the OTO months, they will take primary in-house call on 2 weekends of the month from 7 am – 7 pm, backed up by an upper level resident.
PGY2: First 6 months of PGY-2 year are in house call, the remainder is home call, covering all 3 hospitals averaging 4 calls/month and 1-2 weekends per month.
PGY3: 10 months of home call covering all 3 hospitals averaging 4 calls/month and 1-2 weekends per month.
PGY4: 12 months of home call covering all 3 hospitals, lighter than the PGY-2 and -3 year, with 3-4 calls/month and 1-2 weekends per month.
PGY5: 12 months of “second call” for residents covering Froedtert and VA shared between all PGY-5's.
If you’re not on call for the weekend, then you don’t need to round. Typically each resident gets 2 (sometimes 3) weekends off a month.
A holiday schedule is set at the beginning of the year including the 4th July, Labor Day, Thanksgiving, Christmas, New Year’s and Memorial Day.