Maximum hours of work per week | 80-hour week, averaged over 4 weeks | No change | No change |
Maximum shift length | 30 hours (admitting patients up to 24 hours, and then 6 additional hours for transitional and educational activities) | - 30 hours (admitting patients for up to 16 hours, plus 5-hour protected sleep period between 10 pm and 8 am with the remaining hours for transition and educational activities)
- 16 hours with no protected sleep period
| - Duty periods of PGY-1 residents must not exceed 16 hours in duration
- Intermediate-level and senior residents may be scheduled to a maximum of 24 hours of continuous duty. Strategic napping, especially after 16 hours of continuous duty and between 10 pm and 8 am, is strongly suggested
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Maximum in-hospital on-call frequency | Every third night, on average | Every third night, no averaging | Intermediate-level and senior residents: every third night (no averaging) |
Minimum time off between scheduled shifts | 10 hours after shift | - 10 hours after day shift
- 12 hours after night shift
- 14 hours after any extended duty period of 30 hours and not return until 6 am the next day
| - PGY-1 residents should have 10 hours off and must have 8 hours free from duty between scheduled duty periods
- Intermediate-level residents should have 10 hours off and must have 8 hours between duty periods and 14 hours free from duty after 24 hours of in-hospital duty
- Residents in the final year of training should have 10 hours free from duty and must have 8 hours between scheduled duty periods
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Maximum frequency of in-hospital night shifts | Not addressed | Four nights maximum; 48 hours off after three or four nights of consecutive duty | Residents must not be scheduled for more than six consecutive nights of night duty (night float) |
Mandatory time off-duty | - 4 days off per month
- 1 day (24 hours) off per week, averaged over 4 weeks
| - 5 days off per month
- 1 day (24 hours) off per week, no averaging
- One 48-hour period off per month
| 24 hours off per 7-day period when averaged over 4 weeks; home call cannot be assigned on these free days |
Moonlighting | Internal moonlighting is counted against 80-hour weekly limit | - Internal and external moonlighting is counted against 80-hour weekly limit
- All other duty-hour limits apply to moonlighting in combination with scheduled work
| - Internal and external moonlighting count against 80-hour weekly limit
- PGY-1 residents must not be permitted to moonlight, internally or externally
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Limit on hours for exceptions | Maximum of 88 hours for individual programs with a sound educational rationale | No change | No change. Before submitting the request to review committee, the program director must obtain permission from the designated institutional official and the graduate medical education committee |
Home call | - Frequency of home call is not subject to the every-third-night, or 24 + 6 limitation
- Residents on home call must have 1 day in 7 free from all responsibilities, averaged over 4 weeks
- Hours logged when residents are called into the hospital are counted toward the 80-hour limit
| Not addressed | - Time on home call spent by residents in hospital must count toward the 80-hour maximum weekly limit
- Frequency of home call is not subject to the every-third-night limitation
- 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, although it must be included in the 80-hour weekly maximum, will not initiate a new off-duty period
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Supervision | - Programs must ensure that qualified faculty provide appropriate supervision
| - Residency review committee should establish measurable standards of supervision according to specialty and level of training
- Residents in the first year must have immediate access to in-house supervision
| - Program-specific trainee supervising physician communication guidelines and policies will be required
- Faculty assignments to teaching services need to be of sufficient length
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