UCSF Radiation Oncology : Duty Hours and Fatigue


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All patient care will be supervised by qualified faculty. It is the program director's responsibility to ensure, direct, and document adequate supervision of residents at all times. Residents are provided with rapid and reliable system for communicating with supervising faculty. Radiation Oncology faculty carry long-range pagers with text messaging capability, phone lists are widely available with office phone numbers and pager numbers of all Radiation Oncology Departmental personnel, and 6-month call schedules are readily available listing all MD faculty who take call, along with their home phone numbers. These lists are distributed by e-mail as they are updated and are also posted in numerous sites within the Radiation Oncology Department at Parnassus and at Mount Zion.
Faculty schedules will be structured to provide residents with continuous supervision and consultation. Faculty members who will be absent from work complete a "Request for Leave" form that identifies the covering faculty member; the leave slip is signed by both the covering faculty member as well as the faculty member requesting leave, and the leave and coverage information is recorded in "Lantis" and "MeetingMaker" where it is readily available.
Faculty and residents are educated in this department to recognize the signs of fatigue and through our duty hours policy, see below, we have adopted a plan to prevent and counteract the potential negative effects of fatigue.

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 conferences. Duty hours do not include reading and preparation time spent away from the duty site.
Duty hours will be limited to 80 hours per week averaged over a four-week period, inclusive of all in-house call activities.
Residents will be provided at least 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4 week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

There is no in-house call for Radiation Oncology residents
At-home call (pager call) will be for a period of 7 days with an average of no more than 2 weeks of pager call in a 4 week period.
When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.
No new patients may be accepted after 24 hours of continuous duty. For our department, 24 hours of continuous duty will be defined as performing in-house duties (including transit time) for the majority of the period from midnight to 6 a.m. after performing normal clinical duties the prior day. New patients are defined as any patient for whom the resident has not previously provided care.
When the pager call resident has exceeded 24 hours of continuous duty, as defined above, and he/she has scheduled clinical duties on the following day, coverage for his/her clinic and on-call responsibilities will be arranged by the chief resident for the subsequent 24 hour period.
The program director, chief resident, and faculty will monitor the demands of at-home call and will make scheduling adjustments if necessary to mitigate excessive service demands and/or fatigue.