Duty Hours in the Learning and Working Environment and Fatigue
It is the responsibility of each resident and faculty member to ensure that he/she is in compliance with his/her program’s policy. The Radiation Oncology Residency Program uses MedHub to monitor resident and fellow work hours.
The Radiation Oncology program has designed an effective program structure that is configured to provide residents and fellows with educational opportunities as well as reasonable opportunities for rest and personal well-being.
Resident work hours must be limited to no more than 80 hours per week, averaged over a four- week period, inclusive of all in-house clinical and educational activities, time spent on at-home call, clinical work done from home, and all moonlighting. Of note, as of July 1, 2017, time spent by residents on at-home call and at-home patient care activities such as contouring target volumes and normal tissue volumes and working on notes for the electronic medical record also counts towards the 80-hour maximum weekly limit, averaged over a four-week period.
Residents should have eight hours off between scheduled in-house clinical work and education periods. Residents must be scheduled for a minimum of one day in seven free of clinical work, home-call, and required education (when averaged over four weeks). These free days cannot include at-home call. Independent studying does not count toward work hours.
Residents and fellows must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
Clinical and educational work periods for residents and fellows must not exceed 24 hours of continuous scheduled clinical assignments. Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or trainee education.
In rare circumstances, after handing off all other responsibilities, a resident or fellow, on his/her own initiative, may elect to remain or return to the clinical site in the following circumstances: to continue to provide care to a single severely ill or unstable patient; humanistic attention to the needs of a patient or family; or to attend unique educational events. These additional hours of care or education will be counted toward the 80-hour weekly limit.
Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements. The maximum number of consecutive weeks of night float, and maximum number of months of night float per year, may be further specified by each ACGME Review Committee.
Residents and fellows must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).
Time spent on patient care activities by residents and fellows on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every- third-night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident. Residents and fellows are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient patient care must be included in the 80-hour maximum weekly limit.
An ACGME Review Committee may grant rotation-specific exceptions for up to 10 percent or a maximum of 88 clinical and educational work hours to individual programs based on a sound educational rationale. In preparing a request for an exception, the Program Director must follow the clinical and educational work hour exception policy from the ACGME Manual of Policies and Procedures. Prior to submitting the request to the Review Committee, the Program Director must obtain approval from the GMEC and DIO.
The Radiation Oncology Residency Training Program, in partnership with the UCSF School of Medicine and Office of GME, must educate residents, fellows, and faculty concerning the professional responsibilities of physicians, including their obligation to be appropriately rested and fit to provide the care required by their patients.
The learning objectives of the Radiation Oncology Residency Training Program must be accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events. In addition, they must be accomplished without excessive reliance on residents and fellows to fulfill non-physician obligations and ensure manageable patient care responsibilities.
The Program Director, in partnership with the UCSF School of Medicine and Office of GME, must provide a culture of professionalism that supports patient safety and personal responsibility.
Residents, fellows, and faculty must demonstrate an understanding of their personal role in the following:
- Provision of patient- and family-centered care;
- Safety and welfare of patients entrusted to their care, including the ability to report unsafe conditions and adverse events;
- Assurance of their fitness for work, including
- Management of their time before, during, and after clinical assignments; and,
- Recognition of impairment, including from illness, fatigue, and substance use, in themselves, their peers, and other members of the health care team.
- Commitment to lifelong learning;
- Monitoring of their patient care performance improvement indicators; and
- Accurate reporting of clinical and educational work hours, patient outcomes, and clinical experience data.
Residents, fellows, and faculty must demonstrate responsiveness to patient needs that supersedes self-interest. This includes the recognition that under certain circumstances, the best interests of the patient may be served by transitioning that patient’s care to another qualified and rested provider.
The Radiation Oncology Residency Training Program must provide a professional, respectful, and civil environment that is free from mistreatment, abuse, or coercion of students, residents, fellows, faculty, and staff. Programs, in partnership with their Sponsoring Institution, should have a process for education of residents, fellows, and faculty regarding unprofessional behavior and a confidential process for reporting, investigating, and addressing such concerns.
The program requires all faculty members and residents and any fellows to be educated to recognize the signs of fatigue and sleep deprivation and to be educated in alertness management and fatigue mitigation processes. All core teaching faculty and residents and any fellows are required to take a UCSF educational module on fatigue, including information on how to recognize and mitigate fatigue, descriptions of sleep cycles, and alertness management strategies. The educational model, “Sleep, Alertness, and Fatigue Education (SAFER),” is located on the UC Learning Management System. Go to https://training.ucsf.edu and search “fatigue.”
The program, in partnership with the UCSF School of Medicine and Office of GME, ensures adequate sleep facilities and safe transportation options for residents who maybe too fatigued to safety return home.
Residents and core faculty members are required to monitor the residents with whom they work with for fatigue, and to work with the chief resident to make appropriate arrangements to relieve them of duties if fatigue is suspected that could adversely affect learning, performance or patient care. In addition, any resident who suspects that fatigue could adversely affect his or her learning, performance, or patient care should report this to the chief resident to make appropriate arrangements to relieve him or her of duties. The chief resident will be backed up by the Program Director or Associate Program Director in making arrangements to relieve a resident of duties.
Each patient is cared for by an attending physician and resident together. Continuity of patient care will be maintained by the attending physician in the event that a trainee may be unable to perform his/her patient care duties. In the event that the attending physician of record is not available, patient care will be assumed by the “Doc of the Day” (DOD), the Clinical Site Director (if the DOD is unavailable), or the acting Clinical Site Director (if the Clinical Site Director is unavailable).