Policy Statement:

The work hour regulations as detailed in the NMCSD and ACGME Policies will be strictly adhered to. Duty hours encompass all in-house clinical and academic activities related to the fellowship program, excluding time spent outside the hospital for preparation, study, or research. Fellows are forbidden from carrying out after-hours work activities on-site that could be done from home if it would exceed the 80-hour weekly limit. As most calls are taken from home, there is minimal risk of breaching the “24 and 4 rule”. The program will ensure that fellows receive appropriate supervision and backup for all patient care activities, as outlined in section 5 of this handbook. The program will not excessively rely on fellows to meet department service obligations, ensuring that educational goals and objectives are not compromised. The scheduling of duty hours and call rosters will prioritize patient needs, continuity of care, and fellows’ educational requirements.

ACGME Duty Hour Requirements:

• Duty hours must not exceed 80 hours per week, averaged over a four-week period, including all in-house call activities.
• Fellows will be granted one free day per week (24 hours) from all educational and clinical responsibilities, averaged over a four-week period, including call. This day should be used for rest and personal wellness.
• A minimum of 10 hours of rest and personal time will be provided between all daily duty periods and 14 hours after in-house calls lasting over 24 hours.
• Fellows taking at-home calls will have one free day per week (24 hours) from all educational and clinical responsibilities, averaged over a four-week period. Any hours spent in-house after being called in from home will count towards the 80-hour limit.
• ACGME work hour restrictions do not apply to preparation reading for the next day’s cases, studying, and home-based research.

In-house Call:

• PCCM fellows rarely take in-house calls, but there may be instances when acute patient care necessitates overnight hospital stay.
• Continuous on-site duty must not surpass 24 consecutive hours. Fellows may stay on duty for up to 4 additional hours for didactic activities, patient care transfer, and medical care continuity.
• After 24 continuous hours on duty, no new patients may be accepted. A new patient is defined as any patient the fellow has not previously cared for.

Duty Hours Monitoring:

• Duty hours will be monitored by the program director, staff, and fellows to ensure a balance between education and service.
• Fellows are expected to track their duty hours individually and log them in New-Innovations monthly.
• Fellows must promptly report any ACGME duty hour standard violations to their immediate supervisor and program director.
• All staff should be familiar with the ACGME and institutional duty hour standards and support fellow duties that ensure compliance.
• The program director will oversee work hour requirement compliance by reviewing all individual duty hour logs and fellow evaluation programs. A comprehensive report of fellow duty hours will be submitted to the Graduate Medical Education in line with the GMEC policy in the Appendices.

Fellow Fatigue Monitoring and Support System:

All staff and fellows will be trained to identify signs and potential adverse effects of fatigue. Any fellow showing signs of fatigue or expressing health issues that could affect patient care will be immediately relieved from clinical duty until deemed fit to return by the supervising staff and/or program director. Furthermore, on-call supervising staff should be vigilant of potential fatigue and ensure rest periods are given throughout the call night to maintain patient safety and physician vigilance.