Clinical Experience & Education Hour Resources

Clinical experience and education work hours, previously known as “duty hours”, are defined as all clinical and academic activities related to the program. This includes patient care (both inpatient and outpatient), moonlighting, administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities such as didactics or conferences. Work hours do not include reading and preparation time spent away from the duty site, research activity, or paper writing.

Per ACGME requirements, trainees and their programs must work together meet the following rules (unless changed by a specialty’s residency review committee):

• Clinical and educational 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, clinical work done from home, and all moonlighting.
• Clinical and educational work periods for trainees must not exceed 24 hours of continuous scheduled clinical assignments. Additional time may be used for activities related to patient safety and administrative tasks, such as providing effective transitions of care, humanistic attention to the needs of a patient or family, and/or resident education. These additional hours count towards the 80-hour weekly limit.
• Trainees should have at least eight hours off between scheduled clinical work and education periods for rest and personal activities. They must have at least 14 hours off after 24-hours of in-house call.
• Trainees must be scheduled for a minimum of one day in seven that is free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days.
• Trainees must not be scheduled for more than six consecutive nights of night float.
• Residents must not be scheduled for in-house call more frequently than every third night when averaged over a four-week period.

Each program is required to have a written clinical and educational work hours policy consistent with this Institutional Policy. Specific night float requirements should be articulated in this policy as well as any exemptions if they are approved by the Review Committee. Programs can implement a system of their choosing to monitor compliance with clinical and educational work hour requirements. This customization at the program level is designed to reduce the administrative burden of recording duty hours on trainees in programs where there are infrequent violations. Please see the individual program manuals to understand their reporting system.

The GME office oversees clinical and educational work hours across all programs and addresses areas of non-compliance in a timely manner. The Graduate Medical Education office will review work hour violations as reported by programs quarterly and partner with programs to address non-compliance or concerning trends.

Program leadership and the UMN GME office will work together to prevent clinical experience & educational work hour violations from occurring. Any violation of work hours will be carefully analyzed by the program leadership to determine the cause. In the event that there is a pattern of persistent violations, correction action will be taken by the Program Director and Chair. 

Concerns about continuous violations not adequately addressed by their program can be reported to:

• the Designated Institutional Official at gme@umn.edu.
• anonymous reporting of any violation can occur via a Qualtrics form.
• trainees may also report violations directly to the ACGME.

Individual programs are required to educate faculty and trainees to recognize the signs of excessive fatigue. Programs must provide alternative coverage for a trainee’s clinical responsibilities if they are found too fatigued to continue.

Residents and fellows who are too impaired (or are identified by their peers as being impaired) to drive home safely, can request a transportation voucher at participating affiliated training sites. Trainees identifying risk and safety while arriving and/or departing work should seek security services at the site they are training at to address those needs. More information for current trainees can be located in Resource at Transportation and Safety Policy.

The University of Minnesota allows each program to decide if their trainees can participate in extracurricular and compensated clinical activities. This includes moonlighting and becoming an EPIC trainer. PGY-1 residents are not allowed to moonlight according to the ACGME common program requirements. Trainees on J-1 visas are not allowed to moonlight under any circumstances. Trainees with H-1B visas must obtain a separate H-1B visa for each facility where they want to moonlight outside their training program.

1. ACGME: Well-Being and Work Hour Requirements
2. CLER National Report of Findings 2018: Fatigue Management 
3. The LIFE Curriculum: A collaborative effort of Duke University Hospital, the University of North Carolina Hospitals, the North Carolina Area Health Education Centers, and the North Carolina Physicians Health Program to assist graduate medical education programs, their residents, and faculty to prevent, identify, and manage resident fatigue and impairment.
• Fatigue module
• Fatigue and Impairment 
• Fatigue and Resident Health
• Fatigue and Resident Well-Being
• Night Floats, Fatigue, Handoffs
• Stress & Depression module
• Stress Management in Residency Programs
• Substance Abuse module
• Common Issues Involving Residents Suspected of Substance Abuse
• Disruptive Behavior module
• Signs and Symptoms of Disruptive Behavior in Physicians
• Medical Staff Code of Conduct Policy and Procedures to Deal with Violations: Example
4. Sleep, Alertness and Fatigue Education in Residency (SAFER): SAFER focuses on the demands and stresses of medical residency. The resources below provide practical suggestions for residents to manage fatigue and sleepiness including the influence of circadian and homeostatic processes, when and how long to sleep, and what fatigue countermeasures to use.
• American Academy of Sleep Medicine Lecture
• SAFER Presentation