The learning objectives of the program are accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events and are not compromised by excessive reliance on residents to fulfill non-physician service obligations.

Duty hours are defined as all clinical and academic activities related to the residency program, i.e., 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.

Weekly Duty Hour Limits:

1. Duty hours must be limited to eighty (80) hours per week, averaged over a four (4)-week period, inclusive of all in-house call activities and moonlighting.
   
   
2. The resident is provided with one (1) day in seven (7) free from all educational and clinical responsibilities, averaged over a four (4)-week period, inclusive of call. One day is defined as a continuous twenty-four (24)-hour period free from all clinical, educational and administrative activities..

On-Call Activities:

1. In-house call will occur no more frequently than every fourth (4th) night, averaged over a four (4)-week period.
   
   
2. The program encourages residents to use alertness management strategies in the context of patient care responsibiliites including strategic napping, especially after sixteen (16) hours of continuous duty and between the hours of midnight and 8:00 a.m. if possible.

Maximum Duty Period Length:

1. PGY-1 resident: in-house duty period must not exceed sixteen (16) continuous hours in duration.
   
   
2. PGY-2 residents and above: in-house duty period must not exceed twenty-four (24) continuous hours in duration.
   
   
3. Residents are not scheduled for more than six (6) consecutive nights of night float.
   
   
4. Recognizing that it is essential for patient safety and resident education that effective transitions in patient care occur, residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four (4) hours.
   
   
5. In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severly ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family.
   Under those circumstances, the resident must:
   
• Appropriately hand over the care of all other patients to the team responsible for their continuing care, and
• Document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director who must review each submission of additional service and track both individual resident and program-wide episodes of additional duty.

Time between Duty Periods:

1. PGY-1 residents have at least eight (8) hours free of duty between scheduled duty periods.
   
   
2. PGY-2 and PGY-3 residents have at least eight (8) hours free of duty between scheduled duty periods. They also have at least fourteen (14) hours free of duty after twenty-four (24) hours of in-house duty.
   
   
3. Residents are not assigned to additional clinical responsibilities after twenty-four (24) hours of continuous in-house duty.