BackgroundThe ACGME has established limits on the work hours of interns and residents. In addition, the Institute of Medicine, acting at the request of Congress, has issued a slightly more restrictive report regarding intern and resident work hours. The report, entitled Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, was published in December 2008.
The Liaison Committee on Medical Education (LCME) has established the following standard for all medical schools: "The committee responsible for the curriculum, along with medical school administration and educational program leadership, must develop and implement policies regarding the amount of time students spend in required activities, including the total required hours spent in clinical and educational activities during clinical clerkships."
The following policy, drafted by the Clinical Curriculum Committee, considered the issue of student duty hours and voted unanimously, at its January 2009 meeting, to adopt the following policy. This committee, along with the Core Basic Science Committee, determined that the policy as outlined below would not result in any major alteration in the time commitment required of students enrolled in any of the College's required basic science, preclinical courses or clinical clerkships as they are currently configured. The policy was approved by the Medical Education Council in February 2009. The policy used the recommendations of the IOM as a guide, modified to apply to students rather than residents.
Policy for Student Duty Hours*
- The maximum number of hours that a student may be on duty in one week is 80 hours, averaged over 4 weeks.
- The maximum shift length is 30 hours, with 5 hours protected sleep time between required shifts; or a maximum of 16 hours without protected sleep time.
- The maximum frequency of in-hospital call is every third night.
- The minimum time off between scheduled shifts is 10 hours after a day shift, 12 hours after a night shift, and 14 hours after any extended duty of 30 hours [and residents should not return to service earlier than 6 a.m. the next day].
- The maximum frequency of in-hospital night shifts is 4 nights sequentially. After 3 or 4 night shifts, a student must have at least 48 continuous hours off before the next shift.
- As a minimum, a student must have the following days off duty: 5 days per month; 1 day (24 hours) per week; one continuous 48 hour period off per month.
- In exceptional circumstances, the time on duty can be increased to 88 hours for select programs with a sound educational rationale.
- In the emergency department, the maximum shift limit is 12 hours, with at least an equivalent time between shifts. The maximum number of shift hours per week is 60 hours, with an additional 12 hours permitted for education.
If a student reports the violation directly to the course or clerkship director, the course or clerkship director is required to investigate the situation and attempt to remedy it. If the situation is not remedied, the student must report the situation to an Associate Dean. Evidence of violation of the Student Duty Hours policy by direct student report to an Associate Dean will be brought to the attention of the course or clerkship director. The course or clerkship director will be required to investigate the situation and provide a report to the Associate Dean who filed the report of the violation with a copy to the Senior Associate Dean (Education) indicating how the situation has been remedied.
The policy and its reporting requirements will be published annually in the Weill Cornell Medical College Student Handbook.
*"Duty hours" refers to time when a student is scheduled to participate in patient care or educational events, such as seminars, lectures, and rounds. It does not refer to study time.
Approved by the Executive and General Faculty Councils, October 2009