The Accreditation Council on Graduate Medical Education (ACGME) Board of Directors approved institutional standards for resident duty hours in February 2003, to be implemented by July 2003.

Here at UCLA, we have taken this charge very seriously. Resident well-being has been a priority not only for the program directors of both Internal Medicine and Pediatrics but also the Dean of Graduate Medical Education.

We are happy to report that since the implementation of the 2003 Duty Hours statement, we have worked diligently in both Internal Medicine and Pediatrics to ensure that our Med-Peds residents are in full compliance of the duty hours requirements. We are currently working with both categorical programs in the implementation of the new Duty Hours statement released in Spring 2010, to be effective July 2011.

Our program uses a web-based system, VerinformRM, to handle much of our residency training data, including evaluation completion and duty hours reporting.

Accessing Verinform
In the beginning of residency at UCLA Med-Peds, our residents receive an email from Verinform which includes your username, and a request to create a password. If you do not receive an email with your Verinform account information, please contact the Med-Peds Program Coordinator. Once you have created your password, you can login to Verinform by clicking on the link on our Med-Peds Home Page at http://medpeds.med.ucla.edu

Completing Evaluations
Verinform will send you an email notifying you when you have evaluations to complete
Login to Verinform
Click on the Complete Required Evaluations link on the Verinform Homepage

Reporting your Duty Hours
Our residents are required to report duty hours via Verinform. Our residents receive weekly email reminders from Verinform reminding each residents to confirm duty hours for the week.

Instructions
Log into Verinform
Click on the "Duty Hours" link on the Verinform Home Page
Enter / Adjust your hours

Important Notes
Call/float hours are NOT entered into the system automatically and you will need to add these hours in as needed.
Press SAVE to confirm and make changes
You do not need to record hours for outside rotations (i.e., Olive View, Harbor-UCLA)

While the actual number of hours worked by residents may vary, residents should have sufficient off-duty time to avoid undue fatigue and stress. The program director must monitor on-duty schedules for residents to ensure that these assignments do not interfere with education, performance, or clinical care and judgment. The monitoring should ensure:

1. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities;
2. 1 full day out of 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call activities;
3. On average, on call no more than every third night;
4. Residents may not work for longer than 30 continuous hours (they may be on call for 24 hours and then have 6 hours to transition care to another physician and to leave the hospital;
5. Adequate backup if patient care needs create resident fatigue sufficient to jeopardize patient care or resident welfare during or following on-call periods;
6. That residents are provided adequate rest between scheduled duty hours;
7. That during on-call hours, residents are provided with adequate sleeping, lounge, and food facilities;
8. That support services are such that residents do not spend an inordinate amount of time in non-educational activities that can be properly discharged by other personnel

Written policies on these matters should be established. Formal educational activity shall have high priority in all the allotment of the resident's time and energies.

ACGME Duty Hour Resources:

1. Read more about the new ACGME Duty Hour Standards
   
2. Duty Hour Question Guide for Residents
   
3. Duty Hours: ACGME Standards (Effective July 2011)

(Taken from the UCLA Housestaff Manual)
View the UCLA Housestaff Manual

1. Duty hours are defined as all clinical and academic activities related to the residency program, ie, patient care (both inpatient and outpatient), administrative duties related to 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 include all hours spent in moonlighting activities. Duty hours do not include reading and preparation time spent away from the duty site.
2. Duty hours must be limited to 80 hours per week, averaged over a 4-week period, inclusive of all in-house call activities.
3. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clincial, educational, and administrative activities.
4. Adequate time for rest and personal activities must be provided. This should consist of at least an 8 hour time period provided between all daily duty periods and after in-house call.
5. In addition to specific duty hours, residents an faculty need to be cognizant and concerned about fatigue. Any fatigue concerns should be addressed with the supervising attending. Strategic naps are encouraged. Nap rooms are provided in the House Staff Sleep Quarters during normal day hours and prior to driving home.
6. It is everyone's responsibility to abide and work within the duty hour policy. Programs must develop realistic schedules and mechanisms for off time coverage and transfer of patient responsibilities to others. Faculty must remain vigilant of the trainees under their supervision and frequently monitor the residents' activities. Residents must stay within the duty hours and notify chief/senior residents, faculty and / or the program director if they are having difficulties in meeting daily or weekly duty hour requirements. A Program Director may make a one-time exception for patient safety or educational requirement as per ACGME rules and regulations. Residents should notify their program director and / or the Sr. Associate Dean for Graduate Medical Education if their assigned hours are not in compliance with UCLA or ACGME duty hour policy.
7. The GMEC requires that all program directors monitor and assess compliance for their program and residents. The GME office and the ACGME require completion of a yearly questionaire on duty hours to residents each spring, which is one part of assessing compliance. Additionally, the UCLA GMEC requires an annual Program Director certification of compliance with duty hours.
8. Concerns of duty hour violations should be reported to the Sr. Associate Dean for GME or the institutional Compliance Hotline at (800) 296-7188.
9. Continuous on-site duty, (admitting, inpatient call, etc.), must not exceed 24 consecutive hours. It is essential for patient safety and resident education that effective transitions in care occur. Residents (PGY-2+) 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 hours. All residents must understand that PGY-1 residents have a limitation of 16 hours per day with no additional hours. Therefore, the total day may be up to 28 hours.
10. David Geffen School of Medicine and each ACGME training programs abides by the ACGME duty hour rule (http://www.acgme.org).
    
    Approved by GMEC: 9/12/06; 3/23/11
    
    The Program Director or designate will endeavor to:
    
1. Avoid assigning house officers to continuous hours extended over an unreasonable period of time or to onerous on-call schedules;
2. Fairly schedule duty time of each house officer, including the provision of adequate off duty hours;
3. In addition, a resident's obligation to patients is not automatically discharged at any given hour of the day or any particular day of the week. Daytime hours and night and weekend call must be sufficient to permit implementation of the concept of responsibility for patients and to provide for adequate patient care. Each Program Director or designate must decide on the frequency of nightcall for house officers in the program. This must be advertised in the appropriate program brochure; anticipated changes to night call requirements must be published in writing prior to implementation.
4. The Program Director or designate will endeavor to equitably distribute holiday call among house officers at the same postgraduate level subject to patient care requirements (generally observed holidays are New Year's Day, Martin Luther King Day, President's Day, a Spring administrative holiday, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day).

UCLA GME Procedures for approval of exemptions to policy:

1. Application to the GMEC
2. Approval of GMEC with dual request of Program and GMEC for Program's RRC.
3. Approval of Program RRC in writing