Graduate Medical Education

Graduate Medical Education Policies and Procedures

Duty Hours, Work Restriction and Fatigue

PURPOSE: To limit work in order to maintain an educational environment and to promote patient safety.


  1. Duty hours must be limited to 80 hours/week, averaged over a 4 week period - inclusive of all in-house call activities and all moonlighting.
  2. Residents must be scheduled for a minimum of one day free of duty every week (when averaged over 4 weeks). At-home call cannot be assigned on those days.
  3. Maximum Duty length:
    A. Duty periods of PGY-1 residents will not exceed 16 hours in duration.
    B. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospitals. Additionally, Residents may remain on-site to meet essential patient safety, educational or transitional care needs, but for no longer than four (4) hours.
  4. PGY-1 residents should have 10 hours and must have 8 hours free of duty between scheduled duty periods.
  5. Intermediate residents should have 10 hours free of duty and must have 8 hours free between duty periods. They must have at least 14 hours free of duty, after 24 hours of in-house duty.
  6. Residents in their final year of education must be prepared to enter the unsupervised practice medicine and care for patients over irregular or extended periods.
  7. Residents must not be scheduled for more than 6 consecutive nights of night float.
  8. PGY-2 residents and above must be scheduled for in-house call no more frequently than every 3rd night, averaged over a 4 week period.
  9. Time spent in the hospital by residents on and at home-call must count towards the 80 hour maximum weekly hour limit.
  10. Each Residency will be compliant with their specific duty hour requirements as outlined by the ACGME.
  11. Each Residency will be compliant with ACGME program-specific restrictions on the care of the new and ongoing patients.
  12. Both faculty and residents must be regularly educated about the effects of sleep deprivation, fatigue, on patient safety and quality of care. Programs must institute a Fatigue curriculum; prepare a written curriculum description on how this important safety issue is addressed. Both faculty and residents must be sensitive to the importance of fatigue as a patient safety risk and thus, be willing to find appropriate backup clinical providers for patient care when appropriate. A number of formal education resources are available to support the Fatigue curriculum.


Residents will be surveyed annually by the ACGME. The Residency Executive Committee (REC) and the Graduate Medical Education Committee (GMEC) will review results and make the appropriate intervention.

Approved by GMEC: 9/27/2013, 7/22/2016