Student Duty Hours Policy

Considerations/Assumptions:

• ACGME Resident duty hour rules provide a model for formulating student duty hour rules. Their primary purpose is to address patient and resident safety. Student duty hour rules are primarily concerned with the affect of sleep deprivation on the clerks’ personal safety, mental well-being and ability to study and learn.
  
  
• Clerkships are already time-compressed for the material that needs to be covered so student duty hour rules must take into account the primacy of education gained from the clinical experience and didactic sessions.
  
  
• Faculty commitments require that some lectures will need to be scheduled from noon onward, thereby potentially lengthening the day for the post-call students. This suggests that some noon didactics may need to be moved or optional for the post-call student.
  
  
• Call is a valuable educational experience that offers the clerk the opportunity for quasi-independent action on all services and, specifically, participation in the operating arena on surgical clerkships or evaluating acute problems that present to the Emergency Department and may require admission, or dealing with the evaluation and intervention on the sudden status change of an already hospitalized patient. It also affords the clerk opportunities to acquire the discipline necessary to function safely during prolonged awake hours.
  
  
• Dedicated on-call rooms need to be provided so that the student can sleep when their services are not needed when on call.
  
  
• The Rural Health Education Partnership is a curriculum unique to WVU. It is intended to be a “real world” experience for the clerks, thus the application of duty hour rules should fit the environments students are located in. The clinical faculty is encouraged to take into account the issue of fatigue in regards to the clerks, and adjust students’ duty hour schedules as appropriate.

Student Duty Hour Rules:

1. Medical students will work no more than eighty education contact hours a week, averaged over the clerkship block period. Education contact hours include inpatient ward work, outpatient clinical hours, attendance at required didactic conferences, in house on-call hours, and those hours when students return to work from “at home” call.
   
   
2. Clinical services that have a low volume of nocturnal and weekend activity are encouraged to either allow clerks to take call from home or to institute “short call”. These do not count towards the 80-hour rule. Should a student be required to return to the hospital during an ‘at home’ call situation, then the hours physically present in the hospital do count towards the 80 hour weekly average.
   
   
3. Clerks should not be on 24 hour in-hospital call more than once every four days.
   
   
4. The clerk who has been on 24 hour call should not be involved in patient care after reaching the point of 30 consecutive in-hospital hours. Didactic educational activities after the 30-hour point are permitted to enhance the educational experience. It is difficult to know the exact experience (i.e., amount of sleep) students receive while on-call, therefore some flexibility is needed in applying this rule so that their educational experiences are not compromised.
   
   
5. The clerks will self-report their duty hours every week using E-value. If the student believes that they are being asked to have duty hours that consistently violate the Student Duty Hour Rules, they should immediately consult with the clerkship director and a Dean of Student Services.
   
   
6. The clerkship directors and Dean of Student Services will review the E-value duty hour logs quarterly to assess compliance with the rules through the tracking the hours on duty.
   
   
7. Students should have at least one in seven days off when averaged over the length of the clerkship.
   
   
8. The clinical demands of the Rural Health Partnership are unique. Student duty hours while on RHEP should be monitored by the RHEP Site Coordinator and reported to the responsible field faculty. The faculty should be cognizance of the cumulative hours the clerk is working and assess signs of fatigue and adjust their scheduled accordingly.
   
   
9. Student Duty Hours Policy will be reviewed and adjusted periodically to reflect the best practices in assuring an effective and productive student learning environment. Duty hour rule compliance will be regularly monitored during clerkship evaluations by the Curriculum Committee.

Drafted by Course Director Subcommittee in Summer 2006
Approved by MD Degree Curriculum Committee, November 2006
Approved by Dean Prescott, November 2006