[Adapted from the ACGME Program Requirements] Providing medical students with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and student well-being. Each program must ensure that the learning objectives of the medical curriculum are not compromised by excessive reliance on medical students to fulfill service obligations. Didactic and clinical education must have priority in the allotment of medical students’ time and energies. Duty hour assignments must recognize that faculty, residents and students collectively have responsibility for the safety and welfare of patients.
The preclinical curriculum consists of 19 to 20 credit hours per semester. Required contact hours, including lectures, laboratories, small discussion groups, and other formal educational activities, shall be appropriate to the academic credit given. Time for reading, self-directed learning, and other independent study activities are in addition to time for required course activities.
The maximum time a student is permitted to be clinically active on a required or selective clerkship is 80 hours in any week.
Required core and selective clerkships: The average time a student spends on clinical duties in the hospital during a required or selective clerkship should not exceed 65 hours/week. Students will receive on average at least 1 day off in 7 during a required or selective clerkship. Students should not exceed 16 consecutive hours of clinical duties in the hospital for required or selective clerkships.
Advanced clerkships (required and elective): The average time a student spends on clinical duties in the hospital during an advanced clerkship should not exceed 80 hours/week. Students should not exceed 24 consecutive hours of clinical duties in the hospital. However, a 24+4 rule is in place which allows an extra four hours that can be used to finish work on overnight patients (sign off, check a lab result if students are curious to see the result of an intervention that they did during the night, or to attend a particularly important morning conference). Students should not pick up new work during that time. Students will receive on average at least 1 day off in 7 during an advanced clerkship.
Every clerkship must include this policy in the clerkship syllabus and distribute it to all faculty, fellows, and residents who have responsibility for medical student instruction. Each fall, core and selective clerkship directors will submit to OSAC their clerkship schedule template, clearly demonstrating adherence with duty hour policies.
Medical students who believe they are being required to devote time to clerkship duties in excess of the provisions of this policy are encouraged to first bring their concerns to the clerkship director during the clerkship. If their concerns are not adequately resolved in this way, or after the end of the clerkship, or if they are not comfortable discussing them with the clerkship director, they may bring these concerns to the Senior Associate Dean for Student Affairs and Curriculum.
If a clerkship director perceives that a student is spending excessive time on clerkship duties, such that the student’s well-being or the well-being of patients may be compromised, the director should counsel the student and if appropriate specifically restrict the amount of time the student spends on duty. If the matter is not appropriately resolved in this way, the director should refer it to the Senior Associate Dean for Student Affairs and Curriculum.
Additionally, on the end-of-clerkship evaluation, all students will be asked whether or not the clerkship followed duty hour policies. Students who feel that duty hours were not followed will be prompted to provide additional details. These anonymous reports will not be visible to clerkship faculty and administration. They will be directly forwarded to the Student Affairs and Curriculum deans for further action.