Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 331
Appendix B
Comparison of Select Scheduling
Possibilities Under Committee
Recommendations and Under 2003
ACGME Duty Hour Rules
These examples are offered as possible monthly schedules for a single
resident under the committee’s proposed duty hour parameters and under
current Accreditation Council for Graduate Medical Education (ACGME)
rules.
OCR for page 332
Tables B-1a and B-1b provide a comparison of schedules with extended duty periods. The benefits of the committee’s
recommendations are protected on-duty sleep time per week (e.g., 7.5 hours on average), regularity of days off, and
less possible variability in the week-to-week duty hour totals (60 to 80) than under ACGME rules (60 to 90). Under
the committee’s recommendations, extended duty periods may not be more often than every third night, while under
ACGME rules they might be scheduled closer together because averaging is allowed. Under current rules, residents may
go for more than a week without a day off. The committee recommends 5 days off per month rather than 4, with at
least one day off each week without averaging.
B-1a: Possible Extended Duty (q4) Monthly Schedule for a Single Resident Under Committee Proposal. Extended duty period every fourth night
no averaging (e.g., in hospital from 7 a.m. to 1 p.m. next day); 30-hour maximum consists of 16 hours for admitting patients, 5-hour sleep
period, and 9 hours for completion of work, educational activities, and transfer of responsibilities.
Mon Tues Wed Thurs Fri Sat Sun Duty Hours
30 (16 + 5 sleep + 9) 10 10 30 (16 + 5 sleep + 9) Off duty 80 (including 10 hours for sleep periods)
10 30 (16 + 5 sleep + 9) 10 10 Off duty Off duty 60 (including 5 hours for sleep period)
30 (16 + 5 sleep + 9) 10 10 30 (16 + 5 sleep + 9) Off duty 80 (including 10 hours for sleep periods)
10 10 Off duty 30 (16 + 5 sleep + 9) 10 10 70 (including 5 hours for sleep period)
TOTAL HOURS: 290
AVERAGE DUTY HOURS PER WEEK: 72.5
AVERAGE PROTECTED ON-DUTY SLEEP PERIOD: 7.5
hours/week
DAYS OFF: 5 full days per month
OCR for page 333
B-1b: Possible Extended Duty (q4) Monthly Schedule for a Single Resident Under Current ACGME Rules. Extended duty period every fourth
night on average (e.g., in hospital from 7 a.m. to 1 p.m. next day); 30-hour maximum consists of 24 hours for admitting patients + 6 hours for
completion of work, educational activities, and transfer of responsibilities. Day off per week is averaged.
Mon Tues Wed Thurs Fri Sat Sun Duty Hours
30 (24 + 6) 10 10 30 (24 + 6) 10 90
10 30 (24 + 6) 10 10 Off duty Off duty 60
30 (24 + 6) 10 30 (24 + 6) 10 Off duty 80
10 Off duty 10 30 (24 + 6) 10 10 70
TOTAL HOURS: 300
AVERAGE DUTY HOURS PER WEEK: 75.0
DAYS OFF: 4 full days per month
OCR for page 334
Tables B-2a and B-2b provide a comparison of schedules with extended duty periods every fifth night. The benefits
4
of the committee’s recommendations are protected sleep time per week (e.g., 6.25 hours on average) and regularity of
days off. In this example with extended call every fifth night, the variability in work hours from week to week is the
same under the committee’s recommendations and under the current rules.
B-2a: Possible Extended Duty (q5) Monthly Schedule for a Single Resident Under Committee Proposal. Extended duty period every fifth
night (e.g., in hospital from 7 a.m. to 1 p.m. next day); 30-hour maximum consists of 16 hours of work, 5-hour sleep period, and 9 hours for
completion of work and transfer of responsibilities.
Mon Tues Wed Thurs Fri Sat Sun Duty Hours
Off duty 30 (16 + 5 sleep + 9) 10 10 10 30 (16 + 5 90 (including 10 hours for sleep periods)
sleep + 9)
Continuation 10 10 10 30 (16 + 5 sleep + 9) Off duty 60 (including 5 hours for sleep period)
of 30-hour
shift
10 10 30 (16 + 5 sleep + 9) 10 Off duty Off duty 60 (including 5 hours for sleep period)
30 (16 + 5 sleep + 9) 10 10 10 10 Off duty 70 (including 5 hours for sleep period)
TOTAL HOURS: 280
AVERAGE DUTY HOURS PER WEEK: 70.0
AVERAGE PROTECTED ON-DUTY SLEEP PERIOD:
6.25 hours/week
DAYS OFF: 5 full days per month
OCR for page 335
B-2b: Possible Extended Duty (q5) Monthly Schedule for a Single Resident Under Current ACGME Rules. Extended duty period every fifth night
(e.g., in hospital from 7 a.m. to 1 p.m. next day); 30-hour maximum consists of 24 hours for admitting patients and 6 hours for completion of
work, educational activities, and transfer of responsibilities; day off per week is averaged.
Mon Tues Wed Thurs Fri Sat Sun Duty Hours
Off duty 30 (24 + 6) 10 10 10 30 (24 + 6) 90
Continuation 10 10 10 30 (24 + 6) Off duty 60
of 30-hour
shift
10 10 30 (16 + 5 + 9) 10 Off duty Off duty 60
30 (24 + 6) 10 10 10 10 10 80
TOTAL HOURS: 290
AVERAGE DUTY HOURS PER WEEK: 72.5
DAYS OFF: 4 full days per month
OCR for page 336
Tables B-3a and B-3b provide a comparison of schedules using a daytime shift length of 10 hours. The benefits of the
committee’s recommendations are regularity of days off and, thus, less variability in week-to-week duty hour totals
(50 to 60) than under ACGME rules (50 to 70). Under current ACGME rules, a resident could go for more than 2
weeks without a day off.
B-3a: Possible 10-Hour Daytime Schedule for a Single Resident Under Committee Proposal
Mon Tues Wed Thurs Fri Sat Sun
10 10 10 Off duty 10 10 10 60
Off duty 10 10 10 10 10 10 60
10 10 10 10 10 Off duty Off duty 50
10 10 10 10 10 10 Off duty 60
TOTAL HOURS: 230
AVERAGE DUTY HOURS PER WEEK: 57.5
DAYS OFF: 5 full days per month
B-3b: Possible 10-Hour Daytime Schedule for a Single Resident Under Current ACGME Rules
Mon Tues Wed Thurs Fri Sat Sun
10 10 10 Off duty 10 10 10 60
10 10 10 10 10 10 10 70
10 10 10 10 10 10 Off duty 60
10 10 10 10 10 Off duty Off duty 50
TOTAL HOURS: 240
AVERAGE DUTY HOURS PER WEEK: 60.0
DAYS OFF: 4 full days per month
OCR for page 337
Tables B-4a and B-4b provide a comparison of schedules using a nighttime shift length of 12 hours. The committee’s
proposal offers more recovery sleep time during night shift rotations by providing 48 hours off after 4 nights on so
that there are 8 days off duty rather than 4. The ACGME currently has no limits on the number of consecutive night
shifts.
B-4a: Possible 12-Hour Nighttime Schedule for a Single Resident Under Committee Proposal. After every fourth
night on duty, resident receives 2 days off.
Mon Tues Wed Thurs Fri Sat Sun
12 12 12 12 Off duty Off duty 12 60
12 12 12 Off duty Off duty 12 12 60
12 12 Off duty Off duty 12 12 12 60
12 Off duty Off duty 12 12 12 12 60
TOTAL HOURS: 240
AVERAGE DUTY HOURS PER WEEK: 60.0
DAYS OFF: 8 full days per month
B-4b: Possible 12-Hour Nighttime Schedule for a Single Resident Under Current ACGME Rules. No limits on the
number of consecutive night shifts.
Mon Tues Wed Thurs Fri Sat Sun
12 12 12 12 Off duty 12 12 72
12 12 12 Off duty 12 12 12 72
12 12 Off duty 12 12 12 12 72
12 Off duty 12 12 12 12 12 72
TOTAL HOURS: 288
AVERAGE DUTY HOURS PER WEEK: 72.0
DAYS OFF: 4 full days per month
OCR for page 338
