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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. 

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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

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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 

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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

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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 

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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

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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 

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