It is recognized by the Board of Directors of the American Osteopathic Association that excessive numbers of hours worked by intern and resident physicians can lead to errors in judgment and clinical decision making.
These can impact patient safety through medical errors, as well as the safety of the physician trainees through increased motor vehicle accidents, stress, depression, and illness related to complications.
The training institution and the director of medical education (DME) and intern program director must maintain a high degree of sensitivity to the physical and mental well being of interns and make every attempt to avoid scheduling excessive work hours leading to sleep deprivation, fatigue, or inability to conduct personal activities.
The Northeast Osteopathic Medical Education Network, through its Board of Governors and Program Evaluation Committee, is committed to monitoring trainee's scheduled work hours. This system includes periodic on-site reviews of trainee work schedules and timely responses to complaints.
Any intern or resident receiving postdoctoral training in a NEOMEN sponsored program is entitled to anonymously report alleged violations of the AOA Work Hour Policy and receive a timely informative review and response to the allegation. The following monitoring system is provided:
| AOA Internship | AOA Residency |
|---|---|
| The intern shall not be assigned to work physically on duty in excess of eighty hours (80) per week averaged over a four (4) week period, inclusive of in-house night call. | The resident shall not be assigned to work physically on duty in excess of eighty hours (80) per week averaged over a four (4) week period, inclusive of in-house night call. |
| The intern shall not work in excess of twenty-four (24) consecutive hours inclusive of morning and noon educational programs. Allowance for, but not to exceed up to six (6) hours for inpatient and outpatient continuity, transfer of care, educational debriefing and formal didactic activities may occur. Interns may not assume responsibility for a new patient after twenty-four (24) hours. | The resident shall not work in excess of twenty-four (24) consecutive hours inclusive of morning and noon educational programs. Allowance for, but not to exceed up to six (6) hours for inpatient and outpatient continuity, transfer of care, educational debriefing and formal didactic activities may occur. Residents may not assume responsibility for a new patient after twenty-four (24) hours. |
| Moonlighting is not permitted by interns. | If moonlighting is permitted, all moonlighting will be inclusive of the eighty (80) hour per week maximum work limit and must be reported. (See Moonlighting Policy) |
| The intern shall have alternate week forty-eight (48) hour periods off or at least one (1) twenty-four (24) hour period off each week. | The resident shall have alternate week forty-eight (48) hour periods off or at least one (1) twenty-four (24) hour period off each week. |
| Upon conclusion of a twenty-four (24) hour duty shift, interns shall have a minimum of twelve (12) hours off before being required to be on duty again. Upon completing a lesser hour duty period, adequate time for rest and personal activity must be provided. | Upon conclusion of a twenty-four (24) hour duty shift, residents shall have a minimum of twelve (12) hours off before being required to be on duty again. Upon completing a lesser hour duty period, adequate time for rest and personal activity must be provided. |
| All off-duty time must be totally free from assignment to clinical or educational activity. | All off-duty time must be totally free from assignment to clinical or educational activity. |
| Those rotations requiring the intern to be assigned to Emergency Department duty shall not be assigned longer than twelve (12) hour shifts. | Those rotations requiring the resident to be assigned to Emergency Department duty shall not be assigned longer than twelve (12) hour shifts |
| The intern and training institution must always remember the patient care responsibility is not precluded by this policy. In the case where an intern is engaged in patient responsibility, which cannot be interrupted, additional coverage should be provided to relieve the intern involved as soon as possible. | The resident and training institution must always remember the patient care responsibility is not precluded by this policy. In the case where a resident is engaged in patient responsibility which cannot be interrupted, additional coverage should be provided to relieve the resident involved as soon as possible. |
| The intern may not be assigned to call more often than every third night averaged over any consecutive four (4) week period. | The resident may not be assigned to call more often than every third night averaged over any consecutive four (4) week period. |
| The training institution shall provide an on-call room for interns, which is clean, quiet, safe and comfortable, so to permit rest during call. A telephone shall be present in the on-call room. Toilet and shower facilities should be present in or convenient to the room. Nourishment shall be available during the on-call hours of the night. | The training institution shall provide an on-call room for residents, which is clean, quiet, safe and comfortable, so to permit rest during call. A telephone shall be present in the on-call room. Toilet and shower facilities should be present in or convenient to the room. Nourishment shall be available during the on-call hours of the night. |
| Any professional clinical activity (moonlighting) performed outside of the official residency program may only be conducted with the permission of the program administration (DME/Program Director). A written request by the resident must be approved or disapproved by the Program Director and DME and be filed in the institution's resident file. All approved hours are included in the total allowed work hours under AOA policy and are monitored by the institution's graduate medical education committee. This policy must be published in the institution's housestaff manual. Failure to report and receive approval by the program may be grounds for terminating a resident's contract. |
Contact
OPTI
91AV
11 Hills Beach Road
Biddeford, Maine
04005-9599
Philip Heywood
NEOMEN Executive Director
Phone: (207) 602-2229
Fax: (207) 602-5931
pheywood@une.edu