Scheduled Resident Hours on E.M. Rotations: "The Shift Policy"

Intent

It is proposed to translate the calculation of clinical working hours currently in existence in the residency program for Emergency Department rotations to a defined number of shifts. Implementation of this process should reduce the work load of schedulers and render conflict to a minimum.

Calculations

Based on the clinical hours defined in the resident manual, the number of assigned shifts per month are depicted on the accompanying table. Figures are delineated for institutions that provide 10 hour and 9 hour shifts.

Clarification

1. Current and projected ACGME guidelines on working schedules prevail:

a. As a minimum, residents shall be allowed on average one full 24 hour period (day) in seven free of any clinical or academic responsibilities away from the institution.

b. While on duty in the Emergency Department residents may not work longer than twelve continuous scheduled hours. There shall be an equivalent period of continuous time off between scheduled work.

c. A resident should not work more than 72 duty hours per week. Duty hours comprise all assigned clinical duty time and conferences, whether spent in or outside of the educational program including all on-call and moonlighting hours.

2. Guidelines adopted in December 1988 are reiterated:

a. A resident may specifically request five days during the month, including one weekend, to be days off.

b. No more than two Fridays per month should be scheduled as off days.

c. Residents, at the discretion of the Program Director or Chair, may be excused for clinical activities for major presentations.

3. Written excuse letters will be sent out to your rotations for the following events. Chiefs scheduling E.D.s will also be reminded that these events are mandatory. You may take vacations during these events but you MUST be available to attend.

Function	Avoid Shift Assignments
Orientation Picnic (June)	1st, 2nd
Christmas Party (December)	2nd, 3rd
Spring Retreat (May) 1st, 2nd
Graduation Exercise (June)	2nd, 3rd
Night Before ABEM In-Service (Feb.)	3rd
ABEM In-Service (Feb.)	1st
Oral Board Exams (twice) (Dec. & May)	1st
International Air Show (July)	1st, 2nd

4. Residents may be scheduled for a shift, and be unavailable for a portion of the shift because of an official residency function, yet the shift will be counted as a completed date. Thus, a resident may be engaged in clinical activity but priority of the educational endeavor will supersede. Examples include:

• ACLS exercises
• ATLS
• Friday Conferences
• Journal Club
• Year-Directed Conference
• Various labs
• Special scheduled conferences

The above dates will be highlighted in the Conference Call which is distributed with regularity to your Department. When dates change for any of these functions, the Department will notify schedulers and residents.

5. Residents may request time off for social activities such as the Halloween Party, Spring Fling, Reds trip or Zoo trip, Annual Golf Outing, etc., but time off for one of these events counts for one of open day requests. They will no longer ask for squad days.

6. Time for spending with the prehospital care workers (formally known as squad day) is factored in on the table and additional time for squad activities will be obtained in the resident's unscheduled time.

7. A third year resident on his/her teaching month will be scheduled to perform 50% of the calculated shifts on the table. The shift number shall be rounded off to the next highest number. Additional clinical time will be spent by the teaching resident precepting fourth year medical students on the Emergency Medicine rotation.

8. After a schedule has been made, switching shifts to facilitate personal well being is encouraged. However, all switches MUST be approved by the scheduling chief resident at that site. Furthermore, when switching a shift away from an academic faculty member, that faculty member’s permission should also be sought.

Table: Calculation of ED Shifts
Potential Working Days in the Month

Shifts 10hr/9hr

Calculations based upon:	Calculation steps:
R-I working up to 50 hrs/wk	1) No. of days/month X hrs/wk
R-II working up to 45 hrs/wk	7
R-III working up to 40 hrs/wk	2) Divide by (10 or 9) - 1 day (squad day)
Chief working up to 35 hrs/wk

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