Clinical and educational work hours

Original Approval: 7/1/2017

Revised Approval: 12/10/2025

1. Definition
   Duty hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care responsibility, time spent in- house during call activities and scheduled academic activities such as conferences. Duty hours do not include reading, learning, and preparation time spent away from the duty site.
2. Requirements
   
   1. All Programs, regardless of their accrediting body, are required to meet the ACGME Institutional Requirements related to duty hours as well as all Residency Review Committee requirements as described in the Program Requirements for each specialty.
   2. Each Residency Training and Fellowship Program will establish a formal policy governing resident duty hours and working environment. This policy must comply with the ACGME Common Program Requirements as well as that specialty's Residency Review Committee Program Requirements. Such policies are designed to optimize both resident education and the care of patients.
3. Policy
   
   1. Transitions of Care Programs must design clinical assignments to optimize transitions in patient care, including their safety, frequency, and structure.
      
      • Programs, in partnership with their Sponsoring Institutions, must ensure and monitor effective, structured hand-off processes to facilitate both continuity of care and patient safety.
      • Programs must ensure that residents are competent in communicating with team members in the hand-off process.
      • Each program must develop a back-up system to cover patient care responsibilities when those responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident/fellow fatigue sufficient to jeopardize patient care.
   2. Maximum Hours of Clinical and Educational Work per Week
      • Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, including all in-house clinical and educational activities, clinical work done from home, and all moonlighting.
   3. Mandatory Time Free of Clinical Work and Education
      • Residents should have eight hours off between scheduled clinical work and education periods.
      • Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
      • Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At home call cannot be assigned on these free days.
   4. Maximum Clinical Work and Education Period Length
      • Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.
      • Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. Additional patient care responsibilities must not be assigned to a resident during this time.
   5. Clinical and Educational Work Hour Exceptions
      In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances: to continue to provide care to a single severely ill or unstable patient; to give humanistic attention to the needs of a patient or patient's family; or to attend unique educational events.
      • These additional hours of care or education must be counted toward the 80-hour weekly limit.
      • A Review Committee may grant rotation-specific exceptions for up to 10 percent or a maximum of 88 clinical and educational work hours to individual programs based on a sound educational rationale.
      • In preparing a request for an exception, the program director must follow the clinical and educational work hour exception policy from the ACGME Manual of Policies and Procedures.
   6. Moonlighting
      Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program, and must not interfere with the resident's fitness for work nor compromise patient safety.
      • Time spent by residents in internal and external moonlighting (as defined in the ACGME Glossary of Terms) must be counted toward the 80-hour maximum weekly limit.
      • PGY-1 residents are not permitted to moonlight.
   7. In-House Night Float

      Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements.

   8. Maximum In-House On-Call Frequency

      Residents must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).

   9. At-Home Call
      • Time spent on patient care activities by residents on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks.
      • At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.