ACGME Regulation
Why Duty Hour Limits?
Time and again concerns have been raised that restricted sleep has a negative effect on performance, education and well-being of resident physicians. All this has increased interest in limiting resident duty hours. As the accrediting body for 7,800 graduate medical education programs, the Accreditation Council for Graduate Medical Education (ACGME) is the entity to which the medical community looked to address this issue.
In July2003, the ACGME instituted a comprehensive approach to address duty hours in all accredited residency programs. It focuses on three areas:
- Placing appropriate limits on duty hours
- Promoting enhanced institutional oversight
- Viewing standards for resident hours as one
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A number of other nations, including the , most other European nations, and have limited hours for physicians in training by government regulation.
The Standards
The ACGME's common duty hour standards acknowledge scientific evidence that long hours and sleep loss have a negative effect on resident performance, learning and well-being.
The regulation lists the following rules:
- Cap hours for physicians in training at 80 per week
- Limit continuous duty time to 24 hours, with added time for transfer of care and didactic activities
- Require rest periods between duty shifts and 1 day in 7 to be free of program responsibilities
- Require in-house call to be scheduled no more frequently than every third night, and time on home-call spent in the hospital to be counted toward the weekly duty hour limit
- To provide for added time beyond 80 hours to allow residents to participate in educationally valuable activities, the standards provide for an increase of up to 10 percent beyond the 80-hour weekly limit. Individual programs may apply for this exception with the endorsement of their sponsoring institution's Graduate Medical Education Committee
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( An 80-hour limit was chosen as the upper limit to safeguard against the negative effects of chronic sleep loss, and a limit of 24 hours plus up to six hours was chosen to address the effects of acute sleep loss, and to allow for adequate time for patient hand-off and didactic learning )
