Students’ Duty Hours Policy for Clinical Rotations

The Ponce Health Sciences University School of Medicine (PHSU-SOM) abides by the recommendations of the ACGME, AMA, and the Puerto Rico Legislature related to Residents’ Duty Hours and is committed to regulate and monitor students’ working hours.  This will result in less fatigue, more effective healthcare delivery, an enhancement of patient safety, minimizing the possibility of medical errors, and providing adequate time for self-study and relaxation.

Duty Hours

Definition

Duty hours are defined as all clinical and academic activities related to the clinical clerkship or clinical rotation, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences, small group sessions, seminars, ward rounds, quizzes, and other assessment and evaluation exercises. Duty hours do not include time spent reading, studying, and preparing presentations away from the duty site.

General policies that apply to all medical students

1. Duty hours are limited to 80 hours per week, averaging over four weeks, inclusive of all in-house call activities for fourth-year medical students and 60 hours per week for third-year medical students.
2. All students will be provided with at least one 24-hour period per calendar week, free from all educational and clinical responsibilities, averaged over a 4-week period.
3. Adequate time for rest and personal activities will be provided.  The students must have at least 14 hours free of clinical work and education after 24 hours of an in-house call.

Duty Hours for Third Year Medical Students

1. Students in the third-year clinical clerkships are expected to abide by the working hours as specified in the clerkship syllabus and the policies of the teaching site to which they are assigned.   
2. These working hours should be no more than 10 hours per day, usually from 7:00 - 8:00 a.m. until 5:00-6 p.m. Students not assigned to “in-house on-call” activities that already have been in the hospital for 10 hours should be discharged at 6 PM. 
3. Students may be “on-call” no later than 12:00 Midnight.  Exceptions to allow continuity of care are acceptable if they fall within the following regulations: 

• Students will be “on call” no more than two (2) times per week and no more often than every third (3) night.

On-Call Activities-Fourth Year Medical Student

On-call activities are scheduled to provide fourth-year students with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the regular workday when students, with adequate supervision (-residents or faculty), are required to be immediately available in the assigned institution.

1. In-house calls must occur no more frequently than every third night, averaging over a four-week period.
2. Continuous on-site duty, including in-house calls, must not exceed 24 consecutive hours. At-home call (pager call) is defined as a call taken from outside the assigned institution.
3. The frequency of at-home calls is not subject to every third-night limitation. An at-home call must not be so frequent as to preclude rest and reasonable personal time for each student.

Oversight

1. Each clinical department will have procedures to ensure consistent compliance with this policy.
2. This policy must be distributed to the students in the course syllabus and the Moodle e-learning portal for each clerkship site.  It must also be distributed to supervising faculty and residents at all instructional sites. It is published in the PHSU Catalog, the PHSU Student Policies Manual, and is available through the Public Folders of the Outlook Public Folders.
3. Medical student duty hours’ data is collected by the supervising faculty at each instructional site through attendance logs and reported to clerkship coordinators and department chairs.
4. The students can submit violations of this policy to the clinical department chair for immediate resolution. If a student is not satisfied with the resolution, the student can submit a letter detailing the violation to the Associate Dean of Faculty and Clinical Affairs, the Associate Dean for Medical Education, or the Dean. If the violation persists, the student can submit a grievance to the Vice President of Student Affairs.
5. The Medicine Program Curriculum Committee monitors medical student duty hours through clerkship evaluation performed by the Clinical Curriculum Subcommittee.  

Backup support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create student fatigue sufficient to jeopardize patient care.