Institutional Clinical and Work Hour Policy (Including Fatigue Mitigation)

I.    Scope

This policy was developed for SIU Medicine. SIU Medicine collectively applies to the SIU School of Medicine (SIU SOM), including the Federally Qualified Health Center (FQHC), and SIU HealthCare (SIU HC). These entities are collectively referred to as SIU in this document.

This document applies to SIU staff, faculty, trainees, agents, officers, directors, interns, volunteers, contractors, and any other individual or entity engaged in providing teaching, research and health care items and services at SIU. These individuals are collectively referred to as SIU personnel in this document.

II.    Definitions 

The term “resident” is inclusive of all trainees at SIU School of Medicine, whether training in a residency or fellowship program

III.    Purpose

Individual programs, in partnership with the institution, will design effective program structures that provide trainees with meaningful educational and clinical experiences as well as reasonable opportunities for rest and well-being. The Graduate Medical Education Committee (GMEC) oversees programs’ clinical and educational work hours and ensures that individual training programs are in compliance with all ACGME Common Program Requirements and Residency Review Committee clinical and educational work hour requirements.

IV.    Procedure

This policy shall apply to residents in both accredited and non-accredited training programs.

1. Individual Responsibilities 
   1. Residents and faculty members have a professional responsibility to:
      1. Appear for work appropriately rested and to manage their time before, during and after clinical assignments to prevent excessive fatigue.
      2. Recognize the signs or symptoms of fatigue in themselves or others, and to notify the program director or other appropriate supervisor if they or a colleague are too fatigued to provide safe care.
   2. Residents have a professional responsibility to report clinical and educational work hours accurately, honestly and in a timely manner.
2. Program Responsibilities 
   1. Programs must:
      1. Structure schedules which focus on the needs of the patients, continuity of care, and the educational needs of residents, while giving attention to work intensity and work compression that impacts resident well-being.
      2. Educate all residents and faculty members to recognize the signs of fatigue and sleep deprivation.
      3. Educate all residents and faculty members in alertness management and fatigue mitigation processes.
      4. Encourage residents and faculty members to use fatigue mitigation processes to manage the potential negative effects of fatigue on patient care, learning, and well-being.
   2. There are circumstances in which residents may be unable to work, including but not limited to fatigue, illness, family emergencies, and parental leave. Programs must allow an appropriate length of absence for residents unable to perform their patient care responsibilities.
   3. Each program must have policies and procedures in place to allow an appropriate length of absence for residents unable to perform their patient care responsibilities, to ensure coverage of patient care, and to implement these policies without fear of negative consequences for the resident.
3. Sponsoring Institution Responsibilities
   1. The Sponsoring Institution will oversee:
      1. Resident clinical and educational work hours, and address areas of noncompliance in a timely manner.
      2. Programs’ learning and working environments, and systems of care to facilitate fatigue mitigation.
      3. Programs’ educational endeavors for residents and faculty members in fatigue mitigation.
         1. Fatigue education for incoming residents and new faculty is delivered directly by the Office of Graduate Medical Education.
   2. The Sponsoring Institution will ensure that:
      1. Adequate sleep facilities and safe transportation options are available for residents who may be too fatigued to return safely home.
      2. Work that is extraneous to their educational goals and objectives is minimized, and that their educational experience is not compromised by excessive reliance on residents to fulfill non-physician service obligations.
4. Resources 
   1. SIU SOM Brochure “Fatigue: How to Recognize It, How to Manage It” 
   2. The Office of Graduate Medical Education (OGME) has an online module that is available to anyone that wishes to take the course, or the program identifies as needing additional training.   Contact OGME staff for Brochures or to register for course.  

V.    References

VI.    Attachments 

VII.    Periodic Review

VIII.    Reviewed by

IX.    Office of Responsibility
GME