In 2003 the GMEC and the Neurosurgery RRC granted out request for a 10% exception to 80 hours of duty each week for neurosurgery residents averaged over 4 weeks. Our rationale was as follows:
By calculation of work hours for residents the 80 hour week means that a individual resident on the clinical services will lose one day each week of education and 88 hours will largely avoid this. Our neurosurgical operative procedures average >4 hours which is longer than any other specialty. Additionally, many core disorders such as cerebrovascular, spinal, trauma , and tumors present at odd hour and require urgent treatment which is often surgical. Follow-up care is essential in this education process, hence we have our own 12 and soon to be 14 bed NICU on 6-2 which is staffed by neurosurgery. Additionally, neurosurgical education requires the expected patient care and communication, consultative, outpatient training, conferences, and elective rotations, egs. interventional neuroradiology, neuro-ophthalmology, specialty neurology.
Residents usually arrive at 5:30 – 6:00 a.m. to round on weekdays. At 7:30 most go to the OR and will be there until 4:00 to 6:00 p.m. Two or 3 evenings during the week one or more rooms will run until late in the evening with particularly lengthy or emergency cases. Residents who do not go to the OR will manage the NICU, round with attendings, see consults, manage floor patients, and go to clinic. On Wednesday a.m. from 7:30 until noon there are a series of teaching conferences which all residents attend unless there is an emergency. Almost each afternoon there is a specialty conference or seminar. Overnight there are emergency operative cases about 50% of the time and several emergency admission and consult every night. On weekends there are usually several operative cases. Residents take call at a 3 to 4 nightly interval.
Our options to meet duty hour restrictions for neurosurgical education at Yale are to require residents on the clinical service to stop operating in the midst of core procedures, transfer care abruptly in a critically ill, unstable patient, skip clinic, or conferences since they will be required to miss most of a day each week or leave early on multiple days or provide the Program with an exception. Neurosurgery residents and attendings work closely together at all level of the service to provide outstanding neurosurgical education as noted by the RRC last year. The Department is unwilling to compromise either this excellence in education or in patient care.
The monitoring program for fatigue consists of an education program sponsored by the GMEC for attendings and residents, daily contact between the on-call attending and all residents with direct inquiry as to fatigue, and an awareness program where attendings, residents, P.A.s and nursing report such to the chief resident and the Program Director. In the case of fatigue the resident is sent home or if fatigue were extreme transportation is provided or he or she is asked to rest in the call rooms. Similar programs are also employed to monitor stress.