As per ACGME/RRC mandates, resident duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days. Duty periods of PGY-1 residents must not exceed 16 hours in duration. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.
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.