University of California San Francisco
UCSF School of Medicine UCSF Medical Center

Clinical Work Hours Policy

Purpose

To outline the total number of hours medical students are required to spend in clinical and educational activities during the clerkships.

Overview

The UCSF Student work hours policy outlines expectations for students’ workload in clerkships in order to ensure that students can learn and participate in clerkships while also attending to their need for rest, study and personal time.

Related LCME Standards

8.8: Monitoring Student Time 

Principles

  1. Students’ work hours during clinical rotations should enable them to participate and learn while also providing time for rest, study, and personal time. 

  2. Every clerkship should provide a supportive educational environment with a commitment to patient safety and student well-being.

  3. Accomplishment of the core clinical objectives (see core clinical experiences for the particular rotation) should be feasible within the designated time frame of the rotation.

  4. The rotation must ensure that qualified residents, staff and faculty provide appropriate supervision of medical students.
  5. The student work hour policy should be flexible to address site variation and the difference in roles between students and residents, and to achieve the best possible balance between learning opportunities and student well-being.

Policy

Work hours are defined as all clinical and academic activities related to the rotation. This is defined as patient care (including patient-related administrative duties such as patient notes) and scheduled activities (such as conferences). It does NOT include time spent studying for exams, reading, preparing for oral presentations, or commute time.

  1. Clinical and educational work hours must be limited to no more than 80 hours per week. 
  1. Schedules must account for and anticipate unexpected circumstances which could lead to violations. This means that clerkships should design weekly schedules so that trainees are not scheduled for more than 72 hours/week. 
     
  2. Medical students must be provided with a continuous 24 hours off during every seven days of duty, free from all educational and clinical responsibilities.
     
  3. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours per day for patient care, plus 4 additional hours for educational activities (e.g. transition of care, conferences).
     
  4. At-home call must not be so frequent as to preclude rest and reasonable personal time for each student. When the student is called into the hospital, the hours spent in-house are counted toward the 80-hour limit.
  5. Night float rotation should not exceed 6 nights in a row; at a minimum, there are 8 hours off between shifts.

Procedure

  1. The student work hour guidelines will be communicated to students and supervising physicians (including residents, fellows and faculty) in writing as well as to students in the weekly medical student digest and at each clerkship orientation.
  2. If a student is concerned about a violation of the work hours policy at a site, the student can report this on the end-of-clerkship evaluation form, and/or use the “SAFE” (Supporting A Fair and Equitable Environment) reporting form to confidentially or not confidentially report work hours violations.
  3. All reports of work hour violations including concerns about on-call issues are immediately communicated to the relevant Clerkship Director and the Associate Dean for Curriculum, who will work together to address the violation. For non-anonymous work hour violations, the clerkship director will alter the student’s schedule to bring the student’s work hours into compliance, where possible. For issues identified after the clerkship, the clerkship director will gather information and propose a response plan for approval to the Associate Dean for Curriculum.
  4. The Foundations 2 and Executive governance committees review summary work hour violation reports at least annually with more regular urgent follow up  occurring as needed.
  5. If work hours exceed the maximum amount as indicated in this policy, clerkships will be subject to ongoing, proactive monitoring and will be required to log students’ hours.

Approval Date and Governing Body: January 8, 2021, CCEP