Medical Student Duty Hours on Clinical Rotations

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 duty 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’ duty hours during clinical rotations should enable them to participate and learn while also providing time for rest.
  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 experience card and website for the particular rotation) should be feasible within the designated time frame of the rotation.
  4. Didactic and clinical education have priority in the allotment of students’ time and energy.
  5. The rotation must ensure that qualified residents, staff and faculty provide appropriate supervision of medical students.
  6. The student duty hour guidelines 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

Duty hours are defined as all clinical and academic activities related to the rotation; i.e. patient care (both inpatient and outpatient), out-of-hospital/clinic time spent on patient notes, administrative duties related to patient care, time spent in-house during shift activities, and scheduled activities, such as conferences.

  1. Duty hours must be limited to 80 hours per week, inclusive of all direct patient care activities (whether completed in-house or at home). Such activities may include writing patient notes and research specifically aimed at writing those notes, as well as preparing to present during daily rounds. Duty hours also include didactic teaching sessions, Foundational Science Days, and the longitudinal Family Medicine clerkship. Duty hours do not include time spent studying for exams or for preparation for formal presentations (such as preparing for journal clubs or developing handouts).
  2. Medical students must be provided with a continuous 24 hours off during every seven days of duty, averaged over 4 weeks, 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.

Accountable Dean or Director:  Associate Dean for Curriculum

Procedures

  1. The student duty hour guidelines will be communicated to students and supervising physicians (including residents, fellows and faculty) in writing as well as to students in the MSE digest and at each clerkship orientation.
  2. If a student is concerned about a violation of the duty hours policy at a site, the student can report this on the end-of-clerkship evaluation form, and/or use the “SAFE(link is external)” (Supporting a Fair Environment) reporting mechanism to confidentially report duty hours violations. tiny.ucsf.edu/safe(link is external)
  3. If duty hours exceed the maximum amount as indicated in this policy, clerkships will be subject to onging, proactive monitoring and will be required to log students’ hours.

Last updated: Feb. 13, 2018.