General Surgery programs were cited 36% for work hours and related requirements in 1999 and 35% in 2000. Pediatric Surgery programs were cited 53% (1999) and 44% (2000).1 The RRC(Surgery) definition of work environment and hours (section F below)2 warrants constant review, clarification, even specification.
Graduate education in surgery requires a commitment to continuity of patient care. This continuity of care must take precedence—without regard to the time of day, day of the week, number of hours already worked, or on-call schedules. At the same time, patients have a right to expect a healthy, alert, responsible and responsive physician dedicated to delivering effective and appropriate care.
The program director must establish an environment that is optimal both for resident education and for patient care, while ensuring that undue stress and fatigue among residents are avoided. It is his or her responsibility to ensure assignment of appropriate in-hospital duty hours so that residents are not required to perform excessively difficult or prolonged duties regularly. It is desirable that residents' work schedules be designed so that on average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of routine responsibilities and be on call in the hospital no more often than every third night. During these on-call hours residents should be provided with adequate sleeping, lounge, and food facilities. There must be adequate backup so that patient care is not jeopardized during or following assigned periods of duty. Support services must be such that residents do not spend an inordinate amount of time in non-educational activities that can be discharged properly by other personnel.
Different specialties and different rotations may require different working hours and patterns. A distinction must be made between on-call time in the hospital and on-call availability at home and their relation to actual hours worked. The ratio of hours worked to on-call time will vary, particularly at the senior levels and therefore necessitates flexibility.
Residency training in surgery is a full-time responsibility; activities outside the educational program must not interfere with the resident's performance in the educational process, as determined by the program director, nor must they interfere with the residents' opportunities for rest, relaxation, and study.1
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