Policy Title: College of Medicine Medical Student Education (Duty) Hours Policy
Approval Authority: Undergraduate Curriculum Committee
Responsible Entity: College of Medicine
Policy Owner: Preclerkship Planning and Evaluation Committee and Clinical Science Planning and Evaluation Committee
I. Policy Statement
Student wellness, lifelong learning practice habits, and patient safety are important issues in medical student education at MUSC. Medical students need to learn healthy and appropriate strategies for managing potentially long duty hours. In addition, adequate sleep is key to memory consolidation and a healthy learning environment. The ACGME has established limits on the work hours of interns and residents to help prevent stress, burnout, injury and medical errors. A medical student policy was developed in alignment with ACGME standards for resident duty hours and the recommendations of the Institute of Medicine (IOM).
This policy applies to Medical University of South Carolina College of Medicine students enrolled in the MD degree or dual degree programs.
III. Approval Authority
The final governing committee which is responsible for approving the policy is the Undergraduate Curriculum Committee. The Preclerkship Planning and Evaluation Committee and the Clinical Sciences Planning and Evaluation Committee will periodically review the policy for updates.
IV. Purpose of This Policy
This policy outlines the limit to hours that medical students can be engaged in prescribed education activities/events.
V. Who Should Be Knowledgeable about This Policy
College of Medicine students enrolled in the MD degree or dual degree program
College of Medicine Faculty, Fellows Residents, and Course Directors
College of Medicine Undergraduate Medical Education Deans and Support Staff
VI. The Policy
Years 1 and 2
In the Preclerkship Phase, scheduled student education hours should not exceed 25 hours per week averaged over each block (Blocks 1-13) in order to allow time for independent student study and preparation.
In the 3 FLEX Phase blocks intended for Scholarly Projects and Research, scheduled activities may average 40 hours per week but should not exceed 60 hours per week.
Block leaders (Blocks 1-13) monitor education hours during curriculum planning and confirm actual educational hours with students during the introduction to each block.
Block education hours are determined and recorded by PPEC. The recorded hours are reported to UCC prospectively, at the time of semester schedule review and approval, and retrospectively, at block reviews at the close of each semester in the Preclerkship Phase.
Years 3 and 4
Maximum Hours and Frequency of Clinical Education Time
· The maximum number of hours that a student may be engaged in education activities in one week is 80 hours, averaged over 4 weeks (roughly equal to 13 hours per day for a student working 6 days in one week).
· The maximum frequency of in-hospital call is every third night.
· The maximum frequency of in-hospital night shifts is 6 night shifts sequentially.
· The maximum on-call shift length is 28 hours. This prolonged duty period will be utilized in prescribed settings in the clinical years in order to provide sound educational value through patient continuity and attendance in hand-offs and rounds.
Students on occasion, and of their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient (e.g., required continuity, academic importance, or humanistic needs of a patient or family) or, for example, to take advantage of a procedural training opportunity, but should still adhere to the weekly hour maximum. When students utilize this work hours exception they should count the additional hours toward their weekly maximum.
Call rooms will be provided when the rotation requires overnight call.
Mandatory Time Off
· The minimum time off between scheduled shifts is 8 hours.
· As a minimum, a student must have the following time off duty: 1 day (24 hours) per week averaged over 4 weeks. (For example, if a student is required to round both Saturday and Sunday one weekend but has both Saturday and Sunday off duty the next weekend, this averages 1 day off per week.)
· Students must have a minimum of 14 hours off duty following 24 hour call shift.
The student must keep track of their hours and notify their superiors when they are reaching the end of their shift. In addition, students must keep track of their hours per week and notify their course director if they are in danger of working more than the maximum hours.
Course directors are responsible for periodically checking with students to make sure they are not breaking the education hours policy.
VII. Special situations
VIII. Sanctions for Non-compliance
Preclerkship Phase education hours are monitored in student evaluations of each block through E*Value. Students report their level of satisfaction with scheduled work load. Data is reviewed in consultation with the Office of Assessment, Evaluation and Quality Improvement (OAE-QI) and is used to implement formal improvement plans.
Clerkships or courses found to have a pattern of education hours violations will be placed on monitoring and be required to implement a formal improvement plan.
IX. Related Information
A. References, citations
Procedure for Monitoring, Tracking, and Addressing:
In the case of clerkships and clinical courses, where hospital team members facilitate the violation of the Student Education Hours guidelines, students may make a direct report to the clerkship/course director or make a direct report to an Associate Dean for Curriculum or an Associate Dean for Students Affairs or their designee. If a student reports the violation directly to the course or clerkship director, the course or clerkship director is required to report the violation to the Office of Student Affairs (OSA). In the clinical years, education hours are monitored in the student evaluations of each clinical course through E*Value. Students report their adherence to each item in the education hours policy and these reports are anonymous. Education hours violations are documented after each rotation by the Office of Assessment, Evaluation, and Quality Improvement (OAE-QI) and sent directly to each clerkship director, the Associate Dean for Curriculum, Clinical Sciences, and to the Director, Clinical Curriculum and Visiting Student Program
For all violations reported through any mechanism in the clinical phase, the course or clerkship director is responsible for investigating the situation, attempting to remedy it, and reporting the outcome to the Associate Dean for Curriculum, Clinical Sciences and Office of Student Affairs who tracks outcomes. Violations are reviewed monthly at CSPEC meetings.
At any time, a student who experiences significant fatigue should exercise any of the following mechanisms:
· Use a call room in CSB 124 or the Clinical Launchpad (Main Hospital 272), both of which are available twenty four hours per day, to rest prior to driving or other activities
· Call alternative transportion such as a cab, Uber, or Lyft
· Call the clerkship coordinator for assistance
· Notify Student Affairs or Dean’s Office staff for assistance
· Notify your resident or attending for assistance
X. Communication Plan
Information about this policy will be included in student orientation sessions, posted online, and shared annually with teaching faculty, fellows, and residents through required compliance modules.
Education hours are defined as “prescribed education activities/events, including but not limited to patient care, seminars, lectures, rounds, labs, small group activities, etc.” Education hours do not include individual study time, individual preparation for planned activities, time spent in additional elective or extracurricular activities (e.g., longitudinal electives) or self-directed learning activities.
XII. Review Cycle
Policy will be reviewed every 2 years or more often as needed.
XIII. Approval History
List original approval date and subsequent review dates
Approval Authority Date Approved
Undergraduate Curriculum Committee January 2012
Undergraduate Curriculum Committee December 16, 2016
Undergraduate Curriculum Committee July 19, 2019
XIV. Approval Signature
Donna Kern, MD July 19, 2019
Title: Senior Associate Dean for Medical Education