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Graduate Medical Education

The New ACGME Common Program Requirements: The Impact on Clinical Faculty

Revised: August 11, 2017

Recently the ACGME has implemented far reaching changes in the Common Program Requirements which govern all residency programs. For the first time these CPRs mandate significant changes in the way faculty interact with and are responsible for the program activities.Far more than just duty hours. Require institution to educate faculty in:

Learning Environment

Faculty must demonstrate an understanding and acceptance of their personal role in the following:


Professionalism

The Elements of Professionalism required of physicians are:

Challenges to the Elements of Professionalism:

Supervision

Expected components of supervision

Teamwork

Transitions

Transitions / Hand Offs

Transition Guidelines

Education of Residents on Effective Transitions


Well-Being

Resources

A Case Study



Ana is a second-year resident in a demanding internal medicine residency program. She is generally regarded as one of the most talented residents and has just been elected to the chief resident position for the next year. For several months, however, she has been feeling a significant amount of burnout. Ana’s mood has become low, her energy level has dropped and she is having difficulty getting out of bed in the morning. She is in the middle of a very demanding ICU (Intensive Care Unit) rotation, during which she is on call every third night, so at first she thinks that it might just be sleep deprivation causing the problem. But she continues to feel increasingly unwell both physically and emotionally.

Ana’s mother was recently diagnosed with breast cancer. Her mother lives over a thousand miles away, and it’s impossible to visit her, since Ana only has one day per week off from work. Her mother reassures her, saying, “Don’t worry about me – keep working.” Nevertheless, Ana can’t stop thinking about her mother and is having a hard time focusing on medicine. She has to force herself to complete tasks and she stops doing the extra reading on medical cases that she usually enjoys. She is feeling overwhelmed and increasingly hopeless about life.

Ana also feels that she is not able to care for her patients as well as she used to in previous rotations. The other day when a patient was admitted with recurrent fainting episodes, she took a brief history from the patient and did not do a thorough job asking about family history, missing the fact that both the patient and other family members had histories of blood clots. As a result, she did not think to work the patient up for a pulmonary embolus (blood clots to the lungs) even though he had had some shortness of breath on admission, which is a common presenting symptom of this dangerous condition. If a colleague had not thought about this possibility and suggested the requisite testing, the patient’s life might have been in danger. Ana feels that if she were doing her usual amount of reading of the medical literature, she would have been better prepared.

Ana is afraid to tell anyone how she feels because she knows that people in the program will start to regard her as a “weak” resident if she complains. Besides, all the other residents are working just as hard and don’t seem to be having any problem. She will not even discuss the situation with her family at home because she does not want to disappoint them. She is feeling completely trapped and wonders why she went into the medical field in the first place; she would do anything at this point to escape it.

Is Ana Exhibiting Signs of Burnout?

Yes
No

       I.

Fatigue Management/ Mitigation & Alertness Management

Fatigue Facts (modified from American Academy of Sleep Medicine resources)

Alertness Management

Driving and Drowsiness

Pre-Call Sleep Strategies for Residents

On-Call Sleep Strategies for Residents

Post-Call Sleep Strategies for Residents

Clinical Experience and Educational Work

ACGME Work Hour Limits - 2017

2017 Rules
Maximum hours of work per week
  • 80 hours, averaged over 4 weeks
Maximum Clinical Work and Education Period Length
  • Must not exceed 24 hours of continuous scheduled clinical assignments.
  • Up to 4 hours of additional time may be used for activities related to patient safety, such as ensuring effective transitions of care, and/or resident education.
Maximum in-hospital on-call frequency
  • Every third night, averaged over a 4 week period
Minimum time off between scheduled work periods
  • Must have at least 14 hours free after 24 hours of in-house call
Maximum frequency of in-hospital night float
  • Must occur within the context of the 80-hour, and one-day-off-in seven requirements.
Mandatory time off work
  • 1 day (24 hours) off per week, averaged over 4 weeks
Moonlighting
  • Internal and external moonlighting is counted against 80-hour weekly limit.
  • PGY-1s are not permitted to moonlight.

Time Off Between Work Periods

Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.

At-Home Call

Any Questions?

For LSUHSC-NO residency programs, please contact the Office Of Graduate Medical Education at 568-4006.