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Medical Student Education (Duty) Hours Policy

Medical Students (M.D.)

COM Medical Student Education (Duty) Hours Policy

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).

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.

Policy for Student Education Hours

Years 1 and 2

  • In years 1 and 2, scheduled student education hours should not exceed more than an average of 40 hours per week over each block in order to allow time for independent student study and preparation.

Years 3 and 4

  • 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 on-call shift length is 30 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. Planned duty periods up to but not exceeding 30 hours occur in the following designated clinical settings:

Third Year

  • Internal Medicine Clerkship, Charleston and Anderson: 4 calls over six weeks
  • Surgery Clerkship, Charleston and Anderson: up to 4 calls over six weeks
  • Obstetrics and Gynecology Clerkship, Charleston: 1 call over six weeks
  • Obstetrics and Gynecology Clerkship, Anderson: 4 calls over six weeks
  • Family Medicine, a distributed rural clerkship, has variable call requirements by site but remains within the guidelines outline above.

Fourth Year

  • CCU Externship (4 weeks): 4 calls
  • MICU Externship (4 weeks): call each Monday and Thursday night
  • Maternal Fetal Medicine Externship (4 weeks): 1 call
  • Call rooms will be provided when the rotation requires overnight call.
  • 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 notify the course director in writing and count the additional hours toward their weekly maximum.
  • The maximum frequency of in-hospital call is every third night.
  • The minimum time off between scheduled shifts is 8 hours.
  • The maximum frequency of in-hospital night shifts is 6 night shifts sequentially.
  • As a minimum, a student must have the following time off duty: 1 day (24 hours) per week averaged over 4 weeks.
  • 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.

Students are made aware and reminded of the education hour's policy at orientation to each academic year. The portion of the policy relevant to each academic year is included in each syllabus and posted online for reference.

Compliance

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 the Associate Dean for Students Affairs or 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) and to investigate the situation, attempt to remedy it, and report the outcome to the 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. Education hours violations are documented after each rotation by the coordinator and sent directly to each clerkship director and to the Manager for Clinical Coordination, Credentialing and Compliance for Medical Students who collects data on the frequency and nature of education hour violations. This data is shared with the Office of Student Affairs. The Associate Deans for Student Affairs are responsible for contacting each department regarding violations, establishing an improvement plan and reporting compliance to the Clinical Sciences Planning and Evaluation Committee and the UCC twice a year.

Adopted by UCC January, 2012; Revision approved on December 16, 2016