Background

Washington University School of Medicine (WUSM) is committed to the creation of effective learning environments that balance the importance of meaningful participation in clinical activities with the need to support equilibrium among student clinical responsibilities, learning, and personal health and well-being. The following policies and guidelines are set taking into account the effects of fatigue and sleep deprivation on learning and patient care.

In keeping with Standard 8.8 of the Liaison Committee on Medical Education, clinical course directors, directors of clinical electives, and the Office of Medical Student Education are responsible for monitoring duty hours and ensuring that these are adjusted as necessary. Duty hours are defined as all clinical and required academic activities related to medical student education, including patient care (both inpatient and outpatient), administrative duties (e.g., completion of paperwork, dictation of charts), the provision of the transfer of patient care (e.g., check-in, check-out), time spent in-house while on call, and scheduled academic activities (i.e., required academic conferences). Time spent in self-directed study or practice performed after the student has left the hospital (or after the student has been told that they can leave) does not count toward duty hours.

Policies

• Students must not be scheduled for more than 80 clinical duty hours during a seven-day week, averaged over a four-week period.
• Students must have a minimum of four periods of 24 consecutive hours off over four weeks. Note: Official WUSM school breaks and holidays should not be counted toward this minimum time-off requirement. Weekends that are adjacent to holidays (e.g., Labor Day) are not considered official holidays.
• Students must not be on overnight call more frequently than every third night. Overnight shifts that do not extend a student’s duty hours during the workday, such as those that might occur in Emergency Medicine or Obstetrics, are not included.
  • Students must have access to call room facilities during overnight call shifts that extend a student’s duty hours during the workday.
• Students cannot be on call for more than 24 successive hours, with an added period of up to 4 hours for continuity, educational debriefing, and didactic activities. No new patients should be assigned to students after the 24-hour call limit.
• Students must have at least 14 hours off from clinical work and required educational activities following 24 hours of in-house call.
• Students will have at least 10 hours off between scheduled work periods, including all activities within the definition of duty hours above.
• All students on clinical rotations will have all official Washington University holidays off, regardless of whether the student’s team is on-call or post-call the day of the holiday. On the workday immediately preceding the holiday, students will be dismissed by 5 p.m. and will not be assigned call duties or regular clinical duties until the day immediately following the holiday at the time set forth by the clerkship director, chief resident, or clinical elective director. In the case of clerkships/rotations with evening or night shifts, an equivalent amount of time off will be provided in as immediate proximity to the holiday as is possible to minimize additional loss of clinical exposure.
• All clerkship students are to be excused from clinical duties by 5 p.m. on the evening before they are scheduled to take an assigned National Board of Medical Examiners subject exam.
• Please refer to the relevant attendance policy for additional details regarding excused time off from clinical duties.
• Individual clinical course directors and directors of clinical electives may choose to implement duty hour guidelines that are more restrictive than the above. However, duty hours may not exceed the above regulations.
• If a student has concerns about duty hour violations, they should discuss it first with the clinical course director. If the issue is not resolved to the student's satisfaction, they may approach the Associate Dean for Medical Student Education, the Associate Dean for Student Affairs, or the Office of the Ombuds for Washington University School of Medicine.

Guidelines

• It is strongly suggested that clerkship directors and directors of clinical electives take into consideration additional student workload created by required assignments or other required learning activities when monitoring student duty hours. Examples include but are not limited to e-learning activities, required writing assignments, and quizzes.
• Duty hours data will be collected via end-of-clerkship course evaluations and clinical elective course evaluations, which are completed by students after each clerkship and clinical elective. 
• Clinical course directors will review duty hours data after each rotation to address any concerns and to adjust requirements as necessary.
• The Office of Medical Student Education will review the data quarterly to address any concerns and to adjust requirements as necessary. Data will be presented periodically to the Committee on Oversight of Medical Student Education and its subcommittees, which will charge the appropriate individuals or offices with improvement plans, when necessary.

Last approved on November 5, 2019

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