The faculty of the Department of Neurological Surgery believes strongly that the ACGME work hour guidelines are important for the residents’ education and well-being. We specifically did not request an extension of the work week to 88 hours as many of our peer programs in Neurosurgery have done. This was intentional and our faculty members all feel strongly that it is our responsibility to train well adjusted, well rested, competent Neurosurgeons. Each resident is empowered to be responsible for his/her work hours each week and for each four week period. It is their responsibility to maintain an accurate account of the hours spent at the hospital and to modify their schedule, if necessary, to comply with these guidelines. Peer residents, faculty, and the Program Director are available every day to provide guidance and assistance if a resident is having difficulty complying with all Duty Hours Rules. The resident logs are reviewed each four weeks by the Program Coordinator and the Program Director. No faculty member at any of the participating institutions may encourage them to work beyond these hours. In addition, it is mandatory that if a resident or faculty member feels that a resident is fatigued, that resident must go home immediately and stay at home for a period of time necessary to remedy the fatigue. It is also expected that residents will spend their time on duties which enhances their education. Because of changes to the Duty Hour Rules, the schedule was redesigned using input from all of the residents and faculty in the spring of 2011, as described below. This new duty hour schedule was officially instituted on July 1, 2011.
Resident On-Call Procedures
Because of the commitment to comply with Duty Hour Rules and improve the residency program in Neurosurgery at Vanderbilt, the on-call policies for residents were revised beginning July 1, 2011. The PGY 1 residents do not take overnight call and must go home after 16 hours. The PGY 2, 3, and 4 residents take overnight call on average once in every 6 days and must go home after 24 hours. The PGY 5, 6 and 7 residents take home call as back-up to the more junior residents on average once in every 6 days. Rounds are made with the on call residents twice every day, once in the morning at about 6AM and once in the evening at about 6PM. Neuroimaging studies are reviewed, patient care issues are addressed, teaching opportunities are addressed, and an appropriate hand-off is performed. Since these changes to the call schedule have been instituted, feedback from the residents has been enormously positive. Additionally, feedback from the nursing staff in the ICU and on the wards has also been exceptionally positive as our residents are responsive, available, and attentive.
Monitoring of Duty Hours
Residents are responsible for monitoring and documenting their own hours every day into a simple and user-friendly system on the “New Innovations” web-based program. By recording in this manner, the resident is also attesting to the accuracy of the data. These entered hours are reviewed often by the Residency Program Coordinator and the Residency Program Director. Specifically, at a minimum, the Residency Coordinator views the Duty Hour Reports from New Innovations every 4 weeks and she sends a notification of the report results to the Program Director. If there are any violations, the Program Director discusses the situation with the involved resident(s) and with the Chairperson, if necessary, to be certain the violation is not a recurring problem and to discuss how to prevent further violations. Specifically, duty hours are monitored closely to be certain that every resident: 1) is below 80 hours per week, 2) has at least one 24 hour period completely off from all duties every 7 days, 3) has at least 10 hours off all duties between each daily duty period (or in-house call), 4) does not have any periods of continuous on-site duty (including in-house call) exceeding 24 consecutive hours, and 5) does not have in-house call more often than every third night, (beyond his/her daytime duty hour period). Each resident is also responsible, along with the faculty, for monitoring fatigue, and going home or resting in the residents room to remedy such fatigue if it occurs, regardless of the number of hours worked.
Moonlighting is prohibited by Neurosurgical residents in Vanderbilt’s Department of Neurological Surgery. In very rare and special cases, when a resident is not on the clinical service (e.g. basic research rotation), a possible exception could be made if both the Chairperson and the Program Director agree it is in the best interest of the resident and the program.