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Resident Physician Forum
July 14, 1999

The Requirements of Residency: Work Environment

JAMA. 1999;282(2):188. doi:10.1001/jama.282.2.188
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Article Information
Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.

Last week's Resident Physician Forum presented some of the compensation and fringe benefits listed in the institutional requirements set by the Accreditation Council for Graduate Medical Education (ACGME). In addition to these, each residency program must adhere to the program requirements for that residency's medical specialty. Listed below are some of the institutional requirements that affect the residency work environment.

Supervision

The institution must ensure that residents are appropriately supervised and teaching staff must be readily available to residents at all times. Residents must be supervised by teaching staff in such a way that the residents assume progressively increasing responsibility according to their level of education, ability, and experience. The teaching staff must determine the level of responsibility accorded to each resident.

Duty Hours

Resident duty hours and on-call schedules must foster resident education and facilitate patient care but must not be excessive. Each residency program at an institution must establish a formal policy governing resident work hours. The educational goals of the program and learning objectives of residents must not be compromised by excessive reliance on residents to fulfill institutional service obligations. Programs must ensure that residents are provided appropriate back-up support when patient care responsibilities are especially difficult or prolonged.

Residency Closure/Reduction

If an institution intends to close or reduce the size of a residency program, it must inform the residents as soon as possible. In the event of closure or reduction, the institution must make every effort to allow residents already in the program to complete their education or help the residents enroll in another ACGME-accredited program.

Restrictive Covenants

The institution must not require a resident to sign an agreement that would restrict where the resident can practice after completing the residency.

Physician Impairment

The institution must have a written policy explaining how it will handle physician impairment, including impairment related to substance abuse. The institution should provide residents with education on physician impairment, including substance abuse.

Food and Call Rooms

The institution must provide adequate and appropriate food services and sleeping quarters.

Personal Safety

The institution must take measures to ensure residents' safety in all areas of the institution and in related clinical facilities.

Patient Support Services

The institution must provide support services including intravenous services, phlebotomy, laboratory services, and messenger and transporter services in a manner appropriate to and consistent with educational objectives and patient care.

Information Infrastructure

The institution must provide an effective system for retrieving laboratory, medical records, and radiological information to provide for appropriate conduct of the educational programs and quality and timely patient care.

Last week's Resident Physician Forum presented some of the compensation and fringe benefits listed in the institutional requirements set by the Accreditation Council for Graduate Medical Education (ACGME). In addition to these, each residency program must adhere to the program requirements for that residency's medical specialty. Listed below are some of the institutional requirements that affect the residency work environment.

The institution must ensure that residents are appropriately supervised and teaching staff must be readily available to residents at all times. Residents must be supervised by teaching staff in such a way that the residents assume progressively increasing responsibility according to their level of education, ability, and experience. The teaching staff must determine the level of responsibility accorded to each resident.

Resident duty hours and on-call schedules must foster resident education and facilitate patient care but must not be excessive. Each residency program at an institution must establish a formal policy governing resident work hours. The educational goals of the program and learning objectives of residents must not be compromised by excessive reliance on residents to fulfill institutional service obligations. Programs must ensure that residents are provided appropriate back-up support when patient care responsibilities are especially difficult or prolonged.

If an institution intends to close or reduce the size of a residency program, it must inform the residents as soon as possible. In the event of closure or reduction, the institution must make every effort to allow residents already in the program to complete their education or help the residents enroll in another ACGME-accredited program.

The institution must not require a resident to sign an agreement that would restrict where the resident can practice after completing the residency.

The institution must have a written policy explaining how it will handle physician impairment, including impairment related to substance abuse. The institution should provide residents with education on physician impairment, including substance abuse.

The institution must provide adequate and appropriate food services and sleeping quarters.

The institution must take measures to ensure residents' safety in all areas of the institution and in related clinical facilities.

The institution must provide support services including intravenous services, phlebotomy, laboratory services, and messenger and transporter services in a manner appropriate to and consistent with educational objectives and patient care.

The institution must provide an effective system for retrieving laboratory, medical records, and radiological information to provide for appropriate conduct of the educational programs and quality and timely patient care.

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