Beall DP. The Requirements of Residency: Work Environment. JAMA. 1999;282(2):188. doi:10.1001/jama.282.2.188
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
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
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.