The ACGME Common Program Requirements and COVID-19

27 March 2020

The ACGME recognizes and appreciates the heroic response of hospitals and physicians in the worsening COVID-19 pandemic in New York State. The Governor of New York is making every effort to respond to the crisis by reducing regulations, making state resources available, and assuring there is an adequate workforce to care for the surge in patients. He has suspended the New York State Law enforcing resident/fellow work hour rules in an attempt to increase the availability of physicians to care for these patients. The New York State work hour rules are less flexible than those described in ACGME’s Common Program Requirements.

The ACGME Common Program Requirements (Section VI.F.) remain in place nationally for accredited programs. These requirements are based on evidence, including multicenter educational trials over the past eight years, that demonstrates that violation of these requirements is associated with increased harm to patients and residents and fellows. During this pandemic, violation of the work hour requirements could lead to lapses in infection control procedures, resulting in residents and fellows who become infected with the COVID-19 (SARS COV2) virus. This could reduce the available workforce rather than expand it, diverting clinical resources to the care of the resident/fellow and away from patients.

The ACGME reaffirms the importance of these evidence-based requirements on resident/fellow work hour limitation in order to maintain a healthy workforce of residents and fellows and maintain their effectiveness in the care of patients. The ACGME requirements provide a flexible framework for residency and fellowship programs. The requirements cap the total number of clinical and educational hours for residents and fellows, averaged over four weeks, to:

  • a maximum of 80 hours per week, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting;
  • one day free from clinical experience or education in seven; and,
  • in-house call no more frequent than every third night.

The requirements also address additional safeguards to patient and resident/fellow safety by:

  • Requiring that residents and fellows have eight hours off between scheduled clinical work and education periods, and must have at least 14 hours free of clinical work and education after 24 hours of in-house call;
  • Optimizing the quality of transitions/hand-offs;
  • Ensuring residents and fellows can be relieved of responsibilities when needed;
  • Defining the need for direct oversight of first-year residents;
  • Making sure that patients and the entire health care team know who to contact; and, 
  • Eliminating moonlight for first-year residents, and ensuring if more senior residents or fellows do moonlight, it will not interfere with their patient care duties.