Are There Any Limits on Med Students' Clinical Work Hours?

Anne Vinsel, MS, MFA

Disclosures

August 12, 2009

Question

I've heard about rules that limit the number of hours residents can work, but I can't find any information about medical student work hours. What are the laws for us?

Response from Anne Vinsel, MS, MFA
Project Administrator, Graduate Medical Education, University of Utah Medical Center, Salt Lake City, Utah

You're quite right -- almost all of the attention has focused on resident work hours. And while there are regulations established by the Accreditation Council for Graduate Medical Education (ACGME) for resident work hours, there still are no federal laws governing their work schedules. (Only New York State has established actual work hour laws.)

The medical school accrediting agency (the Liaison Committee on Medical Education or LCME) has language in its accreditation standards for medical schools regarding medical student work hours during clinical rotations. These guidelines essentially instruct schools not to let medical students work longer hours than residents. The language reads:

In addition to monitoring the amount of classroom time and examination frequency, attention should be paid to the hours that medical students work during the clinical years and the educational value of their clinical activities. Student duty hours should be set taking into account the effects of fatigue and sleep deprivation on learning and patient care. In general, medical students should not be required to work longer hours than residents. [1]

Although all US medical schools are to be governed by this paragraph, some have even more explicit policies of their own, while others' Websites and publications just don't mention work hours. Many schools have policies that are similar to those for residents (eg, no more than 80 hours/week averaged over 4 weeks, shifts separated by 10 hours off, 1 day in 7 free averaged over 4 weeks or the length of the rotation). However, schools are free to set more severe limitations on medical student work hours if they choose, and some do, mostly for very intense rotations such as emergency medicine.

Of course, these are the rules, but any institution may follow them more or less closely. As usual, the devil is in the details.

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