Resident Restructure: Attendings adjust to new work-hour rules

Perhaps just as noteworthy, though, are the new guidelines on resident supervision. In the 2003 duty hours mandate, supervision was defined as a residency program ensuring that “qualified faculty provide appropriate supervision of residents in patient care activities.” But in the rules taking effect in July, that definition is further honed. First-year residents now require either direct supervision or what is called “direct supervision immediately available,” meaning that “a supervising physician is physically within the confines of the site of patient care.” In addition, senior residents are now expected to take supervisory positions over junior residents.

Other highlights of the new rules:

• Intermediate level residents are required to have at least eight hours between scheduled duty periods, though 10 hours are recommended.
• Moonlighting is now forbidden for first-year residents.
• Two rules that have not changed: Residents must still be scheduled for a minimum of one duty-free day every week, averaged over four weeks, and duty hours are capped at 80 hours, including in-house call activities and moonlighting. Exceptions, which can add a maximum of 10 percent, or eight hours, must be based on “sound educational rationale.”