Programs must educate faculty and House Officers about alertness management and fatigue mitigation strategies via online modules and at departmental conferences. Pocket cards distributed to all House Officers contain the following alertness management and fatigue mitigation strategies:
1. Warning Signs

1. 1. Falling asleep at conference/rounds
   2. Restless and/or irritable with staff, colleagues, family
   3. Rechecking work constantly
   4. Difficulty focusing on care of the patient
   5. Feeling like you just don't care
   6. Driving while drowsy

2. Sleep Strategies for House Officers
a. Pre-call Residents

1. Don't start call with a sleep deficit; get 7-9 hours of sleep
2. Avoid heavy meals and/or exercise within 3 hours of sleep
3. Avoid stimulants to keep you up
4. Avoid ethanol alcohol to help you sleep

b. On Call Residents

1. Reach out to your Program Director, Chief Resident or Faculty if you're too sleepy to work
2. Nap whenever you can (> 30 min or < 2 hours)
3. Best circadian window: 2PM-5PM & 2AM- 5AM 
4. Avoid heavy meals
5. Strategic consumption of coffee (lasts 3-7 hours)
6. Know your own alertness/sleep pattern

c. Post Call Residents

1. Lowest Alertness 6AM –11AM after being up all night 
2. Full recovery from sleep deficit takes 2 nights
3. Take a 20-minute nap or drink a cup coffee 30 minutes before driving

Programs will employ backup call schedules as needed in the event a House Officer cannot complete an assigned clinical work period.

How Monitored:

The Sponsoring Institution and Program monitor successful completion of all AMA online modules, especially those regarding fatigue mitigation. House Officers are encouraged to discuss any issues related to fatigue and alertness with supervisory House Officers, Chief Residents, and the program administration. Supervisory House Officers will monitor lower-level House Officers during any in-house call periods for signs of fatigue. Adequate facilities for sleep during day and night periods are available at all rotation sights and House Officers are required to notify Chief Residents and program administration if those facilities are not available or not properly maintained. Supervisory House Officers and faculty will monitor lower-level House Officers at all transition periods for signs of fatigue. The institution will monitor clinical and educational work hours violations in New Innovations, the Annual Resident Survey (administered by the institution to all House Officers and as part of the annual review of programs) and the special review process to ensure compliance.