VI. The Learning and Working Environment

Residency education must occur in the context of a learning and working environment that emphasizes the following principles:

• Excellence in the safety and quality of care rendered to patients by residents today

• Excellence in the safety and quality of care rendered to patients by today’s residents in their future practice

• Excellence in professionalism through faculty modeling of:

  • the effacement of self-interest in a humanistic environment that supports the professional development of physicians

  • the joy of curiosity, problem-solving, intellectual rigor, and discovery

• Commitment to the well-being of the students, residents, faculty members, and all members of the health care team

  Background and Intent

  The revised requirements are intended to provide greater flexibility within an established framework, allowing programs and residents more discretion to structure clinical education in a way that best supports the above principles of professional development. With this increased flexibility comes the responsibility for programs and residents to adhere to the 80-hour maximum weekly limit (unless a rotation-specific exception is granted by a Review Committee), and to utilize flexibility in a manner that optimizes patient safety, resident education, and resident well-being. The requirements are intended to support the development of a sense of professionalism by encouraging residents to make decisions based on patient needs and their own well-being, without fear of jeopardizing their program’s accreditation status. In addition, the proposed requirements eliminate the burdensome documentation requirement for residents to justify clinical and educational work hour variations.

  Clinical and educational work hours represent only one part of the larger issue of conditions of the learning and working environment, and Section VI has now been expanded to include greater attention to patient safety and resident and faculty member well-being. The requirements are intended to support programs and residents as they strive for excellence, while also ensuring ethical, humanistic training. Ensuring that flexibility is used in an appropriate manner is a shared responsibility of the program and residents. With this flexibility comes a responsibility for residents and faculty members to recognize the need to hand off care of a patient to another provider when a resident is too fatigued to provide safe, high quality care and for programs to ensure that residents remain within the 80-hour maximum weekly limit.

Patient Safety, Quality Improvement, Supervision, and Accountability