III.E.8 Granting Clinical and Educational Hour Exceptions

If an ACGME Review Committee considers requests for exceptions, the GMEC will accept, review, and act on individual program requests to increase House Officer clinical and educational work hours up to a maximum of 88 hours per week when averaged over a four-week period.
Applications for such increases must be based on a sound educational rationale. Only programs in good standing with their Review Committee may apply for increases.
Process:

1. Programs must submit a written request as described below
2. After screening by the Graduate Medical Education Office to be sure the application is complete, it will be presented for consideration at the next regularly scheduled GMEC
3. GMEC will vote to approve or deny the request based on the merits of the application; the decision cannot be appealed
4. If approved, the DIO/Chair of GMEC will prepare a letter of endorsement to be included in the program's application to their RRC along with a copy of the Institutions Policies and Procedures for Granting Clinical and Educational Work Hour Exceptions
5. The Sponsoring Institution will reevaluate the continued necessity and appropriations of the increase and patient safety aspects of the increased hours at each annual program review

Application Format:
The program must supply sufficiently detailed information on each of the areas below for GMEC to make an informed decision:

1. Patient Safety: describe how the program will monitor, evaluate, and ensure patient safety with extended House Officer work hours.
2. Educational Rationale: provide a sound educational rationale in relation to the program's stated goals and objectives for the assignments, rotations, and levels of training for which the increase is requested; blanket exceptions for the entire educational program should be considered the exception, not the rule
3. Moonlighting Policy: include specific information regarding the program's moonlighting policies for the periods in question
4. Call Schedules: provide specific information regarding House Officer call schedules during the times specified for the exception and explain how they will be monitored
5. Faculty Monitoring: provide evidence of faculty development activities regarding the effects of House Officer fatigue and sleep deprivation