On Call & Duty HoursPolicy for Clinical Clerks

Matthew Tenenbaum, CCDecember 12, 2012

Student Affairs Committee

Background

• Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours (CAIR, April 2012)– Recommends limiting continuous duty hours

to 16 hours or less– Follows 2011 Québec ruling that

24-hour duty periods violate theCanadian Charter of Rights andFreedoms

Background

• Evidence to suggest inferior patient care• Evidence to suggest increased safety risks

– Higher rates of injury (e.g. needle stick)– Higher risk of post-call MVC (2.3x)

• Evidence to suggest impaired learning– Reduced test performance– Being awake >16hrs equivalent to BAC of

0.05-0.10 (legal limit 0.08)

Current Duty Hours Policy (2006)

Each clerkship rotation has its own expectations about students being on-call. On-call schedules are at the discretion of each CTU. Some rotations expect that on-call clerks remain in the hospital through the night. Night call will not exceed, on average across the entire rotation, one night in four. The educational opportunities during the on-call experiences in these rotations have been found by students to be invaluable. In some cases, if an on-call clerk has had to be awake most of the night, arrangements have been made for that clerk to leave the service by approximately noon the next day, however clerks may be expected to remain the entire day.

Current Duty Hours Policy (2006)

This arrangement is at the discretion of the CTU Director. Any departure from these principles must be reported to the CTU Director, or if necessary to the Planner of that clerkship rotation or to the overall Clerkship Director.

Please note that students are required to take call, if scheduled, on hospital and university statutory holidays. Clinical Clerks may be on call during the last weekend of the rotation, but are entitled to be relieved at 0800 on Sunday for the remainder of the day.

There will be no call for the clerk after midnight the night prior to a scheduled evaluation exercise.

Comparators

• Five other Ontario medical schools– University of Ottawa– Queen’s University– University of Toronto– Western University (UWO)– Northern Ontario School of Medicine

• PAIRO Guidelines

Important Domains

• Maximum call frequency– Nights– Weekends

• Protected time on post-call days– Time off duty– Academic responsibilities

• Protected time prior to exams

Maximum Call Frequency (Nights)

1 in 3 1 in 4

Maximum Call Frequency (Weekends)

1 in 2 (2 in 4) 1 in 3 Not specified

Time Off Duty

10:00 12:00

24 hrs + 2 (handover) “After handover”

Time Off Duty

10:00 12:00

24 hrs + 2 (handover) “After handover”

“May be expected to remain the entire day.”

Academic Relief• Not expected to commute while post-call

• Not expected to attend teaching while post-call

• Relieved at midnight prior to teaching

• (Not specified)

• Not expected to attend teaching past 09:00 post-call

• Not expected to attend teaching past 12:00 post-call

Protected Time for Exams• No duties past 17:00 two nights prior to the exam

• No call past 18:00 on the night prior to the exam

• No call on the night prior to the exam

• No call past 24:00 on the night prior to the exam

• (Not specified)

• (Not specified)

Conclusions

• McMaster University…– Is within normal limits with regard to maximum

call frequency– Is the only Ontario school that permits clerks

to remain on duty for a full post-call day– Is the only Ontario school that does not

provide academic relief post-call– Requires that students remain on duty the

latest, on the night prior to an exam

Proposals

• Maintain maximum call frequency at 1 night in 4– Consider specifying maximum for weekends

• Specify that clerks must be relieved of all clinical and academic duties by noon, when post-call

• Relieve clerks of clinical duties earlier in the evening (e.g. 20:00) prior to an exam

Thank You

Matthew Tenenbaummatthew.tenenbaum@medportal.ca