Work Environment and Duty Hours
The Department of Neurological Surgery provides a work environment that allows for a positive and productive educational experience for residents. Faculty provides appropriate supervision with progressive responsibility based on the skill level of each resident.
The faculty of the Department of Neurological Surgery believes strongly that the ACGME work hour guidelines are important for the residents education and well-being. We specifically did not request an extension of the work week to 88 hours as many of our peer programs in Neurosurgery have done. This was intentional and our faculty members all feel strongly that it is our responsibility to train well adjusted, well rested, competent Neurosurgeons. No faculty member at any of the participating institutions may encourage them to work beyond these hours. In addition, it is mandatory that if a resident or faculty member feels that a resident is fatigued, that resident must go home immediately and stay at home for a period of time necessary to remedy the fatigue. It is also expected that residents will spend their time on duties which enhance their education.
Each resident is empowered to be responsible for his/her work hours each week and for each four week period. It is their responsibility to maintain an accurate account of the hours spent at the hospital and to modify their schedule, if necessary, to comply with these guidelines. Peer residents, faculty, and the Program Director are available every day to provide guidance and assistance if a resident is having difficulty complying with all Duty Hours Rules. The resident logs are reviewed each four weeks and a quarterly report submitted to the GME office.
Monitoring of Duty Hours
Residents are responsible for monitoring and documenting their own hours every day into New Innovations a web-based program. By recording in this manner, the resident is also attesting to the accuracy of the data. Specifically, duty hours are monitored closely, and a report sent to the GME office, to be certain that:
- All residents are on duty no more than 80 hours per week, averaged over four weeks
- All residents have at least one 24-hour period completely off from all duties every 7 days, averaged over four weeks
- Residents do not have any periods of continuous on-site duty (including in-house call) exceeding 24 consecutive hours and must have at least 14 hours free of duty after 24 hours of in-house duty. Up to four additional hours can be used for activities related to patient safety and care of current patient, but no new patient care responsibilities can be assigned.
- Residents should have 8 hours free of duty between scheduled duty periods.
- Residents do not have in-house call more often than every third night, averaged over four weeks.
- Residents do not take at-home call on their one free day per week.
Resident Overnight On-Call Procedures
The PGY-1 residents do not take overnight call. The PGY-2, 3, and 4 residents take overnight call on average once in every 6 days and must go home after 24 hours. The PGY-5, 6 and 7 residents take home call as back-up to the more junior residents on average once in every 6 days. Rounds are made with the on call residents twice every day, once in the morning at about 6AM and once in the evening at about 6PM. Neuroimaging studies are reviewed, patient care issues are addressed, teaching opportunities are addressed, and an appropriate hand-off is performed. Since these changes to the call schedule have been instituted, feedback from the residents has been enormously positive. Additionally, feedback from the nursing staff in the ICU and on the wards has also been exceptionally positive as our residents are responsive, available, and attentive.
Moonlighting is prohibited by Neurosurgical residents in Vanderbilts Department of Neurological Surgery. In very rare and special cases, when a resident is not on the clinical service (e.g. basic research rotation), a possible exception could be made if both the Chairperson and the Program Director agree it is in the best interest of the resident and the program.