Washington University Graduate Medical Education (GME) Consortium
Duty Hour Policy
The Clinical Neurophyiology program will operate within the guidelines for duty hours for house officers prescribed by the ACGME. Duty hours will never exceed 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities related to the training program, and hours authorized by the program director for outside employment (moonlighting). One 24 hour span of time in seven days (averaged over four weeks) free from all educational and clinical responsibilities must be provided to all house staff. Six hours post call can be used for transfer of patient care, maintenance of care of patients previously treated as a house staff member, outpatient community clinics and didactic activities or other activities specifically outlined in the RRC Program Requirements. A 10 hour period for rest and personal time should be provided between all duty periods and after in-house call. The complete duty hour specifications may be found on the GME website. The program director should be notified immediately if there is any concern that these guideline may be violated.
The Clinical Neurophysiology Fellowship is a full-time operation that requires great deal of time and effort in the clinical neurophysioloyg laboratories, wards and clinics, as well as for necessary independent reading and study. To maintain physical and mental health, it is important that each fellow have adequate free time for family, recreation, and rest. However, it is recognized that, in some cases, financial concerns resulting from the high costs of medical education or heavy family responsibilities may make it necessary to seek additional income. If this becomes necessary, prior authorization in writing must be obtained from both the director of the area of primary concentration and the Program Director. Written documentation of authorization using this form is required in the resident’s permanent file. Unauthorized moonlighting will be considered a serious infraction that could result in termination. Any moonlighting must fit within the limits of ACGME dictated duty hours including all residency responsibilities and the moonlighting time. The complete duty hour specifications may be found on the GME website.
Supervisory Lines of Responsibility
Responsibility for each patient’s care and the interpretation of Clinical Neurophysiology studies ultimately resides with the faculty Attending Physician. Clinical Neurophysiology residents assist with inpatient and outpatient care and assist in the interpretation of Clinical Neurophysiology studies as assigned by the attending physician. All patient management decisions must be approved by the attending physician. Similarly, the final interpretation of all studies must be approved by the attending physician. When deemed appropriate by the attending physician, CN-residents may assist in the teaching of rotating residents and students about study interpretation or patient management, provide preliminary interpretations of studies to treating physicians, provide guidance for management of Clinical Neurophysiology patients to the responsible housestaff and provide night and weekend coverage in accordance with ACGME duty hour guidelines. Study interpretation should be confirmed with the attending physician as soon as is practical. Any change in interpretation must be immediately communicated to the treating physicians. Guidance for patient management should be based on a plan previously established with the attending physician and/or confirmed with the attending physician as soon as is practical. Again, any change in plan must be immediately communicated to the housestaff. Activity while on night or weekend coverage should be reviewed with the attending physician as soon as is practical and any changes communicated to the patients or housestaff as appropriate. If the CN-resident is unsure of the appropriate test interpretation or patient treatment, the CN-resident is to immediately contact the attending physician for guidance.
Applicants first apply for a training position in their area of primary interest. For example an applicant with a primary interest in EMG would first apply for a training position with the director of the EMG laboratory. This application process includes submission of a curriculum vitae and three letters of recommendation. Applicants are then interviewed. Once accepted to the primary training program, the director of that program forwards the applicant information to the director of the Clinical Neurophysiology program who then evaluates the applicant for a position in the Clinical Neurophysiology Program. The director of the Clinical Neurophysiology program makes the final decisions about who is accepted into the program.