Medical student learning during the third year comes from many sources, which include, but are not limited to, clinical interactions with patients and the health care team, didactic sessions from lecturers and preceptors, and individual reading. Moreover, in addition to clinical activities and duties that medical students may perform, students have the responsibility of taking exams, creating presentations, and engaging in self-directed learning. Thus, students must have adequate time to integrate clinical knowledge through self-directed learning.
Time spent by medical students engaged in clinical activities on a weekly basis must not exceed ACGME specified weekly duty hour caps.
Third Year Students
1) When third year students are engaged in clinical work that involves call, students should be dismissed by midnight. In order for students to meet this 12 a.m. deadline, residents should not assign new patients to students after 10 p.m. These deadlines are intended to give students enough time to finish write ups, discuss patients with their resident, read about their patients, and leave remaining time for an adequate amount of sleep for the next day’s learning activities. These recommendations do not apply to:
- Students on shift assignments.
- Surgical rotations (including gynecologic surgery) in which overnight call and participation in urgent or emergent situations are of educational value. In these settings, students should be dismissed after morning duties are completed.
2) It is recommended that students have one day free of clinical responsibility per week, averaged over one month, in order to study. Clerkship directors should stipulate the rules for their individual clerkship in their orientation material.
- These days off may include any weekend days that are free of clinical activity, e.g. students on ambulatory rotations with weekends off will not receive additional week days free of clinical duties.
- Students are expected to attend all required rotation specific non clinical activities (including but not limited to didactics, small group sessions and preceptor groups) even if that formal educational experience falls on a student’s day free of clinical duties.
3) Specific daily work schedules will vary by clerkship, and are most appropriately determined by the clerkship director.
Fourth Year Students
The guidelines above do not apply to fourth year medical students. For fourth year students on sub-internships, ACGME duty hour guidelines are appropriate.