Medical Student Duty Hours

VP&S Work Hours Policy 

Overview/Rationale 

VP&S (Vagelos College of Physicians & Surgeons) is responsible for monitoring the amount of time medical students spend in required educational activities across the curriculum. Faculty must provide curriculum that supports student learning through planned educational activities, fosters self-directed learning, and protects student personal health and well-being. Faculty need clear guidelines for determining a schedule of educational activities based on data, student input, and sound pedagogical principles.  

This policy outlines expectations for student workload in the pre-clerkship and clinical phases of the curriculum, including expectations for time spent on scheduled and unscheduled required educational activities.  

Accreditation Standards 

• LCME Accreditation Standard: 8.8 Monitoring Student Time 
• LCME Accreditation Standard 6.3: Self-Directed and Life-long Learning 

Stakeholders 

• Medical students and Faculty 
• The clinical phase policy and procedures applies to medical students both at CUIMC (Columbia University Irving Medical Center) and its affiliate sites. 

Policy 

Fundamentals Phase

1. The total student workload in the fundamentals phase curriculum should not exceed on average 60 hours per week. 
2. The overall workload per week is calculated based on the total hours of scheduled in-class activities and out-of-class required activities. 
3. In-class scheduled activities include lectures, large group sessions, small group sessions, review sessions, labs, clinical experiences, and assessments. They do not include optional office hours.  
4. Out-of-class required activities include assigned readings, write-ups and other written assignments, online modules, and weekly synthesis/assessment questions. These out-of-class required activities do not include time spent on regular study or review of material. 
5. In the fundamentals phase curriculum, students are to have two afternoons free of scheduled required educational activities per week so that they may spend time on self-directed learning. Given that some courses teach sections of the class on different afternoons, there will not be free periods for the class en bloc. 
6. Students in good academic standing may take additional courses outside of the required curriculum or participate in enrichment experiences. These hours do not count towards weekly workload limits. Students must receive approval from the Associate Dean for Student Affairs, Support and Services to register for university courses outside of the required VP&S curriculum.  

Clinical Phase (MCY and D&I Phases):

Clinical duty hours are defined as all clinical and academic activities related to the clerkship. This is defined as patient care (including patient-related administrative duties such as patient notes) and scheduled activities (such as conferences). It does not include time spent studying for exams, reading, preparing for oral presentations, or commute time. 

• Medical student duty hours must be limited to 80 hours per week averaged over a four-week period. 
• Continuous (daily) on-site duty must not exceed 24 hours of continuous patient care duties. Up to an additional three hours of transition time used for transfer of patient care, rounds, and grand rounds is allowed. 
• Adequate time for rest and personal activities must include an eight-hour duty-free period and should include a 10-hour period between all daily duty periods. 
• Medical students must have at least 24 consecutive hours free from all clinical, academic, and administrative duties every 7 days, averaged over a four-week period.  

Limiting required duty hours does not imply that medical students must cease providing essential patient care services at arbitrary cutoff times. Priority must always be given to patient safety and well-being and to avoiding transferring patient care responsibilities to others at inappropriate times in the continuum of care (e.g., during an operative procedure, during a rapidly evolving clinical event). 

Procedures

Fundamentals Phase: 

1. Fundamentals phase course directors will receive this policy annually. Course directors, with assistance from Curricular Affairs staff, are responsible for monitoring their course workload including scheduled and unscheduled required activities. Course directors must be mindful of workload policies when developing required course activities. Course directors will post the estimated total time for completion of required out-of-class activities, including weekly synthesis and assessment questions.  Workload hours for each course will be reviewed annually at course CQI meetings. 
2. Data regarding the actual amount of time spent by students on out-of-class required educational activities will be gathered through post-assignment surveys. Additional data on student perceptions of workload for each course will be monitored through end of course evaluations, focus groups with students, and direct feedback from class curriculum representatives. Student perceptions on adequacy of unscheduled time for self-directed learning and overall workload in the fundamentals phase will be gathered through annual VP&S surveys. 
3. The fundamentals subcommittee and CEPC will review data on individual course workload, weekly student workload, and compliance with block schedules policy annually. The CEPC may mandate changes to individual course workload or across the fundamentals phase curriculum to comply with this workload policy. 
4. Requests for class scheduling outside of the block schedule will be made to the Senior Associate Dean for Curricular Affairs who may permit exceptions to the policy under compelling circumstances (e.g., schedule changes due to inclement weather, faculty illness and special curricular events such as visiting lecturers) and in consultation with the vice dean for education. 
5. This policy will be presented annually to students during M1 orientation.

Clinical Phase (MCY and D&I Phases):

1. The student duty hour guidelines will be communicated to students and supervising physicians (including residents, fellows and faculty) in writing and to students at each clerkship orientation. 
2. If a student is concerned about a violation of the work hours policy at a site, the student can report this on the end-of-clerkship evaluation form, and/or use this Learning Environment/Duty Hours Qualtrics online survey form to confidentially or not confidentially report work hours violations. 
3. All reports of work hour violations including concerns about on-call issues are immediately communicated to the relevant Clerkship Director and the Senior Associate Dean for Curricular Affairs, who will work together to address the violation. For non-anonymous work hour violations, the clerkship director will alter the student’s schedule to bring the student’s work hours into compliance, where possible. For issues identified after the clerkship, the clerkship director will gather information and propose a response plan for approval to the Senior Associate Dean for Curricular Affairs. 
4. The MCY/D&I subcommittee and CEPC will review summary work hour survey responses and violation reports at least annually with more regular urgent follow up occurring as needed. 

Policy History/ Approval Date:  

The policy on scheduling in the Fundamentals curriculum and clinical duty hours policy was taken from print-version student handbooks and online formats.  These documents were reformatted and codified into policy where specific procedures and edits were added.  The policy was reviewed and approved by the Committee on Educational Policy and Curriculum on April 19, 2024 and clarified on August 2, 2024.