Duty hours are defined as all clinical and academic activities related to the program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

Residents must be provided with one day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods.

At-home call (pager call) is defined as call taken from outside the assigned institution.

• The frequency of at-home call is not subject to the every-third-night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with one day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.
• When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.

The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. Residents should report time spent at hospital after 2:00 AM to the Program Director or Program Coordinator the next morning and will most likely be released at noon to avoid fatigue related errors.

Weekend Call Duties

The weekend on-call residents have the same responsibilities as weekday call. Additionally, any patient scheduled for admission or work-up on the weekend is the resident's responsibility. If an operative permit is required, it will be explained to the patient by the surgical team who will come in to the hospital to examine the patient and answer the patient's questions. Any questions about weekend patients should be directed to the senior resident on call or the appropriate service.

The second call physician (a senior resident) will be available to the first call resident for consultation. In addition, he or she will decide, after clearing it with the senior staff member on call, when and if emergency operations should be done. No surgery is to be performed without approval of the senior faculty. Intraocular trauma or orbit cases may only be performed in the presence of a senior faculty member. The senior resident must be available by telephone at all times. The senior resident is required to come in to see any patient on whom the "First Call" resident requests consultation.

Finally, there are four "Senior Staff Call" lists. 1) The senior staff member on general call will be consulted by the third-year resident and will be contacted before any patient is admitted to the hospital or before an operation is planned. 2) The senior staff retina call list is made up of members of the Vitreoretinal Service, who will assist in handling posterior segment trauma and retinal detachments. 3) The Oculoplastic Service covers the plastic call and assists in any problems involving trauma to the lids, adnexae, and orbit. 4) The Neuro-ophthalmology on call staff. The senior staff members also have pagers.

No operation may be performed without the consent and assistance of the senior staff member.