Extracted from
external_docs/acgme-common-program-requirements-residency-2025.pdf
(Section 6: The Learning and Working Environment, effective September
3, 2025).
80-Hour Weekly Max (6.20)
80 hours/week averaged over 4 weeks, including
all in-house clinical/educational activities, clinical work from home,
and moonlighting (Core)
Rest Between Shifts (6.21)
8 hours off between scheduled clinical work and
education periods (Detail — “should”)
14 hours off mandatory after 24 hours of in-house
call (Core)
Day Off (6.21.b)
1 day in 7 free of all clinical work and
education, averaged over 4 weeks (Core)
At-home call cannot be assigned on these free
days
A “day off” is defined as one continuous 24-hour period free from
all administrative, clinical, and educational activities
Maximum Continuous Duty
(6.22)
24 hours max of continuous scheduled clinical
assignments (Core)
+4 hours allowed only for transitions of care /
education — no new patient care responsibilities (Core)
In-House Night Float (6.26)
Must comply with 80-hour and 1-day-in-7 rules (Core)
Max consecutive weeks and months/year left to specialty Review
Committees
In-House Call Frequency
(6.27)
No more than every 3rd night (Q3), averaged over
4 weeks (Core)
At-Home Call (6.28)
Patient care time counts toward the 80-hour limit (Core)
Not subject to the every-third-night rule
Must satisfy the 1-day-in-7 requirement
Must not be so frequent as to preclude rest or reasonable personal
time (Core)
Counted activities: phone calls, documentation, EHR notes
Not counted: reading about next day’s case, studying,
research
Moonlighting (6.25)
Counts toward 80-hour limit (Core)
PGY-1 residents cannot moonlight (Core)
Exceptions (6.24)
Review Committees may grant up to 88 hours/week
for specific rotations with sound educational rationale
DIO/GMEC approval required before request goes to Review
Committee
Specialty-Specific
Variations (from Review Committees, not Common Requirements)
Emergency Medicine
Maximum 12 hours continuous duty in the ED
Maximum 60 scheduled clinical hours/week in ED
Minimum rest between ED shifts = shift length (12h shift → 12h
rest)
1 day in 7 cannot be averaged — must occur each week
88-hour exceptions categorically denied
Internal Medicine
Call frequency (Q3) cannot be averaged — strict every-third-night
maximum
Surgery / Surgical
Subspecialties
May have program-specific exceptions for complex cases
Neurological Surgery is the only specialty routinely granted
88-hour exceptions