This document provides foundational domain knowledge for implementing medical resident call scheduling software. It covers terminology, concepts, rules, workflows, and relationships essential for understanding the problem space.
Resident A physician in training who has completed medical school and is completing supervised clinical training in a specialty. Residents are both learners and workers—they provide patient care while developing expertise under supervision.
PGY Level (Post-Graduate Year) The year of residency training, counted from medical school graduation: - PGY-1 (Intern): First year resident. Subject to additional restrictions in some contexts. - PGY-2, PGY-3, etc.: Second year, third year, and so on. - Different specialties have different training lengths (3 years for Internal Medicine, 5+ for Surgery).
Fellow A physician who has completed residency and is doing additional subspecialty training (e.g., Cardiology fellowship after Internal Medicine residency). Often scheduled similarly to residents.
Attending (Attending Physician) A fully trained physician who supervises residents and fellows. Not typically scheduled in resident scheduling systems, though they may appear as supervisors.
Chief Resident A senior resident (often in final year or additional year) with administrative responsibilities including schedule creation, conflict resolution, and peer leadership. Key user of scheduling software.
Program Coordinator Administrative staff member who manages residency program operations, including schedule maintenance, compliance tracking, and communication. Primary power user of scheduling software.
Program Director (PD) Faculty physician responsible for the residency program. Approves schedules, monitors compliance, handles escalations. Reviews reports and dashboards rather than building schedules.
Academic Year The training year, typically July 1 through June 30. All scheduling, tracking, and reporting aligns to this cycle. Residents advance PGY levels on July 1.
Block A fixed period during which residents are assigned to specific rotations. Common block lengths: - 4-week blocks (13 blocks/year) — most common - 2-week blocks (26 blocks/year) - 1-month blocks (12 blocks/year, variable length) - 6-week blocks (less common)
Programs may use different block lengths for different purposes or PGY levels.
Rotation A clinical assignment where a resident works in a specific setting, service, or subspecialty for one or more blocks. Examples: - ICU (Intensive Care Unit) - Night Float - Ambulatory/Clinic - Emergency Department - Elective - Research - Vacation
Rotations define where and what type of work; the schedule defines when and who.
Service A clinical team or unit that requires
staffing. A rotation places a resident on a service. Examples: -
“Medicine Team A” - “Cardiology Consults”
- “MICU” (Medical ICU)
Call Extended duty periods, traditionally overnight, where residents remain available (either in-hospital or from home) to handle patient care needs. “Taking call” means being the responsible resident for a service during off-hours.
In-House Call (On-Call) Call duty where the resident must remain physically in the hospital. Typically overnight (e.g., 5 PM to 7 AM) but can be 24-hour periods. Counts fully toward duty hour limits.
Home Call (At-Home Call) Call duty where the resident is available by phone/pager from home and comes to the hospital only if needed. Only time spent on actual patient care activities counts toward the 80-hour limit. Cannot be assigned on required days off.
Shift A defined work period with specific start and end times. More structured than traditional call. Common in Emergency Medicine and hospitalist models. Examples: - Day shift: 7 AM – 3 PM - Evening shift: 3 PM – 11 PM - Night shift: 11 PM – 7 AM - 12-hour shift: 7 AM – 7 PM
Night Float A rotation structure where residents work only night shifts for a consecutive period (typically 1-2 weeks), then rotate off. Allows other residents to avoid overnight call during that period.
Long Call / Short Call Some programs distinguish between: - Long call: Full overnight call (e.g., 24 hours) - Short call: Partial call, often evening only (e.g., until midnight)
Jeopardy (Backup Call) A designated backup resident who can be called in if the scheduled resident is unable to work (illness, emergency, duty hour violation). Critical for schedule resilience.
Cross-Cover When a resident covers patients for another team or resident, typically during nights or weekends when primary teams are off.
Annual Rotation Schedule (Block Schedule, Master Schedule) The year-long assignment of residents to rotations by block. Shows which rotation each resident is on during each block of the year. Created before the academic year begins.
Example structure:
Block 1 Block 2 Block 3 Block 4 ...
Resident A ICU Wards Clinic Elective
Resident B Wards Elective ICU Night Float
Resident C Clinic ICU Wards VacationCall Schedule (On-Call Schedule) The specific assignment of residents to call duties within a block or month. More granular than the rotation schedule—shows who is on call each specific day/night.
Example structure:
October Call Schedule - Medicine Wards
Mon 10/1: Resident A (long call)
Tue 10/2: Resident B (long call)
Wed 10/3: Resident C (short call)
Thu 10/4: Resident A (long call)
...Shift Schedule For shift-based rotations (especially Emergency Medicine), the assignment of residents to specific shifts. May include multiple shifts per day requiring coverage.
Clinic Schedule Assignment of residents to outpatient clinic sessions, often running in parallel with other duties. Residents typically have a “continuity clinic” they attend weekly throughout the year regardless of rotation.
Day-Off Request (Time-Off Request) A resident’s request to not be scheduled on specific dates. May be for personal reasons, conferences, interviews, etc. Requests are typically submitted in advance and approved/denied by coordinators or chiefs.
Swap (Trade) An exchange of assignments between two residents. Both parties must agree, and the swap must not create duty hour violations for either resident. Types: - Direct swap: Resident A takes B’s shift, B takes A’s shift - One-way swap: Resident A takes B’s shift, B owes A a future shift
Open Shift A shift that needs coverage but has no assigned resident. May result from illness, approved time off, or scheduling gaps. Posted for residents to claim (voluntarily or via jeopardy).
Coverage When a resident works a shift not originally assigned to them, filling in for another resident or an open shift.
Duty Hours The total hours a resident spends on clinical and educational activities. Subject to strict limits (see ACGME Rules section). Includes: - All in-hospital clinical time - Clinical work done from home (EHR, phone calls) - Conferences and didactics - Moonlighting
Violation When a resident’s schedule or logged hours exceed ACGME limits. Violations must be tracked, reported, and addressed. Types include: - Weekly hour violations (>80 hours) - Continuous duty violations (>24+4 hours) - Rest period violations (<8 or <14 hours between shifts) - Day-off violations (<1 day in 7)
Tally A running count of assignments for fairness tracking. Common tallies: - Total call nights this block/year - Weekend calls - Holiday calls - Specific shift types
Moonlighting Paid clinical work outside of residency duties. Must be: - Approved by Program Director - Counted toward 80-hour weekly limit - Not permitted for PGY-1 residents
The Accreditation Council for Graduate Medical Education (ACGME) sets mandatory limits on resident work hours. These rules are non-negotiable—violations can result in loss of program accreditation.
| Rule | Limit | Averaging | Notes |
|---|---|---|---|
| Weekly hours | 80 hours maximum | 4-week average | Includes all duty + moonlighting |
| Continuous duty | 24 hours maximum | Per shift | +4 hours allowed for handoff/education only |
| Rest between shifts | 8 hours minimum | Per occurrence | “Should” provide 10 hours; 8 is minimum |
| Rest after 24h call | 14 hours minimum | Per occurrence | Mandatory, no exceptions |
| Day off | 1 day per 7 | 4-week average | 24 continuous hours free of all duties |
| Call frequency | No more than every 3rd night (Q3) | 4-week average | In-house call only |
| Night float consecutive | 6 nights maximum | Per stretch | Must have day off after 6 consecutive nights |
80-Hour Weekly Maximum - Calculated as a 4-week rolling total ≤ 320 hours - Includes: clinical work, conferences, moonlighting, clinical work from home - Excludes: reading/studying at home, research on personal time - Programs may request exception up to 88 hours (rarely granted)
24+4 Continuous Duty - Residents may be scheduled for up to 24 hours continuously - After 24 hours, may remain up to 4 additional hours ONLY for: - Patient care transitions (handoffs) - Educational activities - NO new patient care responsibilities after hour 24 - The +4 hours still count toward 80-hour weekly limit
Rest Periods - 8 hours minimum between all scheduled work periods (ACGME “must”) - 10 hours recommended between shifts (ACGME “should”) - 14 hours mandatory after 24-hour in-house call - Rest clock starts when resident physically leaves hospital
Day Off Requirements - One 24-hour period free from ALL duties (clinical, educational, administrative) - Averaged over 4 weeks = minimum 4 days off per 28-day period - At-home call cannot be assigned on required days off - Vacation days do NOT count toward day-off requirements
Call Frequency (Q3 Rule) - In-house call no more frequent than every third night - Averaged over 4 weeks - Example: Over 28 days, maximum ~9 call nights - Does NOT apply to at-home call
Emergency Medicine (stricter limits) - 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 - No special continuous duty rules beyond Common Requirements
Surgery / Surgical Subspecialties - May have program-specific exceptions for complex cases - Neurological Surgery only specialty routinely granted 88-hour exceptions
All averaged rules must be calculated by rotation, not as a continuous rolling average: - 4-week periods within a rotation - Monthly periods - Rotation length (if shorter than 4 weeks)
A 12-week rotation would be evaluated as three separate 4-week periods.
Counts toward 80-hour limit: - All in-hospital clinical duties - Time on in-house call - Time called into hospital from home call - Clinical work from home (EHR documentation, phone consultations) - Required conferences and didactics - Moonlighting (internal and external) - Administrative duties related to patient care
Does NOT count: - Reading/studying at home - Research done on personal time (not scheduled research rotation) - Travel time - Brief phone calls during at-home call (at resident discretion)
Resident scheduling is a constraint satisfaction problem with multiple competing objectives:
Hard Constraints (must satisfy): - ACGME duty hour rules - Minimum staffing requirements per shift/service - Resident eligibility (PGY level, rotation assignment) - Pre-approved time-off requests - Cannot be in two places simultaneously
Soft Constraints (optimize for): - Fair distribution of undesirable shifts (nights, weekends, holidays) - Resident preferences - Educational balance (exposure to variety) - Continuity of care - Circadian-friendly shift progressions
Call Equity Track and balance the number of call nights per resident. Typically tracked: - Per block/month - Per year - By type (weeknight vs. weekend vs. holiday)
Weekend Equity Weekend call is considered more burdensome. Track weekend call distribution separately.
Holiday Equity Major holidays (Thanksgiving, Christmas, New Year’s) tracked separately. Common approach: if you work Thanksgiving, you’re off Christmas.
Shift Type Balance For shift-based schedules, balance distribution of desirable (day) vs. undesirable (night/evening) shifts.
Q-Patterns (Call Frequency) - Q2: Every other night (very rare, usually violates rules) - Q3: Every third night (common maximum) - Q4: Every fourth night (common for larger programs) - Q5, Q6, etc.: Less frequent call
Night Float Model Instead of distributing night call across all residents: 1. Designate one or more residents to work nights for entire block 2. Remaining residents work days with no overnight call 3. Rotate night float assignment across residents over the year
24+4 Model (Traditional Call) - Resident works normal day, stays overnight, works next morning - Post-call afternoon off - Example: Arrive 6 AM Monday, leave by noon Tuesday
Shift-Based Model - Discrete shifts (8, 10, or 12 hours) - No 24-hour periods - Common in Emergency Medicine - Requires more transitions but avoids extended duty
Annual/Block Schedule Creation (months before academic year): 1. Define block dates for academic year 2. Set rotation requirements by PGY level 3. Collect resident preferences/constraints 4. Build rotation assignments ensuring requirements met 5. Review and adjust for conflicts 6. Publish rotation schedule
Call Schedule Creation (weeks before each block): 1. Identify which residents are eligible (based on rotation assignment) 2. Collect day-off requests 3. Set staffing requirements per day 4. Generate or manually build call assignments 5. Check ACGME compliance 6. Balance tallies for fairness 7. Review and adjust 8. Publish call schedule
Ongoing Schedule Management: 1. Process swap requests 2. Handle sick calls / emergencies (jeopardy activation) 3. Fill open shifts 4. Track duty hours 5. Address violations 6. Adjust for changing circumstances
Creating Annual Rotation Schedule: 1. Configure blocks for new academic year 2. Set up resident roster (new interns, graduating seniors) 3. Define rotation requirements 4. Build schedule (drag-drop or auto-generate) 5. Review for conflicts and completeness 6. Get PD approval 7. Publish to residents
Creating Monthly Call Schedule: 1. Select block/month and service 2. Review eligible residents (from rotation schedule) 3. Import approved time-off requests 4. Set daily staffing requirements 5. Generate schedule or build manually 6. Run compliance check 7. Review tally distribution 8. Adjust and finalize 9. Publish
Handling Day-to-Day Changes: 1. Receive swap request or sick call 2. Find coverage (check jeopardy, post open shift) 3. Validate change doesn’t create violations 4. Update schedule 5. Notify affected parties
Schedule Review: 1. Review draft schedule for fairness 2. Check that educational needs are met 3. Identify potential conflicts 4. Approve or suggest modifications
Handling Swaps: 1. Receive swap request from residents 2. Verify both parties agree 3. Check ACGME compliance for both 4. Approve or deny 5. Update schedule
Emergency Coverage: 1. Receive notification of sick resident 2. Check jeopardy resident availability 3. Activate jeopardy or find alternate coverage 4. Ensure compliant assignment 5. Update schedule and notify
Viewing Schedule: 1. Open schedule (web or mobile) 2. See personal assignments (today, this week, this month) 3. Sync to personal calendar 4. View who else is working (for coordination)
Requesting Time Off: 1. Submit request with dates and reason 2. Track request status 3. Receive approval/denial notification 4. See updated schedule if approved
Requesting Swap: 1. Find shift to trade 2. Identify willing trade partner 3. Submit swap request (both parties confirm) 4. Await approval 5. See updated schedule if approved
Claiming Open Shift: 1. View available open shifts 2. Check personal schedule for conflicts 3. Claim shift 4. Receive confirmation 5. See updated schedule
Logging Duty Hours (if system includes this): 1. Review pre-populated hours from schedule 2. Adjust for actual times (stayed late, left early) 3. Add at-home call time when doing patient care 4. Add moonlighting hours 5. Submit/confirm weekly hours
| Term | Definition |
|---|---|
| ACGME | Accreditation Council for Graduate Medical Education |
| Block | Fixed scheduling period (typically 2-4 weeks) |
| Call | Extended duty period, often overnight |
| Continuity Clinic | Recurring outpatient clinic assignment |
| Cross-cover | Covering another team’s patients |
| Duty Hours | Total work hours subject to ACGME limits |
| Fellow | Post-residency subspecialty trainee |
| GME | Graduate Medical Education |
| Home Call | On-call from home (not in hospital) |
| In-House Call | On-call while physically in hospital |
| Intern | PGY-1 resident (first year) |
| Jeopardy | Backup coverage system |
| Moonlighting | Paid work outside residency duties |
| Night Float | Rotation dedicated to night shifts |
| PGY | Post-Graduate Year (training level) |
| Q3, Q4, etc. | Call frequency (every 3rd night, 4th night, etc.) |
| Rotation | Clinical assignment for a block period |
| Service | Clinical team requiring coverage |
| Shift | Discrete work period with set times |
| Swap | Exchange of assignments between residents |
| Tally | Running count for fairness tracking |
| Violation | Exceeding ACGME duty hour limits |
Resident transitions mid-block - Senior graduates or new resident starts mid-year - Resident switches programs - Handle partial block assignments
Overlapping assignments - Resident on rotation A but taking call for rotation B - Clinic sessions during ward rotations - Research time during clinical rotations
Variable shift lengths - Same shift type with different durations - Extended shifts for specific circumstances - Partial shifts
Vacation during 4-week window - Vacation days excluded from day-off count - Hours calculations must exclude vacation periods
Rotation shorter than 4 weeks - Use rotation length as averaging period - Don’t extrapolate to 4 weeks
Moonlighting during light rotation - Still counts toward 80-hour limit - May push otherwise compliant schedule into violation
Called in from home call - Only hospital time counts toward hours - Commute time does not count - Does not restart rest clock
Working past scheduled time - Actual hours may exceed scheduled hours - System should track both scheduled and actual - Compliance based on actual hours worked
Overlapping requests - Two residents request same day off - Swap request conflicts with existing time-off request
Cascade effects - Approved request creates need for coverage - Coverage assignment causes violation for covering resident
Last-minute changes - Sick call with no jeopardy available - All eligible residents already at hour limits