Pediatric Resident Physician Fatigue Policy


  1. In accordance with the ACGME Common Program Requirements, the program must:
    • Educate all faculty members and residents to recognize the signs of fatigue and sleep deprivation.
    • Educate all faculty members and residents in alertness management and fatigue mitigation processes.
    • Encourage residents to use fatigue mitigation processes to manage the potential negative effects of fatigue on patient care and learning.
  2. Each program must ensure continuity of patient care in the event that a resident may be unable to perform their patient care responsibilities due to excessive fatigue.
  3. The program, in partnership with its Sponsoring Institution, must ensure adequate sleep facilities and/or safe transportation options for residents who may be too fatigued to safely return home.


  1. Annually, Program Directors (or designee) will present a PowerPoint lecture from the American Academy of Sleep Medicine (or similar lecture) to all residents and hospital-based faculty. This lecture will include recognizing the signs of fatigue and sleep deprivation, strategies to manage fatigue when possible, and how to transfer clinical responsibilities.
  2. The resident must monitor oneself for the signs of fatigue that usually occur after prolonged periods of sleeplessness such as:
    1. Sluggish thought patterns, inability to concentrate.
    2. Inability to maintain wakeful state in the absence of external stimulation.
    3. Irritability, sudden anger, intolerance.
    4. Nausea or stomach cramps unassociated with physical illness.
    5. Tremors, particularly intention tremors while performing delicate procedures.
  3. The resident must stop and acquire rest when fatigued.
    1. If a resident is sufficiently fatigued to potentially impair his/her ability to perform, the resident must:
          Transfer clinical responsibilities to another resident or to an attending and contact the Pediatric Chief Residents.
    2. If the resident cannot find another qualified person to assume these responsibilities, the supervising faculty or residency program leadership (PD, APD, Chief Residents) will make arrangements to transfer the responsibilities.
  4. Supervising faculty or the residency program leadership will assist with the transfer of clinical responsibilities when a resident has been identified, either by staff, other residents, or the resident him/herself, as unable to perform and all attempts to transfer responsibilities to other residents have failed.
  5. If a resident or his/her supervising resident or attending feels that the resident is too fatigued to drive home safely after duty hours are completed, the resident has the following options:
    1. Sleep in an available call room until able to drive safely.
    2. Alternatively, the resident can contact pediatric Medical Education (Chief Residents, PD, APD, or Program Coordinator) and a taxi or Uber ride home will be arranged.
  6. All efforts must be made to implement and utilize these policies without fear of negative consequences for the resident who is unable to provide the clinical work.