Resident wellbeing is a joint commitment between the program creating schedules and a learning environment that is supportive and conducive to wellbeing, and residents engaging in self-care and healthy social activities.
Time to rest
Residency is busy, and trainees need time off work to rest, find work-life balance, and take care of their personal lives. Our residents are scheduled approximately 80 days off per year in addition to 28 days (4 weeks) of vacation. This means residents have more than 6 days off per 4 weeks of work (not counting vacation days), even on almost all the busiest inpatient rotations.
These days off are a mix of weekends and weekdays to allow scheduling personal appointments. Days off are known well in advance. At the request of our residents, we prioritize golden weekends rather than single days off throughout the year.
Census caps
Our busiest inpatient services at UCSF Medical Center and Zuckerberg San Francisco General have census caps, which set a maximum number of patients the resident team can care for. Neurology patients over the cap are cared for by attendings and advanced practice providers. This approach ensures that residents can complete each day’s work without exceeding duty hour limits, that they have time to interact with their patients, and that they have time to learn from each case.
No 24-hour in-house call
Our program has fully eliminated in-house, 24-hour call. Instead, nights are covered 365 days a year by an in-house night float system that begins in the second half of the R2 year. At ZSFG, night float blocks consist of 4-5 consecutive night shifts within a 14-day rotation combined with outpatient clinics where there is 1 post-call day and 3 days off to allow for adequate rest. At UCSF Medical Center, we use a novel sleep-optimized night float system consisting of 1 day off, 2-3 evening shifts, 2-3 night shifts, and then a post call day followed by 3 days off for rest and circadian rhythm recovery. The model employs industry best practices of forward-shifting the circadian rhythm (day to evening to night), limiting the maximum number of consecutive night shifts, and allowing ample time for recovery.
The current distribution of night float shifts is:
R2: 4 blocks in the second half of the year
R3: 5-6 blocks
R4: 5-6 blocks
Nights at the VA are covered by a home call system, shared between inpatient and outpatient rotators. No resident takes more than 2 nights per week, and residents are given either a half-day or full day off after home call to allow adequate rest. The VA National Telestroke Program provides acute stroke coverage overnight and on weekends at the San Francisco VA.”
Separation of inpatient and outpatient work
To enhance trainee well-being and improve patient care, our program designs resident schedules to separate inpatient and outpatient responsibilities. Because of our clinic week block structure, residents on inpatient rotations do not have any outpatient responsibilities (including inbasket management), with rare exceptions. This allows residents to focus on their inpatient services and keeps inpatient teams together. In addition, it allows residents on clinic week blocks to fully focus on outpatient clinics and inbasket management.
Going a step further than the ACGME
The ACGME requires that no resident works more than 80 hours per week, on average over 4 weeks, and has at least 1 day off per week, when averaged over 4 weeks. UCSF takes these rules a step further and creates schedules to ensure no resident ever works more than 80 hours in any single week, and always has at least 1 day off every 7-day Sunday-Saturday stretch of time.
Wellness Wednesdays
Residents are allowed to miss Wednesday afternoon teaching 4 times per year to arrange personal appointments.
Social activities
Our wellness and social chief residents are given a budget to schedule activities throughout the year. These include game nights, picnics in Golden Gate Park, happy hours, and hikes around the Bay Area. Our department also has access to the UCSF Health Suite at Oracle Park several times a year (residents enjoying a Giants game in the luxury suite pictured above).
Wellness weekend
Each Spring, the department sponsors a Wellness Weekend where the majority of residents are freed from clinical duties to spend a weekend together. The Wellness Weekend is scheduled far enough in advance so that schedules can be arranged to ensure residents who stayed behind one year to cover inpatient services are guaranteed to be able to attend the following year.