| name | acgme-compliance |
| description | ACGME regulatory compliance expertise for medical residency scheduling. Use when validating schedules, checking work hour limits, supervision ratios, or answering compliance questions. Integrates with MCP validation tools. |
ACGME Compliance Skill
Expert knowledge of ACGME (Accreditation Council for Graduate Medical Education) requirements for residency program scheduling.
When This Skill Activates
- Validating schedule compliance
- Checking resident work hours
- Verifying supervision ratios
- Answering ACGME-related questions
- Before finalizing any schedule changes
- When coverage gaps are detected
Core ACGME Rules
1. 80-Hour Rule (Duty Hours)
Requirement: Maximum 80 hours per week, averaged over 4-week period
Weekly Hours ≤ 80 (averaged over rolling 4 weeks)
| Calculation | Formula |
|---|---|
| 4-Week Average | (Week1 + Week2 + Week3 + Week4) / 4 |
| Warning Threshold | > 75 hours/week |
| Violation | > 80 hours/week average |
Common Violations:
- Holiday coverage stacking
- Call schedule compression
- Inadequate post-call relief
2. 1-in-7 Rule (Days Off)
Requirement: One 24-hour period free from duty every 7 days
Must have ≥ 1 day completely off per 7-day period
| Status | Definition |
|---|---|
| Compliant | 24+ continuous hours off in 7-day window |
| At Risk | 6 consecutive duty days |
| Violation | 7+ consecutive duty days |
Note: Averaged over 4 weeks for some programs
3. Supervision Ratios
Requirement: Adequate faculty oversight based on training level
| Training Level | Max Residents per Faculty |
|---|---|
| PGY-1 (Intern) | 2:1 |
| PGY-2 | 4:1 |
| PGY-3+ | 4:1 |
Critical Areas Requiring Direct Supervision:
- Emergency procedures
- High-risk patient care
- Night float transitions
4. Duty Period Limits
| Scenario | Maximum Duration |
|---|---|
| Standard shift | 24 hours |
| With strategic napping | 28 hours (rare exception) |
| Minimum time off between shifts | 8 hours |
| Extended (in-house call) | 24 + 4 hours transition |
5. Night Float Requirements
- Maximum 6 consecutive nights
- Adequate handoff time
- No other clinical duties during night float block
MCP Tool Integration
Primary Validation Tool
Tool: validate_acgme_compliance
Purpose: Full compliance check against all rules
Returns: violations[], warnings[], compliant_areas[]
Supporting Tools
| Tool | Use Case |
|---|---|
get_schedule |
Retrieve schedule data for analysis |
check_utilization_threshold_tool |
Verify 80% utilization limit |
run_contingency_analysis_resilience_tool |
Check N-1 coverage |
Validation Workflow
Step 1: Gather Data
# Use MCP tool to get current schedule
mcp call validate_acgme_compliance --schedule_id=current
Step 2: Analyze Results
Check each rule category:
- 80-hour weekly average
- 1-in-7 days off
- Supervision ratios by rotation
- Duty period lengths
- Night float compliance
Step 3: Prioritize Issues
| Severity | Response |
|---|---|
| Violation | Immediate correction required |
| Warning | Schedule adjustment within 48 hours |
| At Risk | Monitor closely, plan mitigation |
Step 4: Recommend Fixes
Always suggest specific, actionable corrections:
- Who needs relief
- Which dates are affected
- Available swap candidates
- Impact on other metrics
Escalation Triggers
Escalate to Program Director when:
- Multiple simultaneous violations
- Systemic pattern (same issue recurring)
- Fix requires policy exception
- Involves moonlighting hours
- Resident health/safety concern
Common Scenarios
Scenario: Post-Call Scheduling
Problem: Resident scheduled for clinic after 24-hour call Rule: Must have 8+ hours off after extended duty Fix: Remove clinic assignment, ensure coverage
Scenario: Holiday Coverage
Problem: Same residents covering multiple holidays Rule: Fair distribution, 80-hour limit still applies Fix: Rotate holiday assignments, check cumulative hours
Scenario: Supervision Gap
Problem: Night shift with insufficient faculty Rule: PGY-1s need 2:1 supervision Fix: Add faculty coverage or redistribute residents
Reporting Format
When reporting compliance status:
## ACGME Compliance Summary
**Overall Status:** [COMPLIANT / WARNING / VIOLATION]
### Violations (Immediate Action Required)
- [List specific violations with affected people/dates]
### Warnings (Action Within 48h)
- [List warnings approaching thresholds]
### Recommendations
1. [Specific actionable fix]
2. [Specific actionable fix]
### Affected Personnel
- [List names and specific issues]
References
- See
thresholds.mdfor configurable warning levels - See
exceptions.mdfor documented exception procedures - ACGME Common Program Requirements: https://www.acgme.org/