Maximum on-call frequency:
- The maximum on-call frequency in all clinical clerkship courses is one night in four averaged across the entire rotation duration.
- Clerks cannot be scheduled for two weekends (which includes Fridays) in a row within any block rotation or throughout the entirety of a longitudinal integrated clerkship.
- Clerks may be scheduled for call duty on the last Saturday of a block, including overnight call duty finishing on the Sunday morning.
- Clerks must not be scheduled for call duty the evening before an examination or on the last day of a six- or eight-week block (usually a Sunday), nor on the Fridays before (a) the December holiday period (Year 3), (b) the CaRMS interview period (Year 4), (c) the March Break (Year 3), (d) the extended weekend break in June (Year 3), and (e) the last rotation of the academic session (Year 3).
Maximum consecutive hours on-call: After being available for service in-hospital for twenty-four consecutive hours, clerks must be relieved of all service and educational duties until the commencement of the next working day, after ensuring adequate handover of patient care responsibilities. Such handover shall not exceed two hours, for a total of twenty-six consecutive hours in the hospital.
On-call activities that are not overnight in-house call: There are two settings where students are on call, but not overnight in the hospital.
- Some rotations include an on-call requirement that extends into the evening but is not overnight, and students are expected to be back to work the following day. In these cases, the on-call period must end by 11:00 pm. From time to time, as a result of clinical duties, a student may need to stay later than 11:00 p.m., to complete a clinical task, to complete handover, etc. If a clerk on such a rotation is required to stay on-call beyond midnight, then the on-call shift is converted to in-hospital call. If this occurs, after ensuring adequate handover of patient care responsibilities s/he must be relieved of all service and educational duties until the commencement of the next working day. Such handover shall not exceed two hours.
- Some rotations include a home-call requirement. Such call will be considered 'converted' to in-hospital call if a clerk commences work in the hospital between the hours of midnight and 6:00 am or if a clerk works in the hospital or other clinical care setting for at least 4 consecutive hours of which one hour extends beyond midnight. If a home call is converted to in-hospital call, then, after ensuring adequate handover of patient care responsibilities the following morning, the clerk must be relieved of all service and educational duties until the commencement of the next working day. Such handover shall not exceed two hours.
Students shall not be asked or expected to exceed the limits specified above under any circumstances.
Mandatory educational activities on days following on-call shifts: If a course or the Clerkship as a whole has designated certain educational activities as mandatory, then students must be relieved of their duties at midnight of the preceding day. Alternatively, such mandatory educational activities can be scheduled first-thing in the morning to enable post-call students to attend within their twenty-six hour limit.
Students do not work on weekends if not on-call: If a student is not on call or on shift, he/she shall not work on a weekend day.
Daily workload limit apart from being on-call: Across the duration of a rotation, the average number of hours per day that a student spends in total in required clinical and didactic experiences shall not exceed 12, excluding days on which the student is on-call or post-call.
On-call limits when pregnant: A medical student who is pregnant will not be required to participate in on-call duty after 27 weeks’ gestation, unless agreed to otherwise by the medical student.
Responsibility to monitor adherence with these standards: It is the responsibility of every site director for each clerkship course to actively monitor adherence to all aspects of this standard and to intervene immediately if any are breached.
Procedure for possible breaches: Concerns from students, teachers, or administrative staff members regarding breaches of the standard should be brought to the attention of the site director in the first instance. If the response is unsatisfactory or if a pattern of breaches emerges, the matter should next be raised with the course director for review and possible redress. If continued non-compliance occurs at one or multiple sites after the course director has intervened, the issue should be reported to the Clerkship Director and relevant University Department Chair for immediate response.