MPAS Clinical Work Hours and Call

The purpose of the MPAS Clinical Work Hours and Call Policy is to establish standards regarding the number of hours Physician Assistant Students participate in during clinical rotations in Year 2 of the MPAS Program, and to specify call and post-call requirements.

Each clinical rotation will be responsible for determining their own ‘on call’ expectations in alignment with this policy. MPAS students participate in the same core rotations, while students’ experiences across campuses and sites may differ; on-call expectations of students should remain similar.

PA Trainee: A student in their second year of the MPAS program, who is completing clinical rotations - a core part of their educational program - as a supervised clinical trainee.

Designated Preceptor: The clinical supervisor who is ultimately responsible for the supervision of an MPAS student in a particular practice or service, usually a licensed physician or licensed/certified Physician Assistant. The designated preceptor oversees the student’s clinical learning experiences and assessments. If applicable, they oversee any student engagement with other MD faculty, PAs, residents, or other health care providers. Designated Preceptors may be:

1. Licensed/Certified Physician Assistant
2. Licensed Physician
3. Most responsible physician: the medical staff member deemed most responsible for a given patient’s (or group of patients’) care; also referred to as ‘attending physician’.
4. Consultant physician: a physician involved in the care of a patient on a consultation basis.
5. The on-call physician for a particular practice or specialty.

Supervisor: Any individual, including a supervising physician, a licensed/certified physician assistant, MD faculty, nurse practitioner, resident, or other non-physician health care provider who may be involved in teaching and supervising a physician assistant student during specific clinical learning experiences.

Home-Call: Home call is defined as either not being in hospital for call, or with call finishing at 2300h.

In-House Call: In-house call is defined as clinical service, or immediate availability for such service, where the student is required to remain in the hospital for the entire period.

This policy applies to all students registered in Year 2 of the Master of Physician Assistant Studies (MPAS) program at the University of Saskatchewan irrespective of the geographically distributed site/campus to which they are currently assigned. This policy pertains to clinical learning experiences including core rotations and electives that occur during Year 2 of the MPAS program, which occur in sites across Saskatchewan. Year 2 MPAS Learners completing Clinical Rotations are referred to as “PA Trainees”.

1.0 Requirements of Core Rotations

All call expectations for each core rotation, regardless of site, are to be provided to the MPAS Program Office for review.

 

2.0 Clinical Duty Hours

PA Trainees should not be expected to work more than 11 hours per day (unless on call) on a regular basis, though this may occur on occasion. The weekly maximum (not including evening, night, or weekend call) is 55 hours per week. Calculations include clinical work and scheduled educational sessions.

Hours of daytime work on weekdays will vary by rotation. Regular shifts can include weekends and statutory holidays, provided it falls within the maximum allotted hours per week. PA Trainees should have a minimum of 8 hours off prior to commencing their next shift.

PA Trainees participate in Academic Days approximately twice per month during which time they will remain engaged in MPAS Program activities but will not provide Clinical Care. The schedule of Academic Days will be provided to learners, clinical sites, and Designated Preceptors in advance.

3.0 Clinical Call

On-call experience is considered an essential part of clinical education, and as such, all PA Trainees may participate in Clinical Call as part of their clinical rotations. Some rotations may not require trainees to

take part in on-call. However, for those Clinical Rotations that outline on-call as part of the clinical rotation, the PA trainee must participate in being on-call.

Call schedules and hours may differ between sites and may be scheduled in the evenings, overnight and/or weekends. The individual approach to Call for each Clinical Rotation should be determined by the Clinical Rotation Coordinator and team, and addressed in the respective Clinical Rotation Syllabus.

Call shifts should be preplanned. PA Trainees should not be coerced into taking “additional” call shifts.

The following criteria apply to all rotations:

Maximum in-house call will be an average of 1-in-4 over the entire rotation, so that:

• For a 2-week rotation, maximum 3 calls
• For a 4-week rotation, maximum 7 calls
• For a 6-week rotation, maximum 10 calls
• For an 11-week rotation, maximum 19 calls

On occasion, in some rotations, the call schedule may be more than 1-in-4 but must not exceed this standard on average during the whole rotation. Where 1-in-4 is modified, the departmental Rotation coordinator should consult with the student(s) involved.

Maximum home-call will be an average of 1-in-3 over the entire rotation, so that:

• For a 2-week rotation, maximum 4 calls
• For a 4-week rotation, maximum 9 calls
• For a 6-week rotation, maximum 13 calls
• For an 11-week rotation, maximum 25 calls

On occasion, in some rotations, the call schedule may be more than 1-in-3 but must not exceed this standard on average during the whole rotation. Where 1-in-3 is modified, the departmental Rotation coordinator should consult with the student(s) involved.

If a student who is on Home Call must come into the hospital, or work in the hospital, after 2300h for clinical duties, the post-call policy will be followed (see Section 4.0).

• If a student is on “home call” less than or equal to 2300h, they are expected to attend regular duties the next day.

Weekend Call is defined as between Friday at 1700h to Monday at 0800h, including statutory holidays.

• Weekend call should be limited to 11 hours per 24-hour period.
• PA Trainees on clinical rotations shall not be on call more than 2 weekends in a row. When changing rotations, the onus is on the PA Trainee to notify the upcoming Rotation Coordinator of their current rotation call schedule at least four (4) weeks in advance to accommodate scheduling so that the PA Trainee is not required to work more than two consecutive weekends when changing rotations.

Call Considerations

• No student should be on call within 36 hours of the start or end of a rotation.
• No student should be on call after 1700h the night before an oral or written examination.
• No student should be on call later than 2300h on every second Tuesday night, until 1700h the following day (Wednesday). Students should be finished with their clinical duties during this time to allow students adequate rest in preparation for and participation in the mandatory Academic Day sessions scheduled every second Wednesday.
  • The MPAS Academic Day schedule will be provided in advance.
• Students may request up to 2 days off-call per 6-week rotation, with a maximum of 1 weekend considered. Please note that these are only requests and may not be granted nor should these requests create undue hardship for other learners on the rotation nor the rotation itself.
  • “Off call” days are subject to approval by the department. A minimum of 6 weeks' notice is required.
• Learners are not permitted to request specific days “Off-call” during 2-week and 4-week rotations.

Statutory Holidays

PA Trainees who are on duty on a statutory holiday for 8 hours between 0800h and 2300h are eligible for time off in lieu of that day. Time off in lieu must be requested via MPAS processes and must be taken on the rotation in which the time was earned. If the stat falls at the end of a rotation, the day in lieu may be requested on a day prior to the stat in that same rotation, with the understanding that if the student is absent on the stat day for any reason they will be required to make up the time on that rotation.

If a PA Trainee requests to work on a statutory holiday, they will not be eligible for a day off in lieu.

Elective Rotations – On-Call

While not all Elective Rotations may require call, PA trainees are required to participate in taking Call during Electives if Clinical Call is outlined as a requirement of the individual Elective Rotation.

Call Schedule Provision

Timely notification of call schedules is an essential part of ensuring optimal student education during clinical rotations. Final call schedules should be provided to the students approximately two-weeks prior to the start of the rotation. The provision of the call schedule on a timely basis is the professional

responsibility of the MPAS Program Assistant, in collaboration with the departmental Rotation Coordinator and local clinical sites.

Adjustments to call schedules during pregnancy will be made in accordance with medical recommendations and University accommodation policies.

4.0 Post-Call Requirements

Attendance at clinical duties and educational activities during clinical rotations is part of the core professional and academic responsibilities of physician assistant students; this includes those activities scheduled post-call.

The following requirements apply for PA trainees post-call:

• 1200h, noon, is the latest a student can be expected to participate in clinical care/educational sessions after being on-call overnight.
• Students are not excused from clinical duties following Academic days, even if on-call until 2300h the previous night.

 

The Academic Director of the MPAS program is responsible for providing oversight to the overall administration of the MPAS Clinical Work Hours and Call Policy.

The Director of Faculty and Clinical Placements of the MPAS Program and the Manager of the MPAS program, with assistance from the MPAS Office, are responsible for the implementation, monitoring, maintenance, and evaluation of the MPAS Clinical Work Hours and Call Policy. This includes the development and stewardship of the standard operating procedures associated with this policy.

Instances or concerns of non-compliance with the MPAS Clinical Work Hours and Call Policy should be brought to the attention of the Academic Director of the MPAS program.

Program Manager, Master of Physician Assistant Studies (MPAS) Program
Phone: 306-966-4252