on duty in excess of 80 hours per week averaged over a 4-week period, inclusive of in-house night call. The trainee shall not work in excess of 24 consecutive hours inclusive of morning and noon educational programs. Allowances for inpatient and outpatient continuity, transfer of care, educational debriefing and formal didactic activities may occur, but may not exceed 6 hours. Residents may not assume responsibility for a new patient after working 24 hours. The trainee shall have on alternate weeks 48-hour periods off, or at least one 24-hour period off each week, averaged over a 4-week period. Upon conclusion of a 24-hour duty shift, trainees shall have a minimum of 10 hours off before being required to be on duty again. Upon completing a lesser hour duty period, adequate time for rest and personal activity must be provided. All off-duty time must be totally free from assignment to clinical or educational activity. Rotations in which trainee is assigned to Emergency Department duty shall ensure that trainees work no longer than 12-hour shifts. The trainee and training institution must always remember the patient care responsibility is not precluded by the work hour policy. In cases where a trainee is engaged in patient responsibility which cannot be interrupted, additional coverage should be provided as soon as possible to relieve the resident involved. The trainee may not be assigned to call more often than every third night averaged over any consecutive four-week period. Another related issue regarding the imposition of maximum hour policies for medical residents is the question of enforcement, where some enforcement proposals have included extending U.S. federal whistle-blower protection to medical residents in order to ensure compliance and afford medical residents certain employment protection. There are still inherent problems with the current ACGME policy. Resident duty hour restrictions are difficult to assess and enforce. Also, it is unclear who is ultimately responsible for monitoring duty hour adherence (i.e. state licensing boards, residency programs, attendings, residents, etc.). Additionally, a one-size-fits all solution may not be ideal, since the need for certain duty hours may vary among specialties. Coping mechanisms Although strategic napping is recommended by the ACGME, no studies have assessed the effect of napping as a fatigue mitigation technique. Requiring naps during long shifts could be a small step toward reducing fatigue and potentially decreasing errors. Resident surveys suggest that a greater emphasis on education, decreased workload, and more ancillary