Academic Medicine Open Forum

Dear Colleagues,

I hope this email finds you well!  The Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV) is gathering information on how other institutions have evaluated and determined reasonable accommodations for residents with disabilities concerning overnight requirements.  Do you currently or have you in the past had residents who were unable to do overnight shifts due to a disability?  If so, were you able to accommodate them?

Are their specific specialties where you have found greater flexibility with overnight requirements?

Have alternative arrangements (such as extending residency or an alternative schedule been considered) to allow the trainee to participate in and complete their program?

Are you aware of programs that use other methods or structures for their GME programs that you could share with us as we study alternatives and flexibility in these requirements?

Yours Truly,

Kate Martin, MD

kate.martin@unlv.edu

Lisa.meeks@cuanschutz.edu. She is heading up the Equity Matters Disability trainings, for the ACGME, leads a national GME group on Disability Inclusion, and is considered the expert on this topic. I am sure she could offer some guidance on best practices.

Karen

Dear Colleagues,

I hope this email finds you well!  The Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV) is gathering information on how other institutions have evaluated and determined reasonable accommodations for residents with disabilities concerning overnight requirements.  Do you currently or have you in the past had residents who were unable to do overnight shifts due to a disability?  If so, were you able to accommodate them?

Are their specific specialties where you have found greater flexibility with overnight requirements?

Have alternative arrangements (such as extending residency or an alternative schedule been considered) to allow the trainee to participate in and complete their program?

Are you aware of programs that use other methods or structures for their GME programs that you could share with us as we study alternatives and flexibility in these requirements?

Yours Truly,

Kate Martin, MD

kate.martin@unlv.edu

Lisa.meeks@cuanschutz.edu. She is heading up the Equity Matters Disability trainings, for the ACGME, leads a national GME group on Disability Inclusion, and is considered the expert on this topic. I am sure she could offer some guidance on best practices.

Karen

Dear Colleagues,

I hope this email finds you well!  The Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV) is gathering information on how other institutions have evaluated and determined reasonable accommodations for residents with disabilities concerning overnight requirements.  Do you currently or have you in the past had residents who were unable to do overnight shifts due to a disability?  If so, were you able to accommodate them?

Are their specific specialties where you have found greater flexibility with overnight requirements?

Have alternative arrangements (such as extending residency or an alternative schedule been considered) to allow the trainee to participate in and complete their program?

Are you aware of programs that use other methods or structures for their GME programs that you could share with us as we study alternatives and flexibility in these requirements?

Yours Truly,

Kate Martin, MD

kate.martin@unlv.edu

Lisa.meeks@cuanschutz.edu. She is heading up the Equity Matters Disability trainings, for the ACGME, leads a national GME group on Disability Inclusion, and is considered the expert on this topic. I am sure she could offer some guidance on best practices.

Karen

Dear Colleagues,

I hope this email finds you well!  The Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV) is gathering information on how other institutions have evaluated and determined reasonable accommodations for residents with disabilities concerning overnight requirements.  Do you currently or have you in the past had residents who were unable to do overnight shifts due to a disability?  If so, were you able to accommodate them?

Are their specific specialties where you have found greater flexibility with overnight requirements?

Have alternative arrangements (such as extending residency or an alternative schedule been considered) to allow the trainee to participate in and complete their program?

Are you aware of programs that use other methods or structures for their GME programs that you could share with us as we study alternatives and flexibility in these requirements?

Yours Truly,

Kate Martin, MD

kate.martin@unlv.edu

Lisa.meeks@cuanschutz.edu. She is heading up the Equity Matters Disability trainings, for the ACGME, leads a national GME group on Disability Inclusion, and is considered the expert on this topic. I am sure she could offer some guidance on best practices.

Karen

Dear Colleagues,

I hope this email finds you well!  The Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV) is gathering information on how other institutions have evaluated and determined reasonable accommodations for residents with disabilities concerning overnight requirements.  Do you currently or have you in the past had residents who were unable to do overnight shifts due to a disability?  If so, were you able to accommodate them?

Are their specific specialties where you have found greater flexibility with overnight requirements?

Have alternative arrangements (such as extending residency or an alternative schedule been considered) to allow the trainee to participate in and complete their program?

Are you aware of programs that use other methods or structures for their GME programs that you could share with us as we study alternatives and flexibility in these requirements?

Yours Truly,

Kate Martin, MD

kate.martin@unlv.edu

Requests to forgo overnights is often related to a disability that worsens or 'flares' when a person experiences disruptions in sleep.  A few examples, though not exhaustive, include psychological disabilities like bi-polar disorder and depression; neurological disabilities like epilepsy; and chronic health disabilities like autoimmune-related disabilities, (e.g., lupus or rheumatoid arthritis). For individuals with these disabilities maintaining good sleep hygiene is essential to the individuals functioning and overall well being.

When this accommodation is requested you have to determine if it is reasonable in the context of your program and whether overnights are an essential function of your residency. Determining if overnight coverage is essential requires a nuanced understanding of the program including the size of the residency class, and the specialty. For example: 

1. Is overnight work a consistent requirement in the specialty and necessary for continuity in patient care?

1. Is the cohort of residents large enough to support a schedule that does not include overnight coverage? A residency class of 5 is very different from one of 50. 

1. Are there skills and abilities that can only be learned during the nighttime that could not be acquired during a weekend or holiday shift? The answer to this is likely no. 

Finally, are you thinking about this need creatively. How might this be a good option for the program, and how it might benefit a residency class?

For example, one resident may not work nights, but would take a disproportionate amount of weekend days or holidays, relieving other residents during those shifts. (This happens a lot!)

Also Is it possible to split shifts such that two residents work 12 of the 24 hours? (This is more rare, but highly satisfying to the two residents). When shared shifts have been piloted, residents report improved satisfaction, less burnout, and less need for coverage due to illness.

In some ways, an alternative call or night schedule may be beneficial to all residents. When residents forgo night shifts for weekend and holiday shifts it increases the opportunity for other residents to enjoy those breaks and there is less probability of having the resident w/a disability call out due to flare or exacerbation of symptoms.

Finally, you can extend the residency, but this does not normally address the night shift concern.

I know I've simplified this for brevity, but am happy to explain more to anyone personally. I just wanted to get the "gist" out there as a response.

I hope this is helpful.
My Best,
Lisa

Lisa.meeks@cuanschutz.edu. She is heading up the Equity Matters Disability trainings, for the ACGME, leads a national GME group on Disability Inclusion, and is considered the expert on this topic. I am sure she could offer some guidance on best practices.

Karen

Dear Colleagues,

I hope this email finds you well!  The Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV) is gathering information on how other institutions have evaluated and determined reasonable accommodations for residents with disabilities concerning overnight requirements.  Do you currently or have you in the past had residents who were unable to do overnight shifts due to a disability?  If so, were you able to accommodate them?

Are their specific specialties where you have found greater flexibility with overnight requirements?

Have alternative arrangements (such as extending residency or an alternative schedule been considered) to allow the trainee to participate in and complete their program?

Are you aware of programs that use other methods or structures for their GME programs that you could share with us as we study alternatives and flexibility in these requirements?

Yours Truly,

Kate Martin, MD

kate.martin@unlv.edu