Trading Rules

BWH MedSchedule

All trades should be submitted to BWH MedSchedule by using the Block Trade and Shift Trade forms (links to each are available below). Trade requests submitted by e-mail to BWH MedSchedule will not be processed except in cases when outside rotators (i.e. Psych, ED, OB, and BI trainees) are involved in the trade request. Residents should expect to receive a response from MedSchedule within 2-4 weeks of submitting the request. MedSchedule’s goal is to process and respond to trade requests 2 weeks from when they are received. Given the volume of requests and the complexity of many trades, please allow for a 4-week response time in cases when the trade is for a rotation more than 3 months away. In order to help streamline the processing of trades, please review the trading deadlines and rules very carefully to ensure your request follows the guidelines outlined by the program’s policy and fill in all required fields on the trade request form.

Request Forms

Block Trade Requests

A trade is considered a “Block Trade” when it is for more than 3 days of a rotation.

Daily Shift Trade Requests

A trade is considered a “Daily Trade” when it is for 3 days or less of a rotation.

With a daily trade request for multiple, consecutive days (up to 3), one Daily Trade Request Form can be submitted as long as the shifts are being traded between the same two residents. Separate request forms must be submitted if “Resident B” is a different resident for each shift of a multi-day trade.

TRADING DEADLINES

In general, trades should be submitted as far in advance as possible.

All trades (block and shift) involving the VA or any clinic must be submitted at least 74 days in advance of the block start date.

Block trades (considered more than 3 days of a rotation) that do not involve clinic or the VA must be submitted at least 28 days in advance of the block start date.

Daily trades (considered 3 days or less of a rotation) that do not involve clinic or the VA must be submitted at least 14 days in advance.

Change requests for electives (while not technically trades) must be submitted at least 45 days in advance.

Trades made for job or fellowship interviews during inpatient rotations are exempt from trading deadlines. If a clinic during an inpatient rotation conflicts with an interview, residents should email Cam Walker (cawalker@bwh.harvard.edu) with the date in conflict and 3 potential clinic flex dates (e.g. during elective) AFTER their inpatient shift has been traded away and approved by MedSchedule.

If an extenuating circumstance prevents you from submitting your trade request by the above deadline, please indicate this in your email to BWH Medschedule and your trade request will be reviewed by senior leadership. In general, exceptions will not be made. If you are having a personal illness or family emergency, please contact the chief medical residents (BWHMROChiefRes@partners.org) for DPH coverage.

TRADING RULES

The reason for the trade does not need to be given and is left up to the discretion of residents involved, provided all the trading rules and deadlines are met. Similarly, whether a trade is “fair” is left up to the discretion of the residents involved, provided all trading rules are met.

All residents involved in the trade must agree to the trade.

Trades must not violate ACGME duty hour rules (see below for specific requirements).

DPH shifts (which last 24 hours, from 7AM-7AM) may not be traded in less than 12 hour increments.

Junior residents may not trade into a Senior DPH block prior to September 1st of the academic year to ensure that appropriate level coverage is available in the DPH pool for senior-only rotations.

Junior residents should have at least 1 block of LCU in their schedules, and no more than 2 blocks, unless there are extenuating circumstances (which should be discussed with program leadership prior to submitting a trade request).

VA and ITU rotations are TWO blocks long (i.e. typically 4 weeks), and any trade involving these rotations must be traded in two block increments.

Residents are responsible for ensuring that trades do not compromise their ability to meet the following program requirements for graduation (see below)

Categorical, Primary Care, and Med-Peds Residents must have…

  • No less than 4 weeks, but no more than 8 weeks of emergency medicine over the course of their residency.
  • No less than 3 months, but no more than 6 months of ICU/Critical Care over the course of their residency. Please note that BMT and VA-Cardiology CAN be counted as critical care time, if needed.
  • All residents must have 130 half day sessions of continuity clinic over the course of their residency (this essentially means that missed clinics because of trades must be made up elsewhere).
  • No more than 4 months of night float over 3 years. Nightfloat rotations are VA nightfloat, GMS nightfloat, ITU nightfloat, oncology flex, oncology nightfloat, cardiology nightfloat, and cardiology twilight. (NOTE: If you make a trade request which results in having two consecutive nightfloat/twilight rotations, you may need to have a clinic scheduled during one of the blocks to ensure there isn’t a violation of the 4-week clinic gap rule.)
  • Geriatrics in their junior year of residency (i.e. do not trade this away)
  • Neurology consults or inpatient neurology once during residency, typically junior year (i.e. do not trade this away)

Preliminary interns may have other specific program requirements; please ask your program director if you need clarification.

Only senior residents can do/cover the following rotations:

  • Phys
  • BWH MICU in the first half of the academic year i.e. June-December
  • F-ICU

Residents on Neurology, Teaching Resident, Geriatrics, and Non-Research Elective rotations can only cover shifts for other residents on the weekends (i.e. evening Friday-Sunday). If you need to request missing a day on one of these rotations, please talk to the chief medical residents (Neurology, Teaching Resident) or the rotation director (Geriatrics, Elective). To trade ED shifts, you will need to involve the ED chief residents.

Interns may not trade away any blocks that fall within the first 60 days of the start of intern year. Daily trades are permissible within the first 60 days.

The chief residents are happy to provide advice on optimal trades.

ACGME DUTY HOUR RULES

Residents can work a maximum of 80 hours per week, averaged over 4 weeks.

Residents must have a minimum of 1 day (24 hours) free of duty every week, averaged over 4 weeks.

Vacation does not count in the numerator or denominator for calculating duty hours or days off.

Duty periods for interns must not exceed 16 hours in duration. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours. Residents may remain on site for 4 additional hours for transitions of care (this additional 4 hours cannot include continuity clinic). Starting July 1st 2017, interns duty periods of up to a maximum of 24 hours will be allowed.

Residents must have 8 hours free of duty between scheduled duty periods. Note: Internal medicine does not have intermediate-level residents, as PGY-2 and PGY-3 residents are considered to be residents in their final years of education (which means there is no requirement for 14 hours free after a 24 hour duty period). //www.acgme.org/Portals/0/PDFs/DH_Definitions.pdf. Starting July 1, 2017 all residents will require 14 hours free after a 24 hour duty period.

PGY-2 residents and above may not be scheduled for in-house call more frequently than q3. [Note: We will allow CCU juniors to trade CCU shifts as long as they are no more than q3 call averaged over the rotation.]

Residents must not be scheduled for more than 6 consecutive nights or more than 4 consecutive weeks of night float. [MICU nights and Cardiology nights currently exempt]

Continuity clinic may not be interrupted by more than 4 weeks, not including vacation.

References

//www.acgme.org/portals/0/pfassets/programrequirements/140_internal_medicine_2016.pdf//www.acgme.org/Portals/0/PDFs/DH_Definitions.pdf //www.acgme.org/Portals/0/PDFs/dh-faqs2011.pdf