The Accreditation Council for Graduate Medical Education has proposed major revisions to the Common Program Requirements that govern U.S. residency training, including a reduction in the guaranteed rest period after a 24-hour call shift.
The draft was posted for public review and comment Sept. 8. Here are seven things to know.
1. The council wants to pare down the rulebook.
The proposal would cut the total number of Common Program Requirements by 43%, part of ACGME’s stated effort to reduce administrative burden and scale back prescriptive, process-based rules. It is framed as a major revision, with a proposed effective date of July 1, 2028.
2. Guaranteed post-call rest would drop from 14 hours to 12.
Under a current requirement, residents must be given at least 14 hours free of clinical work and education after 24 hours of in-house call. The proposal would lower that minimum to 12 hours — the clearest reduction to resident rest in the draft.
“The Task Force proposes modifying the required time free after 24 hours of in-house call to reduce burden related to developing resident schedules, while retaining sufficient time for rest,” according to the proposal’s impact statement. The task force said “no impact is anticipated” on continuity of care, resident and fellow education, patient safety and patient care quality.
3. The every-third-night cap on in-house call could go away.
Current rules bar programs from scheduling residents for in-house call coverage more often than every third night, averaged over four weeks. In its impact statement, the task force argues that the 80-hour weekly maximum, the one-day-in-seven requirement and the 24-hour continuous-work limit already make more frequent call “nearly impossible,” and that monitoring compliance “adds burden that is likely unnecessary.” The rationale points toward dropping the standalone requirement and the duty to track it.
4. “Resident well-being” would come out of the scheduling standard.
The requirement directing programs to weigh scheduling, work intensity and work compression currently ties those factors to resident well-being. The proposed language drops that phrase and instead tells programs to account for “resident competence and patient complexity.”
5. Most core duty-hour limits hold.
The 80-hour weekly cap, averaged over four weeks, stays. The 24-hour limit on continuous scheduled work, plus up to four hours for care transitions, is unchanged, as is the one-day-in-seven rule for residents to be free of clinical work.
6. New protections for lactating and pregnant residents.
The draft creates protected, non-makeup time during work hours for residents who are lactating, with private facilities and refrigeration. It also requires programs to adopt a policy covering duty and schedule modifications for pregnant residents, which the task force notes is meant to fill a gap left by parental-leave policies that do not address pregnancy itself.
7. Specialty-specific duty-hour rules would give way to the common standard.
Several specialty-specific versions of the duty-hour requirements would be deleted once the revision takes effect, leaving the single common rule to govern. ACGME expects to send a final draft to its Committee on Requirements and board at their June 2027 meetings. Parallel revisions to the fellowship requirements are slated for public comment in early 2027.
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