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Appendix D
Glossary, Acronyms, and Abbreviations
GLOSSARY
Actigraphy: A relatively non-invasive method of monitoring human rest
and activity cycles. A small actigraph unit (often in a form similar to a
wrist-watch), is worn by someone to continually measure motor activity.
The data are later transmitted to a computer where it can be analyzed.
Ad libitum: The means of performing an activity, such as sleep, at one’s
own discretion.
Adaptability: In teamwork, an ability to adjust strategies based on informa-
tion gathered from the environment through the use of backup behavior
and reallocation of intrateam resources. Altering a course of action or team
repertoire in response to changing conditions (internal or external).1
Adverse Event: An unintended physical injury resulting from or contrib-
uted to by medical care rather than the underlying condition of the patient,
that requires additional monitoring, treatment, or hospitalization or results
in death. Not all adverse events are caused by errors.2
Attending physician: A physician who has completed his or her medical
residency and is fully licensed to practice medicine independently. Attending
physicians serve as supervisors to residents as they complete their training
and bear responsibility for the clinical work of residents that are assigned
to their team.
Backup behavior: Ability to anticipate other team members’ needs through
accurate knowledge of their responsibilities. This includes the ability to
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4 RESIDENT DUTY HOURS
shift workload among members to achieve balance during high periods of
workload or pressure.1
Burnout: A state of exhaustion or extreme fatigue accompanied by three
common symptoms: (1) emotional exhaustion—depleted energy from over-
whelming work demands, (2) depersonalization—personal detachment from
one’s job or surroundings, and (3) lack of personal accomplishment due to
self-perceptions of inefficiency.
Competencies: Specific knowledge, skills, behaviors, and attitudes and
the appropriate educational experiences required of residents to complete
graduate medical education (GME) programs.3
Cross-coverage: The availability of other residents to care for admitted
patients when the resident who has had primary responsibility for these
patients’ care is not on duty.
Didactic: A kind of systematic instruction by means of planned learning
experiences, such as conferences or grand rounds.3
Duty hours: Applied to medical residents, this means all time spent in
clinical and academic activities related to the program, that is: patient care
(both inpatient and outpatient), administrative duties relative to patient
care, provision for transfer of patient care, time spent in-house during call
activities, and scheduled activities, such as conferences. Duty hours do not
include reading and preparation time spent away from the duty site.3
Extended duty period: Also known as “long call,” refers to the 30-hour (24
+ 6) maximum continuous duty period allowed under the 2003 Accredita-
tion Council for Graduate Medical Education (ACGME) limits.
Float (day or night): A shift of residents that are not assigned to a single
service but “float” across services or teams to help with admissions and
follow-up.
Handover: The transfer of physician responsibility for a patient’s care
along with the transfer of patient information from one healthcare pro-
vider to another. Also, commonly referred to as a “handoff,” “transfer,”
or “sign-out.”
Health care safety net: Those providers that organize and deliver a signifi-
cant level of health care and other related services to uninsured, Medicaid,
and other vulnerable patients.4
Long call: Also known as “extended duty period,” refers to the 30-hour
(24 + 6) maximum continuous duty period allowed under the 2003 ACGME
limits.
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APPENDIX D
Midlevel provider: A term used to categorize clinicians such as nurse prac-
titioners (NPs) and physician assistants (PAs). Midlevel providers are often
referred to as physician extenders.
Mutual performance monitoring: The ability to develop common under-
standings of the team environment and apply appropriate task strategies to
accurately monitor teammate performance.1
On call: Duty hours beyond the normal workday when residents are re-
quired to be immediately available in the assigned institution. Also referred
to as in-house call.3
Percutaneous injuries: Injuries that penetrate the skin (e.g., needlesticks,
cuts).
Physician extender: A term used to categorize clinicians such as nurse
practitioners (NPs) and physician assistants (PAs). Physician extenders are
often referred to as midlevel providers.
Preventable Adverse Event: An adverse event attributable to error.2
Resident: Any physician enrolled in a GME program. A resident has received
a medical degree and practices medicine under the supervision of fully
licensed physicians, in an accredited graduate medical education hospital or
clinic, as a physician in training. These trainees are often referred to by their
training year, PGY-1 being a first year resident (also know as postgraduate
year one, or an intern), PGY-2 a second year resident, and so forth through
PGY-6.
Shift: A scheduled period of work, whether during the day, evening, or
night.
Task-tailored substitute: The lowest-qualified-level personnel to whom
non-educational patient care responsibilities can be transferred.
Team: A distinguishable set of two or more people with specific roles and
boundaries interacting toward a common goal on tasks that are interdepen-
dent and are completed within a larger organizational context.5
Team leadership: Ability to direct and coordinate the activities of other
team members; assess team performance; assign tasks; develop team knowl-
edge, skills, and abilities; motivate team members; plan and organize; and
establish a positive working atmosphere.1
Team orientation: Propensity to take other’s behavior into account dur-
ing group interaction and belief in the importance of the team’s goals over
individual members’ goals.1
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RESIDENT DUTY HOURS
Teamwork: Set of interrelated behaviors, cognitions (thoughts), and atti-
tudes (feelings) held by each team member that combine to facilitate adap-
tive, coordinated performance.6
NOTES
1Salas, E., D. E. Sims, and C. S. Burke. 2005. Is there a “big five” in teamwork?
Small Group Research 36(5):555-599.
2IOM (Institute of Medicine). 2000. To err is human: Building a safer health system.
Washington, DC: National Academy Press.
3ACGME. 2008. Glossary of terms. http://www.acgme.org/acWebsite/about/
ab_ACGMEglossary.pdf (accessed November 7, 2008).
4IOM. 2000. America’s health care safety net: Intact but endangered. Washington,
DC: National Academy Press.
5Kozlowski, S. W. J., and B. S. Bell. 2003. Work groups and teams in organizations.
In Handbook of psychology: Industrial and organizational psychology. Vol. 12,
edited by W. Borman, D. Igen, and R. Klimoski. London: Wiley. Pp. 333-375.
6Salas, E., E. Sims, and C. Klein. 2004. Cooperation and teamwork at work. In
Encyclopedia of applied psychology. Vol. 1, edited by C. D. Spielberger. San Diego,
CA: Academic Press. Pp. 497-505.
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APPENDIX D
ACRONYMS AND ABBREVIATIONS
ACRONYMS
AAMC Association of American Medical Colleges
ABIM American Board of Internal Medicine
ABMS American Board of Medical Specialties
ABNS American Board of Neurological Surgery
ABSITE American Board of Surgery In-Training Examination
ACGME Accreditation Council for Graduate Medical Education
ACS American College of Surgeons
AE adverse event
AHRQ Agency for Healthcare Research and Quality
ALOS average length of stay
AMA American Medical Association
AMI acute myocardial infarction
ANSR Americans for Nursing Shortage Relief
APDIM Association of Program Directors in Internal Medicine
AY academic year
BLS Bureau of Labor Statistics
CFPC College of Family Physicians of Canada
CHGME Children’s Hospital Graduate Medical Education
(program)
CIR Committee of Interns and Residents
CMI case mix index
CMS Centers for Medicare and Medicaid Services
COGME Council on Graduate Medical Education
COTH Council of Teaching Hospitals and Health Systems
DGME direct graduate medical education (payment)
DO doctor of osteopathic medicine
DOD U.S. Department of Defense
DSH disproportionate share hospital (payment)
ED emergency department
EM emergency medicine
EOG electro-oculography
EU European Union
EWTD European Working Time Directive
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RESIDENT DUTY HOURS
FAA Federal Aviation Administration
FMCSA Federal Motor Carrier Safety Administration
FRA Federal Railroad Administration
FTE full-time equivalent
GME graduate medical education
HCUP Healthcare Cost and Utilization Project
HCUP NIS Healthcare Cost and Utilization Project Nationwide
Inpatient Sample
HHS U.S. Department of Health and Human Services
HIPAA Health Insurance Portability and Accountability Act
HOS hours of service
HRO high-reliability organization
HRSA Health Resources and Services Administration
ICU intensive care unit
IHI Institute for Healthcare Improvement
IM internal medicine
IME indirect medical education (payment)
IOM Institute of Medicine
IPPS Inpatient Prospective Payment System (Medicare)
IPRO the designated quality improvement organization for
New York, Medicaid and Medicare review, and other
tasks (originally the Island Peer Review Organization)
IV intravenous
JC Joint Commission (formerly JCAHO)
LOS length of stay
MBI Maslach Burnout Inventory
MD doctor of medicine
MEDPAR Medicare Provider Analysis and Review File
NHS National Health Service (United Kingdom)
NICU neonatal intensive care unit
NIS Nationwide Inpatient Sample (HCUP)
NZRDA New Zealand Resident Doctors Association
OB/GYN obstetrics-gynecology
OJT on-the-job training
OSHA Occupational Safety and Health Administration
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APPENDIX D
PAE preventable adverse event
PGY postgraduate year
PGY-1, PGY-2 postgraduate year 1, postgraduate year 2 of medical
residency
PICU pediatric intensive care unit
PIF program information form
RCA root-cause analysis
RCPSC Royal College of Physicians and Surgeons of Canada
RRC Resident Review Committee
SEIU Service Employees International Union
TEMIS Trauma and Emergency Medicine Information System
U.K. United Kingdom
U.S. United States
USMLE U.S. Medical Licensing Exam
VA U.S. Department of Veterans Affairs
ABBREVIATIONS
CI confidence interval
g grams
mL milliliters
mph miles per hour
ms milliseconds
OR odds ratio
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