How to Submit Call Swaps:

Follow the instructions here! Call swaps can be submitted directly into Lightning Bolt, but PLEASE also email the Chiefs so we can take a look at the swap for you! Lightning bolt may say something is confirmed or pending, but know that it isn’t confirmed until you get a message saying that it has been confirmed by one of the chiefs.

Email pedichiefoncall-dl@childrens.harvard.edu if you have additional questions or difficulties with submission through Lightning Bolt

BCRP SWAP GUIDELINES

Our goal: To enable you to make swaps!!!

Our task: To make sure your swaps are fine from a patient safety perspective, are duty hour compliant, and do not prevent you from obtaining needed elective credit or meeting other graduation requirements

Duty Hour Requirements

  • You can’t work more than 80 hours/week averaged over the rotation, including scheduled shifts and ATOs, and including signout times

  • You must have at least 8 hours after shifts < 24 hours, and at least 14 hours after a 24 hour shift

  • You must have 1 day off for every 7 days worked, averaged over the rotation

  • Maximum shift length is 28 hours (24 hours of patient care + 4 hours for transition of care or education)

  • 24 hour call cannot occur more frequently than every third night averaged over 4 weeks

Clarifications on Duty Hour Requirements

  • For the “day off” per 7 days this needs to be a continuous 24-hour period where the resident does not have any clinical duties

    • Often a full calendar day off

    • Can also be a 24 hour period finishing from an overnight shift to the next morning, as long as the next activity is 24 hours from the time sign-out finishes

      • i.e. Monday overnight finished Tuesday AM w/ sign out done at 7am. This person could be scheduled for Wed AM clinic that starts at 8am, and that counts as a full day off

      • That same person could NOT be scheduled for an inpatient rotation that starts at 6:30am, as that is <24 hours off

    • Days off have to be applied per rotation (not 4 week period)

  • While ACGME requires 8 hours between shifts, the BCRP strives for 10 hours

    • Though it is acceptable to swap into shifts that would result in <10 but >8 hours off in between shifts


Track Specific Requirements

IRP:

  • IRP residents cannot exceed 20% clinical time while on research per ABP rules

    • This includes scheduled clinic and cross-cover time as well as ATO shifts

LEAD:

  • LEAD residents may not make swaps that would interrupt their ability to attend RAP sessions.

  • Similarly, scheduled second clinics are educational requirements that may not be canceled in a swap.

  • Residents with project afternoons may choose to move their project afternoon time as long as it can be fit elsewhere in the schedule in the same scheduling unit


Rotation Specific Guidelines

Rotations that Residents Must Have Done Before to Swap Into:

  • BMT (must have done BMT, exceptions must get approved by rotation director)

  • MSICU, MICU (must have done primary MSICU block)

  • BMC PICU (must be PGY3 and have completed orientation with Sara Ross or PICU chief)

    • Can complete orientation between swap approval and shift

  • BWH DR/NICU (must have done BWH NICU or BMC NICU)

  • BMC Nursery (must have done BMC Nursery before)

ELN/ELC:

  • Must have a minimum of 5 half-days of ELN/ELC in order for electives to count towards graduation requirements on 5 separate calendar days

Oncology

  • If resident swapping into oncology shift has done Oncology rotation, can take any shift

  • If resident swapping has done MSICU but not Oncology, can swap into any weekday or night shift

  • If resident swapping has not done MSICU or Oncology, they can swap into a Tuesday, Wednesday, or Thursday day shift (based on amount of support staff those days)

Flex

  • Cannot swap into a flex shift that would result in missing clinic, academy, RAP if called

  • Cannot swap into a flex shift that creates a possible flex need

    • i.e. if scheduled for a day shift on a Tuesday, can not swap into a flex 24 for the preceding Monday

  • If splitting a flex shift, need to decide who will cover bridge ED shifts

    • This include ERB 10a-8p, 12-10p, 4p-2a; ERC 12-10p, 1-11p, 3p-1a

ERC:

  • Can allow 10pm overnight shift after an afternoon clinic (should be logged continuously)

  • All swap requests must be approved by ED leadership

  • Swaps have to be between equivalent PGYx 

ERB:

  • Swaps between PGY2 and PGY3 are okay

  • Can swap between PGY1 and PGY2/3 as long as an upper level pedi resident is present in the BMC ED at the same time

  • Swaps with other programs need to go through BCRP chiefs + other program chiefs

Clinic:

  • Clinic changes (cancellations or moving dates, most swaps) can only be made 7 days after the schedule is published and >60 days from your clinic date (unless it is a personal/family emergency or for work-related reasons). 

    • If a scheduling delay occurs resulting in <60 days notice, we will advocate for swaps

Keystone:

  • Everyone is expected to be in-person for Keystone activities Monday and Friday mornings (hence there is no possibility to “swap” out of these)

  • DBP and Adolescent shifts cannot be swapped, as prior arrangements are made for patients to be on your schedule

  • Swaps for primary care clinic require at least 2 months notice