A Constraint Programming-based solution approach for ... problem...
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A constraint programming-based solution approach for medical resident
scheduling problems
Seyda Topaloglu
a,
, Irem Ozkarahan
b
a
Dokuz Eylul University, Department of Industrial Engineering, Tinaztepe Yerleskesi, 35160 Izmir, Turkey
b
Troy University - Montgomery, Department of Computer Science, P.O. Drawer 4419, Montgomery, AL 36104, USA
article info
Available online 15 May 2010
Keywords:
Medical resident scheduling
Mixed-integer programming
Constraint programming
Accreditation Council for Graduate Medical
Education
Duty hours
abstract
Persistent calls come from within the graduate medical education community and from external
sources for regulating the resident duty hours in order to meet the obligations about the quality of
resident ed ucation, the well-being of residents themselves, and the quality of patient care services. The
report of the Accreditation Council for Graduate Medical Edu cation (ACGME) proposes common
program requirements for resid ent hours. In this paper, we first develop a mixed-integer programming
model for scheduling residents’ duty hours considering the on-call night, day-off, rest period, and total
work-hour ACGME regulations as well as the demand coverage requirements of the residency program.
Subsequently, we propose a column generation model that consists of a master problem and an
auxiliary problem. The master problem finds a configuration of individual schedules that minimizes the
sum of deviations from the desired service levels for the day and night periods. The formulation of this
problem is possible by representing the feasible schedules using column variables, wh ereas the
auxiliary problem finds the whole set of feasible schedules using constraint programming.
The proposed approach has been tested on a series of problems using real data obtained from a
hospital. The results indicate that high-quality schedules can be obtained within a few seconds.
& 2010 Elsevier Ltd. All rights reserved.
1. Introduction
Postgraduate residency education is required of all medical
school graduates seeking full license in one of the specialties of
medicine. This phase of medical education is conducted primarily
in clinical settings and requires direct participation by residents in
the delivery of patient care services. The residents have a unique
position both, as learners who have to attend educational
activities and as providers of services working long duty hours.
Residents’ duty schedules should be prepared keeping in mind
the potentially adverse impact that resident fatigue may have on
the quality of patient care provided and the resident physical and
emotional well-being. The scientific literature has consistently
demonstrated that the long hours of intense clinical work seen in
residency training programs raise concerns about residents’
stress, mood changes, and capacity to deliver high quality medical
care [1–3]. Much data supports that for many residents, fatigue
cultivates anger, resentment, bitterness, and depression rather
than kindness, compassion, or empathy [4,5]. It also leads to
cognitive impairment that results in higher rates of medical error,
motor vehicle accidents, and pregnancy complications [6–9].
These societal concerns have prompted the Accreditation Council
for Graduate Medical Education (ACGME) to apply certain rules
for regulating the duty hours of residents in order to strike a
balance between educational requirements, personal well-being,
and patient safety. The ACGME is a private, non-profit council that
evaluates and accredits medical residency programs in the United
States. The mission of the ACGME is to improve health care by
assessing and advancing the quality of residents’ education
through accreditation.
The following lists the proposed ACGME common program
requirements for resident duty hours [10]:
Residents must not be scheduled for more than 80 h per week,
averaged over a 4-week period, with the provision that
individual programs may apply to their sponsoring institu-
tion’s Graduate Medical Education Committee for an increase
in this limit of up to 10 percent if they can provide a sound
educational rationale.
Residents must have at least one full (24-h) day out of 7, free of
patient care duties, averaged over 4 weeks.
Residents must not be assigned in-house calls more often than
every third night, averaged over 4 weeks.
Continuous time on duty is limited to 24 h, with additional
time up to 6 h for inpatient and outpatient continuity, transfer
Contents lists available at ScienceDirect
journal homepage: www.elsevier.com/locate/caor
Computers & Operations Research
0305-0548/$ - see front matter & 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.cor.2010.04.018
Corresponding author. Tel.: + 90 232 4127611.
E-mail addresses: seyda.topaloglu@deu.edu.tr (S. Topaloglu),
iozkarahan@troy.edu (I. Ozkarahan).
Computers & Operations Research 38 (2011) 246–255
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