The leftover line is still on the grid. Someone moved last Tuesday. The evaluation for that rotation is still assigned to the faculty member who is no longer teaching them. The clinical and educational work-hour average for the person who absorbed the extra call has not been re-run. Two people think they own the file.
This guide is the operational answer for UME and GME administrators and coordinators: who owns the master schedule, what a change request actually does to evaluations and work hours, when the roster freezes, and how leftover-line cleanup keeps the next block from inheriting the last one. A downloadable operating checklist is linked at the end, with owner and freeze-date columns so the work is visible before the block starts, not after it breaks.
Verified September 1, 2026 against ACGME and LCME. Sources at the end.
| Owner | Clock | Artifact | Failure if skipped |
|---|---|---|---|
| Master-schedule owner (coordinator who drives the system; program director can freeze and overrule) | Named before the academic period opens | One live master copy, with a deputy on the same card | Two people can overwrite the grid; leftover line is how you find out |
| Freeze owner (program director in GME; clerkship or curriculum office in UME) | Last day a change enters without an exception path; set backward from evaluations, work hours, sites, and learners | Published roster from the master on the freeze date | Call picked up in a side chat; freeze in name only |
| Change-request owner (master-schedule owner or deputy) | Before the request is marked done, not after the cell edit | Written cascade: assignment, evaluations, work-hour re-average, leftover lines | Evaluation still assigned to the faculty member who is no longer teaching them |
| Leftover-line cleanup owner (master-schedule owner; PD or clerkship director in the room for clinical decisions) | Scheduled pass before the next block starts | List of empty required lines, ghost assignments, orphan evaluations, work-hour flags, unpublished local copies | Next block inherits last week's grid; cleanup happens only when a learner complains |
| Work-hour owner (program director and coordinator, GME) | Re-check after every approved change; average by rotation | Re-run average for everyone whose assignments changed | Coverage pickup that cannot be staffed inside the work-hour rules |
Who owns the master schedule?
One named person owns the master copy. Everyone else files a change request against it. If two people can both overwrite the grid, you do not have a master schedule. You have two versions, and the leftover line is how you find out.
| Owner | Job | When it is named |
|---|---|---|
| Master-schedule owner | Keep one live copy. Decide what is a request and what is an overwrite. Make freeze dates real. Usually the coordinator who drives the system. | Before the academic period opens |
| Deputy | Same card as the owner. The leftover line does not wait for someone to return from leave. | The same day the owner is named |
| Program director (GME) | Can freeze a roster and overrule a last-minute swap. | When freeze dates are set |
| Clerkship or curriculum office (UME) | Owns the clerkship and elective book. Clerkship directors do not each keep a private book that later gets merged. | Before the clerkship year opens |
| Institutional coordinator or GME operations lead | Owns the calendar of freeze dates across programs, not each program's grid. | When the academic calendar is set |
Write the name down. The owner's job is not to type every cell.
A national survey of GME coordinators, fielded in 2022 and published in Academic Medicine in May 2025, listed scheduling among the job's named duties and ranked tracking down residents, fellows, and faculty to complete required tasks among the leading dissatisfiers. The leftover line is that finding with a grid attached: the chase work starts when the roster and the downstream records disagree.
What does a change request actually change?
A change request is not a cell edit. It is a cascade. The assignment you move is the first object. Evaluations, work-hour averaging, site capacity, and leftover coverage are the ones that break if you stop there.
Until the cascade is checked, the request is not approved. An email that says "ok, swap them" is not a change request. It is a future leftover line.
| Object | What the request has to change | Failure if you stop at the cell |
|---|---|---|
| The assignment | Who is now on which rotation, site, and dates. Confirm the person leaving is actually leaving, and that the person arriving is eligible for the rotation, not just available. | A published roster that still lists someone who is not there |
| Evaluations | End-of-rotation and shift forms follow the teaching relationship. If the learner moved, the evaluator assignment has to move. If the dates moved, the form window has to move. | You chase a form from someone who never saw them |
| Clinical and educational work hours | A coverage pickup is new hours. A cancelled night is fewer hours in that week and, often, a compressed stretch somewhere else. Averaging is by rotation, not a rolling average across a heavy block and a light one. Re-run the average for everyone whose assignments changed before you call the request done. | A request you cannot staff inside the weekly maximum |
| Capacity and leftover lines | A swap that looks even on two names can leave a site over its agreed load and another line empty. | Empty lines become the next block's emergency |
Time off is not a schedule change request. Leave belongs on the leave path, with the balance and the approval trail that path already has. Approving leave and then forgetting to look at overlapping assignments is how you get a published roster that still lists someone who is not there.
Form Assignments
Manage form assignments across your program
| Select all | Form | Context | Responder | Recipient | Status | Dates |
|---|---|---|---|---|---|---|
| End of Rotation EvaluationRotationManual | RotationIM-Wards-A | F1Faculty 1Faculty | PAPGY-2 AResident | Overdue | A: Aug 18V: -D: Aug 25S: - | |
| End of Rotation EvaluationRotationManual | RotationIM-Wards-A | F2Faculty 2Faculty | PBPGY-2 BResident | Draft | A: Aug 20V: Aug 22D: Sep 1S: - | |
| End of Rotation EvaluationRotationManual | RotationIM-Clinic-B | F3Faculty 3Faculty | PAPGY-1 AResident | Submitted | A: Aug 12V: Aug 14D: Aug 28S: Aug 27 | |
| Semi-annual EvaluationRotationManual | ProgramProgram | F1Faculty 1Faculty | PAPGY-3 AResident | Draft | A: Aug 22V: -D: Sep 4S: - |
Demonstration data. The assignment list is the working file: named responder, due date, overdue versus incomplete. When the roster moves and this list does not, that is the leftover line.
The assignment list is the working file: named responder, due date, overdue versus incomplete. When the roster moves and this list does not, you have invented next month's leftover line. It is not a second tracker sitting next to the system of record.
When should the schedule freeze?
The freeze date is the last day a change can enter the grid without an exception path. After that date, the master is the published roster. Requests still exist; they go through the owner, with the cascade attached, and they are exceptions, not edits.
Set freeze dates backward from the events that depend on a stable roster, not forward from when the grid feels done.
| Dependent work | Clock | What a freeze in name only looks like |
|---|---|---|
| Evaluations | Freeze early enough that evaluator lists can be generated from the roster, not rebuilt by hand after the block starts. | Forms assigned to the people who taught last week's roster |
| Clinical and educational work hours | Freeze before call has already been picked up in a side chat. The schedule is one of the structures that has to keep residents and fellows inside the weekly maximum and the required time free of clinical work. | A freeze that lands after the extra night is already worked |
| Sites and preceptors | Sites plan staffing from the names you sent them. A post-freeze swap that the site did not accept is not a completed request. | A seat the site did not accept, counted as filled |
| Learners | Learners make housing, parking, and family plans from the published roster. Publish once, on the freeze date, from the master. | A draft published in hope that leftover lines resolve themselves |
The freeze date is a program rule, written, with the exception path named. "We try to lock it two weeks out" is not a freeze. A freeze is a date, an owner, and a sentence that says what happens to a request that arrives on the wrong side of it.
UME clerkship calendars freeze against the school's academic calendar and against site capacity. GME block and shift calendars freeze against the program's block structure and against the work-hour rules below. The architecture is the same: freeze from the dependent work, not from optimism.
What is leftover-line cleanup?
Leftover-line cleanup is a scheduled pass, before the next block starts, that finds every empty cell, every assignment that no longer matches the person, and every downstream record still pointing at last week's roster. It is a meeting with a list, not a feeling that the grid looks fine.
Run it as a standing task on the checklist, owned by the master-schedule owner, with the program director or clerkship director in the room for anything that needs a clinical decision.
| Leftover line | What you are looking for | Failure if skipped |
|---|---|---|
| Empty required lines | A rotation that must be filled, a call night with no name, a clerkship seat the school still owes a student | Required experiences that cannot be completed on the roster you published |
| Ghost assignments | A name still in a cell after leave, a resignation, a site that withdrew the slot | A published roster that still lists someone who is not there |
| Orphan evaluations | Forms assigned to a teaching relationship the roster no longer contains | Next month's chase list |
| Work-hour flags | Anyone whose changed assignments were not re-averaged | A coverage pickup that was never re-checked |
| Unpublished local copies | A chief's spreadsheet, a site's printout, a private calendar that drifted from the master | Two versions of the same week |
Cleanup that happens only when a learner complains is not cleanup. It is incident response. Put the pass on the calendar the same way you put the freeze date on it, and the leftover line stops being a surprise.
How do clinical and educational work hours constrain the grid?
For ACGME-accredited residencies and fellowships, the grid does not meet the requirements if it cannot be staffed inside the clinical and educational work-hour rules. The ACGME replaced the older "duty hours" language with "clinical and educational work hours"; the limits below are from the Common Program Requirements (Residency) including FAQs, effective July 1, 2026. Specialty program requirements can add to them. They cannot subtract.
| Body | Clock | What it is not |
|---|---|---|
| Weekly maximum | Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, including all in-house clinical and educational activities, clinical work done from home, and all moonlighting. | A rolling average that blends a heavy rotation with a light one |
| What counts from home | Reading, studying, and research done from home do not count toward the 80 hours; using an electronic health record from home and taking calls from home do. | "Home" as a free hour |
| Time free of clinical work and education | Residents should have eight hours off between scheduled clinical work and education periods. They must have at least 14 hours free of clinical work and education after 24 hours of in-house call. They must be scheduled for a minimum of one day in seven free of clinical work and required education (averaged over four weeks). At-home call cannot be assigned on those free days. | At-home call parked on the free day |
| Shift length and call frequency | Clinical and educational work periods must not exceed 24 hours of continuous scheduled clinical assignments, with up to four additional hours for transitions of care and/or education, not for new patient care. Residents must be scheduled for in-house call no more frequently than every third night (averaged over a four-week period). At-home call counts toward the 80-hour weekly limit; its frequency is not subject to the every-third-night rule, but it must still satisfy the one-day-in-seven requirement. | New patient care in the extra four hours |
| How you average | Use a four-week period, a one-month period (28-31 days), or the period of the rotation if it is shorter than four weeks. Vacation and other leave days are omitted from both the numerator and the denominator. The rotation with the greatest hours has to comply on its own. | A rolling average across a heavy block and a light one |
| What the ACGME does not specify | Sponsoring Institutions and programs must monitor residents' and fellows' clinical and educational work hours, including work done from home, to ensure they comply. The ACGME does not specify how that monitoring is done. | A method so informal that a change request can close without a re-check |
| Suspended exception | Enforcement of the rotation-specific weekly-hour exception (Common Program Requirement 6.24 and 6.24.a) has been suspended as of February 9, 2026, pending the outcome of the major revision of the Common Program Requirements. | A staffing plan that assumes that exception is available |
The table is the working version. The paragraphs below are the same clocks, spelled out.
The weekly maximum. Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, including all in-house clinical and educational activities, clinical work done from home, and all moonlighting. Reading, studying, and research done from home do not count toward the 80 hours; using an electronic health record from home and taking calls from home do.
Time free of clinical work and education. Residents should have eight hours off between scheduled clinical work and education periods. They must have at least 14 hours free of clinical work and education after 24 hours of in-house call. They must be scheduled for a minimum of one day in seven free of clinical work and required education (averaged over four weeks). At-home call cannot be assigned on those free days.
Shift length and call frequency. Clinical and educational work periods must not exceed 24 hours of continuous scheduled clinical assignments, with up to four additional hours for transitions of care and/or education, not for new patient care. Residents must be scheduled for in-house call no more frequently than every third night (averaged over a four-week period). At-home call counts toward the 80-hour weekly limit; its frequency is not subject to the every-third-night rule, but it must still satisfy the one-day-in-seven requirement.
How you average. Averaging is by rotation. Use a four-week period, a one-month period (28-31 days), or the period of the rotation if it is shorter than four weeks. The ACGME does not permit a rolling average that blends a heavy rotation with a light one. Vacation and other leave days are omitted from both the numerator and the denominator. The rotation with the greatest hours has to comply on its own.
What the ACGME does not specify. Sponsoring Institutions and programs must monitor residents' and fellows' clinical and educational work hours, including work done from home, to ensure they comply. The ACGME does not specify how that monitoring is done. Your method is a local operating choice. The requirement is that it exists, that it includes work from home, and that a change request cannot close until the people whose hours moved have been re-checked.
Enforcement of the rotation-specific weekly-hour exception (Common Program Requirement 6.24 and 6.24.a) has been suspended as of February 9, 2026, pending the outcome of the major revision of the Common Program Requirements. Do not build a staffing plan that assumes that exception is available.
A change request that cannot be staffed inside these rules is not a coverage problem you can "figure out on the day." It is a request you deny, or a roster you rebuild, before the freeze.
What does LCME require of the clerkship schedule?
The school owns the clerkship schedule. Sites host it. That split is the affiliation-agreement baseline hosted on lcme.org: the school is ultimately responsible for the medical education program, academic affairs, and the assessment of medical students, and the school is primarily responsible for the appointment and assignment of faculty members with responsibility for medical student teaching. A site can tell you it is full. It does not get to become the registrar.
| Object | What this page can say from fetched lcme.org pages | What it is not |
|---|---|---|
| Affiliation agreement | The school is ultimately responsible for the medical education program, academic affairs, and the assessment of medical students, and is primarily responsible for the appointment and assignment of teaching faculty. | The site as registrar |
| Element 8.6 (wording as quoted in an LCME history document hosted on lcme.org, not a fetch of the current-year Functions and Structure) | a medical school has in place a system with central oversight that monitors and ensures completion by all medical students of required clinical experiences in the medical education program and remedies any identified gaps | A hope that leftover lines work themselves out at the sites |
| Clerkship capacity | LCME's 2025 strategic-visioning materials name competition for clinical clerkship placements as a standing challenge. | A software feature |
| Current Functions and Structure | LCME publications, as of the March 9, 2026 notice on lcme.org, are no longer collected on one page; current standards live under the Resources tab. Pull the edition that matches your survey year. | Element numbers invented from a saved copy |
One element that an LCME history document still hosted on lcme.org quotes in full is Element 8.6: a medical school has in place a system with central oversight that monitors and ensures completion by all medical students of required clinical experiences in the medical education program and remedies any identified gaps. The operational meaning for the schedule is blunt. Required clinical experiences have to be completable on the roster you actually published, with central oversight of the gaps, not a hope that leftover lines work themselves out at the sites.
LCME's 2025 strategic-visioning materials, also hosted on lcme.org, name competition for clinical clerkship placements as a standing challenge. Capacity is not a software feature. It is a constraint the master schedule has to respect, which is why leftover-line cleanup includes empty required seats and why a post-freeze swap that a site did not accept is not done.
Pull the current Functions and Structure edition that matches your survey year from the Resources tab before you cite any other element. The Secretariat and those publications remain the only official statement of intent.
The operating checklist
Download the scheduling operating checklist (CSV) if you would rather import it into Excel, Google Sheets, or your own tracker: every task above as a row, grouped by phase, with columns for the suggested owner, timing relative to the block or clerkship period, status, and notes. Put real names in the owner column, put real freeze dates in the timing column, then the standing list lives in the platform.
The workbook is a handoff into a standing process, not the system of record. If the roster, evaluation assignments, and work-hour record already live in one place, the named owner and freeze dates belong there.
Where the roster, evaluations, and hours stay together
Named owners and freeze dates are a standing process in the platform: people first, then a written cascade, then a system of record that keeps evaluations and the roster from drifting when a coordinator leaves.
The checklist above is how you walk that process in. Several of the failure points are records problems: the roster, the evaluation assignments, and the work-hour record drifting apart. Medtrics is one such platform. Enrollment, evaluations, and outcomes live in one system of record with a governed KPI layer and exportable analytics. See GME Leaders for how the named owner, the freeze, and leftover-line cleanup sit with the rest of the clinical calendar. Dedicated schedule-change-request, calendar-overlay, and personal calendar-sync capabilities are proposed for the claims register. They are not cited here.
None of this replaces the operating model. The named owner, the freeze date, the cascade, and leftover-line cleanup still do the work. A platform makes that boring structure durable when people leave.
Sources and status
This guide was verified against the following primary sources, each fetched on September 1, 2026. ACGME facts cover the Common Program Requirements page (all four posted versions effective July 1, 2026) and the Common Program Requirements (Residency) including FAQs, effective July 1, 2026, including the February 9, 2026 interim revision that suspended enforcement of selected requirements. LCME facts are limited to what was fetchable from lcme.org the same day. Current-year Functions and Structure PDFs were not fetchable from the public publications page; pull those editions from the Resources tab. SME review is still required on the ACGME work-hour paraphrase and on the LCME Element 8.6 quote (taken from a history document, not current-year Functions and Structure). Whatever this page says, the current documents on acgme.org and lcme.org remain the requirement.
- ACGME Common Program Requirements page: four posted versions, each effective July 1, 2026. acgme.org/what-we-do/accreditation/common-program-requirements
- ACGME Common Program Requirements (Residency) including FAQs, effective July 1, 2026: clinical and educational work-hour requirements 6.20 through 6.28, and the FAQ on monitoring and averaging. acgme.org/globalassets/pfassets/programrequirements/2026-prs/cprresidency_2026.pdf
- ACGME List of Suspended Common Program Requirements, effective February 9, 2026, including 6.24 and 6.24.a. acgme.org/globalassets/pfassets/programrequirements/2026-prs/list-of-suspended-common-program-requirements-effective-february-2026.pdf
- ACGME newsroom, June 10, 2025: scheduling named among coordinator responsibilities; tracking down faculty and residents and fellows to complete tasks named among top dissatisfiers. acgme.org/newsroom/2025/6/new-study-highlights-mental-health-and-job-satisfaction-challenges-among-gme-coordinators
- Slavin et al., Program and Institutional Coordinator Well-Being: Results From a National Survey, Academic Medicine, May 2025 (fielded August-September 2022): scheduling among named duties; tracking down residents, fellows, and faculty to complete required tasks among leading dissatisfiers. Survey percentages are not restated on this page. journals.lww.com/academicmedicine
- LCME publications page, March 9, 2026 notice: standards live under the Resources tab; the Secretariat and the publications on lcme.org are the only official sources. lcme.org/publications
- LCME history publication hosted on lcme.org, quoting Element 8.6 in full (wording as published in that document, not a fetch of the current-year Functions and Structure). lcme.org/wp-content/uploads/2026/03/October-2017-The-75-Year-History-of-the-LCME_COLOR.pdf
- AAMC Uniform Clinical Training Affiliation Agreement hosted on lcme.org: the school is ultimately responsible for the medical education program, academic affairs, and the assessment of medical students, and is primarily responsible for the appointment and assignment of teaching faculty. lcme.org/wp-content/uploads/2025/09/AAMC-Uniform-Clinical-Affiliation-Agreement_Standards-Affirmed-2019.pdf
- LCME Learn Serve Lead 2025 slides: Challenge #3, competition for clinical clerkship placements. lcme.org/wp-content/uploads/2026/03/LCME_LSL_2025_10-8-25_FINAL.pdf
ACGME, LCME, and AAMC are named descriptively. This article is an independent operational guide from Medtrics, not accreditor guidance, and nothing here promises any accreditation outcome; the work does that, or nothing does.