Graduate Medical Education Policy and Procedure Manual Effective

Transcription

1 Graduate Medical Education Policy and Procedure Manual Effective These Policies and Procedures establish the guidelines for residency and fellowship training at Children s Mercy Hospital (CMH). These guidelines reflect minimum training policies. Programs must meet these minimum guidelines, but are free to adopt more rigorous policies as they see fit or as necessary to meet the requirements of the Accreditation Council for Graduate Medical Education (ACGME) or other accrediting organizations. When conflicts exist between Graduate Medical Education (GME) Policies and Procedures and individual Program policies, GME Policies and Procedures will take precedence. Similarly, should conflict arise between GME Policies and Procedures or the Program policies and the requirements of the ACGME or other accrediting organizations, the policy of the accrediting organization will take precedence. Any other conflicts that arise between CMH written training policies and other guidelines or policies will be resolved by the Chair or Vice Chair of GME and the CMH Executive Vice-President/Executive Medical Director. The content of this manual is subject to change. Unless otherwise noted, all policies become effective upon publication on the CMH external website. Page 1 of 50 Last Updated: 7/1/2013

2 TABLE OF CONTENTS 1. ABOUT CHILDREN S MERCY HOSPITALS & CLINICS Mission and Vision 4 2. INTRODUCTION TO GRADUATE MEDICAL EDUCATION ACGME Graduate Medical Education Committee 5 3. ACCREDITED RESIDENCY AND FELLOWSHIP TRAINING PROGRAMS 7 4. SELECTION AND APPOINTMENT OF RESIDENTS/FELLOWS Eligibility Application Interviews Selection Appointment 9 5. AGREEMENT OF APPOINTMENT Oversight of Appointments Parties Term Appointment Level Stipend (Salary) Benefits Modification of Amendment Nonrenewal Restrictive Covenants Severance by the Resident/Fellow Decision by the Sponsoring Institution not to Offer Subsequent Appointment Closure of a Program Annulment Transfers RIGHTS AND RESPONSIBILITIES The Resident/Fellow Responsibilities Hospital Responsibilities Program Director Responsibilities Levels of Supervision Transitions of Care Records Management Needle Stick Guidelines for Industrial Sales Representatives (Vendors) BENEFITS Health Care Plans Income Protection & Security Take CARE Wellness Programs Retirement Plans Time off Plans Other Benefits EQUAL OPPORTUNITY EMPLOYMENT ANTI-DISCRIMINATION/ANTI-HARASSMENT RESIDENTS/FELLOWS WITH DISABILITIES Definitions Procedure CODE OF PROFESSIONAL AND PERSONAL CONDUCT Professionalism Personal Appearance Name Badge Smoking and Tobacco Free Environment DRUG AND ALCOHOL POLICY Employee Assistance for Drug or Alcohol Related Problems Return to Work Employee Knowledge of Substance Misuse and Illegal Activity Testing of Employees Definitions Release of Information 32 Page 2 of 50 Last Updated: 7/1/2013

3 12.7 Workers Compensation and Employment Exclusions RESIDENT/FELLOW IMPAIRMENT Definitions Procedure PERSONAL USE OF SOCIAL MEDIA Guidelines for CMH Employees Participation in Non-Hospital Social Media Inappropriate Postings EDUCATIONAL PROGRAM & ACGME COMPETENCIES INTERNATIONAL ROTATION/EDUCATIONAL UNIT Eligibility Criteria for Internal Elective Rotation/Educational Unit Travel Criteria Return from Travel DUTY HOURS AND CALL SCHEDULES Limitations on Duty-hours Minimum Time Off between Scheduled Duty Periods Maximum Frequency for In-House Night Float Call Frequency EXTRA SHIFTS AND MOONLIGHTING EVALUATION Resident/Fellow Evaluation Faculty Evaluation Program Evaluation and Improvement PROMOTION AND PROGRAM COMPLETION Promotion/Advancement Program Completion CORRECTIVE ACTIONS, SUSPENSION AND TERMINATION Categories and Criteria Authority Reporting Obligations Remediation Probation Suspension Termination Due Process Voluntary Withdrawal from a Program GRIEVANCES Grievable Matters Non-Grievable Matters Grievance Procedures 47 Page 3 of 50 Last Updated: 7/1/2013

4 1. CHILDREN S MERCY HOSPITALS & CLINICS From our beginning as a single bed hospital in 1897, Children s Mercy Hospital (CMH) in Kansas City has grown into the pediatric specialty provider of choice for families throughout the region. Working closely with community physicians and hospitals, CMH makes the highest quality pediatric expertise and care a priority. We are here for all children. CMH is committed to providing service excellence and efficiency to everyone we serve. We achieve our high standards through leadership in clinical care, education and research; all focused exclusively on children and their unique needs. Clinical Care Medical staff of over 700 pediatric specialists A comprehensive range of programs and services, representing more than 40 pediatric specialties First hospital in Missouri or Kansas to receive magnet designation from the American Nurses Credentialing Center for superior nursing quality Education Affiliation with University of Missouri-Kansas City (UMKC) School of Medicine Pediatric Fellowship training in over 36 subspecialties Residency training in Pediatrics, Internal Medicine & Pediatrics, Clinical Child Psychology, Dentistry, Pediatric Optometry, and an integrated Child Neurology Program Medical student clerkship in Pediatrics for the UMKC School of Medicine Medical student electives Research A research vision that includes clinical pharmacology and personalized medicine, genetics, oncology, neonatology, immunology and health outcomes A nationally designated Pediatric Pharmacology Research Unit that provides state-of-the-art facilities for clinical trials A collaborating partner for Frontiers: The Heartland Institute for Clinical and Translational Science Awards Mission and Vision Mission CMH provides the highest level of medical care, technology, services, equipment and facilities in promoting the health and well-being of children in the region, from birth through adolescence. Patients and their families are treated with compassion in a family-centered environment that recognizes their physical, emotional, financial, social and spiritual needs. The comprehensive health care environment provided by the hospital includes clinical services, research and teaching efforts which are designed to serve today's and tomorrow's children and the community in which they live. Vision CMH commits to providing quality pediatric medical care with service excellence and efficiency to everyone we serve. 2. INTRODUCTION TO GRADUATE MEDICAL EDUCATION The Graduate Medical Education (GME) Department prepares physicians for practice in a medical specialty or subspecialty. GME focuses on the development of professional skills and clinical competencies as well as on the acquisition of medical knowledge in a specialty or subspecialty. The GME process is intended to prepare the physician for the independent practice of medicine and to assist in the development of a commitment to the life-long learning process that is critical for maintaining professional growth and competency. The single most important responsibility of the GME Department is to provide an educational training Program with guidance and supervision of the Resident/Fellow that facilitates professional and personal growth while ensuring safe and appropriate patient care. Residents/Fellows are expected to assume progressively greater responsibility through the course of training, consistent with individual growth in clinical experience, knowledge and skill. Page 4 of 50 Last Updated: 7/1/2013

5 The education of Residents/Fellows relies on an integration of didactics into a structured curriculum with the clinical care under appropriate levels of supervision. The quality of the GME experience is directly related to the quality of patient care. Upon satisfactory completion of a training Program, the Resident/Fellow is prepared to undertake independent practice within the chosen specialty or subspecialty. Residents/Fellows in Programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) typically complete the educational requirements for certification by a specialty board recognized by the American Board of Medical Specialties (ABMS). The level of stipends (salaries), the provision of other benefits, the duty hours, the length of training Programs, the rotation/educational unit of Residents/Fellows to various services, and the methods of testing and evaluating Residents/Fellows, are necessarily determined by the hospital, the Programs and Sponsoring Institution based on ACGME and specialty board guidelines. CMH recognizes that with the authority vested in the Hospital to determine the terms of the Agreement of Appointment comes the responsibility to provide levels of support sufficient to allow the Residents/Fellows to pursue their educational goals and to administer the Programs fairly and uniformly. 2.1 ACGME 1 The ACGME is a private, nonprofit council that evaluates and accredits residency and fellowship programs in the United States. The ACGME was established in 1981 from a consensus in the academic medical community for an independent accrediting organization. The mission of the ACGME is to improve health care by assessing and advancing the quality of resident physicians' education through exemplary accreditation. The ACGME has 28 Review Committees (one for each of the 26 specialties, one for a special one-year transitional-year general clinical program, and one for institutional review). Each Residency Review Committee (RRC) comprises about 6 to 15 volunteer physicians. Members of the RRC are appointed by the American Medical Association (AMA) Council on Medical Education and the appropriate medical specialty boards and organizations. Members of the Institutional Review Committee and Transitional Year Committee are appointed by the ACGME Executive Committee and confirmed by the Board of Directors. The ACGME's member organizations are the American Board of Medical Specialties, American Hospital Association, American Medical Association, Association of American Medical Colleges, and the Council of Medical Specialty Societies. Member organizations each nominate four members to the Board of Directors, which also includes two resident members the chair of the Council of Review Committee Residents and a resident member appointed by the Resident and Fellow Section of the AMA three public directors, the chair of the Council of Review Committees, one to four at-large directors, and a non-voting federal representative. 2.2 Graduate Medical Education Committee 2 CMH is the ACGME accredited institutional sponsor for the Child Neurology, Clinical Neurophysiology, Pediatric Otolaryngology, and Pediatric Rehabilitation Medicine Fellowship Programs. CMH also sponsors and supports other programs that are accredited by specialty boards or other accrediting or governing organizations. The UMKC School of Medicine is an ACGME accredited institutional sponsor for CMH programs in Pediatrics and a number of Pediatric Subspecialties. Policy and Procedure is defined by the applicable ACGME accredited Sponsoring Institution GMEC and by CMH. The ACGME accredited Sponsoring Institution (UMKC or CMH) Graduate Medical Education Committee (GMEC) monitors the regular review of all Residency/Fellowship training Programs regarding compliance with institutional policies and Program requirements. CMH GMEC meetings are held quarterly and minutes are maintained. The CMH GMEC is charged with establishing and implementing policies and procedures regarding the quality of education and the work environment for the Residents/Fellows in ACGME Programs. These policies and procedures include the following: ACGME Institutional Requirements, III Page 5 of 50 Last Updated: 7/1/2013

6 a. Stipends (salaries) and position allocation: Annual review and recommendations to the Sponsoring Institution regarding Resident/Fellow stipends (salaries), benefits, and funding for Resident/Fellow positions. b. Communication with Program Directors (PDs): i. ensure that communication mechanisms exist between the CMH GMEC and PDs; and ii. ensure that PDs maintain effective communication mechanisms with the site directors at each participating site for their respective Programs to maintain proper oversight at all clinical sites. c. Resident/Fellow duty hours: i. develop and implement written policies and procedures regarding Resident/Fellow duty hours to ensure compliance with the Institutional, Common, and specialty/subspecialty-specific Program Requirements; and ii. consider for approval requests from PDs prior to submission to an RRC for exceptions in the weekly limit on duty hours up to 10 percent or up to a maximum of 88 hours in compliance with ACGME Policies and Procedures for duty hour exceptions. d. Resident/Fellow supervision: i. provision of safe and effective patient care; ii. educational needs of Residents/Fellows; iii. progressive responsibility appropriate to Residents /Fellows level of education, competence, and experience; and iv. other applicable Common and specialty/subspecialty-specific Program Requirements. e. Communication with Medical Staff: Communication between leadership of the Medical Staff regarding the safety and quality of patient care that includes: i. the annual report to the Office of Medical Staff; ii. description of Resident/Fellow participation in patient safety and quality of care education; and, iii. the accreditation status of programs and any citations regarding patient care issues. f. Curriculum and evaluation: Assurance that each program provides a curriculum and an evaluation system that enables Residents/Fellows to demonstrate achievement of the ACGME general competencies as defined in the Common and specialty/subspecialty-specific Program Requirements. g. Resident/Fellow status: Selection, evaluation, promotion, transfer, corrective action, and/or dismissal of Residents/Fellows in compliance with the Institutional and Common Program Requirements. h. Oversight of program accreditation: Review of all CMH ACGME program accreditation letters of notification and monitoring of action plans for correction of citations and areas of noncompliance. i. Management of CMH institutional accreditation: Review of CMH ACGME letter of notification from the IRC and monitoring of action plans for correction of citations and areas of noncompliance. j. Oversight of program changes: Review of the following for approval, prior to submission to the ACGME by PDs: i. all applications for ACGME accreditation of new Programs; ii. changes in Resident/Fellow complement; iii. major changes in program structure or length of training; iv. additions and deletions of participating sites; v. appointments of new PDs; vi. progress reports requested by a Review Committee; vii. voluntary withdrawal of Program accreditation; viii. requests for an appeal of an adverse action; and, ix. appeal presentations to a Board of Appeal or the ACGME. k. Experimentation and innovations: Oversight of all phases of educational experiments and innovations that may deviate from Institutional, Common, and specialty/subspecialty-specific Program Requirements, including: i. approval prior to submission to the ACGME and/or respective Review Committee; ii. adherence to Procedures for Approving Proposals for Experimentation or Innovative Projects in ACGME Policies and Procedures; and iii. monitoring quality of education provided to Residents/Fellows for the duration of such a project. l. Oversight of reductions and closures: Oversight of all processes related to reductions and/or closures of: i. individual Programs; ii. major participating sites; and, iii. the Sponsoring Institution. Page 6 of 50 Last Updated: 7/1/2013

7 3. RESIDENCY AND FELLOWSHIP TRAINING PROGRAMS Program Length of Program Accrediting Organization Institutional Sponsor Medical Specialty Board offering Certification Pediatrics 3 ACGME UMKC Allergy/Immunology 2 ACGME UMKC Child Abuse Pediatrics 3 ACGME UMKC Child Neurology 5 ACGME CMH Clinical Child Psychology Internship 1 APA CMH n/a* Clinical Child Psychology Fellowship 1 n/a* CMH n/a* Clinical Cytogenetics 2 ACGME CMH Clinical Neurophysiology 1 ACGME CMH Developmental-Behavioral Pediatrics 3 ACGME UMKC Molecular Genetics 2 ABMG CMH Neonatal-Perinatal Medicine 3 ACGME UMKC Pediatric Adolescent Gynecology 3 n/a* UMKC n/a* Pediatric and Congenital 1 n/a* CMH n/a * Cardiovascular Perfusion Pediatric Cardiology 3 ACGME UMKC Pediatric Clinical Pharmacology 3 ABCP CMH Pediatric Critical Care Medicine 3 ACGME UMKC Pediatric Dentistry 1 CODA CMH n/a* Pediatric Dermatology 1 ABD CMH Pediatric Emergency Medicine 3 ACGME UMKC Pediatric Endocrinology 3 ACGME UMKC Pediatric Ethics and Genomics 1 n/a CMH n/a* Pediatric Gastroenterology 3 ACGME UMKC Pediatric Hematology/Oncology 3 ACGME UMKC Pediatric Hospital Medicine 3 AAP CMH Pediatric Infectious Diseases 3 ACGME UMKC Pediatric Nephrology 3 ACGME UMKC Pediatric Ophthalmology 1 AAPOS CMH n/a* Pediatric Optometry 1 ACOE CMH n/a* Pediatric Otolaryngology 1 ACGME CMH n/a* Pediatric Pathology 3 ACGME UMKC Pediatric Radiology 1 ACGME UMKC Pediatric Rehabilitation Medicine 2 ACGME CMH Pediatric Surgery 2 ACGME UMKC Sleep Medicine 3 ACGME UMKC Surgical Critical Care 1 ACGME UMKC Surgical Scholars 1 n/a* CMH n/a* AAP -American Academy of Pediatrics AAPOS: American Association for Pediatric Ophthalmology and Strabismus ABCP: American Board of American Pharmacology ABD: American Board of Dermatology ABMG - American Board of Medical Genetics ACGME: Accreditation Council for Graduate Medical Education ACOE: Accreditation Council on Optometric Education APA: American Psychological Association CODA: Commission on Dental Accreditation * No national accrediting organization exists and/or no specialty certification offered at this time 4. SELECTION AND ELIGIBILITY OF RESIDENTS/FELLOWS Page 7 of 50 Last Updated: 7/1/2013

8 4.1 Eligibility 3 a. Applicants to the Clinical Child Psychology Internship training program must meet the following qualifications to be eligible for appointment as an Intern: i. enrolled in a doctoral program in professional psychology that requires internship training; ii. expected completion of a practicum experience by the start of internship. b. Applicants to the Pediatric Clinical Pharmacology Fellowship training program must meet the following qualifications to be eligible for appointment as a Fellow: i. possess an M.D., D.O., Ph.D, or Pharm. D degree; ii. must have completed an academic training program in either Pediatrics or Pediatric Pharmacotherapy; iii. must have a desire to pursue an academic career with an emphasis on the evaluation of drugs in children. c. Applicants for Clinical Cytogenetics and/or Molecular Genetic Fellowship training program(s) must meet the following qualification: i. Possess an MD, DO or PhD degree; PhD degree must be in genetics, human genetics, or related field within the biological sciences, as determined by the American Board of Medical Genetics and Genomics (ABMGG). ii. Individuals who hold doctoral degrees earned outside of the US, Canada or Puerto Rico or who have received their medical training outside of the US, Canada or Puerto Rico need to meet additional requirements determined by ABMGG (see web-site for details). d. Applicants to all other programs must meet the following qualifications to be eligible for appointment as a Resident/Fellow: i. graduation from a medical school in the United States, Canada or Puerto Rico accredited by the Liaison Committee on Medical Education (LCME); or ii. iii. iv. graduation from a college of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA); or graduation from a medical school outside the United States with successful completion of a Fifth Pathway Program provided by an LCME accredited medical school; or graduation from a medical school outside the United States, Canada or Puerto Rico with a current, valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG). All Canadian citizens and eligible Canadian Landed Immigrants who are NOT graduates of a foreign medical school must hold a Professional Worker (TN or Trade-NAFTA) non-immigrant Visa status and maintain proper TN status throughout the length of the graduate medical training Program. Possession of a valid I-94 card with stated TN status and CMH as the sponsor is required. All Canadian citizens and eligible Canadian Landed Immigrants who ARE graduates of a foreign medical school must seek and maintain sponsorship through the ECFMG for J-1 non-immigrant Visa status. CMH primarily accepts applicants with J-1 Visa status. To be eligible for appointment, all international citizens must be sponsored by the ECFMG for the J-1 nonimmigrant Visa classification and have and maintain valid ECFMG certification throughout the length of their training Program. In some cases, CMH will sponsor an H-1B Visa. Residents/Fellows who wish to change their immigration classification while pursuing a graduate medical training Program at CMH must seek prior written approval from the GME Department. Failure to seek such approval will subject the trainee to immediate termination from his/her training Program. 4.2 Application Application to a Program is the first step in the process of credentialing a Resident/Fellow for appointment. Most Programs either participate in the National Resident Matching Program (NRMP) or the San Francisco Match (SFM) as well as the Electronic Residency Application Service (ERAS). A list of participating Specialties and Programs can be found on the ERAS website at Applicants to Programs, who do not apply through ERAS or the SFM, must submit supporting credentials directly to the PD or Program Coordinator (PC). These include: 3 ACGME Institutional Requirements, II.A.1. Page 8 of 50 Last Updated: 7/1/2013

9 a. application form (Program application or the GME application); b. letters of recommendation; c. Medical School Performance Evaluation/Dean s letter; d. medical school/graduate school transcript; e. personal statement; f. USMLE or COMLEX transcript; g. ECFMG status report and copy of ECFMG certificate (for graduates of foreign medical schools); and h. curriculum vitae. Applicants beyond the PGY 1 level must also provide evidence of successful completion of Part III of the USMLE and successful completion of previous PGY level(s). 4.3 Interviews Applicants invited for an interview will arrange the date with the PC. The applicant will arrange for transportation. If the applicant is traveling from outside the Kansas City metropolitan area, one night hotel accommodation at a designated local hotel will be provided by CMH and up to $300 of applicable travel costs will be reimbursed. During or prior to the interview day, the applicant will receive information on salary and benefits Selection 5 A selection committee consisting of the PD, Associate Program Director (APD), Chief Residents, if applicable, and representative faculty will review each candidate s application. The candidates will be ranked based on the strength of the application and personal interview. For those programs participating in the NRMP, the rank order list will be forwarded to the NRMP prior to the published deadline. Occasionally, candidates will be selected outside the NRMP in compliance with NRMP rules. It is the policy of CMH not to discriminate on the basis of race, color, religion, sex, pregnancy, sexual orientation, national origin, age, disability, veteran or military status, genetic information, or any other legally protected status in admissions or access to, or treatment or employment in its programs and activities, or in the provision of physician/staff privileges. 4.5 Appointment Before appointment and upon receipt of a contingent offer of appointment, the applicant will provide the Department of GME with the following documents: a. copy of signed Offer/Acceptance Letter; b. copy of signed Agreement of Appointment; c. proof of legal employment status (e.g., birth certificate, passport, naturalization papers, valid Visa) and verification of immigration and Visa status as well as a copy of an ECFMG certificate indicating the validation dates, if applicable; d. a copy of a current temporary or permanent license to practice medicine in the State of Missouri; e. a copy of a current temporary or permanent license in the appropriate jurisdiction, if their Program requires rotation/educational unit to affiliate institutions outside the State of Missouri; f. evidence of current certification in Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS) or Neonatal Resuscitation Program (NRP), as required by the individual Programs, unless certification is provided by the Program during orientation; g. verification of a Missouri Bureau of Narcotic and Dangerous Drug certificate if Resident/Fellow; h. a copy of a current Drug Enforcement Agency (DEA) registration. Residents/Fellows using the CMH DEA number and authorized suffix can write only for CMH patients. Residents/Fellows writing for other populations/institutions in the State of Missouri must obtain and use either an individual Missouri DEA number or use the other institution s DEA authorized suffix. A DEA registration issued for the State of Missouri is not valid for the State of Kansas or any other state. If the Resident/Fellow has a rotation/educational unit at CMH South in the State of Kansas, the Resident/Fellow must obtain a CMH DEA number and authorized suffix to write only for CMH South patients. If the Resident/Fellow 4 ACGME Institutional Requirements, II.C. 5 ACGME Institutional Requirements, II.A.2. Page 9 of 50 Last Updated: 7/1/2013

10 has a rotation/educational unit at an affiliate site in the State of Kansas, the Resident/Fellow must obtain an individual Kansas DEA number or use the other institution s DEA authorized suffix, and; i. all complete documents required for employment by the Hospital such as complete immunizations and TB testing, a complete and satisfactory background check, and a complete application for CMH employment. At the time of orientation, Residents/Fellows will receive any immunizations that are lacking. The Resident/Fellow will continue to meet the Hospital s and the state's standards for immunizations in the same manner as all Hospital personnel for the duration of their training. 5. AGREEMENT OF APPOINTMENT Oversight of Appointments Final approval of all Resident/Fellow Appointments is the responsibility of the GME Department. No offer of a position should be made without the approval of the GME Department. If the Resident/Fellow Appointment is based on incomplete, inaccurate or fraudulent information submitted by a candidate or Program during the application, selection, or appointment process, the Appointment can be rescinded in accordance with NRMP guidelines. 5.2 Parties The Agreement of Appointment allowing a Resident/Fellow to participate in a GME Program is between CMH and the individual Resident/Fellow (through the GME Department). Programs will not go into an Agreement of Appointment with a candidate for professional or educational services independently from the CMH GME Department. 5.3 Term 7 Unless modified by the Program and approved by the GME Department, the Agreement of Appointment term is one year, commencing on July 1st and ending on June 30th of the next year, and can be repeated yearly for the length of the training Program. The Agreement of Appointment does not constitute or imply a benefit, promise, option, or other commitment by the Hospital to offer a subsequent Agreement of Appointment, or otherwise renew or extend the Agreement of Appointment of the Resident/Fellow beyond the termination date of an existing Agreement of Appointment. The decision to offer a subsequent Agreement of Appointment to a Resident/Fellow does not imply a duty or obligation to simultaneously promote the Resident/Fellow to the next training level in the Program. Residents/Fellows subject to corrective actions or pursuing appeal and hearing of a proposed corrective action will not be offered a subsequent Appointment unless and until the corrective actions are completed or the appeal and hearing process produces a finding for the Resident/Fellow. 5.4 Appointment Level The Agreement of Appointment shall specify the Resident s/fellow s training level of appointment by both the postgraduate year level (PGY) and the Program training level. 5.5 Stipend (Salary) 8 6 ACGME Institutional Requirements, II.D. 7 ACGME Institutional Requirements, II.D.4.b) 8 ACGME Institutional Requirements, II.D.4.c) Page 10 of 50 Last Updated: 7/1/2013

11 All Residents/Fellows in CMH Programs receive stipends (salaries) as prescribed in the Resident/Fellow Agreement of Appointment. The base stipend (salary) is determined yearly by the Resident s/fellow s PGY level and is set during the annual budgetary process. The yearly stipends (salaries) are published and can be found on the GME Website. The stipends (salaries) will be taxable to the Resident/Fellow. 5.6 Benefits All Residents/Fellows employed by CMH have benefits as outlined in Section 7 (Benefits) of this manual. 5.7 Modification and Amendment All modifications and amendments to an Agreement of Appointment will be in writing, attached as addenda to the Agreement of Appointment, and referred to in the body of the Agreement of Appointment. 5.8 Nonrenewal 9 In instances where a Resident s/fellow s Agreement of Appointment is not going to be renewed, CMH will ensure that its programs provide the Resident(s)/Fellow(s) with a written notice of intent not to renew the Agreement no later than four months prior to the end of the Resident s/fellow s current Agreement of Appointment. However, if the primary reason(s) for the nonrenewal occurs within the four months prior to the end of the Agreement of Appointment, CMH will ensure that its programs provide the Residents/Fellows with as much written notice of the intent not to renew as the circumstances will reasonably allow, prior to the end of the Agreement of Appointment. 5.9 Restrictive Covenants Programs cannot make or enforce any covenants intended to restrict the choice of practice location, practice structure, or the professional activity of individuals who have completed their post-graduate medical education programs through the Agreement of Appointment. Any attempt to make or enforce such covenants will be grounds for sanction of the program Severance by the Resident/Fellow The Resident/Fellow may sever his/her Appointment at any time after notice to the PD and Chair or Vice Chair of GME, unless such notice is waived by the Sponsoring Institution. The Resident/Fellow will provide at least 60 days written notice of severance to the PD and the GME Department Decision by the Sponsoring Institution not to Offer Subsequent Appointment The treatment of the Resident/Fellow in the event of a decision to not offer a subsequent Appointment will be in compliance with the applicable personnel policies of the Sponsoring Institution, state and federal laws and regulations, and ACGME requirements. Considerations that may cause the Sponsoring Institution or Hospital not to offer a subsequent Agreement of Appointment include, but are not limited to, loss of funding for the position, reallocation of positions among the postgraduate Programs, loss of accreditation by the Program or Institution, decreased financial resources, or closure of the Program or Hospital. Such decisions, based solely on institutional factors, will be final and not subject to appeal or review under the provisions for due process and fair hearing. Further, such decision will not be grievable. In instances where an Agreement of Appointment is not going to be renewed, the Resident/Fellow will be provided notice of intent not to renew the Agreement of Appointment no later than 90 days prior to the end of the current Agreement of Appointment. However, if the primary reason for the nonrenewal occurs within the 90 days prior to the end of the Agreement 9 ACGME Institutional Requirements, II.D.4.d).(1) Page 11 of 50 Last Updated: 7/1/2013

12 of Appointment, the Hospital or Sponsoring Institution will ensure that the Resident/Fellow receives as much written notice of the intent not to renew as the circumstances will reasonably allow, prior to the end of the Agreement of Appointment. In the event of nonrenewal, the Resident/Fellow shall have the right to due process as described in Section 21.8 (Due Process) of this manual Closure of a Program 10 In the event that a Program or Sponsoring Institution is closing, de-accredited, or discontinued for any reason, through actions by the accrediting bodies, the GMEC, DIO and Residents/Fellows will receive written notification. The Sponsoring Institution will: a. allow Residents/Fellows already in the program(s) to complete their education or assist the Residents/Fellows in enrolling in an ACGME-accredited program(s) in which they can continue their education; b. provide stipend (salary) and benefits up until the conclusion of the term of the existing Agreement of Appointment; and c. provide appropriate notification to licensure and specialty boards Annulment A Resident's/Fellow s Appointment will be annulled and terminated automatically and immediately upon the rejection of the application for Missouri medical licensure or the suspension or termination of the Resident s/fellow s temporary or permanent license(s) in any jurisdiction; or if the Resident/Fellow fails to provide valid documentation to process them through Human Resources (e.g. valid social security number, valid identification, valid driver s license) The Resident/Fellow must report such rejection, suspension, or termination immediately to the PD and the GME Department. If, after a previous rejection, suspension or termination, the Resident/Fellow succeeds in obtaining a valid Missouri license, or if the suspended or terminated license is reinstated, the Resident/Fellow may again seek appointment. An Appointment will also be immediately annulled if: a. the Resident/Fellow is a foreign citizen whose Visa is revoked; b. the Resident/Fellow fails to provide valid credentials, including but not limited to diplomas, certificates of prior training, valid ECFMG certificate or copies of medical licenses; or c. the application or any documents submitted to the Hospital or any accrediting, certifying, or licensing agencies in the process of seeking an Appointment or license contains inaccurate, incomplete, or fraudulent information Transfers 11 Programs can accept Residents/Fellows transferring from another Program. Before a Program can accept a transfer, the PD must obtain written or electronic verification of previous educational experiences and a summative competency-based performance evaluation of the transferring Resident/Fellow. PD s must also provide timely verification of residency/fellowship education and summative performance evaluations for Residents/Fellows who leave a Program prior to completion. 6. RIGHTS AND RESPONSIBILITIES 12 The existence of a valid Agreement of Appointment between a Resident/Fellow and CMH establishes a series of explicit and implicit expectations, rights, obligations and responsibilities beyond those codified in the Agreement of Appointment. 10 ACGME Institutional Requirements, II.D ACGME Common Program Requirements III.C. 12 ACGME Institutional Requirements, II.D.4.a) Page 12 of 50 Last Updated: 7/1/2013

13 Although the Residents/Fellows are licensed to practice medicine in the State of Missouri and Kansas if applicable, their participation in clinical activities during their GME training is at the discretion of the Hospital, and the PDs. The participation of the Residents/Fellows in patient care must in no way interfere with the best interests and well-being of patients and is subject to these policies and procedures and to the terms and conditions set forth in the Agreement of Appointment. Residents/Fellows who do not comply with these policies and procedures or who violate the Agreement of Appointment may be subject to corrective action, suspension and termination as outlined in Section 20 (Promotion and Program Completion) of this manual. 6.1 The Resident/Fellow will: a. adhere to the policies and procedures for GME; b. adhere to the corresponding policies and procedures of all training facilities; c. adhere to the applicable federal, state, and local laws, as well as to the standards required to maintain accreditation by the Joint Commission (JC), ACGME, and any other relevant accrediting, certifying, or licensing organizations; d. participate fully in the educational and scholarly activities of the program, including the performance of scholarly and research activities as assigned or as necessary for the completion of educational requirements, meet educational conference attendance requirements, assume responsibility for teaching and supervising other Residents/Fellows and students, and participate in assigned Hospital committee activities; e. provide safe, effective, timely, efficient, equitable, and compassionate patient-centered care; f. adhere to the highest standards of professionalism at CMH and other training facilities; g. provide clinical services commensurate with his/her level of training, under appropriate supervision by the faculty medical staff, and at sites specifically approved by the Program; h. develop and follow a personal program of self-study and professional growth under the guidance of the PD and teaching faculty; i. acquire an understanding of ethical, socioeconomic, and medical/legal issues that affect the practice of medicine and GME training as prescribed by the appropriate ACGME or other accrediting body; j. fully cooperate with the Program and Sponsoring Institution in coordinating and completing ACGME accreditation submissions and activities, including: i. the timely completion of patient medical records, reports, duty hour logs, operative and procedure logs at CMH and training facilities; and ii. submission of timely and complete faculty and Program evaluations, and/or other documentation required by the ACGME, Sponsoring Institution, Department, and/or Program; k. acquire and maintain life support certification(s) as required by the Program and Hospital; l. adhere to the Hospital s Risk Management Program; m. report immediately to the CMH Legal Affairs & Risk Management Department any inquiry by any private or government attorney or investigator and refrain from communicating with any inquiring attorneys or investigators except merely to refer such attorneys and investigators to the Legal Affairs & Risk Management Department; n. report and refer any inquiry by any member of the press to the Hospital s Department of Community Relations; o. abide by the Hospital s institutional policies prohibiting discrimination and sexual harassment; p. meet CMH s and the State's standards for immunizations; q. return, at the time of the expiration or in the event of termination of the Agreement of Appointment, all Hospital and department property, including but not limited to books, equipment, badges, pagers, and complete all medical charts and Program evaluations; r. settle all professional and financial obligations; and permit the Hospital to obtain from and provide to all proper parties any and all information as required or authorized by law or by any accreditating body. Progress reports, letters and evaluations will be provided only to individuals, organizations and credentialing bodies that are authorized by the Resident/Fellow to receive them for purposes of pre-employment or pre-appointment assessments. This provision will extend the completion, termination or expiration of the Appointment; s. In those instances where a Resident/Fellow feels that a faculty physician s practices or judgments are impaired or are otherwise not in the best interests of a patient, the Resident/Fellow must report her/his concerns to the PD, Vice Chair of GME, Chair of GME and/or Division Director; t. participate in the CMH Quality and Safety Program; u. abide by the Hospital s Levels of Supervision as outlined in Section 6.4 (Levels of Supervision) of this manual; and v. abide by the Programs policy on transitions of care; Page 13 of 50 Last Updated: 7/1/2013

14 w. in the event of manmade, environmental, or other disasters, Residents/Fellows (classified as essential staff) are required to report to the hospital and provide help as determined by the hospital administration. The PD will provide the needed guidance to the Resident/Fellow during such emergencies. 6.2 The Hospital will: a. provide a stipend (salary) and benefits to the Resident/Fellow as stipulated in the applicable Agreement of Appointment; b. provide an educational training Program that meets the ACGME's accreditation standards or applicable accrediting body; c. use its best efforts, within the limits of available resources, to provide the Resident/Fellow with adequate and appropriate support staff and facilities in accordance with federal, state, local, and ACGME requirements; d. orient the Resident/Fellow to the facilities, rules, regulations, procedures and policies of the Hospital, Department and Program and to the ACGME s Institutional and Program Requirements; e. provide the Resident/Fellow with appropriate faculty classification of supervision for all educational and clinical activities; f. allow the Resident/Fellow to participate fully in the educational and scholarly activities of the Program and Hospital and in any appropriate institutional medical staff activities, councils and committees, particularly those that affect GME and the role of the Resident/Fellow in patient care; g. clearly communicate to the Resident/Fellow any expectations, instructions and directions regarding patient management; h. maintain an environment conducive to the health and well being of the Resident/Fellow; i. provide adequate food service while on in-house-call or otherwise engaged in clinical activities requiring the Resident/Fellow to remain in the Hospital overnight; j. provide adequate sleeping quarters to the Resident/Fellow while on in-house overnight call; k. provide personal protective equipment; l. provide patient and information support services; m. provide security; n. evaluate the educational and professional progress and achievement of the Resident/Fellow on a regular and periodic basis; o. provide a fair and consistent method for review of concerns and/or grievances, without the fear of reprisal; p. provide, upon satisfactory completion of the Program, a Certificate of Completion; and q. incorporate and monitor the Residents/Fellows participation in the CMH Quality and Safety Programs. 6.3 The Program Director will 13 : a. administer and maintain an educational environment conducive to educating the Residents/Fellows in each of the ACGME competency areas; b. oversee and ensure the quality of didactic and clinical education in all sites that participate in the program; c. approve a site director at each participating site who is accountable for Resident/Fellow education; d. approve the selection of Program faculty as appropriate; e. evaluate Program faculty and approve the continued participation of Program faculty based on evaluation; f. monitor Resident/Fellow supervision at all participating sites using the classifications of supervision outlined in Section 6.4 (Levels of Supervision) of this manual. g. prepare and submit all information required and requested by the ACGME, including but not limited to the program information forms and annual program resident updates to the Accreditation Data System (ADS), and ensure that the information submitted is accurate and complete; h. provide each Resident/Fellow with documented semi-annual evaluation of performance with feedback; i. ensure compliance with grievance and due process procedures as set forth in the Institutional Requirements and referenced in Sections 21.8 (Due Process) and 22 (Grievances) of this manual; j. provide verification of residency/fellowship education for all Residents/Fellows, including those who leave the program prior to completion; 13 ACGME Common Program Requirements, II.A.4. Page 14 of 50 Last Updated: 7/1/2013

15 k. implement policies and procedures consistent with the Institutional and Program requirements for Resident/Fellow duty hours and the working environment, including moonlighting, and, to that end, distribute these policies and procedures to the Residents/Fellows and faculty; l. monitor Resident/Fellow duty hours, according to Sponsoring Institution policies, with a frequency sufficient to ensure compliance with ACGME requirements; m. adjust schedules as necessary to mitigate excessive service demands and/or fatigue; and, if applicable, monitor the demands of at-home call and adjust schedules as necessary to mitigate excessive service demands and/or fatigue; n. monitor the need for and ensure the provision of back up support systems when patient care responsibilities are unusually difficult or prolonged; o. comply with the Sponsoring Institution s written policies and procedures, including those specified in the Institutional Requirements, for selection, evaluation and promotion of residents, corrective action, and supervision of residents; p. be familiar with and comply with ACGME and Review Committee policies and procedures as outlined in the ACGME Manual of Policies and Procedures; q. obtain review and approval of the Sponsoring Institution s GMEC/DIO before submitting to the ACGME information or requests for the following: i. all applications for ACGME accreditation of new programs; ii. changes in Resident/Fellow complement; iii. major changes in program structure or length of training; iv. progress reports requested by the Review Committee; v. responses to all proposed adverse actions; vi. requests for increases or any change to Resident/Fellow duty hours; vii. voluntary withdrawals of ACGME-accredited programs; viii. requests for appeal of an adverse action; ix. appeal presentations to a Board of Appeal or the ACGME; and x. proposals to ACGME for approval of innovative educational approaches. r. obtain DIO review and co-signature on all program information forms, as well as any correspondence or document submitted to the ACGME that addresses: i. program citations; and/or ii. request for changes in the program that would have significant impact, including financial, on the program or institution. 6.4 Levels of Supervision 14 For the resident/fellow, the essential learning activity is interaction with patients under the guidance and supervision of faculty members. As residents/fellows gain experience and demonstrate growth in their ability to care for patients, they can assume roles that permit them to exercise those skills with greater independence. This concept--graded and progressive responsibility-- is one of the core tenets of American graduate medical education. In the CMH clinical learning environment, all patient care provided by residents/fellows will be under the supervision of an identifiable, appropriately-credentialed and privileged attending physician who is ultimately responsible for that patient s care. PLA s between CMH and participating programs must include responsibilities for supervision of residents/fellows. The CMH medical record will demonstrate the involvement of the supervising attending physician in the patient s medical care. Each program must have a program-specific supervision policy that must include: 1. Definitions for the levels of supervision 2. The guidelines and circumstances when a resident/fellow is required to communicate with the supervising physician 3. Methods used by the PD to monitor supervision at all participating sites 4. Criteria used to determine readiness for graded increased responsibility of patient care over the course of training 14 ACGME Common Program Requirements, VI.D.3. Page 15 of 50 Last Updated: 7/1/2013

16 6.4a Definitions for Levels of Supervision 1. Direct supervision: The supervising physician is physically present with the resident/fellow and the patient. 2. Indirect supervision with direct supervision immediately available: The supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide direct supervision. 3. Indirect supervision with direct supervision available: The supervising physician is not physically present within the hospital or other site of patient care but is immediately available by means of telephonic and/or electronic modalities, and is available to provide direct supervision. 4. Oversight: The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. 6.4b Mechanisms to Report Inadequate Supervision Residents/fellows who feel they have had inadequate supervision can report their experience in a protected manner that is free from reprisal using one of three options: 1. Report the concern directly to their program director. 2. Report the concern to the Chair or Vice Chair of GME 3. Report via the hospital s Electronic Event Reporting System which may be submitted anonymously (if desired). In all situations the concerns will be thoroughly investigated by the PD and the Department of GME. The PD will be responsible for providing the Department of GME with a plan of action for substantiated reports. 6.5 Transitions of Care 15 Clinical assignments are designed to minimize the number of transitions in patient care. The Sponsoring Institution, CMH and each Program will monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety. Programs will ensure that Residents/Fellows are competent in communicating with team members in the handover process. CMH will ensure the availability of schedules that inform all members of the health care team of faculty and Residents/Fellows currently responsible for each patient s care. 6.6 Records Management Resident/Fellow files serve as both records of employment and academic program records. They are the primary source used for verification of training throughout the career of most physicians. As such, it is necessary that they are accurate and contain all information needed for licensure and medical privileges applications. The files also serve as a record of a Resident s/fellow s performance and competency. In order to ensure that all Residents/Fellows trained at CMH have training records that support their future needs, a uniform policy of minimal standards for records management is implemented. This policy recognizes four categories of Resident/Fellow: a. Residents/Fellows who are accepted into and complete their program; b. Residents/Fellows who are accepted into but do not complete their program; c. Individuals that apply and are interviewed for the program but do not enroll in the program; d. Individuals that apply for the program but are not interviewed for a program position. Program Applicants: It is important that an accurate description of the applicant pool is maintained for a minimum of three years. This can be most effectively accomplished by maintaining each application (either electronically or in hard copy). The application includes the standard application form plus all supporting documents (personal statement, exam scores, letters of recommendation). A Resident/Fellow Selection Policy outlining the criteria used to select Residents/Fellows for the training program is acceptable. Interviewed Applicants: All records pertaining to interviewed applicants must be maintained for a minimum of three years. In addition to the full application and supporting documents, this would typically include interview evaluation forms used by the program to obtain feedback from program faculty and Residents/Fellows about each applicant. 15 ACGME Common Program Requirements, VI.B. Page 16 of 50 Last Updated: 7/1/2013

17 Program Resident/Fellow: Resident/Fellow files are kept in three categories: a. employment and immigration records maintained by CMH Human Resources; b. contract, credentialing, and academic records maintained by GME; and c. health records maintained by Occupational Health GME will be responsible for maintaining records related to Resident/Fellow academic program participation, completion, and medical/dental/optometry licensure. The required elements of the GME Resident/Fellow file should include: a. agreement of appointment; b. state medical/dental license; c. BNDD/DEA Certification; d. ECFMG certificate (for graduates of foreign medical schools); e. completion/certificate of Completion; f. consent for release of information; g. written performance evaluations from faculty and others; h. semi-annual summary evaluations from the PD or selected faculty; i. record of the resident s/fellow s rotations and other training experiences; j. record of surgical and procedural training; k. corrective action; l. moonlighting approval form (for applicable residents); m. documentation of prior training and performance evaluation (for transferring residents); and n. any other information specifically required by the training program accrediting body. GME files will be kept electronically and will be available for the Resident/Fellow to review. Resident/Fellow should give GME 48 hours to retrieve the documents. 6.7 Needle Stick Residents/Fellows exposed to a needle stick need to report to Occupational Health immediately or page the CMH Occupational Health Nurse Supervisor. If the needle stick occurs at a participating site other than CMH, the Resident/Fellow will follow the policy at that facility and report to CMH Occupational Health the following day. 6.8 Guidelines on Industry Gifts Residents/Fellows will observe AMA Guidelines 16 on Industry Gifts. a. Unacceptable Gifts: Cash; Subsidies for travel, lodging or personal expenses, or in compensation of time spent for physician attending conferences/meetings; Payment for token focus groups, consulting or advisory services; or Gifts with strings attached, such as those given in relation to a physician s prescribing practices. b. Acceptable Gifts: Textbooks and other educational gifts not of substantial value; Work-related gifts of minimal value; pens, note pads and penlights; Subsidies to underwrite the costs of continuing medical education conferences or professional meetings; Scholarships for medical students and Residents/Fellows to attend educational conferences, if selection and payment is made by the academic institution; Reasonable compensation and reimbursement of expenses sustained by consultants; and modest meals, in conjunction with educational programs. 7. BENEFITS 7.1 Health Care Plans The Resident/Fellow is eligible to participate in the following Take Care benefits plans at CMH s expense. Coverage is effective the first day of their Program Page 17 of 50 Last Updated: 7/1/2013

18 Residents/Fellows are required to enroll/re-enroll in Health Care benefits on an annual basis. To maintain enrollment in the Enhanced or Premium Medical Plans you must complete the Health Basics Check and Health Risk Assessment on an annual basis. a. Medical Coverage 17 - CMH provides three account-based medical plan options, which provide comprehensive coverage designed to promote your wellness. b. Prescription Drug Coverage - CMH provides comprehensive prescription drug coverage when enrolled in a medical plan. You must enroll in a medical plan to have prescription drug coverage. c. Vision Coverage - CMH provides basic vision coverage when enrolled in a medical plan. Coverage for frames, lenses and contacts is available at the Resident s/fellow s expense. d. Dental Coverage - CMH offers three dental plan choices, which differ in the services they cover. All three plans provide coverage for preventative and basic services. Major services, including crowns/bridges/dentures, are covered in two of the plans and orthodontia is only covered in one of the plans. e. Flexible Spending Accounts (FSAs) - CMH offers two FSA plans, including the Health Care FSA and the Dependent Care FSA. FSAs enhance financial wellness by saving you money; allowing you to set aside money from your paycheck pretax to pay for eligible health or dependent care expenses. The Health Care FSA reimburses for eligible out-of-pocket health care expenses not covered by the health plans. The Dependent FSA reimburses for eligible dependent care expenses. f. Employee Assistance Program (EAP) 18 - Residents/Fellows who are employed by CMH may use the ComPsych EAP for confidential assessment, short term counseling and referrals on a variety of topics. Residents/Fellows are encouraged to first speak with their PD, APD, Vice Chair or Chair of GME before using the EAP. i. Services are available to all employees and their family members, whether enrolled in a medical plan or not. ii. There is no cost for short-term counseling with ComPsych. Employees are responsible for costs not covered by medical coverage when an outside referral is recommended by a ComPsych counselor. iii. Services are available for: Confidential Counseling - This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultants(SM) - highly trained master s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling and other resources for: o Stress, anxiety and depression o Job pressures o Relationship/marital conflicts o Grief and loss o Problems with children o Substance abuse Financial Information and Resources - Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues, including: o Getting out of debt o Retirement planning o Credit card or loan problems o Estate planning o Tax questions o Saving for college Legal Support and Resources o Divorce and family law o Real estate transactions o Debt and bankruptcy o Civil and criminal actions o Landlord/tenant issues o Contracts Work-Life Solutions o Child and elder care o College planning 17 ACGME Institutional Requirements, II.D.4.g) 18 ACGME Institutional Requirements, II.D.4.k) Page 18 of 50 Last Updated: 7/1/2013

19 iv. o Moving and relocation o Pet care o Making major purchases o Home repair GuidanceResources Online For additional information about the program, contact CMH Human Resources at (816) Call ComPsych at (TDD: ) or visit guidanceresources.com using our company Web ID: CMH 7.2 Income Protection & Security a. Basic Life and Accidental Death and Dismemberment (AD&D) Coverage - CMH provides basic life and accidental death and dismemberment (AD&D) insurance at no cost to Residents/Fellows. Basic life insurance coverage equals one times your annual pay rate, rounded up to the nearest $1,000, to a maximum of $500,000. Basic AD&D coverage matches your basic life insurance benefit, up to a maximum of $100,000. b. Supplemental Life and Accidental Death and Dismemberment (AD&D) Coverage - CMH provides optional coverage to Residents/Fellows. Coverage equal to 1, 2, 3, 4, or 5 times your annual pay rate is available, up to a maximum of $1 million. This request may require evidence of insurability to document proof of good health. Supplemental AD&D coverage matches your supplemental life insurance benefit, up to a maximum of $100,000. c. Long-Term Disability Coverage 19 - CMH provides long-term disability coverage at no cost to Residents/Fellows. This benefit pays 60% of your pay rate, up to $15,000 a month, if you are disabled and unable to perform the essential duties of your job because of accidental bodily injury, sickness, mental illness, substance abuse or pregnancy. Coverage is effective following a 90-day waiting period and ends when you are medically able to return to work. d. Short-Term Disability Coverage 20 - CMH provides this optional coverage to Residents/Fellows at their expense. Residents/Fellows are encouraged to sign up for this benefit. This benefit pays 60% of your pay rate from the 15th to the 90th day of your disability, or until you are released to work, whichever is earlier. The plan may fill the gap until long-term disability coverage is effective. e. Critical Illness Coverage - CMH provides this optional coverage to Residents/Fellows who sign up for such. This benefit pays a one-time tax-free payment upon diagnosis of a coverage critical illness or condition, e.g., heart attack, stroke, and transplants. f. Long-Term Care Coverage - CMH provides this optional coverage to Residents/Fellows who sign up. This benefit covers services for individuals with chronic illnesses or injuries who are unable to care for themselves over relatively long periods of time, including home-health, assisted living or nursing home care. 7.3 Take CARE Wellness Programs CMH provides employees with a variety of wellness tools, including: access to a personal Health Coach who will work with you to design a program to get you on the road to wellness; year-round programs on a variety of topics, including smoking cessation, weight loss and more; a wellness newsletter to make you aware of upcoming wellness-related opportunities; and online wellness tools and information, including recipes, exercise programs, articles, a health risk assessment and more. 7.4 Retirement Plan and Tax-Deferred Annuity (TDA) Plan The CMH retirement plan is a money purchase pension plan. When eligible Residents/Fellows are automatically entered into the retirement plan, it is effective the 1st of the month following two years of service. Children s Mercy s makes contributions based on your age plus years of service: If your age plus years of service is: Children s Mercy s contributes: <50 3.0% % % >70 6.0% 19 ACGME Institutional Requirements, II.D.4.g) 20 ACGME Institutional Requirements, II.D.4.g) Page 19 of 50 Last Updated: 7/1/2013

20 All the money is tax-deferred and Residents/Fellows have the choice of investment options with TIAA-CREF. CMH also provides employees with a 403(b) or tax-deferred annuity (TDA) plan. TDA plans allow you to save for retirement by making pre-tax contributions to tax-deferred annuities beginning the first of the month following your date of hire. Employees who have two or more years of service and who make contributions to a TDA plan will receive a matching contribution of up to 3 percent. To receive the full 3 percent match, you must make a 6 percent or greater contribution to your TDA. 7.5 Time off Plans While Residents/Fellows have several options to have time off away from work, taking time away from your training can extend the length of your program. Please check with your PC.. a. Vacation - The Resident/Fellow is eligible for up to 20 days of paid vacation, exclusive of Saturdays, Sundays and holidays annually. Vacation may be taken during approved rotations/educational units, and must be approved in advance by the PD or his/her designee. Vacation also may be used concurrently with an approved leave of absence. Vacation may not be carried over from Agreement of Appointment year to the next and no payment will be made for unused vacation at the termination of the Appointment. b. Paid Sick Time/Extended Illness Time (EIT) - The Resident/Fellow will accrue one day of paid time off for illness after each full month of service. If the Resident/Fellow has no accrued paid time off for illness, time off for illness will be without pay, unless the Resident/Fellow uses available vacation days or the Resident/Fellow qualifies for worker s compensation or long-term disability insurance. Accrued paid time off for illness may be used concurrently with an approved leave of absence due to illness of self or family members. Accrued paid time off for illness may be carried over from one Agreement of Appointment year to the next. Residents/Fellows are limited to a maximum EIT balance of 60 days. No payment will be made for unused accrued paid time off for illness at termination of the Appointment. c. Family Illness Paid Time (FIP) - The Resident/Fellow will have 10 days during their program for time off to care for an immediate family member with a serious medical condition. FIP may also be used if you are the spouse or domestic partner of a primary caregiver after the birth or adoption of a child. Anticipated leaves must be scheduled with the approval of the PD. In these situations FIP must be used in the period immediately following the birth of the child or placement of the adopted child in your home. Residents/Fellows must first utilize 2 workdays of vacation to replace scheduled work hours before using FIP. FIP may be taken all at once, intermittently, or on a reduced work schedule. d. Bereavement Leave - Residents/Fellows are allowed five (5) days per year to attend funeral services of an immediate family member (spouse, domestic partner, children, or parent). If the death involves an immediate family member and the Resident/Fellow will require more time off, the Resident/Fellow should contact the PD as soon as feasible. Extended time off may be taken as a leave of absence. Residents/Fellows also are allowed three (3) days per year to attend funeral services for a sibling, grandparent, in-laws, or any person living in the Residents/Fellows household at the time of death. Bereavement days do not count as vacation or sick days. The Resident/Fellow should notify the PD as soon as possible so service coverage can be addressed. e. Leave of Absence (LOA) 21 - Residents/Fellows are eligible for an LOA after 90 calendar days of employment. i. These leaves of absence are not eligible under the Family and Medical Leave Act (FMLA) and are granted on a case-by-case basis by the PD and are normally unpaid. o The ability to use vacation and/or EIT time will be decided by the PD. The decision will be based on the underlying need for the leave. o Reasons for which an LOA may be granted include: the birth of a child or placement of a child by adoption or foster care; the serious health condition of a Resident/Fellow; the serious health condition of a Resident s/fellow s family member; and other circumstances. The Resident/Fellow may be required to make up all rotation/educational units missed. o The Resident/Fellow may be terminated from the Program if the length of the LOA extends beyond six (6) months. o If the Resident/Fellow is terminated due to an extended leave, he/she may reapply to the Program. ii. Residents/Fellows are eligible for an LOA which may qualify for the benefits of FMLA, including up to 12 weeks of job protected leave, after one year of employment. 21 ACGME Institutional Requirements, II.D.4.h) Page 20 of 50 Last Updated: 7/1/2013