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2 On behalf of the Dean, DIO, directors, faculty and staff, we welcome you to the Residency Programs at The University of Texas Rio Grande Valley School of Medicine. We hope the time you spend with us will be educational and enjoyable. All information outlined in this manual is subject to periodic review and change. Revisions may occur as needed. Residents are responsible for familiarizing themselves with and adhering to the policies and guidelines contained in this manual. Graduate Medical Education Associate Deanship table of contents Residency Positions Resident Eligibility Stipend Leave Policies Impaired Resident/Fellow Policies and Procedures Dress Code Residents Responsibilities Evaluation Clinical Competency Committee Supervision Resident Mentoring Completion of Licensing Examinations Resident Promotion, Dismissal, Non-renewal or Non-Promotion Resident Grievance and Appeal Procedure Resident Duty Hours Closure Policies Moonlight Policy Transitions of Care Resident Travel Affiliation Contracts for Rotations Clinical Rotations/Visiting Residents Internet and Social Networking Graduate Medical Education Committee Clinical Learning Environment Review (CLER) graduate medical education manual 3

3 GRADUATE MEDICAL EDUCATION Graduate Medical Education prepares physicians for practice in a medical specialty. GME focuses on the development of professional skills and clinical competencies, as well as on the acquisition of detailed factual knowledge in a specialty. 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 any GME program is to provide an organized educational program, with guidance and supervision of the resident that facilitates professional and personal growth while ensuring safe and appropriate patient care. A resident will be expected to assume progressive greater responsibility through the course of a residency, consistent with individual growth in clinical experience, knowledge and skill. The education of residents relies on an integration of didactic activities in a structured curriculum, with the diagnosis and management of patients under appropriate levels of supervision. The quality of the GME experience is directly related to the quality of patient care. Within any program, the quality of patient care must be given the highest priority. A proper balance between educational quality and the quality of patient care must be maintained. A program must not rely on residents solely to meet service needs and, in doing so, compromise both the quality of patient care and of resident education. Upon satisfactory completion of a residency, the resident is prepared to undertake independent practice within the chosen specialty. The resident s primary role is that of a trainee in an educational program, rather than an employee. In the educational setting, the level of stipends, the availability of other benefits, the duty hours, the length of training programs, the rotations of residents to various services, and the methods of testing and evaluation residents, are determined by the programs and the sponsoring institution based on the guidelines provided by the ACGME ( org) and the various Residency Review Committees and specialty boards. Furthermore, the decision to reappoint or promote a resident is to be made by the officers of the program based upon evaluation of both the resident s performance and potential for future growth. 4 graduate medical education manual 5

4 Location: Regional Academic Health Center Suite Treasure Hills Blvd. Harlingen, Texas P: F: Yolanda Gomez, M.D. Associate Dean Designated Institutional Official Mrs. Amy Knudsen-Stout Senior GME Program Coordinator Matiana Gonzalez-Wright, EdD, MeD Director of Quality Assurance ASSOCIATE DEANSHIP GRADUATE MEDICAL EDUCATION The Graduate Medical Education Institutional Office of The University of Texas Rio Grande Valley complies with the Institutional Requirements established by the Accreditation Council for Graduate Medical Education (ACGME) and is governed by the policies of the Graduate Medical Education Committee. Oversight of the education and wellbeing of physicians in training at the UTRGV is vested in the Graduate Medical Education Committee, led by a Designated Institutional Official (DIO), which is charged with the following: To ensure the DIO and program directors have sufficient financial support and protected time to effectively carry out their educational and administrative responsibilities; To establish sufficient salary support and resources allowing for effective administration of the GME Office and all of its GME programs; To create and maintain appropriate oversight of and liaison with program directors, and assurance that program directors establish and maintain proper oversight of and liaison with appropriate personnel of other institutions participating in the GME programs sponsored by the institutions; To manage and implement procedures ensuring that the DIO, or a designee in the absence of the DIO, reviews and cosigns all GME programs information forms and any documents or correspondence submitted to the ACGME by the program directors; To regularly review all ACGME letters of notification and the monitoring of action plans for the correction of areas of non-compliance; To present an annual report to the organized medical staff and the governing bodies of the major participating institutions in which GME Programs are conducted; To conduct annual reviews of all GME Programs to assess the performance of their residents and the use of their outcome assessment results for program improvement, as well as their compliance with the Common, specialty-specific program and institutional requirements of the relevant ACGME RRCs. Mrs. Alexandra Smith Administrative Coordinator Alexandra.smith@utrgv.edu To assure that each GME program establishes and implements formal written criteria and processes for the selection, evaluation, promotion and dismissal of residents in compliance with both the institutional and program requirements of the ACGME RRCs. To assure an educational environment in which residents may raise and resolve issues without fear of intimidation or retaliation. Including: Provision of an organizational system for residents to communicate and exchange information on their working environment and their educational programs; Process by which individual residents can address concerns in a confidential and protected manner; Establishment and implementation of fair institutional policies and procedures for adjudication of resident complaints and grievances related to actions which could result in dismissal, non-renewal of a resident s contract, or could significantly threaten a resident s intended career development. To ensure faculty members and residents have ready access to adequate communication resources and technology support. Residents must be able to access specialty/subspecialty-specific and other appropriate reference material in print or electronic format, at all times. If in electronic format, medical literature databases must have search capabilities; To implement and maintain the collection of intra-institutional information and development of recommendations on the appropriate funding for resident positions, including benefits and support services; To assure that the residents curriculum provides a regular review of ethical, socioeconomic, medical/legal and cost-containment issues that affect GME and medical practice. The curriculum must also provide an appropriate introduction to communication skills and to research design, statistics and critical review of the literature necessary for acquiring skills for lifelong learning. There must be appropriate resident participation in departmental scholarly activity, as set forth in the applicable program requirements; To provide administrative support for GME programs and residents in the event of a disaster or interruption in patient care. 6 graduate medical education manual 7

5 CLINICAL TRAINING PROGRAMS ACGME ACCREDITED SPECIALTY PROGRAMS Family Medicine McAllen Medical Center Doctors Hospital at Renaissance Internal Medicine Valley Baptist Medical Center Doctors Hospital at Renaissance Obstetrics-Gynecology Doctors Hospital at Renaissance General Surgery Doctors Hospital at Renaissance RESIDENCY POSITIONS All residency positions will be available through the National Residency Matching Program (NRMP). All residency programs will have access to the maximum number of positions allowed by their individual Residency Review Committees (RRC). All accredited residency programs must have an academic program that complies with its individual accreditation requirements and the time needed to complete them. All programs must have a defined level of entry (PGY) for the specialty. Residents who are transferring from another program will begin at the level of entry of the new program unless specified by the respective specialty board. For a program to accredit the previous experience, it must petition in writing to the appropriate board and this office and must state the basis for accreditation and the probable date of completion. This date shall not exceed the official time of completion of the program. RESIDENT ELIGIBILITY Each GME Program will be required to have a policy in place for resident eligibility. This policy must ensure all applicants under consideration for residency training in the GME Program meet the eligibility requirements of UTRGV and the ACGME. Only applicants who meet the following qualifications are eligible for appointment to GME programs sponsored by UTRGV: 1. Medical Education Applicants must complete their medical education in one of the following ways: Graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME); Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA); Graduates of Medical Schools outside the United States and Canada who meet one of the following qualifications: Have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates prior to appointment, or, Have a full and unrestricted license to practice medicine in the USA licensing jurisdiction in which they are training. And, graduates of medical schools outside the United States who have completed a Fifth Pathway program provided by an LCMEaccredited medical school. 2. Eligibility of Foreign-Born Nationals and International Medical Graduates: The entry of foreign nationals to the United States is governed by the US Immigration and Nationality Act, as amended, which is administered by the U.S. Department of Homeland Security Customs and Immigration Service (USCIS) and U.S. Department of Labor regulations. All offers of employment must be contingent on the foreign national being able to secure the appropriate permissions to work in the U.S., which then shall be provided to UTRGV as part of the I-9 process before or on the first day of employment. Failure to complete the I-9 process before or on the first day of employment is a violation of U.S. employment regulations and will result in termination of the offer of employment. 8 graduate medical education manual 9

6 STIPEND Annual and monthly stipends for academic year PGY Level Stipend $49, $50, $52, $53, $55, Monthly Stipend $4, $4, $4, $4, $4, NON-COMPETITION Program directors considering foreign national applicants should carefully review the applicant s U.S. immigration status to ensure the applicant holds or is eligible to apply for a U.S. immigration status valid for appointment. International medical graduates must hold a currently valid Standard Certificate of the Educational Commission for Foreign Medical Graduates (ECFMG). The most appropriate immigration status for medical residents is as follows: Neither the Sponsoring Institution nor any of its ACGME-accredited programs will require a resident/fellow to sign a non-competition guarantee or restrictive covenant. Programs cannot make or enforce any covenants intended to restrict the choice of practice location, practice structure, or the post-residency professional activity of individuals who have completed their post-graduate medical education programs. United States citizenship, Legal Permanent Resident of the United States, ECFMG J-1 visa/status LEAVE POLICIES First Year Subsequent Year The UTRGV Residency Programs participate in the National Residency Matching Program (NRMP). Programs will select residents from among eligible candidates on the basis of preparedness, ability, aptitude, academic credentials, communication skills and personal qualities such as motivation and integrity. Vacation Sickness 10 days 10 days 15 days 10 days Programs will not discriminate with regard to race, color, religion, national origin, sex, age, disability or sexual orientation. CONTRACTS Residents Graduate Medical Education Agreements contain all elements required by the ACGME. Agreements are limited to one year in duration. Links to examples of the Residents GME Agreements employed for the GME programs are included in that section of the GME website. TEXAS MEDICAL BOARD A physician-in-training (PIT) permit is granted by the Texas Medical Board (TMB) to a physician who serves in Texas as a Resident in Graduate Medical Education programs accredited by the ACGME. Information about this permit is sent to all applicants of GME programs. All house staff/residents at UTRGV will be required to have an appropriate TMB PIT as a condition of appointment by the first day of employment. The permits are valid in Texas training programs only. If residents do elective rotations outside of Texas, they must obtain a permit to practice medicine from the appropriate state medical board. Eligible employees may take up to 12 weeks paid or unpaid leave under certain qualifying conditions based on the terms of the Family and Medical Leave Act of 1993 (FMLA). The total maximum time a resident can be away from a program in any given year, or for the duration of the residency program, shall be determined by the requirements of the specialty board involved. All absences must be approved by the program director. Each program will have a policy that addresses the effect of leave on promotion and length of training. If excessive time is taken, the resident may be required to extend his/her training to fulfill Board requirements. Ensuring availability of appropriate Board requirements to residents is a shared responsibility of the program director and the trainee. Both are strongly advised to access the specific relevant information from their certifying boards, and to maintain familiarity with the appropriate requirements in order to avoid unforeseen delays in board certification. It is the responsibility of the resident and program director to ensure that Board eligibility requirements are met within the original residency / fellowship period and that alternative arrangements are made to comply with those requirements. 10 graduate medical education manual 11

7 IMPAIRED RESIDENT/FELLOW POLICIES AND PROCEDURES An impaired resident/fellow shall be defined as any resident/fellow who, by virtue of physical disability, mental illness, psychological impairment, chemical substance abuse or misconduct, is unable to safely care for patients, perform duties normally expected of a resident physician or engage in peer interaction necessary for patient care. The following may be signs and symptoms of impairment. Warning signs and symptoms, although certainly not specific to problems of substance abuse, may include: Physical signs such as fatigue, deterioration in personal hygiene and appearance, multiple physical complaints, accidents, eating disorders. Disturbance in family stability. Social changes such as withdrawal activities, isolation from peers, embarrassing or inappropriate behavior. Professional behavior patterns such as unexplained absences, spending excessive time at the hospital, tardiness, decrease in quality or interest in work, inappropriate orders, behavioral changes, altered interaction with other staff, and inadequate professional performance. Behavioral signs such as mood changes, depression, lapses of attention, chronic exhaustion, risk-taking behavior and flat affect. Drug use indicators such as excessive agitation or edginess, dilated or pinpoint pupils, self medication with psychotropic drugs, stereotypical behavior, alcohol on breath at work, uncontrolled drinking at social events, others. This must be documented by written reports from at least two individuals (faculty, resident/fellows or others) who have first-hand knowledge of an incident involving the resident/fellow. The decision of what constitutes inability to perform duties shall rest with the program director. Remedial measures in dealing with the impaired resident/fellow require identification and immediate institution of an appropriate treatment program. There must be available methods that identify stresses and factors within the environment that could cause problems, and personality traits that could put the resident/fellow at risk. The program director will review the situation with the DIO, including written documentation outlining performance deficiencies and plans of action. All residents/fellows identified as being at risk of any difficulty or in need of behavioral intervention must be referred to the Counseling Program for confidential evaluation and referrals, as needed. PROCEDURES 1. There should be regular monitoring of resident/fellow performance by the program directors and the faculty. When a suspicion of impairment is detected, an in-depth interview with the resident/fellow by the program director and one other faculty member should be carried out. Mutually agreeable resources may be utilized to establish the fact and severity of the impairment. 2. As soon of the program director is aware of a problem with resident/ fellow impairment, an immediate method of handling the problem should be determined. 3. The program director and the resident/fellow will formulate a plan of action once the problem is identified. This plan should stipulate specific goals and objectives and must be put in writing and signed by both parties. 4. There must be a periodic review of the plan by the program director. 5. If a leave of absence is involved in the plan, it must meet criteria stated in the regulations of the appropriate specialty boards. 6. Return from leave from impairment should be based upon written reentry policies that include understandings with the resident/fellow training program and the School of Medicine. Any return from leave shall be based on a complete review of the individual medical history from all sources involved in treatment. Appropriate follow-up must be provided during the remainder of training. 7. Faculty and residents must receive education in recognizing signs of fatigue and adopt and apply preventive measures. Some training programs may have stricter standards regarding health conditions that may affect the ability to practice medicine safely, calling for additional steps or actions beyond the above. In such cases, the program must have a written policy, and a copy must be placed in the program manual and provided to the GME office. DRESS CODE Residents are expected to dress according to generally accepted professional standards appropriate for their training program and the School of Medicine. Dress, grooming and personal cleanliness standards contribute positively to the morale and professional image the resident physician presents to patients and their families. It represents another form of patient respect. Clothing should allow for adequate movement during patient care, and should not be tight, low cut or expose the trunk with movement. Jewelry, clothes, hairstyles and fragrances should be appropriate for the performance of duties in the hospital or clinic. Residents should maintain a professional appearance and dress appropriately whenever they are representing UTRGV in any on- or off-campus setting. This includes academic and clinical sites, meetings and special events. UTRGV white coats and identification badges must be worn at all times. Each training program and hospital may set more specific guidelines for dress code standards for residents and faculty members. 12 graduate medical education manual 13

8 RESIDENTS RESPONSIBILITIES Graduate medical education is based on the principle of progressively increasing levels of responsibility in caring for patients, under the supervision of the faculty. The faculty is responsible for evaluating the progress of each resident in acquiring the skills necessary for the resident to progress to the next level of training. Factors considered in this evaluation include the resident s clinical experience, judgment, professionalism, cognitive knowledge and technical skills. These levels are defined as postgraduate years (PGY) and refer to the clinical years of training that the resident is pursuing. At each level of training, there is a set of competencies the resident is expected to master. As these are learned, greater independence is granted to the resident in the routine care of the patient, at the discretion of the faculty who, at all times, remain responsible for all aspects of the care of the patient. Residents are expected to: Participate in safe, effective and compassionate patient care under supervision, commensurate with their level of advancement and responsibility. Participate fully in the educational and scholarly activities of their program and assume responsibility for teaching and supervising other residents and students. Participate in institutional programs and activities involving the medical staff and adhere to established practices, procedures and policies of the institutions. Participate in institutional committees and councils, especially those that relate to patient care activities. Develop an understanding of ethical, socioeconomic and medical/legal issues that affect graduate medical education, and of how to apply cost containment measures in the provision of patient care. Participate in risk management, compliance and quality assurance/ improvement activities. Participate in evaluation of the quality of education provided by the program. There may be additional responsibilities and expectations of resident physicians specific to the service to which they are assigned. Develop a personal program of self-study and professional growth, with guidance from the faculty. Residents at every level are expected to treat all other members of the health care team with respect and with recognition of the value of the contribution of others involved in the care of patients and their families. Residents at all levels should have a strong commitment to patient safety and professionalism. All residents must provide data on their educational experience to their program director. The provision of regular feedback on faculty, program and overall educational experiences, via confidential written or electronic evaluations, is an essential part of the continuous improvement of the educational programs within our institution, and is required by the ACGME. Resident Forum To encourage communication about all pertinent issues to graduate, medical education residents must ensure availability of an organization, council, town hall or other. The Resident Forum will allow the communication and exchange of information about their programs and their learning and working environment. Membership: Members are peer-selected and represent individual residency programs at UTRGV. Responsibilities: To assist in identifying concerns about the work environment and in seeking solutions. To disseminate institutional information to the residents and seek their input into issues that affect them. To express general concerns about residency education or any other matter they choose. To participate in operations or quality improvement and restructuring initiatives. Residents have the option to conduct their meetings without the DIO, faculty members or other administrators present, and then present concerns that arise from the Forum to the DIO and the GMEC. Faculty Responsibility At each participating site, there must be a sufficient number of faculty with documented qualifications to instruct and supervise all residents at that location. Program Directors are responsible for selecting teaching faculty based on qualifications, commitment of time to the educational program, and evaluation-based demonstration of strong interest in the education of the residents ensuring appropriate teaching and supervision of trainees. Teaching faculty members are expected to actively participate in the following as assigned by the program director: Evaluation of residents under their supervision; Evaluations of the program, including participation in annual reviews of program effectiveness sessions; ACGME Faculty Survey; Participation in periodic reviews of the program; Participation in ACGME accreditation site visits of program and institution. Faculty must establish and maintain an environment of inquiry and scholarship. They must also participate in organized clinical discussions, rounds, journal clubs, and conferences. In addition, some faculty members should also demonstrate scholarship by one or more of the following: Peer-reviewed funding; Publication of original research or review articles in peer-reviewed journals, or chapters in textbooks; Publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; Participation in national committees or educational organizations; Grant reviews, participation and research. 14 graduate medical education manual 15

9 EVALUATION The evaluation of residents and faculty, including the specification of satisfactory performance, are within the purview of the program. However, all expectations, responsibilities and duties, as well as the evaluation procedures, are to be clearly formulated in writing at the departmental level and explained to the faculty and residents. Resident evaluation: Evaluation and feedback are critical to the personal development of the resident and to continuous improvement in the educational process. Evaluations are to be used in making decisions about promotion, program completion, remediation and any disciplinary action. Residency programs are responsible for regular evaluation of residents progress. The evaluation system must consist of both formative and systematic evaluations. Formative Evaluation: The faculty must evaluate resident performance in a timely manner during each rotation or similar educational assignment, and document this evaluation at completion of the assignment. The program must: Provide objective assessments of competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice. Use multiple evaluators (e.g., faculty, peers, patients, self and other professional staff). Document progressive resident performance improvement appropriate to educational level. Provide each resident or fellow with documented semiannual evaluation of performance with feedback. This must be a documented face-to-face meeting with the program director or designee (advisor). Evaluations of resident performance must be accessible for review by the resident. Summative Evaluation The program director (this may not be delegated) must provide a summative evaluation for each resident upon completion of the program. Specialty-specific milestones must be used as one of the tools to ensure that residents are able to practice core professional activities without supervision upon completion of the program. This evaluation must become part of the resident s permanent record maintained by the institution, and must be accessible for review by the resident in accordance with institutional policy. This evaluation must: a. Document the resident s performance during the final period of education. b. Verify that the resident has demonstrated sufficient competence to enter practice without direct supervision. Faculty Evaluation At least annually, the program must evaluate faculty performance as it relates to the educational program. These evaluations should include a review of the faculty s clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, interpersonal and communication skills and scholarly activities. They must include written, confidential evaluations by the residents or fellows. They must be provided to departmental chairs for use in annual faculty evaluations. Program Evaluation and Improvement 1. The program must document formal, systematic evaluation of the curriculum at least annually. The program must monitor and track each of the following areas: Resident performance. Faculty development. Graduate performance, including performance of program graduates on the certification examination. Program quality, specifically: Residents and faculty must have the opportunity to evaluate the program confidentially and in writing at least annually. The program must use the results of residents assessments of the program, together with other program evaluation results, to improve the program. 2. Oversight of the accredited programs must be demonstrated by conducting Annual Program Evaluation (APE), Special Program Reviews (SPR), Periodic Program Reviews (PPR), and Mock Self-Study Visits (MSS). a. APE: Will be conducted by the Program and reviewed by the GMEC for compliance with requirements. b. SPR: Will be conducted when concerns arise from APEs. Negative trends are identified in ACGME Resident and Faculty Surveys; negative communications are received from the ACGME; insufficient clinical experiences or patient volumes are reported; failure to address action plans identified in APEs and others. c. PPR: Will be conducted approximately midway between self-study visits. d. MSS: Will be conducted following the ACGME self-study site visit protocol. If deficiencies are found, the program should prepare a written plan of action to document initiatives to improve performance in the areas identified. The action plan should be reviewed and approved by the teaching faculty, documented in meeting minutes and presented to the GMEC. 16 graduate medical education manual 17

10 SUPERVISION Clinical Competency Committee (CCC) To demonstrate accountability as medical educators and graduate trainees who will provide highquality and safe care to patients and maintain the standards of the health care system, all residency programs are required to appoint a Clinical Competency Committee (CCC). The CCC will review all residents evaluations and assess progress with respect to ACGME Milestones for each specialty. They must have a written policy describing how the CCC for the program will be constituted, how often it will meet, and its specific duties. Each clinical competency committee must meet the minimum ACGME requirements described below. Membership: Is appointed by the program director; Must be composed of at least 3 members of the program faculty; Additional members can be appointed: Physician faculty members from the same program. Other health professionals who have extensive contact and experience with the program residents in patient care and other health care settings. Chief residents who have completed core residency programs in their specialty and are eligible for board certification. Coordinators may attend but may not serve as members. There is no mandatory role for the PD; he/she can be a Chair. Responsibilities: Review all resident evaluations semi-annually. Prepare and ensure the reporting of Milestones semi-annually to the ACGME. Advise the program director on resident progress, including promotion, remediation, graduation and dismissal. Must have a written description of responsibilities. Meetings: The CCC must meet at least twice a year, and the meeting should occur approximately one month prior to the deadline for data submission to the ACGME. In the clinical learning environment, each patient must have an identifiable, appropriately credentialed and privileged attending physician (or licensed independent practitioner as approved by each Review Committee) who is ultimately responsible for that patient s care. This information should be available to residents, faculty members and patients. Residents and faculty members should inform patients of their respective roles in each patient s care. The program must demonstrate that the appropriate level of supervision is in place for all residents who care for patients. Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty member. For many aspects of patient care, the supervising physician may be a more advanced resident or fellow. Other portions of care provided by the resident can be adequately supervised by the immediate availability of the supervising faculty member or resident physician, either in the institution, or by means of telephonic and/or electronic modalities. In some circumstances, supervision may include post-hoc review of resident delivered care with feedback as to the appropriateness of that care. Levels of Supervision To ensure oversight of resident supervision and graded authority and responsibility, the program must use the following classification of supervision: Direct Supervision: the supervising physician is physically present with the resident and patient. 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. 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. Oversight: The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. The program director and faculty members must assign the privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident. The program director must evaluate each resident s abilities based on specific criteria. When available, evaluation should be guided by specific, national standards-based criteria. Faculty members functioning as supervising physicians should delegate portions of care to residents, based on the needs of the patient and the skills of the residents. 18 graduate medical education manual 19

11 Resident Mentoring The Graduate Medical Education environment is conducive to the institution of a mentorship program. Pairing residents with learned faculty mentors helps develop physicians to maximize their potential and to reach professional and personal goals. Faculty mentors will serve as guides, role models and advocates for residents. All residents should be provided with a positive, supportive environment in which they can explore and refine career goals with the guidance of experienced faculty members. Mentorship should be a tool for monitoring and promoting career goals, research productivity, professionalism and personal goals. Senior residents or fellows should serve in a supervisory role of junior residents in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual resident or fellow. Programs must set guidelines for circumstances and events in which residents must communicate with appropriate supervising faculty members, such as the transfer of a patient to an intensive care unit or end-oflife decisions. Each resident must know the limits of his/her scope of authority, and the circumstances under which he/ she is permitted to act with conditional independence. In particular, PGY-1 residents should be supervised either directly or indirectly with direct supervision immediately available. Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of each resident and delegate to him/her the appropriate level of patient care authority and responsibility. It is the responsibility of individual program directors to establish detailed written policies describing resident supervision at each level for their programs. The requirement for on-site supervision will be established by the program director for each program in accordance with ACGME guidelines and should be monitored through periodic departmental reviews with institutional oversight through the GMEC internal review process. There must be sufficient institutional oversight to assure that residents/fellows are appropriately supervised. Each resident should be paired with one faculty mentor. Faculty members should be assigned one/two residents per academic year. Pairing should take into consideration career goals, interest and faculty availability. Resident should provide their mentors with updated CVs. Mutually agreed frequency of meetings and set of goals should be established early in the mentor-mentee relationship. Residents will be asked about career interests and faculty mentor preferences at the end of each academic year. Residents will complete a self-reflective essay for the mentor at the end of each academic year, to assess the year s progress and pinpoint future goals. In case more than one senior resident with similar career interests requests the same mentor, the decision to accept an additional mentee is at the discretion of the faculty mentor. The program director will discuss mentorship pairing with the resident at the biannual resident review meetings. A quarterly evaluation form will be completed by both the mentor and mentee as a way to monitor the perceived usefulness of the mentorship program. The evaluation also will serve to regularly schedule faculty-resident meetings on, at least, a quarterly basis. This evaluation form is intended to be used as a tool to monitor the program and implement improvement strategies. This is not intended to be an individual evaluation of either mentors or mentees. Completion of Licensing Examinations All residents enrolled in graduate medical education programs meet eligibility requirements to obtain full medical licensure. An essential parameter for obtaining a medical license is the successful completion of the medical licensing examinations. The purpose of this policy is to ensure that residents enrolled in graduate medical education programs meet eligibility requirements to obtain full medical licensure. UTRGV will require of its residents the following: PGY-1: All residents in ACGME-accredited programs should have passed USMLE Steps 1, 2 CK, and 2 CS (or COMLEX, if graduates of an osteopathic medical school), for appointment to a PGY1 position. Graduates of international medical schools must have passed Steps 1, 2 CK, and 2 CS of the USMLE, or equivalent Canadian Medical Licensing Examination, and hold a valid ECFMG certificate. PGY-3: All residents in ACGME-approved programs should successfully complete USMLE Step 3 (or COMLEX Part 3) examination activities, as evidenced by obtaining a passing grade for that examination, prior to March 1 of the second post-graduate year of attendance in an ACGME-approved training program. Program Directors of ACGME accredited programs are responsible for tracking the progress of residents in their programs. 20 graduate medical education manual 21

12 Resident Grievance and Appeal Procedure The Accreditation Council for Graduate Medical Education (ACGME) requires that sponsoring institutions provide fair and reasonable written institutional policies and procedures for grievance and due process, which may be utilized when academic or other disciplinary actions taken against residents could result in dismissal, non-renewal of a resident s agreement or other actions that could significantly threaten a resident s intended career development, including non-promotion to a subsequent PGY level. The Graduate Medical Education Committee (GMEC) serves as the appeals body for all residents, independent of their funding source, for dismissal or non-renewal or other actions that could significantly threaten a resident s intended career development, including non-promotion to a subsequent PGY level. Resident Promotion, Dismissal, Non-renewal or Non-Promotion Policy: Through the course of training in a residency program, a resident is expected to acquire progressively increasing competence in the discipline in which he/she is training. Promotion to the next resident level (e.g. PGY1 to PGY2) is based on the achievement of program-specific milestones, including specific cognitive, clinical, technical skills, and professional and ethical conduct as determined by the program. Dismissal or non-renewal or non-promotion to a subsequent PGY level could occur because of failure to comply with the resident s responsibilities, failure to demonstrate appropriate medical knowledge or skill as determined by the program s supervising faculty, or failure to abide by the terms of the resident s contract employment. Programs must provide their residents with a written notice of intent not to renew contract no later than four months prior to the end of the resident s current contract. However, if the primary reason for the nonrenewal occurs within the four months prior to the end of the contract, the Sponsoring Institution must ensure that its ACGME-accredited programs provide the residents with as much written notice of the intent not to renew as the circumstances will reasonably allow, prior to the end of the contract. Residents must be allowed to implement the institution s grievance procedures when they have received a written notice of intent not to renew their contracts. If the primary reason(s) for the non-renewal or non-promotion occurs within the four (4) months prior to the end of the agreement, the program should provide the resident with as much written notice of the intent not to renew or not to promote as circumstances will reasonably allow, prior to the end of the resident s GME agreement. If a resident s performance has been significantly deficient and additional training time is required, the program director may address a request to the DIO for an extension of the resident s GME agreement. The matter will be given due consideration. Residents are allowed to implement the grievance and appeal policy if they receive a written notice either of intent not to renew their agreement(s) or of intent to renew their agreement(s) but not promote them to the next level of training. Academic Failure: Residents are learners within our programs. When a resident fails to progress academically, it is the responsibility of the program director to document a warning period prior to instituting probationary status, dismissal, failure to reappoint, or failure to promote to the subsequent PGY level; to demonstrate efforts for the provision of opportunities for remediation; and to notify the Associate Dean for Graduate Medical Education (ADGME) of the proposed action(s). It should be very unusual to dismiss a resident for academic failure without a probationary period. Opportunities should be provided (and documented) for the resident to discuss with the program leadership the basis for probation, the expectations of the probationary period and the evaluation of the resident s performance during the probation. Misconduct: In addition to their academic responsibilities, residents have clinical responsibilities within our programs. Dismissal without warning may be justified in response to specific examples of misconduct. Examples include (but are not limited to) the following: lying, falsification of a medical record, violation of medical record privacy, being under the influence of intoxications or drugs, disorderly conduct, harassment of other employees (including sexual harassment), or the use of abusive language on the premises, fighting, encouraging a fight or threatening, attempting or causing injury to another person on the premises. Informal Procedure: Residents who are concerned about actions within their programs that could significantly threaten their intended career development are encouraged to contact the ADGME regarding their concerns. The ADGME will work with the resident and the program as the particular situation requires. Formal Grievance Procedures: In the event a resident is to be placed on probationary status, dismissed, his/ her training agreement not renewed, or not promoted to a subsequent PGY level, he/she may initiate a formal grievance procedure. The resident shall present the grievance in writing to the ADGME within thirty (30) working days after the date of notification of proposed adverse status. The grievance shall state the facts upon which the grievance is based and requested remedy sought. The ADGME or designate shall respond to the grievance in writing no later than fifteen (15) working days after he/she received it. If the resident is not satisfied with the response, he/she may then submit, within fifteen (15) working days of receipt of the ADGME s response, a written request for a hearing. 22 graduate medical education manual 23

13 Hearing: The hearing procedure will be coordinated by the ADGME or designate, who will preside at the hearing but will not be a voting participant. The hearing will be scheduled within thirty (30) working days of the resident s request for a hearing. The hearing panel will consist of at least three (3) members of the GMEC. The ADGME will determine the time and site of the hearing in consultation with the resident and program leadership. The resident shall have a right to self-obtain legal counsel at his/her own expense; however retained counsel many not actively participate or speak before the hearing participants, nor perform cross-examination. The format of the hearing will include a presentation by a departmental representative; an opportunity for a presentation of equal length by the house officer; an opportunity for response by the representative, followed by a response of equal length by the house officer. This will be followed by a period of questioning by the hearing panel. The ADGME, in consultation with the departmental representatives and the resident, will determine the duration of the presentations and the potential attendees at the hearing. The resident will have a right to request documents for presentation at the hearing and the participation of witnesses. The ADGME, at his/her discretion, will invite the latter, following consultation with the hearing panel. A final decision will be made by a majority vote of the hearing panel and will be communicated to the resident within ten (10) working days after the hearing. This process will represent the final appeal. RESIDENT DUTY HOURS Maximum Hours of Work per Week 1. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. Duty Hour Exceptions: A Review Committee may grant exceptions for up to 10 percent or a maximum of 88 hours to individual programs based on a sound educational rationale. In preparing a request for an exception, the program director must follow the duty hour exception policy from the ACGME Manual on Policies and Procedures. Prior to submitting the request to the Review Committee, the program director must obtain approval of the institution s GMEC and DIO. 2. Moonlighting Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program. Time spent by residents in Internal and External Moonlighting (as defined in the ACGME Glossary of Terms) must be counted toward the 80-hour Maximum Weekly Hour Limit. PGY-1 residents are not permitted to moonlight. 3. Mandatory Time Free of Duty Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days. 4. Maximum Duty Period Length Duty periods of PGY-1 residents must not exceed 16 hours in duration. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage residents to use alertnessmanagement strategies in the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10 p.m. and 8 a.m., is strongly suggested. CLOSURE POLICIES UTRGV, in conjunction with participating institutions, will notify the GMEC, the DIO and the residents when it intends to reduce the size of or close one or more programs, or when the Sponsoring Institution intends to close. If a decision is made to close or reduce the size of a residency program, UTRGV will work with the participating institutions to establish a phase-out plan that allows currently enrolled residents to complete their education. If that is not possible, the sponsor, in conjunction with the participating institutions, will assist the displaced residents in enrolling in other ACGMEaccredited training positions in which they can continue their education. In the event the sponsor and participating institutions decide to reduce the number of positions in any residency-training program, the residents in that program will be notified. Every effort will be made to accomplish the reduction without adverse effect on residents currently in training. If that is not possible, the sponsor, in conjunction with participating institutions, will assist the displaced residents in obtaining positions in other training programs. 24 graduate medical education manual 25