Graduate Medical Education House Staff Rules and Regulations
ARTICLE NINE: CORRECTIVE ACTIONS
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- The decision of the Dean or his designee is final.
- ARTICLE TEN: GRANTING OF CERTIFICATE OF COMPLETION OF OGME–TR/RESIDENCY/ FELLOWSHIP PROGRAM
- ARTICLE ELEVEN: OGME - 1 DUTY HOUR REQUIREMENTS ROWAN UNIVERSITY SCHOOL OF OSTEOPATHIC MEDICINE/KENNEDY UNIVERSITY HOSPITAL/OUR LADY OF LOURDES MEDICAL CENTER
- II. SCOPE This policy is directed to all members of the house staff, and program administration. III. DEFINITION OF TERMS
- IV. RESPONSIBILITY/REQUIREMENTS
- V. POLICY House Staff Duty Hours 1. Maximum Hours of Clinical and Educational Work per Week
- 2. Mandatory Time Free of Clinical Work and Education
- 3. Maximum Clinical Work and Education Period Length
- 4. Clinical and Educational Work Hour Exceptions
- 5. Moonlighting (also see separate Moonlighting policy and required forms)
- PGY-1 residents are not permitted to moonlight
- 7. Maximum In-House On-Call Frequency
- House Staff Supervision
- 2. Levels of Supervision
- With Direct Supervision available
- [Each Review Committee may describe the conditions and the achieved competencies under which PGY-1 residents progress to be supervised indirectly with direct supervision available.]
- ARTICLE THIRTEEN: AOA/ACGME PROGRAM CLOSURE OR REDUCTION REQUIREMENTS
- ARTICLE FOURTEEN: RESIDENT/FELLOW NON-RENEWAL HEARING PROCEDURE
ARTICLE NINE: CORRECTIVE ACTIONS 9.1 Purpose The corrective actions in this Article apply to academic and medical judgment issues. In compliance with the Agreement between ROWAN and the Housestaff Organization of ROWAN/Committee of Interns and Residents (CIR), actions regarding terms and conditions of employment will be subject to provisions of the Agreement between ROWAN and the CIR. 9.2 Routine Corrective Action Whenever an OGME – TR or RESIDENT/FELLOW engages in, makes or exhibits acts, statements, demeanor or professional conduct, either within or outside of the medical center, and the same is or is reasonably likely to be detrimental to patient safety or to the delivery of quality patient care, disruptive to medical center operations or an impairment to the community's confidence in the medical center and/or its OGME – TR / RESIDENT/FELLOW training program, corrective action against the OGME – TR / RESIDENT/FELLOW may be initiated by any University administrator, officer of the medical staff, by the Chief or Program Director of any Department, by the Chief Executive Officer of the corporation, Administrator of the Division, or corporate officer. 9.2-1 Requests and Notices All requests for corrective action must be in writing, submitted to the Associate Dean for Graduate Medical Education, and supported by references to the specific activities or conduct which constitutes the grounds for the request. The Associate Dean for Graduate Medical Education will promptly notify the Dean, ROWAN-SOM and the representative of the hospital (Chief Medical Officer or Program Director). 9.2-2 Investigation The Dean (or his/her designee) will conduct, or order to be conducted, an investigation concerning the grounds for the corrective action request. The investigation is not a "hearing," but may include a discussion with the person(s) initiating the request, and with other individuals who may have knowledge of the events involved. The OGME – TR / RESIDENT/FELLOW is entitled to make a personal appearance before the investigative person(s) at a time scheduled to discuss the matters pertaining to his/her standing. During that appearance before the investigative person(s), the OGME – TR / RESIDENT/FELLOW may be accompanied by one fellow OGME – TR / RESIDENT/FELLOW and one or two other faculty members or personnel of the ROWAN-School of Osteopathic Medicine. Upon completion of the investigation, a written report will be prepared for the Dean. The Dean may then direct subordinates to proceed with action as provided below. (a) Recommend rejection of the request for corrective action. (b) Recommend admonition in the form of a formal letter. (c) Recommend a warning in the form of a formal letter. (d) Recommend a probationary period. (e) Recommend a period of suspension that must be remediated during or after the conclusion of the residency.
Recommend termination of the OGME training. The OGME – TR / RESIDENT/FELLOW may appeal the decision of the investigation to the Dean. During that appearance, the OGME TR / RESIDENT/FELLOW may be accompanied by one fellow OGME TR / RESIDENT/FELLOW and one or two other faculty members or personnel of the ROWAN-School of Osteopathic Medicine. The decision of the Dean or his designee is final. 9.2-3 Records (a) Following investigation, any corrective measures listed under Article 9.2-2 (c-f) shall become a part of the OGME – TR’s, RESIDENT/FELLOWS's permanent Credentials File and are subject to disclosure as presented in Articles 8.1 to 8.6 of these Rules and Regulations. (b) A second or subsequent admonition (9.2-2 (b) will also become part of the OGME – TR’s / RESIDENT/FELLOWS's permanent credentials file.
(b) Second offense: The OGME – TR / RESIDENT/FELLOW will be automatically suspended. The OGME – TR / RESIDENT/FELLOW will be required to meet with the Associate Dean for Graduate Medical Education, Assistant Dean for Graduate Medical Education, Manager of Postdoctoral Training, and/or the Chief Medical Officer. After such interview, further corrective action may be imposed and may include suspension, termination of the OGME – TR / RESIDENT/FELLOW, or other measures as outlined in 9.2-2 (b - f). These actions shall become a part of the RESIDENT/FELLOW's Credentials File. (c) All corrective action obligations must be fulfilled before the OGME – TR / RESIDENT/FELLOW will receive the official certificate of the OGME – TR / RESIDENCY training.
9.5-4 Dress Code-Proper Conformity Failure of the OGME – TR / RESIDENT/FELLOW to abide by the stated dress code policy (4.2 c) shall result in the same corrective action as outlined under Article 9.4 (a-c) 9.5-5 Conduct, Attitude, Availability Failure of the OGME – TR / RESIDENT/FELLOW to abide by the standards of conduct, attitude and availability as set forth, shall be subject to the same corrective action as outlined under Article 9.4 (a-c) 9.6 OGME Evaluation (Remediation) Evaluations of OGME – TR / RESIDENT/FELLOW performance will be completed by clinical faculty within fifteen days (15) of completion of each month's service or block. The Track Coordinator/Program Director shall have ultimate responsibility for review of the evaluation with the OGME – TR / RESIDENT/FELLOW. Any remedial recommendations must be fulfilled in a timely fashion by the OGME – TR / RESIDENT/FELLOW. All incomplete or remedial work must be completed to the satisfaction of the Chief of Service, Track Coordinator/Program Director, Director of Medical Education, and the Associate Dean for GME before an official certificate of OGME – TR / RESIDENT/FELLOW training is presented to the OGME – TR / RESIDENT/FELLOW. ARTICLE TEN: GRANTING OF CERTIFICATE OF COMPLETION OF OGME–TR/RESIDENCY/ FELLOWSHIP PROGRAM On satisfactory completion of an OGME – TR / RESIDENCY / FELLOWSHIP training program, ROWAN-SOM OPTI shall award the certificate of completion. All OGME – 1R trainees will be issued a letter of completion for the AOA approved OGME – 1R year, in the appropriate specialty by ROWAN-SOM OPTI, for licensing purposes. This letter will be provided at the end of the first year. The certificate letter shall confirm the successful fulfillment of the program requirements, the starting and completion dates of the program, the name(s) of the training institution, program director(s) and the ROWAN-SOM OPTI. Such certificate letters will be granted to the OGME – TR only after the following requirements have been met. 10.1 OGME – TR / RESIDENCY / FELLOWSHIP Performance Evaluations are received and satisfactorily document all fifty-two weeks of OGME/ACGME training in accordance with AOA/ACGME regulations and the OGME Training Program. Any remediation recommended on OGME – TR / RESIDENT/FELLOWS Performance Evaluations has been satisfied, verified by the Track Coordinator/Program Director and reported to the Office of Graduate Medical Education. Any remediation required for attendance at Core Lecture or Departmental progress is satisfied and reported to the Office of Graduate Medical Education. Any corrective action measures taken have been satisfied and reported to the Office of Graduate Medical Education. Any fair hearing proceedings have been completed and corrective actions satisfied and reported to the Office of Graduate Medical Education. 10.6 All service evaluations by the OGME – 1 / RESIDENT/FELLOW, faculty evaluations by the OGME – TR / RESIDENT/FELLOWS, and all logs are completed and submitted to the Office of Graduate Medical Education. 10.7 All University and medical center supplies, materials, equipment, books, beepers, passes, and records have been satisfactorily returned and verified. All medical records for patients assigned to the OGME – 1 / RESIDENT/FELLOW have been satisfactorily completed at each division of the medical center. The OGME – 1 must sit for Part III of the COMLEX. ARTICLE ELEVEN: OGME - 1 DUTY HOUR REQUIREMENTS ROWAN UNIVERSITY SCHOOL OF OSTEOPATHIC MEDICINE/KENNEDY UNIVERSITY HOSPITAL/OUR LADY OF LOURDES MEDICAL CENTER GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES NUMBER: 101 TITLE: Housestaff Duty Hours and Supervision EFFECTIVE DATE: 7/1/17 REVISED: 6/2/11, 9/22/11, 6/9/17 REFERENCES: ACGME Common Program Requirements Section VI 2017
(a) Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting. 2. Mandatory Time Free of Clinical Work and Education (a) The program must design an effective program structure that is configured to provide residents with educational opportunities, as well as reasonable opportunities for rest and personal well-being. (b) Residents should have eight hours off between scheduled clinical work and education periods. There may be circumstances when residents choose to stay to care for their patients or return to the hospital with fewer than eight hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements. (c) Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call. (d) Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days. 3. Maximum Clinical Work and Education Period Length (a) Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments. (b) Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. Additional patient care responsibilities must not be assigned to a resident during this time. 4. Clinical and Educational Work Hour Exceptions (a) In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances: to continue to provide care to a single severely ill or unstable patient; humanistic attention to the needs of a patient or family; or, to attend unique educational events. (b) These additional hours of care or education will be counted toward the 80-hour weekly limit. 5. Moonlighting (also see separate Moonlighting policy and required forms) (a) Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program, and must not interfere with the resident’s fitness for work nor compromise patient safety. (b) 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 limit. PGY-1 residents are not permitted to moonlight 6. In-House Night Float (a) Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements. [The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the individual specialty Review Committee.] 7. Maximum In-House On-Call Frequency (a) Residents must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period). 8. At-Home Call (a) Time spent on patient care activities by residents on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks. (b) At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident. (c) Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient patient care must be included in the 80-hour maximum weekly limit. House Staff Supervision 1. Supervision and Accountability (a) Although the attending physician is ultimately responsible for the care of the patient, every physician shares in the responsibility and accountability for their efforts in the provision of care. (b) Each patient must have an identifiable and appropriately-credentialed and privileged attending physician (or licensed independent practitioner as specified by the applicable Review Committee) who is responsible and accountable for the patient’s care. This information must be available to residents, faculty members, other members of the health care team, and patients. (c) Residents and faculty members must inform each patient of their respective roles in that patient’s care when providing direct patient care. (d) The program must demonstrate that the appropriate level of supervision in place for all residents is based on each resident’s level of training and ability, as well as patient complexity and acuity. Supervision may be exercised through a variety of methods, as appropriate to the situation. [Individual Review Committees may specify which activities require different levels of supervision.] 2. Levels of Supervision To promote oversight of resident supervision while providing for graded authority and responsibility, each training program must use the following classification of supervision: (a) Direct Supervision – the supervising physician is physically present with the resident and patient. (b) 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. (c) 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 (d) Oversight – the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. - The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members. The program director must evaluate each resident’s abilities based on specific criteria, guided by the Milestones. - Faculty members functioning as supervising physicians must delegate portions of care to residents based on the needs of the patient and the skills of each resident. - Senior residents or fellows should serve in a supervisory role to 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 the supervising faculty member(s). - Each resident must know the limits of their scope of authority, and the circumstances under which the resident is permitted to act with conditional independence. (e) Initially, PGY-1 residents must be supervised either directly, or indirectly with direct supervision immediately available. [Each Review Committee may describe the conditions and the achieved competencies under which PGY-1 residents progress to be supervised indirectly with direct supervision available.] (f) Faculty supervision assignments must be of sufficient duration to assess the knowledge and skills of each resident and to delegate to the resident the appropriate level of patient care authority and responsibility. ### ARTICLE TWELVE: CORE COMPETENCY COMPLIANCE The American Osteopathic Association and Accreditation Council for Graduate Medical Education requires DIO’s, DME’s and Program Directors to implement training, and Program Evaluators to assess, the AOA/ACGME Core Competencies in all AOA/ACGME training programs. Osteopathic Philosophy Principles and Manipulative Treatment RESIDENT/FELLOWs are expected to demonstrate and apply knowledge of accepting standards in OPP/OMT appropriate to their specialty. The educational goal is to train a skilled and competent osteopathic practitioner who remains dedicated to life-long learning and to practice habits in osteopathic philosophy and manipulative medicine. Medical Knowledge and Its Application Into Osteopathic Medical Practice: RESIDENT/FELLOWs must demonstrate and apply integrative knowledge of accepted standards of clinical medicine and OPP in their respective osteopathic specialty area, remain current with new developments in medicine, and participate in life-long learning activities, including research. Osteopathic Patient-Care Osteopathic RESIDENT/FELLOWs must demonstrate the ability to effectively treat patients, provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive medicine, and health promotion. Interpersonal and Communication Skills in Osteopathic Medical Practice: RESIDENT/FELLOWs are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams. Professionalism in Osteopathic Medical Practice: RESIDENT/FELLOWs are expected to uphold the Osteopathic Oath in the conduct of their professional activities that promote advocacy of patient welfare, adherence to ethical principles, collaboration with health professionals, life-long learning, and sensitivity to a diverse patient population. RESIDENT/FELLOWs should be cognizant of their own physical and mental health in order to care effectively for patients. Osteopathic Medical Practice-Based Learning and Improvement: RESIDENT/FELLOWs must demonstrate the ability to critically evaluate their methods of clinical practice, integrate evidence-based traditional and osteopathic medical practices into patient care, show an understanding of research methods, and improve patient care practices. System-Based Osteopathic Medical Practice RESIDENT/FELLOWs are expected to demonstrate an understanding of health care delivery systems, provide effective and qualitative osteopathic patient care within the system, and practice cost-effective medicine. The core competencies shall be taught and assessed throughout the OGME – 1 internship year by a variety of methods as indicated in the ROWAN-SOM OPTI Core Competency Plan. ARTICLE THIRTEEN: AOA/ACGME PROGRAM CLOSURE OR REDUCTION REQUIREMENTS: In the event of a discontinuation of a training program, the University agrees that it will make every effort to place displaced HSO in another appropriate University (ROWAN) program, or if necessary, a program outside the University. The training institution shall immediately notify the AOA/ACGME, its OPTI and its trainees of a program closure or reduction in positions, which would impact trainees prior to program completion. If a training institution reduces in size or closes a program every attempt should be made to permit the current OGME-TR’s/RESIDENT/FELLOWs enrolled in the program to complete their training prior to such action. In the event of a hospital or program closure or reduction in positions, which would impact trainees prior to program completion, the training institution shall immediately notify the AOA/ACGME and it’s OPTI to aid in placement of the enrolled OGME-TR’s/RESIDENT/FELLOWs in other AOA/ACGME, approved programs within or if necessary outside the OPTI structure. Severance pay shall be provided for two months when institutional program closure or reduction decisions prevent the OGME-TR’s/RESIDENT/FELLOWs from program completion in that or another geographically proximate program arranged by the institution and/or the OPTI. ARTICLE FOURTEEN: RESIDENT/FELLOW NON-RENEWAL HEARING PROCEDURE Policy A grievance procedure for house officers who wish to appeal a notice of non-renewal of the house officer’s contract is available to the housestaff. The University shall provide for the appointment of an Ad Hoc Non-Renewal Committee to conduct the grievance procedure, and all such committees shall review non-renewal appeals in accordance with the standards set forth in this policy. Procedure A house officer may appeal a Program Director’s decision not to renew the house officer’s contract for the following academic year by submitting a written request to the Department Chair within five (5) working days of receipt of notice of the decision. If the house officer submits timely notice of appeal, the Department Chair shall convene a Non-Renewal Committee to consider the appeal. The Non-Renewal Committee shall be composed of either: the Department Chair, the Associate Dean of Graduate Medical Education, or their designees, and one faculty member designated by the Chair of the GME Committee, or such other individuals as designated by the GME policies of the School. The house officer will be invited to meet with and make a personal presentation to the Non-Renewal Committee and may be accompanied by a faculty member or fellow house officer who may act as an advisor. The house officer may also be accompanied by a representative of the CIR, who shall not participate in the proceedings. The Non-Renewal Committee may invite the Program Director and any other witnesses to make presentations. All parties may submit any relevant information to the Non-Renewal Committee prior to or during the hearing. The Non-Renewal Committee shall consider only whether the non-renewal conforms to the following standards: the decision was communicated to the house officer in writing; the decision was communicated in a timely manner, in accordance with ROWAN procedure on non-renewal of house officer contracts; and the non-renewal decision was not based on reasons prohibited by law or ROWAN policy. If the Non-Renewal Committee determines that the non-renewal decision conforms to these standards, the decision shall be upheld. Following the hearing, the Non-Renewal Committee shall deliberate and render a writing decision, which shall be communicated to the house officer and Program Director. The decision of the Non-Renewal Committee will be final and binding. Directory: som som -> Chapter Three The New World som -> Readings: "Body Ritual Among the Nacerima" by Horace Miner som -> Animal Behavior Studies Cry of the Kalahari som -> Jessica Schaid and Zoltán Grossman som -> Some of the silent auction items for Tailgaiting: Alabama Baseball Camp Experience som -> Allan m. Eisenbaum, M. D som -> 3d-tape Drawing in Virtual and Augmented Reality som -> In this presentation, I’m going to give you an overview of our course som -> Georges Méliès som -> Dialogue and Sound Download 297.57 Kb. Share with your friends:
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