Louisiana state university health science center new orleans emergency medicine residency program policies to supplement lsuhsc house officer manual



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Revised June 2008, M. Haydel, MD

LOUISIANA STATE UNIVERSITY HEALTH SCIENCE CENTER – NEW ORLEANS
EMERGENCY MEDICINE RESIDENCY PROGRAM
POLICIES TO SUPPLEMENT LSUHSC HOUSE OFFICER MANUAL & ROTATION GUIDE

Prepared For the Worst ~ Providing the Best”



TABLE OF CONTENTS LSU EM Residency Manual



INTRODUCTION 4

POLICIES – ACGME 5

ACGME Core Competencies 5


Core Competencies 5



Core Competencies & LSU EM 6

Resident Duty Hours and the Working Environment 9

Duty Hours - Emergency Medicine 11

POLICIES - LSUHSC 12

Ethics Code - LSUHSC Emergency Medicine Residency 12



Code Of Professional Conduct 13

Honor Code 13

Grievance Policy - Academic 14

Ombudsman 17

MCLNO Quality of care statement 18

Job Description - EM house officer 19



House Officer I 19

House Officer II 19

House Officer III 20

House Officer IV 20

HOUSE OFFICER CONTRACT 21

LEAVE: 22

Pay Scales - LSUHSC House Officer 26

Emergency Fund for Residents 27

House Officer Selection and Eligibility LSUHSC 28

Campus Assistance Program 30

Fitness For Duty And Substance Abuse Policy 31

Work Related Injury/Illness 32

Dress Code 33

LIBRARY - LSUHSC 42

WELLNESS CENTER 44

HOUSE STAFF CLEARANCE FORM 45

POLICIES – Section of EM 47

Mission Statement 47

Role of the Residency in the Emergency Department 48

EM Residency Applicants 49

Residency Promotions 50

Satisfactory Academic Standing 51

Evaluations 52

Emergency Department Resident Monthly Evaluation 53

360 degree Annual Evaluation 55

Annual Self-Evaluation 57

6-month Faculty Advisor Meeting 60

Faculty Advisors 61

Procedure and Patient Experience Documentation 62



Ultrasound 63

Common Procedures 64



Follow-Up Log 66

Residency Partner 68

Educational Stipend 69

Travel Forms 70

Mailboxes/ Email 71

Beepers 72

Vacation 73

Yearly Schedule Requests 73

ED Schedules 74

Disaster Call 75



Disaster Call Scheduling 76

Disaster Call & Duty Hours 77

Code Grey – Hurricane Guidelines 78

Advanced Life Support Programs Policy 82

Moonlighting Policy 84

Call Room 85

Sick Leave 86

Conference Attendance Policy 87

Monthly CORD Exam 88



Journal Club Literature Critique Form 91

M & M Presentations 92

Medical Records 94

Electronic Signature 94

LSU EM Reading Topics 2008-09 95

Research Requirement 99

Resident's Research Proposal And Progress Form 100

Chief Resident Responsibilities 101

Chief Resident Questionnaire 101

Residency Curriculum 102

Model For Emergency Medicine 102

Reference Book Loan-Out Policy 103

Medical License 104

105



DEA number 105

NPI number 105

Notary 105

Guidelines To Rotations/Goals & Objectives 107



UH/ MCLANO Emergency Department 108

EMS Guidelines: NOHD & Acadian 108

ANESTHESIA 115

CHABERT Medicine Wards 117

CHILDREN’S HOSPITAL 120

MICU 123

OBSTERICS 126

OLOL Pediatric ED 129

OCHSNER ED 132

SLIDELL ED 136

TOXICOLOGY 139

TRAUMA SURGERY 143

WEST JEFFERSON ED 146

ELECTIVE 150


INTRODUCTION

Welcome to the LSU Emergency Medicine Residency Program. This LSU EM Policies To Supplement LSUHSC House Officer Manual & Rotation Guide is meant to augment the LSUHSC School of Medicine, Office of Graduate Medical Education, House Officer Manual. The House Officer Manual is updated each year and is available on the LSUSHC website at:


http://www.medschool.lsuhsc.edu/medical_education/graduate/HouseOfficerManual.asp

A hard copy of this manual is available in the emergency medicine offices and online at the LSU EM yahoo website. http://health.groups.yahoo.com/group/LSUEM/


POLICIES – ACGME




ACGME Core Competencies



Core Competencies Guidelines (ACGME 2007)


Core Competencies


You MUST MEMORIZE this list of the 6 Core Competencies for ACGME accreditation purposes.  Click on each item to for more details.

  1. Patient Care

  2. Medical Knowledge

  3. Practice Based Learning

  4. Interpersonal & Communication Skills 

  5. Professionalism

  6. Systems Based Practice


Annual Competency Assessment – The programs must define competencies that are expected for each year of training taking into account the defined ACGME core competencies. Multiple tools may be used to evaluate these competencies. Competency evaluation of chief complaints, procedures, resuscitations and off-service rotations may be used as part of the annual competency evaluation.
The RRC will review:
What competencies are expected for each year of training?

What are the measurable competency objectives for each year of training?

How are these objectives measured?

How are deficiencies remediated?

Deficiencies in specific areas do not necessarily mean that the resident is held back in progressing to the next year; however, plans must be in place to achieve the required competencies.

Chief Complaint Competency - The RRC expects that programs will assess the competency of residents to handle key chief complaints in emergency medicine. At the time of program review, the program will demonstrate how it assesses resident competency for 3 chief complaints over the course of the training program. The program can use a variety of tools including direct observation, check-lists, simulations, etc.

Procedural Competency – The primary responsibility for the determination of procedural competency rests with the program director and the faculty. The RRC accredits programs, and does not certify or credential individuals.

The RRC expects programs to assess the competency of residents to perform key index procedures. At the time of program review, the program will need to demonstrate how it assesses competency of residents for 3 procedures.

Selected index procedures should consequentially impact patient care, and ideally facilitate competency assessment initiatives across disciplines.

One of the selected procedures must be ED bedside ultrasound (PR V.B.2.b; appendix 1)




Resuscitation Competency – The RRC expects programs to assess resident competency in the resuscitation of critical patients. These include adult and pediatric medical and trauma resuscitations. At the time of program review, the program will demonstrate how it assesses competency in one type of resuscitation. The program may use a variety of techniques including simulations and direct observations.

Off-Service Rotations – The program should define measurable competency objectives for off-service rotations, how the objectives are assessed and remediated when necessary. At the time of program review, it is expected that measurable objectives and the tools used for evaluation will be available for half of the off-service rotations.

Core Competencies & LSU EM


The residency program must require that its residents obtain competence in the six areas listed below to the level expected of a new practitioner. Programs must cite examples how these competencies are taught and evaluated within the training program.


  1. Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Among other things, residents are expected to:




  1. Gather accurate, essential information in a timely manner.

  2. Generate an appropriate differential diagnosis.

  3. Implement an effective patient management plan.

  4. Competently perform the diagnostic and therapeutic procedures and emergency stabilization.

  5. Prioritize and stabilize multiple patients and perform other responsibilities simultaneously.

  6. Provide health care services aimed at preventing health problems or maintaining health.

  7. Work with health care professionals to provide patient-focused care.


Residency Experience: each clinical rotation and every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, teaching ACLS/PALS/ATLS and freshman anatomy labs.
Residency Assessments: Direct observation and documentation of Daily, Monthly and Yearly evaluations, simulation cases, oral board cases, Morbidity and Mortality cases 360 evaluations.
2. Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
Among other things, residents are expected to:


  1. Identify life threatening conditions, the most likely diagnosis, synthesize acquired patient data, and identify how and when to access current medical information.

  2. Properly sequence critical actions for patient care and generate a differential diagnosis for an undifferentiated patient.

  3. Complete disposition of patients using available resources.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, teaching ACLS/PALS/ATLS and freshman anatomy labs.

Residency Assessments: National In-service Exam, Quarterly local in-service exams, Quarterly question sets, Daily, Monthly and Yearly evaluations, 360 evaluations, oral board cases, simulation cases and journal club.
3. Practice-Based Learning: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices.
Among other things, residents are expected to:


  1. Analyze and assess their practice experience and perform practice-based improvement.

  2. Locate, appraise and utilize scientific evidence related to their patient’s health problems.

  3. Apply knowledge of study design and statistical methods to critically appraise the medical literature.

  4. Utilize information technology to enhance their education and improve patient care.

  5. Facilitate the learning of students and other health care professionals.


Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, journal club, teaching ACLS/PALS/ATLS and freshman anatomy labs.
Residency Assessments: Daily, Monthly and Yearly evaluation, 360 evaluations, oral board cases, simulation cases, journal club, Trauma Conference, Toxicology rotation, RSI forms, End of Year evaluations and Ultrasound QA.
4. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and professional associates.
Among other things, residents are expected to:


  1. Develop an effective therapeutic relationship with patients and their families, with respect for diversity and cultural, ethnic, spiritual. Emotional and age-specific differences.

  2. Demonstrate effective participation in and leadership of the health care team.

  3. Develop effective written communication skills.

  4. Demonstrate the ability to handle situations unique to the practice of emergency medicine.

  5. Effectively communicate with out-of-hospital personnel as well as non-medical personnel.



Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, bedside teaching, teaching ACLS/PALS/ATLS and teaching freshman anatomy labs.
Residency Assessments: Daily, Monthly, Yearly evaluation, 360 evaluations, oral board cases and simulation cases.
5. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.
Residents are expected to demonstrate a set of model behaviors that include but are not limited to:


  1. Treats patients/family/staff/paraprofessional personnel with respect.

  2. Protects staff/family/patient’s interests/confidentiality.

  3. Demonstrates sensitivity to patient’s pain, emotional state and gender/ethnicity issues.

  4. Able to discuss death honestly, sensitivity, patiently and compassionately.

  5. Unconditional positive regard for the patient, family, staff and consultants.

  6. Accepts responsibility/accountability.

  7. Openness and responsiveness to the comments of other team members, patients, families and peers.


Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, death notification, cultural competency, pain management, conflict resolution, AMA, teaching ACLS, PALS and ATLS.
Residency Assessments: Daily, Monthly, yearly evaluations, 360 evaluations, oral board cases and simulation cases.
6. Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
Among other things, residents are expected to:


  1. Understand access, appropriately utilize and evaluate the effectiveness of the resources, providers and systems necessary to provide optimal emergency care.

  2. Understand different medical practice models and delivery systems and how to best utilize them to care of the individual patient.

  3. Practice cost-effective health care and resource allocation that does not compromise quality of care.

  4. Advocate for facilitates patients’ advancement through the health care system.


Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, Disaster Drills, Hazmat, EMS, chart/EMS run report reviews, patient follow ups and CQI project (RSI sheets, radiology call backs and M & M)
Residency Assessments: Daily, Monthly, Yearly evaluations, 360 evaluations, oral board cases, simulation cases, Toxicology rotation, M & M and interesting case conference



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