Title: Duty Hours and Learning Environment Policy and Procedure for Residents
Purpose: The University of Pittsburgh School of Medicine Department of Ophthalmology establishes this policy regarding resident duty hour requirements to ensure program compliance with ACGME resident duty hour regulations and UPSOMGMEP institutional requirements. In addition, this document describes the culture and the academic leadership support to ensure attention to the letter and spirit of these regulations and those regarding the learning environment. Residents/Fellows must be provided a sound academic and clinical education. Their training must be carefully planned and balanced to insure optimal patient care and safety, which requires a diligent commitment to resident well-being. Each program must ensure that the learning objectives of the program are not dependent on residents/fellows to fulfill service obligations. Didactic and clinical education must have priority in the allotment of resident’s time and energies. Clinical assignments must respect that faculty and residents collectively have responsibility for the safety and welfare of patients. The department will join and support GME efforts to comply with this policy which may require that a program request from the Health System additional resources.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Procedure
I. Supervision of Residents
A. Qualified faculty supervise all patient care as specified in the "Supervision Policy". The program director ensures, directs, and documents supervision and faculty support appropriate for the level of training of residents/fellows at all times. Residents/Fellows are provided with efficient, reliable systems for communicating with supervising faculty.
B. Faculty schedules are structured to provide residents/fellows with continuous supervision and consultation.
C. Faculty and residents/fellows are educated to recognize the signs of fatigue and adopt and apply practices to prevent and counteract the potential negative effects.
II. Duty Hours
A. Duty hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities. All academic or administrative activities that residents are required to attend are counted towards the duty hours standards. This includes required onsite educational activities such as meetings, conferences and research. Duty hours do not include reading and preparation time spent away from the clinical site.
B. Duty hours are averaged over a four-week period, inclusive of all in-house call activities and are limited to 80 hours per week on average.
C. Averaged over a four-week period, inclusive of call, residents are provided with 1 day in 7 free from all educational and clinical responsibilities. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
D. A required 10-hour time period for rest and personal activities is provided between all daily duty periods, and after in-house call as per ACGME guidelines for resident duty hours.
E. The department of Ophthalmology is in full compliance with both the letter and spirit of these and respective specialty duty hour requirements.
III. On-Call Activities
The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal workday when residents are required to be immediately available in the assigned institution.
A. Averaged over a four-week period, in-house call occur no more frequently than every third night.
B. Continuous on-site duty, including in-house call, does not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, maintain continuity of medical and surgical care, transfer care of patients, or conduct outpatient continuity clinics.
C. A new patient is defined as any patient for whom the resident/fellow has not previously provided care. No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity clinics.
D. At-home call is defined as call taken from outside the assigned institution.
i. The frequency of at-home call is not subject to the every third night limitation. However, at-home call is not so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call are provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.
ii. When residents are called into the hospital from home, the hours spent in-house are counted toward the 80-hour limit beginning from the time the resident/fellow arrives at the hospital.
iii. The program director, faculty, and residents monitor the demands of at-home call in this programs and scheduling adjustments are made as necessary to mitigate excessive service demands and/or fatigue.
IV. Moonlighting
A. Moonlighting is defined as any outside activity for which compensation is received, especially when not related to the training program. Because residency education is a full-time endeavor, it is the policy of the department of Ophthalmology that absolutely no moonlighting is permitted.
V. Learning Environment
A. The department of Ophthalmology is committed to providing all medical learners with a safe and positive learning environment which stimulates intellectual, professional, and personal growth.
B. The academic climate in our training program fosters the above in an open and nonthreatening manner. This climate will be concordant with the UPMCMEP policies and procedures outlined in the resident contract as well as the policies on Teacher /Learner Interactions and Harassment.
C. The physical environment of our training programs will also facilitate safety and learning. Components of this include call rooms, lounges, meal services, parking, security, and adequate ancillary patient care services such as patient transport, phlebotomy teams and IV teams. An adequate physical environment is guaranteed in the resident contract.
D. Oversight and monitoring of the Learning Environment is the responsibility of the department and the entire GME system. Programs and the facilities that they reside in have local monitoring that includes trainee involvement. The GMEC will provide oversight and monitoring through the Resident/Fellow Duty Hour and Learning Environment Subcommittee as outlined below and in compliance with the other policies as mentioned above.
VI. Oversight
A. This program must has written policies and procedures consistent with the ACGME/RRC Institutional and Program Requirements for resident duty hours and the learning environment. These policies must be distributed to the residents and the faculty. Duty hours are monitored on an ongoing basis to ensure an appropriate balance between education and service. The department of Ophthlmology is committed to ensuring that programs have adequate support to provide a safe ACGME compliant learning environment as well as the ability to monitor duty hours. Moonlighting activities are strictly forbidden. Failure to comply with this policy may result in disciplinary action up to and/or including dismissal.
The department of Ophthalmology monitors at least monthly duty hours and the overall learning environment. The program directors is required to attest to their review of duty hour reports and their response to violations of the duty hours standards. Trainees have input into this process. The ACGME resident survey is an important component of this monitoring process. The programs ensures a minimum of 70% participation in the survey. Residents are oriented to the survey before completing it. The program uses the survey at annually as an internal monitoring tool.
B. The department of Ophthalmology ensures that back-up support systems are provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.
Residents have mechanisms in place to address concerns without fear of reprisal and are encouraged to contact the GME Office in strictest confidence.
VII. Monitoring & Auditing
A. The department of Ophthalmology maintains an accurate schedule for each resident defining the workday (start and end) and coverage structures including tools to make each resident/fellow's schedule transparent to attendings.
B. The department of Ophthalmology submits verified and accurate resident duty hours information into the automated system-wide tracking (GME ROCS). The program director monitors and responds to the automated duty hours reports.
.
Title: Resident Fatigue: Prevention, Identification and Management Policy
Purpose: The Accreditation Council for Graduate Medical Education (ACGME) requires all training programs to educate faculty and residents to recognize the signs of fatigue and adopt and apply policies to prevent and counteract their potential negative effects.
Scope: University of Pittsburgh School of Medicine Department of Ophthalmology
Responsible Parties: Faculty and Residents of the University of Pittsburgh School of Medicine Department of Ophthalmology
Overview: It is inevitable there will be some sleep loss and fatigue in the course of medical training. The development of strategies to minimize the effects of sleepiness in physicians is of paramount importance. Learning to recognize and manage fatigue is essential. This policy parallels the Departmental and GME Institutional Policies: "Duty Hours and Learning Environment Policy and Procedure for Residents"; which focuses on the Duty Hour Standards. This policy was developed to further demonstrate our commitment and efforts to increase awareness of the potential impact fatigue can have on a resident's well being and learning ability and ensure their provision of safe care for our patients.
Prevention
The department of Ophthalmology residency program
• Incorporates discussions regarding the management of fatigue into the program curriculum and evaluation process for both faculty and residents.
• Monitors resident and program compliance with Institutional and Program-specific duty hour policies.
• Minimizes prolonged work (>24 hours of clinical duties)
• Protects periods designed to address sleep debt (i.e., the minimum of at least 24 hours off each week free from all clinical responsibilities)
• Provides services and develops systems to reduce non-essential tasks or tasks more appropriately assigned to other personnel in a manner appropriate to and consistent with educational objectives and patient care.
• Incorporates the topic of prevention, identification and management of fatigue into the annual system-wide and departmental orientation programs.
• Assists residents to identify co-existent medical issues which impair their sleep (i.e. undiagnosed sleep disorder, depression, stress)
• Provides safe and secure napping resources
• Provides day call rooms for residents that elect to rest before driving post-call.
Identification
Restricting duty hours alone does not preclude fatigue. The ophthalmology residency program must identify the presence and effects of persistent fatigue and strategies to ameliorate the impact. We have a responsibility to ensure that faculty and residents are educated to become knowledgeable about sleep science as it applies to resident performance and health. Resident stress may increase if residents are concerned about losing significant learning opportunities, procedural experience and interaction with colleagues. Residents may feel support is lacking from senior residents and faculty who may have an inadequate understanding of the rules surrounding duty hour mandates.
As has been reported widely, fatigue, similar to the effects of alcohol, slows reaction time, saps energy, diminishes attention to detail and degrades communication and decision-making skills---all things that hinder patient safety and the safety of our residents. Fatigue, called by some authors "excessive daytime sleepiness", may be due to a variety of factors. These may exist alone or in combination and include:
• too little sleep
• fragmented sleep
• disruption of the circadian rhythm (such as may occur with night float work)
• a myriad of other conditions which may masquerade as fatigue such as anxiety, depression, thyroid disease or other medical conditions, or medical side effects
• primary sleep disorders
Too little sleep may be the most common reason for sleepiness among residents, occurring when residents get less sleep than optimal. Although there is individual variation, most adults require an average of 8 hours of sleep each night. Residents may not have developed good sleep habits in college and medical school for adequate sleep even on their nights off. Further, sleep deprived subjects are often unaware of the severe degradation of their decision-making skills.
Management
Residents need to consider the following:
• refrain from driving if drowsy; get a ride from the department taxi service, take a nap using day room service first and/or pull over and take a nap if necessary
• get educated and learn to recognize the signs of fatigue. Do not be embarrassed to discuss these issues openly.
• make sleep a priority; be appropriately selfish about needed sleep time. Excessive fatigue can affect every facet of life.
• aim for 7-9 hours of sleep per night. This is especially true after a period of sleep loss.
• keep to routine when possible. Going to bed and rising at the same time may help.
• get adequate exercise but avoid exercising directly before sleep.
• protect sleep time. Turn off phone. Ask your family/significant others, friends to help you. Try not to incur a sleep debt from non-work activities.
• get light exposure when awake.
The prevention, treatment and management of resident fatigue are shared responsibilities of accrediting bodies, institutions, programs, faculty and residents.
Title: Moonlighting
Purpose: This policy addresses "moonlighting" by residents. Moonlighting is defined as professional activities that a resident would undertake as a physician that are outside the scope of their graduate medical education program.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Title: Supervision and Progressive Responsibility
Purpose: To specify the manner and mechanism in place to assure that all University of Pittsburgh Department of Ophthalmology residents are supported and supervised in their clinical activities. Residents must be assured of appropriate attending involvement in their patient care activities through each level of training.
Scope: University of Pittsburgh Department of Ophthalmology Faculty and Residents
Policy This policy states formally the University of Pittsburgh Department of Ophthalmology Policy on Progressive Responsibility of Residents and Resident Supervision and is intended to be consistent with all UPMC policies and procedures and all regulations and standards of accreditation and licensing organizations.
The medical staffs of all University of Pittsburgh Medical Center hospitals have overall responsibility for the quality of the professional services provided to patients, including patients under the care of participants in professional graduate education programs (also known as “residents”, "fellows", “graduate trainees”, or “house staff”). It is, therefore, the responsibility of these medical staff to assure that each participant in a graduate education program is supervised in his/her patient care responsibilities by a licensed independent practitioner (LIP) defined as an individual who is independently licensed to practice medicine, and is appropriately and individually appointed, credentialed and privileged by the health care facility/hospital organization in question to practice in the area of medicine being considered. MDs or Dentists without current PA licenses, without required professional liability insurance, or without clinical privileges, and others with doctoral degrees other than an MD (or equivalent) or appropriate Dental degree are not medical staff members and are not treated as LIPs within the Bylaws of University of Pittsburgh Medical Center facilities. A resident or fellow is not, and cannot be, a LIP, as long as he/she is a resident and holds a medical training license, and/or is registered with the UPMCMEP office as a professional graduate medical trainee, and/or is engaged in a course of training in an ACGME or AOA accredited program.
The teacher/trainee relationship is fundamental to this policy and founded on respect and professionalism. Much of the learning process and the development of progressive responsibility is based on teaching by example under supervision. Supervision and close observation provides the ability of the mentor/program director to ascertain when a resident is ready and able to assume progressive responsibility. This readinessis reflected in the evaluation process with evaluations completed in a timely fashion and addressing the achievement of core and specialist competencies commensurate with the level of training and the specific nature of the training program and the responsibilities involved. Patient safety and continued quality improvement in patient care are fundamental to the policy on Progressive Responsibility.
The detailed descriptions of resident supervision in patient care settings in the department of Ophthalmology is as follows:
University of Pittsburgh Medical Center
Outpatient Clinic Setting
Residents are supervised directly by the faculty on service. Each patient seen by a resident is also seen by faculty. Feedback is typically provided at the time of the encounter or at end-of-day wrap-up sessions.
Emergency Department Setting
Weekday emergency room coverage is assigned to the PGY-2 resident on the ED rotation. Night and weekend coverage is assigned to a PGY-2 resident on a daily rotating basis averaging every sixth night. PGY-2 residents take in house call. All patients seen by the residents are examined by the emergency room faculty after the resident has evaluated the patient. A PGY-4 resident is assigned to be available by pager to discuss management and if necessary see any patient. In addition, a faculty member is assigned to be available by pager to discuss management and if necessary see any patient. The resident call schedules are determined by the residency program director. The call schedule for the in-house on-call resident, the senior resident providing first backup and the attending on-call is distributed on a monthly basis to residents, fellows, faculty, staff and paging coordinator for the UPMC health system. A large percentage of patients seen in the emergency room are seen for follow-up at UPMC Eye Center during regular clinic hours. These patients are seen by faculty with the resident who saw them in the emergency room whenever possible.
Inpatient Consult Setting
Inpatient consult patients are seen first by the resident. They are subsequently seen by faculty with the resident either during inpatient consult rounds at the bedside or in the outpatient clinical areas. In addition, the resident reviews the entire list of inpatient consult patients with the faculty assigned to the inpatient consult service.
Operating Room Setting
All surgical cases, without exception, must be performed under the supervision of faculty.
University of New Mexico / New Mexico VA
Outpatient Clinic Setting
During the rotation in New Mexico an attending is immediately available to see every patient. All patients for which the treatment plan requires laser or incisional operative care is seen by faculty. All charts are reviewed by faculty.
Emergency Department and Inpatient Consult Setting
At UNM, weekday emergency room coverage is covered by the PGY-4 resident on rotation at UNM. The VA, weekday coverage is provided by the Optometry residency. Night and weekend coverage is combined for UNM and the VA and is assigned to one of the PGY-4 residents. Since there are two rotating residents at any time, the resident averages covering every other night. The residents divide the call up between themselves, usually taking about a half-week at a time before switching. Call is taken from home. All patients seen by the residents are examined by the emergency room faculty after the resident has evaluated the patient. An Ophthalmology faculty member is on call to discuss management of and, if necessary, see any patient.
Any patient transferred to the ER with an eye condition as the primary issue must first be accepted by the Ophthalmology attending on-call. The resident and faculty call schedules are determined by the local residency program director. Most patients seen in the emergency room are subsequently followed at the UNM Eye Clinic, generally by the resident who evaluated them in the ER.
Operating Room Setting
All surgical cases, without exception, must be performed under the supervision of faculty.
Pittsburgh VA
Outpatient Clinic Setting
During the rotation through the VA in Pittsburgh an attending is immediately available to see every patient. All patients for which the treatment plan requires laser or incisional operative care is seen by faculty. All charts are reviewed by faculty.
Emergency Department Setting
Emergency coverage is divided among the three residents assigned to the VA. A VA faculty member is assigned to be available by pager to discuss management and if necessary see any patient.
Operating Room Setting
All surgical cases, without exception, must be performed under the supervision of faculty.
Compliance with this policy is monitored through the and assessed by documentation of evaluations, and by direct interviews of residents and faculty. The Program Director and the relevant Department Chairman are responsible for compliance with this policy.
Procedure
Supervision, Roles and Responsibilities of Residents Expectations for Attendings:
1. Physician has ultimate responsibility for all medical decisions regarding his/her patients.
2. Physician is responsible for providing oversight and supervision of all care provided by trainees.
3. Physicians are expected to behave in a professional manner at all times in regard to trainee supervision and are expected to encourage each trainee to seek guidance from the attending at any time the trainee believes it to be helpful in the care of the patient. The attending physicians make clear to each trainee that it is only the failure to seek guidance that will be considered problematic.
Responsibilities of Attendings:
1. Physician must develop a plan for the medical management of each patient in conjunction with the house staff and consulting service.
2. The attending physician is responsible for the implementation of the plan of care and for documentation of the plan in the medical record.
3. If the attending physician delegates, in whole or in part, the medical management plan, the attending remains responsible for ensuring that all delegates have appropriate training, experience and competence to undertake such management.
4. The attending physician must communicate clearly to each trainee involved in the care of the patient when the attending expects to be contacted by the trainee. At a minimum, the trainees must be told to notify the attending of significant changes in the patient’s condition regardless of the time of day or day of week.
Factors that require resident to notify Attendings:
(1) Patient admission to Hospital
(2) Transfer of patient to the intensive care unit
(3) Need for intubation or ventilator support
(4) Cardiac arrest or significant changes in hemodynamic status
(5) Development of significant neurological changes
(6) Development of major wound complications
(7) Medication errors requiring clinical intervention
(8) Any significant clinical problem that will require an invasive procedure or operation.
1. All resident or fellow patient care responsibilities will be under the supervision of a LIP independent who has full appropriate appointment and privileges at a University of Pittsburgh Medical Center hospital granted through the medical staff credentialing process. The LIP will monitor patient care services provided by residents or fellows to assure provision of quality patient care. The LIP supervisor will sign appropriate resident or fellow notes and orders as appropriate to hospital and program policy.
2. Licensed residents or fellows at all levels of training may write orders. All orders shall include the date signed by the resident. These orders are written under the supervision of a LIP as noted in 1 above.
3. Resident orders shall be in accordance with the appropriate University of Pittsburgh Medical Center and the University of Pittsburgh Physicians (UPP) medical records policy and shall be signed by the resident. A resident in accordance with UPMC hospital policies may give verbal orders. They may be received by a registered nurse, physician, resident physician, respiratory therapist or pharmacist and must be signed by the resident per specific UPMC hospital policy.
4. Requirements for the completeness and timing of the patient history and physical exam (“H&P”), including a listing of the minimum contents to be included in the medical record by house staff officers, shall comply with appropriate medical records policies and applicable hospital licensing and JCAHO standards.
5. Progressive responsibility for residents and fellows is provided in accordance with UPMCMEP Program policies on achievement of general and specific competencies, including the six General Competencies as promulgated by the ACGME and endorsed and implemented by the UPMCMEP Graduate Medical Education Office and the University of Pittsburgh School of Medicine. Documentation of the residents/GTs achievement of these competencies is provided through Faculty evaluations of the residents and evaluations and reviews provided by the Program Director. The Graduate Medical Education Committee (GMEC) of the UPMCMEP and the Chairman of the GMEC provide institutional oversight of this process with the concurrence of the Chief Medical Officer of the UPMC.
NOTE: This policy addresses progressive responsibility of residents or fellows and supervision of residents and fellows. Nothing in this policy is intended to supercede any additional requirements for teaching physician documentation required for billing purposes under the CMS teaching physician guidelines or UPP policies.
Title Evaluation of Faculty and Program
Purpose Resident evaluation of the instructors, educational material, the program, and the rotations are very important in order to maintain the quality of education. The ACGME and the Ophthalmology RRC require evaluation of faculty and the program as part of the evaluation process for accreditation. This policy outlines the procedures that the Department of Ophthalmology will use to satisfy this requirement.
Evaluation of the Program
Continuous program improvement is a key component of program success.
The program participates in the Annual ACGME sponsored resident survey. The results of this survey are distributed to the faculty and discussed at residency steering committee meetings as well as the Annual Program Evaluation meeting (see below)
In addition, all residents and faculty are required to submit an evaluation of the program at the end of the year. The form used for this evaluation is attached below.
An evaluation of the program is also an important part of the resident's semi-annual review meeting of the program director with each resident.
In addition to resident evaluations of all clinical experiences, there is a separate and distinct formal meeting held annually: the Annual Program Evaluation (APE), to systematically evaluate the overall performance and effectiveness of the educational program, the faculty and residents. This meeting is documented and the minutes are kept on file. The attached template is used for this meeting and includes review of
Collective resident performance in meeting the Competency-based goals and objectives of the curriculum
a. Trainees’ performance during rotations
b. Inservice exams and case logs
c. Number and quality of presentations, publications
d. Involvement of residents in patient safety and quality of care education and improvement activities
e. Participation in committees involving their own education and/or affecting patient care
f. Compliance with required policies and procedures of the hospital department, program and institution, including completion of required education related to patient privacy, medical records, and personal and patient safety.
g. Participation in educational activities related to physician impairment, including substance abuse and sleep deprivation.
Faculty Development Activities
Compilation of the key faculty members’ activities such as participation in professional society development programs, continuing medical education programs, and departmental or specialty sessions designed to further their clinical, educational, administrative, leadership, and research skills. This is in
addition to the review of collective faculty performance.
Graduate Performance
This includes at a collation of Board pass rate and postgraduate activities, including current position and involvement in clinical, research, administrative or educational endeavors.
Program Quality
This includes the annual survey of both residents and faculty about rotations, program support, organization and quality, as well as written evaluation of the program by graduates 1 and 5 years after completion. It may include an assessment by the graduates of how well the program prepared them for their current practice. There must also be discussion of the results of GME Internal Reviews and most recent Letter of Notification and RRC Communication. Evaluation: Residents/Fellows, Faculty and Program
Findings from the APE are analyzed and discussed to identify any areas for improvement and innovation. An action plan must be developed, approved by the teaching faculty, and documented in meeting minutes. The action plan must be implemented over the next academic year, and results discussed at the following APE.
Title: Evaluation of Residents
Purpose: The Department of Ophthalmology has developed academic requirements, including goals, objectives, an organized curriculum, and evaluation methods, consistent with the ACGME general competencies, for the educational development and evaluation of the residents enrolled in the program. In order to progress academically, the resident or fellow must meet those academic requirements, as determined by evaluation tools. The program is responsible for regular evaluation of residents' progress. Evaluations of residents are used in improving resident performance and in making decisions about promotion, program completion, remediation, and any disciplinary action. Multiple evaluators (e.g. faculty, peers, patients, self and other professional staff) are involved in the periodic assessment of resident performance.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Procedure
Faculty Evaluation of Residents
Standards of evaluation are applied uniformly to all residents and are available to members of the resident staff and faculty.
The faculty are required to evaluate and document resident performance in a timely manner. This must occur at the completion of each rotation or similar educational assignment. Feedback regarding evaluations and performance should be provided during the rotation and must be provided at the completion of the rotation or assignment. The current end of rotation resident assessment form used by faculty is attached below.
In addition, faculty and program director evaluation of resident achievement in the ACGME competencies is documented using
Staff, Peer, Patient and Self Evaluation of Residents
Resident achievement in the 6 ACGME general competencies is regularly evaluated by
The current forms for these evaluations are attached below.
The semi-annual performance evaluation
A formal meeting is conducted by the program director to review all evaluations and performance with the resident twice a year. A written report of each such meeting is maintained in the resident’s program file.
The evaluations document evidence of resident achievement in each of the 6 ACGME general competencies, appropriate for the educational level in order to advance to the next PGY level of training.
Adverse actions
Residents are be notified in writing when the program determines that an adverse action such as probation, non-advancement, non-renewal of contract or termination is warranted. In instances where a resident’s agreement will not be renewed, or when a resident will not be promoted to the next level of training, the resident must be provided with a written notice of intent no later than four months prior to the end of the resident’s current agreement. If the primary reason(s) for the non-renewal or non-promotion occurs within the four months prior to the end of the agreement, the program must provide the resident(s) 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 agreement. Residents should be referred to the UPMCMEP Grievance and Appeals Policy for further information regarding the appeals process.
End of training summative evaluation
The program director provides a summative evaluation for each resident upon completion of the program. This documents satisfactory performance during the final period of training and verifies that the resident has demonstrated sufficient competence to enter practice without direct supervision. This evaluation becomes part of the resident’s permanent record, kept on file, and is accessible to the resident.
Title: Recruitment, Appointment, Eliigibility and Selection of Residents
Purpose: This document outlines the policy of the Department of Ophthalmology in the selection or residents. In addition to the criteria listed below, the resident selection policy will follow all institutional policies.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Eligibility
Applicants will be considered only if, after completing training in the program, they would be eligible for certification by the American Board of Ophthalmology. ABO requirements for Certication are attached below. In addition, applicants must meet all requirements for eligibility set by the University of Pittsburgh School of Medicine Graduate Medical Education Program. This policy is attached below as well. The result of these requirements is that applicants for residency must be pending graduates or graduates of at least one of the following:
Title: Conditions and Duration of Appointment, Reappointment, Non-Renewal or Non-Promotion of ResidentContracts
Purpose: To describe conditions for the appointment, reappointment of residents and
fellows and to establish guidelines for the non-promotion or non-renewal
of a resident/fellow.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology, ACGME/NRMP Designated Institutional Official; Vice President,
Graduate Medical Education
Policy
Duration of Appointment: All residency/fellowship appointments should be for a period not to exceed one year.
Conditions for Reappointment: Resident and fellow appointments are renewable annually on the recommendation of the Program Director. A decision to reappoint will be based on the resident/fellow’s performance, evaluations and his/her ability to work and learn effectively within the residency/fellowship program, as per the programs curriculum.
Non-renewal of appointment or Non-Promotion: In instances where a resident/fellow’s agreement will not be renewed, or when a resident will not be promoted to the next level of training, programs must provide the resident/fellow with a written notice of intent no later than four months prior to the end of the resident/fellow’s current agreement. However, if the primary reason(s) for the non-renewal or non-promotion occurs within the four months prior to the end of the agreement, the program must provide the resident(s)/fellow(s) 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 agreement.
Residents may appeal this determination by submitting a written request for an appeal to the Program Director (see Grievance and Appeal Policy).
Title: Professionalism and Discipline Policy
Purpose: To describe the standards of performance in the residency training program related to attendance and administrative responsibilities and to describe the consequences for failure to meet these standards.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Effective: July 1, 2011
Policy
Administrative responsibilities are vital to the practice of medicine. They are critical to patient care and to the maintenance of the Residency Program. Throughout the residency there are numerous administrative and patient care tasks that must be completed. Failure to do so violates the essence of professionalism, one of the six core competencies.
These tasks include:
Consequences
Each documented incident of failure to attend a clinic, OR, pathology session, contact lens session, POS will result in the assignment of an administrative point.
Failure to maintain unexcused morning conference/Grand Rounds attendance rate of
for any calendar month period will result in assignment of two administrative points.
Residents are excused from conference if they are on leave, in New Mexico, expected to be first surgeon on a surgical case prior to 8 am. In addition, a resident may be excused from morning conference if they are involved with urgent patient care. In these cases, PGY-2 residents should make every effort to sign out to a PGY-4 resident for the period of the conference.
Point assignments for other incidents are as follows
|
Category |
Point Assignment |
Notes |
|
Scholarly project proposal and manuscript deadlines |
3 |
These include deadlines published on OphEd and deadlines documented in email to the resident by a member of the Scholarly Project Committee. Additional point for each subsequent week late. |
|
Scholarly project proposal progress report deadlines |
2 |
Additional point for each subsequent week late. |
|
Operative Notes |
1 per note |
Additional points per note for each day after the resident is informed of the deficiency |
|
Clinic Documentation |
1 per clinical session |
Additional point per clinical session for each day after the resident is informed of the deficiency |
|
Weekly surgical log update |
1 |
|
|
Response to pager |
2 |
|
|
Post rotation faculty evaluations within two weeks of completion of rotation |
1 |
Additional point for each additional week late |
|
Annual program evaluation |
1 |
|
|
Completion of bi-annual self assessment or peer assessment |
1 |
|
|
Completion of end of conference block quizzes and make ups |
1 |
It is the resident’s responsibility to
|
|
Institutional requirements (e.g. online modules) |
1 |
Additional point for each additional week late |
|
CPC projects within two months of completion of pathology rotation |
1 |
Additional point for each additional week late |
|
Other assigned tasks |
1 |
The general principle is that 1 point will be assigned for missing a deadline and an additional deadline will be assigned for each additional week late. Any exceptions to this will be clearly stated in email communications to residents. |
Points expire after six months from the time they are assigned.
Accumulation of 3 points will result in extra overnight in-house call. The call will be assigned by the chief resident. The first year resident relieved of call will be chosen at random. In the case that assignment of additional call would result in violation of duty hour regulations the extra call assignment may be postponed even until the following post graduate year of training.
Accumulation of 9 points will result in administrative leave. During administrative leave a resident may not participate in operative cases until all outstanding responsibilities are completed. Residents on administrative leave are required to fulfill all other clinical and academic responsibilities. Administrative leave is a residency specific corrective action that is not reportable and does not become part of the permanent record.
Accumulation of 18 points will result in administrative probation for a period of three months. Administrative probation is a residency specific corrective action that is not reportable and does not become part of the permanent record. Accumulation of any additional points during a period of administrative probation will result in a 3 month period of probation. Assignment of 3 or more points after completing a period of administrative probation will result in an additional 3 month period of administrative probation.
Probationis a specific remediation that is reportable for the purposes of obtaining a license, obtaining privileges at a hospital or applying to participate with an insurance carrier. Probation becomes part of a resident’s permanent record.
Accumulation of additional points during a period of probation may result in final actions including
Accumulation of additional points after a period of probation is completed will result in an additional 3 month period of probation.
Title: Grievance and Appeal Policy
Purpose: To describe the standards of performance in the residency training program and to describe the procedures for resident grievances and appeals within the department and to the UPMCME.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Policy
I. STANDARDS OF PERFORMANCE IN THE RESIDENCY TRAINING PROGRAM
The ophthalmology residency training program is established for the purpose of providing specialized advanced educational instruction within the field of ophthalmology. The program is under the supervision of the residency program director and the full-time faculty member of the University of Pittsburgh School of Medicine Department of Ophthalmology
Entrance of a qualified resident into the training program indicates an intention to continue until the completion of the program, subject to satisfactory academic progression and meeting prescribed professional standards. Appointment to the training program is for one year with succeeding reappointment based in part upon satisfactory performance and progression in the year completed.
The performance of each graduate physician in the educational process of the graduate training programs is under the direction and the evaluation of the academic faculty within the program. Professional evaluation of residents will include not only academic and intellectual achievement, but also consideration of ethical and moral behavior and of judgmental capability in treating patients.
The program has minimum standards of performance based upon program requirements and the ACGME general competencies. These standards are based on:
The program has the responsibility of providing regular evaluations and feedback to the residents as described in program requirements and the evaluation policy. Each resident has access to all such evaluations and meets at least twice yearly with the program director to review his/her evaluations. This meeting is documented in writing.
The program has a promotions competency committees that periodically reviews the evaluations and makes recommendations for promotion to the next year of training. The composition of the competency committee includes the program director, all full-time clinical faculty of the department of ophthalmology and at the chief resident of the program. Residents are notified of evaluations indicating an unsatisfactory performance and a plan for remedial action. These are documented in the resident’s file. The competency committee will mandate whatever remedial or disciplinary actions it deems fair and appropriate for a given resident. This may include a requirement to repeat one or more rotations, a requirement for an additional period of training, denial or delay of board eligibility or dismissal from the residency program. When such actions are taken, the resident will be advised both verbally and in writing of the action being taken, the reasons for such action, and the right of appeal.
II. STANDARD FOR INITIATION OF GRIEVANCE
A resident may file a grievance if a reasonable basis exists to support allegations that he/she has been treated contrary to existing policies governing the residency training program.
III. STANDARD FOR INITIATION OF APPEAL
A resident may appeal disciplinary, remedial or other actions that could result in dismissal or significantly threaten a resident status in, or ability to graduate from, the program.
I V . PROCEDURE
a. Grievance Actions alleged to constitute a grievance shall be filed in writing with the program director. Any alleged grievance must be filed within ten (10) days of the date on which the alleged grievance causation occurred. Any grievance not timely filed shall be waived and not processed under this policy. The program director shall review the alleged grievance of the resident in a timely manner and shall gather additional information and/or consult with appropriate individuals in order to fairly render a determination concerning the alleged grievance. If the resident disagrees with the decision of the program director, he/she may request in writing further review of the decision by the department chairperson whose decision shall be final. In cases where the department chairperson is also the program director, the resident may request in writing such further review by the UPMCME DIO or designee, whose decision shall be final. The final decision on any grievance action shall be issued within thirty (30) days of the date that the grievance was filed, unless circumstances justify a reasonable delay as determined by the UPMCME DIO or designee.
b. Appeal Actions alleged by a resident to constitute the basis for an appeal must be presented to the program director in writing within ten (10) days of the date on which the alleged actions underlying the appeal occurred. Any appeal not timely filed shall be waived and not processed under this policy. If satisfactory resolution of the resident allegation is not achieved after discussion with the program director, then the resident, in writing, may request access to the formal departmental appeal procedure.
A departmental appeal will result in the creation of an initial department review panel composed of three members appointed by the department chairperson. The department chair will appoint at least one resident from the program after consultation with the program director. Other appointments to the review panel may be drawn from full time, part time or volunteer faculty, but should exclude the program director, or members of the program who have been or may be involved in the allegations raised by the trainee which are the basis for the appeal. The chairperson of the review panel shall be a faculty member determined by majority vote of the panel.
The review panel shall conduct a fair and reasonable review of the allegations brought forward by the resident including but not limited to receiving oral and written information from the resident and any other appropriate individual who may be significant to the panel's review, evaluation and conclusions regarding the appeal. The review panel proceedings shall be closed to the public and may be restricted at any time to hearing a single individual in the absence of all other witnesses. In these proceedings, the resident may, at his/her sole expense, have an advisor who may be an attorney and who may assist the resident in questioning witnesses to reasonably evoke evidence. Likewise, the review panel may have an advisor who may be an attorney. All evidence and testimony may be subject to inquiry by the review panel. Formal rules of evidence or legal procedure do not need to be followed as long as a reasonable opportunity is made available to the trainee to present his/her position to the review panel. The review panel shall maintain a written record of its findings, conclusions and decisions, a copy of which shall be provided to the trainee. The written record of the review shall be issued within thirty (30) days of the date that the appeal was filed unless, circumstances justify a reasonable delay as determined by the UPMCME DIO or designee.
c. Policies that apply in the event that the departmental appeal procedure upholds the department's actions and the resident wishes to further appeal the decision to the UPMCME DIO or designee are outlined in the UPMCE Grievance and Appeal Policy available on the GME Knows website. This recourse is available to all residents the program only after departmental review has been exhausted. This policy (as of 3/11/2011) is attached below.
Title: Travel Stipend Policy
Purpose: To describe the rules and procedures concerning resident stipends for travel.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Policy
Residents will be reimbursed for eligible expenses incurred while engaged in certain approved educational activities.
Eligible activities and the reimbursable amounts include
Eligible expenses include
Per UPMC Policy all travel and lodging must be arranged through UPMC’s travel agent. Please check with the program coordinator for details.
Title: Vacation and Leave Policy
Purpose: To describe the rules and procedures concerning time taken off from routine residency assignments.
Responsible Parties: Faculty and Residents of the UPSOM Department of Ophthalmology
Policy
The Ophthalmology RRC states that, regarding the length and scope of training, “The length of training in ophthalmology must be at least 36 calendar months, including appropriate short periods for vacation, special assignments, or exceptional individual circumstances approved by the program director. The length of time of residency training for a particular resident may be extended by the program director if that resident needs additional training.”
Vacation
Residents will receive 20 weekdays of vacation each year. Vacation days not used by the end of the academic year are not carried over to the following year. A resident must request a vacation 6 weeks in advance by submitting a vacation request form to the program coordinator.
Interview Leave
Residents are allowed time away from on-site clinical education activities for the purpose of interviewing for a job or fellowship at a rate of loss of one vacation day for each two days used for an interview. It is often impossible to schedule interviews six weeks in advance. Nevertheless, the resident should make every effort to coordinate time off for interviews with the chief resident and the program coordinator as early as possible. Time off for interviews will only be granted if a vacation request form is submitted in advance to the program coordinator.
Education Leave
PGY-3 and PGY-4 residents are allowed time away from on-site clinical education activities for other educational experiences (e.g. a review course or a national meeting) at a rate of loss of one vacation day for each two days used for the educational experience. Time off for these activities will only be granted if a vacation request form is submitted 6 weeks in advance to the program coordinator.
International Missions
Residents are allowed time away from on-site clinical education activities for other departmentally approved international mission trips at a rate of loss of one vacation day for each two days used for the mission Time off for these activities will only be granted if a vacation request form is submitted 6 weeks in advance to the program coordinator.
Leave for presentation of scholarly work.
Residents are allowed two working days off for the purpose of presenting a poster or oral presentation at an approved national meeting. Time off for these activities will only be granted if a vacation request form is submitted 6 weeks in advance to the program coordinator.
Leave of Absence/Family Medical Leave/Personal Leave of Absence
UPMCME policies related to extended leave of absence are attached below.
Extended Leave and length of resident training
Approval by the program, of an extended leave of absence may be accompanied by a need to extend resident training beyond three calendar years. The guiding principle in making this determination will be based on the program director's judgment that a resident graduate of the program is competent to practice independently and without supervision within the scope of comprehensive ophthalmology.
The UPMC Education Program Board of Trustees has approved the following salaries for Graduate Medical Trainees at Children's Hospital of Pittsburgh of UPMC, Magee-Womens Hospital of UPMC, UPMC Mercy, UPMC Presbyterian, UPMC Shadyside, and VA Pittsburgh Healthcare System effective July 1, 2011 through June 30, 2012:
| 2011-2012 | ||
| Level | Annual Gross Salary | |
| GMT Level I | $47,673.80 | |
| GMT Level II | $48,943.20 | |
| GMT Level III | $49,899.20 | |
| GMT Level IV | $51,001.60 | |
Trainees designated as "chief residents" may have their salaries augmented slightly for extra services rendered.
UPMC Graduate Medical Education-Residents and Fellows
January 2011 SUMMARY OF BENEFITS
UPMC GME Residents and Fellows – Full-Time
| Effective 1/1/2011 through 12/31/2011 | |||
| Open | November for a January effective date | ||
| Enrollment | |||
| Medical and | UPMC Advantage HMO – Premium paid for by UPMC, no cost to the physician | ||
| UPMC Open Access PPO – UPMC and the physician share the premium cost | |||
| prescription | |||
| coverage | All employees should complete the My Health requirements, which reduces | ||
| (Election paid for by | |||
| physician and UPMC) | the deductible by $500 per individual/$1,000 per family. | ||
| Dental coverage | United Concordia and UPMC Dental will offer both a Premium PPO or a Standard | ||
| PPO. Premium for Standard PPO (individual coverage) is paid for by UPMC, all other | |||
| (Election paid for by | |||
| physician and UPMC) | coverage levels have UPMC and the physician sharing the premium cost. | ||
| Vision coverage | If medical coverage is elected, basic vision coverage will be provided at no | ||
| (Election paid for by | additional cost. An enhanced vision benefit is available for an increased cost and | ||
| physician and UPMC) | |||
| can be selected along with the medical coverage or for those not purchasing | |||
| medical, a stand alone vision benefit is also offered. | |||
| Health Care FSA | $5,000 annual employee maximum | ||
| (Election paid for by | Effective for 01/01/2011, Over the Counter Medications (OTC’s) will no longer be eligible for | ||
| physician) | |||
| reimbursement without a prescription. | |||
| Dependent Care | |||
| FSA (Election paid | $5,000 annual family maximum | ||
| for by physician) | |||
| Life Insurance | Group-term life insurance coverage of 1X times the UPMC base salary. | ||
| and Accidental | |||
| Death & | Group-term AD&D insurance coverage of 1X times the UPMC base salary. | ||
| Dismemberment | Make sure that you designate your beneficiary through My HUB | ||
| (Employer provided at no | |||
| cost to physician) | |||
| Optional Group | Supplemental term life insurance may be purchased up to a maximum of 5X times | ||
| Life Insurance | UPMC base salary to $1,000,000. | ||
| (Election paid by | Guarantee issue (upon first becoming eligible) is 3X times UPMC base salary. | ||
| physician) | |||
| Optional AD&D | May be purchased in increments up to a maximum of $1 million. | ||
| coverage | |||
| (Election paid by | |||
| physician) | |||
| Dependent | Supplemental term life may be purchased: | ||
| Group | Spouse: $10,000 increments up to $100,000. Guarantee issue (upon first | ||
| Life/AD&D | becoming eligible) is $30,000. | ||
| Insurance | | Dependent: may choose a coverage level of $5,000 or $10,000 per | |
| (Election paid by | dependent | ||
| physician) | |||
| Supplemental AD& D insurance may be purchased: | |||
| Spouse: up to a maximum of $500,000. | |||
| Dependent: available in the amount of $10,000. | |||
| Salary | Defined as the first 26 weeks of disability. 100% coverage of UPMC base salary for | ||
| Continuation | up to 26 weeks. | ||
| (Employer provided at | |||
| no cost to physician) | |||
| Long-term | Employer-paid coverage of 60% of the UPMC base salary through age 65. The | ||
| Disability | elimination period is 26 weeks. | ||
| (Employer provided at | |||
| no cost to physician) | |||
| Tuition | Residents or fellows who are candidates for a graduate degree, or approved | ||
| certificate program or academic courses for credit, at University of Pittsburgh or | |||
| Reimbursement | |||
| Carnegie-Mellon University (CMU) as a required part of their UPMCMEP-approved | |||
| (Paid for by physician | |||
| graduate medical training program may be eligible for non-taxable qualified | |||
| and UPMC) | |||
| scholarship monies as per the Qualified Scholarship Policy. Please refer to the | |||
| UPMCMEP Qualified Scholarship Policy for complete details. | |||
| For all others, the UPMC tuition assistance benefit is available up to a maximum of | |||
| $3,500 per academic year. The benefit also provides a tuition assistance at the | |||
| University of Pittsburgh for dependent children and spouses for first baccalaureate | |||
| degree only at 50% up to $5,000 maximum/year for dependent children (must be | |||
| full-time student) and up to $2,000 maximum/year for spouse (full or part-time | |||
| student). Please refer to the UPMC Tuition policy for complete details. | |||
| Note: The awarding of scholarship funds under the Qualified Scholarship | |||
| Policy prohibits employees from seeking reimbursement for remaining | |||
| balances under the UPMC Tuition Policy. | |||
| Adoption | Reimbursement of qualified adoption expenses of up to $2,000. | ||
| Assistance | (Reference Adoption Assistance Program Policy HS-HR0728 for details.) | ||
| Effective 1/1/2011 through 12/31/2011 | |||
| Retirement | Employer Match, 403(b) Plan | ||
| Plan | |||
| 50% match on up to 4% of deferral of salary | |||
| Can contribute at date of hire | |||
| Eligible for match beginning the January 1 or July 1 after age 21 & paid 1,000 hours | |||
| 3-year vesting period for matching contribution. | |||
| Pre-tax employee contribution limit for 2011 is up to $16,500. $22,000 if age 50 or older | |||
| by 12/31/11. This amount must be aggregated if more than one employer. | |||
| | After-tax contributions permitted. | ||
| For 2011, Participants will be eligible to receive matching contributions under the Plan | |||
| until the IRS limit of $245,000 worth of pension eligible earnings has been reached. | |||
| Investment options: Vanguard Prime Institutional; Vanguard Short-Term U.S. Treasury | |||
| Fund; Vanguard Total Bond Market Index Fund; PIMCO Total Return Fund; Vanguard | |||
| Wellington Fund; Vanguard Institutional Index; Vanguard Windsor II Fund; AmFunds | |||
| Growth Fund of America; Artisan Mid Cap Fund; Lord Abbett Small Cap Value Fund; | |||
| Artisan Mid Cap Value Fund; DFA International Value Fund; Vanguard Target Retirement; | |||
| Vanguard Target Retirement 2010; Vanguard Target Retirement 2015; Vanguard Target | |||
| Retirement 2020; Vanguard Target Retirement 2025; Vanguard Target Retirement 2030; | |||
| Vanguard Target Retirement 2035; Vanguard Target Retirement 2040; Vanguard Target | |||
| Retirement 2045; Vanguard Target Retirement 2050. | |||
| UPMC Voluntary Benefits: | Representatives are available to provide enrollment | |||
| • | Allstate Critical Illness Insurance | assistance and additional information for the | ||
| voluntary plans listed. | ||||
| • AFLAC Personal Accident Expense Plan | ||||
| Call UPMC DirectLink at | ||||
| • | ARAG Legal Services | |||
| 1-800-994-2752, option # 5 | ||||
| • | ING Universal Life Insurance | |||
| • | Hurley Associates Voluntary Income Protection Program | Representatives are available to provide additional | ||
| assistance on the plans available. | ||||
| Call Hurley Associates directly at 412-682-6100 | ||||
| Note: | This summary is only intended as a general overview. If this summary inadvertently disagrees with the policies or | |||
| official contracts that govern the institutional plan, the policies and official contracts are followed to determine your | ||||
| benefits. | ||||
| UPMC benefits are subject to UPMC policies and may be modified by UPP/UPMC-HS. | ||||
| Revised 11/30/10 | ||||
SUMMARY OF TERMS AND CONDITIONS OF THE POST GRADUATE TRAINING AGREEMENT FOR RESIDENT/FELLOW “HOUSE STAFF” OF THE UNIVERSITY OF PITTSBURGH MEDICAL CENTER MEDICAL EDUCATION (UPMCME) — FY10
Each Resident/Fellow Physician appointed and receiving training as a “House Officer” through the UPMCME must sign a contractual agreement that describes the terms, conditions, obligations, and expectations concerning such appointment. The following information provides a summary of significant aspects of that appointment and contractual agreement.
Appointment Term: The House Officer is appointed to the position of Resident on the House Staff of a specific Residency Program of the UPMCME for the maximum term of one year. Reappointment is dependent upon and Procedures of the UPMCME, as well as any rules and regulations promulgated under those policies Residency Program determination of the House Officer’s performance during the appointment term.
Policy and Regulatory Compliance: This appointment is subject to and contingent upon compliance with the Graduate Medical Education Policies and any applicable federal, state, and local laws and regulations.
Residency Program: The UPMCME will provide a training program consistent with the "Essentials of Accredited Residencies" adopted by the Accreditation Council on Graduate Medical Education, published by the American Medical Association or similar requirements of the American Osteopathic Association, the American Dental Association, or the Council on Podiatric Medical Education, as applicable.
Program Services: The House Officer will perform the services required by the training program under the supervision of the Program Director and Residency Program faculty and at a level of achievement consistent with the standards set by the Residency Program.
Licensure Compliance: The House Officer will at all times act in conformity with applicable federal, state, and local laws and regulations applicable to the practice of medicine and operation of medical facilities.
Rotation: While assigned to a rotation at affiliated hospitals, the House Officer will comply with the policies and regulations in effect at the affiliated hospitals, specifically including without limitation, HIPAA and other patient confidentiality laws.
Medical Records: The House Officer will complete in a timely fashion the medical records that are his/her responsibility.
Defense of Claims: The House Officer agrees to cooperate with the investigation and defense by the UPMCME or its insurance carrier of any incident, claim, or lawsuit which may arise in connection with patient care activities taking place during the term of this appointment, whether or not the House Officer is a named defendant. In the event that the House Officer is served with a summons or a subpoena pertaining to the UPMCME, or any of its affiliated entities or its other respective officers or employers, he/she will promptly notify the UPMCME Graduate Medical Education Office or the University of Pittsburgh Medical Center Risk Management Department. These obligations will survive the expiration or termination of the House Officer's appointment with UPMCME.
Dual Employment/Moonlighting: The House Officer is required to notify his/her department in advance of any proposed employment outside of the UPMCME, and the number of hours devoted to such employment. The House Officer is prohibited from working additional hours as a physician rendering patient care services elsewhere without prior approval from his/her department, or if such dual employment would cause him/her to exceed the maximum number of work hours permitted by UPMCME’s policy on Duty Hours and the Accreditation Council for Graduate Medical Education (ACGME) regulation. Any failure to comply with this provision will be deemed a material breach of this Appointment Agreement, and may cause the House Officer to be subject to disciplinary action.
Pre-employment Responsibilities: The House Officer must satisfactorily complete a pre-employment test to rule out the use of non-approved substances under applicable UPMC polices and practices supporting a drug- and alcohol-free work environment. The House Officer must also satisfactorily complete employment, reference, criminal history, and other standard UPMC background checks under applicable UPMC policies and practices.
PGY- Financial Support: The House Officer's annual financial support can be found on the UPMCME website for the specific PGY appointment each appointment year and will be payable bi-weekly through direct deposit into the House Officer’s bank account. If the House Officer accepts an assignment during which he/she is supported financially or paid by another institution, a grant, or a fellowship, etc., he/she will not receive financial support from the UPMCME for that period.
Health and Dental Insurance: The House Officer is eligible for individual or family health insurance programs offered under the UPMCME group plans. The health insurance benefit begins on the resident/fellow’s first recognized day of training in the residency/fellowship program. The House Officer will pay any applicable premiums by payroll deduction.
Short Term Disability: Benefits are available for a maximum of 180 days of total disability during a 52-consecutive-week period.
Long Term Disability: Long-term disability insurance is available after a disability extends beyond 180 days. The program provides a monthly benefit of 60% of basic monthly financial support up to a maximum of $3,000. Coverage becomes effective on the first day of the month following employment.
Life Insurance: The House Officer is provided basic term life and accidental death and dismemberment (AD&D) insurance coverage equal to his/her base annual salary. (S)he may purchase additional protection for her/himself and eligible family members.
Professional Liability Insurance: The House Officer will be covered on an occurrence basis, with total limits of $1million per occurrence, $3 million aggregate, under the insurance program of the UPMCME and the Pennsylvania catastrophic fund for claims arising out of duties performed within the scope of training in the UPMCME.
Savings Plan: The House Officer is permitted to contribute to the Savings Plan on a pretax and/or after-tax basis up to the annual IRS limits. UPMCME matches a portion of your contributions.
The Resident and Fellow Assistance Program (RFAP) provides a confidential resource to House Officers who may be experiencing personal problems. The RFAP will help to identify and explore alternative solutions to problems that may be emotional, financial, legal, marital, or substance related.
While on a regularly scheduled 24-hour call at hospitals within the UPMCME, a subsidy for evening meals will be provided along with availability of an on-call room with housecleaning services.
Tuition Assistance
UPMC provides full-time and flexible full-time staff up to $3,500 per academic year for programs offered at an accredited college or university, provided studies are relevant to a career within the UPMC system. This benefit is subject to state and local taxes.
Voluntary Benefits
Each Program Director serves as the key resource on specialty board examinations and materials for application and preparation. Therefore the Program Director should be contacted by the House Officer to confirm the effect that a leave of absence, for any reason, will have on their ability to satisfy criteria for completion of the residency or fellowship program.
Vacation Leave: The House Officer may receive up to a maximum of three weeks leave time (21 days, including weekends) per academic year, to be scheduled by agreement with the Program Director. (Varies by department.)
Sick Leave: Sick leave may be arranged at the discretion of the Program Director, in accordance with applicable law.
Professional Leave: The House Officer may receive time off to attend a professional conference to be arranged at the discretion of the Program Director.
Family and Medical Leave of Absence: The House Officer is eligible for Family and Medical Leave of Absence (FMLA) as set forth by the federal government. All leave requests must be approved by the House Officer's Program Director to ensure all program requirements can be met to satisfy completion of the program.
Residency Program Credit: Credit for completion of the program year, and certification of completion of a terminal program year will be contingent upon satisfactory performance, in accordance with the requirements of the House Officer's Residency Program.
Disciplinary Action/Probation Suspension or Termination: The House Officer may be placed on probation, suspended, or have his/her appointment terminated by the UPMCME for breach of the terms of this Agreement by the House Officer. Any such suspension or termination will be carried out in accordance with UPMCME procedure.
Grievances Appeals and Discipline: If a House Officer feels that he/she is being treated in a manner that is inconsistent with the treatment of other house officers, and he/she feels that the matter cannot be resolved within the structure of his/her department, he/she may elect to seek assistance through the UPMCME Graduate Medical Education Office.
Physician Impairment and Substance Abuse Education: It is the policy of the UPMCME that the unlawful manufacture, distribution, sale, dispensing, possession, or use of an illegal drug or alcoholic beverage is prohibited in the workplace/classroom. The UPMCME will provide the House Officer with an educational program regarding physician impairment, including substance abuse. Assistance for physicians with substance abuse issues will be made available through the UPMCME, RFAP, and the Professional Health Monitoring Programs of the Pennsylvania State Board of Medicine. Under some circumstances, UPMCME is required by law to report substance abuse to the Pennsylvania State Board of Medicine.
Residency Closure/Reduction: If the UPMCME should decide to eliminate or reduce the size of any Residency Program, House Officers affected by the decision will be so informed prior to the start of the new academic year to the extent possible. The UPMCME will then make reasonable efforts to allow completion of the current residency year and, if practical, the remainder of training as planned.
Sexual Gender Racial and Other Forms of Harassment:
Any House Officer who believes he/she is being harassed by an employee of the UPMCME, or on University of Pittsburgh Medical Center or affiliated hospital or health care facility premises, should report such harassment to his/her immediate supervisor or to the UPMCME Graduate Medical Education Office. Any person who is found by the UPMCME to have harassed a house officer, employee, student, or applicant will be subject to corrective action, up to and including discharge. The UPMCME policy on harassment is found at the UPMCME website.
Updated 3/10/2011 from http://www.upmc.com/careersatupmc/student/GME/ResidentContractOverview/P...
THIS AGREEMENT, datedas of, is entered into by and between ___________________________(hereinafter referred to as “Resident/Fellow Physician”) and the University Health Center of Pittsburgh d/b/a University of Pittsburgh Medical Center Medical Education (UPMCME), a non-profit corporation organized and existing under the laws of the Commonwealth of Pennsylvania (hereinafter referred to as (“UPMCME”) which is a cooperative venture of various hospitals that are part of or affiliated with the UPMC system with approved residency and fellowship training programs and with principal offices at 3600 Forbes Avenue, Pittsburgh, Pennsylvania 15213.
WITNESSETH:
WHEREAS, this Agreement, sets forth obligations and expectations of the Resident/Fellow Physician, including without limitation, academic, clinical, ethical, humanistic, scientific and professional obligations, in connection with the Resident/Fellow Physician’s appointment and possible reappointment to the __________________________ Program (hereinafter referred to as “Residency Program”) of UPMCME; and
WHEREAS, this Agreement further sets forth obligations and expectations of UPMCME in connection with providing an appropriate environment for residency training for the Resident/Fellow Physician; and
WHEREAS, various policies and procedures are referenced herein and may be revised, amended, or newly issued from time to time for notice and compliance by all Resident/Fellow Physicians, and may be accessed at the UPMCME Graduate Medical Education website,and from the Residency Program Director or UPMCME Office of Graduate Medical Education.
NOW, THEREFORE, intending to be legally bound, UPMCME and Resident/Fellow Physician agree as follows:
1) TERM OF AGREEMENT
This Agreement shall be in effect beginning ________________________ and shall continue until _______________________. The term of this Agreement may not exceed one (1) year unless renewed or extended in writing by UPMCME authorized representatives under then current practices and the Resident/Fellow Physician has no expectations otherwise.
2) RENEWAL OR EXTENSION OF AGREEMENT
Renewal or extension of this Agreement is dependent upon minimally satisfactory progress by the Resident/Fellow Physician as determined solely by evaluation of the Resident/Fellow’s performance by the Residency Program Director and faculty. UPMCME shall use best efforts to notify Resident/Fellow Physician at least one hundred and twenty (120) days prior to the expiration of the current term of the Agreement regarding renewal or non-renewal of this Agreement and, if renewed, the term of such renewal. However, if the primary reason(s) for the non-renewal occurs within the four months prior to the expiration of the then current term, the Resident/Fellow Physician shall be provided with as much notice of non-renewal intent as the circumstances will reasonably permit. In any event, nothing herein contained shall be construed to confer upon Resident/Fellow Physician an automatic right to extension of this Agreement for a subsequent residency year or part thereof.
3) TERMINATION OF AGREEMENT AND DUE PROCESS
Resident/Fellow Physician may terminate this Agreement voluntarily by providing no less than sixty (60) days prior written notice to the Program Director.
(b) UPMCME may terminate this Agreement via the Residency Program’s termination process as outlined in the Residency Program’s Evaluation, Appointment, and Termination Policy. UPMCMEP may terminate this Agreement with or without notice should Resident/Fellow fail to attain and retain all requirements of training; see Section 7 herein.
(c) UPMCME may terminate this Agreement immediately and without notice in the event Resident/Fellow Physician is charged with or convicted of a serious misdemeanor or felony or enters a plea of no contest (nolo contendere) to same, or is charged with serious misbehavior in any forum and of any type where inimical to the Residency Program or UPMCME institutional standards (in the sole determination of UPMCME senior management) before or during the term of this Agreement.
(d) A Resident/Fellow Physician who is terminated from the Residency Program may request fair and reasonable review of that decision under the UPMCME Grievance and Appeal policy.
4) ASSIGNMENT OF RESIDENT/FELLOW PHYSICIAN
RESPONSIBLITIES
The Residency Program Director or his/her assigned designee is responsible for the delineation of Resident/Fellow Physician responsibilities.
5) LEVEL OF TRAINING APPOINTMENT
The Residency Program Director is responsible for determining the Resident/Fellow Physician’s level of training appointment and the specific assigned duties therewith. By this Agreement, the Resident/Fellow Physician is appointed as a PGY ___ Resident/Fellow in the ______________________ Residency Program.
6) FINANCIAL SUPPORT AND BENEFITS
(a) The UPMCME shall provide appropriate financial support and benefits (including vacation, paid and unpaid leave) to ensure that Resident/Fellow Physician is able to fulfill the responsibilities of the Residency Program. Resident/Fellow Physician’s financial support and benefits for the appointment described herein are summarized and located at the UPMCME Graduate Medical Education website,in effect or modified from time to time by UPMCME at its discretion. UPMCME will use its best efforts to notify Resident/Fellow Physician of significant changes as they occur with respect to such financial support or benefits.
(b) No payment or compensation of any kind or nature shall be paid to or accepted by Resident/Fellow Physician from patients or third party payers or any other sources for performance or any services rendered pursuant to this Agreement.
7) RESIDENT/FELLOW PHYSICIAN PREREQUISITES TO BEGIN TRAINING
Eligibility to begin training and receive the financial support and benefits outlined in this Agreement requires at least the following:
(a) The Resident/Fellow Physician’s ability to demonstrate that he/she is a graduate of an accredited medical/osteopathic/dental school.
(b) The Resident/Fellow Physician’s ability to deliver information and documents for UPMCME to properly complete Form I-9, and, as applicable, a copy of an appropriate visa as required by the U.S. Department of Citizenship and Immigration Services (CIS) and to demonstrate certification by the Educational Commission for Foreign Medical Graduates (ECFMG), and all other similar authoritative bodies.
(c) The Resident/Fellow Physician’s ability to obtain a valid graduate training license from the Commonwealth of Pennsylvania and to comply with the applicable provisions of Pennsylvania law pertaining to licensure.
(d) The Resident/Fellow Physician’s ability to demonstrate he/she is fit for duty, including the passing of a medical screening prior to commencement of appointment performance hereunder.
(e) Satisfactory completion of a pre-employment test to rule out the use of non-approved substances under applicable UPMCME/UPMC polices and practices supporting a drug- and alcohol-free work environment.
(f) Satisfactory completion of employment, reference, criminal history and other standard UPMCME/UPMC background checks under applicable UPMCMEP/UPMC policies and practices.
In circumstances where Resident/Fellow Physician has not met eligibility requirements prior to start date, this Postgraduate Training Agreement shall become null and void at the sole discretion of UPMCMEP.
8) OBLIGATIONS OF RESIDENT/FELLOW PHYSICIAN IN TRAINING
Appointment as a UPMCME Resident/Fellow Physician is an honor associated with previous accomplishments and presumed capabilities as well as with significant continuing obligations hereunder by which the Resident/Fellow Physician agrees to perform and obtain competencies, including without limitation, summarized as follows:
(a) Provide the Program Director written notification of any change in status regarding prerequisites in Section 7 above, regarding education, license, visa, and fitness for duty.
(b) Meet the clinical (patient care) requirements of residency training.
(c) Meet the academic (conference and study) requirements of residency training, as specified by the Residency Program.
(d) Meet the humanistic (doctor-patient relationship) requirements of residency training.
(e) Meet the scientific (scholarly and/or research) requirements of residency training.
(f) Meet the professional (peer and colleague relationship) requirements of residency training.
(g) Meet the moral and ethical requirements of residency training.
(h) Complete medical records on a timely basis as directed by the Program Director unless there is a valid excuse (e.g., vacation, illness, out-of-town rotation).
(i) Complete History and Physicals on a timely basis as directed by the Program Director.
(j) Be cost effective in the provision of patient care.
(k) Always seek and utilize appropriate supervision.
(l) Perform at a level commensurate with the level of training and responsibilities assigned by the Program Director.
(m) Use best efforts to work with other members of the health care team to provide a quality, respectful, safe, effective and compassionate environment for the delivery of care and the study of medicine.
(n) When on rotation become familiar with and abide by the rules, regulations, policies and practices of each hospital or health care facility participating site, including without limitation, those on HIPAA compliance, Disaster Plan, Fire Safety, Radiation Safety and Electrical Safety.
(o) Become familiar with and abide by the respective Residency Program’s Manual.
(p) Abide by the overall rules, regulations and practices of the Residency Program e.g. Duty Hours, certification in Basic and Advanced Cardiac Life Support, Universal Precautions, Infection Control Procedures.
(q) Immediately notify the Residency Program Director in the event the Resident/Fellow Physician becomes aware of any circumstance that may cause UPMCME or any participating hospital or health care facility site to be noncompliant with any federal, state or local laws, rules or regulations or the standards of any accrediting bodies to which it is subject.
(r) Exercise utmost good faith with respect to maintaining the confidentiality of information and materials learned or acquired by virtue of providing services pursuant to this Agreement, including, but not limited to business affairs of UPMCME and any participating hospital or health care facility site.
(s) Authorize the program director/designee, as necessary, to access appropriate institutions to obtain written documentation/confirmation of prior education and/or training.
(t) Return all property of UPMCME or any hospital or health care facility participating site at the time of the expiration or in the event of termination of this Agreement, including without limitation, identification card, beeper, books, equipment, library card, parking card, and to complete all records and settle all professional and financial obligations before academic and professional credit will be verified.
9) OBLIGATIONSOF UPMCME
(a) UPMCME shall use its best efforts to exhibit institutional commitment to graduate medical education by providing a program of education that meets standards established by the appropriate accreditation bodies, including, but not limited to, the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), American Dental Association (ADA), as well as the Specialty Boards of the Residency Programs.
(b) UPMCME shall use its best efforts to provide the Resident/Fellow Physicians with a reasonable opportunity to fulfill the obligations set forth in Section 8.
(c) UPMCME shall use its best efforts to maintain its staff and affiliated facilities in a manner designed to meet the standards established by the appropriate recognized accrediting and approving bodies.
(d) UPMCME shall provide on-call quarters within the hospital when Resident/Fellow Physician is required to be physically present at a hospital or health care facility. Such on-call quarters are to be occupied only at those times that the Resident/Fellow Physician is scheduled for on-call duty. On-call rooms are not to be used as a residential facility or for any other personal use.
(e) UPMCME will comply with the Americans with Disabilities Act and all other applicable laws and directives including UPMC Human Resources policies in terms of making required reasonable accommodation determinations with respect to applicable UPMCME residents and fellows.
(f) UPMCME Residency Programs will assign resident responsibilities based on the ACGME Duty Hour requirements.The Residency Program will abide by UPMCME's institutional policy on Duty Hours which is located on the UPMCME GME website.
(g) UPMCME will provide professional liability insurance for authorized services within the teaching programs performed at UPMCME or at other institutions in which the Resident/Fellow Physician performs services as part of the formal teaching program to which he/she is assigned. Such insurance shall insure Resident/Fellow Physician for claims made during and after termination of this Agreement, which are based on alleged conduct that occurred during the term of this Agreement. The amounts of such insurance shall, at minimum, meet the statutory requirement of the Commonwealth of Pennsylvania.
(h) UPMCME Residency Programs will provide regular evaluation and feedback as to the Resident/Fellow Physician’s status within his/her Residency Program.
(i) UPMCME’s Residency Programs will award academic credit in accordance with requirements and policies of the Residency Program.
(j) UPMCMEP will provide, upon proper authorization and request, verification of appointment-related information to appropriate organizations, e.g. state boards, specialty boards, medical staffs, health providers, etc. consistent with Resident/Fellow’s performance in the Residency Program.
(k) UPMCME will facilitate Resident/Fellow access to appropriate and confidential counseling, medical and psychological support services, as needed.
(l) The Residency Program will abide by UPMCME’s institutional policy on impairment. The Resident/Fellow Physician will be educated regarding physician impairment, including substance abuse, at orientation and as a part of the Residency Program curriculum.
(m) In accordance with the ACGME requirements, UPMCME provides policies and procedure regarding the closure/reduction of the residency program.
10) RESIDENT/FELLOW PHYSICIAN EVALUATION, PROMOTION, REMEDIATION, SUSPENSION AND TERMINATION.
The Resident/Fellow Physician is expected to provide the necessary effort to perform at or above a satisfactory level in the Residency Program. The Resident/Fellow Physician’s performance will be evaluated regularly with periodic feedback provided. Resident/Fellow Physicians who remain in good standing and who produce at least satisfactory continuing performance as determined by the Program Director and Residency Program faculty may be eligible for promotion to the next level of responsibility and ultimately may be awarded a certificate of completion from the Residency Program. However, in all cases, the term of this Agreement shall not exceed one (1) year.
Resident/Fellow Physicians who have performed at a lower than satisfactory level or fail to meet program requirements for progress approval as determined by the Program Director and Residency Program faculty, may be provided with an opportunity for remediation and performance improvement.
Resident/Fellow Physicians who fail to improve may be required to extend their training, or may be placed on probation, suspended or terminated. Resident/Fellow Physicians engaged in unacceptable or egregious misconduct, as determined by the Program Director in consultation with the ACGME Designated Institutional Official for UPMCME and/or Vice President for Graduate Medical Education, may be immediately suspended or terminated. The specific processes for evaluation, promotion, remediation, suspension and termination within the Residency Program should be outlined in the departmental policy manual or otherwise described by the Program Director.
11) COMPENSATED WORK OUTSIDE OF RESIDENCY (MOONLIGHTING)
The UPMCME GME policy for compensated work outside of the Residency Program is described in the UPMCME GME policy on moonlighting. The Resident/Fellow Physician agrees that he/she must receive prior written approval and authorization from the Program Director before planning to or engaging in such activity.
12) NON-DISCRIMINATION
UPMCME complies with all applicable federal, state and local laws and regulations relating to non-discrimination in employment. UPMCME does not and will not discriminate on the basis of race, color, age, sex, sexual orientation, religion, ancestry, citizenship, national origin, marital, familial or disability status or veteran status, or any other characteristic protected by applicable law with respect to any aspect of employment.
13) SEXUAL/RACIAL/ETHNIC HARASSMENT
The UPMCME strives to provide training to all Resident/Fellow Physicians in an environment that is free from sexual, racial, ethnic or other prohibited harassment. All allegations of sexual harassment will be thoroughly and discretely investigated per the UPMCME Sexual/Racial/Ethnic Harassment Policy.
14) RESIDENT/FELLOW PHYSICIAN GRIEVANCE
Should Resident/Fellow Physician have a grievance against or appeal concerning the Residency Program or UPMCME, the UPMCME Grievance and Appeal policy governs the Resident/Fellow Physician.
15)ILLNESS OR INJURY RELATED TO RESIDENCY PROGRAM INVOLVEMENT
Any illness or injury related to Residency Program involvement must be reported immediately to the Program Director or his/her designee, and the UPMCME Office of Graduate Medical Education.Absences necessitated by such illnesses or injuries will be addressed in accordance with UPMCME policy. Academic credit will be considered on an individual basis by the Program Director in consultation with the ACGME Designated Institutional Official for UPMCME and/or Vice President for Graduate Medical Education, in accordance with State Licensing and Specialty Board requirements.
16) GENDER
Whenever the context hereof requires, the gender of all words shall include the masculine and/or feminine.
17) STRICT PERFORMANCE
No failure by either party to insist upon the strict performance of any covenant, agreement, term or condition of this Agreement or to exercise a right or remedy shall constitute a waiver. No waiver of any breach shall affect or alter this Agreement, but each and every covenant, condition, agreement and term of this Agreement shall continue to full force and effect with respect to any other existing or subsequent breach.
18) CAPTIONS AND CONSTRUCTIONS
The captions used as headings of the various paragraphs hereof are for convenience only, and the parties agree that such captions are not to be construed to be part of this Agreement or to be used in determining or construing the intent or context of this Agreement.
19) SEVERABILITY
If any clause, sentence, provision, or other portion of this Agreement is or becomes illegal, null, or unenforceable for any reason, or is held by any court of competent jurisdiction to be so, the remaining portions shall remain in force and effect.
20) ENTIRE AGREEMENT
This Agreement supersedes any and all prior Agreements, either oral or in writing, between the parties with respect to the subject matter hereof, and contains the entire agreement between the parties relating to said subject matter.
21) CONTROLLING LAW
The laws of Commonwealth of Pennsylvania hereunder shall in all respects govern this Agreement, the interpretation and enforcement thereof, and the rights of the parties.
22) EXPRESS ACKNOWLEDGEMENT
Resident/Fellow Physician hereby acknowledges that she/he has read and understands the terms contained in this agreement, all attachments hereto, and all applicable policies and procedures referenced herein including those found at the previously referenced UPMCME Graduate Medical Education website and any other policies and procedures applicable to the Residency Program.
UPDATED 3/10/2011 from http://www.upmc.com/careersatupmc/student/GME/ResidentContractOverview/P...
The full list of UPMC GMEC System-wide policies is available within the firewall at this link.