Department of OB/GYN. Residency Policies and Procedures

Transcription

1 Department of OB/GYN Residency Policies and Procedures

2 INDEX I. Administrative Chief Residents II. Adverse Actions III. Call Responsibilities IV. Conference Attendance V. Duty Hours and Record VI. Eligibility & Selection of Residents VII. Faculty Supervision of Resident Activity VIII. Sleep Deprivation, Fatigue Mitigation and Alertness Management Policy IX. Leave, Vacation, & Absence Record X. Medical Records & Hospital Policy XI. Moonlighting XII. Professional Conduct XIII. Professional Development Funds XIV. Progress & Promotion XV. Resident Statistics XVI. Transitions of Care/Handover

3 I. ADMINISTRATIVE CHIEF RESIDENTS Each year, the Program Director with the concurrence of the Residency Education Committee, will select an Administrative Chief Resident. The Administrative Chief Resident will work closely with the Program Director on such issues as the Resident Call Schedule, conferences, resident leave, and orientation of new residents. Also, to ensure accurate presentation in the Morbidity and Mortality Conferences, to help plan the end of the year resident graduation banquet, and to communicate frequently with other residents and the faculty to ensure an atmosphere of cooperation, open mindedness, and mutual respect in the overall conduct of the program. The Chief Resident will receive a supplement to their salary for their efforts. II. ADVERSE ACTIONS It is an ACGME requirement that all residency training programs ensure the implementation of fair policies, grievance procedures, and due process as established by the sponsoring institution (UK) and in compliance with the (ACGME s) Institutional Requirements. More importantly it is the right thing to do. The following material has been excerpted from the GME Manual for you. Adverse Actions - Definitions Probation: As used in this document, probation refers to a condition in which a resident has 1) had problems identified which, if not corrected, may lead to failure to renew a contract or dismissal from the program and, 2) been formally notified of this fact through an established process. A resident on probation may continue to provide patient care and to engage in the training program, but only within clearly defined limits that are stated in writing. Suspension: As used in this document, suspension refers to a circumstance in which a resident is administratively removed from some or all assigned duties for a specific period of time. Suspension may be with or without pay. Dismissal: As used in this document, dismissal refers to the separation of a resident from a training program for cause. In general, this occurs because a resident has failed to meet the conditions of probation. In instances, however, of a gross violation of academic or professional standards, a resident not on probation may be dismissed. Non-renewal of contract: As used in this document, non-renewal of contract refers to a decision by a program not to renew the annual contract of a resident before that resident has completed training. Such a decision may be appealed through Stage III as described in the Grievance Procedure for House Staff (AR 5.5) Notice of concern: As used in this document, refers to written notification from the program to the resident of their deficiencies, plans for improvement, and remediation. Adverse Actions At times, residents may fail to achieve adequate progress in mastery of their discipline, may fail to provide patient care in a manner consistent with expectations or may fail to work in a collegial manner

4 with other providers. In such circumstances, programs may take one of several adverse actions. Residents at risk for such actions should be notified as soon as is practical with a notice of concern. However, such an action may be taken without notice if the program director deems it urgently necessary. Adverse actions include: Probation: Residents who are considered to have academic deficiencies or other concerns so serious as to place them at risk for non-renewal of contract or dismissal from the residency program should be placed on probation. Probation is a serious decision that should involve multiple individuals at the departmental/program level. Prior to placing a resident on probation, the program shall inform the Associate Dean and/or the Director of GME who will be available, both to the program and to the resident, for administrative assistance as needed. Written notification of probation is required and shall include at a minimum: reason for probation, remediation requirements, what the resident must accomplish in order to come off of probation, the anticipated length of probation, method of ongoing evaluation, and a faculty advisor/supervisor for the probationary period. Probationary periods must be time-limited, but may be extended when appropriate. In such instances, written notification is required. The program shall maintain documentation that the resident has received written notification and a copy of the notification must be sent to the GME Office. Residents may appeal being placed on probation using the resident grievance procedure (AR 5.5). Suspension: In urgent circumstances, a resident may be administratively suspended from all or part of assigned responsibilities by his/her department chairperson, program director, or the Chief of Staff of the University Hospital or of the affiliated institution or facility for cause, including failure to meet general or specific academic standards, failure to provide patient care in a manner consistent with expectations or failure to work in a collegial manner with other providers. Programs must have established mechanisms for determining whether a resident should be suspended. The mechanism must be documented and residents provided a copy of the document that defines the mechanism. A resident must be notified verbally and in writing as to the reason for suspension. When a resident is suspended, the Associate Dean and/or the Director of GME should be notified prior to suspension or as soon as possible thereafter. The program shall maintain documentation that the resident has received written notification and a copy of the notification must be sent to the GME Office. Suspensions must be time-limited but can be renewed if appropriate. A suspension may conclude in the resident being reinstated, placed on probation or dismissed. Residents may appeal being placed on suspension using the resident grievance procedure (AR 5.5). Dismissal from the Residency Program: A resident may be dismissed from a program because of failure to make academic progress, gross and serious violation of expected standards of patient care or gross and serious failure to work in a collegial manner with other providers. Programs must have established mechanisms for determining under what circumstances a resident can be dismissed. The mechanism must be documented and residents provided a copy of the document that defines the mechanism. This decision should involve multiple individuals at the

5 departmental/program level. The program must consult with the Associate Dean and/or the Director of GME in dismissal decisions. Dismissal may, depending upon the situation, follow a period of suspension and/or probation. Insofar as is possible, a resident should be notified in person and in writing about the dismissal decision. This notification must include the reason for the dismissal decision, the date of the dismissal, and method for appeal. Residents may appeal being dismissed using the resident grievance procedure (AR 5.5). Non-renewal of contract: While residents are generally granted a renewal of contract annually until they have achieved board eligibility, program directors may determine that continuation in the program is not warranted because of deficiencies in academic progress or for other reasons. A decision regarding re-appointment must be reached by the RTD no later than March 1 (unless the resident is on suspension or probation) of the year of the current appointment (for residents on a July 1-June 30 contract year; no later than 4 months prior to end of the current appointment if on an off-cycle contract). Such a decision may be appealed through Stage III using the resident grievance procedure (AR 5.5). Grievance Procedure: The Grievance Procedure for House Officers is outlined in UK AR 5.5 and is available in the GME Office or via the UK web page. Should a grievance be filed, the Associate Dean and/or the Director of GME will be available, both to the program and to the resident, for administrative assistance as needed. The decision to invoke one of the adverse actions outlined above is not taken lightly by the Faculty of the Department of Obstetrics and Gynecology. The overall mechanism applied by the Faculty is as follows: Each circumstance and situation will be considered individually. The Program Director will typically consult with the Associate Dean for GME as well as the Residency Education Committee. Further consultation with University Legal Counsel may be requested. The above individuals and groups will evaluate past and current performance in the context of the deficiency/problem under consideration. Before any decision is made the Program Director will also speak with the resident for whom an adverse action is being considered. The departmental policy on probation is guided by the policy on probation from the institutional policy and procedures manual as noted above. A portion of each resident education meeting and each faculty meeting is devoted to a confidential (resident members excluded) discussion of resident performance. The committee may recommend probation when in their judgment previous evaluations or current observation indicate that a resident s knowledge base and/or clinical skills have not developed consistent with that expected for their level of training or when there are deficiencies in other competencies and these have not improved despite previous discussion/coaching with the resident. Further, probation may be considered for a single deficiency if it is considered significant. When the majority of committee members recommend probation, terms of probation including mandated remediation strategies will be defined and submitted to the director of residency education and the departmental chairman for approval. Notice of probation will then be extended to the resident. Dismissal or non-renewal of a resident from the training program may occur in several circumstances, and others that may be defined in the future, and will occur in accordance with institutional guidelines:

6 Failure of the resident to fulfill obligations as outlined in the residents training agreement. Failure of the resident to satisfactorily complete the required educational curriculum despite remedial attempts, including probation. Failure of the resident to comply with the employment requirements of the sponsoring institutional. Professional or personal behavior, which in the judgment of the faculty and Program Director is inconsistent with completion of the training program and recommendation for licensure and support of credentialing. Typically academic deficiencies are responded to with attempts at remediation and additional instruction before an adverse action is considered. At the other extreme, violations of Professional Conduct may be dealt with in a vigorous manner. The mechanism used for and causes associated with a resident being placed on suspension are similarly individualized. The Program Director (in consultation with the Associate Dean for GME) may place a resident on suspension for reasons A through D in the preceding paragraph or for less severe causes/issues/infractions than those associated with probation, non renewal or dismissal. III. CALL RESPONSIBILITIES Resident call responsibilities will be assigned by the Administrative Chief Resident with the concurrence of the Program Director. It is anticipated that the call schedule will be constructed at least six months in advance. Residents may change call responsibilities with the approval of the Administrative Chief Resident and Program Director. Call assignments will be made to ensure the Residency Program is 100% compliant with the resident duty hour policies. The frequency of resident call responsibilities is enumerated below in the Call Guidelines Policy: We must ensure compliance for all residents in the 80 hour work week, including 24 hours off each week. To accomplish this, the following guidelines are in place; 1. Labor and Delivery a. Service turnover: i. Saturday morning: All residents will report for work at 6:00am, person to person check out will be from 6:00-6:30am. Friday night person must be out the door at 6:30am. ii. Sunday morning: All resident will report for work at 6:30 AM, person to person check out will be from 6:30-7:00am. Saturday night person must be out the door at 7:00am. iii. Interns: Will arrive at 6:00am or 7:00pm depending on their weekend call shift. iv. Monday morning: This is more confusing, but I will try to be straightforward. 1. Mid-Level OB: MFM & L&D resident come in at 7:00am regardless of call. 2. GYN: Saturday person will come in at 7:00am. 3. Chief: Saturday Chief will come in at 7:00am, arrangements should be made with your respective teams.

7 b. Resident responsibility: i. Intern: On-coming resident is responsible for notes on MBU. These notes will hopefully be completed prior to board rounds at 9:00am, or at earliest convenience. Off-going resident is responsible for all discharge paperwork. If any reasonable discharge paperwork is not complete, notify the chief. While it is not appropriate to keep residents over their allotted work time, deliveries/procedures may be restricted in those residents that are not compliant with paperwork. ii. Mid-level: On-coming resident is responsible for notes on antepartum service and labor & delivery patients. Off-going resident is responsible for having up-todate and concise checkout on all patients. Not having to write a note is not an excuse for not knowing the patients. Concise checkout can only occur if the offgoing resident has a clear grasp of the board/patients. iii. Chief: On-coming resident is responsible for MBU rounds, ensuring labor and delivery coverage while interns and mid levels round. Must verify that gynecology service has been taken care of prior to NOON. Off-going resident is responsible for overseeing paperwork being completed at MBU and overall OB/GYN service updates. GYN patients on the benign service need to be checked out to on-coming chief. THIS INCLUDES GSH PATIENTS. c. Board Checkout: i. Attending coverage will remain unchanged. On-coming attendings will arrive at 8:00am. ii. Formal checkout rounds will be held in work room at 10:00am with an attending. 2. Gynecology a. Service Turnover: i. Saturday morning: On-coming resident will report for work at 6:00am, person to person check out will be from 6:00-6:30am. Off-going resident must be out the door at 6:30am. ii. Sunday morning: On-coming resident will report for work at 6:30am, person to person check out will be from 6:30-7:00am. Off-going resident must be out the door at 7:00am. iii. Monday morning: Saturday person only will report for work at 7:00am. This should still allow time for rounding before OR for both GYN and GYN-ONC service. If there are conflicts about rounding on GYN patients at UK vs. GSH, these should be ascertained prior to Monday morning so that the GYN-ONC chief/third year may assist in rounding. b. Resident Responsibility: i. Off-going resident: Will prepare all notes for GYN-ONC rounds & UK benign GYN patients. They should also keep a tally of things to be completed (i.e.-if notes have not been completed). This resident will no longer round at GSH after leaving UK. This does not excuse them from having up-to-date check out on the GSH patients vitals; uop and labs (if available) need to be available at time of check out.

8 ii. On-coming resident: Will do all discharges. Will round at GSH prior to 12:00pm. If there seems to be a conflict, the chief and/or fellow needs to be notified. GSH patients are NOT to be treated as second class patients because it is inconvenient to round on them. Tidying up GYN-ONC service does NOT take priority over GSH/Benign GYN patients. c. Rounds: i. The Fellow determines rounding time, typically 6:30am. We will ask that rounds on Sunday be at 7:00am. 3. Monday: a. Mid-Level: Both L&D and MFM resident will report at 7:00am on all Mondays regardless of call. (based on call pool, at least one of them will have been on call each weekend). They will divvy up the MFM service and attempt to complete rounds by 7:30am. If service is particularly large, they may ask Sunday night that the night float help them on rounds. b. GYN: Saturday call residents will report to work at 7:00am. If there is a true conflict GYN chief and either intern/3 rd year took call on Saturday, then the ONC chief/3 rd year may be asked to round on any benign GYN patients at UK. I would ask that GYN residents be particularly vigilant of their schedules. c. Chief: Weekend Saturday Chief is not to report prior to 7:00am. Arrangements need to be made with your respective teams. IV. CONFERENCE ATTENDANCE Residents on all rotations at the University of Kentucky as well as all rotations at Central Baptist Hospital, and Norton Hospital are expected to attend the formal teaching activities on Tuesday mornings unless the residents are involved with critical, unscheduled, clinical care activities. Attendance will be monitored by entering in the conference roster into New Innovations conference attendance module. Residents are also expected to attend the Rotation Specific educational activities unless involved in unscheduled, urgent clinical care. V. RESIDENT DUTY HOURS House staff and faculty members are educated concerning the professional responsibilities of physicians to support patient safety and assume personal responsibility by assuring fitness for duty, appropriate management of their time, recognition of impairment including fatigue, monitoring of patient care performance, and commitment to lifelong learning. Duty hours are defined as all clinical and academic activities related to the training program including scheduled academic/educational conferences where attendance is required. Duty hours must be logged into New Innovations on a daily basis. The hours are monitored via the educational office each month. If a resident is delinquent in entering their hours, they will be taken off their current rotation until their hours are up to date.

9 Maximum Hours of Work per Week Duty hours must be limited to 80 hours per week, averaged over a four week periods inclusive of all inhouse call activities and all moonlighting. Mandatory Time Free of Duty House staff must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). One day is defined as a continuous 24-hour period between all daily duty periods and after in-house call. Maximum Duty Period Length Duty periods of PGY-1 house staff must not exceed 16 hours in duration. To ensure compliance with the time off between scheduled duty periods (10 hours) PGY1 schedules are planned for only 14 hours. Duty periods of PGY-2 house staff and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. House staff may remain on-site up to an additional 4 hours to accomplish patient transitions in care. No additional clinical responsibilities after 24-hours of continuous in-house duty may be assigned. House staff is encouraged to use alertness management strategies (see VIII). House staff, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. Care of all other patients must be handed over. The house officer must document in New Innovations the reason(s) for remaining and submit it to the program director for review and monitoring. Minimum Time Off between Scheduled Duty Periods PGY-1 house staff should have 10 hours off between scheduled duty periods. PGY1 house staff, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient limited to reasons as listed above but must have eight hours, free of duty between scheduled duty periods. Intermediate-level house staff, PGY-2 should have 10 hours free of duty, and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of inhouse duty. House staff in the final years of education, PGY-3,4 should have eight hours free of duty between scheduled duty periods, there may be circumstances: required continuity of care for a severely ill or unstable patient, or a complex patient with whom the resident has been involved; events of exceptional educational value; or, humanistic attention to the needs of a patient or family when these house officers must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty. These circumstances must be monitored by the program director. Maximum Frequency of In-House Night Float House staff must not be scheduled for more than six consecutive nights of night float as specified by the Review Committee.

10 Maximum In-House On-Call Frequency In-house call is defined as those duty hours beyond the normal workday when the house officer is required to be immediately available in the assigned institution. PGY-2 house staff and above must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period). At-Home Call At-home call (pager call) is defined as call taken from outside the assigned institution. Time spent in the hospital by house staff on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident. House staff is permitted to return to the hospital while on at-home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new off-duty period. VI. ELIGIBILITY AND SELECTION OF RESIDENTS Application to Residency The Obstetrics and Gynecology Residency Training Program at the University of Kentucky will accept applications only through the ERAS System. The Program will abide by its ethical and procedural rules. The ACGME s Institutional Requirements for residency eligibility and selection will also be carefully followed. Resident Eligibility: Graduates of LCME and AOA accredited schools are eligible. Additionally, graduates of medical schools outside the United States and Canada who meet one of the following requirements: (1) have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates prior to appointment, or (2) have a full and unrestricted license to practice medicine in a US licensing jurisdiction in which they are training. Graduates of medical schools outside the United States who have completed a fifth pathway provided by an LCME-accredited medical school. Resident Recruitment: Completed applications from ERAS will be reviewed by the Program Director and/or members of the Residency Education Committee. Applications will be reviewed based on a candidate s preparedness, eligibility, ability, aptitude, academic credentials and potential, communications skills, letters of recommendation and personal qualities such as motivation and integrity. The Program will not discriminate with regard to sex, race, age, religion, color, national origin, disability, or veteran status. After screening, specific applicants will be invited to interview. After invitations to interview have been extended, and applicants have responded, a series of resident interview days will be established. Typically, there will be five to six half days devoted to this activity. Efforts are made to accommodate applicant convenience among the scheduled days.

11 On the evening before the interview day, invitees will be encouraged to attend a gathering which is sponsored by current resident physicians in the program. Faculty may also be present. The goal is to provide an opportunity outside of the medical center in which current residents, faculty and applicants can converse. The interview day will include an overview of the various divisions and components of the program. Applicants for residency positions typically meet with two teams of interviewers which are composed of a faculty member and a resident. Additionally, all interviewees will interview with the Program Director and Chairman. Applicants will be discussed during a brief postinterview meeting of all resident and faculty interviewers for each specific day of interviews. At the beginning of their day of interviewing, the Residency Coordinator will give applicants information about stipends and benefits at the University of Kentucky, a copy of the current University of Kentucky contract, a copy of the Graduate Medical Education Resident and Fellow Handbook, as well as the University of Kentucky Interviewee Information Items which contains information about which they need to be aware. After being provided the required items, interviewees will be asked to confirm that they have received the information and sign a certifying statement to that effect. Additionally, they will be given a supplemental information form, and an authorization for release of information form. The training program encourages second visits so that a candidate and a program can learn more about one another. Resident physicians as well as faculty physicians review all of the applicants who interviewed and develop separate rank order lists. The criteria outlined above (Resident Recruitment) as well as information learned during the interviews and ensuing discussions is used to construct the lists. The Program Director and/or the Residency Education Committee will carefully evaluate both lists and determine the final overall ranking for the program. The Departmental ranking will be entered in the NRMP in accordance with their timeframes. After Match results are known, the Department will communicate with and welcome the new residents. In the event that the Residency Program does not fill of its positions through the Match, the program will, through personal communication and/or through the scramble attempt to identify suitable candidates. Positions unfilled in the Match may be offered to qualified applicants by our Program, but this offer will be made with a clear communication to the applicant, both verbally and in writing, that the appointment is contingent on the applicant meeting requirements, and passing a credential review. Appointment is effected through execution of a contract between the applicant and the University of Kentucky.

12 VII. FACULTY SUPERVISION OF RESIDENT ACTIVITY To ensure oversight of house staff supervision and graded authority and responsibility, the following classification of supervision are used: Direct Supervision the supervising physician is physically present with the resident and patient. Indirect Supervision with direct supervision immediately available the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision. Indirect Supervision with direct supervision available the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision. Oversight the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. Each patient, in the clinical learning environment has an identifiable, appropriately credentialed and privileged attending physician who is ultimately responsible for that patient s care. This information is made available to house staff, faculty members, other healthcare providers and patients through the use of patient room white boards, the EMR, team schedules, etc. House staff and faculty members should inform patients of their respective roles in each patient s care with each encounter. Faculty supervision assignments should be of sufficient duration to allow assessment of the knowledge and skills of each house officer and delegate to him/her the appropriate level of patient care authority and responsibility. An appropriate level of supervision exercised through a variety of methods as defined above is in place for all house staff that care for patients. Faculty members functioning as supervising physicians are expected to delegate portions of care to house staff, based on the needs of the patient and the skills of the house officer. Senior residents or fellows have a supervisory role of junior residents in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual resident or fellow. The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each house staff by PGY/level of training include: PGY1: Indirect supervision is allowed for: Patient Management Competencies: evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests evaluation and management of post-operative patients, including the conduct of monitoring, and orders for medications, testing, and other treatments

13 discharge of patients from the hospital interpretation of laboratory results Procedural Competencies: Pap tests STD testing Digital cervical exams Basic ultrasound for presentation Direct supervision is required until competency is demonstrated for: Patient Management/Procedural Competencies Required for all surgeries and deliveries Leep/Colposcopy Endometrial/vulvar biopsy IUD placement Intermediate Resident: Indirect supervision is allowed for: Patient Management Competencies: evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests evaluation and management of post-operative patients, including the conduct of monitoring, and orders for medications, testing, and other treatments discharge of patients from the hospital interpretation of laboratory results transfer patients between hospitals Procedural Competencies: Pap tests STD testing Digital cervical exams Basic ultrasound for presentation Endometrial/vulvar biopsy IUD placement Direct supervision is required until competency is demonstrated for: Patient Management/Procedural Competencies Required for all surgeries and deliveries PGY-3/4: Indirect supervision is allowed for: Patient Management Competencies: evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests

14 evaluation and management of post-operative patients, including the conduct of monitoring, and orders for medications, testing, and other treatments discharge of patients from the hospital interpretation of laboratory results transfer patients between hospitals Procedural Competencies: Pap tests STD testing Digital cervical exams Basic ultrasound for presentation Endometrial/vulvar biopsy IUD placement Leep/Colposcopy Direct supervision is required until competency is demonstrated for: Patient Management/Procedural Competencies Required for all surgeries and deliveries Circumstances to Contact Supervising Physician PGY-1 residents must communicate with PGY-3,4/Attending under the following circumstances/events: ER consults Floor consults Admissions/discharges Fetal heart abnormalities (category 2 or 3) Fevers/post op complications Unstable patient Deliveries/surgeries Intermediate residents must communicate with PGY-3,4/Attending under the following circumstances/events: ER consults Floor consults Admissions/discharges Fetal heart abnormalities (category 3) Fevers/post op complications Unstable patient Deliveries/surgeries PGY-3/4 residents must communicate with attending under the following: Unstable patient/rapid deterioration o Including post partum hemorrhage, seizures, respiratory distress, mental status changes Deliveries c-section or vaginal

15 Surgery either inpatient or outpatient Patient attempting to leave against medical advice Patient requiring blood transfusion Patient requiring antibiotics All admissions If for any reason the attending on call for the service in question is not available or accessible, the in house attending should be called. If the in-house attending is unable to respond or unavailable, the chairman and program director should be called. VIII. SLEEP DEPRIVATION, FATIGUE MITIGATION AND ALERTNESS MANAGEMENT POLICY House staff and faculty members are educated concerning the professional responsibilities of physicians to support patient safety and assume personal responsibility by assuring fitness for duty, appropriate management of their time, recognition of impairment including fatigue, monitoring of patient care performance, and commitment to lifelong learning. House staff receives sleep deprivation, fatigue recognition, alertness management and fatigue mitigation training along with physician impairment training during GME orientation. All faculty and residents receive education to recognize the signs of fatigue and sleep deprivation through PowerPoint presentation listed on home page of New Innovations residency management software. All faculty members and house staff are encouraged to adopt fatigue mitigation processes to manage the potential negative effects of fatigue on patient care and learning such as naps. To ensure continuity of patient care in the event that a house officer may be unable to perform his/her patient care duties due to fatigue the following back up call schedules are in place. The intern is instructed to contact the upper level resident, in turn if the upper level resident is fatigued; they are instructed to contact the attending in house. There is an attending available in house every 24 hours. Options for house staff that may be too fatigued to safely return home include use of the already available on-call rooms and safe transportation via taxi request through the sponsoring institution. During the Norton rotation in Louisville, residents have access to free accommodations if they are too fatigued to drive to residence. IX. LEAVE, VACATION, AND ABSENCE RECORD All vacation leave is subject to the following guidelines: First Year Residents (PGY-1) receive 2 calendar week vacations (5 consecutive days in accordance with University Hospital policy) plus 8 additional (potential) holidays. - Holidays: Independence Day, Election Day, Thanksgiving Day, Christmas Day New Year s Day, Martin Luther King Day, Memorial Day. Holiday leave will include the observed day and may not be the actual holiday.

16 - In addition, 4 bonus days to be taken according to the pre-arranged Christmas and New Year holiday leave plan. You will work one of the holiday weeks. Vacation cannot be used to have both off. Second, Third, and Fourth (Chief) Year Residents (PGY-2,3,4) will receive 3 calendar week vacations (5 consecutive days in accordance with University Hospital policy) plus 8 additional (potential) holidays. - Holidays: Independence Day, Election Day, Thanksgiving Day, Christmas Day New Year s Day, Martin Luther King Day, Memorial Day. Holiday leave will include the observed day and may not be the actual holiday. - In addition, 4 bonus days to be taken according to the pre-arranged Christmas and New Year holiday leave plan. You will work one of the holiday weeks. Vacation cannot be used to have both off. ALL RESIDENTS 1. An absence record requesting vacation or other leave must be completed: signed by the resident requesting the leave, approved and signed by the Administrative Chief Resident, and then submitted to the Education Office (Bill Towles or Brian Judge) for processing and submission to the Residency Director for final approval. a. The Absence Record must be completed 5 work days prior to the date of requested leave. b. ALL administrative duties MUST be completed prior to the date of requested leave (i.e. Duty Hours & Case Logs up to date, and Medical Records deficiencies completed including electronic order signatures) Failure to do so may result in the vacation being cancelled and/or work suspension. 2. If an absence occurs due to an illness, an absence record must be completed immediately after returning to work following the steps in #1. 3. Only one resident per team may have vacation at a given time. Only 2 residents may be on vacation at one time. 4. Vacations will not be allowed during popular meeting weeks ie SGO, ACOG, SMFM, AAGL. This can be amended when attendance plans are confirmed. 5. Vacation leave may not be used in July or in the last 2 weeks of June when the departing chief residents are on leave. 6. Vacation may not be taken on Night Float Rotation. 7. Vacation may not be taken on the same rotation twice in the same year. 8. Interns may not take vacation on Central Baptist Rotation. 9. The Central Baptist Rotation only allows for 7 weeks of vacation per year for the entire department. Vacations on these rotations will be granted on first come first served basis. Requests that will exceed the allowed 7 week limit will be denied. 10. All absences are subject to the American Board of Obstetrics and Gynecology and may not exceed 8 weeks per year. CHIEF RESIDENTS 1. Chief Residents are allowed up to 4 days of leave for fellowship or job interviews with prior approval from the Administrative chief resident and Program Director. These days would be allowed for interviewing and professional needs. Vacation days would be required to be used for travel, house hunting, or any other activities outside of the interview.

17 2. No more than 2 chief residents may be on leave at one time including maternity, paternity, vacation, and sick leave time. 3. All chief residents are allowed an elective study time in the last 2 weeks of June. Should a resident plan to leave Lexington for other activities, vacation must be saved and used. 4. All leave is subject to the American Board of Obstetrics and Gynecology and may not exceed 6 weeks in the chief year. BONUS DAYS/HOLIDAYS Residents will be excused from all duties on holidays and bonus days except for those residents on call. MATERNITY LEAVE Maternity leave in excess of accrued vacation or sick leave (8 weeks PGY 1-3, 6 weeks PGY4) will be considered leave without pay. In order to meet ABOG requirements, the individual may be required to make up this time if maternity leave in addition to other leave exceeds 8 weeks. PATERNITY LEAVE Paternity Leave will be granted annually to any male house officer to care for his newborn child and the mother of his newborn child. Leave may not exceed accrued vacation or sick days or this will be considered leave without pay. Leave in excess of these days may require make up time in order to meet ABOG requirements. GENERAL POLICIES Yearly Rotation schedules will not be amended to accommodate desired vacations. Residents are expected to request vacations within the restriction guidelines only, and will not be granted special consideration except in extreme circumstances. Once the call schedule has been released, any modification requests are expected to be arranged by the resident wishing to make the change and will NOT be facilitated by the Administrative Chief Resident. This includes clinic/or/floor coverage should these be affected. Any switch after the call schedule is released must be reported to the chief resident and approved. XI. RESIDENT MOONLIGHTING The program does not allow moonlighting.

18 XII. PROFESSIONAL CONDUCT House staff is expected to conduct themselves in a professional manner regarding achievement of educational objectives, provision of patient care and relations with their colleagues. The appointment contract makes explicit these expectations and makes reference to other relevant documents that govern resident behavior. They are the University Administrative Regulations (AR), the Chandler Medical Center Behavioral Standards in Patient Care, the Behavioral Code and other Medical Center documents, all of which are available via the GME Office. House staff is bound to and must abide by the Behavioral Standards, and agree to abide by the policies, regulations and procedures of any hospital or institution to which they are assigned for any part of training and other responsibilities as assigned by the program. XIII. PROFESSIONAL DEVELOPMENT FUNDS 1. Each year, faculty in the Department of Obstetrics and Gynecology contribute monies that residents may spend for professional development. Allowances are as follows: PGY-1 - $500 PGY-2 - $750 PGY-3 - $750 PGY-4 - $2000 (additional $1,500 to be used towards a course) (given at the beginning of the year through payroll) 2. These professional development funds may be used for membership dues, medical journal subscriptions, books, and educational courses. 3. Should this allotment become depleted, the resident will be responsible for any expenditure. It is strongly suggested that each resident inquire with the Education Office to determine the status of residual monies and the appropriateness of any potential purchase before making the purchase. The Department of Obstetrics and Gynecology will not pay for charges over the allotment. All receipts and paperwork should be turned into the Education Office of the Department of Obstetrics and Gynecology. 4. Laboratory coats are furnished by the GME Office. The Department of Obstetrics and Gynecology provides funds to have them monogrammed. Residents are responsible for their own laundry expenses. 5. Pagers are the property of the Department of Obstetrics and Gynecology. Batteries are furnished by the Department, and may be picked up from the Education Office in Room C-368. Any problems with pagers should be directed to the Education Office. 6. The department will also cover expenses for any resident presenting their research during a conference. Residents will be reimbursed up to $1, Prior to ordering a textbook and/or making travel arrangements for a course, please consult the Education Office for proper procedures.

19 Guidelines for obtaining these yearly educational funds are handed out to residents at the beginning of each year and are available from the Education Office. XIV. PROGRESS AND PROMOTION Advancement from one academic year to the next is dependent upon satisfactory performance of the established didactic and clinical educational curriculum for that academic year. The decision to promote a resident is based on the Residency Education Committee s evaluation of the resident s performance in the 6 areas of competencies as determined using various assessment tools. If the evaluations warrant, a resident may not be promoted but instead receive an adverse action (see section). Residents receive feedback on a regular basis both formally and informally. At the end of each clinical rotation, each resident receives an evaluation filled out by faculty through New Innovations. These competency-based evaluations are specific to each rotation, with each successive year representing more advanced goals, objectives, patient responsibilities, and teaching responsibilities. Residents are notified through New Innovations when an evaluation has been completed on them. If a resident disagrees with a Clinical performance evaluation by a faculty member, the resident may address the evaluation further with the evaluating faculty member. If unresolved, the Program Director, Residency Education Committee and Chair may be appealed to. If still unresolved the resident physician may follow the option of grievance. Although each resident receives an evaluation at the end of each rotation, if a resident s performance at the midpoint of any rotation is judged to be unsatisfactory, it is the responsibility of the attending physician(s) to meet with the resident, discuss and document the deficiencies and to devise a plan to address the deficiencies. Documentation in memo/letter format must be sent to the Program Director. The Program Director is available to discuss resident performance issues with them anytime for a timely appointment, as needed. A decision regarding reappointment must be reached no later than March 1, (unless the resident is on suspension or probation) of the year of the current appointment. Reappointment is the usual expectation if the resident is making normal progress toward board eligibility and/or attainment of the learning objectives of the program. It is affected through execution of and contract between the applicant and the University of Kentucky. XV. RESIDENT STATISTICS Upon entering the Residency Program, each PGY1 resident will be specifically instructed in the ACGME approved case log recording system. In addition, there are several computer terminals which are accessible for entering statistics. It is the responsibility of each resident to assure that these statistics

20 are correct and maintained on a regular basis. Each resident should enter all cases on a weekly basis but it is mandatory that it be completed at least once a month. All surgical cases will be recorded separately for the primary surgeon and the assistant. Common problems encountered while performing ambulatory care also need to be documented. The Education Office will prepare an updated list each Monday morning to indicate the status of each resident s compliance with this directive. If there is a resident who is not up-to-date with documentation of their case experience, this will be discussed with them and further action taken. This may include the resident being taken off current rotation and prevented from participating in further clinical activity until the statistics are completed. Correct and accurate reporting of statistics is imperative for both self assessment of the program curriculum and for documentation for the Residency Review Committee, whose role it is to assure that we are providing an adequate clinical experience for all of the residents in the Program. Any questions should be directed to the Program Director or the Education Office. XVII. TRANSITIONS OF CARE/HANDOVER All clinical assignments are designed to minimize the number of transitions in patient care by incorporating a night float system. The program ensures and monitors effective, structured hand-over processes that facilitate both continuity of care and patient safety by using the following baseline as a program standard: - Handoffs are face-to-face in a quiet, confidential location with ready computer access to the electronic medical record and/or handoff tool. At minimal, verbal contact via phone with use of an updated handoff tool is required. - The handoff tool includes the following information for each patient: o Identification/location o Code status o Active problem(s) o Patient medical history o Current medications o Allergies o Recent procedures o Patient to do list o Anticipation for any problems that may arise - There is sufficient time during the handoff for questioning and clarification or correction of information. - The incoming resident(s) assumes care for patients via the electronic medical record and/or exchanges pagers if applicable. The program ensures that house staff is competent in communicating with team members in the handover process by direct and indirect supervision. For each specific service, the following transfer protocol is used:

21 OB/MFM GYN - Monday-Friday daily formal board check-out with entire OB team, MFM faculty, fellows, and/or Generalist faculty at 7:30am. - Monday-Friday evening check-out at 5:00pm with OB team and on-call faculty. - Weekend formal check-out at 10:00am with on-call OB team and on-call faculty. - Monday-Friday daily morning rounds with PGY-1,3,4 GYN team. In addition attending of the week speaks with PGY-4 resident. - Monday-Friday phone check-out is done by PGY-2 Night Float resident. - Weekend phone check-out is done with attending before noon. GYN/ONC - Daily check-out with entire GYN/ONC team which consists of PGY-1,2,3,4 residents and GYN/ONC fellow at 6:30am. - Monday-Friday informal rounds with GYN/ONC fellow and PGY-1,2,3,4 at 6:00pm. - Weekend phone check-out with GYN/ONC fellow in the evening. Schedules that inform all members of the health care team of attending physicians and house staff currently responsible for each patient s care are available on secure website and through .