Format for a Written Survey of Residents for Internal Reviews

[Instructions to the Ad Hoc Committee for the Internal Review: As you undertake your internal review of a residency program, you may find that your interviews with the program’s residents have not been entirely representative of the program. In that case, you may wish to use a written questionnaire that could be sent to all residents in the program and then returned to the Office of Medical Education for compiling. This may be applicable especially in programs with large numbers of residents. The format below has specific questions that address the program’s compliance with the Institutional Requirements. Please add any questions from the Program Requirements or from the Subspecialty Requirements, if appropriate, to the questionnaire as needed. The sections of these requirements are included, but be free to edit to suit the committees needs.]

[The following paragraph is instruction for the resident receiving the questionnaire.]

Your residency program is undergoing an internal review by an ad hoc committee established by the Graduate Medical Education Committee. This process is a requirement of the Accreditation Council for Graduate Medical Education (ACGME). As part of this internal review, information from the residents is key to understanding how effective the program is in meeting the ACGME’s Institutional and Program Requirements and how effective the program is in achieving its own educational goals. Please take a few minutes of your time to complete the following brief questionnaire and return it to ______.

Institutional Requirements

  1. Is there a mechanism that provides you with the opportunity to address concerns in a confidential and protected manner? Yes ___ No___
  2. Which of these pathways do you feel you would find useful to deal with issues of working conditions or the educational program?
  3. The JCIR? Yes ___ No___
  4. Your Program Director or other faculty in your program? Yes ___ No ___
  5. The Director of Medical Education? Yes ___ No ___
  6. The Graduate Medical Education Committee? Yes ___ No ___
  7. Other ______
  1. Are you aware of the grievance procedures in the Memorandum of Understanding between Los Angeles County and the Joint Council of Interns and Residents? Yes ___ No ___
  1. Are you aware of due process procedures that would apply to you should you be disciplined for academic reasons or should any action be taken that could affect your career? Yes ___ No ___
  1. Do you have, as components of the curriculum of your program a regular review of ethical, socioeconomic, medical/legal, and cost-containment issues that affect Graduate Medical Education and medical practice? Yes ___ No ___
  1. Do you have, as components of the curriculum of your program an introduction to communication skills and to research design, statistics, and critical review of the literature necessary for acquiring skills for lifelong learning? Yes ____ No ____
  1. Do you receive instruction in quality-assurance/performance improvement? Yes ____ No ____
  1. Do you participate in components of the institution's performance improvement program? Yes ____ No ____
  1. Are you aware of opportunities for you or your resident representatives to participate on institutional committees and councils whose actions affect your education and /or patient care? Yes ___ No ___
  1. Do you submit to the program director or to a designated institutional official at least annually confidential written evaluations of the faculty and of the educational experiences? Yes ___ No ___
  1. When you were applying to the program, did you receive the following written information: the terms and conditions of employment and benefits including financial support, vacations, professional leave, parental leave, sick leave, professional liability insurance, hospital and health insurance, disability insurance, and other insurance benefits for the residents and their family, and the conditions under which living quarters, meals and laundry or their equivalents are to be provided? Yes ___ No ___
  1. Did you receive written guidelines for the supervision of residents on your service that included on-call schedules for teaching staff that ensure that supervision is readily available to residents on duty?

Yes ___ No ___

  1. For the following items please rate them using a scale from 1 to 5

InadequateHighly Satisfactory

  1. Food and food service12345
  2. Sleeping quarters12345
  3. IV therapy services12345
  4. Phlebotomy services12345
  5. Messenger and transporter service12345
  6. Laboratory services12345
  7. Laboratory information retrieval12345
  8. Radiology information retrieval12345
  9. Security and personal safety 12345
  10. Medical record availability (ward)12345
  11. Medical record availability (clinics)12345
  12. Medical record availability (ED)12345

Comments on the above list:______

  1. Personal safety.
  2. Do you have any concerns about getting from the parking lot to the hospital? Yes ___ No ___
  3. Do you have any concerns about getting from the hospital to the parking lot? Yes ___ No ___

Program or Subspecialty Program Requirements

[These are just a few of the major areas that the committee may wish to address in the questionnaire.]

Participating Institutions (resident opinion on the educational value of experience in affiliating institutions)

Program Director Responsibilities

Facilities and Resources

Specific Program Content

Curriculum requirements

Conferences (documentation of attendance)

Teaching Experience (resident responsibilities for teaching other residents and students)

Procedures (Types, quantity and process for recording)

Research and scholarly activity

Evaluation

Resident

Faculty

Program