Internal Medicine Residency Program Rwjms

POLICY MANUAL

2012-2013

INTERNAL MEDICINE

RESIDENCY PROGRAM

INDEX

CALL COVERAGE

COMMUNICATION

COMMUNITY SERVICE

CONTINUITY CLINIC

DAILY CONFERENCE ATTENDANCE

DRESSCODE

DUE PROCESS

DUTY HOURS

ELECTIVES

EVALUATION

FLOAT ANDPERSONAL DAYS

HOUSESTAFF SELECTION

HOUSESTAFF SUPERVISION

LEAVE OF ABSENCE

MEDICAL DOCUMENTATION

MEDICAL RECORDS COMPLETION – RWJUH

MEDICAL RECORDS COMPLETION – UMCP

MOONLIGHTING

NATIONAL CONFERENCES

NON-TEACHING PATIENT COVERAGE

ORDER WRITING

PERFORMANCE DEFICIENCES

PHARMACEUTICAL INDUSTRY

PINCH HITTER USAGE

PROCEDURES

PROMOTIONS

RECOMMENDATION LETTERS

RESEARCH

SCHEDULING REQUESTS

SERVICES – RWJUH

SERVICES – UMCP

SICK DAYS

SUBSPECIALTY FELLOW AND INTERNAL MEDICINE RESIDENT INTERACTION

TEACHING SERVICE RESPONSIBILITIES FOR MEDICAL INTENSIVE CARE UNIT SERVICE (ICU) AT RWJUH AND UMCP

TEACHING SERVICE RESPONSIBILITIES FOR MEDICAL TEACHING SERVICE (MTS), CARDIOLOGY TEACHING SERVICE (CTS), ONCOLOGY TEACHING SERVICE (OTS), NIGHT FLOAT AND BACK-UP AT RWJUH AND UMCP

TRANSITIONS OF CARE

TRAVEL POLICY

UMDNJ POLICYMANUAL

UNIVERSITY HOLIDAYS

VACATIONS

Compliance with all UMDNJ policies is required. The UMDNJ policy manual can be reviewed at the following site:

Policy Name: Dress Code Policy

Policy Number: 1

Approval by Program Leadership: 7/1/05

Amendment Date:

Purpose:

To ensure that residents appear professional at all times.

Policy:

All housestaff must wear a clean white coat at all times.

Men - must wear a shirt and tie with slacks, even on weekends.

Women - must be neat and professional at all times.

Jeans, tee shirts, open-toed shoes, etc. are not acceptable attire.

Scrubs may only be worn during Night Float and during overnight ICU or overnight floor call.

Policy Name: Work Hour Policy

Policy Number: 2

Approval by Program Leadership: 7/1/05

Amendment Date: 6/9/11

Purpose:

To ensure that residentsare well rested and able to provide safe, effective patient care while maintaining compliance with the ACGME work hour rules.

Policy:

The work week for each resident will be restricted to a maximum of 80 hrs/week when averaged over 4 weeks. This includes residency activities and moonlighting hours irrespective of the site or type of assignment. Random duty hour audits will be conducted and necessary adjustments made to ensure full compliance.

When averaged over a 4week rotation, residents must have at least 1 day in 7 free of residency related activities. A day off is defined as one continuous 24 hour period free from all clinical, educational, and administrative duties.

Each resident must have an8 hour duty free period between all daily shifts and after in-house call. They must also have at least 14 hours free of duty after 24 hours of in-house duty.

Continuous on-site duty, including in-house call, must not exceed 24 hours for PGY 2 and PGY 3 residents. No new patients may be accepted after 24 continuous hours on duty.

Continuous on-site duty, including in-house call, must not exceed 16 hours for PGY 1 residents.

In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are 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.

Under those circumstances, the resident must: appropriately hand over the care of all other patients to the team responsible for their continuing care; and, document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director.

Residents will notbe assigned to in-house overnight on call duty at a frequency greater than every fourth night.

Weekdays:

Residents on elective are to be at Board Review at 7:00am.

Residents on service, if not at Board Review are required to be at sign in rounds in the residency call room at RWJUH or residency lounge at UMCP at 7:00am.

Residents on elective may leave at 4:30pm or until all the work is done.

Residents on service may sign out no earlier than4:30pm. (unless post overnight call).

Residents in clinic may not leave clinic until all the residents at that clinic site and day have seen all their patients, even if on call that day.

Weekends/Holidays:

Residents on elective are off, unless they are the pinch hitters for that period.

Residents on serviceare required to be at sign in rounds in the residency call room at 8:00am.

Residents on service may sign out no earlier than 12:00pm.

Policy Name: Non-Teaching Patient Coverage Policy

Policy Number: 3

Approval by Program Leadership: 7/1/05

Amendment Date:

Purpose:

To ensure that residents’ service responsibilities are limited to patients for whom they have primary diagnostic and therapeutic responsibility, as per the ACGME regulation.

Policy:

1. Residents will not respond to emergencies on non-teaching service patients unless it is a code situation.

2. Residents will not place any orders on non-teaching service patients.

3. Residents will only admit those patients that who will remain on the teaching services during their hospital admission.

Policy Name: Medical Documentation Policy

Policy Number: 4

Approval by Program Leadership: 7/1/05

Amendment Date:5/31/09

Purpose:

To ensure safe patient care and efficient communication among healthcare providers.

Policy:

All resident progress notes, procedure notes and H&Ps must be dated, timed and signed by the resident, with name and pager number printed legibly under the signature.

All H&Ps must be co-signed by a senior resident and an independent brief resident note must be included.

All progress notes written by a medical student must be accompanied by a addendum from a resident or intern.

H&Ps written by medical students will not be accepted as part of the medical record.

All patient interactions, family meetings and evaluations in a cross-coverage situation should be clearly documented.

All notes written by residents and placed in the medical record are legal documents and falsification of them is a criminal action.

Policy Name: Order Writing Policy

Policy Number: 5

Approval by Program Leadership: 7/1/05

Amendment Date:5/31/09

Purpose:

To ensure safe patient care by providing a single point of contact for medical orders.

Policy:

In the non-emergency setting, residents must write all orders for patients under their care, with appropriate supervision by the attending physician.

In an emergency setting, should an attending physician write an order on a resident’s patient, the attending must communicate his/her action to the resident or cross-covering resident in a timely manner.

Policy Name: Daily Conference Attendance Policy

Policy Number: 6

Approval by Program Leadership: 7/1/05

Amendment Date: 6/9/11

Purpose:

To ensure that residents participate in the art, science, and business of medicine curriculum.

Policy:

A. Board Review:

Board review is from 7:00am to 7:45am Monday – Friday from July – May.

It is held in MEB 108B at RWJUH and in the classroom next to the noon report room in the 1st floor of Lambert House at UMCP. It is video-conferenced between the two sites.

All PGY-2 & 3 on RWJ floor service and night float are encouraged to attend. All PGY-2 and PGY-3 residents on service on UMCP floor service are encouraged to attend. PGY-2 & 3 residents on night float at UMCP are REQUIRED to attend.

All PGY-1, 2 & 3 residents on elective are REQUIRED to attend and MUST attend at their elective site.

Ideally, a resident should not miss board review unless there are extenuating circumstances. If extenuating circumstances occur, a resident may not miss more than two board review sessions during a two week elective block or four board review sessions during a four week elective block. These include days missed for personal days, sick days, and interview days. Hospitalizations will not be counted. Interview days in excess of the time allotted need to be approved by the chief resident. Absences from board review in excess of the above will result in the resident being placed on Academic Warning/Probation as outlined in Policy #25. Additional offenses after the resident has been placed on Academic Warning/Probation may result in dismissal proceedings.

B. Night Float Rounds:

At RWJUH, night float rounds will be held daily from 7:45 to 8:30am except on holidays, weekends, and days of Grand Rounds conferences. The attending will meet the team by MEB 108B.

At UMCP, night float rounds will be held daily from8:00 to 8:30am except on holidays, weekends, and days of Grand Rounds conferences. The senior night float resident will contact the attending to find out where they will meet.

C. Conference:

EVERY resident is responsible for attending all conferences while on floor service or in-house elective listed below and in case of conflict, please contact the chief resident directly. Those residents on the oncology service are encouraged to attend noon conference based upon census but are required to attend Grand Rounds.

Every resident may be assigned to give Journal Club, CPC and/or M&M conference during the year.

All Journal Club articles must be approved by the chief residents.

1.RWJUH:
Monday throughFriday in MEB 108B unless otherwise stated. Please follow times based on the monthly schedule for conferences.

a) Noon Report: Daily starting at noon.

b) Core Conference: Multiple times a week following Noon Report and includes Journal Club.

c) Grand Rounds: Wednesdays from September - June inCAB 1302 from 8:00am to 9:00am.

d) Art of Medicine and Business of Medicine Conferences: Occurring alternating months in MEB Room 108B, time to be determined.

e) M&M: Occurring the last week of every month where each service team presents

2. UMCP:

a) Noon Report: Monday, Wednesday, Thursday, and Friday in Class Room #3 Lambert-1st floor at noon.

b) Grand Rounds:Tuesdays from September -June in Ground Floor Conference Room A from 8:00am to 9:00am.

c) Art of Medicine and Business of Medicine Conferences: Occurring alternating months, time to be determined. See monthly schedules

d) Core Conference: Multiple times a week following noon report. See monthly schedules.

e) M&M: Occurring the last week of every month where each service team presents appropriate cases

D. Clinic Conference: Residents will be assigned topics within the Outpatient Johns Hopkins Internal Medicine Curriculum. Residents should review their assigned topic prior to clinic and be prepared to moderate the discussion with supervision by the clinic preceptor.

E. Failure to present a CPC/M&M/Journal club or any other scholarly activity: If a resident is not prepared to present at conference, he/she will have to present that conference at a later date. In addition, an extra conference presentation will be assigned along with a written formal explanation regarding the event.

Policy Name: Housestaff Selection Policy

Policy Number: 7

Approval by Program Leadership: 7/1/05

Amendment Date:

Purpose:

This policy ensures that the residency program selects the best qualified individuals without discrimination.

Policy:

Applicants are selected based on theirpreparedness,abilities, aptitude, academic credentials, communication skills, and personal qualities such as motivation and integrity. The program does not discriminate with regard to gender, race, age, religion, color, national origin, disability, or veteran status.

The selection protocol for all applicants involves review and verification of the application with supporting documents and a formal interview process.

When applying for a PGY II or PGY III position, a letter of reference from the applicant’s former program director will be required.

For admission to the PGY III year of training, the applicant must have passed USMLE step 3, NBMOE Part III or COMLEX Level III. In addition, all applicants must fulfill criteria for registration, permits, or licensure with the New Jersey Board of Medical Examiners

Review the UMDNJ-Robert Wood Johnson Medical School Graduate Medical Education Policy Manual, policy number I.1, for further details.

Policy Name: Promotions Policy

Policy Number: 8

Approval by Program Leadership: 7/1/05

Amendment Date:

Purpose:

To establish minimum proficiency criteria for advancement to the next level of training as determined by the Residency Promotions Committee.

Policy:

1. Proficiency Criteria for Determination of Advancement in Training

Advancement to PGY2 Level of Training:

Medical Knowledge / 1. Demonstrate knowledge needed to obtain a comprehensive history and perform a physical exam, interpret basic laboratory studies, and generate a differential diagnosis.
2. Demonstrate knowledge and application of the basic pathophysiology and natural history of those diseases encountered in caring for one’s patients.
3. Demonstrate knowledge of inpatient clinical parameters for patients under one’s care, including generation of a diagnosis, the clinical course and an updated problem list.
Patient Care / 1. Demonstrate the skills needed to perform a comprehensive history and physical exam, interpret diagnostic studies, and generate a meaningful and timely patient care plan, including all orders.
2. Demonstrate the ability to synthesize, present and document (including medical records) the above in the form of a meaningful timely patient care plan.
3. Demonstrate the ability to recognize, assess and treat emergencies.
4. Demonstrate the ability to generate meaningful consultative requests while understanding the relationships of consultants to the primary care physician(s).
5. Perform procedures as indicated and with the necessary supervision. Maintain accurate logs and web-based entry of procedures performed as prescribed by the Procedural Committee of the Residency Program.
Interpersonal & Communication Skills / Demonstrate the ability to communicate effectively with patients, families, colleagues, all members of the health care team and office staff (residency, private office, and clinic).
Professionalism / 1. Demonstrate a high standard of personal honesty and integrity.
2. Exhibit humanistic qualities in caring for the patients.
3. Demonstrate active participation in working and teaching rounds.
4. Respond to administrative requests, pages, and email communication in a timely manner.
5. Accept reading and teaching assignments as prescribed by the senior resident, attending, or chief residents.
6. Record >80% attendance at all academic conferences and board review with active participation.
7. Adherence to all program policies and requirements.
8. Demonstrate the ability to accept feedback related to any of the competencies and demonstrate change.
Systems Based Practice / 1. Demonstrate an awareness of team structure and function.
2. Demonstrate the ability to identify resources within the local healthcare delivery system with the sole aim of promoting patient care.
Practice Based Learning / 1. Demonstrate an interest and awareness in accessing resources needed to incorporate evidence into the clinical decision making arena.
2. Demonstrate enthusiastic participation in the outcomes project aimed at measuring and improving clinical parameters for select disease modules.

Each of the above criteria in combination assess the ability of the intern to transition into their role as TEAM LEADER where necessary skills in medical knowledge, data gathering, clinical insight and critical thinking lend itself to effective leadership and role modeling. Residents should use the milestones file on the residency website as a guide to determine if they are meeting current requirements.

2. Proficiency Criteria for Determination of Advancement in Training

Advancement to PGY3 Level of Training:

In addition to meeting the junior level proficiency criteria, PGY-2s must demonstrate progression in the competencies as outlined below in order to advance. Residents should use the milestones file on the residency website as a guide to determine if they are meeting current requirements.

Medical Knowledge / 1. Display further expansion of medical knowledge, including evidence-based guidelines, specific disease-based recommendation and refinement in history taking skills and physical exam signs using a self-directed learning style.
2. Demonstrate evidence of outside reading.
Patient Care / 1. Demonstrate the ability to construct, present and document a concise and relevant resident note with greater emphasis on the clinical assessment and care plan.
2. Accept responsibility and demonstrate familiarity with important clinical parameters for patients under one’s care and when supervising interns on other teams.
3. Demonstrate the ability of quick recognition, assessment and treatment of emergencies, including role as code leader.
4. Demonstrate the ability to recognize and manage “new” clinical problems, i.e. those scenarios not previously encountered.
5. Continue to perform procedures within one’s expertise while safely supervising interns/students with their procedural skills.
6. Demonstrate the ability to coordinate care between different settings.
Interpersonal & Communication Skills / 1. Demonstrate the ability to communicate feedback in real time to interns and students on their data gathering skills, clinical assessment, care plans and documentation.
2. Demonstrate progressive development of communication skills in the arena of Bioethics and End of Life Care.
3. Demonstrate the ability to communicate effectively and directly with consultants from within and outside the specialty of internal medicine.
Professionalism / 1. Demonstrate a high standard of personal honesty and integrity.
2. While exhibiting humanistic qualities in caring for patients, function as a role model to other members of the healthcare team.
3. Demonstrate ability to lead rounds by selecting cases and scenarios for discussion, organizing structure and duration of rounds and helping each member attain their individual educational objectives.
4. Accept reading and teaching assignments as prescribed by attending physicians and chief residents.
5. Respond to administrative requests, pages and email communication in a timely manner.
6. Record >80% attendance at ALL academic conferences and board review with active participation.
7. Adherence to all program policies and requirements.
8. Demonstrate the ability to accept feedback related to any of the competencies and demonstrate change.
Systems Based Practice / 1. Demonstrate effective leadership skills as team leader and patient advocate in facilitating access to resources and care.
2. Demonstrate willingness to review and discuss all aspects of care, including individual and system related errors.
3. Demonstrate utilization of cost effective “best practices” in all aspects of patient care.
Practice Based Learning / 1. Demonstrate proficiency in accessing resources and establishing guidelines in the practice of evidence based medicine.
2. Demonstrates the ability to utilize the principles of evidence based medicine in the context of differing clinical scenarios.
3. Demonstrates a commitment to periodic self-assessment.
4. Demonstrates the ability to implement change when constructive feedback is provided.

3. Proficiency Criteria for Graduation: