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HOUSESTAFF POLICY MANUAL
2013-2014
TABLE OF CONTENTS
WELCOME
4. Mission
5. Letter from the President & CEO
6. Letter from the Osteopathic Director of Medical Education
7. Professional Guidelines and General Information
ACADEMIC AND INSTITUTIONAL POLICIES GOVERNING RESIDENCY TRAINING
8.
9.
15.
16.
21.
22.
23.
26.
28.
32.
33.
36.
37.
37.
38.
39.
39.
40.
40.
40.
41.
41.
52.
53.
54.
56.
61
63.
Core Tenets of Residency Education
Core Competencies
Osteopathic Competencies (DO only)
Competency Based Progressive Learning Objectives
Didactic Education and Conference Structure
Evaluation of Residents
Mentorship Program
Procedures Requirements and Documentation
Research and Scholarly Activity
Offsite Rotations Policy
Supervision Policy
Policy on Resident Recruitment, Eligibility and Selection
Policy on Disability and Accommodations
Policy on Resident Appointments and Reappointments
Policy on Resident Transfers
Policy on Program or Institutional Closure and Reduction
Professional Liability Insurance
Residents Health Benefits
Long Term Disability Program
Workers Compensation
Unemployment Compensation
Leaves of Absence
Educational Leave
Medical Leave (incl Maternity Leave)
Family Leave (incl Paternity Leave)
Interview Leave
Bereavement Leave
Jury Duty
Family Medical Leave of Absence
Vacation and Holiday Leave
How to Raise and Resolve Issues
Mechanisms to Resolve Issues
GME Office
Human Resources
Risk Management
Patient Safety
Policy on Discrimination and Harassment
Progressive Discipline and Remediation Policy
Due Process
Policy on Resident Impairment
Books
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63.
63.
63.
63.
63.
63.
64.
Employment Reference Checks
Personal Data Changes
Pay Days
Administrative Pay Corrections
Pay Deductions
Safety
Resident Professional Conduct and Work Rules
ID Badge Policy
Drug and Alcohol Use
Attendance and Punctuality
Personal Appearance
Return of Property
Exit Interview
65. Vendor Interactions
66. Medical Education and Licensure
CLINICAL GUIDELINES
69.
70.
71.
74.
74.
74.
75.
75.
75.
76.
77.
77.
78.
78.
78.
79.
79.
79.
80.
80.
82.
82.
83.
84.
84.
84.
Individual Responsibility
Ambulatory Care
Duty Hours
Emergency Room
Consultative Services
In-Patient Medical Services
Library Facilities
Laboratory Facilities
Medical Records
History and Physical
Problem List
Incident Reporting
Progress Notes
Diagnostic Procedures Documentation
Discharge Summary
Reimbursement Documentation
Electronic Medical Record
Delinquent Records
Order Writing
Sign Out Process
Rounds
Scheduling
Schedule Changes
Sick Call
Work Environment
Attending Physician Peer Review
INFORMATION AND INFORMATION TECHNOLOGY POLICIES
85. Digital Professionalism Policy for appropriate usage of the Internet, Electronic Networking and
other Media
86. Digital Media Policy
88. Professional Conduct and Information Technology
88. WCGME Electronic Access and Usage Policy
94. WCGME Social Media Policy
97. WCGME Information Technology Disaster Recovery and Data Backup Policy
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OSTEOPATHIC RESIDENCY ADDITIONAL GUIDELINES
101. Program specific considerations
102. Osteopathic Structural Exam form
103. AOA Code of Ethics
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The mission of the Wright Center for Graduate Medical Education is to provide
excellent graduate medical education in an innovative and collaborative spirit in order
to deliver high quality, evidence-based, and patient-centered care. It is our primary
goal to educate and prepare physicians for board eligibility in a variety of medical
disciplines through curricula, which reflect an appropriate balance of patient care,
education, and research.
Linda Thomas, M.D.
President & CEO
The Wright Center for Graduate Medical Education
Randall Brundage, D.O.
Chairman
The Wright Center for Graduate Medical Education
Marlene M. Karam
DIO
The Wright Center for Graduate Medical Education
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LETTER FROM THE PRESIDENT & CEO
Welcome New Residents!
On behalf of your colleagues, and the faculty, I welcome you to WCGME and wish you every success as you
proceed through your training.
We believe that each resident contributes directly to WCGME's growth and success, and we hope you will take
pride in being a member of our team. Your continued professional development in becoming the best doctor you
can be is our highest priority. We want your training with us to be as formative, valuable and memorable as
possible. We welcome our trainees’ perspectives and talents, and look forward to your contributions to
WCGME’s programmatic development and future accomplishments.
This manual was developed to describe some of what we expect of our residents and to outline the policies,
programs, and benefits available to eligible residents. Residents should familiarize themselves with the contents
of this manual as soon as possible. It will answer many questions about employment with WCGME.
We hope that your experience here will be challenging, enjoyable, and rewarding. Again, welcome!
Linda Thomas, M.D.
President & CEO
The Wright Center for Graduate Medical Education
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LETTER FROM THE DIRECTORS OF OSTEOPATHIC MEDICAL EDUCATION
The faculty, local physicians and residents welcome you to the Wright Center for Graduate Medical
Education for your Osteopathic Residency.
You will have both inpatient and outpatient experience integrating osteopathic practices and principles into
your medical armamentarium to improve patient care. There is an excellent mix of osteopathic and
allopathic health care providers who can teach you to focus on all aspects of patient care integrating the
core competencies necessary to become a proficient and caring osteopathic physician.
There are multiple formal educational opportunities (from morning report to formal case presentations and
lectures) to enhance your medical knowledge. Osteopathic practices and principles are formally presented
and web based osteopathic modules are available for further education.
We feel that the tradition of being taught and teaching others is necessary to our learning. At the WCGME,
the learning never stops.
Once again, welcome and we look forward to an exciting productive year!
Sincerely,
Michael Kondash, D.O.
Director of Medical Education
The Wright Center for Graduate Medical Education
Lisa Watts, D.O.
Director of Medical Education
The Wright Center for Graduate Medical Education Teaching Health Center Consortium
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PROFESSIONAL GUIDELINES
Resident professional responsibilities fall into two major categories:
PATIENT CARE, AND EDUCATION. In the clinical setting, these two areas are inseparable and
excellence in clinical care will result in a superior educational experience. Personal pride in the
performance of responsibilities is the keystone of professional excellence. Although some specific
responsibilities of various individuals (student, resident, attending physician) are clearly designated, patient
care and education should be viewed as a team effort.
Attendance at conferences is expected of all residents and attending physicians. These sessions are
designed to improve the clinical and scientific knowledge upon which we base our judgment and decision
making in the care of our patients. Conferences are designed to help us reflect on our clinical
responsibilities and to expand our knowledge to solve clinical problems.
We strive to provide the finest patient care and educational experience. We require a dedication to
excellence of students, residents and attending physicians.
Resident Physicians will be guided by the Medical Staff Bylaws and Rules and Regulations the partnering
hospitals. These are kept on file in the respective Medical Staff Offices. Appropriate portions of these
Bylaws and Rules and Regulations have been incorporated into this manual and familiarity with the bylaws
is required for each resident.
GENERAL INFORMATION
DRESS:
All residents are expected to have a neat, professional appearance. Impeccable
personal hygiene and grooming are to be closely observed. Scrub suits
should be worn only in the emergency room, intensive care unit and during night
call. Respectable business attire under a clean white coat will be worn at all other
times. A shirt and tie would be appropriate for gentlemen. Your Wright Center
badge is to be worn at all times during duty periods.
WORK WEEK:
Residents will work a maximum of 80 hours per week, averaged over a four
week period. All applicable duty hour requirements are strictly adhered to.
ILLNESS:
Kindly refer to the WCGME Sick Call Policy in the Policies Section of this
manual.
RELATIONSHIPS
WITH HEALTH
PROFESSIONALS: Respect a n d p o l i t e t r e a t m e n t o f all members of the patient care team are
essential. Undue familiarity, inappropriate levity in patient care areas, particularly
in the intensive care unit, is discouraged.
MALPRACTICE
WCGME provides malpractice insurance to its residents which covers residency
program mandated training at all participating sites.
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ACADEMIC AND INSTITUTIONAL POLICIES
GOVERNING RESIDENCY EDUCATION
RESIDENCY EDUCATION
Residency is an integral component of the formal education of physicians. In order to practice medicine
independently, physicians must receive a medical degree and complete a supervised period of residency
training in a specialty area. To meet their educational goals, resident physicians must participate actively in
the care of patients and must assume progressively more responsibility for that care as they advance
through their training. In supervising resident education, faculty must ensure that trainees acquire the
knowledge and special skills of their respective disciplines while adhering to the highest standards of
quality and safety in the delivery of patient care services. In addition, faculty are charged with nurturing
those values and behaviors that strengthen the doctor-patient relationship and that sustain the profession of
medicine as an ethical enterprise.
CORE TENETS OF RESIDENCY EDUCATION
Excellence in Medical Education
Institutional sponsors of residency programs and program faculty must be committed to maintaining high
standards of educational quality. Resident physicians are first and foremost learners. Accordingly, a
resident's educational needs should be the primary determinant of any assigned patient care services.
Residents must, however, remain mindful of their oath as physicians and recognize that their
responsibilities to their patients always take priority over purely educational considerations.
Highest Quality Patient Care and Safety
Preparing future physicians to meet patients' expectations for optimal care requires that they learn in
clinical settings epitomizing the highest standards of medical practice. Indeed, the primary obligation of
institutions and individuals providing resident education is the provision of high quality, safe patient care.
By allowing resident physicians to participate in the care of their patients, faculty accept an obligation to
ensure high quality medical care in all learning environments.
Respect for Residents' Well-Being
Fundamental to the ethic of medicine is respect for every individual. In keeping with their status as
trainees, resident physicians are especially vulnerable and their well-being must be accorded the highest
priority. Given the uncommon stresses inherent in fulfilling the demands of their training program,
residents must be allowed sufficient opportunities to meet personal and family obligations, to pursue
recreational activities, and to obtain adequate rest.
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CORE COMPETENCIES
Kindly refer to the WCGME website for detailed Competency Based Curricula. The following is a
summary of the competencies:
1. PATIENT CARE
Residents must be able to provide patient centered care that is compassionate, appropriate and
effective for the treatment of health problems and the promotion of health.
Competency: Demonstrate caring, respectful and effective communication skills when interacting
with patients and families.
Knowledge/Skills/Attitudes Objectives:
Interact in a culturally sensitive manner with all patients regardless of their socio-economic
or insurance status.
Demonstrate the ability to translate complex medical jargon to a level that the patient and his /
her caretaker can understand.
Demonstrate respectful recognition of patient capabilities, limitations and preferences.
Competency: Gather essential and accurate information about the patient.
Knowledge/Skills/Attitudes Objectives:
Obtain an accurate comprehensive history from the patient.
Access additional sources of information from family, caretakers, witnesses and
previous medical encounters.
Convey value of the caretaker’s opinions regarding the patient’s health and illness.
Perform a detailed and accurate physical examination.
Competency: Formulate diagnostic and therapeutic interventions based on patient information
and preferences, current scientific evidence and clinical judgment.
Knowledge/Skills/Attitudes Objectives:
Formulate and prioritize a differential diagnosis.
Recognize patients’ comprehension and anxiety about their illness as well as their discomfort and
financial stress related to testing.
Obtain and interpret appropriate laboratory and radiological studies after the patient
provides informed consent.
Utilize data obtained to formulate diagnoses and synthesize an evidence-based management plan
that is optimized by active patient participation.
Recognize personal limitations and seek help aptly.
Utilize subspecialty consultation appropriately.
Demonstrate responsibility and accountability for decisions.
Competency: Develop and implement patient management plans that actively engage the patient.
Knowledge/Skills/Attitudes Objectives:
Educate patients and families regarding diagnoses, available therapies and the entailed risks and
benefits.
Create a management plan that encompasses patient and caretaker capabilities and preferences.
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Ensure patient and caregiver comprehension of the management plan.
Provide written discharge instructions that the patient / caretaker can clearly comprehend.
Competency: Counsel and educate patients and families.
Knowledge/Skills/Attitudes Objectives:
Empower patients and families to make educated decisions by providing accurate, up to
date Information.
Utilize nutritional, rehabilitative and other ancillary personnel to extend patient education.
Provide both good and bad news in a professional and empathetic manner.
Recognize patient and family emotional response and connect them to the appropriate
psychosocial resources.
Competency: Use information technology to optimize patient care.
Knowledge/Skills/Attitudes Objectives:
Access and update Electronic Medical Records as a data gathering resource.
Use information technology tools to optimize patient care and minimize complications.
Review clinical standards of care and evidence based medicine routinely to enhance patient
care.
Competency: Perform competently appropriate medical and invasive procedures.
Knowledge/Skills/Attitudes Objectives:
Know the indications, potential complications and alternatives for a given procedure.
Explain the procedure and the entailed risks and benefits to the patient and caretaker in a language
that is appropriate to their educational, developmental, and emotional status.
Ensure adequate supervision and patient comfort while performing the procedure.
Demonstrate and document proficiency in the required procedures.
Competency: Promote health maintenance and disease prevention.
Knowledge/Skills/Attitudes Benchmarks:
Provide anticipatory guidance and promote standard health maintenance based on age, gender
and risk factors.
Inform the patient about the indications, potential complications and possible outcomes
including incidental findings of recommended screening tests.
Promote routine vaccination based on standard recommendations.
Access and maintain health maintenance records as a routine aspect of patient care.
Competency: Work with other health professionals to provide patient focused care.
Knowledge/Skills/Attitudes Objectives:
Participate in inter-disciplinary teams to optimize patient care and education.
Recognize the value and promote comprehensive in-patient sign-outs.
Encourage communication intra-professionally with involved sub-specialists.
Educate and connect patient to appropriate community resources.
Transfer information to other providers when appropriate.
2. MEDICAL KNOWLEDGE
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and
cognate (e.g. epidemiological and social behavioral) sciences and the application of this knowledge to
patient care and the education of others.
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Competency: Demonstrate an investigatory and analytic approach to clinical situations.
Knowledge/Skills/Attitudes /Objectives:
Ask relevant clinical questions and utilize information resources aptly.
Utilize consultations appropriately and eagerly engage consultants in mutual education
about standard and up to date medical practice issues.
Apply an open-minded, analytical approach to acquiring new knowledge by utilizing evidencebased medicine skills and critically evaluating current medical information.
Apply knowledge acquired effectively to the care of patients.
Work actively with faculty preceptors at the beginning of rotations to identify prescribed as well
as individual learning objectives.
Demonstrate commitment to lifelong learning by implementing strategies to increase
knowledge based on self assessment, faculty and peer feedback and performance on written
exams.
Utilize basic quality methods, such as root cause analysis, to assess sub-optimal patient outcomes
and their precipitants within the current healthcare system.
Competency: Know, apply and teach the basic and clinically supportive sciences
which are appropriate to family medicine.
Knowledge/ Skills/Attitudes /Objectives:
Develop informatics skills that foster the maintenance of a fundamental, current knowledge base
for the practice of medicine.
Remain current with new developments in medicine and the standard recommendations for quality
care defined by large national professional organizations.
Seek up to date medical information to augment one’s knowledge base and support clinical
problem solving and decision making.
Attend and participate in all required conferences on a regular basis.
Communicate actively with specialists and other professionals to maintain a fundamental
knowledge of their skills / abilities to enhance patient care.
Optimize clinical decision making by considering current scientific information, risk / benefits,
potential clinical outcomes, cost-effectiveness and patient preference of available tests and
therapies.
Demonstrate commitment to life-long learning.
Participate in programmatic and self directed education of peers, medical students, other healthcare
professionals and patients.
3. PRACTICE-BASED LEARNING AND IMPROVEMENT
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence, and improve their patient care practices.
Competency: Analyze practice experience and perform practice based
improvement activities using a systematic methodology.
Knowledge/Skills/Attitudes Objectives:
Identify areas for improvement in the quality of patient care and implement strategies to
augment one’s knowledge base, procedural skills and decision making skills on a continuous
basis.
Maintain and develop a desire to learn from sub-optimal outcomes and errors and to use these
experiences to improve the system and processes of care.
Familiarize with the process of population management and practice assessment.
Utilize the necessary resources to complete the process of practice improvement including relevant
medical literature, informatics and necessary personnel.
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Learn and apply basic quality techniques of root cause analysis and rapid cycle change as a
member of a multidisciplinary team.
Competency: Locate, appraise and assimilate evidence from scientific studies
related to their patients’ health problems.
Knowledge/Skills/Attitudes Objectives:
Learn the principles of evidence-based medicine and basic biostatistics.
Access search engines to effectively explore the available literature.
Incorporate evidence-based medicine into daily practice to optimize patient care.
Disseminate educational material to promote patient education as the foundation for compliance with
disease management and prevention.
Develop a foundation of informatics skills to filter the medical literature and keep current with
standards of care.
Competency: Obtain and use information about their own population of patients and the larger
population from which the patients are drawn.
Knowledge/Skills/Attitudes Objectives:
Learn the epidemiology of common diseases in the regional population including incidence,
prevalence, risk factors and availability and utilization of resources.
Apply epidemiologic information to improve health maintenance and disease management.
Competency: Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness.
Knowledge/Skills/Attitudes Objectives:
Appraise the literature on selected topics utilizing basic biostatistics and principles of evidencebased medicine.
Prepare and participate in Journal Club.
Complete a scholarly activity in accordance with WCGME curricular requirements utilizing
informatics skills and faculty support.
Competency: Use information technology to manage information, access on-line medical
information and support their own education.
Knowledge/Skills/Attitudes Objectives:
Familiarize with practice management reports provided by payors and with the process of pay for
performance.
Access the current EMR system to generate practice performance reports to assess quality.
Explore insurance based websites including CMS for available disease management resources and
practice management / reimbursement guidelines.
Seek opportunities to employ on line resources to maintain a current knowledge base, current CME
certification and board certification status.
Competency: Facilitate the learning of students and other health care professionals.
Knowledge/Skills/Attitudes Objectives:
Assess and address the educational needs and objectives of other members of the healthcare
team.
Engage others including students, colleagues and patients in bi-directional learning.
Explore and employ the principles of adult learning to optimize education as a team leader.
Provide constructive feedback to students and colleagues and to listen as they reciprocate.
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4. INTERPERSONAL SKILLS AND COMMUNICATION
Residents must be able to demonstrate interpersonal and communication skills that result in
effective information exchange and teaming with patients, their patients’ families, and
professional associates.
Competency: Create and sustain a therapeutic and ethically sound relationship with
patients.
Knowledge/Skills/Attitudes Objectives:
Establish and maintain open lines of communication with patients and their families.
Demonstrate HIPAA compliance while dealing with families and friends.
Empower patients to make knowledgeable decisions through effective education.
Demonstrate value and compassion for patient preferences.
Interact respectfully with difficult patients.
Maintain a therapeutic relationship with patients over time.
Competency: Use effective listening skills and elicit and provide information using effective
non-verbal, explanatory, questioning and writing skill.
Knowledge/Skills/Attitudes Objectives:
Identify members of the health care team and explain their roles appropriately.
Communicate with patient / caregiver in suitable, private settings.
Elicit initial and interval histories from patients using effective verbal and non-verbal techniques.
Provide verbal and written education keeping in mind the developmental and educational level of
the patient and caregiver.
Maintain legible, accurate, timely documentation and comply with EMR templates.
Competency: Work effectively with others as a member or leader of a health care team or other
professional group.
Knowledge/Skills/Attitudes Objectives:
Learn the names and roles of health care team members.
Identify educational goals and objectives for team members when acting as the team leader.
Facilitate team communication.
Promote constructive reciprocal feedback amongst team members.
Provide and obtain effective professional consultation to optimize patient care.
Ensure seamless patient care by promoting effective communication across professions and
systems of care.
5. PROFESSIONALISM
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population.
Competency: Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the profession; and a
commitment to excellence and on- going professional development.
Knowledge/Skills/Attitudes Objectives:
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Demonstrate honesty, integrity and reliability consistently.
Seek, honor and complete assigned duties.
Exhibit respect, compassion, and empathy in all interactions.
Display self-awareness, recognize limitations, seek appropriate assistance and strive for self
improvement.
Demonstrate commitment to lifelong learning including regular attendance at conferences and
reading medical literature.
Respond positively to constructive criticism.
Acknowledge error, demonstrate accountability and strive for system improvement and error
prevention.
Inspire accountability in others by promoting peer review in a blameless environment.
Dress and behave appropriately.
Validate the significant role physicians play in society.
Competency: Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices.
Knowledge/Skills/Attitudes Objectives:
Recognize ethical dilemmas and consult with the hospital’s ethics committee appropriately.
Adhere to the primacies of confidentiality, scientific integrity, and informed consent.
Recognize the situational need for determining competence and healthcare proxies.
Address end-of-life issues in a timely and compassionate manner.
Engage in ethical business practices.
Interact with the pharmaceutical industry in a professional and principled manner.
Competency: Demonstrate sensitivity and responsiveness to patients and colleagues’ culture, age,
gender, race, religion, and sexual preferences.
Knowledge/Skills/Attitudes Objectives:
Recognize the impact of culture, experience, age, gender, and disability on patient perceptions,
preferences, compliance, and outcomes.
Display sensitivity to the significant interplay of issues related to cultural beliefs,
socioeconomic status and health literacy and how they relate to patients’ utilization and
compliance.
6. SYSTEMS-BASED PRACTICE
Residents must demonstrate an awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to provide care that is of optimal
value.
Competency: Understand how their patient care and other professional practices affect other
healthcare professionals, the healthcare organizations and the larger society and how these elements
affect their practice.
Knowledge/Skills/Attitudes Objectives:
Optimize interaction and communication with other health-care professionals, healthcare organizations and community resources to promote quality patient care.
Participate actively in quality initiatives undertaken by health care organizations.
Optimize patient length of stay in acute care facilities by promoting appropriate transition to
ancillary levels of care.
Promote medication reconciliation across levels and systems of care.
Familiarize with the epidemiology of major health issues in the local community.
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Understand how the local community demographics and socio-cultural beliefs affect health
and disease.
Competency: Know how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources.
Knowledge /Skills/Attitudes Objectives:
Understand the fundamental differences between the various insurance plans including local PPOs
and HMOs, fee-for-service, Medicare, and state Medical Assistance.
Recognize the guidelines determining provider and institutional reimbursement including fee-forservice, capitation, etc.
Document appropriately for different levels of care.
Become familiar with various formulary guidelines and pre-certification requirements.
Competency: Practice cost-effective health care and resource allocation that does not compromise
quality of care.
Knowledge/Skills/Attitudes Objectives:
Recognize resource limitation within the regional and global health care systems.
Practice cost-effective medical care by considering cost / benefit analyses in all diagnostic and
therapeutic decisions.
Identify factors that contribute to rising health care costs and strive to contain costs by optimizing
formulary compliance and avoiding unnecessary testing.
Practice cost-effective patient care by optimizing length of stay in acute care facilities and
promoting transition to sub-acute levels of care appropriately.
Competency: Advocate for quality patient care and assist patients in dealing with system
complexities.
Knowledge/Skills/Attitudes Objectives:
Minimize perceived conflicts of interest between individual patients and their health care
organizations through patient education.
Recognize true conflict of interest between individual patients and their health care organizations
and always advocate actively on the patient’s behalf.
Competency: Partner with health care managers and health care providers to assess, coordinate,
and improve health care and know how these activities can affect system performance.
Knowledge /Skills/Attitudes Objectives:
Identify and work with other health care professionals and organizations to optimize patientcentered care.
Connect patients with established disease management programs offered through their insurances or
local institutions.
Utilize practice performance data to sharpen population management skills and understand how that
improves global system performance.
OSTEOPATHIC PHILOSOPHY AND MANIPULATIVE MEDICINE (For DO’s only)
Residents must demonstrate and apply knowledge of accepted standards in Osteopathic Manipulative
Treatment (OMT) appropriate to their program. The educational goal is to train a skilled and
competent osteopathic practitioner who remains dedicated to life-long learning and t o practice habits
in osteopathic philosophy and manipulative medicine.
Competency: Demonstrate competency in his / her understanding and application
of OMT
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Knowledge/Skills/Attitudes /Objectives:
Participate actively in OMT training opportunities both in the in-patient and out-patient settings.
Review major osteopathic journals on a regular basis.
Perform a critical appraisal of medical literature related to OMT.
Be observed and evaluated in the performance of OMT through the assessment of his / her
diagnostic skills, medical knowledge, and problem solving abilities.
Competency: Integrate Osteopathic concepts and OMT into the medical care he / she provided to
patients as appropriate.
Knowledge/ Skills/Attitudes /Objectives:
Assume increased responsibility for the performance and incorporation of OMT in patient
management.
Document OMT timely and comprehensively.
Promote OMT educational endeavors amongst peers and students.
Participate in CME programs provided by AOA and the specialty colleges.
Seek constructive feedback from osteopathic attendings.
Competency: Understand and integrate Osteopathic principles and philosophy into all clinical and
patient care activities.
Knowledge/ Skills/Attitudes /Objectives:
Utilize caring compassionate behavior with patients.
Demonstrate the treatment of people rather than the symptoms.
Demonstrate understanding of somato-visceral relationships and the role of the musculoskeletal
system in disease.
Demonstrate listening skills in interaction with patients.
Demonstrate knowledge of and behavior in accordance with the osteopathic oath and AOA code of
ethics.
COMPETENCY BASED PROGRESSIVE LEARING OBJECTIVES
Progressive Learning Objectives
Kindly refer to the WCGME website for detailed Competency Based Curricula. The following is just a
summary of the Progressive Learning Objectives:
Patient Care
PGY-1
1. Perform a thorough history and physical examination
2. Synthesize data into a problem list and differential diagnosis
3. Recognize psychosocial issues that may effect patient compliance and outcomes
4. Formulate a diagnostic and therapeutic plan with some supervision
5. Optimize patient care plans by routine use of Up-to-date
6. Demonstrate humanistic and professional behavior in patient, peer and staff interactions
7. Accept personal responsibility to follow-up on patient care plans and test results
8. Respond in person to nursing calls on patient issues and document problems, assessment and plans
of care
9. Apply preventive care in an outpatient setting and recognize overdue preventative care needs in
inpatients and the need for follow-up
10. .Perform the majority of procedures required by ABIM
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Assessment: mini-CEX, monthly evaluations, patient surveys, record review, procedure log
PGY-2
1. Coordinate patient care among all members of the health care team
2. Establish and identify oneself as a responsible and responsive team leader
3. Review the residents’ history, physical exam and assessment
4. Formulate therapeutic and diagnostic plan independently
5. Use information technology to support patient care decisions
6. Counsel and educate patients and families
7. Engage the patient in management plans and address noncompliance
8. Develop skills for end of life and palliative care discussions and planning
9. Promote seamless patient care by optimizing discharge planning and follow-up
10. Perform and supervise procedures required by ABIM
Assessment: monthly evaluations, patient and peer surveys, procedure logs
PGY-3
1. Efficiently evaluate and manage patients in the inpatient and outpatient setting at the level of a
general internist
2. Function competently as an family medicine consultant
3. Coordinate patient care among all members of the healthcare team and demonstrate leadership skills
to promote multidisciplinary management for optimal patient outcomes
4. Demonstrate effective ability to lead end of life and palliative care discussions planning
5. Perform and supervise every procedure required by ABIM achieving full competence in all
Assessment: monthly evaluations, patient/peer/nurse surveys, procedure logs
Medical Knowledge
PGY-1
1. Describe basic pathophysiology for common conditions
2. Develop basic knowledge base for common inpatient and outpatient conditions
3. Demonstrate commitment to continued knowledge accrual
4. Utilize Up to Date routinely on a patient basis
5. Develop skills for effective review of the medical literature
6. Follow-up on questions regarding optimal, evidence based patient care
7. Develop skills for effective case presentation and discussion of optimizing
medical care for common medical diseases
Assessment: In Training examination, monthly evaluations, conference attendance log, evaluation of
conference presentation
PGY-2
1. Demonstrate in-depth pathophysiology for common conditions
2. Demonstrate knowledge of medical literature analysis
3. Demonstrate informatics skills to promote evidence based medicine and quality care application
4. Develop filter skills for keeping up with medical discovery and evolution of evidence based
medicine guidelines and standards of care
5. Review MKSAP on a regular basis
6. Solidify knowledge base by educating others
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Assessment: In Training examination, monthly evaluations, conference attendance log, conference
presentation evaluation, chart reviews
PGY-3
1. Demonstrate in-depth pathophysiology for common and uncommon conditions
2. Apply critical reading skills to current literature
3. Commit to intensive subspecialty medical review while on elective rotation
4. Read and review key journal publications on a regular basis
5. Demonstrate a systematic approach to acquiring and maintaining current medical knowledge
6. Complete and present a comprehensive literature review for a senior project of the resident’s choice
7. Engage in scholarly activity and available research
Assessment: In Training examination, monthly evaluations, completion of portfolio, scholarly activity,
conference attendance log, conference presentation evaluation, senior project evaluation, chart reviews
Practice-Based Learning and Improvement
PGY-1
1. Keep a checklist of patient care needs from rounds and assume responsibility
2. Ask for help when needed
3. Seek and accept feedback
4. Participate in quality improvement activities and root cause analysis
5. Demonstrate continual improvement in clinical management and knowledge
6. Teach students effectively
7. Use Up-to-date regularly
8. Focus on improving medical knowledge deficits as demonstrated on the In Training exam and
global rotation evaluations. Assume responsibility to “patch the gaps” in one’s knowledge base and
skills
Assessment: monthly evaluations, conference attendance log, semi-annual self assessment in the
competencies with comparison to actual performance assessment by others
PGY-2
1. Encourage intern requests for help and respond in a timely and patient centered fashion
2. Teach students, residents and peers effectively
3. Use patient care errors and near-misses to teach students, residents and peers
4. Promote continuous quality improvement with root cause analysis
5. Use information technology such as PubMed or Ovid to enhance patient care
Assessment: monthly evaluations, peer evaluations, Semi-annual self assessment in the competencies
with comparison to actual performance assessment by others
PGY-3
1. Teach residents, students, and other residents effectively
2. Analyze own practice for needed improvement
3. Complete a QA/QI project under faculty direction
Assessment: portfolio (scholarly activity, critical reading skills test, QA/QI Activity), monthly
evaluations, peer evaluations, semi-annual self assessment in the competencies with comparison to actual
performance assessment by others
Systems-Based Practice
18
PGY-1
1. Recognize the systematic complexities that affect patient outcomes
2. Demonstrate ability to effectively sign out with maintenance of quality sign out sheets
3. Function as a physician within a multidisciplinary team
4. Serve as a patient advocate in the outpatient and inpatient setting
5. Work with ancillary team members (discharge planners, case managers, and social workers) to
provide high quality, non-redundant and cost-effective care
6. Develop a working knowledge of various care systems and the most appropriate disposition for
certain patients dependent on patient needs and system allowances
Assessment: monthly evaluations, 360 degree evaluations, patient surveys
PGY-2
1. Direct care in inpatient and outpatient settings as a member of a multi-disciplinary team
2. Direct subspecialty, surgical, nutritional, podiatric and social service consultations
3. Demonstrate effective utilization of transitioning patients between systems of care for their benefit
4. Use systematic approaches to reduce errors and effectively transition patients between care settings
5. Strive to optimize patient follow-up by effective discharge planning
6. Promote medication reconciliation
Assessment: monthly evaluations, 360 degree evaluations, patient surveys
PGY-3
1. Demonstrate knowledge of types of medical practice and health delivery systems
2. Practice effective allocation of health care resources to avoid compromising quality of care. Reduce
unnecessary testing.
3. Demonstrate knowledge of business aspects of medical practice including coding and insurance
4. Recognize system deficiencies/complexities and strive for system improvement
Assessment: monthly evaluations, 360 degree evaluations, patient surveys, portfolio (QA/QI project)
Interpersonal Skills and Communication
PGY-1
1. Present a case accurately and succinctly on rounds
2. Later in the first year, with supervision, present a case accurately and succinctly while on call to
attendings
3. Provide timely, legible, thorough, succinct medical record documentation –
1. histories and physical examinations, progress notes, and discharge summaries
4. Document all clinical responses to patient care needs legibly in the chart
5. Work well within team context relating to students, attendings, other housestaff, nurses, and patients
6. Communicate and establish a therapeutic relationship with patients and families
7. Develop skills to address frustration with our current healthcare system, residency scheduling or
programmatic issues in a productive and constructive manner
Assessment: monthly evaluations (with chart audits), mini-CEX’s, 360 degree evaluations including
patient and student surveys
PGY-2
1. Provide timely, legible, thorough and succinct resident admit and progress notes
2. Work effectively as a leader of the health care team
3. Establish the hierarchy of communication for the service team for the month
4. Demonstrate effective listening skills and reliable responsiveness to the needs of students and
residents as well as the opinions and requests of multidisciplinary team members
5. Provide education and counseling to patients, families, and colleagues
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6. Demonstrate skill in delivering end-of-life counseling to patients
7. Communicate effectively with consultants and primary care doctors to coordinate patient care and
follow-up
8. Develop skills to address noncompliance and the frustrations of displeased patients
Assessment: monthly evaluations (with chart audits), 360 degree evaluations including patient, peer, nurse
and student surveys
PGY-3
1. Work effectively as a leader of the health care team including a team with potential dysfunction
2. Demonstrate skill in handling all difficult patient care situations
3. Promote involvement of necessary consultants, social services and patient advocacy teams
4. Communicate near misses or mismanagement issues with the healthcare providers involved in an
educational and blameless manner
5. Function effectively as a consultant for specialty and subspecialty care
6. Demonstrate the ability to provide documentation of IM consultation and appropriate level of
consultative billing
Assessment: monthly evalutions, 360 degree evaluations
Professionalism
PGY-1
1. Establish trust with patients and staff
2. Demonstrate respect, compassion, and integrity
3. Demonstrate punctuality, reliability, and honesty
4. Recognize self limitations and ask for help
5. Recognize personal strengths and offer help
6. Show regard for the opinions of others
7. Accept and seek out constructive criticism
8. Maintain patient confidentiality
9. Compassionately respond to issues of culture, age, gender, ethnicity, and disability in patient care
10. Complete medical record documentation in a timely fashion
11. Return student, peer and rotation evaluation in a timely fashion
12. Complete all necessary employee health mandates as directed
Assessment: monthly evaluations, 360 degree evaluations, mini-CEXs’
PGY-2
1. Display initiative and leadership
2. Demonstrate responsiveness to the needs of patients, residents and peers
3. Recognize the limitations and fears of residents and peers, offering help
4. Delegate responsibility to others effectively
5. Acknowledge errors and work to minimize them
6. Demonstrate commitment to life long learning and self-improvement
7. Commit and contribute to system improvement
8. Avoid engagement in non-constructive endeavors and lead positive system change
9. Promote professional accountability and enhance professional development and professionalism in
peers and other healthcare providers
Assessment: monthly evaluations, 360 degree evaluations
PGY-3
1. Demonstrate concern for educational development of students and residents
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2.
3.
4.
5.
Remain responsive to patients, students, residents and peers
Stay wholeheartedly involved in daily program activities
Volunteer for activities for the good of the institution and community
Assume professional responsibility for our healthcare system and demonstrate commitment to
system improvement
6. Demonstrate understanding of the ethical concerns about pharmaceutical and patient gifts
Assessment: monthly evaluations, 360 degree evaluations
DIDACTIC EDUCATION AND CONFERENCE STRUCTURE
A series of lectures and conferences is an essential component of the educational experience for residents
in our training program.
Each academic year begins with a series of daily lectures covering emergency situations residents are
likely to encounter and commonly seen cases throughout the year. This series lasts about 3 weeks and is
followed by a group of lectures that are part of a didactic curriculum. These lectures include a variety of
formats including case presentations, ambulatory lectures, hospital based grand rounds, subspecialty
lectures, morbidity and mortality conferences, EKG and radiology classes, and MkSAP review.
Additionally, an evidence-based medicine journal club and RICU (resident ICU course) are scheduled once
a month.
Research Conferences: This format includes curricular components including methods for analyzing,
interpreting, and presenting original data published in medical journals. These conferences involve detailed
discussion of a latest published study to enhance the research activities of the residents and better
understanding of the research methods.
Senior presentations: 3rd year residents present their project work or a specific topic including review of
latest trials on the subject in last 6 months of their training.
Didactic sessions: are done to enhance the educational activity of the residents.
RAP session: is done the last Friday of every block and is a forum in which residents and faculty meet
together and discuss resident problems and concerns.
Mortality and Morbidity conferences: Morbidity and mortality (M&M) conferences are considered to be
powerful opportunities for learning and reflection. Traditionally, the goal of M&M conferences is to
provide a forum for faculty and trainees to explore the management details of particular cases wherein
morbidity or mortality occurred. In carefully reviewing the records and specifics of care, a primary goal of
these sessions is to revisit errors to gain insight without blame or derision. A minimum of two M &M
conferences are required every 6 months.
Resident as Teachers Conference – (This conference is held annually in May)
Goals: To facilitate the transition of residents into the senior resident role emphasizing the development
of skills for team leadership, supervision of patient care, peer education and performance feedback, and
increased communication with the family and involved consultants.
Objectives:
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The development of teaching skills.
The ability to give effective formative feedback.
The role of mentoring and modeling professionalism.
The necessary components of leadership including emotional intelligence and sensitivity and selfawareness and self-regulation.
The enhancement of communication skills.
The development of system improvement skills.
How are residents assessed: Feedback is given by the program faculty to the resident participants as
part of the conference itself and continually in their future performance in the mentioned areas through
monthly rotational competency based 360 degree evaluations.
EVALUATION OF RESIDENTS
Evaluation is an essential vehicle to measure competency and an invaluable educational tool in providing
timely feedback to learners with regard to strengths, weaknesses, and program expectations. Such
information aids the faculty in directing its efforts toward program improvement and correction of
individual deficiencies.
Evaluations are completed online at www.myevaluations.com. You will receive information regarding
proper utilization of the software program during your orientation. In accordance with program guidelines,
the Wright Center for Graduate Medical Education has selected and assigned a set of competency and
timeline based evaluations for each level of training, and tools by which to measure each resident's
accomplishments in meeting these standards.
Supervision of the Evaluation Process
The evaluation of trainees occurs under the direction of the Program Directors and the
Clinical Competence Committee (Allopathic residents).
Attending's Evaluation: Each rotation, the attending physician is responsible for the completion of a detailed
evaluation form, observing the resident’s progress throughout the rotation. The purpose of this evaluation is
to assess how the resident functions within the expectations of each competency, including but not limited to
day-to-day care of patients, interpersonal relationships and the timely ability to learn new information.
Clinical Evaluation Exercise (CEX):
During each rotation, Residents and Residents will be evaluated by the faculty attending utilizing a number
of direct observation tools:
Resident Evaluations: After each rotation, the resident will complete an online evaluation form via
www.myevaluations.com. This evaluation is reviewed by the Program Director and referred for
implementation of corrective action as required. The senior and intern residents and attending physicians
will evaluate each other. The resident will also be evaluated by patients and other members of the
interdisciplinary healthcare team. All evaluations must be returned within 5 days of the allocation of the
evaluation.
Semi-annual Evaluation with Program Director: Residents are required to meet with the Program
Director or his/her delegate once every six months. The resident's file is reviewed and strengths,
22
weaknesses, and any personal or professional problems the resident may be encountering are discussed.
Allopathic semi-annual evaluations will have the oversight of the program’s Clinical Competence
Committee as well.




Each WCGME resident will be evaluated according to accrediting and certifying body
requirements on the basis of clinical judgment, knowledge, technical skills, humanistic qualities,
professional attitudes, behavior and overall ability to manage the care of a patient. The evaluation
will include assessment of the general competencies and resident progression through training.
Evaluations will occur as indicated by the accrediting or certifying body at the end of the resident's
rotation. All evaluations will be discussed with the resident at their mid-year and annual evaluation
with the Program Director.
If a resident’s performance or conduct is judged to be detrimental to the care of a patient(s) at any
time, action will be taken immediately to ensure the safety of the patient(s).
At the end of each rotation, each resident will be given the opportunity to complete a confidential
evaluation of their attending physicians. Such evaluations will include the adequacy of clinical
supervision by the attending physician. Semi-annually, the resident will be given the opportunity to
confidentially evaluate the overall quality of the program. The evaluations will be reviewed by the
Program Director electronically on www.MyEvaluations.com.
All electronic evaluations of WCGME residents and attending physicians are printed out and kept
in their individual files for the required time frame according to the guidelines established by
accrediting and certifying agencies.
MENTORSHIP PROGRAM
(9/12)
The Wright Center is pleased to introduce our Residents and Residents to our Residency
Mentorship Program. The main goal of the program is to help establish a learning/support relationship
between a faculty member and resident mentee in our program. The program promotes early career
planning and encourages exploration of different career paths during residency and is tailored to the
resident’s particular interests. In addition to career development, the mentorship program strives to
promote an improved sense of community within the Residency, providing residents with enthusiastic
faculty members for issues that arise both inside and outside the patient care setting.
You will be provided access to a faculty mentor, chosen for their connections with other faculty
and experts, their openness for guidance and support, and their natural ability for counseling - all atop their
participation in mentorship training. If appropriate, your mentor may facilitate a connection with another
trained professional possessing expertise relevant to your particular interests which pertain to the chosen
sub-specialty. Ideally, you and your mentor will create a long-term relationship to craft your professional
and educational plan to include experiences which support your goals.
Please know that the Mentor-Mentee relationship is meant to be one founded on mutual respect and
subjectivity, and is separate from the Attending-Resident relationship, which is grounded in an objective
learning environment. Although your mentor will have access to your patient care evaluations so as to
ensure there are no overarching issues where you may need additional guidance, he/she will not be
critiquing you in a learning capacity. No information will be documented from Mentor meetings without
23
disclosure and consent. Signatures are required from both Mentor and Mentee before submission of
evaluations.
The Wright Center executive team and faculty are committed to supporting your three postgraduate years to ensure you fulfill your professional and personal potential. As a resident in training, you
are strongly encouraged to proactively seek out your mentor as often as needed. The Mentorship Program
is consistently evolving and is a valuable opportunity for connecting you to experts to assist you in
developing and attaining your goals. To this end, in the near future you will receive audio/visual and
reading media for you to understand the best ways to work with your mentor and the overall process for
professional success.
MISSION
The mission of the Wright Center Residency Mentorship Program is to provide our residents with the
opportunity to forge a sacred and long-standing relationship with a faculty member who can be considered
both a personal ally and source of professional support. While mentors are to be entirely accessible as often
as needed, individualized meetings are intended to reflect the dynamic of mutual respect and genuine
program outcomes from an objective standing.
OBJECTIVES
I.
To provide support and guidance to Residents/Mentees in the following areas:
 Rotation Performance
 Individualized Learning Plan
 Career Goals
 Preparation for Board Exam
 Stress/Personal Issues
II.
III.
IV.
I.
II.
To provide feedback to the mentee when issues of concern arise during their training
To provide advocacy for the mentee when issues of concern arise during their training
To provide a source of networking and support in the form of recommendation letters to be used in the
mentee’s pursuit of career goals
TOOLS
Mentorship Progress Report
Educational Portfolio: Facilitate professional development and self-assessment; provide evidence of
self-directed learning, progress and support of promotion; and document educational experiences and
performance.
 Previous mentor evaluation reports
 In-Training Exam scores (ITE): report, flow sheet, remediation documentation
 Evaluations: failures, status of evaluations, concern cards, praise cards
 Procedures log signed by resident and attending physician
 Professionalism: curriculum assignments and administrative paperwork status
 Presentations
III.
Other – Letters of Recommendation, committee appointments, remediation documentation,
commendations, publications.
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PROCEDURE
General Guidelines
I.
II.
Incoming residents/mentees choose their mentors based upon availability by October 1, or a mentor
will be chosen for them.
Mentors and mentees will receive meeting guidelines at the beginning of each academic year. A
workshop will be offered to review protocol and portfolio items for faculty at a Coordinator’s
Meeting venue and for the residents in the form of a RAP Session.
The monitoring of these meetings will be done by the Program Director via review of the
Mentorship Progress Report.
Serious concerns that arise during these meetings should be brought to the attention of the Focused
Assessment Committee at the monthly meeting.
Evaluation form will be free text with guidelines to focus discussion.
III.
IV.
V.
Mentor Responsibilities
I.
II.
III.
IV.
V.
Faculty are required to participate in the program.
Mentors review the resident’s educational portfolio with the resident at these meetings.
Mentors use the agenda completed by the mentee via their MyEvaluations portfolio prior to the
meeting as a guide for the issues that should be discussed at semi-annual sessions.
The mentor completes the meeting evaluation form to document these meetings. Once completed, this
form is reviewed by the mentee. Both mentor and mentee electronically sign the form before
submitting it to the MyEvaluations system.
Mentors should direct mentees to other resources that are specific to their career goals (i.e. fellowship)
as early as possible in their training for additional support and guidance in that area.
Mentee Responsibilities
I.
II.
III.
IV.
V.
Residents/mentees have the option to change their mentor at any point during the academic year if
serious conflict is a deterrent to an optimal relationship.
During the first three months of the academic year before mentors are chosen, residents should seek out
their chief residents with any concerns or issues.
Where concerns have been raised, a resident should meet with their mentor at minimum every month
until these concerns are resolved to the satisfaction of the Focused Assessment Committee.
It is the mentee’s responsibility to facilitate meetings. Reminders will be sent via e-mail from the GME
Administrative Assistant on a semi-annual basis.
Prior to scheduled meetings, it is the mentee’s responsibility to submit an agenda via their
MyEvaluations Educational Portfolio at least 24 hours in advance.
SPECIAL ISSUES
I.
If serious concerns regarding a resident arise, a failing progress report is submitted by his/her mentor.
 Those documents should be forwarded to the Program Director (PD), Associate Program
Director (APD) and Chief Resident (CR).
 Similarly, phone calls from the mentor raising the concern should be directed to the PD,
APD or CR.
25


The mentor then schedules a meeting with the mentee to specifically discuss the concern.
This meeting should be formally documented and forwarded to the PD, APD and CR to be
reviewed and filed in the trainee’s Educational Portfolio.
A mentor may bring the resident to the attention of the PD or APD who will review the case
and suggest review by the Focused Assessment Committee.
II.
If lapses in Professionalism occur, documentation of these incidents is sent to the APD to be placed in
the resident’s portfolio. The resident’s mentor will discuss these incidents with the resident at their
Mentorship meetings. The Program Director will also meet with the resident if the severity and
frequency of these incidents warrants a meeting.
 These meetings will be appropriately reported to program administration with full
disclosure to trainee for the purpose of formative/constructive improvement planning.
III.
A mentor will be called upon to advocate for their mentee if resolution of concerns do not occur and
the mentee is brought before committee as dictated by the Disciplinary Procedure in the WCGME
Housestaff Policy Manual. A mentor will be asked to attend Focused Assessment Committee meetings
if their mentee is to be discussed.
PROCEDURES AND DOCUMENTATION – INTERNAL MEDICNE (6/28/2012)
In order to graduate, each Wright Center IM Resident is required to complete the following with regard to
procedures:
Instructional Videos (46 modules) for procedures at www.proceduresconsult.com/scrantontemple
(includes testing, competency tracking and reporting). Your login for proceduresconsult.com will consist
of your (username): your Wright Center email address, and (password): hello1
These videos and the accompanying tests are to be completed in the following order:
PGY I – 7 by mid year
15 by end of year
PGY 2 – 22 by mid year
30 by end of year
PGY 3 – 38 by mid year
46 by end of year
In order to graduate, Residents must be certified in program specific procedures.
All procedures performed in the clinical setting are to be documented in Resident Procedure Log books.
As documented, these are to be signed by an attending physician. All procedures are to be logged into the
procedures section of www.myevaluations.com.
It is important for your certification of competency in these procedures be recorded and signed off by the
supervising attending in the procedure log page of www.myevaluations.com.
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PROCEDURES AND DOCUMENTATION REQUIREMENTS – FAMILY MEDICINE
Competency must be demonstrated prior to graduation.
In order to graduate, Residents must be certified in program specific procedures.
It is important for your certification of competency in these procedures be recorded and signed off by the
supervising attending in the procedure log page of www.myevaluations.com.
PROCEDURES:
SKIN





LOCAL ANESTHESIA INJECTION
EXCISIONS
SUTURING
ABCESS I & D
PUNCH BIOPSY
OB/GYN
 PAP
 SVD
 MANAGEMENT OF NL L & D
 KOH/WET PREP
 PIT AUG/INDUC
MUSCULOSKELETAL
 SPLINTING
 JOINT INJECTIONS
OTHER
 ACLS
 NEONATAL RESUSCITATION (NALS)
 PALS
 INSERTION OF URETHERAL CATHETER
 CIRCUMCISION
 ENDOTRACHEAL INTUBATION
 OFFICE SPIROMETRY
 EKG INTERPRETATION
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REQUIREMENTS FOR RESEARCH AND SCHOLARLY ACTIVITY
POLICY:
In accordance with ACGME and AOA guidelines for Residency Programs, residents must engage in
research and scholarly activity. The Wright Center adheres to the definition of scholarship as
encompassing any and all of the following:




Discovery, as evidenced by peer-reviewed funding or publication of original research in peer
reviewed journals.
Dissemination, as evidenced by review articles or chapters in textbooks.
Application, as evidenced by the publication or presentation at local, regional, or national
professional and scientific society meetings, for example, case reports or clinical series.
Active Participation in clinical discussions, rounds, journal club, and research conferences in a
manner that promotes a spirit of inquiry and scholarship.
The Wright Center’s scholarly activity goals strongly align with Graduate Medical Education’s six
required competencies.
We guide and generously support our residents and residents through a research curriculum which is
designed with four of the basic competencies in mind: medical knowledge; practice-based learning and
improvement; interpersonal and communication skills; and systems-based practice. By providing our
students with the skills necessary to address their interests, we encourage and focus curiosity in such a way
that by graduation each has demonstrated proficiency in bringing quality improvement evidence to
practice-based learning. This is accomplished by completing a research-based quality improvement project
that has application in systems-based practice. A fifth competency, professionalism, results from our
approach to research. Our students acquire the skills needed to contribute to the literature and thereby
come to appreciate its intrinsic value, in practice, to quality of care. By teaching the skills necessary for
research, we shape curiosity into an appreciation for life-long learning.
Please especially note the “outcomes” detailed in our research curriculum which is detailed below.
Residents will fulfill their required scholarly activity by participating in the following specific
programmatic requirements for research and scholarship. In order to maintain compliance,
programmatic documentation requirements must be closely adhered to:
Active attendance and participation in academic discussions in the clinical and conference setting are
required of all Residents.
All conference attendance will be documented with the MyEvaluations System, therefore it is an important
responsibility of each Resident to assure that their conference attendance is properly recorded. Late arrival
at conference will be considered an absence. Specific guidelines must be followed to be excused from
conference.
28
Specific research and scholarly activity requirements by year of training are as follows:
YEAR 1: A CASE REPORT
The Resident will compose an abstract concerning a case. Once carefully prepared, the abstract should be
submitted to the appropriate faculty member for review, comments and possible revision. When complete
submit abstract to ACP for presentation.
OBJECTIVE(S):



Learn to review the literature to assess case significance;
Learn to review standards of care to determine how your care compares;
Learn to compose a clinically significant and professionally acceptable case report abstract.
OUTCOME(S):



Abstract composition
Posters
ACP exposure
DOCUMENTATION: Residents MUST submit a digital copy of their abstract to the GME Coordinator.
Residents must also assure proper documentation of their scholarly activity in their individual
MyEvaluations System Portfolio.
YEAR 2: A REFLECTIVE PRACTICE IMPROVEMENT PROJECT
Review Quality Improvement guidelines of the U.S. Preventive Services Task Force (USPSTF)
http://www.ahrq.gov/clinic/uspstfix.htm and undertake a QI study at one of The Wright Center’s outpatient
clinics by reviewing randomly selected charts. Document findings re: standard of care at clinics vis-à-vis
USPSTF standards of care. Present results of survey plus recommendations.
OBJECTIVE(S):






Learn to compose a study protocol;
Learn what constitutes significance in terms of data (sample);
Learn from submission to IRB whether a proposed study requires Informed Consent;
Learn to extract data from charts;
Evaluate extracted data according to plan (IRB pre-approved protocol);
Compose QI data evaluation study with recommendations for TWC’s ambulatory clinics.
29
OUTCOME(S):




Learn skills noted above;
Documentation of program’s quality of care in light of accepted standards (could be used by
program to document QI and qualify for pay-for-performance);
Poster;
Abstract with paper -> submit for presentation
DOCUMENTATION: Residents MUST submit a digital copy of their project and related materials to the
GME Coordinator. Residents must also assure proper documentation of their scholarly activity to their
individual MyEvaluations System Portfolio.
YEAR 3: CME-WORTHY SENIOR PRESENTATION WITH A CASE ASSESSMENT
(INCLUDING LITERATURE REVIEW) AT GRAND ROUNDS
We use the following as the needs assessment for each senior presentation:
There’s an ongoing need to keep healthcare professionals updated with research findings. Senior resident
research presentations are intended to help address that need.
There’s continuous need to enhance patient care with best of evidence research findings which are
formulated from research questions not addressed in the current literature. A senior presentation
necessarily involves a detailed review of the published literature concerning the
senior's assigned topic and makes note of those clinical questions that are yet to be resolved. This
encourages further research and publication.
The Senior Presentation is an essential part of resident training. It fills a gap in training that cannot be
addressed in any other manner. Such training fills the needs to know how to evaluate the current literature,
address a clinical research question, undertake valid research and to present one's findings to one's peers.
Each case requires prior approval by the appropriate faculty member.
OBJECTIVE(S):



Learn to search the published literature for case significance and topic applicability;
Learn to dissect applicable published case studies;
Compose a Case Presentation appropriate for presentation at Grand Rounds
OUTCOME(S):







Senior Presentation;
Publishable paper;
Poster;
Protocol;
Informed Consent if necessary;
Expertise in the critical evaluation of the published literature;
Recommendations for improved patient care.
30
DOCUMENTATION: Residents MUST submit a digital copy of their Senior Presentation and related
materials to the GME Coordinator. Residents must also assure proper documentation of their scholarly
work in their individual MyEvaluations System Portfolio.
EXCELLENCE IN SCHOLARLY ACTIVITY
In support of the high academic standards of The Wright Center for Graduate Medical Education
Residency Program, a resident who has shown superior scholarship in any number of settings may be
asked to present their activity in some form to their colleagues or to members of the Wright Center
Community at the discretion of the Program Director.
IMPORTANT NOTE!
All research, publication and any other scholarly projects MUST be submitted (digitally) in a timely
manner to the GME Department. All research, publication, and any other scholarly projects MUST
be recorded by the resident in their individual MyEvaluations System Portfolio.
Revision date 12/22/11
RESEARCH PROCESS CHECKLIST
Formulate health care-related question
Literature search regarding the topic
Question answered
Modify or abandon original question
Question not answered
Proceed to draft your study protocol
Protocol
Working title: State your question in a manner that suggests the benefit of an answer
How to answer your question = protocol draft
Draft goes to scientific review for evaluation; advice; methodology check
Finalized protocol to research coordinator for HIPAA compliance review, IRB format check and
submission forms
HIPAA cleared
Consent needed?
Risk level(s)?
To IRB for review – if needed
Do not proceed without clearance
CHECKLIST FOR CONFERENCE ATTENDANCE
Abstract – get approval to travel prior to abstract submission, in case it’s accepted
Submitted
31
Accepted
Not accepted
Poster- get approval to travel prior to abstract submission, in case it’s accepted
Submitted
Accepted
Not accepted
Conferences - get official approval to travel first
POLICY FOR OFF-SITE ROTATIONS
Definitions:
With few exceptions, the institution (Wright Center for Graduate Medical Education) does not pay for offsite rotations. The following guidelines are in place:
Educational Activity is program Required/Suggested Experience:
- If educational activity is required and available at WCGME – off-site rotation not permitted*
- If educational activity is required and not available at WCGME – off-site rotation permitted,
and is limited to one off-site rotation over the duration of training
- If educational activity is suggested selective and available at WCGME – off-site rotation not
permitted*
- If educational activity is suggested selective and not available at WCGME –off-site rotation
permitted, and is limited to one off-site rotation over the duration of training
Educational Activity is Not program Required/Suggested Experience:
- Must count toward required training
- Must be funded by the off-site provider or individual program
All off-site rotations must be approved by the Program Director and/or Associate Program Director and
require that a fully executed agreement be in place before the beginning of the rotation. It is the
responsibility of the program to initiate a Program Letter of Agreement (PLA) between WCGME and the
site no later than four months before the rotation is to begin. Forms necessary for this purpose are
available from the GME Office. In doing this, the PLA:
- Identifies the faculty who assume both the educational and supervisory responsibilities for
house staff.
- If the rotation is to a US facility other than a program accredited training site, the supervisor must
be a member of the WCGME Community-Based Faculty, or have similar credentials at another
program accredited training program;
- Specifies the faculty responsibilities for teaching, supervision, and formal evaluation of house
staff, as specified later in this document;
- Specifies the duration and content of the educational experience;
- States the policies and procedures governing house staff education during the assignment; and
Outlines the goals and objectives for the rotation.
In addition the program must identify the payment source for the resident’s stipend and benefits while
he/she is on rotation, if applicable. If necessary the program must secure agreement of the site to which
the resident is to rotate to pay for stipend and benefits, or identify that costs are to be covered using
departmental funds.
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Faculty at sites to which residents rotate must provide training that is consistent with both the general
and program specific academic standards that govern GME at WCGME.
*May request an exception or be funded by off-site provider or program
SUPERVISION POLICY
Policy
This policy focuses on WCGME resident supervision from the educational perspective.
WCGME is in accordance with the statement that "[medical] residents” must be supervised by teaching
staff in such a way that the residents assume progressively increasing responsibility according to their level
of education, ability and experience." This process is the underlying educational principal for all graduate
medical education, regardless of specialty or discipline. Clinician educators involved in this process must
understand the implications of this principle and its impact on the patient and the resident. All programs
which include residents within WCGME, Inc. must be approved by the appropriate program accreditor or
have special approval by the GMEC.
WCGME Teaching Faculty
All patient care is supervised by qualified WCGME faculty. Our faculty is committed to maintaining the
highest standards of care, respect the needs and expectations of patients, and embrace the contributions of
all members of the healthcare team. WCGME faculty ensures that all components of the educational
program for residents is of the highest quality to include their own contributions as teachers.
WCGME faculty are committed to fostering academic excellence, exemplary professionalism, cultural
sensitivity, and a commitment to maintaining competence through life-long learning. WCGME faculty
continues to demonstrate respect for all residents as individuals, without regard to gender, race, national
origin, religion, disability or sexual orientation; and cultivates a culture of tolerance among the entire
WCGME staff. Our faculty ensures that residents will have opportunities to participate in patient care
activities of sufficient variety and sufficient frequency to achieve the competencies required by their
chosen discipline.
WCGME faculty ensures that residents are not assigned excessive clinical responsibilities and are not
overburdened with services of little or no educational value. WCGME faculty provides residents with
opportunities to exercise graded progressive responsibility for the care of patients so that they can learn
how to practice their specialty and recognize when, and under what circumstances, they should seek
assistance from their colleagues.
Our faculty is committed to preparing residents to function effectively as members of healthcare teams.
WCGME faculty are dedicated to ensuring that residents receive appropriate supervision for all of the care
they provide during their training. WCGME faculty evaluates each resident’s performance on a regular
basis, provides appropriate verbal and written feedback, and documents achievement of the competencies
that are required to meet all educational objectives.
WCGME ensures that residents’ have opportunities to partake in required conferences, seminars and other
non-patient care learning experiences and that they have sufficient time to pursue the independent, self33
directed learning essential for acquiring the knowledge, skills, attitudes, and behaviors required for
practice.
WCGME faculty support residents in their role as teachers of other residents and of medical students. The
Program director(s) ensures, direct and document adequate supervision of residents at all times. WCGME
residents are provided with rapid, reliable systems for communicating with supervisory faculty.
WCGME faculty and residents are educated to recognize the signs of fatigue and adopt and apply policies
to prevent and counteract the potential negative effects.
Program letters of agreement identify the faculty who will assume educational and supervisory
responsibility for residents and specify the faculty responsibilities for teaching, supervision and formal
evaluation of resident performance.
WCGME Residents
Resident professional responsibilities fall into two major categories:
Patient Care and Education: In the clinical setting, these two areas are inseparable and excellence in
clinical care will result in a superior educational experience. Personal pride in the performance of
responsibilities is the keystone of professional excellence. Although some specific responsibilities of various
individuals (student, resident, attending physician) are clearly designated, patient care and education should be
viewed as a team effort.
Attendance at conferences is expected of all students, residents’ and attending physicians. These sessions are
designed to improve the clinical and scientific knowledge upon which we base our judgment and decision
making in the care of our patients. Conferences are designed to help us reflect on our clinical responsibilities
and to expand our knowledge to solve clinical problems.
We strive to provide the finest patient care and educational experience. We require a dedication to excellence
of students, residents’ and attending physicians.
Residents will be guided by the Medical Staff Bylaws and Rules and Regulations of the Medical Staff of all
participating sites. These are kept on file in the respective Medical Staff Offices.
Responsibilities
The GMEC for WCGME, Inc. is responsible for establishing local policy to fulfill the requirement of this
policy and the applicable accrediting and certifying body requirements.
The Program Director is responsible for the quality of the overall affiliated education and training program
and for ensuring that the program is in compliance with the policies of the respective accrediting and/or
certifying bodies. The Program Director defines the levels of responsibilities for each year of training by
preparing a description of the types of clinical activities residents’ may perform and those for which
residents’ may act in a teaching capacity. They are responsible for:
1. Arranging for all WCGME residents entering their first rotation to participate in an orientation to
policies, procedures and the role of residents’ within the affiliated training program.
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2. Ensuring that WCGME residents are provided the opportunity to contribute to discussions in
committees where decisions being made may affect their activities.
3. Defining the levels of responsibilities for each year of training by preparing a description of the
types of clinical activities WCGME residents may perform and those for which WCGME residents
may act in a teaching capacity.
Supervision
Graduate Levels of Responsibility
1. The WCGME training program is structured to encourage and permit residents to assume
increasing levels of responsibility commensurate with their individual progress in
experience, skill, knowledge and judgment.
2. As part of their training program, WCGME residents are given progressive responsibility
for the care of the patient. The determination of a residents ability to provide care to patients
without a supervisor present or to act in a teaching capacity will be based on documented
evaluation of the resident's clinical experience, judgment, knowledge, and technical skill.
Ultimately, it is the decision of the WCGME Faculty as to which activities the resident will
be allowed to perform within the context of the assigned levels of responsibility. The
overriding consideration is the safe and effective care of the patient that is the personal
responsibility of the WCGME Faculty.
3. The Program Director defines the levels of responsibilities for each year of training by
preparing a description of the types of clinical activities WCGME residents may perform
and those for which residents may act in a teaching capacity. The documentation of the
assignment of graduated levels of responsibility will be made available to other staff as
appropriate. These guidelines include the knowledge, attitudes and skills which will be
evaluated and be presented for a resident to advance in the training program, assume
increased responsibilities (such as the supervision of lower level trainees), and be promoted
at the time of the annual review.
4. Diagnostic or therapeutic procedures require a high level of expertise in their performance
and interpretation. Although gaining experience in performing such procedures is an
integral part of the education of the resident such procedures may be performed only by
residents with the required knowledge/skill, and judgment and under an appropriate level of
supervision by attending physicians. Examples are the placing of intravenous and arterial
lines, thoracentesis, paracentesis, lumbar puncture, routine radiologic studies, wound
debridement, and drainage of superficial abscesses. WCGME Faculty will be responsible
for authorizing the performance of such procedures and such procedures should only be
performed with the explicit approval of WCGME Faculty.
5. WCGME Faculty will provide appropriate supervision for the patient's evaluation,
management decisions and procedures. For elective or scheduled procedures, the WCGME
Faculty will evaluate the patient and write a pre-procedural note describing the finding,
diagnosis, plan for treatment, and/or choice of specific procedure to be performed.
6. During the performance of such procedures, WCGME Faculty will provide an appropriate
level of supervision. Determination of this level of supervision is generally left to the
discretion of WCGME Faculty within the context of the previously described levels of
responsibility assigned to the individual resident involved. This determination is a function
of the experience and competence of the resident and the complexity of the specific case.
Progressive Learning Objectives for PG1, PG2, and PG 3 housestaff and competency based curriculum are
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located on the Wright Center Web Site.
Clinical Responsibilities:
The clinical responsibilities for each resident must be based on PGY-level, patient safety, resident
education, severity and complexity of patient illness/condition and available support services.
Optimal clinical workload may be further specified by each Review Committee.
Teamwork:
Programs must provide opportunities for residents to care for patients in an environment that maximizes
effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care in the specialty as defined by each Review
Committee.
POLICY ON RESIDENT RECRUITMENT, ELIGIBILITY, AND SELECTION
Recruitment and selection of residents is the responsibility of the programs. Each program must have a
policy with standards, appropriate to the specialty, to guide resident selection. The recruitment and
selection processes, including the solicitation for applicants, screening of applications, invitation for
interview, interview, applicant evaluation and ranking must be conducted in an ethical manner.
The program must inform all applicants who are invited for an interview, in writing or by electronic
means, of the terms, conditions, and benefits of their potential appointment, including financial
support; vacations; parental, sick, and other leaves of absence; professional liability, hospitalization,
health, disability and other insurance provided for the residents and their families; and the conditions
under which the Sponsoring Institution provides call rooms, meals, laundry services, or their
equivalents. The program director must have all interviewed applicants sign the GME Interviewee
Certification Form indicating this information has been received.
Applicants are eligible for appointment if they are graduates of schools approved by the Liaison
Committee on Medical Education (LCME ) or the American Osteopathic Association (AOA) or, in
the case of international schools, approved for listing by the World Health Organization or equivalent
accrediting bodies and possess a valid Educational Commission for Foreign Medical Graduates
(ECGMG) certificate or 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 US who have
completed a Fifth Pathway program provided by an LCME-accredited medical school are also eligible
for appointment.
Selection from eligible applicants must be based on training program-related criteria such as applicant
preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as
motivation and integrity. Programs must not discriminate with regard to sex, race, age, religion, color,
national origin, disability, or any other applicable legally protected status. All medical trainees must meet
the minimum selection criteria as described by the ACGME, American Board of Specialties (ABMS) or
AOA for the specialty.
Residents who require visas are sponsored on J-1 visas through the ECFMG. Residents are sponsored on
H-1B visas only in rare cases. These require justification from the applicant and program director, and
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approval from the GME office. Visa issues or questions should be referred to the GME office.
All programs offering positions at the PGY1 level must determine if they will participate in the
National Resident Matching Program, or program-specific equivalent (if available), and if so, must
abide by its ethical and procedural rules. If a program is participating in the Match, the program must
go through the SOAP process to match any unfilled positions. Appointments must be made with a
clear communication to the applicant, both verbally and in writing, that appointment is contingent on
the applicant meeting program and institutional requirements and passing a credential review by the
program, the GME Director and the DIO.
The program director may not appoint more residents than approved by the applicable RC unless
otherwise stated in the specialty-specific requirements and approved by the GMEC through a complement
increase request. The sponsoring institution and programs educational resources must be adequate to
support the number of residents appointed to the program. Appointment is effected through execution of a
contract between the applicant and the sponsoring institution which is processed by the GME office and
signed by the President and CEO.
To assure compliance with these requirements, residents recruitment and selection is reviewed as part
of the internal review of each program.
POLICY ON DISABILITY AND ACCOMMODATIONS
In accordance with the Wright Center for Graduate Medical Education Equal Opportunity Employment
policy, programs do not discriminate in its admissions or selection of residents. WCGME is committed to
providing quality educational and occupational opportunities for everyone, including qualified individuals
with disabilities. WCGME is dedicated to providing reasonable accommodation to qualified students,
residents, employees, and all those with disabilities participating in its programs and services.
Applicants to WCGME programs who may need reasonable accommodations at any point in the selection
process, as well as incoming or current residents who may require reasonable accommodations may
consult with the GME office. Requests for accommodations are evaluated on a case-by-case basis.
Residents may also contact the GME office for concerns related to academic accommodations.
POLICY ON RESIDENTS APPOINTMENTS AND REAPPOINTMENTS
All residents new to the Wright Center for Graduate Medical Education are given a conditional offer of
appointment. The offer is contingent upon primary source verification of credentials to confirm that the
individual possesses the basic requisite education, training, skills, personal characteristics, and
professionalism to make the experience as residents a successful one for the individual and for the
program. Failure by residents to meet all conditions of appointment will result in revocation of the offer
of appointment. Should the applicant feel that a Match violation has occurred; he/she may contact the
National Residency Match Program (NRMP) or other applicable Match program.
The program director may not appoint more residents than approved by the Review Committee, unless
otherwise stated in the specialty-specific requirements and approved by the DIO. The program’s
educational resources must be adequate to support the number of residents appointed to the program.
All written agreements of appointment/contracts are for one year and each residents member must be
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reappointed for each subsequent year of training, contingent upon satisfactory completion of the current
post-graduate year and assurance that all requirements are met for progression. Residents are provided
with appropriate financial support and benefits to ensure that they are able to fulfill the responsibilities of
their educational program. Terms and conditions of appointment to a program are outlined in the contract.
The sponsoring institution will honor the full term of the contract except when a resident member’s
performance justifies termination.
Recommendations for the appointment and reappointment of residents are initiated by programs. The
appointment and reappointment of residents is the responsibility of the DIO, based on the
recommendation of the program director and is contingent upon review of credentials of the applicant
and assurance of requirements met by the GME Director when applicable and acceptable progress in the
program. No residents member will be asked to sign a non-competition guarantee.
A decision regarding reappointment must be reached by the program director no later than 4 months
prior to the end of the current appointment unless the residents member is on suspension or probation.
For most residents who are on a July 1 – June 30 contract year, this decision must be made prior to
March 1.
Appointment and/or reappointment does not constitute an assurance of successful completion of a
training program or post-graduate year. Successful completion is based on performance as measured by
individual program standards. Reappointment is the usual expectation if the residents member is making
normal progress toward attainment of the learning objectives of the program and board eligibility (if
applicable).
Residents are expected to notify their department sufficiently in advance (preferably by March 1st) if
they do not intend to return the following year.
In instances where a residents member’s contract will not be renewed, or when a residents member will
not be promoted to the next level of training, the program director, after review with and concurrence by
the DIO or GME director, must provide the residents member with a written notice of intent no later than
four months prior to the end of the residents member’s current contract. If the primary reason(s) for the
non-renewal or non-promotion occurs within the four months prior to the end of the contract or the
residents member is on suspension or probation, the program director must ensure that its provide the
residents member with as much written notice of the intent not to renew or not to promote as
circumstances reasonably allow, prior to the end of the contract. Nonrenewal and non-promotion are both
actions which may enact a grievance procedure. See Disciplinary and Grievance Procedures as outlined in
this manual for additional information.
POLICY ON RESIDENTS TRANSFERS
Prior to initiating the acceptance of a transferring residents member, the transferring residents member
must sign an “Authorization of Release of Information” form before information is exchanged between
institutions/programs.
Before accepting a resident member who has prior graduate medical education training, the program
director must obtain written or electronic verification of previous educational experiences and a
summative competency-based performance evaluation of the transferring resident member including an
assessment of competence in the following areas:
1. Patient Care including procedural data.
2. Medical Knowledge
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3. Practice-Based Learning and Improvement
4. Interpersonal and Communication Skills
5. Professionalism
6. Systems-Based Practice
The GMEC also recommends that program directors of programs with training prerequisites whose
entry level is at the PGY-2 level or higher also make personal contact with the program director or
other individuals able to evaluate the resident’s performance.
WCGME program directors are required to provide timely verification of education and summative
performance evaluations for residents in likewise fashion to other requesting programs for any residents
who may leave the program prior to completion of their education.
POLICY ON PROGRAM OR INSTITUTIONAL CLOSURE AND REDUCTION
Economic or other conditions may force the closures of a sponsoring institution, a program or a reduction
in the size of a program. The Wright Center for Graduate Medical Education, through the DIO should
give as much notice as possible to the Graduate Medical Education Committee and all affected residents
in the event of any anticipated changes.
In the event that the WCGME or any program is closed, the program must allow residents already in the
program to complete their education or assist the residents in enrolling in an ACGME/AOA accredited
program in which they can continue their education. In the event that alterations are made to program size,
only the number of future positions to be offered will be changed. Residents who have been appointed in a
program are not at risk for losing their positions; all residents will be allowed to complete their programs.
PROFESSIONAL LIABILITY INSURANCE
Professional liability insurance for residents in the form of occurrence coverage is provided by the
WCGME through HPIX professional liability insurance company for activities that are an approved
component of the training program. Risks incurred within WCGME training requirements, at
outside clinics and hospitals as part of an approved rotation are covered under this plan. Risks
incurred, however, while practicing at the VA Medical Center are covered by the Federal Tort
Claims Act.
There is no coverage under the WCGME‘s program for external moonlighting.
Occurrence coverage means that regardless of when the claim is filed, as long as the resident cooperates in
the institution's defense of the claim the HPIX plan will pay for all costs associated with defense of the
claim, as well as the cost of any settlement or judgment. Even if a resident is no longer with WCGME
when the claim is filed, as long as he or she was acting within the scope of his or her duties and
responsibilities of the Wright Center for Graduate Medical Education training program then the insured
plan remains in force. Therefore, it is not necessary for residents to purchase tail coverage for their duties
on behalf of this institution.
Insuring limits are $1,000,000 per occurrence and $3,000,000 in the aggregate. Requests for certificates of
insurance (documenting malpractice coverage) should be directed to the GME office. Additional questions
about the scope of professional liability coverage should be directed to the Chief Operations Office.
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RESIDENTS HEALTH BENEFITS
Health Insurance, Dental insurance and Vision Insurance are available to all eligible residents. For residents
and eligible dependents, the WCGME will pay a portion of the monthly premiums. Coverage will begin
immediately upon start of employment. Residents will receive an identification card and booklet describing
coverage when processing has been completed through the Blue Cross-Blue Shield of Northeastern
Pennsylvania.
The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives residents and their qualified
beneficiaries the opportunity to continue health insurance coverage under WCGME's health plan when a
"qualifying event" would normally result in the loss of eligibility. Some common qualifying events are
resignation, termination of employment, or death of a resident; a reduction in a residents hours or a leave of
absence; residents divorce or legal separation; and a dependent child no longer meeting eligibility
requirements.
Under COBRA, the resident or beneficiary pays the full cost of coverage at WCGME's group rates in
addition to a 2% administrative fee. WCGME provides each eligible resident with a written notice
describing rights granted under COBRA when the resident becomes eligible for coverage under WCGME's
health insurance plan. The notice contains important information about the residents’ rights and obligations.
LONG TERM DISABILITY PROGRAM
Eligible residents will receive disability insurance coverage upon start of their employment. The cost of this
insurance will be paid entirely by WCGME. A booklet describing coverage will be provided to residents
when processing has been completed.
WORKERS COMPENSATION
The WCGME provides a comprehensive workers' compensation insurance program at no cost to residents.
This program covers any injury or illness sustained in the course of employment that requires medical,
surgical, or hospital treatment. Subject to applicable legal requirements, workers' compensation insurance
provides benefits after a short waiting period or, if the resident is hospitalized, immediately. Residents must
file a report of injury with WCGME’s Human Resources office. This must be done no matter where the
job-related injury or illness occurred (for example, even when rotating at a participating site, the report of
injury is filed with WCGME’s Human Resources office). Since benefits under the law do not begin until
after the seventh day of lost time from work, sick leave benefits, if eligibility requirements are met will be
paid during the first seven days. Absence from work compensated for under the Workmen's Compensation
Law is not deducted from sick leave.
For additional information concerning benefits under the Workers’ Compensation Act, contact WCGME’s
Human Resources office.
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UNEMPLOYMENT COMPENSATION
In the event employment is terminated, under certain circumstances, you may be entitled to unemployment
compensation. In order to determine if you are eligible for such benefits, you should inquire at the nearest
office of the Bureau of Employment Security.
LEAVES OF ABSENCE
Leave requests are to be approved through appropriate department channels prior to the leave being
taken. When leave is taken for any reason, specialty board requirements supersede WCGME policy. This
may require the extension of training beyond the usual number of months. Specific board requirements
regarding leave may be found in the GME Resident/Fellow Handbook.
EDUCATIONAL LEAVE
Eligible residents at the 2nd and 3rd year level may be granted educational leave for a period of up to five
(5) days per year. Requests will be evaluated based on a number of factors, including anticipated work load
requirements and staffing considerations during the proposed period of absence. Residents in their first year
of training are not eligible for educational leaves.
The conference stipend for R-2's and R-3's will be a maximum of $1,500.00 for a five day conference, with
prior approval. Lesser amounts of conference time may be taken, for example, a three day conference. Only
the conference, hotel and travel expenses, not to exceed the amount stated above, will be reimbursed for
shorter conferences. Conferences will require prior approval by the program Director or Associate Program
Director and should be presented to the office well in advance of the scheduled conference.
Subject to the terms, conditions, and limitations of the applicable plans, WCGME will continue to
provide health insurance benefits for the full period of the approved educational leave. Vacation, sick leave,
and holiday benefits will continue to accrue during the approved educational leave.
MEDICAL LEAVE (INCL. MATERNITY LEAVE)
WCGME provides medical leaves of absence without pay to eligible employees who are temporarily unable
to work due to a serious health condition or disability. For purposes of this policy, serious health conditions
or disabilities include inpatient care in a hospital, hospice, or residential medical care facility; continuing
treatment by a health care provider; and temporary disabilities associated with pregnancy, childbirth, and
related medical conditions. Employees will be required to first use any accrued paid leave time before
taking unpaid leave.
Eligible employees may avail medical leave only after having completed 90 calendar days of service.
Exceptions to the service requirement will be considered to accommodate disabilities.
A physician’s statement must be submitted verifying the need for medical leave and its beginning and
expected ending dates. Any changes in this information should be promptly reported to the WCGME.
Employees returning from medical leave must submit a physician’s verification of their fitness to return to
work.
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Leave without make-up for residents will be guided by the policies and requirements of the American Board
of Internal Medicine (ABIM) regarding leave of absence and board eligibility. (The ABIM policy is as
follows: Up to one month of credit may be granted in any one year for vacation time or illness.
Subject to the terms, conditions, and limitations of the applicable plans, health insurance benefits will be
provided by WCGME for up to 12 weeks once the approved personal leave begins. At that time,
employees will become responsible for the full costs of these benefits if they wish coverage to continue
through COBRA. When the employee returns from personal leave, benefits will again be provided by
WCGME according to the applicable plans.
Benefit accruals, such as vacation, sick leave, or holiday benefits, will be suspended during the leave and
will resume upon return to active employment.
FAMILY LEAVE (INCL. PATERNITY LEAVE)
The WCGME provides family leaves of absence, without pay, to eligible employees who wish to take time
off from work to fulfill family obligations directly related to child birth, adoption, or placement of a foster
child. This provision is also available to care for a child, spouse or parent with a serious health condition. A
serious health condition means an illness, injury, impairment or a physical/mental condition that involves inpatient care in a hospital, hospice, residential medical care facility; or continuing treatment by a health care
provider.
All other requirements applicable under the medical leave policy will also apply to the family leave policy.
Subject to the terms, conditions and limitations of the applicable plans, WCGME will continue to
provide health insurance benefits for the full period of the approved educational leave. Vacation, sick
leave and holiday benefits will continue to accrue during the approved educational leave.
INTERVIEW LEAVE
Residents are permitted reasonable days off to allow them to appear for job and fellowship interviews.
However, they need to put in a written request to the WCGME office on the appropriate form along with a
copy of the job or fellowship interview invitation ahead of time and duly signed by the Chief Resident and
the person in charge of scheduling. It is the resident’s responsibility to provide coverage for their missed
calls and/or clinics.
BEREAVEMENT LEAVE
Residents who wish to take time off due to the death of an immediate family member should notify their
supervisor immediately. Up to three consecutive days of paid bereavement leave will be provided to eligible
residents. Immediate family is defined as: spouse, parent, child, sibling, grandparent or individual residing
within the employee’s place of residence.
JURY DUTY
If residents are required to serve jury duty beyond a period of paid jury duty leave, they may request an
unpaid jury duty leave of absence. Residents must show the jury duty summons to the program director as
soon as possible so that he may make arrangements to accommodate their absence. Of course, residents are
expected to report for work whenever the court schedule permits. Either WCGME or the resident may
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request an excuse from jury duty if, in WCGME's judgment, the residents absence would create serious
operational difficulties. WCGME will continue to provide health insurance benefits for the full term of the
jury duty absence.
FAMILY MEDICAL LEAVE OF ABSENCE
Residents are eligible for Family Medical Leave under WCGME’s policy as noted below:
WCGME will not discriminate against employees as a result of the approved use of family care or medical
leave or a proper request for such leave. Requests for family care and medical leave will be considered
without regard to race, color, citizenship status, national origin, ancestry, gender, sexual orientation, age,
religion, creed, physical or mental disability, marital status or veteran status.
The function of this policy is to provide employees with a general description of their FMLA rights. In the
event of any conflict between this policy and the applicable law, employees will be afforded all rights
required by law. If you have any questions, concerns, or disputes with this policy, you must contact your
employer in writing.
A. General Provisions
It is the policy to grant up to 12 weeks of unpaid family and medical leave during any 12-month period to
eligible employees, in accordance with the Family and Medical Leave Act of 1993 (FMLA) and up to 26
weeks of unpaid leave in any 12-month period in compliance with the expansion of FMLA under The
Support for Injured Service members Act of 2007.
Under this policy, your employer will grant up to 12 weeks (or up to 26 weeks of military caregiver leave
to care for a covered service member with a serious injury or illness) during a 12-month period to eligible
employees. The leave may be paid, unpaid or a combination of paid and unpaid leave, depending on the
circumstances of the leave and as specified in this policy.
B. Eligibility
To qualify to take family or medical leave under this policy, the employee must meet all of the following
conditions:
1) The employee must have worked for the employer company for 12 months or 52 weeks. The 12 months
or 52 weeks need not have been consecutive. Separate periods of employment will be counted, provided
that the break in service does not exceed seven years. Separate periods of employment will be counted if
the break in service exceeds seven years due to National Guard or Reserve military service obligations or
when there is a written agreement, including a collective bargaining agreement, stating the employer’s
intention to rehire the employee after the service break. For eligibility purposes, an employee will be
considered to have been employed for an entire week even if the employee was on the payroll for only part
of the a week or if the employee is on leave during the week.
2) The employee must have worked at least 1,250 hours during the 12-month period immediately before
the date when the leave is requested to commence. The principles established under the Fair Labor
Standards Act (FLSA) determine the number of hours worked by an employee. The FLSA does not include
time spent on paid or unpaid leave as hours worked. Consequently, these hours of leave should not be
43
counted in determining the 1,250 hours eligibility test for an employee under FMLA.
3) The employee must work in an office or work site where 50 or more employees are employed by the
company within 75 miles of that office or work site. The distance is to be calculated by using available
transportation by the most direct route.
C. Type of Leave Covered
To qualify as FMLA leave under this policy, the employee must be taking leave for one of the reasons
listed below:
1) The birth of a child and in order to care for that child.
2) The placement of a child for adoption or foster care and to care for the newly placed child.
3) To care for a spouse, child or parent with a serious health condition (described below).
4) The serious health condition (described below) of the employee.
An employee may take leave because of a serious health condition that makes the employee unable to
perform the functions of the employee’s position. A serious health condition is defined as a condition that
requires inpatient care at a hospital, hospice or residential medical care facility, including any period of
incapacity or any subsequent treatment in connection with such inpatient care or a condition that requires
continuing care by a licensed health care provider. This policy covers illnesses of a serious and long-term
nature, resulting in recurring or lengthy absences. Generally, a chronic or long-term health condition,
which, if left untreated, that would result in a period of three consecutive days of incapacity of more than
three days, with the first visit to the health care provider within seven days of the onset of the incapacity
and a second visit within 30 days of the incapacity would be considered a serious health condition. For
chronic conditions requiring periodic health care visits for treatment, such visits must take place at least
twice a year. Employees with questions about what illnesses are covered under this FMLA policy are
encouraged to consult with a member of management or Human Resources.
If an employee takes paid sick leave for a condition that progresses into a serious health condition and the
employee requests unpaid leave as provided under this policy, the company may designate all or some
portion of related leave taken as leave under this policy, to the extent that the earlier leave meets the
necessary qualifications.
5) A Qualifying exigency leave for families of members of the National Guard and Reserves when the
covered family member’s military member is on active duty or called to active duty in the Armed Forces
support of a contingency operation.
An employee whose spouse, son, daughter or parent either has been notified of an impending call or order
to active military duty or who is already on active duty may take up to 12 weeks of leave for reasons
related to or affected by the family member’s call-up or service. Reasons related to the call-up or service
include helping the family member prepare for the departure or caring for children of the service member.
The qualifying exigency must be one of the following: 1) short-notice deployment, 2) military events and
activities, 3) child care and school activities, 4) financial and legal arrangements, 5) counseling, 6) rest and
recuperation, 7) post-deployment activities and 8) additional activities that arise out of active duty,
provided that the employer and employee agree, including agreement on timing and duration of the leave.
The leave may commence as soon as the individual receives the call-up notice. (Son or daughter for this
44
type of FMLA leave is defined the same as for child for other types of FMLA leave, except that the person
does not have to be a minor.) This type of leave would be counted toward the employee’s 12-week
maximum of FMLA leave in a 12-month period. Employees requesting this type of FMLA leave must
provide proof of the qualifying family member’s call-up or active military service before leave is granted.
6) To Military caregiver leave (also known as covered service member leave) to care for an ill or injured
service member. This leave may extend to up to 26 weeks in a single 12-month period for an employee
whose to care for a spouse, son, daughter, parent or next- of- kin is injured or recovering from an with a
serious illness or injury suffered while incurred in the line of duty on active military duty and who is
unable to perform the duties of the service member’s office, grade, rank or rating. Next- of- kin is defined
as the closest blood relative of the injured or recovering service member. An employee is also eligible for
this type of leave when the family service member is receiving medical treatment, recuperation or therapy,
even if the service member is on temporary disability retired list.
Employees requesting this type of FMLA leave must provide certification of the family member or nextof-kin’s injury, recovery or need for care. This certification is not tied to a serious health condition as for
other types of FMLA leave. This is the only type of FMLA leave that may extend an employee’s leave
entitlement beyond 12 weeks to 26 weeks. Other types of FMLA leave are included with this type of leave
totaling the 26 weeks.
D. Amount of Leave
An eligible employee can take up to 12 weeks (or up to 26 weeks of leave to care for an injured or ill
service member) for the FMLA circumstances (1) through (5) above under this policy during any 12month period. The company will measure the 12-month period as a rolling 12-month period measured
backward from the date an employee uses any leave under this policy. Each time an employee takes leave,
the company will compute the amount of leave the employee has taken under this policy in the last 12
months and subtract it from the 12 weeks (or 26 weeks for the care of an injured or ill service member) of
available leave, with and the balance remaining being is the amount the employee is entitled to take at that
time.
An eligible employee can take up to 26 weeks for the FMLA circumstance (6) above (military caregiver
leave) during a single 12-month period. For this military caregiver leave, the company will measure the 12month period as a rolling 12-month period measured forward. FMLA leave already taken for other FMLA
circumstances will be deducted from the total of 26 weeks available.
If a husband and wife both work for the company and each wishes to take leave for the birth of a child,
adoption or placement of a child in foster care, or to care for a parent (but not a parent "in-law") with a
serious health condition, the husband and wife may only take a combined total of 12 weeks of leave. If a
husband and wife both work for the company and each wishes to take leave to care for a covered injured or
ill service member, the husband and wife may only take a combined total of 26 weeks of leave.
E. Employee Status and Benefits during Leave
While an employee is on leave, the company will continue the employee’s health benefits during the leave
period at the same level and under the same conditions as if the employee had continued to work.
45
If the employee chooses not to return to work for reasons other than a continued serious health condition of
the employee or the employee's family member or a circumstance beyond the employee's control, the
company will require the employee to reimburse the company the amount it paid for the employee's health
insurance premium during the leave period.
Under current company policy, the employee pays a portion of the health care premium. While on paid
leave, the employer will continue to make payroll deductions to collect the employee's share of the
premium. While on unpaid leave, the employee must continue to make this payment, either in person or by
mail. Arrangements from the payment of benefit premiums will be made at the time of leave notification to
the company. The payment must be received by your employer by the 1st day of each month. If the
payment is more than 30 days late, the employee's health care coverage may be dropped for the duration of
the leave. The employer will provide 15 days' notification prior to the employee's loss of coverage.
If the employee contributes to any life insurance plans, the company or disability plan, the employer will
continue making payroll deductions while the employee is on paid leave. While the employee is on unpaid
leave, the employee may request continuation of such benefits and pay his or her portion of the premiums;
or the employer may elect to maintain such benefits during the leave and pay the employee's share of the
premium payments. If the employee does not continue these payments, the employer may discontinue
coverage during the leave. If the employer maintains coverage is maintained, the company may recover the
costs incurred for paying the employee's share of any premiums, whether or not the employee returns to
work.
F. Employee Status After Leave
An employee who takes leave under this policy may be asked to provide a fitness for duty (FFD) clearance
from the health care provider. This requirement will be included in the employer’s response to the FMLA
request. Generally, an employee who takes FMLA leave will be able to return to the same position or a
position with equivalent status, pay, benefits and other employment terms. The position will be the same or
one which is virtually identical in terms of pay, benefits and working conditions. The company may choose
to exempt certain key employees from this requirement and not return them to the same or similar position.
G. Use of Paid and Unpaid Leave
An employee who is taking FMLA leave because of the employee's own serious health condition or the
serious health condition of a family member must use all paid vacation and, personal time or sick leave
prior to being eligible for unpaid leave. Personal time Sick leave may be run concurrently with FMLA
leave if the reason for the FMLA leave is covered by the established sick leave policy.
Disability leave for the birth of the child and for an employee's serious health condition, including workers'
compensation leave (to the extent that it qualifies), will be designated as FMLA leave and will run
concurrently with FMLA. For example, if an employer provides six weeks of pregnancy disability leave,
the six weeks will be designated as FMLA leave and counted toward the employee's 12-week entitlement.
The employee may then be required to substitute accrued (or earned) paid leave as appropriate before
being eligible for unpaid leave for what remains of the 12-week entitlement. An employee who is taking
leave for the adoption or foster care of a child must use all paid vacation, personal and or family leave
prior to being eligible for unpaid leave.
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An employee who is using military FMLA leave for a qualifying exigency must use all paid vacation and
personal leave prior to being eligible for unpaid leave. An employee using FMLA military caregiver leave
must also use all paid vacation, personal leave or sick leave (as long as the reason for the absence is
covered by the company’s sick leave policy) prior to being eligible for unpaid leave.
H. Intermittent Leave or a Reduced Work Schedule
The employee may take FMLA leave in 12 consecutive weeks, may use the leave intermittently (take a day
periodically when needed over the year) or, under certain circumstances, may use the leave to reduce the
work week or work day, resulting in a reduced hour schedule. In all cases, the leave may not exceed a total
of 12 work weeks (or 26 work weeks to care for an injured or ill service member over a 12-month period).
The company may temporarily transfer an employee to an available alternative position with equivalent
pay and benefits if the alternative position would better accommodate the intermittent or reduced schedule,
in instances of when leave for the employee or employee's family member is foreseeable and for planned
medical treatment, including recovery from a serious health condition or to care for a child after birth, or
placement for adoption or foster care.
For the birth, adoption or foster care of a child, the company and the employee must mutually agree to the
schedule before the employee may take the leave intermittently or work a reduced hour schedule. Leave
for birth, adoption or foster care of a child must be taken within one year of the birth or placement of the
child.
If the employee is taking leave for a serious health condition or because of the serious health condition of a
family member, the employee should try to reach agreement with the company before taking intermittent
leave or working a reduced hour schedule. If this is not possible, then the employee must prove that the use
of the leave is medically necessary.
The company may require certification of the medical necessity as discussed in Sections I and K.
I. Certification of the Employee’s Serious Health Condition of the Employee or the Spouse, Child or
Parent of the Employee
The company will require certification of for the employee’s serious health condition. The employee must
respond to such a request within 15 days of the request or provide a reasonable explanation for the delay.
Failure to provide certification may result in a denial of continuation of leave. Medical certification will be
provided by using the Medical DOL Certification Form. Request for a medical certificate must be made in
writing as part of the employer response to employee request for leave. of Health Care Provider for
Employee’s Serious Health Condition (http://www.dol.gov/esa/whd/forms/WH-380-E.pdf ).
Certification of the serious health condition shall include the date when the condition began, its expected
duration and a brief statement of treatment. For medical leave for the employee’s own medical condition,
the certification must also include a statement that the employee is unable to perform work of any kind or a
statement that the employee is unable to perform the essential functions of the employee’s position. For a
family member who is seriously ill, the certification must include a statement that the patient, the family
member, requires assistance and that the employee’s presence would be beneficial or desirable. If the
employee plans to take intermittent leave or work a reduced schedule, the certification must also include
47
dates and the duration of treatment as well as a statement of medical necessity for taking intermittent leave
or working a reduced schedule. The company may directly contact the employee’s health care provider for
verification or clarification purposes using a health care professional, an HR professional, leave
administrator or management official. The company will not use the employee’s direct supervisor for this
contact. Before the company makes this direct contact with the health care provider, the employee will be a
given an opportunity to resolve any deficiencies in the medical certification. In compliance with HIPAA
Medical Privacy Rules, the company will obtain the employee’s permission for clarification of individually
identifiable health information.
The company has the right to ask for a second opinion if it has reason to doubt the certification. The
company will pay for the employee to get a certification from a second doctor, which the company will
select. The company may deny FMLA leave to an employee who refuses to release relevant medical
records to the health care provider designated to provide a second or third opinion. If necessary to resolve a
conflict between the original certification and the second opinion, the company will require the opinion of
a third doctor. The company and the employee will mutually select the third doctor, and the company will
pay for the opinion. This third opinion will be considered final. The employee will be provisionally entitled
to leave and benefits under the FMLA pending the second and/or third opinion.
J. Documentation of the Covered J. Certification for the Family Member’s Active Duty or Call to Active
Duty in the Armed Forces
Employees requesting this type of service member FMLA leave must provide proof of the qualifying
family member’s call-up or active military service. This documentation may be a copy of the military
orders or other official Armed Forces communication.
K. Documentation of the Need for Service member FMLA Leave to Care for an Injured or Ill Service
member
Employees requesting this type of Service member FMLA leave must provide documentation of the family
member’s or next-of-kin’s injury, recovery or need for care. This documentation may be a copy of the
military medical information, orders for treatment, or other official Armed Forces communication
pertaining to the service member’s injury or illness incurred on active military duty that renders the
member medically unfit to perform his or her military duties.
L. Procedure for Requesting Leave for 1) the birth of a child or in order to care for that child; 2) the
placement of a child for adoption or foster care and to care for the newly placed child; 3) to care for a
spouse, child or parent with a Serious Health Condition or 4) the serious health condition of the
employee.
The employee must respond to such a request within 15 days of the request or provide a reasonable
explanation for the delay. Failure to provide certification may result in a denial of continuation of leave.
Medical certification will be provided using the DOL Certification of Health Care Provider for Family
Member’s Serious Health Condition (http://www.dol.gov/esa/whd/forms/WH-380-F.pdf ).
All employees requesting this type of FMLA leave must provide verbal notice with an explanation of the
reason(s) for the needed leave to their immediate supervisor, who will advise the HR department. If the
48
leave is foreseeable, the immediate supervisor may require the employee to provide a written request for
leave and reasons(s) with a copy to the HR department. Failure of the employee to provide a written
request for leave cannot be grounds to deny or delay the taking of FMLA leave.
The company will provide individual notice of rights and obligations to each employee requesting leave
within two business days or as soon as practicable. For employees on intermittent or recurring leave for the
same incident, this notice will be provided every six months. When an employee plans to take leave under
this policy, the employee must give the company 30 days’ notice. If it is not possible to give 30 days’
notice, the employee must give as much notice as is practicable. An employee who is to undergo planned
medical treatment is required to make a reasonable effort to schedule the treatment in order to minimize
disruptions to the company’s operations.
If an employee fails to provide 30 days’ notice for foreseeable leave with no reasonable excuse for the
delay, the leave request may be denied until at least 30 days from the date the employer receives notice.
While on leave, employees are requested to report periodically to the company regarding the status of the
medical condition and their intent to return to work.
M. Procedure for Requesting Leave for 1) a covered family member’s active duty or call to active duty in
the Armed Forces or 2) to care for an injured or ill service member
All employees requesting this type of FMLA leave must provide verbal notice with an explanation of the
reason(s) for the needed leave to their immediate supervisor, who will advise the appropriate individuals.
Leave may commence as soon as the individual receives the call-up notice. If the leave is foreseeable, the
immediate supervisor may require the employee to provide a written request for leave and reasons(s) with
a copy to the HR Department. The company will provide individual notice of rights and obligations to
each employee requesting leave within two business days or as soon as practicable.
The company may directly contact the employee’s family member’s health care provider for verification or
clarification purposes using a health care professional, an HR professional, leave administrator or
management official. The company will not use the employee’s direct supervisor for this contact. Before
the company makes this direct contact with the health care provider, the employee will be a given an
opportunity to resolve any deficiencies in the medical certification. In compliance with HIPAA Medical
Privacy Rules, the company will obtain the employee’s family member’s permission for clarification of
individually identifiable health information.
The company has the right to ask for a second opinion if it has reason to doubt the certification. The
company will pay for the employee’s family member to get a certification from a second doctor, which the
company will select. The company may deny FMLA leave to an employee whose family member refuses
to release relevant medical records to the health care provider designated to provide a second or third
opinion. If necessary to resolve a conflict between the original certification and the second opinion, the
company will require the opinion of a third doctor. The company and the employee will mutually select the
third doctor, and the company will pay for the opinion. This third opinion will be considered final. The
employee will be provisionally entitled to leave and benefits under the FMLA pending the second and/or
third opinion.
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N. Certification of Qualifying Exigency for Military Family Leave
The company will require certification of the qualifying exigency for military family leave. The employee
must respond to such a request within 15 days of the request or provide a reasonable explanation for the
delay. Failure to provide certification may result in a denial of continuation of leave. This certification will
be provided using the DOL Certification of Qualifying Exigency for Military Family Leave
(http://www.dol.gov/esa/whd/forms/WH-384.pdf ).
O. Certification for Serious Injury or Illness of Covered Service member for Military Family Leave
The company will require certification for the serious injury or illness of the covered service member. The
employee must respond to such a request within 15 days of the request or provide a reasonable explanation
for the delay. Failure to provide certification may result in a denial of continuation of leave. This
certification will be provided using the DOL Certification for Serious Injury or Illness of Covered Service
member (http://www.dol.gov/esa/whd/forms/WH-385.pdf).
P. Recertification
The company may request recertification for the serious health condition of the employee or the
employee’s family member no more frequently than every 30 days and only when circumstances have
changed significantly, or if the employer receives information casting doubt on the reason given for the
absence, or if the employee seeks an extension of his or her leave. Otherwise, the company may request
recertification for the serious health condition of the employee or the employee’s family member every six
months in connection with an FMLA absence. The company may provide the employee’s health care
provider with the employee’s attendance records and ask whether need for leave is consistent with the
employee’s serious health condition.
Q. Procedure for Requesting FMLA Leave
All employees requesting FMLA leave must provide verbal or written notice of the need for the leave to
the HR Department. Within five business days after the employee has provided this notice, the HR
Department will complete and provide the employee with the DOL Notice of Eligibility and Rights
(http://www.dol.gov/esa/whd/fmla/finalrule/WH381.pdf ).
When the need for the leave is foreseeable, the employee must provide the employer with at least 30 days'
notice. When an employee becomes aware of a need for FMLA leave less than 30 days in advance, the
employee must provide notice of the need for the leave either the same day or the next business day. When
the need for FMLA leave is not foreseeable, the employee must comply with the company’s usual and
customary notice and procedural requirements for requesting leave, absent unusual circumstances.
R. Designation of FMLA Leave
Within five business days after the employee has submitted the appropriate certification form, the HR
Manager will complete and provide the employee with a written response to the employee’s request for
FMLA leave using the DOL Designation Notice (http://www.dol.gov/esa/whd/forms/WH-382.pdf) will
resume upon return to active employment.
50
So that an employee's return to work can be properly scheduled, an employee on medical leave is requested
to provide WCGME with at least two weeks advance notice of the date the employee intends to return to
work, When a medical leave ends, the employee will be reinstated to the same position, if it is available, or
to "an equivalent position for which the employee is qualified,
If an employee fails to report to work promptly at the end of the medical leave, WCGME will consider the
employee to have voluntarily resigned.
VACATION AND HOLIDAY LEAVE
Vacation and holiday leave are outlined in the residents contract and are defined by program specific
requirements.
Residents are encouraged to request and take the vacation time in week-long blocks (Sunday through
Saturday). If, however, it becomes necessary to request and take the vacation time in days, then a week
is defined as 5 work days. Please be aware that work days do not mean only Monday- Friday. If, for
example, a resident requests a day off (a Saturday), and the program requires the resident to be on duty
on Saturdays, then it would count as a vacation day.
Insofar as possible, residents are to be given defined holidays off. However, patient care demands and
educational requirements may necessitate that a resident work on a holiday. Should that occur, the resident
should be given an in-lieu day and allowed to take the “holiday” on another day.
Vacations and holidays are to be scheduled with the appropriate individual(s) in the program; and are to
be approved by that individual(s). In most cases, vacation time should be taken while training with the
“home” program. If the resident is rotating to another program, then the time must be requested of, and
approved by, both program directors (rotating program and home program).
Vacations and holidays are to be taken within the contract year, and will not be carried forward if not
used.
REQUEST FOR TIME OFF/VACATION POLICY
Any resident who requests a specific day not to be on call must follow the guidelines below: All requests must
be submitted to the WCGME faculty in writing. Vacations/conferences can only be taken during subspecialty
or elective rotations.
The Vacation policy is as follows (note difference between ACGME and AOA vacation
allowances) :
R1 - 3 weeks
R2 - 3 weeks plus 1 week of conference
R3 - 3 weeks plus 1 week of conference
Osteopathic residents are allowed two weeks of vacation during the year and one week of self study,
for which they will maintain logs.
Vacations without pay and without make-up for Residents will be at the discretion of the Director and will
comply with accrediting guidelines. Vacation time cannot be forfeited to meet training requirements.
HOLIDAY POLICY
The following days are WCGME Resident Official Holidays:
 Independence Day
 Labor Day
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




Thanksgiving Day
Friday after Thanksgiving Day
Memorial Day
Christmas Day
New Years Day
Call coverage for these holidays will be as on Sunday and will be arranged at the beginning of the year.
Residents who work on any of the above holidays (excluding Christmas and New Years Day) are entitled
to a day off, provided an appropriate form is filled out. Of note, this day can only be taken when suitable
coverage is arranged.
Religious holidays will be honored as the need arises. At present, individuals involved will make separate
arrangements for coverage and inform the Program Director.
HOW TO RAISE AND RESOLVE ISSUES
The Wright Center for Graduate Medical Education is committed to having a positive learning and
working environment for its residents. All individuals have the right to enjoy an environment free from
all forms of conduct that can be considered abusive, harassing, threatening or intimidating. Every
individual must be allowed to raise concerns or express opinions in a non-threatening atmosphere of
mutual respect. WCGME is committed to providing options for residents to raise and resolve patient
safety, program related, attending/staff related, personal or other issues without intimidation or fear of
retaliation. WCGME, under the DIO and the GMEC will adjudicate those residents complaints and
grievances related to the work environment or issues related to the program or faculty.
Impaired Physician Program
Hospital Risk Mgt
Attending Faculty
Member
Site Coordinator
Patient Safety Net
Site Coordinator
PD/APD
DIO/GMEC Committee
WCGME HR Officer
PD/APD
Chief Resident
Attending
Chief Medical Officer
Department Risk Mgr
Patient Safety Issue
Issue
Hospital HR Officer
Attending Staff Issue
Residents Mentor
Resident has
a Concern
Attending/Faculty
Member
Employee Assistance/HR
Personal Issue
PD/APD
Attending/Faculty
Member
Chief Resident
Program Related Issue
DIO/GMEC
Chief Resident
For Another Resident
PD/APD
Chief Resident
Site Coordinator
Attending/Faculty
Member
DIO/GMEC
DIO/GMEC
PD/APD
Impaired Physician Program
Impaired Physician Program
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Mechanisms to Resolve Issues
Each program is required to provide its residents with guidelines on how to raise and resolve issues. Most
concerns should be dealt with at an individual program level in consultation with the chief resident or
fellow, program director, faculty or chairperson. In the event that those efforts do not bring resolution to
the concerns, or if a resident is not comfortable bringing forth issues within their own program, then the
following alternative support systems can be used as depicted above.
GME Office
The GME Office, including the DIO, has an open door policy. Any member of the residents with a
concern may request assistance at any time.
Human Resources
Human Resources at the Wright Center for Graduate Medical Education can be contacted at 570343-2383.
Risk Management
Risk Management for the Wright Center for Graduate Medical Education can be contacted at
570-343-2383.
Patient Safety
Some concerns raised potentially have injurious and far-reaching effects on the careers and lives of
accused individuals. Therefore allegations must be made in good faith and not out of malice. Knowingly
making a false or frivolous allegation will not be tolerated and will subject the person making such a
report to disciplinary action.
Every effort will be made to prevent retaliation directed at a person who has filed a complaint or
participated in an investigation of an allegation. Any person found to have engaged in or attempted
any form of retaliation is subjected to disciplinary action per WCGME policy.
POLICY ON DISCRIMINATION AND HARASSMENT
The Wright Center for Graduate Medical Education is committed to a policy of equal opportunity for
all in every aspect of its operations. WCGME has pledged not to discriminate on the basis of race,
color, sex, age, religion, national origin, sexual orientation, marital status, or physical handicap. This
policy extends to all educational programs and activities.
WCGME values the contribution of all students including residents, faculty, staff and visitors in our
community. Discrimination and harassment create a harmful atmosphere that denies residents the right
to an education. WCGME will absolutely not tolerate discrimination or harassment of any student,
resident, faculty, staff or visitor.
Residents may contact the GME office or the Human Resources office with any concerns.
Residents Responsibilities
Residents are expected to conduct themselves in a professional manner regarding achievement of
educational objectives, provision of patient care and relations with their colleagues.
Residents must:
- Devote time and interests fully to the welfare of the patients assigned;
- Provide compassionate, efficient and cost-effective care commensurate with level of training and
53
responsibility;
Assume responsibility in the teaching or professional direction of students and other
interns/residents/fellows;
- Be responsive to the supervision and direction of professional staff involved in education and
patient care activities; and
- Take advantage of all opportunities offered to improve knowledge and skills in the
profession.
Residents are also 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. Any misrepresentations or failures to
fully disclose requested information shall be sufficient cause to result in the immediate revocation of
appointment or denial of appointment. Residents contract may be terminated for any serious or repeated
breach of ethics or discipline.
-
All residents are required to have a Pennsylvania license at the earliest date for which he/she is eligible.
Residents are responsible for the completion of all examination and licensure requirements.
Fellows must apply for a full license which requires successful completion of USMLE Step 3. No
fellows can be appointed without successful completion of USMLE Step 3 prior to the appointment date.
Any in coming medical resident at a PGY1 level with prior GME training must also be licensed. It is the
resident’s responsibility to ensure all licensure requirements are met prior to the appointment date. Failure
to do so may result in loss of appointment.
In addition to these general standards, individual programs may have specific academic standards to
which residents are held accountable. Residents must be informed of these specific academic standards
at departmental orientation and provided ready access to the relevant documents through the program
office. In instances in which the resident does not attend orientation, it is the program director’s
responsibility to assure that the resident is informed of these specific academic requirements.
PROGRESSIVE DISCIPLINE AND REMEDIATION POLICY
The primary responsibility for defining the standards of academic performance and personal professional
development rests with the program director and faculty of each individual program. In each program,
there must be clearly stated bases for evaluation and advancement. Program Directors and supervising
faculty must provide and document timely feedback on an ongoing basis for residents including formative
"on-the-spot" and summative feedback. This must include both positive feedback as well as feedback on
minor performance or conduct concerns as they occur. Documentation must appropriately reflect the
feedback provided.
Most concerns should be managed initially with feedback including informal verbal counseling by the
program director and faculty. Failure of the resident to appropriately remediate after such intervention or
concerns that should not be addressed with informal verbal counseling alone must be managed with
additional intervention. In those situations, the actions listed below can be taken, depending on the nature
and/or severity of the deficiency, actions, or conduct. In determining which level of intervention is
appropriate, the program director should take into account the resident’s overall performance, including
previous evaluations, results of any informal counseling, etc.
Residents in graduate training programs are considered to be students although they enjoy most of the rights
and privileges that are accorded to the medical staff of the integrated hospitals.
54
WCGME has supervisory and evaluative mechanisms to identify clinical performance and educational
problems prior to those problems becoming serious. The objective is to assist the resident through educational
opportunities and supervision, in the correction of the difficulties. Residents will be offered a variety of
supervised experiences tailored to the deficiencies identified. Problems, steps developed to remedy the
problems, anticipated outcomes, and a time frame within which improvements to occur will be clearly
defined.
In accordance with the severity of the problem(s) identified, remedial actions may call for any of four steps verbal warning, written warning, suspension with or without pay, or termination of employment - depending
on severity of the problem and the number of occurrences. There may be circumstances when one or more
steps are bypassed.
Progressive discipline means that, with respect to most disciplinary problems, these steps will normally be
followed: a first offense may call for a verbal warning; a next offense may be followed by a written warning;
another offense may lead to a suspension; and, still another offense may then lead to termination of
employment. Problems are dealt with in the least stringent manner necessary, taking more severe actions if
initial remedial efforts do not succeed.
WCGME recognizes that there are certain types of resident problems that are serious enough to justify either a
suspension, or, in extreme situations, termination of employment, without going through the usual progressive
discipline steps.
It is expected that remedial actions involving non-clinical/educational offenses will be similar to those actions
that will be taken with staff of the integrated hospitals. It is incumbent upon the WCGME preceptors,
attendings and/or coordinators to inform the Program Director when such instances occur, prior to the taking
of any remedial actions, to assure consistency in the application of remedial actions.
An important element to success in remedial efforts is to document all plans and actions taken and efforts to
obtain the resident's agreement to these actions. Such documentation will also serve as written record of past
efforts, if more stringent actions, suspension or termination, must be considered. In those cases where more
stringent forms of discipline are taken by the Program Director, it is important that the resident be informed by
the Program Director that a fair hearing can be requested if the resident disagrees with these actions.
It is recognized that the rigors of fulfilling the responsibilities of a resident may cause emotional stress
requiring the support of psychological services. Should a resident display evidence of the need for such
support and if deemed necessary by the department chairman, psychological evaluation may be mandated.
Additionally, a resident may identify a need for psychological support in order for him/her to continue his/her
responsibilities in a satisfactory manner. WCGME has established a program whereby the resources of the
hospital and the community are made available to the resident physician in need of psychological support.
It is expected that every resident will observe basic rules of good conduct. While it is impossible to list every
type of behavior that may be deemed a serious offense, the RESIDENT CONDUCT AND WORK RULES
POLICY includes examples of problems that are not all necessarily serious offenses, but may be examples of
unsatisfactory conduct that will trigger progressive discipline.
By using progressive discipline, we hope that most resident problems can be corrected at an early stage
55
benefiting both the resident and WCGME.
Most of these are common sense rules which serve to maintain a professional atmosphere. Listed below are
some non-clinical/educational offenses which could also result in disciplinary action ranging from verbal
counseling to immediate discharge from all duties and responsibilities as a resident:
1.
2.
3.
Chronic or habitual lateness or absenteeism.
Deliberate violation of posted health, safety, fire prevention or security rules.
Deliberate false, fraudulent, or malicious statement or action involving relations with a patient, the
hospital, co-workers, or the public.
4.
Falsification of residency application or records.
5.
Theft or inappropriate removal or possession of property of a patient or visitor, an employee, the
hospital, or an independent contractor.
6.
Actual or threatened physical violence, profane, or abusive language.
7.
Possession, distribution, sale, transfer, or use of alcohol or illegal drugs in the workplace, while on
duty.
Disorderly, immoral, or disruptive conduct while on hospital premises.
8.
Inappropriate appearance, improper wearing of uniform, gross inattention to good grooming and
personal hygiene.
9.
Insubordination or other disrespectful conduct.
10.
Smoking in prohibited areas.
11.
Sexual or other unlawful or unwelcome harassment.
12.
Possession of dangerous or unauthorized materials, such as explosives or firearms, in the workplace.
13.
Unauthorized absence from work station during the workday.
14.
Unauthorized use of telephones, mail system, or other employer-owned equipment.
15.
Unauthorized disclosure of confidential information.
16.
Violation of personnel policies.
17.
Unsatisfactory performance or conduct.
If the circumstances are determined to be so serious as to warrant immediate dismissal from the program, the
circumstances must be documented in writing, presented to the Program Director, and the information
presented to the resident and the Grievance Committee.
If the resident disagrees with the action that has been taken, and the problem cannot be resolved within the
program, a request for a hearing may be made to the Program Director. The Program Director will inform the
Grievance Committee of the initiation of due process procedures. Should the Grievance Committee
recommend dismissal, the Program Director will notify the resident in writing and notify appropriate others in
WCGME administration and faculty. Should the recommendation be non-renewal of contract, the Program
Director will notify the resident and administration of this action.
DUE PROCESS
I. Conditions Mandating Enactment of Due Process
A.
The resident physician’s professional performance and/or conduct does not meet the
standards of the WCGME, and/or the medical staff of the integrated hospitals.
B.
The professional conduct and/or activities of a resident physician are deemed
disruptive to the operation of the three integrated hospitals.
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C.
A resident physician initiates a grievance procedure against the WCGME and/or
aspects
of the program, alleging that the program does not meet the
needs of his/her professional growth and development as the program may have
purported.
II. Procedures
A.
All requests for the initiation of due process procedures must be communicated in
writing, supported by reference to the specific activity and/or conduct which constitute
grounds for the request. Written acknowledgment of the notification of initiation of due
process is required of the parties involved.
(1) The resident physician against whom the due process procedure has been
requested will be informed of that request by the Program Director. Written
acknowledgment of receipt of the request is required of the resident physician.
(2) If a resident physician is initiating a grievance procedure against the WCGME,
the notification is to be sent to the Program Director. Written acknowledgment
of receipt of the request is required of the Program Director.
B.
It is the responsibility of the Program Director to inform the Grievance Committee of
the initiation of due process procedures.
C.
Within seven days of the receipt of notification for due process procedures, the
Grievance Committee will select a date for a hearing and notify all parties involved.
D.
The scheduled hearing is a guarantee for both parties of an equitable mechanism for the
redress of grievances involving professional and educational matters.
III. Grievance Committee
A.
Membership in the Grievance Committee is determined by the Board of Directors.
Representatives to this committee include designated individuals as follows:
1. WCGME administration
2. WCGME teaching staff
3. Curriculum and Evaluation Committee
4. Recruitment and Resident Selection Committee
5. Administration of the Integrated Hospitals
6. Resident Housestaff Representatives
B.
The Grievance Committee will make recommendations to the WCGME Board of
Directors. Final determination of grievances is the responsibility of the WCGME
Board of Directors.
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PRELIMINARY ACADEMIC ACTION
Program Directors are encouraged to use the following preliminary measure to resolve minor instances of
poor performance or misconduct but which do not impact the health or safety of patients or others.
Actions that may adversely impact on health or safety of patients or others are addressed by Probation,
Suspension and/or Immediate Dismissal.
NOTICE OF CONCERN
A Notice of Concern may be issued by the Program Director when (1) a resident’s unsatisfactory
performance or conduct is too serious to be dealt with by informal verbal counseling or (2) a resident’s
unsatisfactory performance or conduct continues and does not improve in response to verbal counseling.
A Notice of Concern must be in writing, provide an explanation of the unsatisfactory performance or
conduct in competency-based language with the expectation of improvement outlined and include a time
frame in which the resident meet these expectations. The time frame should not be greater than three
months. Review by the Notice of Concern by the GME director and the Clinical Competence Committee
is required. The Program Director or designee will then review the Notice of Concern with the resident
which both must sign. A copy is placed in the resident’s program file. During or at the end of the Notice
of Concern Period the resident will meet with the program director or designee to determine whether the
unsatisfactory performance or conduct has been corrected or whether further corrective action will be
taken. If the resident fails to achieve and/or sustain improvement or a repetition of the conduct occurs,
then the program director may take additional action including Non-Promotion, Probation, Immediate
Dismissal or Non-renewal actions after consulting with the Clinical Competence Committee.
This action need not precede other academic actions described in this document. For the purposes of
this policy and for responses to any inquiries, a Notice of Concern does not constitute a disciplinary
action.
FORMAL DISCIPLINARY ACTIONS
Formal disciplinary action may be taken for any appropriate reason, including but not limited to any of the
following examples:
- Failure to satisfy the academic or clinical requirements or standards of the training program expected
for the level of training;
- Any inadequacy or conduct which adversely bears on the individual's performance, such as attitude,
conduct, interpersonal or communication skills, or other misconduct;
- Violations of professional responsibility, policies and procedures, state or federal law or any other
applicable rules and regulations.
Formal disciplinary action may include, but is not limited to:
NON-PROMOTION OF A RESIDENT
If a resident has not met the program standards sufficiently in his or her current training level, the
program may make a decision not to promote a resident to the next level of training in lieu of dismissal
from the program. An official period of probation may or may not be indicated.
The resident should be notified of this decision as soon as circumstances reasonably allow, and in most
58
cases 4 months prior to the end of the contract year. Exceptions to this timeframe would include
performance issues that primarily arise within the final 4 months of the contract year. If a house
officer has received a notice of concern or is on probation, and the end of the resident’s remediation
period is within 4 months of the end of the contract year, the fact that the resident is remediating will
serve as notice that the resident may not be promoted. The notice of non-promotion should outline the
remediation steps to be accomplished prior to the resident’s advancement to the next level and provide an
estimation of the amount of remediation time anticipated. As determined by the applicable
specialty/subspecialty board, the total training time in the program may be lengthened by the duration of
remediation. The resident will be paid at his or her present level until he/she is advanced to the next
level. If the resident does not successfully complete the remediation plan, the process listed below for
dismissal will apply.
Residents may appeal being non-promoted using the resident grievance procedure.
PROBATION
If a resident’s academic or clinical performance, attitude, behavior, or interpersonal or communication
skills puts him/her in jeopardy of not successfully completing the requirements of the training program or
other deficiencies exist which are not corrected by informal verbal counseling or a preliminary academic
action, or are of a serious nature such that informal verbal counseling or a preliminary academic action
are not appropriate, the resident is placed on Probation. Probation should be used instead of a Notice of
Concern when the underlying deficiency requires a substantial change in resident oversight. Probation
may include, but is not limited to, special requirements or alterations in scheduling a resident’s
responsibilities, a reduction or limitation in clinical responsibilities or enhanced supervision of the
resident activities. This temporary modification of the resident’s participation in or responsibilities
within the training program are designed to facilitate the resident’s accomplishment of the program
requirements. The resident will be informed in writing by the Program Director that he/she is being
placed on Probation. Written notification should include an explanation of the deficiencies, performance
or conduct in competency- based language giving rise to Probation, remediation requirements (what the
resident must accomplish in order to come off of probation), the anticipated length of probation, method
of ongoing evaluation, a faculty advisor/supervisor for the probationary period, and the time period of the
Probation. The length and conditions of the Probationary Period must be determined by the Program
Director, after consultation with the GME director. Probationary periods must be time-limited. All
rotations during the probationary period should be within the sponsoring institution. Failure to meet the
terms of probation may result in dismissal from the training program or nonrenewal of contract. If a
resident is on probation, and the end of the resident’s probation period is within 4 months of the end of
the contract year, the fact that the resident is on probation will serve as notice that the resident contract
may not be renewed or he/she may be dismissed from the program if the probation is not remediated
successfully.
Residents may appeal being placed on probation using the resident grievance procedure.
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 Medical Officer
(or designee) of the Wright Center for Graduate Medical Education or of the affiliated institution or
facility for cause, including but not limited to failure to meet general or specific academic standards,
failure to provide patient care in a manner consistent with expectations, potential impairment of the
resident, potential misconduct by the resident, or failure to work in a collegial manner with other
providers. A resident may also be suspended pending an investigation of an allegation of any of the
above concerns.
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A resident must be notified verbally and in writing as to the reason for suspension. When a resident is
suspended, the DIO and/or the GMEC 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. Unless otherwise directed by the
program director, a resident suspended from clinical services may not participate in other program
activities. Suspension is generally with pay. Suspensions must be time-limited but can be renewed if
appropriate. A suspension may be coupled with or followed by other academic actions or conclude in the
resident being reinstated.
Residents may appeal being placed on suspension using the resident grievance procedure.
NON-RENEWAL OF APPOINTMENT
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 prior period of probation or suspension is
not required. A decision regarding reappointment must be reached by the program director 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).
The notice of non-renewal of contract must be approved by the DIO and/or the GMEC. The notification
will be made in writing to the resident with a copy to the official GME file. If the primary reason for the
non-renewal occurs within the four months prior to the end of the contract, the program must provide the
resident with as much written notice of the intent not to renew as the circumstances will reasonably allow.
The resident may be offered the opportunity to conclude the remainder of the academic year or to resign
from the program. For those who continue, at his/her appointed level of training through the end of the
contract period full credit for the year may be given to the resident at the discretion of the Program
Director and guidelines of the individual board. If deficiencies in professional competence that may
endanger patients arise during continued training under a non renewal status, the resident may be
terminated or suspended immediately after consultation with the DIO and/or the GMEC. A decision of
non-renewal of appointment may be appealed using the resident grievance procedure.
DISMISSAL/TERMINATION
A resident may be dismissed from a program because of failure to remediate deficiencies during a
probationary period; suspension or revocation of the resident’s license or permit; conduct constituting
criminal activity; gross and serious violation of expected standards of patient care; failure
to abide by the Behavioral Standards or the applicable regulations of the Wright Center for Graduate
Medical Education, and or other hospitals and facilities to which the resident may rotate or other
responsibilities as specified by the program; or gross and serious failure to work in a collegial manner with
other providers. This decision should involve multiple individuals at the program/departmental level. The
program must consult with the DIO and the GMEC in dismissal decisions. Dismissal may, depending upon
the situation, be immediate or 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. Credit for
training may be given in the event of any satisfactory performance prior to dismissal, per the guidelines of
the individual board.
Residents may appeal being dismissed using the resident grievance.
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POLICY ON RESIDENT IMPAIRMENT
Impairment is defined as “the inability to practice medicine with reasonable skill and safety due to
physical or mental illness, loss of motor skills or abuse of drugs including alcohol” (American Medical
Association). It is professional misconduct to practice medicine while impaired. The Wright Center
for Graduate Medical Education is committed to the provision of support and appropriate referral for
residents whose performance is impaired due to psychological stress, psychiatric illness or abuse of
drugs and/or alcohol. Accordingly, programs must assure that all residents are aware of these services
and informed of the mechanisms through which they may confidentially access them, either to address
problems they are experiencing personally, or to intervene when problems are suspected or observed in
a peer. WCGME will take all reasonable steps to protect the confidentiality of the resident who seeks
voluntary treatment or is referred for treatment subject to applicable legal constraints and the provisions
of this policy.
Voluntary Self Referral for Mental Health or Drug/Alcohol Counseling in the Absence of
Performance Issues
Services available for voluntary self referral related to mental health or drug/alcohol treatment in the
absence of performance issues include:
Counseling Services
Under the auspices of the WCGME network of Psychiatrists, access to confidential consultation
regarding the need for non-emergent psychiatric services is available by contacting the program director.
Resident Crisis Referral Program
Under the auspices of the Wright Center for Graduate Medical Education, access to confidential
consultation regarding the need for emergency psychiatric services is available to residents through the
psychiatric Nurse Practitioner at the Wright Center for Primary Care MVP office
Impaired Physicians Program
The Impaired Physicians Program (IPP) will provide assistance to physicians with mental health or
drug/alcohol related illness. It provides evaluation, referral for treatment and ongoing aftercare including
regular meetings and compliance monitoring. IPP serves as an advocate for the recovering physician with
the Pennsylvania Board of Medical Licensure and other appropriate agencies. Help for oneself or a peer
can be obtained confidentially.
For residents who seek treatment or who require further voluntary evaluation and possibly treatment, the
program director should notify the DIO who will assist the resident in contacting the IPP. A resident who
has enrolled in an IPP approved treatment program may be permitted to return to the training program
with agreement of the IPP and in accordance with the “Return to Duty Section” of this policy.
Required Evaluation for Mental Health or Drug/Alcohol Concerns by Others in the Context of
Performance Related Concerns
When a resident is experiencing performance-related problems or engaging in suspicious behavior, and
impairment is suspected, the institution shall have the right to require the resident to undergo further
evaluation. Suspicious behavior is defined as any instance in which another resident, faculty member,
other hospital employee, patient or patient’s family, or other person suspects that a resident is impaired
during the exercise of his/her professional duties. These incidents may include, but are not limited to,
perceived problems with judgment, behavior, speech, emotional outbursts, depression, alcohol odor or
other evidence of impairment.
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Reports of suspicious behavior should go to the resident’s attending physician or program director.
Upon receiving such a report, the attending physician or program director should immediately meet
with the resident to ascertain if there is cause for concern. The attending physician must make the
program director aware of the situation.
The program director shall make a reasonable effort to determine whether the suspicion is reasonable. If
the program director determines that the report has no foundation and that there are no performance
concerns with respect to the resident, no further action will be taken.
Documentation of this assessment should be recorded by the program director. If the program director
determines that there is cause for concern, the DIO and the GMEC must be contacted and a course of
action shall be determined, which may include but is not limited to further inquiry, suspension, or
resident testing.
Return to Duty
If treatment or rehabilitation is recommended by IPP, and the resident enrolls in an IPP-approved
treatment program, the resident will be required to waive his/her right to confidentiality to the
extent that:
the program will be notified as to whether the proposed treatment plan limits the resident’s
ability to work, and if so, will be provided with a description of the limitations,
the program will be notified periodically whether the resident is participating in the
treatment plan and whether treatment has been successful; and any other information
needed to assess the resident’s continued fitness for the training program.
Whether a resident will be allowed to return to duty or complete his/her training will be evaluated on a
case-by-case basis, taking into consideration the recommendations of the treatment program;, the
limitations, if any, on the resident’s ability to practice and expected duration of the limitations; whether
reasonable accommodations can be made by the training program; the circumstances that give rise to the
initial report of potential impairment (i.e. whether any serious incidents or violations of law occurred);
and whether patient and staff safety can be maintained.
Refusal to Cooperate
If a resident who requires further treatment as determined by the IPP refuses to enroll or
remain enrolled with IPP, the program director will be obligated to report the resident to the
Pennsylvania Board of Medical Licensure. In addition, the resident may be suspended or terminated
from the training program. The resident shall have the right to appeal the suspension and/or termination
pursuant to the appeal.
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ADDITIONAL INSTITUTIONAL POLICIES
BOOKS
Second and third year residents get $200.00 yearly for books. All receipts have to be presented for
reimbursement.
EMPLOYMENT REFERENCE CHECKS
To ensure that individuals who join WCGME are well qualified and have a strong potential to be productive
and successful, it is the policy of WCGME to check the employment references of all applicants.
The Program Coordinator will respond in writing only to those reference check inquiries that are submitted
in writing. Responses to such inquiries will confirm only dates of employment, wage rates, and position(s)
held. No employment data will be released without a written authorization and release signed by the
individual who is the subject of inquiry.
PERSONNEL DATA CHANGES
It is the responsibility of each resident to promptly notify WCGME of any changes in personal
data.
PAY DAYS
Residents are paid biweekly on every other Friday. Each paycheck will include earnings for all work
performed through the end of the previous payroll period.
ADMINISTRATIVE PAY CORRECTIONS
WCGME takes all reasonable steps to ensure that residents receive the correct amount of pay in each
paycheck and that residents are paid promptly on the scheduled payday.
PAY DEDUCTIONS AND SETOFFS
The law requires that WCGME make certain deductions from every resident’s compensation. Among these
are applicable federal, state, and local income taxes. WCGME also must deduct Social Security taxes
on each resident’s earnings up to a specified limit that is called the social security "wage base". WCGME
matches the amount of Social Security taxes paid by each resident.
If you have questions concerning why deductions were made from your pay check or how they were
calculated, the administrative office can assist in having your questions answered.
SAFETY
To assist in providing a safe and healthful work environment for residents, customers, and visitors, the
hospitals in which WCGME operates have established work place safety programs. These programs are a
top priority for both WCGME and the hospitals. The success of the programs depends on the alertness and
personal commitment of all.
WCGME provides information to residents about work place safety and health issues through regular
internal communication channels such as housestaff meetings, bulletin board postings, memos, or other
written communications.
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RESIDENT PROFESSIONAL CONDUCT AND WORK RULES
To ensure orderly operations and provide the best possible work environment, WCGME expects residents
to follow rules of conduct that will protect the interest and safety of all residents and the organization.
People who work together have an impact on each other's performance, productivity, and personal
satisfaction. In addition, the manner in which The Wright Center's employees act toward patients, family
members, physicians, vendors, and other visitors to our facilities either positively supports or negatively
compromises The Wright Center's image and established reputation for the highest level of professionalism
in medical care.
Because individual employee conduct affects many people, The Wright Center expects all employees to
act in a professional manner whenever on company property, conducting company business, or
representing the company at business or social functions.
Although it is not practical to provide an all inclusive list of what professional conduct means, it does, at a
minimum, include the following: adhering to all of the rules established by The Wright Center that apply to
employment, including those are job-specific; refraining from rude, offensive, or outrageous behavior or
gossip; refraining from ridicule and hostile jokes; treating coworkers, patients, family members, vendors,
and other visitors with patience, respect, and consideration; being courteous and helpful to others;
communicating openly, confidentially, and professionally regarding all work-related matters to only those
individuals who have a need to know.
While this policy does not control how employees conduct themselves outside of work, if such conduct or
behavior (whether intentionally or unintentionally) has a resulting effect on professional relationships or
facility operations within The Wright Center, the work-related matters that have been adversely impacted
will be addressed with the individual(s) involved.
It is not possible to list all the forms of behavior that are considered unacceptable in the workplace. The
following are examples of infractions of rules of conduct that may result in disciplinary action, up to and
including termination of employment.
ID BADGE POLICY
As a vital part of our security system, The Wright Center identification badge with your name, photo and
department is being issued to you. Everyone is required to wear an ID badge in plain view while on
Company property or any time while representing The Wright Center. ID Badges are for the sole use of
the person to whom they are issued and should never be used or borrowed by anyone else.
If your identification badge is lost or stolen, you must immediately obtain a replacement. The first
replacement will be provided at no charge. For subsequent loss of an ID badge, a fee of $6.00 will be
assessed for all replacement badges and will be deducted directly from the employee paycheck. Lost or
stolen cards should be reported to Human Resources as soon as possible. Failure to wear your ID badge or
excessive loss or damage to cards can lead to disciplinary action up to an including termination.
Upon termination or The Wright Center's request, employees will be required to return ID badges. ID
badges remain the property of The Wright Center.
DRUG AND ALCOHOL USE
It is WCGME's desire to provide a drug-free, healthful, and safe workplace. To promote this goal, residents
are required to report to work in appropriate mental and physical condition to perform their jobs in a
satisfactory manner.
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While on WCGME premises and while conducting business-related activities off WCGME premises, no
resident may use, possess, distribute, sell, or be under the influence of alcohol or illegal drugs.
ATTENDANCE AND PUNCTUALITY
To maintain a safe and productive work environment, WCGME expects residents to be reliable and to be
punctual in reporting for scheduled work. Absenteeism and tardiness place a burden on other residents and on
WCGME. In the rare instances when residents cannot avoid being late to work or are unable to work as
scheduled, they should notify their attending as soon as possible in advance of the anticipated tardiness or
absence.
Poor attendance and excessive tardiness are disruptive. Either may lead to disciplinary action, up to and
including termination of employment.
PERSONAL APPEARANCE
Dress, grooming, and personal cleanliness standards contribute to the morale of all residents and affect the
business image WCGME presents to patients and visitors. During business hours, residents are expected to
present a clean and neat appearance and to dress according to the requirements of their positions. Consult
your Program Director if you have questions as to what constitutes appropriate attire. Scrub suites should
not be worn during the day.
RETURN OF PROPERTY
Residents are responsible for all property, materials, or written information issued to them or in their
possession or control. Residents must return all WCGME property immediately upon request or upon
termination of employment.
EXIT INTERVIEW
Resident exit interviews will afford an opportunity to discuss your transition, outstanding assignments (the
may include incomplete medical records) as well as information regarding employee benefit terminations
and final paychecks. Formal completion of the program will be dependent upon the resolution of all
outstanding issues.
VENDOR INTERACTIONS
1. The WCGME Ethics curriculum must include instruction in and discussion of published guidelines
regarding gift-giving to physicians such as “Gifts to Physicians from Industry” found in the Code of
Medical Ethics of the American Medical Association, 14 the Policy on Physician-Industry Relations of
the American College of Physicians-American Society of Internal Medicine, 15,16 “Physicians and the
Pharmaceutical Industry” promulgated by the Canadian Medical Association, 17.
2. Full and appropriate disclosure of sponsorship and financial interests is required at all program and
institution-sponsored events, above and beyond those already governed by the Standards for
Commercial Support promulgated by the ACCME. 18 Likewise, full disclosure of research interests
must be published in keeping with the local policies of institutional review boards and following the
recommendations of the Association of American Medical College’s (AAMC) Task Force on Financial
Conflicts of Interest in Research.19
3. WCGME GME trainees must not see medical sales representatives in clinical areas and are to limit
their conversations to evidence based discussions. They must not accept gifts of monetary value greater
than $5.00 and should avoid attending sponsored affairs after duty hours.
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4. Clinical skills and judgment must be learned in an objective and evidence-based learning
environment.
5. Through the medium of noon conferences, residents educated about biases conveyed at sponsored
events and the primacy of patient welfare must be clearly emphasized in the context of industry
attempts to influence medical decision making. Faculty must clarify the differences between education
and promotion.
Residents must be helped to understand the purpose, development, and application of drug formularies
and clinical guidelines. Discussion should include issues as branding, generic drugs, off-label use, and
use of free samples.
6. WCGME programs must assure that clinical skills and judgment are learned in objective and
evidence-based clinical and teaching environments free from inappropriate influence.
7. WCGME curricula must include appropriate considerations of cost-benefit analysis as a component of
prescribing practice.
MEDICAL EDUCATION AND LICENSURE
STATEMENT ON THE PRESCRIBING AUTHORITY OF PHYSICIANS APPROVED FOR
TRAINING IN RESIDENCY PROGRAMS *IN THE COMMONWEALTH OF PENNSYLVANIA*:
1. An intern or resident, properly registered by the Board to participate in a training program in the
Commonwealth of Pennsylvania, may write orders for "inpatients" in the hospital for drugs, controlled
or otherwise. Such orders are legally valid so long as they are countersigned within a reasonable
period of time by an attending staff physician licensed in the Commonwealth of Pennsylvania and
holding a valid DEA registration.
2. An intern or resident, properly registered by the board to participate in a training program in the
Commonwealth of Pennsylvania, cannot write prescriptions for drugs, controlled or otherwise, for
"outpatients" in the ambulatory care settings or for "inpatients" on discharge unless he or she maintains
an unrestricted license to practice medicine or surgery in the Commonwealth of Pennsylvania and also
holds a valid DEA registration. Thus any prescriptions written for drugs, controlled or otherwise, in
the two settings mentioned above have to be written by the preceptor in the clinic in the first case, and
by attendings of the patient in the second case.
3. All new physicians licensed in the Commonwealth of Pennsylvania must apply to the Drug
Enforcement Administration for their DEA number.
4. Under the current laws of the State of Pennsylvania and the federal government, until a resident in
training receives his or her medical license, prescriptions for drugs, controlled or otherwise, written by
residents using a hospital BNDD number with the prefix attached, which is the four digits of one's
social security number, are not acceptable for pharmacies both in and out of the hospital.
5. A holder of a limited license in the Professional category (ll-P) may write prescriptions only for
non-narcotic drugs for "outpatients".
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OSTEOPATHIC INTERNS
Osteopathic interns will take Part III of the osteopathic medical exams. Advancement to further
training and completion of internship requirements will be governed by the rules set forth by the ADA
Division of Postdoctoral Training.
INFORMATION FOR ALL RESIDENTS WHO ARE PARTICIPATING IN GRADUATE
MEDICAL EDUCATION AT LEVEL I, II, AND III:
See Pennsylvania State Board of Medicine at www.dos.state.pa.us/med to review requirements for
licensure.
ALLOPATHIC LICENSURE REQUIREMENTS
Graduate License
(a) A graduate license authorizes the licensee to participate in a year of graduate medical training
within the complex of the hospital to which the licensee is assigned, and a satellite facility or other
training location utilized in the graduate training program.
(b) To secure a graduate license, an applicant shall satisfy one of the following:
(1) Have graduated from an accredited medical college or an unaccredited medical college and
received a medical degree.
(2) Have completed the formal requirements for graduation from an unaccredited medical
college, except an internship or social service requirement, and have successfully completed
a fifth pathway program and an ECFMG certification examination.
(3) Hold a license to practice medicine without restriction in this Commonwealth or an
equivalent license granted by another state, territory or possession of the United States, or the
Dominion of Canada.
(c) Additional requirements for securing a graduate license are that the applicant shall satisfy the
following:
(1) Have been certified by the ECFMG, if the applicant is a graduate of an unaccredited medical
college.
(2) An applicant who is a graduate of an unaccredited medical college or who satisfies the
requirements of subsection (b) (2), and files a complete application for a graduate license shall
submit a diploma and transcript verified by a medical college listed in the International
Medical Education Directory and chartered and recognized by the country in which it is
situated for the provision of medical doctor education. The transcript must identify the
successful completion of the equivalent of 4 academic years of medical education including 2
academic years in the study of the arts and sciences of medicine generally recognized by the
medical education community in the United States and 2 academic years of clinical study of
the practice of medicine as generally recognized by the medical education community in the
United States.
(3) Satisfy the requirements in § 16.12 (relating to general qualifications for licenses and
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certificates).
(d) To participate in graduate medical training at a second-year level under the authority of a graduate
license, the licensee shall first secure a passing score on FLEX I or Part I of the National Boards or
Step 1 of the USMLE plus Part II of the National Boards or Step 2 of the USMLE; a passing
score on a licensing examination acceptable to the Board as set forth in § 17.1(a)(1)(iii), (viii) and
(ix) (relating to license without restriction), or, hold a license to practice medicine without restriction
in this Commonwealth or an equivalent license granted by another state, territory or possession of the
United States or the Dominion of Canada.
(e) To participate in graduate medical training at a third-year level or higher, the licensee shall secure a
passing score on both FLEX I and FLEX II; Part I of the National Boards or Step 1 of the USMLE
plus Part II of the National Boards or Step 2 of the USMLE plus Part III of the National Boards or
Step 3 of the USMLE; Part I of the National Boards or Step 1 of the USMLE plus Part II of the
National Boards or Step 2 of the USMLE plus FLEX II; or FLEX I plus Step 3 of the USMLE; a
passing score on a licensing examination acceptable to the Board as set forth in § 17.1(a)(1)(iii),
(viii) and (ix); or, hold a license to practice medicine without restriction in this Commonwealth or
an equivalent license granted by another state, territory or possession of the United States or the
Dominion of Canada.
(f) A graduate of an unaccredited medical college, who does not possess the qualifications for the
issuance of a graduate license enumerated in subsections (a)—(e), but who desires to train in a
hospital within this Commonwealth in an area of advanced graduate medical training, may have the
unmet qualifications waived by the Board if the Board determines that the applicant possesses the
technical skills and educational background to participate in the training and that the issuance
of a graduate license to the applicant is beneficial to the health, safety and welfare of the
people of this Commonwealth.
(g) A graduate license is only valid for a maximum of 12 consecutive months, but may be renewed
by the Board to permit additional training.
(h) For a graduate license to be renewed, the Board has to receive, prior to the expiration of the
previously issued license, the required renewal fee—see § 16.13 (relating to licensure,
certification, examination and registration fees)—and a completed renewal form. Renewal forms
are provided to hospitals in this Commonwealth that offer graduate medical training programs.
OSTEOPATHIC LICENSURE REQUIREMENTS
Temporary License
(a) A temporary license is required of an osteopathic medical college graduate for permission to
participate in an approved graduate osteopathic or medical training program in this
Commonwealth.
(b) Specific requirements for temporary training licensure are as follows. The applicant shall
have:
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(1) Graduated from an approved osteopathic medical college.
(2) Submitted an application obtained from the Board, together with the required fee.
(c) The temporary training license permits the graduate to train only within the complex of the
hospital and its affiliates where the graduate is engaged in an approved graduate osteopathic or
medical training program.
(d) The temporary training license is valid for 1 year, after which it shall be surrendered to the
Board. The Board may extend the validity of the temporary training license within its discretion.
Please Note: Proof of securing a passing score on the appropriate exams must be submitted to the
Board before a graduate license can be issued. It is advisable for residents to sit for the
appropriate exam in December or a prior date so a break in training can be avoided.
CLINICAL PRACTICE POLICIES
INDIVIDUAL RESPONSIBILITY (7/12)
FIRST YEAR RESIDENTS:
1. Direct care of each patient on his/her service under supervision of the senior resident and the
attending physician
2. Instruction of sub-residents and medical students.
3. Intern admission notes including history and physical and formulation of plans for patient
management and completion of admission orders. The admission note should be on the chart within 12
hours of admission
4. Formulation of complete problem list.
5. Daily progress notes on each patient, and discharge summaries to be dictated in the second half of the
year.
6. Present cases at morning report while on medical service or ICU service.
7. Attendance at conferences and rounds.
8. Care of assigned patients in the WCHC.
SECOND AND THIRD YEAR RESIDENTS:
1.
Direct care of each patient on his/her service under the supervision of the attending physician.
2.
Organization, evaluation and instruction of the patient care team including intern, sub-intern, and
medical students.
3.
Resident admission notes including formulation and revision of plans for patient management. The
admission notes should be on the chart within 12 hours of admission. Also, calling the attending
physician on each admission is mandatory.
4.
Review and completion of progress notes and problem lists, as well as writing and dictating
discharge summaries during the first six months of the year.
5.
Supervision of procedures performed by medical students and residents.
6.
Attendance at conferences and rounds. Presentation of or supervision of appropriate case
presentations by residents.
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7.
8.
9.
Care of assigned patients in the Clinics.
Daily progress notes on each patient reflecting graded responsibility on part of the upper year
commenting on the sub-intern and intern's notes.
Perform consultative services at all hospitals with the attending on service.
OSTEOPATHIC RESIDENTS:
In addition to the above listed –
1.
Recording of musculoskeletal examinations on all history and physicals, on all patients admitted to
the osteopathic attendings.
2.
Recording in the chart of any osteopathic manipulative therapy given.
3.
Keeping a detailed physician log as distributed and explained at orientation.
SUB-RESIDENTS/STUDENTS:
1.
2.
3.
4.
5.
Direct care of assigned patients on his/her service under the supervision of the resident, senior
resident and the attending physician.
Admission notes, including history and physical, on all assigned patients, as well as formulation of
plans for patient management, completion of admission orders countersigned by supervising
resident.
Daily progress notes countersigned by supervising resident.
Call as assigned by the program which may vary from month to month. While on call, subresidents/students will be responsible for the care of all patients in their charge, under the
supervision of the residents. Sub-residents/students will be called to evaluate all problems that do
not require the immediate attention of a licensed physician, including fevers, abnormal test results,
changes in patient status and other non-life threatening conditions. The residents will closely
supervise sub- residents/medical students under all patient care areas.
Attendance at conferences and rounds.
AMBULATORY CARE
During residency training, increasing amounts of time will be devoted to developing skills in this area and
the accumulation of a specific panel of patients for whom the resident will be the primary physician.
The WCGME conducts ambulatory training for its residents at multiple sites.
Residents have varying continuity clinic schedules and also do block rotations in ambulatory care. The
ambulatory care block is designed to be a more intense experience in ambulatory care. Residents and
residents will be able to see patients in the morning and afternoons, in addition to their normal continuity
clinics. They will also be able to spend several days/half days in ambulatory care related office practices,
such as dermatology and rheumatology.
In order for the ambulatory care program to be effective, each resident must provide good service to his/her
patients. This means being in the office on time, responding to pages promptly and returning patient calls
promptly. Ambulatory care is as important as responsibilities to the hospitalized patient. It is the
responsibility of the individual resident to seek approval from the associate program director for any change
in their schedule. Final approval of clinic changes rests with the person in charge of the schedule.
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The main office and the clinic receptionist must be informed of vacation dates, meetings, etc. at least three
months in advance so appointments are not scheduled at these times. If ill, the resident is responsible for
determining which patients can be rescheduled and which should be seen by another resident.
To assure continuity of care for a clinic patient, notifying your fellow resident that his/her patient has been
admitted to the hospital or seen in the emergency room is crucial. It is expected that a resident visit his
patients even when not on service.
Residents will be required to comply with all processes and procedures as set forth in the respective
clinical settings.
OFFICE VISIT PROCEDURES
At each visit, the nurse will weigh the patient, record his/her temperature, pulse, respirations and blood
pressure in the sitting and standing positions. This information will be recorded in the EMR.
Each resident will see and examine his/her patient and then present the case to the attending physician.
After presenting to the attending physician, the resident continues his/her encounter with the patient to discuss
the care plan, any tests, prescriptions, and goal setting before the patient is discharged. This is vital for patient
billing and is a federal requirement.
MEDICAL RECORDS (Progress notes):
Progress notes must be completed before leaving the clinic at the end of the session. Complete, appropriate
medical records are the responsibility of the resident physician. On the first visit, a comprehensive history
and physical examination will be recorded in the EMR. If the patient has been discharged from the hospital,
copies of the initial history and physical and the discharge summary will be obtained and reviewed.
Progress notes will be comprehensive, including the completion of billing data as soon as the appointment is
concluded. In addition to the resident's note, including his signature, the attending physician will annotate
and sign each visit. All reports and consultations will be filed in the patient record by the staff.
Controlled drugs should never be filled or refilled over the phone. Patients who require these
medications should be directed to come set up an appointment with their continuity care resident for the
purpose of examination and to further discuss the need for controlled medications.
PATIENT CARE OTHER THAN DURING THE HOURS OF OPERATION: Each resident is
responsible for providing continuing care. The senior resident on call in the hospital on nights and weekends
will be responsible for covering the ambulatory care practice.
DUTY HOURS
I.PURPOSE
The purpose of this policy is to ensure that The Wright Center for Graduate Medical Education meets the
program requirements for resident duty hours to support the physical and emotional well-being of all
residents while promoting an educational environment that promotes patient care. Duty hour assignments
recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
II. POLICY
Providing WCGME residents’ with sound academic and clinical education is carefully planned with
concerns for patient safety and the residents’ well being. Our Program Director(s) ensures that the learning
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objectives of the Program are not compromised by excessive reliance on residents’ to fulfill service
obligations. Duty hours, however, reflect the fact that responsibilities for continuing patient care are not
automatically discharged at specific times. The Wright Center for Graduate Medical Education ensures
that our residents’ are provided appropriate back-up support when patient care responsibilities are
especially difficulty or prolonged. At WCGME, didactic and clinical education has priority in the
allotment of the residents’ time and energies. Duty hour assignments recognize that WCGME faculty and
residents’ collectively have responsibility for the safety and welfare of patients. Our Program Director(s)
has established an environment that is optimal for Housestaff education and patient care ensuring that
undue stress and fatigue among residents’ is avoided.
WCGME Residents’ duty hours and on-call time periods are not excessive. The structuring of duty hours
and on-call schedules focus on the needs of the patient, continuity of care, and the educational needs of
each and every resident. Duty hours are also consistent with our Institutional and Program Requirements
as outlined by the Accreditation Council for Graduate Medical Education (ACGME).
III. DEFINITIONS
A. Duty Hours are defined as all clinical and academic activities related to the training 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 such as
conferences. Duty hours do not include reading and preparation time spent away from the work site.
B. In-house Call is defined as those duty hours beyond the normal work day when residents’ are required
to be immediately available in the assigned institution.
C. New patient: Any patient for whom the Resident has not previously provided care.
IV. PROCEDURE
A. Oversight
WCGME has established and implemented formal written policies and procedures governing resident duty
hours and their working environment in compliance with the ACGME Institutional and Program
Requirements. WCGME communicates with and provides a copy of the policy to the residents’ and
faculty annually.
These formal policies apply to all facilities where our residents train. The structuring of duty hours and oncall schedules focus on the needs of the patient, continuity of care, and the educational needs of the
resident.
WCGME’s Program Director(s) and faculty have adopted policies to prevent and counteract effects of
fatigue. WCGME ensures that the residents’ are provided with appropriate back-up support when patient
care responsibilities are especially difficult or prolonged, or if unexpected circumstances create resident
fatigue sufficient enough to jeopardize patient care.
B. Monitoring
WCGME has established a method for obtaining data on compliance with Resident Duty Hours
Requirements with formal monitoring of duty hours though the www.myevaluations.com system. Accurate
duty hours are to be entered by each resident on a daily basis, and any violation will require an online
explanation that will be reviewed and assessed by the Program Director. The duty hours are monitored and
questions related to the balance of educational and service components of rotations are discussed with the
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residents’ at their semi-annual evaluation meetings with the Program Director. The resident schedule is
constructed with full respect of the duty hours and a priority to avoid any potential opportunities for
violation. Residents’ are encouraged and frequently reminded to access their on-line schedule and to
anticipate any potential duty hour violations so immediate attention can be given to appropriate
preventative adjustments. Every resident is responsible for providing accurate and timely data to the
Program Director or his/her designee and will provide program accreditors with this information, if
requested. The Program Director reviews each resident’s rotation schedule to assure compliance with
WCGME’s institutional policy and the common program requirements. WCGME’s GMEC monitors
compliance with this policy through the Internal Review process, annual GME reports and periodic
monitoring of the program.
Falsification of duty hour data or pressure to cause the falsification of such data is considered egregious
behavior for residents’ and can result in disciplinary action to include dismissal. The residents’ are advised
to notify their Program Director immediately of requests or pressure to work in excess of duty hours
authorized by this policy.
C. Duty Hour Requirements – ACGME (6/28/2012)
The Wright Center for Graduate Medical Education fully supports and adheres to the Residents’ Work
Hours policy established by the Accreditation Council for Graduate Medical Education (ACGME), which
sets forth the following requirements:
1. Maximun hours of work per week: A maximum of 80 hours per week averaged over four weeks,
inclusive of all in-house call activities.
2. Moonlighting: WCGME does not permit moonlighting.
3. Minimum time off between scheduled duty periods:
PGY-1 Residents should have 10 hours, and must have 8 hours, free of duty between scheduled duty
periods.
PGY-2 and 3 Residents should have 10 hours, and must have 8 hours, free of duty between
scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house
duty.
4. Mandatory time free of duty: Residents must be provided with 1 day in 7 free from all
educational and clinical responsibilities, averaged over a four week period, inclusive of call. One
day is defined as a continuous 24 hour period free from all clinical, educational and administrative
activities.
5. Maximum duty period length:
PGY-1 Residents – must not exceed16 hours maximum continuous on-site duty .
PGY-2 and above Residents - 24 hours maximum continuous on-site duty.
Up to 4 additional hours are permitted for patient transfer and other activities.
No new patients a r e to be admitted by a resident after 24 hours of continuous duty.
6. Maximum in-house on-call frequency: In-house call PGY-2 and above, must occur not more
than every 3rd night, averaged over four weeks.
7. WCGME does not require at-home call.
Duty Hour Requirements for Osteopathic Residents - AOA: (9/12)
The Wright Center for Graduate Medical Education fully supports and adheres to the Residents’ Work
Hours policies established by the AOA which sets forth the following requirements:
1.
Maximum hours of work per week: A maximum of 80 hours per week averaged over four weeks,
inclusive of all in-house call activities.
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2.
Moonlighting: WCGME does not permit moonlighting.
3.
A minimum of 10 hours time period for rest and personal activities must be provided between all
daily duty periods and after in-house call.
4.
Mandatory time free of duty: Residents must be provided with 1 day in 7 free from all educational
and clinical responsibilities, averaged over a four week period, inclusive of call. One day is defined as
a continuous 24 hour period free from all clinical, educational and administrative activities.
5.
Maximum duty period length: 24 hours maximum continuous on-site duty. Up to 6 additional
hours are permitted for patient transfer and other activities.
6.
No new patients are to be admitted by a resident after 24 hours of continuous duty.
7.
Resident time spent in the hospital during at-home call to be counted toward the 80 hour maximum
hours.
8.
WCGME does not require at-home call.
9. In house call must occur not more than every 3rd night, averaged over four weeks.
D. Duty Hours Exception
WCGME does not permit a duty hour exception.
EMERGENCY ROOM (7/12)
The time spent by residents in the Emergency Room is considered meaningful patient responsibility.
During this rotation, residents are supervised by the ER physicians. The goal is to become well versed with
the emergencies.
A separate schedule will be issued to each resident working in the Emergency Room, including morning,
afternoon and evening shifts.
CONSULTATIVE SERVICES (7/12)
The senior resident or a coordinator/attending is called with the consult, who then assigns the consult to the
appropriate team.
Consults are written in the same format as the history and physical. The senior resident then discusses the
case with the attending on service and calls the consulting attending with his or her opinion. He also dictates
the consult saying which attending he is covering for.
If, after contributing to the care of the patient, the resident who is consulted does not feel the need to follow
the patients further he can sign off the case only after discussing the matter with the attending on
service/call and notifying the consulting attending of the decision.
IN-PATIENT MEDICAL SERVICES (7/12)
During this period of training, the residents are expected to develop skills in history taking, physical
examination and patient management as part of developing the core competencies.
Other important areas are learning include how to use the laboratory services effectively and economically;
and the appropriate use of x-ray and other diagnostic services. The residents learn how to work with
consultants and how to resolve diagnostic and therapeutic dilemmas. Training also enables the residents to
use the medical literature effectively.
One of the more important parts of the medical rotation is the opportunity to teach. Most frequently this
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will be on an informal basis with other residents or allied health professionals. In addition, when medical
students are assigned to the service, there will be ample opportunity to provide example, guidance and
training. The results of experiences with interesting problems and the summaries of literature searches may
be presented at morning report or other conferences. The preparation of case reports for publication is
strongly encouraged.
ORGANIZATION OF THE MEDICAL SERVICES
Teaching service patients are admitted into “Services” run at the hospitals under the direct supervision of
WCGME faculty members. Service teams usually include an intern and a senior resident though
occasionally can be run by a senior resident alone under the guidance of a WCGME faculty member.
Patient numbers in each service and admissions to each service per day are strictly within program
parameters.
RESPONSE TO CARDIAC ARRESTS (7/12)
Senior residents and residents are expected to respond to cardiac arrests/codes within the hospital. They
will be notified about cardiac arrests via their beepers or on the overhead paging system of the hospital.
LIBRARY FACILITIES
Reference to the medical literature is an essential feature of practice. The resident is expected to develop
skill and facility in the use of the current literature and to apply the knowledge to resolution of his patient's
problems. The collections at each participating site and online library contain current texts and a wide
selection of journals.
Familiarity with the use of a medical library is essential for a well-rounded physician. It is hoped that each
resident will avail themselves of the opportunity to become personally familiar with the procedure of a
literature search regarding patient care questions.
LABORATORY FACILITIES
At our participating hospitals and in each ambulatory care facility, basic laboratory equipment is available.
In the hospital laboratories, stains for blood smears and gram stain are also available. It is expected that the
residents will use these facilities to complete the necessary studies on their patients. Each resident will
be responsible for cleaning up after themselves, by discarding unused specimens and protecting all
equipment. If additional supplies or reagents are required, the charge nurse in each area is to be notified.
MEDICAL RECORDS
The medical record provides a comprehensive, up-to-date, legible and lucid account of all information
pertinent to the clinical course of the patient. The problem-oriented record is the only uniform system of
medical record keeping currently available, and its use is required. All members of the health care team
should share the conviction that complete, high-quality medical records are essential to, and are a direct
reflection of, high standards of patient care.
All clinical entries in the patient's medical record shall be accurately dated and timed and authenticated by
written signature or identifiable initials.
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Symbols and abbreviations may be used only when they have been approved by the Medical Staff. An
official record of approved abbreviation is kept on file in the record room of each institution.
Medical Record Keeping (7/12)
Progress notes should be dated, signed and name stamped, with time recorded.
Orders should be dated, signed and name stamped with time recorded. Osteopathic residents MUST
document the musculoskeletal exam.
Pelvic exam should be done and recorded on every female patient unless done within the last two years or
refused by the patient. These reasons, if given, should be specifically recorded.
Rectal examination should be done on every adult patient. If not done, the reason should be explicitly
recorded.
Functional status of patient at home should be recorded in the history.
Discharge summaries should be done within 24 hours of discharge, and a discharge note documented on the
chart on the day of the discharge. Preferably, discharge summaries should be done on the day of discharge.
Progress notes should reveal graded responsibility on the part of the residents.
All imaging test requests should be accompanied by a specific reason for the particular study and the
diagnosis list on the order sheet.
Problem lists, located in front of the progress notes, should be completed on the day of admission and
updated daily.
The chart is an integrated document compiled by a team, which include attending and housestaff, medical
students, nurses and allied health personnel. It should reflect the close working relationship, which must
exist to provide coherent medical care. Redundancy should be kept to a minimum.
HISTORY AND PHYSICAL (7/12)
A complete history and physical examination must be performed and charted and dictated within 24 hours,
on every patient admitted. The results of rectal and pelvic exams must also be charted within 24 hours. If
not, the reason for deferral must be stated on the chart. Osteopathic physicians must document the
musculoskeletal exam.
Residents are responsible for establishing phone contact with physicians caring for the patient and requesting
all data from previous hospital admissions.
The admission note (history and physical) must be in the problem-oriented form. The usual sequence is:
Chief Complaint
History of Present Illness
Past Medical History
Past Surgical History
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Family History
Social History
Medications
Allergies
Review of Systems
Physical Examination
Admission Laboratory Studies, EKGs, Radiological Studies
Assessment
Plan
In many instances clinical decisions must be based upon timely basic laboratory work. Laboratory facilities
available in the teaching clinical area include:
Hematocrit
Peripheral Blood Smear
Urinalysis
Stool Guaiac
Gram Stain of secretions and body fluids and indicated studies will be done on admission and as
required during the hospital stay. Results of these tests will be recorded in the admission note
The admission history and physical must be dictated within 24 hours of the admission and definitely before
discharge of the patient. Since such notes will not be on the chart for many hours, a written note is required.
This will be of sufficient length to identify major problems, and diagnostic and therapeutic goals.
The supervisory physician should personally note in the patient's medical record that he saw the patient on
admission or within a reasonable period thereafter.
PROBLEM LIST
The problem list is the key or index to the medical record. It also serves to help the physician effectively
organize his thoughts, resolve diagnostic problems and effectively plan therapeutic intervention.
A well conceived problem list includes:
1. All problems past and present are defined.
2. Social, psychiatric and medical problems are included.
3. Each problem is defined at your level of understanding and may be defined in terms of a. an observation
b. a sign
c. a symptom
d. a specific diagnosis.
4. When one problem is a major diagnosis but has various manifestations, the latter are listed
as separate problems and are so indicated, e.g. #1 cirrhosis; #2 ascites due to #1.
5. Entries are revised as necessary.
6. When several individual problems are found to constitute a diagnosis, add this as a new problem
and indicate that the earlier problems are secondary to this major diagnosis.
7. Transient problems are listed as temporary.
8. The status of each entry is kept current.
REPORTING INCIDENTS
Every department of the hospital is supplied with Incident Report Sheets. A confidential report of an
incident concerning a patient is to be filled out, signed and submitted to the Director of Nursing. A
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confidential report of an incident concerning a visitor, employee or others is to be filled out, signed and
submitted to Administration.
The definition of an incident is as follows - "An incident is any happening which is not consistent with the
routine operation of the hospital or the routine care of a particular patient. It may be an accident or a
situation, which might result in an accident. This might involve patient, visitor, employee or other."
PROGRESS NOTES (7/12)
A. Resident
Progress notes are the responsibility of the residents and should be written daily in the problem- oriented
format (SOAP note) by both the senior and junior residents. The resident should summarize the progress
made in diagnosis and therapy and outline future plans. Visits made by the attending physician should be
noted and specific advice or orders given by the attending should be emphasized. In addition, progress notes
should be dated, timed, signed and should be LEGIBLE. Covering residents should write a brief note for
any significant change in the condition or management of the patient they are called to evaluate. The service
resident should write a summary of patient’s hospital course at the end of their rotation to benefit the
incoming team.
B. Attending Physician
The attending physician should write progress notes daily. The emphasis in all progress notes should be to
convey a summary of the current diagnostic and therapeutic approval to the patient rather than a repetition
data recorded elsewhere in the chart. The problem list should be re-examined and revised frequently to reflect
the patient's current status.
DIAGNOSTIC OPERATIVE PROCEDURES DOCUMENTATION
Diagnostic procedures such as joint aspiration, lumbar puncture, thoracentesis and minor operative
procedures should be entered in the progress notes and should be in the following format:
Operators
Indication
Procedure
Complications
Results
DISCHARGE SUMMARY (7/12)
The discharge summary is also an important element of the medical record. In general, it will be the only
document concerning the hospitalization that will be placed in the out-patient record. It must be concise, but
complete.
At the time of discharge, the resident is responsible for completion of the face sheet and discharge summary.
If the discharge summary is not done at discharge, at least the summary sheet should be completed
documenting the final diagnosis explaining admission. The summary must be completed within three weeks
of discharge.
Summaries should be dictated in the following format:
This is Dr…….. (your name)
Dictating the Discharge Summary
On……………. (patient’s name)
MR #....................
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Attending………. (specific name rather than TS)
Date of admission…….
Date of discharge…….
Primary admission diagnosis….. (cause of admission eg CP R/o MI)
Discharge diagnoses…… (main diagnosis first, followed by the full problem list)
Medications….. (list all meds given on discharge and their duration of use)
Hospital course…. (briefly explain what was done from admission to discharge during the course of his
stay; not H&P)
Physical exam..... (at the time of discharge)
Consults…. (mention name and speciality)
Procedures….. (if any and outcome; eg appendectomy)
Labs and Special studies….. (admission and discharge labs and any significant changes in between.
Special studies like ERCP)
Discharge plan….. (rehab, duration of therapy, home health, labs to be done etc)
No graduation from WCGME will be granted and the last paycheck will not be released to any resident
who has incomplete charts at any of the partnering facilities.
DOCUMENTATION OF RECORDS REQUIRED FOR REIMBURSEMENT
As medical post-graduate education faces a challenge to its very existence deriving in large part to the rising
costs of hospital care, it is incumbent upon everyone to do what is necessary to help support the teaching
program. Central to this goal is optimal recovery of justifiable charges to third-party payers. Adequate
documentation of services rendered is the sine quo non of the payment process.
The following information is intended to outline the requirements. A supervising physician in a teaching
setting may receive payment for any direct patient care that he personally provides the patient. The
documentation of this service in the record should be made by the supervising physician and should clearly
show that he provided the service.
THE ELECTRONIC MEDICAL RECORD
The Wright Center Residency Program utilizes an electronic medical record (EMR) system clinics to
document all instances of patient care. Training will occur at orientation and through individual services.
DELINQUENT RECORDS
PURPOSE
Residents are required to complete medical records at all participating institutions in order to avoid
delinquency as outlined in Medical Staff bylaws of the participating institutions of the Wright Center
Residency Program.
POLICY
Delinquency in completion of medical records at all participating institutions constitutes grounds for
withholding Resident compensation.
The Wright Center for Graduate Medical Education Resident Agreement contains a statement outlining
institutional requirements for completion of medical records. A signed contract is obtained from each
member of the WCGME housestaff.
On the first weekday of each month, Medical Records publishes a list of resident delinquent in
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completion of medical records.
Correspondence is addressed to each delinquent resident notifying them of delinquency and instructing
them to complete delinquent records.
The resident must complete his/her delinquent records by the second pay period after
notification. Medical Records publishes a list of housestaff who remain delinquent in completion of
medical records. This list is forwarded to the Graduate Medical Education Office and to payroll.
Direct deposits and checks for any individuals on the delinquent list are held, and the resident is
notified.
Upon notification of record completion from Medical Records, t he resident’s paycheck will be
released.
ORDER WRITING (7/12)
All patients are the responsibility of their respective staff physicians. In order to encourage and improve
personal communication between the attending physician and the housestaff and, thereby, improve the
educational experience, all orders are to be written by the resident, except surgical orders and orders for
procedures written by sub-specialists.
The attending physician may incorporate suggestions into the progress notes which will be written as orders
by the residents. For more urgent problems, the attending should call the resident and advise him/her of
what needs to be done and vice versa. Overall frequent communication between residents and the attending
is essential and is to be encouraged. Telephone verbal orders should be limited to emergency and laboratory
requests whenever possible.
In emergency situations, orders may be written by the attending or consulting physician.
Orders written by medical students will neither be noted nor carried out until countersigned by a resident.
Both admission orders and discharge orders are to be countersigned by the attending physician.
In a well-managed case, all orders are written in a timely manner and only once a day. This should be done
when the patient is seen on morning rounds. We all recognize that changes in the patient's status or the
return of results from laboratory or x-ray studies can make it necessary to write additional orders. Even in
these instances, all the new orders should be written at one time. Orders should always be dated, timed and
signed, followed by your pager number.
After orders are written, the chart should be flagged to call the new orders to the attention of the charge
nurse. This is customarily done by folding the order sheet diagonally so that the bottom protrudes from the
side of the chart and then the chart is kept on the rack in front of the charge nurse.
The incoming team should write a transfer order on the first day specifying the attending senior resident
and intern of the team.
In urgent situations, the resident should personally call orders to the attention of the charge nurse.
SIGN-OUT PROCESS
Goals: To transfer information and responsibility about patient care safely, effectively and in a
standardized format.
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Objectives:
• To promote resident appreciation of the paramount professional responsibility of safe, seamless
patient care.
• To promote resident appreciation of Systems-Based Practice quality processes that diminishes
performance variability.
• To learn the process of accurate transfer of information about patients’ current state and their
plan of care.
• To practice transferring patients’ information, responsibility, and authority from one resident to
another.
• To learn the skills needed to communicate a clear mental picture of the patients for whom they
are assuming care, know the current status and plan of care for those patients, and have a sense
of what problems and issues may arise during the next shift.
• To learn to conduct a concise, face-to-face, written and verbal communication of pertinent
patient information that is necessary for optimal patient care until the next shift.
• To learn to identify and communicate effectively anticipated problems and the appropriate plan
of care for each, before the next hand-off of care, as well as an opportunity to ask questions and
obtain clarification.
• To learn to use WCGME’s web-based patient sign-out system at www.mypatientyourpatient.com.
• To promote residents’ educational utilization of ICD-9 diagnosis codes.
How are residents assessed: Frequent direct faculty supervision of the sign-out process amongst the
residents followed by verbal feedback, Mini-CEX.
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ROUNDS (7/12)
PRE-ROUNDS: Residents on service will see their patients prior to the morning report. They will gather
overnight data, examine the patient, and get a preliminary patient care plan organized for the work rounds.
Progress notes can be written at this time as time allows. Pre-rounds will also be performed by the subresidents and medical students on the patients allotted to them.
WORK ROUNDS: Each patient on service is seen by the senior resident, intern and medical student as a
team. At this time, evaluation of the patient's status is made and therapeutic and diagnostic plans are
formulated. These rounds start at the beginning of the work day, immediately after the morning report, and
should be completed expeditiously. In-depth teaching discussion with students is not appropriate at this
time, nor is writing progress notes.
ATTENDING ROUNDS: The Residency Review Committee distinguishes between work (or patient
management rounds) and teaching rounds. The attending is intended to provide the latter, so questions of
academic interest with reference to past medical literature should be a prime focus as well as discussions of
specific problems. The requirement is for one and one-half hour of attending teaching rounds three times a
week. The first patients presented and discussed will be the medical service patients. The next group will be
the private patients of the attending physician. If time permits, patients of other physicians who are on the
resident service will be presented.
SIGN-OUT ROUNDS: When leaving the service, nights and weekends, in the charge of a covering resident,
the service resident will meet with the covering resident and provide him with a list of patients and give him a
detailed sign-out on each patient. He will also discuss in depth any problem patients and outline any
therapeutic regimen he wishes to be followed on his patients.
CHART ROUNDS: On a weekly basis, each resident should set aside sufficient time to review each of his
patient's charts. These will be designed to review the progress of patient problems as reflected in the medical
record. A review of all standing orders, with the nurse-in-charge, should be made at this time.
SCHEDULIING
(7/12)
RESIDENT RESPONSIBILITY FOR HIS/HER SCHEDULE
The resident physician should always be aware of his/her rotation schedule. Residents are advised to check
www.amion.com at least once each day to verify their schedule.
1. The WCGME Call schedule is available online at www.amion.com. The password to access the
schedule will be provided during the orientation.
2. The yearly schedule will be made up of thirteen four-week blocks.
3. All requests for days off or vacation must be submitted in writing to the WCGME office prior to the
start of the academic year by the date specified. Conference time can be scheduled at a later date, but
no later than 60 days prior to the conference.
4. Making block schedules ahead of time will allow you more opportunity to be aware of your schedules.
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Schedule change requests made after the schedule is made will not be honored except under
special circumstances.
5. In general, no more than two residents will be allowed to be on vacation or conference during a given
time. Exceptions can be made to this rule only for extreme circumstances.
6. One week of vacation may be taken continuously. Longer vacation blocks will be allowed only under
special circumstances and with prior approval. Vacation can even be split into individual days.
GRIEVANCE PROCEDURE AND SCHEDULE CHANGE REQUESTS
Step 1-Informal Complaint-Scheduling situations may arise in which a resident believes he/she has not
received fair treatment with assigned calls, clinics, vacation, etc. If this is the case, please speak with the
Chief Resident who will discuss the complaint with the scheduler. Please be assured that your grievance
will be looked into in a fair and unbiased way.
Step 2- Mediation-If there is still no satisfactory resolution to the informal complaint the Associate
Program Director, an impartial expert, will act as a mediator to try and settle this amicably.
PROCEDURE TO BE FOLLOWED FOR CHANGE REQUESTS:
CLINIC CHANGE REQUEST-The Clinic Change Request Form must be completed by the resident
and given to the Chief Resident or APD, for signature approval. Once approved, the resident will then
give the signed form to the scheduler who will make the necessary changes online (at www.amion.com)
and notify the clinic staff regarding the change.
CALL CHANGE REQUEST-The Call Change Request Form must be completed by the resident and
handed over to the Chief Resident who will then determine if the call change is reasonable and discuss it
with the scheduler to see if the requested change can be accommodated. If both are in agreement, the
call change form will be signed by the Chief Resident and faxed over to the scheduler who will then
publish the necessary change online and notify hospital operators and the answering service as
necessary. The scheduler will keep a copy of the request form on file and give a copy to the payroll
department for the purposes of tracking resident time-off. No last minute call changes are allowed on
weekends unless for a medical reason, in which case the Sick Call Policy will apply. If the Chief
Resident and the Scheduler do not agree to a call change or if the resident does not agree with the
decision that was made, the resident can follow the grievance procedure listed above.
VACATION REQUEST-The Vacation Request Form must be completed and faxed to the scheduler.
Requests will be honored on a first-come-first-served basis, provided they are within the WCGME and
program guidelines. If the scheduler cannot honor the request he/she will consult the Associate Program
Director to see if something can possibly be done. If not, the Associate Program Director will sign the
form and state the reason why the request was denied and forward it to the resident. If the resident has
an issue with the explanation for denial he/she will need to discuss it with the Associate Program
Director.
CME REQUESTS-The CME Request Form must be completed and given to the Associate Program
Director for signature to verify the educational value of the CME activity. The form will then be handed
over to the scheduler who will check the schedule to make sure it is during an elective block and
whether or not it requires any clinic or call changes in which case the above procedure will apply. Only
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when all the clinic, and/or call change coverage has been provided by the resident will the CME activity
be approved.
SICK CALL ( 7/12)
This policy is designed to:
Provide coverage for clinical duties if another resident is ill or has a family emergency.
Ensure the availability of residents’ assigned to “at risk” call duty.
Delineate the resident’s responsibility for coverage.
Procedure to follow when calling off sick:
The resident will page the Chief Resident to inform them of his/her illness or situation. The name and
contact information of the colleague on “at risk” call is available on the web at www.amion.com. You will
immediately contact this colleague. During the conversation with your colleague, you will discuss the
work type and duration for which you need coverage. It is your responsibility to ensure safe,
comprehensive transfer of your duties to the covering colleague. Immediately after this conversation, you
will page and inform the Chief Resident of the transfer of coverage and you will then call the hospital
operators and answering services to alert them of the change. This procedure is to be followed during the
week as well as on the weekends. On weekends we ask that you get in touch with the Chief Resident or,
as a last resort, the attending physician on call. Should you be unable to contact the colleague on “at risk”
call, please notify the Chief Resident who will then assist you further. For each night “at risk” call is used
the resident who is ill will update the Chief Resident regarding their condition. Each “at risk” call resident
who takes your call(s) will be paid back by you. There are two residents “at risk”, the first “at risk” is the
second year resident, followed by the third year “at risk”. If only one resident is “at risk”, then that
person is responsible for sick coverage. If you are scheduled for clinic on the day you call in sick please
be sure to inform the Chief Resident who will assign another resident to see your patients. If you call in
sick during your service weekday, you will be asked to replace a call for the covering resident.
This policy applies similarly to the Night Float block.
WORK ENVIRONMENT (7/12)
1. Food services: Residents’ on duty will have access to adequate and appropriate food services.
Food is provided to Residents’ who take in-house call.
2. Call rooms: Call rooms are provided for Residents’ who take in-house call.
3. Support services: Adequate ancillary support for patient care is provided for residents’ at all times.
4. Laboratory/pathology/radiology services: These services and the associated information
systems are available and adequate to support timely and quality patient care.
5. Medical Records: Medical records system that documents the course of each patient’s illness and
care are available at all times and is adequate to support quality patient care, the education of the
Resident, quality assurance and provide a resource for scholarly activity.
6. Security/safety: Appropriate security and personal safety measures are provided to Residents’ at
all training locations.
ATTENDING PHYSICIAN PEER REVIEW
Attending physicians are being scrutinized by Kepro. When you are involved in managing a case you must
remember to document the reasons for your approach to patient care.
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e.g., Microscopic pyuria - you may or may not with to investigate it, but you must document why you take a
particular course of action.
e.g., Anemia - you should clearly state why you think a patient is anemic and not just gloss over it.
e.g., Abnormalities on imaging reports - you may disagree with a report, but you should document the
reasons why you did not react appropriately to what is written on a report.
e.g., Vital signs - if you discharge someone with elevation of temperature, make sure you state, clearly,
why.
Please remember that the attending physicians will have to spend hours reviewing the record and responding
to Kepro in order to try to avoid getting quality points against him/her. Being an attending is challenging
and enjoyable, but quite stressful in terms of time expenditures. In order to maintain the morale of our
volunteer attending staff, WCGME needs complete cooperation from the housestaff.
POLICIES GOVERNING INFORMATION AND INFORMATION TECHNOLOGY
DIGITAL PROFESSIONALISM POLICY FOR APPROPRIATE USE OF THE INTERNET,
ELECTRONIC NETWORKING AND OTHER MEDIA (9/6/2011)
These Guidelines apply to all postgraduate trainees including postgraduate students, fellows, clinical
research fellows, or equivalent. Use of the Internet includes posting on blogs, instant messaging [IM],
social networking sites, e-mail, posting to public media sites, mailing lists and video-sites.
The capacity to record, store and transmit information in electronic format brings new responsibilities to
those working in healthcare with respect to privacy of patient information and ensuring public trust in our
hospitals, institutions and practices. As with most recent technological innovations of recent years, the law
is having a difficult time keeping up with these fast paced advancements. It has become increasingly
evident it is necessary to establish some kind of digital media and social networking guidelines. Significant
educational benefits can be derived from this technology but trainees need to be aware that there are also
potential problems and liabilities associated with its use. Material that identifies patients, institutions or
colleagues and is intentionally or unintentionally placed in the public domain may constitute a breach of
standards of professionalism and confidentiality that damages the profession and our institutions. Guidance
for postgraduate trainees and the profession in the appropriate use of the Internet and electronic publication
is necessary to avoid problems while maintaining freedom of expression.
Postgraduate trainees are reminded that they must meet multiple obligations in their capacity as members
of the profession and as employees of hospitals and other institutions. These obligations extend to the use
of the Internet at any time – whether in a private or public forum.
These Guidelines were developed by reference to existing standards and policies as set out in the
Regulated Health Professions Act, the Medicine Act and Regulations, the Standards of Professional
Practice Behavior for all Health Professional Students [the Standards] and the WCGME Electronic Usage
and Access Policy. Postgraduate trainees are also subject to the Personal Health Information and Privacy
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Act as “health information custodians” of “personal health information” about individuals.
DIGITAL MEDIA POLICY (12/7/2011)
General Guidelines for Safe Internet Use:
These Guidelines are based on several foundational principles as follows;
- The importance of privacy and confidentiality to the development of trust
between physician and patient,
- Respect for colleagues and co-workers in an inter-professional environment,
- The tone and content of electronic conversations should remain professional;
this includes any and all online postings as well as the use of email sent from
your WCGME email account.
- Responsibility for the content of individual online postings (for example: blogs,
social networking sites and other digital media).
- The permanency of published material on the Web,
- That all involved in health care have an obligation to maintain the privacy and
security of patient records under The Health Information Portability and
Accountability Act [HIPAA],
- The importance of your individual safety when posting personal materials, such
as phone numbers, locations, or daily schedules online; (cyberspace can create
an illusion of safety or intimacy that can be dangerous in reality.)
RULES AND REGULATIONS
I. Posting Information about Patients
Never post personal health information about an individual patient.
Personal health information has been defined in the HIPAA as any information about an individual in oral
or recorded form, where the information “identifies an individual or for which there is a reasonable basis to
believe it can be used to identify the individual.”
2
These guidelines apply even if the individual patient is the only person who may be able to identify him or
herself on the basis of the posted description. Trainees and staff should ensure that anonymous descriptions
do not contain information that will enable any person, including people who have access to other sources
of information about a patient, to identify the individuals described. This encompasses all emails and text
messages sent from personal phones. Most electronic media becomes cached information. Caching, in
effect, means that if you post or send something electronically, even if you take it down or change it, it
may remain accessible to the rest of the world on the Internet.
1
2
Health Information Portability and Accountability Act (HIPAA), 1996, 104-191.
HIPAA, 1996, C.F.R. 160.103
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EXCEPTIONS that would be considered appropriate use of the Internet:
It is appropriate to post:
1. With the express consent of the patient or substitute decision-maker. This
includes all photos of patients. Clear documentation of verbal consent is
needed for all photo images.
2. Within secure internal hospital networks if expressly approved by the hospital or institution.
Please refer to the specific internal policies of the hospital or institution
3. Within specific secure course-based environments that have been set up by The Wright Center
for Graduate Medical Education and that are password-protected or have otherwise been made
secure.
Even within these course-based environments, participants should
a. adopt practices to “anonymise” individuals;
b. ensure there are no patient identifiers associated with presentation materials; and
c. use objective rather than subjective language to describe patient behavior. For these
purposes, all events involving an individual patient should be described as objectively as
possible, i.e., describe a hostile person by simply stating the facts, such as what the person
said or did and surrounding circumstances or response of staff, without using derogatory or
judgmental language.
4. Entirely fictionalized accounts that are so labeled
II. Posting Information about Colleagues and Co-Workers
Respect for the privacy rights of colleagues and coworkers is important in a professional working
environment. If you are in doubt about whether it is appropriate to disseminate any information about
colleagues and co-workers on any form of online media, ask for their explicit permission – preferably in
writing. Posting demeaning or insulting comments or images about colleagues and co-workers to third
parties is unprofessional behavior.
III. Professional Communication with Colleagues and Co-Workers
Respect for colleagues and co-workers is important in an inter-professional working environment.
Addressing colleagues and co-workers in a manner that is insulting, abusive or demeaning is
unprofessional behavior. In accordance with WCGME policy on Electronic Use and Access, it is not
appropriate to send email considered discriminatory or harassing in nature. Such communication may also
breach the WCGME’s codes of behavior including but not limited to the Sexual Harassment Policy.
IV.Posting Information Naming WCGME or other Institutions
Postgraduate trainees must not represent or imply that they are expressing the opinion of the organization.
Be aware of the need for WCGME, the hospitals, and other institutions to maintain the public trust.
Consult with the appropriate resources such as the Human Resources Department, Graduate Medical
Education Office, or Program Directors who can provide advice in reference to material posted on the Web
that might identify the institution. Caution should be exercised when postings name or mention WCGME
in any form. Please also be aware of the image you are portraying with all posted images and photographs.
It is important to remember that employers, patients, and administrators can search and view all
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information posted in any forum. Enacting privacy settings does not necessarily mean that information
will not end up in a public format.
PROFESSIONAL CONDUCT AND INFORMATION TECHNOLOGY
Academic and Personal Integrity extends to the appropriate use of the Internet
WCGME’s Housestaff Policy Manual discusses appropriate housestaff conduct. Digital media and online
technology does not absolve you of the responsibility to use it in legal and appropriate ways — including
taking into account your obligations regarding proper conduct as a representative of WCGME. It is
important to remain vigilant of all privacy settings on social networking sites. It is safest not to post
anything that may be construed as offensive or unprofessional. These provisions extend to the realm on
academic integrity as well. Conduct may be inappropriate if it includes attributing work of others to
oneself, collaborating on work where specifically instructed not to do so, etc.
Penalties for inappropriate use of the Internet
The penalties for inappropriate use of the Internet include:
- Remediation, dismissal or failure to promote to the subsequent post graduate training year by
department and program directors.
- Administrators are not necessarily monitoring blogs, facebook or other social
networking sites, however, they will act on any violations of law or company policy if brought to
their attention.
- Discipline for breach of WCGME or institutional policy.
- Prosecution or a lawsuit for damages for a contravention of the PHIPA. (Personal Health
Information Protection Act, 2004)
- A finding of professional misconduct
Enforcement
All professionals have a collective professional duty to assure appropriate behavior, particularly in matters
of privacy and confidentiality.
A person who has reason to believe that another person has contravened these guidelines should approach
his/her immediate supervisor/program director for advice. If the issue is considered serious, he/she may
complain in writing to the Graduate Medical Education Office.
The Wright Center for Graduate Medical Education Electronic Access and Usage Policy (EAUP)
(12/7/2011)
Electronic Access and Usage Policy
The Wright Center for Graduate Medical Education (WCGME) recognizes the professional, educational
and business need for some, if not all of its residents, faculty, staff and postgraduate trainees including
postgraduate students, fellows, clinical research fellows, or equivalent to have electronic access while on
the job using WCGME computers. This electronic access normally consists of an e-mail account, a
network connection, and Internet/Intranet access. In some
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limited cases residents, faculty and staff are provided VPN or Terminal Server access using privately
owned computers. In all cases this access has been made available for WCGME business and educational
purposes only.
Foundational Principles
These Guidelines are based on several foundational principles as follows;
1. The importance of privacy and confidentiality to the development of trust between physician and
patient,
2. Respect for colleagues and co-workers in an inter-professional environment,
3. The tone and content of electronic conversations should remain professional;
this includes any and all online postings as well as the use of email sent from your WCGME email
account.
4. Responsibility for the content of individual online postings (for example: blogs, social networking sites
and other digital media).
5. The permanency of published material on the Web,
6. That all involved in health care have an obligation to maintain the privacy and security of patient records
under The Health Information Portability and Accountability Act [HIPAA],
7. The importance of your individual safety when posting personal materials, such as phone numbers,
locations, or daily schedules online; (Cyberspace can create an illusion of safety or intimacy that can be
dangerous in reality.)
E-Mail Policy
WCGME’s e-mail system is designed to improve service, enhance internal communications, and reduce
paperwork. Residents, faculty and staff using the email system must adhere to the following policies and
procedures:
1. The WCGME e-mail system is intended for business-use only. Employees may not use their WCGME
e-mail account for personal use. However accessing personal e-mail accounts during non-working hours
via the Internet is acceptable but only in strict compliance with the terms of this policy.
2. Respect for the privacy rights of colleagues and coworkers are important in a professional working
environment. If you are in doubt about whether it is appropriate to disseminate any information about
colleagues and co-workers on any form of online media, ask for their explicit permission – preferably in
writing.
3. Respect for colleagues and co-workers is important in an inter-professional working environment.
Addressing colleagues and co-workers in a manner that is insulting, abusive or demeaning is
unprofessional behavior.
4. The WCGME e-mail system is not designed for secure transmission of patient information. Under no
circumstances is the WCGME e-mail system to be used for this purpose. E-mail messages must contain
professional and appropriate language at all times. Sending abusive, harassing, intimidating, or threatening
messages via WCGME e-mail is strictly prohibited.
5. All information created, sent, or received via WCGME’s e-mail system, including all e-mail messages
and electronic files, is the property of WCGME. Employees should have no expectation of privacy
regarding this information.
6. Employees are prohibited from sending chain letters or participating in any way in the creation or
transmission of unsolicited commercial e-mail ("spam") that is unrelated to legitimate Company purposes.
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Network and Internet Policy
By accepting an account or by using a “general account” and accessing the WCGME network to access the
Internet/Intranet system, WCGME residents, faculty and staff agree to adhere to the WCGME policies
regarding their use. The Network and Internet Policy for WCGME employees applies to all company
computers and smartphones.
1. Use of the network extends throughout the term of employment, providing access is not terminated for
cause. WCGME at its sole discretion will determine what materials, files, information, software,
communications, and other content and/or activity will be permitted or prohibited.
2. WCGME reserves the right to monitor, inspect, copy, review, and store at any time, without prior notice,
any and all usage of the network and the Internet/Intranet, as well as any and all materials, files,
information, software, communications, and other content transmitted, received or stored in
connection with this usage. All such information, content, and files are the property of WCGME.
Residents, faculty and staff should have no expectation of privacy regarding them.
3. WCGME may provide access to certain necessary applications from remote sites via the WCGME
Terminal Server. Please note that all laws pertaining to confidentiality must be adhered to while accessing
the WCGME network remotely. Files downloaded from the Internet must be scanned with virus detection
software before being opened. (WCGME licensed anti-virus software will do this automatically.)
Remember, information obtained from the Internet is only as good as its source.
4. WCGME specifically prohibits its residents, faculty and staff from accessing the following types of sites
using company computers and/or smartphones:
a. Gambling sites
b. Auction sites
c. Hate sites
d. Pornographic sites
e. Any site engaging in or encouraging illegal activity
5. WCGME strictly prohibits any form of copyright infringement, including the illegal uploading and
downloading of copyrighted works through peer-to-peer (P2P) file sharing.
6. Users may not use WCGME’s computers, smartphones, or wireless connections to obtain unauthorized
access, including hacking, into any other computer or network, or participate in other unlawful online
activities.
7. WCGME employees are not to use the company’s internet resources to stream any audio or video to
their computers. Audio and video streams consume enormous amounts of bandwidth which would result in
a very noticeable degradation in network performance for all users.
Software Usage Policy
Software piracy is both a crime and a violation of the WCGME software usage policy. Residents, faculty
and staff are to use software strictly in accordance with its license agreement. Unless otherwise provided in
the license, the duplication of copyrighted software (except for backup and archival purposes by
designated personnel) is a violation of copyright law. In addition to being in violation of the law,
unauthorized duplication of software is contrary to the WCGME standard of
employee conduct.
1. Residents, faculty and staff will use only the software licensed for use by WCGME on WCGME
computers.
2. Anyone who knowingly places or uses unauthorized software on WCGME computers shall be subject to
disciplinary action.
3. Residents, faculty and staff are not permitted to install their personal software onto WCGME computer
systems.
4. In cases that require use of WCGME licensed software at home, WCGME will purchase an additional
copy or license.
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5. All software used on WCGME-owned computers will be purchased through appropriate procedures.
Consult your supervisor, Chief Operating Officer or Chief Information Officer for proper procedures.
6. Software installations on all machines and smartphones are to be approved and performed by the
Information Technology Department.
Social Media Policy
1. The Wright Center for Graduate Medical Education (WCGME) takes no position on your decision to
start or maintain a blog or participate in other social networking activities. However, it is the right and duty
of the company to protect itself from unauthorized disclosure of information. WCGME’s social networking
policy includes rules and guidelines for company-authorized social networking and personal social
networking and applies to all administrative staff, trainees, clinical and non-clinical personnel.
a. Blogging or other forms of social media or technology include but are not limited to video or wiki
postings, sites such as Facebook and Twitter, chat rooms, personal blogs or other similar forms of online
journals, diaries or personal newsletters not affiliated with WCGME.
b. Unless specifically instructed, employees are not authorized and therefore restricted to speak on behalf
of WCGME. Employees may not publicly discuss clients, products, employees or any work-related
matters, whether confidential or not, outside company-authorized communications. Employees are
expected to protect the privacy of WCGME and its employees and clients and are prohibited from
disclosing personal employee and nonemployee information and any other proprietary and nonpublic
information to which employees have access. Such information includes but is not limited to patient
information, trade secrets, financial information and strategic business plans.
c. Again, employees are cautioned that they should have no expectation of privacy while using company
equipment or facilities for any purpose, including authorized social networking. WCGME reserves the
right to monitor comments or discussions about the company, its employees, patients and the medical
industry posted on the Internet by anyone, including employees and non-employees. WCGME reserves the
right to use blog-search tools and software to monitor forums such as blogs and other types of personal
journals, personal and business discussion forums, and social networking sites.
2. WCGME reserves the right to use content management tools to monitor, review or block content on
company blogs that violate company blogging rules and guidelines.
3. WCGME requests and strongly urges employees to report any violations or possible or perceived
violations to supervisors, managers or the HR department. Violations include discussions of WCGME and
its employees and patients, any discussion of proprietary information and any unlawful
activity related to blogging or social networking.
4. The goal of authorized social networking and blogging is to become a part of the industry conversation
and promote web-based sharing of ideas and exchange of information. Authorized social networking and
blogging is used to convey information about company products and services, promote and raise awareness
of the WCGME brand, search for potential new markets, communicate with employees and customers to
brainstorm, issue or respond to breaking news or negative publicity, and discuss corporate and departmentspecific activities and events.
a. When social networking, blogging or using other forms of web-based forums, WCGME must ensure that
use of these communications maintains our brand identity, integrity and reputation while minimizing actual
or potential legal risks, whether used inside or outside the workplace.
b. The following rules and guidelines apply to social networking and blogging when authorized by the
employer and done on company time. The rules and guidelines apply to all employer-related blogs and
social networking entries, including employer subsidiaries or affiliates.
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c. Only authorized employees can prepare and modify content for WCGME’s blog located on [web site]
and/or the social networking entries located on [web site]. Content must be relevant, add value and meet at
least one of the specified goals or purposes developed by WCGME. If uncertain about any information,
material or conversation, discuss the content with your manager.
d. All employees must identify themselves as employees of WCGME when posting comments or
responses on the employer’s blog or on the social networking site.
e. Any copyrighted information where written reprint information has not been obtained in advance cannot
be posted on WCGME’s blog.
f. Individual departments are responsible for ensuring all blogging and social networking information
complies with WCGME’s written policies. Department heads are authorized to remove any content that
does not meet the rules and guidelines of this policy or that may be illegal or offensive. Removal of such
content will be done without permission of the blogger or advance warning.
g. WCGME expects all guest bloggers to abide by all rules and guidelines of this policy. Company
reserves the right to remove, without advance notice or permission, all guest bloggers’ content
considered inaccurate or offensive. WCGME also reserves the right to take legal action against guests who
engage in prohibited or unlawful conduct.
5. WCGME respects the right of employees to write blogs and use social networking sites and does not
want to discourage employees from selfpublishing and self-expression. Employees are expected to follow
the guidelines and policies set forth to provide a clear line between you as the individual and you as the
employee.
a. WCGME respects the right of employees to use blogs and social networking sites as a medium of selfexpression and public conversation and does not discriminate against employees who use these media for
personal interests and affiliations or other lawful purposes.
b. Bloggers and commenters are personally responsible for their commentary on blogs and social
networking sites. Bloggers and commenters can be held personally liable for commentary that is
considered defamatory, obscene, proprietary or libelous by any offended party, not just WCGME.
c. Employees cannot use employer-owned equipment, including computers, company-licensed software or
other electronic equipment, nor facilities or company time, to conduct personal blogging or social
networking activities.
d. Employees cannot use blogs or social networking sites to harass, threaten, discriminate or disparage
against employees or anyone associated with or doing business with WCGME.
e. If you choose to identify yourself as a WCGME employee, please understand that some readers may
view you as a spokesperson for WCGME. Because of this possibility, we ask that you state that your views
expressed in your blog or social networking area are your own and not those of the company, nor of any
person or organization affiliated or doing business with WCGME.
f. Employees cannot post on personal blogs or other sites the name, trademark or logo of WCGME or any
business with a connection to WCGME. Employees cannot post company-privileged information,
including copyrighted information or company-issued documents.
g. Employees cannot post on personal blogs or social networking sites photographs of other mployees,
clients, vendors or suppliers, nor can employees post photographs of persons engaged in company
business or at company events.
h. Employees cannot post on personal blogs and social networking sites any advertisements or photographs
of company products, nor sell company products and services.
i. Employees cannot link from a personal blog or social networking site to WCGME’s internal or external
web site.
j. If contacted by the media or press about their post that relates to WCGME business, employees are
required to speak with their manager before responding.
6. If you have any questions relating to this policy, your personal blog or social networking, ask your
manager or supervisor.
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Computer Hardware Usage Policy
Quality computer hardware is provided to the WCGME community. Although normal wear and tear is
expected, every attempt should be made to maximize the usable life of the equipment. Users are
responsible for helping maintain the quality of computer hardware by taking reasonable precautions with
the equipment and avoiding situations in which the equipment could be damaged, lost or stolen.
1. Computer equipment is deployed in working order with the standard supported
hardware and software.
2. An inventory of WCGME owned desktop, laptop, and mobile computers, smartphones, monitors and
printers is maintained. The inventory protects the assets in the case of a disaster such a fire, flood, or other
incidents of loss by providing information for warranty and insurance claims.
3. Residents, faculty and staff are not to relocate or modify WCGME owned computer hardware.
4. In cases that require access to the WCGME information system from home, or on the road, WCGME
may at its discretion, purchase the hardware as well as the software to access the WCGME information
system remotely.
5. All computer hardware used by WCGME will be purchased through appropriate procedures. Consult
your supervisor, Chief Operating Officer or Chief Information Officer for proper procedures.
6. WCGME employees who have access to protected health information (PHI) must always remember to
lock their workstations when they are not using them. Smartphones must be secured by the employee and
unauthorized access to company smartphones is strictly prohibited to non-WCGME
employees. Employees that have been issued smartphones must take utmost care to ensure that protected
health information (PHI) that may be obtained using a smartphone is secure from unauthorized access.
7. Non-WCGME employees are not to use WCGME computer systems or smartphones without approved
authorization in order to be in compliance with HIPAA and ensure all protected health information (PHI) is
secured.
8. WCGME smartphones are not to be used anywhere outside of the United States of America nor are they
to be used for international phone calls and/or SMS text messages for any reason without approved
authorization from the Chief Operating Officer (COO).
Discipline for Violations
WCGME investigates and responds to all reports of violations of the Electronic Access and Usage Policy.
Violation of this policy will result in disciplinary action up to and including immediate termination.
Discipline or termination will be determined based on the nature and factors of the violation. WCGME
reserves the right to take legal action where necessary against employees who engage in prohibited or
unlawful conduct.
Acknowledgement of Receipt and Understanding
I hereby certify that I have read and fully understand the contents of the WCGME Electronic Access and
Usage Policy. Furthermore, I have been given the opportunity to discuss any information contained therein
or any concerns that I may have. I understand that my employment and continued employment is based in
part upon my willingness to abide by and follow the WCGME policies, rules, regulations and procedures.
I acknowledge that WCGME reserves the right to modify or amend its policies at any time, without prior
notice. These policies do not create any promises or contractual obligations between WCGME and its
residents, faculty and staff. My signature below certifies my
knowledge, acceptance and adherence to the WCGME policies, rules, regulations and procedures
regarding Electronic Access and Usage.
Signature ___________________________________________ Date _______________
Printed name ____________________________________________________________
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WRIGHT CENTER FOR GRADUATE MEDICAL EDUCATION SOCIAL MEDIA POLICY
Adopted: September, 2011
Overview: Online social networks such as Facebook, LinkedIn and Twitter have taken on increasing
importance in both personal and professional life. These social media offer unique opportunities for people
to interact and build relationships and have great potential to enhance interpersonal and professional
communication. As health care professionals with unique social and ethical obligations, medical students,
resident physicians and medical school faculty must be keenly aware of the public nature of social media
and the permanent nature of its content.
This policy has been developed to ensure that actions taken on the social Internet by members of the
Wright Center for Graduate Medical Education (WCGME) community reflect the school’s core values of
professionalism, compassion, accountability, integrity, honor, acceptance of diversity and commitment to
ethical behavior.
Scope & Definitions
This policy applies to all resident physicians in residency and fellowship programs of the Wright Center
for Graduate Medical Education, including contractors acting on its behalf, and covers all interaction with
social media. It incorporates all Wright Center for Graduate Medical Education policies relating to
professional conduct, ethical behavior and online communications, HIPAA and Responsible Use of
Information Technology. Resident physicians should follow these guidelines whether participating in
social networks personally or professionally, or using personal or WCGME-owned computing equipment
when doing so.
The terms social media, social web and social networks comprise Internet- and mobile-based tools for
sharing and discussing information based on user participation and user-generated content. Examples
include social networking sites like LinkedIn and Facebook, social bookmarking sites like Del.icio.us,
social news sites like Digg, Twitter, Youtube and other sites that are centered on user interaction. Social
media content may take the form of blogs, social networks, social news, wikis, videos and podcasts.
Official WCGME Business
Only resident physicians authorized by the WCGME administration may use social media to portray
themselves as representing the WCGME or to conduct official business in the name of the institution or
one of its units. Use of any social media in an official context should have the approval of the Institution
and Communications or the Office of the DIO. WCGME logos may not be used on any social media site
without the express written approval of the organization.
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Individual Use
Postings within social network sites are subject to the same professionalism standards as any other
personal interactions. Resident physicians of the Wright Center for Graduate Medical Education should
routinely monitor their own Internet presence to ensure that the personal and professional information on
their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.
Resident physicians of the Wright Center for Graduate Medical Education who participate in a social
media site, whether in a personal or official capacity, should:

Take steps to ensure that they have implemented appropriate privacy settings to avoid inadvertent
dissemination of personal information to audiences outside their control. This includes making an
effort to ensure that you are not “tagged” in images posted by others that might be seen as
portraying you in an unprofessional manner.

Include a disclaimer with any posting that relates to their role as a member of the Wright Center for
Graduate Medical Education community clearly stating that all opinions belong to the poster alone
and do not necessarily reflect the views of the Wright Center for Graduate Medical Education.

Refrain from violating standards of patient confidentiality or communicating about patients in a
manner that could in any way convey a patient’s identity, even accidentally. Patients with rare
diagnoses, unusual physical appearances and/or in specific locations within the community may be
easily identifiable even in the absence of names and medical record numbers.

Not express defamatory comments about employees, students, health professionals or patients
associated with WCGME or its affiliates, post images that would denigrate anyone they come into
contact with in the course of carrying out their roles as residents or employees of WCGME or
depict other residents or employees engaging in unprofessional behavior.

Not interact with or “friend” individuals through social networks when they are or have been in a
physician-patient or similar relationship.
Responsibility
WCGME administrators may look up profiles on social networking sites and may use the information in
informal or formal proceedings without providing notice to the individuals involved. The same standards
of professional conduct apply to social networking as to any other ethical or professional breach up to and
including dismissal from the WCGME or termination of employment.
Summary
Regardless of whether students, resident physicians, faculty, or staff are conducting official WCGME or
personal business, they are ambassadors for WCGME and the medical profession. In online social
95
networks, the lines between public and private, personal and professional are blurred. Just by identifying
oneself as WCGME resident physician, those affiliated with WCGME portray an impression of the
institution for those who have access to their social network profiles or blogs. Each member of the
WCGME community should ensure sure that all content he or she is associated with is consistent with his
or her position at WCGME and with its values and professional standards.
Appendix
The American Medical Association adopted the following policy on Nov. 8, 2010
AMA Policy: Professionalism in the Use of Social Media
The Internet has created the ability for medical students and physicians to communicate and share
information quickly and to reach millions of people easily. Participating in social networking and other
similar Internet opportunities can support physicians’ personal expression, enable individual physicians to
have a professional presence online, foster collegiality and camaraderie within the profession, provide
opportunity to widely disseminate public health messages and other health communication. Social
networks, blogs, and other forms of communication online also create new challenges to the patientphysician relationship. Physicians should weigh a number of considerations when maintaining a presence
online:
(a) Physicians should be cognizant of standards of patient privacy and confidentiality that must be
maintained in all environments, including online, and must refrain from posting identifiable patient
information online.
(b) When using the Internet for social networking, physicians should use privacy settings to safeguard
personal information and content to the extent possible, but should realize that privacy settings are not
absolute and that once on the Internet, content is likely there permanently. Thus, physicians should
routinely monitor their own Internet presence to ensure that the personal and professional information on
their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.
(c) If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the
patient-physician relationship in accordance with professional ethical guidelines just, as they would in any
other context.
(d) To maintain appropriate professional boundaries physicians should consider separating personal and
professional content online.
(e) When physicians see content posted by colleagues that appears unprofessional they have a
responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or
take other appropriate actions. If the behavior significantly violates professional norms and the individual
does not take appropriate action to resolve the situation, the physician should report the matter to
appropriate authorities.
96
(f) Physicians must recognize that actions online and content posted may negatively affect their reputations
among patients and colleagues, may have consequences for their medical careers (particularly for
physicians-in-training and medical students), and can undermine public trust in the medical profession.
INFORMATION TECHNOLOGY DISASTER RECOVERY AND DATA BACKUP POLICY
(6/28/2012)
OBJECTIVE
The purpose of the Information Technology Disaster Recovery and Data Backup Policy is to provide for
the continuity, restoration and recovery of critical data and systems. The Information Technology
Department will ensure critical data on servers under the control of the IT Department is backed up
periodically and copies maintained at an offsite location. All other functional units must develop and
maintain a written business continuity plan for critical assets that provides information on recurring backup
procedures, and also recovery procedures from both natural and manmade disasters.
The primary objective of this Disaster Recovery Plan is to help ensure the continued operation of
WCGME by providing the ability to successfully recover computer services in the event of a disaster.
Specific goals of the Plan relative to an emergency include:
1) To detail the correct course of action to follow,
2) To minimize confusion, errors, and expense, and
3) To effect a quick and complete recovery of services.
Secondary objectives of this Plan are:
1) To reduce risks of loss of services,
2) To provide ongoing protection of company assets, and
3) To ensure the continued viability of this Plan.
A. SCOPE
The data backup section of this policy applies to all entities and third parties who use computing devices
connected to the WCGME network or who process or store critical data owned by The Wright Center for
Graduate Medical Education. WCGME users are responsible for arranging adequate data backup
procedures for the data held on IT systems assigned to them.
The disaster recovery section of this policy applies to all persons who are responsible for systems or for a
collection of data held either remotely on a server or on the hard disk of a computer.
The Department of Information Technology (IT) is responsible for the backup of data held in central
systems and related databases. The responsibility for backing up data held on the workstations of
individuals regardless of whether they are owned privately or by WCGME falls entirely to the user.
B. DATA BACKUP
All backups must conform to the following best practice procedures:
1. All data, operating systems and utility files must be adequately and systematically backed up.
97
2.
3.
4.
5.
6.
(Ensure this includes all patches, fixes and updates).
Records of what is backed up and to where must be maintained.
Records of software licensing should be backed up.
The backup media must be precisely labeled and accurate records must be maintained of back-ups
done and to which back-up set they belong.
Copies of the back-up media, together with the back-up record, should be stored safely in a remote
location, at a sufficient distance away to escape any damage from a disaster at the main site.
Regular tests of restoring data/software from the backup copies should be undertaken, to ensure
that they can be relied upon for use in an emergency.
C. DISASTER RECOVERY
Best Practice Disaster Recovery Procedures. A disaster recovery plan can be defined as the on-going
process of planning developing and Implementing disaster recovery management procedures and processes
to ensure the efficient and effective resumption of critical functions in the event of an unscheduled
interruption.
D. THE INFORMATION TECHNOLOGY (IT) ACTION TEAMS
The following Action Teams have been defined for use in disasters or major emergencies. The purpose and
responsibilities of the Action Teams are described on the following pages. The Teams will be activated
selectively by the Emergency Coordinator and/or the Emergency Response Team according to the
nature of the emergency. The Action Teams report to the Emergency Coordinator during an emergency or
major disaster.
a. APPLICATIONS TEAM
The purpose of the Applications Team is to ensure proper functioning of the applications and to
coordinate with users about how their applications should be operated during the contingency period.
The Applications Team will:
In an emergency, the Applications Team must participate in preparation and validation of the
production environment at the contingency site. If problems are identified with how an application
will operate at the contingency site, the Applications Team must prepare and document solutions
for the problems.
Coordinate with end-users to determine work that was in progress at the time of the disaster. When
operations are restored at the contingency site, the Applications Team must first help recover any
lost work that was in progress.
Once production capability has been recovered, coordinate with the users to synchronize the work
done on the disaster recovery systems with the new production systems.
b. COMMUNICATIONS NETWORK TEAM
The Communications Network Team is responsible for all shared network systems, as well as, repair or
replacement of all lines and associated communications hardware, and its installation and testing.
Participate in the evaluation and selection of contingency site(s), testing at the contingency site, and all
hardware-related contingency planning. The Communications Network Team will:
In the event of a disaster, assess the extent of damage or the affect of failures on data and voice
networks.
Coordinate with vendors in obtaining necessary repairs or replacement of hardware.
Coordinate with Purchasing, Finance, Insurance, and other departments in equipment salvage,
insurance claims, and financing for replacement equipment.
Install and test all new/replacement electronics or data lines, and supervise all problems solving when
98
problems or failures are encountered.
c. USER SUPPORT TEAM
The User Support Team is responsible for all desktop considerations related to problem calls during a
disaster. This includes providing information about the status of services and alternatives. The User
Support Team will:
Participate in the evaluation and selection of all desktop hardware-related contingency planning.
In the event of a disaster, assess the extent of damage or the affect of failures on desktop
computers.
Install and test all new/replacement desktop hardware and supervise all problem solving when
problems or failures are encountered.
d. ENGINEERING TEAM
The Engineering Team is responsible for the operating system and application software for all
Application servers. The Engineering Team will:
Participate in the evaluation and selection of contingency site(s), testing at the contingency site,
and all hardware-related contingency planning.
In the event of a disaster, assess the extent of damage or the affect of failures on server hardware.
Coordinate with vendors in obtaining necessary repairs or replacement of hardware.
Coordinate with Purchasing, Finance, Insurance, and other departments in equipment salvage,
insurance claims, and financing for replacement equipment.
Install and test all new/replacement server hardware, and supervise all problem solving when
problems or failures are encountered.
e. TEAM MEMBERSHIP
The Applications Team:
Chief Information Officer (CIO)
Application Specialist(s)
Information Technology Support Specialist(s)
Information Technologist(s)
The Communications Team:
Chief Information Officer (CIO)
Information Technology Support Specialist(s)
Information Technologist(s)
Contracted Support Personnel As Needed
The User Support Team:
Chief Information Officer (CIO)
Application Specialist(s)
Information Technology Support Specialist(s)
Information Technologist(s)
Contracted Support Personnel As Needed
The Engineering Team:
Chief Information Officer (CIO)
Information Technology Support Specialist(s)
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Information Technologist(s)
Contracted Support Personnel As Needed
E. CRITICAL APPLICATIONS
The following tables list the major systems, critical applications and network infrastructure that will be of
primary importance in the case of a major disaster.
a. FSO Server
b. MEDENT Server
i. Cache Server @ Tobin
Hall
ii. Cache Server @ MVP
c.
d.
e.
f.
g.
h.
i.
j.
k.
Financial Services Office MIP Server
MEDENT EMR/Practice Management
Graphics Cache & In/Outbound Fax
Graphics Cache & In/Outbound Fax
HRSA Server
APPS Server
ERAS Server
File Server
Tobin Hall to Internet
HRSA HIV/AIDS Data Management
Administrative Applications Server
Recruiting Server
File Server
Primary network connection to Internet and
MEDENT VPN
Student Health to Tobin Hall Fiber optic connection from Student Health to
Tobin Hall
Clarks Summit to Internet Primary network connection to Internet and
MEDENT VPN
Mid-Valley to Internet
Primary network connection to Internet and
MEDENT VPN
Regional Hospital of
Primary network connection to Internet and
Scranton to Internet
MEDENT VPN
F. REVIEW AND UPDATE
This policy shall be reviewed and updated on an annual basis, or as special events or circumstances dictate.
Reviewed 6/28/2012
10
0
OSTEOPATHIC RESIDENCY ADDITIONAL GUIDELINES
All osteopathic residents are expected to follow the guidelines for the osteopathic residency as outlined by the
AOA. These guidelines include everything in this Housestaff Policy Manual. There are, however, special
considerations that apply only to our osteopathic residents, which must be followed and are outlined below.
1. Resident LogsAt the end of each service, each osteopathic resident is required to present to the Director of Medical
Education (DME), a log of activity performed during that service. Logs should be maintained daily. They
must be signed by the intern and the rotation coordinator to verify accuracy of numbers presented. Logs
are not only a program requirement of the training institution and the AOA, but should be accurately
maintained for requesting future hospital privileges. Logs will be distributed at the beginning of the academic
year and as needed, depending upon the rotation. No intern will receive credit for a rotation until the log is
submitted to the DME.
2. Osteopathic Structural ExamsAll osteopathic residents are required to document a complete musculoskeletal exam on all patients admitted
to their hospital service when being supervised by a DO attending. The official form of the AOA and the
Educational Council on Osteopathic Principles will be used. These forms will be distributed to all
osteopathic residents at the beginning of the academic year and can be obtained from the program office. A
completed form must be placed in the H & P section of the patient’s chart. Compliance with this will be
regularly assessed, as this is a strict requirement for continued AOA certification of this program.
3. Osteopathic Manipulative Therapy (OMT)All residents are encouraged to perform OMT on as many patients as possible. All OMT given should be
documented in the patient record. In addition to OMT given at the bedside, OMT tables will be available in
both hospitals and in the Health Center for practice or personal use. At regular intervals D.O. faculty will be
giving periodic lectures and demonstrations of OMT. All osteopathic residents must attend these
sessions.
4. Osteopathic Manipulative Medicine Conferences (OMM)To improve osteopathic residents’ knowledge of OMM techniques, quarterly OMM Lectures are given by
Osteopathic faculty members.
REQUIREMENTS FOR APPROVAL OF OSTEOPATHIC RESIDENCY
To receive credit for AOA-approved rotating residentship, residents shall:
a. Have graduated from an AOA-accredited college of osteopathic medicine and remain
members in good standing of the AOA.
b. Satisfactorily complete the residentship, as described in the AOA Policies and Procedures for Intern
Training.
10
1
of the Hospitalized Patient
Examiner: ,..,=. ;._-----------Chief Complaint: ------------
Required
Ant./Post.Spinal Curvet: I
Cervical Lordosis
Thoracic Kyphosis
Lumbar Lordosis
N
For CodinG
0
Pwpo•• Only
Optional Worksheet
0 0 0
0 0 0
0 0 0
I• N•--...i:D•.._
Scoliosis (lateral Spinal Curvesl
0
Non.
llltlnQ
0
· o
':.0
... ,_.. 0
..n:: 0
.J L
Severity
.Region
Evaluated
0 1 2 3
Head
Neck
Thoracic T1-4
TS-9
T10-12
Lumbar
Pelvis/Sacrum
Pelvisnnnominate
Major Correlations with:
Specific of Major Somatic Dysfunctions
0000
0000
0 0 00
0000
0 0 0 0
0 0 0 0
00 0 0
00 0 0
0
Traumatic
!] Orthopedic
0
Neurological
0
0
ViScerasomatic
Primary
Me-Skeletal
(] Activities of
daily living
(] Other
" ·a o o o
[l
Rhaumatological
0 EENT
0 Cardiovascular
0 Pulmonary
0 Gutraintestinal
(] Genitourinary
ll
Congenital
Extremity llowert
L
Extremity (uppert"
L
Ribs
Other I Abdomen
0 0
0 0
00
0 0
0 0
0 0
Other:\
0+0 ------------------f
0 0
'"------------1
0 0
0 0
O.M olE..,......,•...,_.
10
2
American Osteopathic Association (AOA) Code of Ethics
The American Osteopathic Association has formulated this Code to guide its member physicians in
their professional lives. The standards presented are designed to address the osteopathic physician's
ethical and professional responsibilities to patients, to society, to the AOA, to others involved in
healthcare and to self.
Further, the American Osteopathic Association has adopted the position that physicians should play a
major role in the development and instruction of medical ethics.
Section 1. The physician shall keep in confidence whatever she/he may learn about a patient in the
discharge of professional duties. The physician shall divulge information only when required by law or
when authorized by the patient.
Section 2. The physician shall give a candid account of the patient's condition to the patient or to those
responsible for the patient's care.
Section 3. A physician-patient relationship must be founded on mutual trust, cooperation, and respect.
The patient, therefore, must have complete freedom to choose her/his physician. The physician must
have complete freedom to choose patients whom she/he will serve. However, the physician should not
refuse to accept patients because of the patient's race, creed, color, sex, national origin or handicap. In
emergencies, a physician should make her/his services available.
Section 4. A physician is never justified in abandoning a patient. The physician shall give due notice
to a patient or to those responsible for the patient's care when she/he withdraws from the case so that
another physician may be engaged.
Section 5. A physician shall practice in accordance with the body of systematized and scientific
knowledge related to the healing arts. A physician shall maintain competence in such systematized and
scientific knowledge through study and clinical applications.
Section 6. The osteopathic medical profession has an obligation to society to maintain its high
standards and, therefore, to continuously regulate itself. A substantial part of such regulation is due to
the efforts and influence of the recognized local, state and national associations representing the
osteopathic medical profession. A physician should maintain membership in and actively support such
associations and abide by their rules and regulations.
Section 7. Under the law a physician may advertise, but no physician shall advertise or solicit patients
directly or indirectly through the use of matters or activities, which are false or misleading.>
Section 8. A physician shall not hold forth or indicate possession of any degree recognized as the basis
for licensure to practice the healing arts unless he is actually licensed on the basis of that degree in the
state in which she/he practices. A physician shall designate her/his osteopathic school of practice in all
professional uses of her/his name. Indications of specialty practice, membership in professional
societies, and related matters shall be governed by rules promulgated by the American Osteopathic
Association.
Section 9. A physician should not hesitate to seek consultation whenever she/he believes it advisable
for the care of the patient.
103
Section 10. In any dispute between or among physicians involving ethical or organizational matters,
the matter in controversy should first be referred to the appropriate arbitrating bodies of the profession.
Section 11. In any dispute between or among physicians regarding the diagnosis and treatment of a
patient, the attending physician has the responsibility for final decisions, consistent with any
applicable osteopathic hospital rules or regulations.
Section 12. Any fee charged by a physician shall compensate the physician for services actually
rendered. There shall be no division of professional fees for referrals of patients.
Section 13. A physician shall respect the law. When necessary a physician shall attempt to help to
formulate the law by all proper means in order to improve patient care and public health.
Section 14. In addition to adhering to the foregoing ethical standards, a physician shall recognize a
responsibility to participate in community activities and services.
Section 15. It is considered sexual misconduct for a physician to have sexual contact with any current
patient whom the physician has interviewed and/or upon whom a medical or surgical procedure has
been performed.
Section 16. Sexual harassment by a physician is considered unethical. Sexual harassment is defined as
physical or verbal intimation of a sexual nature involving a colleague or subordinate in the workplace
or academic setting, when such conduct creates an unreasonable, intimidating, hostile or offensive
workplace or academic setting.
Section 17. From time to time, industry may provide some AOA members with gifts as an inducement
to use their products or services. Members who use these products and services as a result of these
gifts, rather than simply for the betterment of their patients and the improvement of the care rendered
in their practices, shall be considered to have acted in an unethical manner. (Approved July 2003)
Section 18. A physician shall not intentionally misrepresent himself/herself or his/her research work in
any way.
Section 19. When participating in research, a physician shall follow the current laws, regulations and
standards of the United States or, if the research is conducted outside the United States, the laws,
regulations and standards applicable to research in the nation where the research is conducted. This
standard shall apply for physician involvement in research at any level and degree of responsibility,
including, but not limited to, research, design, funding, and participation either as examining and/or
treating provider, supervision of other staff in their research, analysis of data and publication of results
in any form for any purpose.
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105