Download CARDIOVASCULAR DISEASE FELLOWSHIP PROGRAM Fellows

CARDIOVASCULAR DISEASE
FELLOWSHIP PROGRAM
Fellows Manual
Academic Year 2015-2016
Sanford USD Medical Center – Sioux Falls, South Dakota
Updated June 30, 2015
Department of Internal Medicine
Division of Cardiovascular Disease Fellowship Training Program
1400 West 22nd Street
Sioux Falls, SD 57105
Phone: 605-312-2253
Fax: 605-312-2222
Program Director
Adam Stys, MD
[email protected]
Program Coordinator
Darla Fjerstad
[email protected]
INTRODUCTION
Welcome to the Cardiovascular Disease Fellowship Program of the Sanford School of Medicine of The
University of South Dakota. You are now entering the most important phase of your professional
training. The skills and knowledge you develop during this time will last a lifetime.
This manual contains guidelines and policies that apply to the Cardiovascular Disease Fellowship
Program. The policies contained within this manual are subject to periodic review by the GME
Committee and will be updated to reflect any changes implemented by the Committee.
Fellows are responsible for knowing and adhering to the policies and guidelines contained in this
manual. When in doubt, fellows are responsible to contact the program coordinator or director.
The Sanford School of Medicine University of South Dakota Cardiology Fellowship program prides itself
in having developed an appropriate mix of patient care, educational conferences, and professional
growth to allow for the development of outstanding clinical and academic cardiologist in an atmosphere
of scholarship and collegiality. One must balance the primary obligation to the patient, to deliver
excellent medical care, with an obligation to one’s own personal development as a physician. To have
simply discharged your duties of patient care without at the same time tending to your educational and
professional growth as a physician would be to have done only half of your job.
It is for this reason that participation and attendance at educational exercises during your fellowship
training are as much a requirement as the delivery of the highest quality patient care. You must strive
every day to take on the challenge of being the best physician that you can possibly become.
We strive to produce the next generation of clinical and academic cardiologists. We encourage each
fellow to develop a research plan with their research mentor early in the course of their fellowship so
that each research project can be completed during the course of the fellowship.
We expect the cardiology fellow must develop not only a strong knowledge base in cardiology but also
develop the skills to practice cardiovascular medicine. Each fellow should strive to be patient-centered,
caring, empathic, and honest.
Finally, a commitment to lifelong learning is essential, so that the process of medical education
continues for the rest of each fellow’s professional life. Fellowship training is a busy time, with many
pressures. We encourage you to tend to all aspects of the job, including your own education and
development. The faculty and especially the program director is available whenever needed to help
tend to personal problems and to improve your fellowship experience. Do not hesitate to make use of
the faculty.
Once again, welcome to our fellowship program!
Table of Contents
INTRODUCTION ............................................................................................................................................. 2
DURATION OF PROGRAM ............................................................................................................................. 6
PREREQUISITE TRAINING/SELECTION CRITERIA ........................................................................................... 6
PROGRAM CERTIFICATION............................................................................................................................ 6
GENERAL INFORMATION .............................................................................................................................. 6
1. Mission Statement ................................................................................................................................ 6
2. Training Structure ................................................................................................................................. 6
3. Facilities................................................................................................................................................. 7
CURRICULUM ................................................................................................................................................ 7
1. Introduction .......................................................................................................................................... 7
2. COCATS 3............................................................................................................................................... 8
3. ACGME Core Competencies .................................................................................................................. 8
CONFERENCES ............................................................................................................................................. 13
REQUIRED ROTATIONS................................................................................................................................ 15
ELECTIVE ROTATIONS.................................................................................................................................. 19
EDUCATIONAL GOALS BY YEAR ................................................................................................................... 20
FIRST YEAR FELLOWSHIP TRAINING ........................................................................................................ 22
SECOND YEAR FELLOWSHIP TRAINING ................................................................................................... 24
THIRD YEAR FELLOWSHIP TRAINING....................................................................................................... 26
SUPERVISION............................................................................................................................................... 27
DELINEATION OF RESPONSIBILITIES ....................................................................................................... 2929
GENERAL FELLOWSHIP RESPONSIBILITIES .............................................................................................. 3030
CALL DUTIES ................................................................................................................................................ 31
ROTATION COVERAGE ................................................................................................................................ 32
SCHEDULE CHANGES ................................................................................................................................. 322
RESEARCH/PRESENTATIONS ..................................................................................................................... 333
EVALUATIONS ............................................................................................................................................. 33
PROCEDURE DOCUMENTATION ................................................................................................................. 34
CRITERIA FOR ADVANCEMENT ................................................................................................................. 355
DUTY HOURS ............................................................................................................................................... 37
MOONLIGHTING ....................................................................................................................................... 377
PAGERS........................................................................................................................................................ 38
LAB COATS................................................................................................................................................. 388
DRESS POLICY ............................................................................................................................................ 388
SEXUAL HARASSMENT/DATING POLICY .................................................................................................... 388
PARKING ...................................................................................................................................................... 38
MEALS ......................................................................................................................................................... 39
ID BADGES ................................................................................................................................................... 39
LIBRARY FACILITIES ................................................................................................................................... 399
COMPUTER ACCESS..................................................................................................................................... 40
FELLOW OFFICE/MAILBOXES .................................................................................................................. 4040
VACATION ................................................................................................................................................... 40
SICK LEAVE .................................................................................................................................................. 40
GRIEVANCE PROCEDURE............................................................................................................................. 41
DISCIPLINARY ACTION ................................................................................................................................. 41
MISCELLANEOUS RESOURCES ..................................................................................................................... 41
INDIVIDUAL PORTFOLIOS .......................................................................................................................... 411
CONTRACTS ................................................................................................................................................. 42
PREAMBLE AND HONOR CODE………………………………………………………………………………………………………………43
GME BENEFITS AND POLICIES………………………………………………………………………………………………………………..46
DURATION OF PROGRAM
The Duration of the Cardiovascular Diseases Program is three years with 6 accredited positions in the
general program emphasizing preparation in academic cardiology. Comprehensive training in all major
aspects of clinical cardiology is combined with training in basic and clinical cardiovascular research.
Opportunities exist in a variety of research disciplines.
PREREQUISITE TRAINING/SELECTION CRITERIA
All fellow trainees selected for the Cardiovascular Diseases Fellowship Training Program are required to
have completed an accredited three year residency program in internal medicine. Fellowship trainees
are selected through the NRMP (National Resident Matching Program).
PROGRAM CERTIFICATION
The Cardiovascular Diseases Fellowship Training Program is certified by the Accreditation Council for
Graduate Medical Education (ACGME). All fellowship trainees are required to be licensed by the South
Dakota Board of Osteopathic & Medical Examiners.
GENERAL INFORMATION
1. Mission Statement
The mission of the Fellowship Training Program in Cardiovascular Diseases is to provide an academically
and clinically rigorous training program in general cardiology as well as advanced training in clinical
cardiology subspecialties and cardiovascular research. The aims of the program are to provide the
trainee with the basic and clinical knowledge, procedural skills, clinical judgment, professionalism and
interpersonal skills, and abilities necessary to continue to hone these skills through the course of a long
career, as required of a leader in cardiovascular medicine. The curriculum is designed to provide a broad
clinical exposure in acute and chronic cardiovascular care occurring in the inpatient and outpatient
settings, as well as extensive experience in non-invasive and invasive cardiac procedures. Fellowship
training will prepare fellows to function not only as outstanding cardiologists, but also as either sub
specialists in a clinical area or investigators in the field of cardiovascular research.
2. Training Structure
Fellowship training occurs over the course of 3 years. Two hospitals participate in this program: the
Sanford USD Medical Center and the Sioux Falls VA Medical Center. The training program offers
advanced training in clinical subspecialties of cardiology (nuclear cardiology, echocardiography, cardiac
catheterization/interventional cardiology, electrophysiology, heart failure) as well as academic research
training. All fellows must be intimately involved in a research project during the course of their
fellowship.
The core clinical training for the program is based on the ACC Revised Recommendations for Training in
Adult Cardiovascular Medicine Core Cardiology Training III (COCATS 3) published in 1995 and updated in
2011. Training is conducted in compliance with the Accreditation Council for Graduate Medical
Education (ACGME) program requirements for general fellowship education in the subspecialties of
Internal Medicine and the specific requirements for fellowship education in Cardiovascular Disease.
These guidelines can be reviewed on the ACGME website (www.acgme.org).
3. Facilities
Sanford USD Medical Center provides exposure to a diverse patient population, which includes male and
female patients ranging in age from teenagers to the very elderly.
The fellow will be exposed to examinations of patients with a wide range of cardiac abnormalities which
include but are not limited to:
Chronic coronary artery disease, acute coronary syndromes, valvular heart disease, arrhythmias, lipi
disorders, hypertension/hypertensive heart disease, pericardial disease, cardiomyopathies, cardiac
masses, pulmonary vascular/heart disease and pulmonary embolism, diseases of the great vessels/aorta,
peripheral vascular disease, infections and inflammatory heart disease, cardiovascular rehabilitation,
congestive heart failure, adult congenital heart disease, and cardiovascular trauma.
The VA Medical center provides exposure to patients of an older, predominantly male population.
The fellow will be exposed to examinations of patients with a wide range of cardiac abnormalities which
include but are not limited to:
Chronic coronary artery disease, acute coronary syndromes, valvular heart disease, arrhythmias, lipid
disorders, hypertension/hypertensive heart disease, pericardial disease, cardiomyopathies, cardiac
masses, pulmonary vascular/heart disease and pulmonary embolism, diseases of the great vessels/aorta,
peripheral vascular disease, infections and inflammatory heart disease, cardiovascular rehabilitation,
congestive heart failure, and adult congenital heart disease.
CURRICULUM
1. Introduction
The curriculum of the cardiovascular diseases fellowship consists of a variety of clinical experiences and
didactic conferences that take place at both Sanford and the VAMC. Fellows rotate on several inpatient
services and outpatient services and provide both direct and consultative care. Procedural skills are
gained as fellows rotate through the invasive and non-invasive laboratories at both hospitals
A final aspect of the curriculum involves fellow involvement in teaching. This occurs in several settings,
including direct clinical teaching of Internal Medicine residents on the inpatient cardiology services as
well as assisting in the early training of new cardiology fellows. Fellows are expected to give didactic
lectures at cath conferences, cardiology clinical conference lecture series.
2. COCATS 3
COCATS 3 (Core Cardiology Training Symposium) is the curriculum guiding document for fellowships in
cardiovascular disease. This document consists of the reports of individual task forces which reviewed
and made recommendations for training in each of 13 vital areas (see below) of cardiovascular disease.
When developing the Fellowship Program curriculum, each of the 13 areas was taken into account.
Task Force 1: Training in Clinical Cardiology
Task Force 2: Training in Electrocardiography, Ambulatory Electrocardiography, and Exercise
Testing
Task Force 3: Training in Diagnostic and Interventional Cardiac Catheterization
Task Force 4: Training in Echocardiography
Task Force 5: Training in Nuclear Cardiology
Task Force 6: Training in Specialized Electrophysiology, Cardiac Pacing, and Arrhythmia
Management
Task Force 7: Training in Cardiovascular Research
Task Force 8: Training in Heart Failure
Task Force 9: Training in the Care of Adult Patients with Congenital Heart Disease
Task Force 10: Training in Preventive Cardiovascular Medicine
Task Force 11: Training in Vascular Medicine and Peripheral Vascular Catheter-Based
Interventions
Task Force 12: Training in Advanced Cardiovascular Imaging (CMRI)
Task Force 13: Training in Advanced Cardiovascular Imaging (Computed Tomography)
3. ACGME Core Competencies
The curriculum is designed to meet the required core competencies as defined by the ACGME. The core
competencies that must be demonstrated are:
A. PATIENT CARE: Fellows must be able to provide patient care that is compassionate,
appropriate, and effective in the treatment of health problems and the promotion of health.
B. MEDICAL KNOWLEDGE: Fellows 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.
C. PRACTICED-BASED LEARNING AND IMPROVEMENT: Fellows must be able to investigate and
evaluate their patient care practices, appraise and assimilate scientific evidence, and improve
their patient care practices.
D. INTERPERSONAL AND COMMUNICATION SKILLS: Fellows 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.
E. PROFESSIONALISM: Fellows must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
F. SYSTEMS-BASED PRACTICE: Fellows 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.
The curriculum assures the teaching and assessment of these competencies, and the following listing of
general core competency elements applies to all rotations of the fellowship. Core competency-related
teaching and assessment that is specific to individual rotations will be identified in the “Objectives”
section of the curriculum for each rotation.
PATIENT CARE:
1. Fellows will demonstrate the ability to take a history relevant to cardiovascular diseases and
perform a directed cardiovascular physical examination in an adult patient population that
includes both men and women and is ethnically diverse. Patient encounters will occur in both
the inpatient and outpatient setting, including all cardiac procedure laboratories.
2. Fellows will demonstrate the ability to judiciously order diagnostic tests that are clinically
appropriate and cost effective.
3. Fellows will demonstrate the ability to safely perform all invasive diagnostic tests for which
they seek certification. In addition to procedure performance, fellows will be expected to
demonstrate knowledge of appropriate indications, contraindications, and post-procedure
complications specific to each cardiac procedure.
4. Fellows will demonstrate the ability to accurately interpret the results of all invasive and noninvasive diagnostic tests and procedures for which they seek certification.
5. Fellows will demonstrate the ability to integrate all social aspects of patient care, including
gender sensitivity, cultural diversity, and economic issues.
6. Fellows will demonstrate the ability to provide appropriate follow-up care in both the
inpatient and outpatient setting.
7. Fellows will demonstrate the ability to synthesize all history, physical examination, and
diagnostic testing information into a well-thought out logical plan of care that is documented in
a clearly organized consult or note.
8. Fellows will demonstrate the ability to triage and manage critically ill patients in the on-call
setting.
9. Fellows will demonstrate the ability to be patient advocates by utilizing hospital resources,
such as social work, consult services, pharmacy services, etc, to help facilitate the best possible
patient care.
10. The above elements will be evaluated by direct observation and interaction with the
cardiology faculty.
MEDICAL KNOWLEDGE:
1. Fellows will assist in conducting rounds on inpatient services and/or present patients directly
thereby allowing the supervising attending physician to assess their medical knowledge as it
relates to specific patient cases.
2. Fellows will provide periodic didactic teaching sessions for the house staff on inpatient
teaching rounds.
3. Fellows are expected to develop a reading system that will facilitate a broad knowledge base
of cardiology. This reading system should include major cardiology texts, landmark clinical trials,
and current literature published in common cardiology journals.
4. Fellows will present at a variety of weekly conferences.
5. Fellows will give a formal grand rounds lecture.
6. Fellows will present at Journal Club.
7. Fellows will maintain a thorough procedure log to document technical skills training.
8. Fellows are expected to attend teaching conferences that are designed to cover a thorough
curriculum in cardiovascular diseases.
9. Each fellow will have the opportunity to attend national meetings.
10. Fellows present patients to the attending and are directly observed while performing
invasive procedures.
PRACTICE-BASED LEARNING AND IMPROVEMENT:
1. Fellows will learn to use information technology, literature sources, and other available
resources to learn to practice evidence-based medicine that is guided by sound medical
principles consistent with the standard of care and approved practice guidelines.
2. Fellows will learn to individualize patient management based on the available resources and
the circumstances particular to the patient.
3. Fellows must be able to analyze their clinic and rotation experiences and discuss methods for
improvement as it relates to patient care, fellow education, and junior house staff education.
4. Fellows must be able to recognize their own limitations in knowledge base and clinical skills
and be receptive to life-long learning.
5. Fellows will periodically meet as a group with the program director to discuss identified
problems and potential solutions.
6. Fellows must be able to use the medical literature to update their practice methods and
improve patient care.
7. Fellows must be able to critically evaluate the medical literature.
8. Fellows approach to and use of the medical literature will be assessed by the supervising staff
physician on a given rotation.
9. Fellows will maintain online portfolio in which they are required to document experiences in
which they identify their own strengths, deficiencies, and limitations in knowledge.
INTERPERSONAL AND COMMUNICATION SKILLS:
1. Fellows will learn to effectively communicate as a consultant cardiologist to the referring
health care provider and other members of the health care team.
2. Fellows will learn to communicate a patient’s medical diagnosis and potential therapies or
procedures in a manner that is easily understood by the patient and his or her family members.
3. Fellows will learn to generate accurate, thorough, and easily understood reports for cardiac
procedures.
4. Fellows will learn to listen to and understand patient and family member concerns.
5. Fellows are expected to provide thorough, timely, and legible written consultations in the
patient’s medical record.
6. These skills will be evaluated by direct observation from the attending physicians as fellows
rotate through the clinical services, and the results will be reported via monthly rotation
evaluations.
PROFESSIONALISM:
1. Fellows are expected to treat patients and their family members, colleagues, house staff,
support staff, and administrative staff members with appropriate respect.
2. Fellows are expected to approach patient care with compassion and integrity and to be
sensitive to individual patient needs with respect to patients’ age, gender, culture, and/or
disabilities.
3. Fellows are expected to maintain the highest ethical standards including maintaining strict
patient confidentiality, ensuring adequate informed consent, adhering to ethical business
practice, and informing patients of all practical therapeutic options.
4. Fellows are expected to be committed to excellence and on-going professional development.
5. Fellows are expected to report to work in a timely fashion that provides adequate time to
prepare for rounds, instruct junior house staff, and attend to complicated or critically ill
patients.
6. Fellows will check out any patient issues that may need attention overnight to the on-call
fellow.
7. Professionalism will be evaluated through direct observation by attending physicians and
reported via rotation evaluations.
8. Professionalism will be evaluated by support staff members via 360 degree evaluations that
will be developed.
SYSTEMS-BASED PRACTICE:
1. Fellows will learn to interact professionally in the context of the health care system as a whole
and remain sensitive to the role of ancillary services, other health care providers, good business
practice, and adherence to high ethical standards.
2. Fellows will learn to work with all members of the health care team (nurses, social workers,
pharmacists, etc) to provide the best and most efficient plan of care for all patients.
3. Fellows will specifically learn to integrate various cardiology services and procedures with the
medical and surgical services involved in the patient’s care.
4. Within cardiology, fellows will learn to integrate the services and procedures provided by the
various cardiac disciplines involved in the patient’s care.
5. Fellows will learn to partner with a patient’s primary care provider in order to ensure that the
best possible care is provided to the whole patient.
6. Fellows will learn to practice cost-effective health care while not compromising quality of
care.
7. Fellows are expected to be strong patient advocates.
CONFERENCES
The training program provides didactic instruction in the following specified topics, with which each
fellow is expected to demonstrate a good understanding.
1. Basic science
a. Cardiovascular anatomy
b. Cardiovascular physiology
c. Cardiovascular metabolism
d. Molecular biology of the cardiovascular system
e. Cardiovascular pharmacology
f. Cardiovascular pathology
2. Prevention of cardiovascular disease
a. Epidemiology and biostatistics
b. Risk factors
c. Lipid disorders
3. Evaluation and management of patients with:
a. Coronary artery disease and its manifestations and complications
b. Arrhythmias
c. Hypertension
d. Cardiomyopathy
e. Valvular heart disease
f. Pericardial disease
g. Pulmonary heart disease
h. Peripheral vascular disease
i. Cerebrovascular disease
j. Heart disease in pregnancy
k. Adult congenital heart disease
l. Complications of therapy
4. Management of:
a. Acute and chronic congestive heart failure
b. Acute myocardial infarction and other acute ischemic syndromes
c. Acute and chronic arrhythmias
d. Preoperative and postoperative patients
e. Cardiac transplant patients
5. Diagnostic techniques, including:
a. Magnetic resonance imaging
b. Fast compute tomography
c. Positron emission tomography
Conferences Schedule:
DIDACTIC CLINICAL CONFERENCE
EVERY THURSDAY
06:30-07:30
SCI CONFERENCE ROOM
NONINVASIVE CARDIAC CASE CONFERENCE
FIRST FRIDAY OF EVERY MONTH
07:00-08:00
SCHROEDER AUDITORIUM
INVASIVE CARDIOLOGY CASE CONFERENCE
2ND – 5TH FRIDAY OF EVERY MONTH
07:00-08:00
SCHROEDER AUDITORIUM
EKG RECOGNITION & MANAGEMENT
1ST & 3RD TUESDAY OF EVERY MONTH
06:00-07:00
MEETING ROOM C
INTERNAL MEDICINE GRAND ROUNDS/CARDIOLOGY GRAND ROUNDS
EVERY WEDNESDAY
12:00-13:00
HEALTH SCIENCE CENTER, ROOM 106
ELECTROPHYSIOLOGY CONFERENCE
2ND TUESDAY OF EVERY MONTH
06:00-07:00 MEETING ROOM A
4TH TUESDAY OF EVERY MONTH
18:00-19:00 LOCATION TBD
RESEARCH CONFERENCE
4TH WEDNESDAY OF EVERY MONTH
06:00-07:00
SCI CONFERENCE ROOM
CARDIOLOGY JOURNAL CLUB
2nd MONDAY OF EVERY MONTH
06:30-07:30
SCI CONFERENCE ROOM
ADULT STRUCTURAL HEART DISEASE CONFERENCE
1ST &3RD THURSDAY OF EVERY MONTH
06:00-07:00
CENTER FOR HEALTH & WELL BEING CONFERENCE ROOM
Fellows are expected to participate in case presentations and discussions.
Conference attendance is recorded for every conference, and each individual fellow’s attendance is
included in his/her file. Failure to attend conferences will be mentioned in letters of recommendation
written by the Program Director. A 75% attendance is required to advance.
REQUIRED ROTATIONS
For detailed information regarding goals and objectives of each rotation, please refer to the
Cardiovascular Fellowship Curriculum.
For precise details of each rotation regarding specific duties, expectations, and responsibilities, please
see below (please note: start/end times and rotation specific responsibilities will be the discretion of
the supervising physician):
1. Clinical rotation/CVICU - Sanford USD Medical Center (SUMC) & Sanford Heart Hospital (SHH)
The fellow will start with pre-rounding on teaching service patients and attending to urgent issues that
need addressing before the attending rounds. The residents and students assigned to this rotation are
required to pre-round with the fellow. The attending rounds typically begin at 08:00 with the entire
team: fellow, resident(s), student(s).
After rounds, the fellow will participate in consults for the teaching service attending and the clinical
faculty on call for that given day. The acute admissions during the day (ER, transfers, etc.) will be
worked- up by the fellow and discussed with the faculty on the case. The fellow will be responsible for
patient care issues on teaching service with residents and/or students, providing them with feedback
and teaching. The procedures required in CVICU, telemetry, or floors on teaching service patients will be
performed by the fellow under direct supervision of the attending physician. The fellow will review
invasive and noninvasive data of the teaching service patients as it presents throughout the day. The
fellow will then discuss it with the attending physician. The day will end at approximately 17:00. The
fellow may stay longer if there are patient care issues; however, the attending must approve. The
ACGME duty hour rules must not be violated under any circumstances.
Teaching service faculty derives from the key clinical faculty (KCF) of the program. A KCF member is
assigned for a given week of the rotation. Teaching service patients consist of the KCF patients for the
given week and designated patients of the rest of the program faculty (interesting cases that are listed
as such by all of clinical faculty). The list of teaching service patients for a given day will be available on a
daily basis at 07:00 from nursing staff of the KCF on the teaching service rotation.
The primary fellow on this rotation is assigned teaching service KCF patients for rounds. Also, this fellow
works with the teaching attending on consults and admissions to the teaching attending service. The
primary fellow also works with on-call cardiology attending, participating in his/her consults and
admissions (sometimes the teaching attending might also be on-call attending). If there are two
Cardiovascular Disease fellows on Clinical Service Rotation at the same time in the month, the Senior
Fellow will participate in the Internal Medicine Morning Report every Monday at 09:00 in the Network
Conference Room 5405 of the Sanford University Medical Center. If there is a second fellow on this
rotation, then the second fellow participates in teaching rounds and participates in consults/admissions
for the rest of the faculty (non-teaching service at that time and not on-call).
2. Noninvasive rotation - Sanford Heart Hospital (SHH) & Sanford Cardiovascular Institute (SCI)
In general, the fellow will start at 0700. In the event of a morning conference, the fellow will begin
immediately following the conference. The fellow will begin with pre-reading of echocardiography,
nuclear cardiology, Holter, cardiac event recorder, and cardiac CT/MRI studies. This reading will occur in
the reading room of Sanford Cardiovascular Clinic (SCI) with the fellow using their individual computer
sign-on. The studies assigned to the SCI cardiologist on call that day will be pre-read by the fellow and
then discussed with the on call attending during the day. As the attending finalizes the study reports the
final feedback will be given to the fellow. As discussed and agreed upon with the Sanford Internal
Medicine group, the fellow will pre-read all EKGs from Sanford Hospital that are listed under the Internal
Medicine reading attending on for the time frame (usually 2 weeks rotation for the attending). The
reading schedule for the Internal Medicine group is available at the fellowship’s coordinator office.
At approximately 08:00-12:00, the fellow will participate in cardiac stress testing under supervision of
the program clinical faculty. The list of tests for a given day is available for the fellow directly from the
SHH stress lab. The first 25 stress tests for a given fellow in his/her first year will be dictated by his/her
attending; afterwards it is the fellow’s duty to dictate a stress test report for any stress test that he/she
participates in.
At approximately 12:00-14:00, the fellow will start transthoracic echocardiographic scanning of
outpatients under supervision of the designated echocardiography technician and faculty in the Sanford
Heart Hospital (SHH) echo lab.
From 14:00 until 17:00, the fellows will be in the reading rooms of Sanford Cardiovascular Institute for
echo/nuclear reading with clinical faculty on call and others.
Transesophageal echocardiographic studies (TEE) are performed by the program faculty throughout the
day. The fellow is expected to participate in as many studies as possible. The fellows are permitted to
attend the TEE, even if it occurs during the stress tests time period. The stress lab staff will arrange for a
stress test to be covered by an APP if this was to occur. The TEEs are performed at the Sanford Cardiac
Catheterization Laboratory and in the intensive care units of SUMC. The list of TEE studies for the day is
available for the fellow on the cath lab schedule in the One Chart computer system.
Cardiac CT studies are read with the attending of the day, in the SHH reading rooms. Cardiac MRI studies
will be read with Dr. Julie Prescott at her reading station. The fellows will be paged directly by her.
The day will end at approximately 17:00.
3. Continuity Clinic – Sanford Cardiovascular Institute (SCI)
Each fellow will have a specific day of the week assigned to him/her for continuity clinic which will
remain the same for the length of the fellowship. Continuity clinic hours are 08:00–12:00 or 12:00–
16:00, one half-day per week, for the duration of the fellowship (except vacation time and out of town
electives). The continuity clinic is located at the Sanford Cardiovascular Institute (SCI) clinic site. The KCF
will supervise the fellows in the clinic and assign patients to the fellows that require special care, that
have great educational value, or that will require long term follow-up.
Each half day of continuity clinic will require the fellow to see 4-8 patients (approximately 1-2 new
patients and 2-3 follow-up visits). Prior to the attending physician seeing the patient, the fellow will be
expected to document the following in the electronic medical record: patient history, physical exam,
diagnosis, and treatment plan. The documentation will be discussed between the fellow and attending
with the attending physician either approving the fellows’ documentation or making changes as needed.
4. Invasive cardiology – Sanford USD Medical Center (SUMC) & Sanford Heart Hospital (SHH)
In general, the fellow will start at 0700 in the cardiac catheterization laboratory (SHH/SUMC) and will
follow the schedule of procedures. The schedule will be available the day before. The priority cases for
the fellow are KCF and clinical faculty patients. Before a procedure, the fellow will visit with the patient
in the cath lab holding area (outpatients) or in the patient’s hospital room (inpatients). The fellow will
review all pertinent data, examine the patient, discuss the informed consent, and answer the patient’s
questions. On the first invasive rotation, the fellow will scrub-in with the cath lab staff and assist in the
preparation for the procedure (scrubbing, setting up injectors, choosing equipment, etc.). This will give
the fellow a comprehensive experience of all aspects of invasive cardiology. The fellow on this rotation
will be responsible for case presentations for the invasive cardiology conference at 07:00 on all Fridays
of the month, except the first Friday on the month. The day will end at approximately 16:00.
The fellow, according to the ACGME progressive responsibility for patient management principle, can
eventually order conscious sedation medications for a patient if and when the supervising attending
agrees to it. This decision (as other decisions on the fellow’s progression of responsibilities in the cath
lab, i.e. vascular access, the extent of catheter manipulation, etc.) is at the discretion of the supervising
clinical faculty and is made on an individual basis. The clinical faculty will make these determinations
after observing and teaching a specific fellow during their Invasive rotation.
5. Cardiac Electrophysiology – Sanford USD Medical Center (SUMC) & Sanford Heart Hospital (SHH)
In general, the fellow will be expected to begin rounding on the EP patients at 0700 daily. The fellow
will then will be with the Electrophysiologist on call for the day. The fellow will be responsible for new
consult evaluations and to present a complete plan of care to the attending. The fellow is expected to
be present in the EP lab during most of the electrophysiology studies and device implantations. The
fellow will also be required to be in the device clinic at least one half day per week. Fellows will be
expected to present cases at the Tuesday morning EP conference.
By the end of the rotation, the fellow will become familiar with heart rhythm programming for device
checks. The day generally ends at 17:00.
Research – Cardiovascular Health Research Center
The fellow must begin corresponding with their research mentor prior to their rotation. In particular,
they must identify a project, and the training and approvals that must be in place. Research labs employ
a variety of techniques and approaches, and your effort will vary from lab to lab and by study design;
plan on at least one month for new human subjects (IRB) or animal studies (IACUC) protocols. In many
cases, simple amendments will require a month. The typical rotation will include 1) background
research & study design; 2) specific methodological research and lab specific training by observation; 3)
validation of fellow on quantitative accuracy with pilot experiments; 4) execution of primary study; 5)
analysis of results; 6) follow-up studies; 7) write up & written report to mentor. Working hours will be
determined by study design. Typical projects include weekend and evening hours that should be
coordinated with your mentor's team. Clear expectations will facilitate your success.
6.
Vascular Imaging/Vascular Disease – Sanford USD Medical Center (SUMC) & Sanford Heart
Hospital
The rotation hours are typically 8:00 am to 5:00 pm. The fellow will interpret vascular studies under the
supervision of the interpreting vascular clinical faculty. The fellow’s primary responsibility is to the oncall clinical faculty who is responsible for vascular studies interpretation. While on rotation, the fellow is
expected to present a vascular case at Imaging Conference. The clinical faculty will call the fellow to
discuss the peripheral angiograms and interventions as they are done in the cath lab (participation in
7.
these is required on the cath lab rotation). The fellow is expected to evaluate patients and prepare
them for the peripheral vascular ultrasound studies, as well as perform them under the supervision of a
trained ultrasound technician and attending physician. All studies will be reviewed by the faculty
attending who will provide feedback and education to the fellows. The fellow will also review computed
tomography peripheral angiograms and magnetic resonance angiograms with the clinical faculty. An
exposure to vascular/wound clinic is planned and the fellow will be directed there by the faculty.
VA Medical Center – Royal C. Johnson Veteran’s Administration Medical Center
Cardiovascular fellows while on call will provide coverage for the VA with their clinical faculty back-up.
The clinical experience at the VA, while on-call (call from home) will include cardiology consultations,
EKG interpretation and ECHO interpretation.
8.
OFF-SERVICE ROTATIONS
For detailed information regarding goals and objectives of each rotation, please refer to the
Cardiovascular Fellowship Curriculum.
For precise details of each rotation regarding specific duties, expectations, and responsibilities, please
see below (please note: start/end times and rotation specific responsibilities will be the discretion of
the supervising physician):
1. Pediatric Cardiology – Sanford Children’s Pediatric Cardiology Clinic
The fellow will attend outpatient clinic at Sanford Children’s Pediatric Cardiology Clinic, which typically
starts at 08:00 on weekdays and runs until approximately 17:00. Rounding will begin at the Sanford
Children’s Hospital at 0700 and sometimes continue throughout the day. Also, the fellow will
participate in inpatient consultations for the Pediatric Cardiology service.
Fellow participation in outpatient and inpatient services is required at the discretion of the attending
Pediatric Cardiologists. The fellow will attend Pediatric Cardiology team meetings and educational
conferences as the schedule permits.
Participation in the service after hours and on weekends will be at the discretion of the attending
Pediatric Cardiologists, as allowed by the call schedule requirements of the Cardiovascular Fellowship
program as well as work hour limitations.
2. Cardiothoracic and Vascular Surgery – Sanford USD Medical Center (SUMC) & Sanford Heart
Hospital (SHH)
The fellow reviews the surgery schedule of Sanford Cardiothoracic Surgery the day before. The fellow
starts at 07:30 (reports at Sanford Cardiothoracic Surgery Clinic or Sanford Heart Hospital operating
rooms) and finishes the day at 17:30. The fellow is required to participate in the daily hospital rounds,
prepare and present patients for hospital consults, evaluate new admissions, assist in cardiothoracic
surgery procedures, and participate in outpatient clinic. The fellow is also required to present to the
cardiothoracic surgery team the reviewed literature on topics assigned by the cardiothoracic surgery
attending.
3. Heart Transplant and Heart Failure Rotation – Mayo Clinic in Rochester, Minnesota
This option is meant to provide for a unique and important educational experience unavailable at
Sanford USD Medical Center. Mayo Clinic shall arrange for a two-week rotation for the Cardiology
fellow to obtain Heart Transplant/Heart Failure Observational experience at its clinical site in Rochester,
Minnesota. The fellow will gain experience in the evaluation and management of patients for cardiac
transplant/VAD patients in hospital and clinic settings. The fellow will also learn the appropriate
cooperative relationships with other specialty consultants and primary care physicians in heart
transplant /VAD patients.
4. Elective Rotations
Elective rotations include those listed above; any required rotation may also be chosen as an elective.
The Program Director and Program Coordinator will be informed a minimum of 4 weeks in advance of
the elective. Elective time is not considered vacation time. Attendance at on-site or off-site elective
rotations is mandatory. Failure to demonstrate regular attendance may lead to loss of pay and/or
academic credit. Fellows must carry their pagers while on elective rotations. Fellows on elective
rotations are required to attend all scheduled conferences.
Fellows may do an off-site elective rotation, but this must be approved by the Program Director in
advance. This option is meant to provide for a unique and important educational experience
unavailable at Sanford USD Medical Center. If a fellow wishes to do an off-site elective rotation, he/she
must provide a curriculum, a letter from his/her site director, and a reason why the elective rotation
cannot be done at Sanford USD Medical Center. This information is required at least 90 days in advance
to ensure that the rotation sponsorship is appropriate, that the rotation meets the Residency Review
Committee (RRC) requirements, and that it will allow the fellow to receive the required elective credit
needed to sit for the ABIM board exam. At the conclusion of the elective rotation, the fellow must
provide a written evaluation by the sponsor. The fellow must also provide a brief report to the GME
Committee on what he/she has learned during the elective rotation. Please refer to the “Away
Rotation” GME policy.
EDUCATIONAL GOALS BY YEAR
The Sanford School of Medicine Cardiovascular Disease Fellowship Program is a three-year program
designed to train clinical and academic cardiologists. We are committed to training fellows to assume
leadership role in cardiovascular medicine in basic and clinical research and clinical cardiology. The
curriculum is organized to provide increasing levels of responsibility for trainees with respect to patient
care and procedure performance. Adequate progression through the curriculum is assessed by
evaluating each fellow’s clinical judgment, clinical skills, medical knowledge, procedural skills,
professionalism, communication skills, leadership ability, and continuing scholarship. At all times during
their training, fellows are expected to conduct themselves with the highest of ethical standards and are
expected to display integrity, honesty, compassion, and respect to all members of the health care team,
patients, and patient family members. Fellows should always be strong advocates for all patients under
their care and should utilize the health care system to maximize the benefit to each individual patient
while respecting the patient’s expressed wishes. In the end, the welfare of the patient should be the
fellow’s primary concern.
The specific objectives of the program are to help the Fellow:
1. Develop the knowledge base and the clinical, procedural and interpersonal skills necessary to
practice cardiovascular medicine in both inpatient and ambulatory care settings.
2. Develop expertise in caring for patients with a variety of acute and critical cardiovascular illnesses in
any hospital settings
3. Develop expertise in caring for patients with cardiovascular diseases in the outpatient setting,
through continuity ambulatory care experience.
4. Develop expertise in evaluation and diagnosis of patients presenting with cardiovascular diseases
through history, physical examination and appropriate diagnostic testing of a wide range of
cardiovascular disease problems.
5. Learn the psychosocial underpinnings of medicine and the skills necessary to deal with psychosocial
problems.
6. Develop self-directed learning habits and skills that will enable you to continue professional growth
throughout your careers.
7. Develop and produce original research projects in field of interest with goal of peer reviewed
publication.
8. Develop and enhance the skills needed to communicate effectively with patients, allied health
personnel and peers.
9. Incorporate into practice the core role of patient care, patient safety and patient advocacy, and use
these tenets as the underpinnings for all actions and behavior.
10. Develop an interest and skill in teaching others, to perpetuate and strengthen the tradition of
mutual teaching and learning in cardiology.
Specific curricular goals in each of these areas and for each rotation are outlined in the Cardiology
Fellowship Curriculum. Each fellow will be expected to meet specific core competency milestones, as
identified and outlined by the ACCF Cardiology Competency Statements.
Fellows are expected to gain the skills intrinsic to the practice of cardiovascular medicine. These would
include the skills of doctor/patient communication and the ability to establish a meaningful, empathic
relationship with patients. The ability to obtain a complete focused medical history and perform an
effective, focused physical examination are specific objectives of the fellowship program. In addition,
fellows are expected to master procedural skills required to practice cardiology. Further, interpretive
skills are expected to be mastered by fellows in the areas of cardiovascular diagnostic studies. Fellows
are expected to perform primary interpretation of noninvasive and invasive cardiology procedures and
be able to interpret and utilize the reported results of more complex testing.
Graduates are expected to maintain high standards of humanistic behavior in their professional lives.
They are expected to demonstrate honesty, integrity, and high moral conduct in all professional
dealings. They should demonstrate professionalism, respect and compassion for patients, and respect
for all staff. In addition, they need to demonstrate open, nonjudgmental approaches to dealing with all
patients and all patient complaints.
It is the obligation of our training program to ensure that the above goals are met and an appropriate
method of evaluation is in place.
Fellows are expected to have passed their Internal Medicine Boards in their first year of fellowship.
FIRST YEAR FELLOWSHIP TRAINING
General:
The overall purpose of the first year of training is to provide new fellows with a broad exposure to all
aspects of clinical cardiology as well as ample introductory experience to a wide variety of invasive and
non-invasive cardiac procedures. Fellows will also be introduced to both clinical and basic science
research. By the end of the first year, fellows will be able to evaluate cardiac patients and to initiate care
appropriate for a wide variety of acute and chronic cardiac conditions but will not be expected to be
experts in either clinical care or procedural skills. The goals for the first year of training are for fellows to
be introduced to the full range of cardiovascular disease clinical and research opportunities, identify a
specific area of interest and a projected career path, be paired with an appropriate mentor, and to
select a research project.
Clinical Judgment and Skills:
By the end of the first year of fellowship training, fellows should be able to obtain an accurate and
complete cardiac history and to perform a thorough but directed cardiac physical examination for
patients being evaluated for a wide variety of cardiovascular diseases. During their first year of training,
fellows will learn the proper role of the various invasive and non-invasive cardiac procedures and tests.
Using the information available from the history, physical examination, and test results, first year fellows
should be expected to be able to develop a differential diagnosis and a plan of care for common acute
and chronic cardiovascular disease states. Additionally, first year fellows will be expected to identify lifethreatening cardiovascular conditions and emergencies and to be able to initiate prompt therapy. First
year fellows will gain experience in understanding the pathophysiologic basis of cardiac conditions. First
year fellows should be able to contribute to patient management discussions on rounds in conjunction
with the staff physician
Medical Knowledge:
First year fellows will begin to build the critical knowledge base that will permit them to function as
competent well-rounded cardiologists. This knowledge will be acquired by reading current cardiology
literature sources and standard textbooks as well as via didactic lecture sessions. Clinical knowledge will
be gained in the following areas: coronary artery disease, myocardial diseases and heart failure,
congenital heart disease, valvular heart disease, peripheral vascular disease and diseases of the aorta,
cardiovascular prevention, hypertension, pericardial diseases, cardiac dysrhythmias and clinical
electrophysiology, cardiothoracic surgery, cardiac rehabilitation, and pulmonary hypertension. First year
fellows will begin to learn the basic literature related to cardiovascular testing and procedures and will
begin to develop interpretive skills.
Procedural Skills:
First year fellows will learn the indications, contraindications, and potential complications related to
each major cardiovascular procedure. First year fellows will also begin to develop a working knowledge
of the risk/benefit assessment that must take place prior to performing an invasive cardiac procedure.
First year fellows will begin to learn how to safely perform procedures and to interpret the data
obtained. These procedures will include electrocardiograms, ambulatory ECG monitoring, transthoracic
and transesophageal echocardiograms, cardiac catheterization (hemodynamic and angiographic
studies), exercise and pharmacologic stress testing, cardiac CT and MRI, electrical and chemical
cardioversion, temporary pacemaker placement, and nuclear cardiac imaging. First year fellows will be
instructed in how to properly document procedure findings and will be expected to document a
thorough and accurate report on any procedure performed. By the end of the first year, fellows should
be expert in the pre-procedural and post-procedural assessment of patients referred for cardiac testing
and should participate in the performance of invasive procedures only under the direct supervision of an
attending cardiologist.
Teaching:
First year fellows will be expected to provide teaching to medical students and residents on the basics of
common cardiovascular conditions and routine bedside invasive. Teaching methods should include
actively participating in case discussions on rounds, conducting brief teaching sessions, and introducing
house staff to common cardiology literature sources (journal articles, textbooks, etc).
Professionalism:
First year fellows are expected to conduct themselves with exemplary professionalism at all times, as
evidenced by the display of honesty, integrity, respect, and compassion when caring for patients and
interacting with patient families, referring providers, and other members of the health care team. First
year fellows will accept responsibility for the care of cardiac patients and will be held accountable for
conducting themselves with the highest of ethical standards at all times.
Communication Skills:
First year fellows will learn how to write a thorough, informative, and instructive cardiac consultation
note as well as accurate and detailed procedure notes. First year fellows will learn to verbally
communicate effectively with patients, families, and all members of the health care team. Fellows will
learn the importance of maintaining complete and accurate medical records easily accessible to
referring providers.
Leadership:
First year fellows should be able to provide guidance for medical students and residents as it relates to
routine patient care. First year fellows should be able to participate in management discussions on
teaching rounds in conjunction with the service attending.
Continuing Scholarship:
First year fellows will be expected to develop a reading program that will build the foundation of basic
cardiology knowledge necessary to become a competent clinical cardiologist. Fellows will learn the
significance of keeping current with the literature in order to be able to adapt their clinical practice as
new advances are made. Attendance at journal club will allow the fellows to keep abreast of the current
literature. Fellows will improve their ability to critically review the cardiovascular literature and to
correctly apply the literature in their clinical practice. Fellows will be introduced to both clinical and
basic science research as it applies to cardiovascular diseases in order to help them select their
fellowship research project.
SECOND YEAR FELLOWSHIP TRAINING
General:
Second year fellows will continue to build upon the knowledge and skills gained during the first year of
training and will begin to focus on their particular area of interest. Second year fellows will be given
greater latitude in patient management decisions in the continuity of care clinic. During the second year,
the fellow’s research project should be well-established, and each second year fellow should be able to
present his/her activities at the dedicated research conference. Depending upon the outcome of their
research work, some second year fellows may be positioned to submit their findings in abstract form to
national or regional scientific meetings.
Clinical Judgment and Skills:
Second year fellows will improve upon the clinical judgment and skills acquired during their first year of
training by continued participation in patient care in a variety of settings and will work to master the
development of acute and chronic management plans for patients with cardiovascular diseases. Second
year fellows will be expected to understand the pathophysiologic basic of common cardiovascular
diseases and will use this knowledge to help guide clinical management decisions. Fellows will gain a
better understanding of how best to utilize cardiac procedures in the care of patients, will demonstrate
continued improvement in test result interpretation, and will continue to refine their understanding of
the risks and benefits of the various cardiac procedures. During the second year, fellows will continue to
improve their ability to synthesize the cardiology literature and apply it in an evidence-based manner to
the care of their patients.
Medical Knowledge:
Second year fellows will continue to advance their knowledge base by critically reviewing the cardiology
literature and continuing to read standard cardiology texts. They are expected to regularly attend the
core curriculum conference, journal club and the weekly clinical cardiology conference.
Procedural Skills:
Second year fellows will be skilled in determining the appropriateness of planned procedures. The
development of procedural skills will be limited by the number of research months during the second
year of training.
Teaching:
In addition to teaching medical students ECG ‘s, second year fellows are expected to help introduce first
year fellows to the program and to assist with bedside procedures (e.g., PA catheter placement,
temporary pacemaker placement, transthoracic echocardiography, etc).
Professionalism:
Second year fellows will continue to perform their duties with utmost professionalism utilizing the
highest of ethical standards.
Communication Skills:
Second year fellows will work to improve their written and verbal communication skills relative to direct
patient care reporting. Second year fellows will continue to gain experience in interacting with patients,
family members, and all members of the health care team especially in the continuity of care clinic.
Second year fellows will understand the importance of maintaining complete and accurate medical
records easily accessible to referring providers.
Leadership:
Second year fellows will be expected to be role models for first year fellows and to set the highest
professional and ethical standards for them to follow.
Continuing Scholarship:
Second year fellows will continue to update their cardiovascular knowledge base via critical review of
the literature and continued reading of standard cardiology texts. Second year fellows will be expected
to be able to interpret the cardiology literature correctly and to apply it appropriately in an evidencedbased manner to the care of individual patients. Second year fellows will be expected to formulate a
meaningful research experience in conjunction with an appropriate mentor.
THIRD YEAR FELLOWSHIP TRAINING
General:
The overall purpose of the third year of fellowship is for trainees to perfect their clinical patient care and
procedural skills and to be able to practice evidence-based medicine for the full spectrum of
cardiovascular diseases. By the end of their third year, fellows should be deemed capable of practicing
clinical cardiology competently and independently and to safely and expertly perform all procedures.
Third year fellows should fully meet all six of the ACGME general core competencies. Additionally, third
year fellows may submit the results of their research project as an abstract to the appropriate forum.
They will also be encouraged to submit full-length manuscripts for publication in clinical or scientific
journals. The faculty will provide guidance and support with regard to such scholarly endeavors.
Clinical Judgment and Skills:
Third year fellows will improve upon the clinical judgment and skills acquired during the first two years
of training by further participation in patient care in a variety of settings and will be expected to apply
evidence-based medicine to develop comprehensive acute and chronic management plans for the full
spectrum of cardiovascular diseases. Third year fellows will be expected to skillfully select the most
appropriate cardiac tests for individual patients and to expertly apply the results leading to the safest
and most optimal care. By the end of the third year, fellows should be able to manage all cardiac
patients expertly and should be able to function independently as a consultant cardiologist.
Medical Knowledge:
Third year fellows will continue to build their cardiology knowledge base by further review of the
available literature, and by the completion of the training program, fellows will be expected to be wellversed in all aspects of the clinical cardiovascular diseases literature. Third year fellows will be able to
expertly interpret cardiac tests and to apply the results appropriately to the care of individual cardiac
patients.
Procedural Skills:
Third year fellows will perfect their procedural skills and will become skilled in performing procedures in
complicated patients. Third year fellows will have a thorough understanding of the risks and benefits of
the procedures they perform, will be able to manage associated complications, will be able to expertly
interpret and apply all data obtained, and will be able to effectively communicate procedure results to
patients and referring providers.
Teaching:
Third year fellows will be expected to teach medical students, residents, and junior cardiology fellows on
clinical services, laboratory and non-laboratory setting and actively participate in conferences.
Professionalism:
Third year fellows will continue to conduct themselves professionally at all times and with the highest of
ethical standards.
Communication Skills:
Third year fellows will be able to write complete, accurate, and informative consults as well as detailed
and accurate procedure reports. Third year fellows will be able to communicate effectively with
patients, their families, and all members of the health care team.
Leadership:
Third year fellows should be able to function as team leader for the clinical cardiovascular services under
the direction of the assigned staff physician. Third year fellows will be expected to mentor junior fellows
in all aspects of the training program.
Continuing Scholarship:
Third year fellows should have a well-established educational program that will continue into their
practice and allow them to stay current with the cardiology literature and should be expert at
interpreting and applying new data to enhance patient care. By the end of third year, fellows are
expected to demonstrate the outcome of their research activities in an appropriate formal setting.
Fellows may choose to present their research project results as an oral presentation to the Division of
Cardiovascular Diseases, a written abstract submitted to a local or national meeting, or a manuscript
submitted to a peer reviewed journal. Those interested in pursuing a career in academic medicine will
become acquainted with the benchmarks of academic success and will gain an understanding of the
extramural funding process as it pertains to their specialty area.
SUPERVISION
Fellows must be supervised at all levels of training at each training site at all times. Fellows are assigned
a faculty supervisor during each rotation. The faculty supervisor may be the patient’s attending
physician, the consulting physician, or the teaching attending physician, depending upon the role of the
faculty supervisor for a given patient. The responsibility for supervision extends to all fellow activity
during the rotation of the faculty supervisor.
The cardiovascular disease fellowship program recognizes and supports the importance of graded and
progressive responsibility in graduate medical education. The goal is to promote assurance of safe
patient care, and the fellow’s maximum development of the skills, knowledge, and attitudes needed to
enter the unsupervised practice of cardiovascular disease.
DEFINITIONS:
Supervising Physician: A faculty physician, or a more senior fellow.
Supervision:

Direct:

Indirect:

Four levels of supervision are recognized. They are:
The supervising physician is physically present with the fellow and the
patient.
There are two types of indirect supervision:
 Indirect supervision with direct supervision immediately available:
The supervising physician is present in the hospital (or other site of
patient care) and is immediately available to provide Direct Supervision.
The supervisor may not be engaged in any activities (such as a patient
care procedure) which would delay his/her response to a fellows
requiring direct supervision.
 Indirect supervision with direct supervision available:
The supervising physician is not required to be present in the hospital or
site of patient care, or may be in-house but engaged in other patient
care activities, but is immediately available through telephone or other
electronic modalities, and can be summoned to provide Direct
Supervision.
Oversight: The supervising physician is available to provide review of
procedures/encounters with feedback provided after care is delivered.
PROCESS:
The principles which apply to supervision of fellows include:

The cardiovascular disease fellowship program assigns qualified faculty physicians to
supervise at all times and in all settings in which fellows provide any type of patient
care. The type of supervision to be provided is delineated in the curriculum’s
rotation description.







The program recognizes that all fellows have completed residency training in
internal medicine, certified by their program directors. They are thus qualified to
make independent medical decisions regarding patient care.
The minimum amount of supervision required in each situation as determined by
the definition of the type of supervision specified, is tailored specifically to the
demonstrated skills, knowledge, and ability of the individual fellow. In all cases, the
faculty member functioning as a supervising physician should delegate portions of
the patient’s care to the fellow, based on the needs of the patient and the skills of
the fellow.
Senior fellows may serve in a supervisory role of junior fellows in recognition of
their progress toward independence.
All fellows, regardless of their year of training, must communicate with the
appropriate supervising faculty member when there is a complex patient, ICU
transfer, DNR or any other end of life decision.
All fellows are directly supervised, with a supervising faculty member physically
present, during all invasive cardiac procedures.
In every level of supervision, the supervising faculty member must review progress
notes, sign procedural and operative notes and discharge summaries.
Faculty members are continuously present to provide supervision in ambulatory
settings, and be actively involved in the provision of care, as assigned.
While fellows are gradually given more responsibility as they progress through the program, at all times
final responsibility for patient care rests with the faculty. All patient care must be supervised by qualified
faculty. All reports must carry an attending name and electronic signature, which signifies that the
attending has verified the findings and assessment. The program director ensures, directs, and
documents adequate supervision of the faculty at all times. Fellows will be provided with rapid, reliable
systems for communication with supervising faculty.
Fellows are supervised by teaching staff in such a way that the fellows assume progressively increasing
responsibility according to their level of education, ability, and experience. On-call schedules for
teaching staff are structured to ensure that supervision is readily available to fellows on duty.
The teaching staff must determine the level of responsibility given to each resident/fellow.
Faculty and fellows are educated to recognize the signs of fatigue and will adopt and apply policies to
prevent and counteract the potential negative effects.
DELINEATION OF RESPONSIBILITIES
DELINEATION OF THE AUTONOMY OF THE FELLOW
1. Major therapeutic decisions are to be formulated by the fellows and discussed with the
attending before implementation.
2. Attending and fellows must discuss patient assessment and plan on the day of admission.
3. Fellows should be involved in the evaluation and therapy of all CICU admissions as soon as
possible.
4. Fellows will assess and treat abrupt changes in patient status with prompt notification of the
attending physician.
5. Fellows may initiate subspecialty consultation on their patients.
DELINEATION OF ATTENDING PHYSICIAN RESPONSIBILITIES
1. Attending staff must respect the fellows’ responsibilities and autonomy.
2. Attending staff should carry out rounds with the fellows at the designated time.
3. The attending staff must closely supervise the quality and accuracy of chart documentation on
their patients.
4. Feedback to the fellows regarding performance, as well as deficiencies, should take place
routinely. Correction of errors should be done in a discreet manner.
5. The attending staff should try to make each patient a teaching opportunity.
6. It is the responsibility of the attending physician to discuss with the fellows the appropriate use
and timing of consultation
GENERAL FELLOWSHIP RESPONSIBILITIES
Responsibilities specific to individual rotations are described in each rotation’s curriculum. General
responsibilities that apply to the daily performance of fellowship duties will be listed in this section.
1. In general, daily work hours are from 7:00 to 17:00 Monday through Friday. Obviously, work hours
will vary based on the required duties of each rotation. Fellows on inpatient services with early morning
rounds will need to arrive at a time that allows adequate preparation for rounds. Fellows on procedure
rotations are expected to arrive in time to evaluate the patient prior to starting the planned procedure.
2. Fellows will provide safe, timely, and effective care for all patients he/she is responsible for.
3. Fellows will document all patient care in the medical record in a timely fashion.
4. Fellows will attend scheduled cardiology teaching conferences and initial attendance documentation
sheet.
5. Fellows will review each rotation’s curriculum with the attending at the beginning of the month and
strive to achieve the outlined goals and objectives.
6. Fellows will keep an accurate and up-to-date procedure log. This log will be reviewed at each 6-month
evaluation with the program director.
7. Fellows will review the call schedule and perform all call duties as scheduled
8. Fellows are expected to carry their pagers at all times while on duty and to respond to pages in a
timely fashion.
9. Fellows are expected to supervise and teach all house staff members on his/her team.
10. Fellows are expected to communicate with the attending physician, house staff members of the
team, the patient, and family members as frequently as is necessary to facilitate excellent patient care.
This includes discussing urgent issues that arise on call with the on-call attending.
11. Fellows will check out all critically ill patients, pending test results, and other pertinent information
to the on-call fellow prior to leaving for the day.
12. Fellows will comply with the program’s duty hour guidelines and report any problems with
compliance to the program director.
13. Fellows will notify the program director of any unplanned absence in order to ensure that continuity
clinics are cancelled and rescheduled appropriately and that rotation/call duties are covered. Coverage
for scheduled vacation and conferences is pre-arranged at the beginning of the year.
14. Fellows will conduct themselves in a professional manner at all times and will treat all others,
including colleagues, faculty, residents, medical students, ancillary staff, referring health care providers,
and patients and their families, with the utmost respect.
15. Fellows will develop a personal self-study program that is guided by the fellowship curriculum.
16. Fellows will adhere to all Sanford School of Medicine GME-related policies.
17. Fellows will adhere to all Sanford and VAMC institutional policies.
18. Fellows will complete all rotation, faculty, and program evaluations in an honest, constructive, and
timely fashion.
19. Fellows will comply with the licensure requirements of the State of South Dakota.
20. Fellows will comply with all state and federal laws governing the practice of medicine.
21. Fellows will abide by the institutional order writing policy.
CALL DUTIES
The Fellows will be on call as follows:
o Every 6th weekday (Monday-Friday) – considering adjustments for conferences, PTO, etc.
o Every 6th Saturday
o Every 6th Sunday
The Fellows will take call from home, but will conduct weekend rounds with the attending on call.
Call will be taken with the Key Clinical Faculty who is on call for that day.
On weekdays, call begins at 17:00 and ends at 07:00 the next morning. On weekends (Saturday/Sunday)
and holidays, call begins at 07:00 and ends at 07:00 the next morning.
Each day there will be an assigned attending on call to discuss consults. The attending call schedule will
be published at the beginning of each month.
Fellows will see all urgent consults on call and page the responsible attending to discuss the plan of care.
Fellows will provide assistance to the residents as needed to help manage critically ill cardiac patients,
new admissions, and consults. Fellows are expected to come in to see any critically ill patients.
The fellow on call, before the end of call, will participate in the attending on-call rounds on all the
consulted/admitted patients by the fellow during the call period. This provides an opportunity for
bedside teaching on a case by case and one-on-one basis. The time spent in the hospital by the fellow
during his/her call hours must be meticulously and immediately recorded in the New Innovations so that
monitoring of duty hours can be efficiently performed. The duty hours must be monitored by every
fellow and when a potential for duty hours violation appears, the fellow needs to notify the fellowship
coordinator immediately, allowing for the necessary schedule changes.
The fellow on call for the weekend day is responsible for all EP consults, urgent TTEs, rounding with the
attending on consults, and taking overnight call.
In the event the on-call fellow is ill or a personal emergency arises, the fellow is responsible for notifying
the primary on-call attending physician. The fellow is also responsible for immediately contacting the
Clinical Call Center (605-333-4444) to notify them of the call change.
ROTATION COVERAGE
The coverage policy has been developed to allow for continuous patient care without any disruptions
due to emergency situations. The protocol for coverage has several features to allow for adequate
coverage in all situations.
Fellows requiring coverage on an immediate basis must themselves be involved in an emergent,
unforeseeable incident that could not have been otherwise prevented. These events will require the
requesting fellow to contact the program director either in person or via phone and discuss the specifics
of the coverage options. When the decision has been made by the program director to grant coverage,
the name of the available coverage fellow will be provided. For situations where the requesting fellow is
incapable of contacting the coverage fellow, the program director will assist. Otherwise, it is then the
responsibility of the fellow who is requesting coverage to contact the coverage fellow either in person or
via phone and discuss the specifics of the coverage requirements. Also, it is the responsibility of the
fellow requiring coverage to provide full details regarding pertinent patient care issues either over the
phone or via email to the covering fellow.
The above policies are meant to serve as guidelines to be as fair as possible to all fellows. Minor
adjustments in the enforcement of the above policies will be at the discretion of the program director.
Issues of concern with regard to this policy may be periodically reviewed and refined to suit the needs of
the fellowship program.
SCHEDULE CHANGES
Alterations in program structure and/or content, or significant life changes among fellows occasionally
necessitate changing the schedule. These changes will be made known to the affected fellows. All
fellows have the responsibility of reviewing their personal/professional needs carefully to minimize
conflicts with their training. Once the final schedule is made, changes will only occur if deemed essential
by the Program Director. Fellows who wish to request an alteration in the schedule must do so in
writing in a timely fashion and be specific regarding the legitimate reason. The program does not
provide coverage for religious holidays; however, trades may be requested and are subject to approval
by the Program Director based upon professional responsibilities.
RESEARCH/PRESENTATIONS
Cardiology trainees are expected to take an active role in clinical and basic science research during the
period of fellowship training. Research mentorship is initiated during the first year of clinical training to
help guide the trainee towards a clinical research experience related to his field of clinical sub specialty,
or to a basic science laboratory and specific mentor in anticipation of an investigative career in
cardiovascular diseases. The program makes scholarship a high priority and strongly encourages
presentation of original research at a national meeting, completion of original research which is
published in a peer reviewed journal, or substantial scholarly work related to cardiology as a
requirement for completing the training program. Guidance in planning research directions with the
trainee is provided by the Research Faculty. Research is supervised directly by the individual faculty
mentor.
EVALUATIONS
Evaluations are an important part of training that should occur frequently and provide constructive
feedback. The purpose of frequent evaluation is to ensure that fellows learn and grow commensurate
with their level of cardiology training. In addition, evaluations help identify potential problems early so
that issues can be addressed before they become irreparable and adversely affect the fellow’s ability to
function as a well-rounded cardiologist. It is extremely important that the supervising staff physicians
outline the goals and objectives at the beginning of each rotation and provide fellows with feedback
during the midpoint of the rotation. Performance evaluation is based on the standard ACGME core
competencies and the goals and objections for each rotation set forth by the fellowship curriculum.
All fellows are evaluated on an ongoing basis by the cardiology faculty. At mid-month, each fellow will
receive verbal feedback on his/her performance. At the end of each rotation, attending staff will
complete evaluations on each fellow. These evaluations specifically evaluate the medical knowledge,
skills, and rotation specific competencies in each rotation. Faculty members are also encouraged to
provide written comments. These evaluations address the six ACGME general competencies: Patient
Care, Medical Knowledge, Interpersonal and Communication Skills, Professionalism, Systems Based
Practice, and Practice Based Learning and Improvement. These evaluations will be compiled in each
fellow’s individual file and will be reviewed at least biannually during specific meetings (Clinical
Competency Committee) and then the program director will meet with the fellow to discuss
performance. It is the responsibility of the fellow to ensure that he/she review his/her evaluations. It is
the expectation of the Department that specific verbal feedback is offered to each fellow mid-rotation.
Additional evaluations addressing specific competencies are also performed to allow for growth in each
of the six competencies. They include:
Patient evaluations to address professionalism and communication skills (1 per month, both
from clinic and hospital patients)
Conference presentation evaluations for presentations and performance to address medical
knowledge and practice-based learning and improvement (composite semi-annual evaluation by
faculty member)
Nursing evaluation of each fellow on a bi-annual basis to address systems-based practice,
communication skills, and professionalism from clinic nursing and hospital nursing. If these
evaluations indicate significant issues, specific evaluations and counseling will be initiated with
the fellow.
Non-faculty evaluation of each fellow on a bi-annual basis to address systems-based practice,
communication skills, and professionalism from cath lab and ECHO lab supervisors. If these
evaluations indicate significant issues, specific evaluations and counseling will be initiated with
the fellow.
Excellence in all aspects of cardiovascular medicine is the goal of our program. It is very important that
all take a responsible role in the evaluation of our peers. Therefore, we urge all fellows to carefully and
honestly complete evaluations of faculty. These evaluations should be submitted one week after the
end of each rotation. These evaluations are kept confidential. As professionals, we are required to
participate in peer review to assure the quality of our profession. The Program Director will meet biannually with each fellow to review evaluations and overall performance.
PROCEDURE DOCUMENTATION
Fellows are required to keep a detailed procedure log in New Innovations. An updated log is to be
presented to the program director for review at the bi-annual fellow evaluation.
1. The following procedures require documentation:
-ECG interpretation (patient identification information not required)
-elective cardioversion
-temporary transvenous pacemaker insertion
-programming and surveillance of permanent pacemakers and ICDs
-right heart catheterization
-left heart catheterization, including coronary angiography
-cardiac biopsy
-peripheral angiography and aortography
-exercise and pharmacologic stress testing
-transthoracic echocardiogram (2D and Doppler) acquisition and interpretation
-transesophageal echocardiograms
-stress echocardiograms
-ambulatory ECG recording (Holter) interpretation
-radionuclide studies of myocardial function and perfusion interpretation
-pericardiocentesis
-intra-aortic balloon pump placement
2. Specialized procedures requiring extra training:
-percutaneous cardiovascular interventions
-percutaneous peripheral vascular interventions
-intravascular ultrasound (IVUS)
-intracardiac EP studies
-permanent pacemaker/ICD placement
CRITERIA FOR ADVANCEMENT
Fellows will be advanced to the next PGY level based on clear evidence of progressive academic and
professional growth over the range of cardiovascular diseases.
For a first year cardiology fellow to advance to the next level, he/she must be able to:
a. Obtain an accurate and thorough directed cardiac history and perform a detailed cardiac
physical examination.
b. Synthesize the history, physical exam, laboratory, and diagnostic testing information into an
organized and meaningful presentation.
c. Develop a differential diagnosis based on the available data.
d. Demonstrate progressive development in the management of common cardiovascular
diseases.
e. Effectively lead a team of internal medicine residents and medical students on the intensive
care unit service.
f. Educate medical students and internal medical residents in the basics of cardiovascular
disease.
g. Discuss indications, contraindications, and possible complications of routine cardiac
procedures.
h. Show progress in the performance of cardiac procedures under the supervision of attending
cardiologists.
For a second year cardiology fellow to advance to the next level, he/she must be able to:
a. Show continued progress in the elements required to advance from first to second year fellow
level
b. Use all history, physical examination, laboratory data, and diagnostic testing results to narrow
differential diagnosis to a presumptive diagnosis and initiate therapy.
c. Approach patient management in an evidence-based manner.
d. Perform cardiac procedures safely under the supervision of attending cardiologists.
For a third year fellow to successfully graduate from the fellowship training program, he/she must be
able to:
a. Meet all of the above listed criteria for advancement.
b. Meet the six ACGME core competencies.
c. Demonstrate competence in all areas of clinical Cardiology.
d. Be able to function independently as a cardiologist.
e. Safely perform usual invasive and non-invasive cardiac procedures
Written offers of reappointment for the next academic year (starting the following July 1st) will be
provided to each fellow in the final quarter of each academic year.
Fellows with less than satisfactory performance may be asked to repeat the year or may not be offered
contract renewal, at the discretion of the Program.
Each fellow will be expected to meet specific core competency milestones, as identified by the ACCF
Cardiology Competency Statements, in order to advance through the program.
DUTY HOURS
The Sanford School of Medicine Cardiovascular Disease program complies fully with the ACGME,
Internal Medicine RRC duty hour guidelines. These guidelines are summarized as follows:
1. Duty hours are limited to 80 hours per week averaged over a 4-week period.
2. Fellows will be provided 1 day in 7 free from all educational and clinical responsibilities,
averaged over a 4 week period.
3. Continuous on-site duty must not exceed 24 consecutive hours. Fellows may remain on duty
for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct
outpatient follow-up clinics, and maintain continuity of patient care.
4. No new patients may be accepted after 24 hours of continuous duty.
5. Adequate time for rest and personal activities will be provided. This will consist of a 10-hour
time period provided between all daily duty periods.
Cardiology fellow work hours are subject to the 80 hours per week limit as stated above, and this
includes moonlighting. Although call is taken from home, fellows may be required to return to the
hospital to assist in the care of a critically ill patient or to perform a procedure. The hours the fellow
spends in the hospital count toward the 80 hour limit for the week.
All fellows are required to submit their duty hours at the end of the month. The duty hours are regularly
monitored by the program coordinator and the program director. Fellows should report to the program
director if the duty hour guidelines are violated in any way. The duty hour data is reviewed to confirm
that the program is in compliance with the duty hour policy.
MOONLIGHTING
Moonlighting must not interfere with assigned fellowship duties, and total work hours including
moonlighting must not exceed 80 hours per week. In general, moonlighting shifts should not start
before 19:00 and should end by 07:00. Fellows are not allowed to moonlight during the intensive
care unit rotations. Fellows are not allowed to take call from home and moonlight at the same time.
Moonlighting will be allowed at the discretion of the program director. It is the responsibility of the
program director to monitor moonlighting activities and moonlighting hours to ensure compliance
with institutional and ACGME policies. Fellows are not required to moonlight. Fellows are expected
to incorporate moonlighting hours into the duty hours when completing the duty hours reporting
form. The professional liability policy for fellows does not cover any activities that are not part of
the formal education program. Fellows on a J-1 visa are not permitted to be employed outside the
fellowship program. It is the responsibility of the fellows to be properly licensed and credentialed
as determined by the organization in which the moonlighting will occur.
Fellows will participate on various hospital and GME Committees as assigned by the Program Director.
Fellows are expected to make every effort to attend all committee meetings. Attendance at committee
meetings will be tracked.
PAGERS
A pager will be provided at the beginning of the first year of fellowship. Batteries for the pagers are
available from the program coordinator. If a pager needs repair, the program coordinator must be
notified immediately. A temporary pager will be issued while the original is being serviced. If a pager is
abused or misplaced, a new pager will be issued with the fellow being responsible for the cost of the
new pager.
At the end of the fellowship, pagers must be turned into the Cardiovascular Fellowship Office or the
fellow will be charged a replacement fee.
A revised pager list is created every July and periodically updated through the year.
LAB COATS
Three lab coats are provided at the beginning of the first year of fellowship. First year fellows should
purchase their labs coats from Sparkle Uniform and have the invoice sent directly to the Business
Manager at the Sanford School of Medicine Residency Corporation.
DRESS POLICY
Fellows are expected to wear professional attire with a white lab coat while on duty. Scrubs may be
worn by those on call, during the cath lab rotation, EP rotation, CICU rotation and when procedures are
anticipated.
SEXUAL HARASSMENT/DATING POLICY
Fellows may not initiate a dating relationship with any trainee (student or house staff) while the fellow is
on a rotation with that trainee in a supervisory position. This can create an uncomfortable work
environment and may be interpreted as sexual harassment. Please refer to the Sexual Harassment
GME policy.
PARKING
Sanford - Fellows will be provided a physician parking sticker which allows them to park in any area
designated specifically for physicians. This includes all flat surface and parking ramp locations. Fellows
are not allowed to utilize valet parking or park in any area designated specifically for patients. Parking
stickers can be obtained from the Human Resources Department at Sanford.
VA Medical Center – Fellows are allowed to park in the lots designated for employee parking (please see
lsit below). A blue hanging tag must be obtained from the VA police office. If covering hospital call after
hours, parking is allowed in the front VA parking lot but only after 3:00 pm. Fellows are encouraged to
page the officer on duty for escort to their vehicle after daylight. If a handicap sticker is required, please
contact the VA police office.
Designated VA employee parking lots:
North of the Regional Office building
South of the VA hospital - off of 26th street
Next to the VA daycare behind the hospital - just off Garfield Avenue
Near the VA’s water-tower located - just to the west side of the hospital
Lot directly behind the VA - accessible from Garfield Avenue
MEALS
Sanford - Fellows are able to eat in the Physician Lounge, located on the 5th floor of the main hospital,
free of charge. The Physician Lounge serves breakfast and lunch on weekdays. During holidays,
weekends, and evenings, cold sandwiches and other options are available. The Physician Lounge is
locked from 18:00 to 06:30. However, the fellow’s ID badge will allow access to that area. The hospital
cafeteria is located on ground level of the main hospital and is open 05:30 to 02:00. Food is available in
the cafeteria for a fee.
VA Medical Center - Fellows will be provided 1 lunch ticket per day to be used at the VA café. The café is
located on 2nd floor and is open from 07:00 to 15:00 Monday through Friday (closed on federal
holidays). The tickets can be obtained from Angela Nussbaum in the Hospitalist Office, room 351C. If
Angela is unavailable, the tickets can be obtained from the AOD office on ground floor.
ID BADGES
A Sanford ID badge is required to be worn in the hospital and will provide afterhours access through
designated areas into the hospital. Fellows will be provided an ID badge during orientation at the
beginning of the first year of fellowship. If this badge is misplaced, the fellow must notify the program
coordinator immediately.
A government-issued ID badge must also be worn at the VAMC at all times. This badge will be obtained
during the VAMC orientation. If this badge is misplaced, the fellow must notify the program coordinator
immediately.
LIBRARY FACILITIES
The fellows will have access to all educational resources of Sanford School of Medicine, including the
Wegner Health Information Center. They will have access through this facility to electronic educational
resources including, but not limited to, PubMed, Index Medicus, Cardiosource, and tctmd.com. The
fellows can access these resources using any internet capable computer from any location.
In addition to the above, the fellows will have direct access to the cardiology fellows’ library housed at
the Sanford Cardiovascular Institute. This library will be updated on a regular basis and includes most of
the literature that comprises the suggested bibliography for each rotation.
COMPUTER ACCESS
A network account will be created and given to each fellow, along with an ID and password, by the
fellowship coordinator. Fellows will need their ID and password for access to e-mail, network folders,
One Chart, and the various patient information systems such. For computer, network account, and ID
assistance please contact the IT Help Desk at 328-7333.
FELLOW OFFICE/MAILBOXES
A fellow office with work space, locked cabinets, fellow mailboxes, internet access, phones, a printer,
fax, and scanner is located in the Sanford Cardiovascular Institute, Room G834. The program
coordinator will assign each fellow a key to the Fellowship Office. Keys must be returned to the
program coordinator at the end of the fellowship. Fellows are required to frequently check e-mail since
most correspondence is now communicated electronically.
VACATION
Fellows are eligible for 15 working days paid time off each year. There are certain rotations during which
vacations should not be taken during cardiology fellowship training. Most fellows take vacation during
non-invasive or elective rotations. Vacation requests should be made at the beginning of each
academic year. Vacation hours are noncumulative and will not carry over into the next contract year.
SICK LEAVE
Fellows will receive 10 scheduled workdays, regardless of length, of paid sick leave at the beginning of
each academic year. Sick leave can be used for an illness or injury of the fellow, spouse, dependent
children, or parent. A physician statement may be required for absences of 3 days or more. Sick hours
are noncumulative and will not carry over into the next contract year.
Emergency leave for sickness or pressing family situations, paternity or maternity leave needs are to be
discussed on an individual basis with the fellowship program director.
Fellows who need to call in sick must notify the Program Director, Program Coordinator or Chief
Fellow for their hospital/rotation at least 1 hour prior to the start of their shift. Failure to notify the
Program Director, Program Coordinator or Chief Fellow will result in the absenteeism being considered
"unauthorized" which can result in loss of pay and/or academic credit. Fellows are expected to be
honest with sick time. Sick time coverage requires others to be "pulled" from elective to cover. Fellows
should make arrangements for child care ahead of time.
If the fellow is scheduled to be on call and is ill or a personal emergency arises, the fellow is responsible
for notifying the primary on-call attending physician. The fellow is also responsible for immediately
contacting the Clinical Call Center (605-333-4444) to notify them of the call change.
GRIEVANCE PROCEDURE
A fair and consistent method of review of fellow concerns and/or grievances is outlined in the official
grievance policy. If a fellow has a grievance with any aspect of the training program, he/she is
encouraged to bring the matter immediately to the program director. If the issue is not resolved to the
satisfaction of the fellow after discussion with the program director, the grievance may be formally
presented in writing to the division director, chairman of internal medicine, or GME Office for further
consideration.
DISCIPLINARY ACTION
The Sanford School of Medicine Cardiovascular Fellowship believes in a collaborative, collegial multidisciplinary care model, guided by the leadership and professionalism standards of the cardiovascular
staff and trainees. Fellows are expected to manage the clinical services in which they participate,
exemplifying the highest standards of professionalism and modulating the profession. In times of high
stress or conflict it is expected that the fellow will model calm and thoughtful care. In the event of
conflicts which cannot be easily and professionally resolved or performance issues with other members
of the health care delivery team, it is expected that the fellow will avail him or her of discussion with the
program director or other members of the senior faculty.
The Sanford School of Medicine GME Department has developed a policy regarding disciplinary action,
“Disciplinary Action and Assurance of Due Process”. Please refer to this policy for additional
information.
MISCELLANEOUS RESOURCES
The Employee Assistance Plan (EAP) offered to the fellows through Midwest EAP Solutions. This is a
comprehensive set of professional support services designed to help you and your family face and
overcome life’s challenges. All of the services are confidential and free to you and your family members.
For additional information regarding this program, please see their website at
http://www.midwesteap.com/memberlogin.php. Username: Sanford; password: member.
INDIVIDUAL PORTFOLIOS
All fellows have an individual portfolio started for them at the beginning of their first year of training.
The portfolios include evaluations, procedure logs, scholarly activities, research, etc. and are kept
securely in the Program Coordinator’s office. Fellows may review their own portfolio during working
hours from 08:00 – 17:00 weekdays.
CONTRACTS
Each fellow receives a contract for each year of his/her training program.
• New or “incoming” fellows: GME office sends new or incoming fellows contracts to their
homes.
• Returning fellows: Contracts for existing fellows are sent to the program for signatures.
Contracts are distributed the last quarter of the academic year.
Once signed, a copy of the contract should be sent or delivered to the GME office for filing purposes.
PREAMBLE
The health care professions require men and women of superb character who lead lives that exemplify
high standards of ethical conduct. A shared commitment to maintaining these standards, embodied in
an Honor Code, creates an atmosphere in which residents can develop professional skills and strengthen
ethical principles.
Sanford School of Medicine strives for the total development of the resident into an independently
practicing physician. When beginning residency, the resident becomes part of a larger professional
community and consequently is expected to uphold the moral integrity and ethical standards of the
practicing physician. This transition includes consistently abiding by moral character and honorable
principles.
The central purpose of the Honor Code is to sustain and protect an environment of mutual respect and
trust in which residents have the freedom necessary to develop their personal and professional
potential. To support a community of trust, residents and faculty must accept individual responsibility
and apply themselves to developing a collegial atmosphere of best practices. The intent of the Honor
Code is to communicate to the health care community that the integrity of our residents is
unquestioned and accepted by those in the academic, clinical, and research facilities. Participation in the
Honor Code confers upon our residents the responsibility to respect and protect the integrity of Sanford
School of Medicine of The University of South Dakota. The Honor Code requires absolute honesty from
each individual. When meticulously observed, the Code provides residents the freedom to focus on best
practices in their final stages of formal training.
THE HONOR CODE
We, as medical residents of Sanford School of Medicine of The University of South Dakota, believe there
is a need to support and cultivate the high ethical standards of honor associated with the medical
community.
This Honor Code intends to make explicit expected standards to which we, as a community, will hold our
colleagues and ourselves accountable. Personal and academic integrity are the foundation of the Code,
with particular focus on respectful communication among peers and others.
We are aware that integrity, accountability, mutual respect and trust are essential to the medical
profession and we will actively support and work to achieve these ideals throughout our professional
career. The environment that we create is critical to this endeavor.
As members of our community, we realize that our actions affect those around us and the quality of the
community.
This Code should supplement, but not supplant, our personal, religious, moral and ethical beliefs, nor is
this Code meant to supersede any policies, regulations, codes, statutes or laws that exist within the
hospital systems where we train, The University of South Dakota, the state of South Dakota or any
federal jurisdiction.
Establishing and maintaining the highest concepts of honor and personal integrity during residency are
critical to our training as physicians. It is our responsibility to actively support these standards and it is
reasonable to expect that our colleagues will do the same.
A. Respect for Patients
We will take the utmost care to ensure patient respect and confidentiality. As residents, we will
demonstrate respect for patients through appropriate language and behavior, including that which is
non-threatening and non-judgmental. Patient privacy and modesty should be respected as much as
possible during history taking, physical examinations and any other contact, to maintain professional
relationships with the patients and their families. It is also important that we be truthful and not
intentionally mislead or give false information. With this in mind, we should avoid disclosing information
to a patient that only the patient’s physician should reveal.
We should consult more experienced members of the medical team when unsure of a course of action
or at the request of a patient. Appropriate medical and/or personal information about patients should
only be shared with health professionals directly involved or for educational purposes.
The written medical record is important in communication between health care providers and to
execute effective patient care. It is also a legal document and available for patient review. As such, it is
crucial that we maintain the integrity of patients' medical care through accurate reporting of all
pertinent information about which we have direct knowledge. Written medical documents, including
electronic correspondence pertaining to patients and their care must be legible, truthful, complete and
accurate to the best of our knowledge and abilities. To avoid an accidental breach of confidentiality, we
will not discuss patient care in common areas.
B. Respect for Faculty, Staff, Colleagues, and Hospital Personnel
We will exhibit respect for faculty, staff, colleagues and others, including hospital personnel, guests and
members of the general public. This respect should be demonstrated by punctuality in relationships with
patients and peers, prompt execution of reasonable instructions and deference to those with superior
knowledge, experience or capabilities. In addition, we should make every effort to maintain an even
disposition, display a judicious use of others' time and handle private information maturely. We should
express views in a calm, respectful and mature manner when in disagreement with another individual.
Under this Code, “confrontation” is defined as the initiation of a constructive dialogue with another
community member with the goal of reaching some common understanding by means of respectful
communication. Confrontation is encouraged, though it should be understood that achieving a common
understanding does not necessarily mean reaching agreement.
C. Respect for Self
We realize that a diversity of personal beliefs serves to enrich the medical profession, and therefore we
encourage the upholding of personal ethics, beliefs and morals in both daily conduct and in our practice
of this Code. For example, we have an obligation to inform patients and their families of all available
treatment options that are consistent with acceptable standards of medical care. However, we are not
required to perform procedures that conflict with our personal beliefs.
Our social relationships should be based on mutual respect and concern. We must consider how our
words and actions may affect the sense of acceptance essential to an individual’s or group’s
participation in the community. Upon encountering actions or values that we find degrading to
ourselves or to others, we should feel comfortable confronting our peers.
Our behavior and speech should demonstrate our respect for the diversity of our colleagues. We will
strive to create an environment that fosters mutual learning, dialogue and respect, while avoiding
verbal, written or physical contact that could create a hostile or intimidating environment.
“I hereby accept the Sanford School of Medicine Honor Code, realizing that it is my duty to uphold the
Code and the concepts of personal and collective responsibility upon which it is based.”
Signature__________________________________________________
Date______________________________________________________
BENEFIT DISCLAIMER
The Residency Corporation reserves the right to amend, modify, substitute, terminate, or alter any
resident/fellow benefits at any time with or without notice. A resident’s/fellow’s eligibility and the terms
and conditions of coverage are governed by the actual policies, documents, or plan descriptions which
are distributed by the company who is providing the benefit. The company policies or contract
provisions shall prevail if any discrepancies are found between the resident/fellow benefit and the
specific terms of the applicable policy or plan.
1. The Board of Directors is responsible for establishing the benefits package, monitoring it, and
periodically reviewing and updating benefits.
2. The HR representative is responsible for resident eligibility, enrollment, and for providing
residents/fellows with summary descriptions of their benefit plan on a regular basis.
Adopted Date: 1997
Revised Date(s): 2013
BEREAVEMENT LEAVE
The Residency Corporation is sensitive to resident’s/fellow’s needs when a death occurs in your
immediate family. Immediate family is defined as lawful father, mother, spouse, children, mother-inlaw, father-in-law, son-in-law, daughter-in-law, brothers, sisters, grandparents, grandchildren,
stepchildren, stepparents, or foster children.
Residency Corporation will provide up to three paid days off at the discretion of the Program Director.
Time off will be provided separately from sick leave and vacation. Factors to be considered for
determining amounts of time off are distance, relationship, involvement in funeral arrangements, and
administrative arrangements. (This, as with other absences from program duties, must be considered
with respect to the maximum allowed by the Residency Review Committee requirements.)
1. Residents/fellows who suffer a loss and are unable to report for work should call the
designated individual in each program and follow the procedures set forth in each
program.
2. Bereavement leave requests must be made in writing using the Resident Time-off
Request form. Requests should be made as far in advance as possible.
3. The Program Director approves the leave and sends a copy of the form to the payroll
representative for processing.
4. For absences in excess of three consecutive working days, a written request for vacation
time must be approved.
5. In some instances proof of bereavement leave may be required.
Adopted Date: 1997
Revised Date(s): 2013
COBRA BENEFITS
Federal law requires employers to allow residents/fellows to continue group health, medical expense
spending accounts, and dental benefits if coverage is lost because of a reduction in hours of
employment or the termination of employment for reasons other than gross misconduct. Spouses or
dependents of the residents/fellows may also have continuation rights under this law. The
resident/fellow or a family member is responsible to inform the HR representative of divorce, legal
separation, or child losing dependent status.
Upon completion or termination of contract, the HR representative will notify the proper health
insurance company to terminate the benefits of the resident/fellow and family. The HR representative
will send out COBRA information regarding the resident’s/fellow’s COBRA rights and the appropriate
application forms for continuing health insurance and medical expense spending account coverage by
mail within 10 days of contract completion or termination. The HR representative will notify the dental
coverage carrier of the resident/fellow contract completion or termination and the dental coverage
carrier will send out the appropriate COBRA forms for dental insurance.
Adopted Date: 1997
Revised Date(s): 2013
DENTAL INSURANCE
The Residency Corporation will pay the premium for single coverage. If family coverage is elected, the
resident/fellow will pay the difference via payroll deductions. Coverage begins on the first day of the
month after the contract begins and ends on the last day of the month in which the resident’s/fellow’s
contract expires. Specific benefit information is provided in the group policy.
Enrollment for dental insurance will be completed at or before orientation. Changes to dental insurance
can only take place within 30 calendar days of employment, during open enrollment periods, or within
30 calendar days of a qualifying event. Qualifying events include: marriage, birth of child, adoption of
child, addition of stepchild or foster child, addition of child by court order, spouse beginning or ending
employment, death of dependent or spouse, legal separation, divorce, and change in dependent
eligibility status. These changes must be reported to the HR representative within 30 calendar days.
Adopted Date: 1997
Revised Date(s): 2013
DISABILITY INSURANCE
The Residency Corporation will pay the premium for the resident/fellow. Insurance coverage begins on
the first day the contract begins and ends on the day of termination. Specific benefit information is
provided in the group policy.
Adopted Date: 1997
Revised Date(s): 2013
EDUCATIONAL ALLOWANCE
Each contract year, residents/fellows receive an educational allowance of $550 for preapproved,
documented, educational expenses (e.g., textbooks, electronic devices designed to access/read
library materials, meeting registrations, boards, etc.). Educational allowance funds may also be
used for expenses related to away rotations, such as traveling or lodging.
Educational allowance may not be used to fund contracts of service for electronic devices, to
purchase protection insurance, or for medical devices (e.g., stethoscopes).
Once the request to use educational allowance funds has been approved by program
administration, residents/fellows should pay the approved expense directly to the vendor and
submit the receipt to the program coordinator for reimbursement. If this process is not feasible,
the resident/fellow should speak with the program coordinator for an alternative purchasing
option.
Receipts must be dated within the contract period from which the resident/fellow wants to be
reimbursed. An exception is provided to a new resident/fellow who makes a purchase prior to
arrival; however, reimbursement will not occur until after the contract begins. Any remaining
funds at the end of the contract period will be forfeited. Money won during the Residency Bowl
will be deposited directly into educational allowance accounts. Any unused amount won at the
Residency Bowl will also be forfeited at the end of the contract period. Residents/fellows may
not borrow educational funds from the forthcoming year.
Adopted Date: 1997
Revised Date(s): 2013
EDUCATIONAL LEAVE
Each contract year, residents/fellows receive five days of paid educational leave. Educational leave must
be scheduled and taken with prior approval of the Program Director.
Educational leave may be taken for structured educational activities intended to strengthen the
resident’s/fellow’s training. Leave may be taken for other activities upon approval of the Program
Director. Residents/fellows should refer to their program’s policies concerning what additional activities
may be considered for educational leave.
Educational leave does not need to be taken for activities that are part of the program’s curriculum (e.g.,
taking Step 3, presenting at a conference, appointment to a regional/national board).
1. Educational leave requests must be made in writing, using the Resident Time-off Request
form. Requests should be made as far in advance as possible, in accordance with the
program’s procedure, but no less than one month's advance notice.
2. Sick leave is normally not granted during educational leave. However, if a major illness
or injury occurs during educational leave, the resident/fellow may present a physician's
documentation for the illness or injury. The Program Director considers each request and
makes the decision whether to grant sick leave.
Adopted Date: 1997
Revised Date(s): 2013
FAMILY AND MEDICAL LEAVE
The Residency Corporation offers Family and Medical Leave for qualifying residents/fellows. The South
Dakota Board of Regents (and the US DOL) FMLA policy can be found by clicking on this link.
The resident/fellow should notify their program as soon as possible when aware of an impending leave.
The program then notifies the GME office. The GME office will communicate with the resident/fellow
about FMLA paperwork and leave options.
Please note that the FMLA policy should also include the following information regarding Military Family
Leave Entitlements pertaining to Qualifying Events Eligible for Family Medical Leave:
Military Family Leave Entitlements
1. Eligible employees with a spouse, son, daughter, or parent on active duty or call to active
duty status in the National Guard or Reserves in support of a contingency operation may
use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying
exigencies may include attending certain military events, arranging for alternative
childcare, addressing certain financial and legal arrangements, attending certain
counseling sessions, and attending post-deployment reintegration briefings.
2. FMLA also includes a special leave entitlement that permits eligible employees to take
up to 26 weeks of leave to care for a covered service member during a single 12-month
period. A covered service member is a current member of the Armed Forces, including a
member of the National Guard or Reserves, who has a serious injury or illness incurred in
the line of duty on active duty that may render the service member medically unfit to
perform his or her duties for which the service member is undergoing medical treatment,
recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired
list.
Options for residents/fellows who do not qualify for FMLA and are having a baby or adopting:
1. May use any remaining paid sick leave time.
2. May use any remaining vacation time.
3. When sick leave and vacation leave have been exhausted, may select leave without pay.
The resident/fellow should attempt to arrange rotations so that they are not on a rotation in which their
abrupt absence could compromise patient care or result in excessive inconvenience to other
residents/fellows. Examples include teaching service, ambulatory, emergency medicine, and any
rotation with curriculum requirements particular to their program.
If the resident/fellow decides to work until the time of delivery or when the adoption is completed, the
resident/fellow has certain responsibilities:
1. The attending physician must be notified by the resident/fellow that he/she will possibly
deliver or adopt during the rotation time period.
2. The Program Director must be notified so that any necessary arrangements can be made
regarding rotations.
3. The resident/fellow must make advance arrangements for the care of their currently
hospitalized patients.
4. Arrangements should be made in advance through the Program Director or his/her
designee for coverage of program responsibilities.
Taking additional leave (or taking leave without pay) each contract year may extend the
resident’s/fellow’s time in the program to meet academic requirements.
The resident/fellow or Program Director must notify the Business Manager immediately upon the
resident/fellow starting leave. A Time-off Request form must be completed in advance and sent to the
payroll representative. A meeting with the Program Director may be necessary to discuss the possibility
of extending the length of training.
Adopted Date: 1997
Revised Date(s): 2013
SSOM USD RESIDENCY CORPORATION
FRINGE BENEFIT SUMMARY FY 2015
PROFESSIONAL LIABILITY – Provided by Midwest Medical Insurance Company
Premiums are paid by the Residency Corporation.
A. Limit: $1,000,000 Each person
$3,000,000 Total limit
B. Coverage provides a "tail" for all residents.
HEALTH INSURANCE – Provided by Wellmark Blue Cross Blue Shield
Residency Corporation pays total premium (single or family) for the $1,000 Deductible Plan and a portion of the
premium for the $500 Deductible Plan.
A. Eligibility: Hire Date
B. Benefit Plan Year – January 1 through December 30th
C. Summary of Benefits:
$1,000 Single/$2,000 Family Deductible Monthly Premiums
Employer’s Monthly Share
Employee’s Monthly Share
Total Monthly Premium
Employee: $442.40
Employee: $0
Employee: $442.40
EE/Spouse: $890.32
EE/Spouse: $0
EE/Spouse: $890.32
1. Deductible:
Single
Family
2. Coinsurance:
80/20 (In Network) (70/30 Out of network)
3. Maximum Out-of-pocket:
EE/Child(ren): $824.07
EE/Child(ren): $0
EE/Child(ren): $824.07
Family: $1,326.70
Family: $0
Family: $1,326.70
$1,000
$2,000
Single
$2,000/
Family
$4,000
4. Unlimited Lifetime Maximum as of January 1, 2011.
5. Physician Office Visits: $20 co-pay
(both primary care and specialty physician)
6. ER Co-Pay: $150.00
6. Prescription Drugs (no deductible):
Generic
Specially Selected Brand Names
All Other Brand Names
$8 co-pay
$35 co-pay
$50 co-pay
7. Other Covered Benefits: Tobacco cessation drugs are covered under the drug plan, preventive services are
covered at 100%, no pre-existing condition clauses for children under age 19, and dependents may remain on the
plan until age 26.
$500 Single/$1,000 Family Deductible Monthly Premiums
Employer’s Monthly Share
Employee’s Monthly Share
Total Monthly Premium
Employee: $442.40
Employee: $44.02
Employee: $486.42
EE/Spouse: $890.32
EE/Spouse: $90.14
EE/Spouse: $1902.90
1. Deductible
Single
Family
$500
$1,000
2. Coinsurance:
80/20 (In network)
(70/30 out of network)
EE/Child(ren): $824.07
EE/Child(ren): $83.32
EE/Child(ren): $907.39
Family: $1,326.70
Family: $135.08
Family: $1,461.78
3. Maximum Out-of-pocket:
Single
$1,000
Family
$2,000
4. Unlimited Lifetime Maximum as of January 1, 2011.
5. Physician Office Visits: $20 co-pay (both primary care and specialty physician)
6. ER Co-pay: $150.00
7. Prescription Drugs (no deductible):
Generic
Specially Selected Brand Names
All Other Brand Names
$8 co-pay
$35 co-pay
$50 co-pay
8. Other Covered Benefits: Tobacco cessation drugs are covered under the drug plan, preventive services are
covered at 100%, no pre-existing condition clauses for children under age 19, and dependents may remain on the
plan until age 26.
VISION INSURANCE – Provided by Avesis Vision Care Plans of South Dakota
Residency Corporation pays total premium (single or family).
A. Eligibility: hire date
B. Benefit Plan Year: July 1 through June 30
C. Summary of Benefits:
1.
2.
3.
4.
5.
Vision Examinations covered in full after a $10 copayment every 12 months
Frames are covered in full after $15 copayment on frames retailing between $100-$150 every 24 months
Spectacle lenses (standard single vision, bifocal, trifocal, and lenticular lenses) are covered in full every 12
months
Contact Lenses (in lieu of spectacle lenses and frames) are covered every 12 months up to an amount of
$130 if elective and covered in full if it is medically necessary
Save 20% on all lens options; and save up to 20% off retail progressive lenses, plus a $50 allowance
DENTAL INSURANCE – Provided by Delta Dental of South Dakota
Residency Corporation pays single premium. If family coverage is elected, the resident pays difference
via payroll deductions $24.34 per pay period. Dependent children are covered to age 26. There is no age
restriction for unmarried dependent children who are full-time students.
A. Eligibility: 1st of the month after the hire date
B. Deductible: $25 deductible per person per coverage year not to exceed $75 per family. The deductible does
not apply to diagnostic, preventive or orthodontic services.
C. Basic Services
1. Diagnostic: Routine examinations - twice per coverage year. Bitewing x-rays - two per coverage year up
to age 19, and once per coverage year age 19 and over. 100% paid - no deductible required.
2. Preventive: Routine cleaning - twice per coverage year; fluoride – two per coverage year up to age 19;
space maintainers, fixed (band type) on primary posterior teeth up to age 14. Dental sealants - once for
unrestored 1st and 2nd permanent molars of children up to age 16. 100% paid by Delta Dental, no
deductible required.
3. Ancillary: provides for emergency treatment for relief of pain. 80% paid by Delta Dental.
4. Oral surgery: 80% paid for extractions and other surgery.
5. Regular restorative dentistry: fillings and crowns. 80% paid by Delta Dental.
D. Special Services
1. Endodontics: procedures for root canal treatments. 80% paid by Delta Dental.
2. Periodontics: treatment for the diseases of the tissues supporting the teeth. 80% paid by Delta Dental.
3. Special restorative dentistry: Pre-formed or stainless steel restorations and restorations such as silver
(amalgam) fillings, and tooth-colored (composite) fillings. If a tooth-colored filling is used to restore back
(posterior) teeth, benefits are limited to the amount paid for a silver filling. 80% paid by Delta Dental.
4. Prosthetics: 80% paid for bridges, partial dentures, complete dentures, and dental implants..
5. Orthodontics: treatment for the proper alignment of teeth. 80% paid by Delta. $1,000 lifetime benefit.
E. Maximum Benefits: $1,000 per person per coverage year (July – June). All services (except Braces) are
subject to the annual maximum benefit and will not be paid if your annual maximum benefit has been reached.
DISABILITY INSURANCE – Provided by Med Plus Advantage Sponsored by the AMA
Residency Corporation pays total premium.
A.
B.
C.
D.
Coverage begins the first day of employment.
Eligibility: All residents/fellows who are participating in a full time education or training program.
Waiting period: 90 days
Long Term Disability (LTD) Benefit: The base benefit is $5,000 per month for permanent and total
disability, and $2,500 per month if disabled but not permanently and totally disabled. A 60% of income
plan may be available.
E. “Specialty” Occupation Definition of Disability: Disability is defined by "specialty" during the first 60
months of disability. Thereafter, doctor of medicine definition applies.
F. Duration of Benefits: Benefits while disabled, as defined, will continue until at least Social Security
Normal Retirement Age (SSNRA).
G. Survivor Benefit: if the insured dies while LTD benefits are payable and on that date the insured has been
continuously disabled for 180 days, five (5) times the monthly benefit is payable to the surviving spouse or
unmarried children, including adopted children under age 27.
H. $200,000 Student Loan Repayment: Eligible loans made to cover the expenses of college and/or school
tuition, living expenses, fees, textbooks and equipment required for education may be paid in part or full
upon meeting the definition of permanent and total disability and LTD benefits are payable.
I. Pre-existing Conditions: If a pre-existing condition is discovered or suspected at any time during the 6month period immediately preceding the effective date of LTD coverage under this plan, the
resident/fellow will not be covered for a disability caused by that pre-existing condition, unless on the date
the resident/fellow becomes disabled, the resident/fellow has been continually insured under the group
policy for at least 12 months and has been actively participating for at least one full day after the end of
those 12 months.
J. Rehabilitation Plan Benefits: While disabled and approved to participate in the Rehabilitation Plan,
expenses for training, education, family care, work and job search in connection with returning to work can
be covered.
K. Conversion of Coverage: Upon completing your residency/fellowship, you may convert your coverage.
LIFE INSURANCE – Provided by Med Plus Advantage Sponsored by the AMA
Residency Corporation pays total premium.
Eligibility: First day of employment for full-time residents/fellows. A term life insurance policy is provided to the
resident/fellow for $50,000. If death is due to an accidental injury, the beneficiary will receive the Accidental Death
& Dismemberment (AD&D) benefit of an additional $50,000. Spousal benefit: $25,000; Child benefit: $5,000;
Child is defined as unmarried child from live birth through age 18 (through age 26 if a registered student in
full-time attendance at an accredited educational institution).
WORKER’S COMPENSATION:
Please contact [email protected] or your respective residency coordinator if you become injured while on the
job. You will need to complete a first report of injury form (FROI) to document the date/time of the injury. Our
current provider is Acuity.
Please note: The Corporation reserves the right to add, amend, modify, terminate or change any employee benefit
at any time without notice. The above descriptions are intended as a summary only. Employees should review the
policy or summary plan description for each benefit for the current benefits offered by the corporation. Should
there be a discrepancy between the summary contained herein and the actual policy contract, the policy or contract
provisions shall prevail.
TAX FREE SPENDING ACCOUNTS
Pursuant to Section 125 of the Internal Revenue Code of 1986, eligible full-time employees may elect to reduce their
cash compensation for tax-free reimbursement in two areas; medical expense reimbursement and/or dependent care
assistance. This allows residents to set aside money on a tax-free basis for qualified medical, dental and vision care
expenses not covered or partially covered under your health plans. It also allows you to pay eligible dependent care
expense with tax-free dollars. Please contact Char Oltmanns at (605) 357-1321 or [email protected] with
any questions.
Important information regarding Healthcare Reform (from the Patient Protection and Affordable Care Act and
Health Care and Education Reconciliation Act of 2010) to begin January 1, 2011:
Over the Counter Prescriptions are no longer reimbursed under Health Savings Accounts, Medical Flexible Saving
Accounts, and Health Reimbursement Accounts. Please note: this could affect the amount of money that you may
want to contribute to the Medical Flexible Savings Account. Changes to the elected Medical Flexible Savings
Account are not permitted mid-plan year.
SICK LEAVE
Residents/fellows will receive 10 days of paid medical leave at the beginning of their employment and each contract
year, thereafter. These are non-cumulative, therefore will not carry over into the next contract year. Sick leave may
be used for an illness or injury of the resident/fellow, dependent child, spouse and parent.
VACATION LEAVE
Residents/fellows will receive 15 days of vacation leave at the beginning of their employment and each contract year
thereafter. These are non-cumulative, therefore will not carry over into the next contract year.
BEREAVEMENT LEAVE
Residents/fellows will receive up to 3 days of paid time off without the use of vacation or sick leave for the death of
an immediate family member. Please refer to the Resident or Fellowship Manual for more details. Duration is
based on the particular circumstances of the request.
FAMILY MEDICAL LEAVE
Family Medical Leave is available to residents/fellows with one year of service for the serious health conditions of
employee and immediate family (spouse, child or parent) or the birth or adoption of a child. Family Medical Leave
is not a “leave pool.” It is a “legal” status for time away from work. Please contact Human Resources at (605) 3571304 or [email protected] to see if the medical event qualifies for this protection. You can also refer to your
“Resident or Fellowship Manual” for further information.
EDUCATIONAL LEAVE
Each contract year, residents/fellows receive 5 scheduled days of paid educational leave. Educational leave must be
scheduled and taken with the prior approval of the Program Director. Please refer to the policy manual for further
information.
UNIFORMS
First year residents/fellows are provided 3 long laboratory coats.
EDUCATIONAL ALLOWANCE
Residents/fellows receive an educational allowance of $550 each contract year for documented educational expenses
(e.g. textbooks, meeting registrations, boards, etc.).
Revise
HEALTH INSURANCE
The Residency Corporation will pay the premium for single or family coverage. Insurance coverage
begins on the first day of the contract and ends on the last day of the month in which the
resident’s/fellow’s contract expires. Specific benefit information is provided in the group policy. An
option is provided for the resident/fellow to “buy down” the deductible at the resident’s/fellow’s
expense via payroll deduction. Specifics of this option are provided on the enrollment form.
Enrollment for health insurance must be completed at or before the time of orientation.
Changes to health insurance can only take place within 30 calendar days of employment, during open
enrollment periods, or within 30 calendar days of a qualifying event. Qualifying events include:
marriage, birth of child, adoption of child, addition of stepchild or foster child, addition of child by court
order, spouse beginning or ending employment, death of dependent or spouse, legal separation,
divorce, and change in dependent eligibility status. These changes must be reported to the HR
representative within 30 calendar days.
Adopted Date: 1997
Revised Date(s): 2013
LAB COATS
First-year residents/fellows are provided three long laboratory coats. Residents/fellows should wear the
laboratory coats at the discretion of their attending physician. Name badges must be worn in
accordance with the institution at which they are rotating.
First-year residents/fellows should purchase their lab coats from Sparkle Uniform and have the invoice
sent to their program coordinator.
Adopted Date: 1997
Revised Date(s): 2013
LEAVE OF ABSENCE
A resident/fellow who is ill or temporarily disabled (including pregnancy) or who experiences critical or
emergency situations, is entitled to request a Leave of Absence for the length of the disability or
emergency situation up to two months per 12-month period. The leave may be taken in two consecutive
months or intermittently. Some types of leave will fall under the Family and Medical Leave Policy and
follow those procedures as outlined in that policy. All other leaves will fall under the following
procedures.
Any absence for illness in excess of three days requires a written attending physician's statement
documenting the need for absence. Request should be scheduled as far in advance as possible,
preferably one month's notice, and cleared with other residents/fellows who must cover for them in
their absence. It is the resident's/fellow’s responsibility to become informed of the proper procedures to
follow for each hospital.
A Time-off Request form must be submitted for all leaves except leaves that fall under the Family
Medical Leave. All leaves must be approved by the Program Director.
A resident/fellow taking leave must use all paid vacation leave prior to being eligible for an unpaid leave.
For pregnancy, prolonged or recurrent illness, or injury for yourself, a spouse, or a dependent child, sick
and vacation leave must be used. When leave balances are exhausted, the remaining leave is without
pay.
Resident/fellow benefits remain in effect when a resident/fellow is on an approved leave of absence.
While on a paid leave, the Residency Corporation will continue to pay for benefits at the same level and
conditions as if the employee had continued to work. During a nonpaid leave, the resident/fellow must
pay both the employer and resident premium for health, dental, vision, and disability insurance.
Arrangements must be made with the HR representative.
In the event the disability continues beyond two months, and the resident/fellow is not able to perform
the essential functions of his/her training, the resident/fellow contract may be terminated. The
Residency Corporation will comply with all regulations in accordance with the American Disability Act
(ADA).
Under special circumstances, a leave of absence may be extended for an additional period.
Extensions must be approved prior to the end of the current leave by the Program Director.
Residents/fellows on leave of absence for over two months will be put under inactive status.
Eligibility for company benefits will cease, and the resident/fellow will be given the option of COBRA
benefits.
Residents/fellows who do not return to duty on the agreed date from a leave of absence may be
terminated.
Residents/fellows may be eligible to file for disability benefits through the Residency Corporations'
disability insurance carrier after a 90-day waiting period.
Residents/fellows are allowed a maximum of 30 days absence (one calendar month) away from the
program. This includes sick leave (illness, pregnancy, etc.), vacation time, interview time, or other
approved reasons for absence. Absences in excess of 30 days (one calendar month) will have to be made
up to successfully complete the program. Programs will provide residents/fellows with accurate
information regarding the impact of an extended leave of absence upon the criteria for satisfactory
completion of the program and upon a resident’s/fellow’s eligibility to participate in examinations by
the relevant certifying board(s).
Adopted Date: 1997
Revised Date(s): 2013, 2014
MILITARY LEAVE
Residency Corporation will abide by the provisions of the Uniformed Services Employment and
Re-employment Rights Act and expects each resident/fellow to abide by its obligations in accordance
with applicable federal law.
Residents/fellows are allowed to use up to 15 days of vacation time, if available, for such a leave. If no
vacation time is available, such a leave would be considered leave without pay. Taking additional leave
(or taking leave without pay) each contract year may extend the resident’s/fellow’s length of training to
meet academic requirements set forth by the program.
A written request must be submitted to the Program Director indicating the start and end date of the
military training leave along with a copy of the resident’s/fellow’s military orders as soon as he/she is
advised of the training schedule.
If the resident/fellow chooses to take vacation leave while on military leave, the request must be made
in writing, using the Resident Time-off Request form. Requests should be made as far in advance as
possible.
Adopted Date: 1997
Revised Date(s): 2013
PART-TIME BENEFITS
Residents/fellows who rotate less than full time may receive prorated benefits provided by Residency
Corporation.
Part-time benefits will be administered as follows:
Health Insurance
.75 FTE or Greater FTE
The resident/fellow will not be
responsible for health premiums
and will receive full health insurance
benefits.
.74 FTE or Less FTE
The resident/fellow will be
responsible for half of the health
insurance premiums and will receive
full health insurance benefits.
Sick, Vacation, Other Approved
Leave
Approved leave will be prorated
based on the percentage of time
worked vs. full-time leave.
Approved leave will be prorated
based on the percentage of time
worked vs. full-time leave.
Dental, vision, life, disability, and malpractice insurance coverage will be unaffected, and the
resident/fellow will not be responsible for insurance premiums (if the resident/fellow has elected family
dental insurance coverage he/she will continue to be responsible for his/her portion of the premium).
Adopted Date: 1997
Revised Date(s): 2013
PROFESSIONAL LIABILITY INSURANCE
The Residency Corporation will at all times carry Professional Liability insurance on all active
residents/fellows within their training programs. The Professional Liability insurance will also include
legal defense.
Professional Liability is currently provided with the following provisions:
A. Limit:
$1,000,000 Each Person
$3,000,000 Total Limit
B. Coverage provides a “tail” for all residents/fellows within our programs.
At the beginning of each academic year, the business manager will send a letter to our Professional
Liability Insurance agent listing each of the residents and fellows according to program and program
year. Also included in this letter will be a list of residents/fellows who are graduating and will not be
returning. Based on this letter, the agent will update and keep current our liability insurance.
If there is a resident/fellow who is out of cycle, leaves training early, or begins training late, an additional
letter will be sent to the agent to update our file.
Residents/fellows may request further liability coverage details at any time.
Adopted Date: 1997
Revised Date(s): 2013, 2014
STIPENDS
Residents/fellows are paid a stipend by the Residency Corporation. Pay dates are on the 15th and the
last day of the month. If the 15th or the last day of the month falls on a weekend, payday will be the
Friday prior to that weekend. No payroll advancements will be given.
Residents/fellows are required to have their paychecks deposited into a checking and/or savings
account at the bank(s) of their choice via direct deposit. The resident/fellow receives a payroll stub
(marked nonnegotiable) indicating earnings, deductions, and leave accruals.
Direct deposit stubs are sent to the resident’s/fellow’s home address.
Annual stipends are determined each year by the Graduate Medical Education Committee and the
Residency Corporation Board of Directors.
Adopted Date: 1997
Revised Date(s): 2013
TAX-FREE SPENDING ACCOUNTS
Pursuant to Section 125 of the Internal Revenue Code of 1986, eligible full-time employees may elect to
reduce their cash compensation for tax-free reimbursement for medical expense reimbursement and/or
dependent care assistance.
The HR representative is the plan administrator and will perform all duties in accordance to the plan
description.
Residents/fellows will be offered the option to enroll at the time of their employment and July 1 each
year. The HR representative will send annual notification during May or June requiring residents/fellows
to resubmit their elections for the upcoming year. The plan year begins July 1 and ends June 30.
For reimbursement, the resident/fellow should follow the vendor’s claims process.
Adopted Date: 1997
Revised Date(s): 2013
TERM LIFE INSURANCE
The Residency Corporation will pay the premium for single or family coverage. Insurance coverage is
provided the first day the resident’s/fellow’s contract begins and ends on the day of termination.
Specific benefit information is provided in the group policy.
Enrollment for life insurance will be completed at or before orientation. Changes to life insurance can
only take place within 30 calendar days of employment, during open enrollment periods, or within 30
calendar days of a qualifying event. Qualifying events include: marriage, birth of child, adoption of child,
addition of stepchild or foster child, addition of child by court order, spouse beginning or ending
employment, death of dependent or spouse, legal separation, divorce, and change in dependent
eligibility status. These changes must be reported to the HR representative within 30 calendar days.
Adopted Date: 1997
Revised Date(s): 2013
VACATION AND SICK LEAVE
Vacation Leave
Residents will receive 15 scheduled workdays, regardless of length, of paid vacation leave at the
beginning of their employment and each contract year thereafter.
Sick Leave
Residents will receive 10 scheduled workdays, regardless of length, of paid sick leave at the beginning of
their employment and each contract year thereafter. Sick leave can be used for an illness or injury of the
resident/fellow, spouse, dependent children, or parent. A physician statement may be required for
absences of three days or more on each occurrence.
Provisions for Vacation and Sick Leave
1. Vacation and sick leave hours are noncumulative and do not carry over into the next
contract year. Upon termination from the Residency Corporation, any unused vacation
and sick leave will not be paid.
2. All vacation and sick leave requests must adhere to the procedure set forth by each
program. Residents/fellows who are ill or unable to report for duty must notify the
program as soon as possible.
3. Vacation leave requests must be made in writing, using the Resident Time–off Request
form. Requests should be made as far in advance as possible, in accordance with the
program’s procedure, but no less than one month's advance notice. The Program Director
approves the leave and sends a copy of the form to the payroll representative for
processing within two calendar weeks.
4. Upon returning from sick leave, a written request form must be completed, using the
Resident Time-off Request form. The Program Director approves the leave and sends a
copy of the form to the payroll representative for processing.


For absences in excess of three consecutive working days, a written attending
physician's statement must accompany the Resident Time-off Request form.
Sick leave requests in excess of the 10 days paid medical leave, not otherwise
governed by the FMLA policy, fall under the Leave of Absence policy.
5. Sick leave is normally not granted during vacation leave. However, if a major illness or
injury occurs during vacation, the resident/fellow may present a physician's
documentation for the illness or injury. The Program Director makes the decision
whether to grant sick leave.
6. Vacation and sick leave is prorated for residents/fellows not completing a full academic
year.
Adopted Date: 1997
Revised Date(s): 2013
VISION INSURANCE
The Residency Corporation will pay the premium for single or family coverage. Coverage begins
on the first day of the contract and ends on the last day of the month in which the contract
expires. Specific benefit information is provided in the group policy.
Enrollment for vision insurance will be completed at or before orientation. Changes to vision insurance
can only take place within 30 calendar days of employment, during open enrollment periods, or within
30 calendar days of a qualifying event. Qualifying events include: marriage, birth of child, adoption of
child, addition of stepchild or foster child, addition of child by court order, spouse beginning or ending
employment, death of dependent or spouse, legal separation, divorce, and change in dependent
eligibility status. These changes must be reported to the HR representative within 30 calendar days.
Adopted Date: 1997
Revised Date(s): 2013
WORKERS’ COMPENSATION
The Residency Corporation carries workers’ compensation insurance to provide payment for medical
expenses and loss of wages to residents/fellows who suffer work-related injuries.
Workers’ Compensation Procedure
1. The resident/fellow is responsible for reporting any work-related injury or illness to the
Residency Corporation HR representative. This must be reported immediately but no
later than three days of the injury or illness to ensure the right to collect under this plan,
unless there is a reasonable excuse for the delay. For any serious (life threatening) injury
or illness causing death, the HR representative must be notified immediately.
2. A First Report of Injury form (found at the end of this document) is completed by the
resident/fellow and the HR representative.
3. The HR representative is responsible for recording and sending the appropriate forms to
the workers' comp insurance carrier. Companies are allowed seven days from the time of
injury to report these incidents to the Division of Labor & Management. Late penalty
fines are imposed if the employer is late in reporting these claims.
4. The HR representative will complete a Log and Summary of Occupational Injuries and
Illnesses (OSHA Form 200) and post the last section of the form on the HR bulletin board
no later February 1 and will remain in place until March 1.
5. Records will be kept in a locked cabinet of the HR representative to be made available to
OSHA Compliance Officers upon request.
6. Forms will be kept for five years.
Subject to certain important statutory restrictions, the resident/fellow may receive medical treatment
from any medical practitioner.
Infectious exposures, such as needle sticks and sharps, must also be reported within three days of the
injury as a work comp injury.
Infectious Exposures
1. All occupational exposures should be reported as a workers' comp injury and follow the
same procedures under section Workers’ Compensation Procedure. Occupational
exposures are defined as reasonably anticipated skin, eye mucous membrane, or
parenteral contact with blood or potentially infectious materials that may result from the
performance of an employee's duties.
2. All residents/fellows are required to complete OSHA training at the beginning of their
residency/fellowship.
3. Residents/fellows can receive treatment at Sanford USD Medical Center, Avera
McKennan Hospital & University Center, or the Sioux Falls VA Health Care System and
will follow the procedures established by that institution. Initial treatment, counseling and
follow-up testing at six weeks, 12 weeks, and six months will be provided with no charge
to the resident/fellow.
4. Sanford USD Medical Center, Avera McKennan Hospital & University Center, or the
Sioux Falls VA Health Care System will inform the resident/fellow of the test results and
will also send the results to the designated person on the individual contracts established
with each institution.
5. It is required by our workers’ comp insurance carrier that all follow-up testing be done to
ensure that later complications will be covered.
6. The HR representative will send a Post-Exposure Follow-up Letter to the resident/fellow
to ensure that the proper information and counseling was given to the resident/fellow.
7. Medical records will be maintained as required by OSHA standards.
Adopted Date: 1997
Revised Date(s): 2013
GRADUATE MEDICAL EDUCATION
ACADEMIC IMPROVEMENT POLICY
Each Program Director is responsible for assessing and monitoring a resident’s/fellow’s academic and
professional progress in the areas of:






Medical Knowledge
Clinical Competence in Patient Care
Interpersonal and Communication Skills
Professionalism
Practice-Based Learning and Improvement
Systems-Based Practice
Failure to perform adequately in any of these areas may result in corrective action, up to and including
termination. If a resident/fellow is not progressing appropriately, the program has a responsibility to
inform the resident/fellow of the deficiency and provide him/her with an opportunity to correct the
deficiency. At times it is possible and appropriate for the program to provide extra assistance or
educational experiences for the resident/fellow to aid in this process. Ultimately, the resident/fellow is
responsible for taking the necessary steps to meet expectations.
NOTICE OF DEFICIENCY
Structured Feedback: All residents and fellows should be provided routine verbal and written feedback
that is consistent with their educational program. Some examples of feedback techniques include verbal
feedback (from supervising faculty and Program Director), rotation evaluations, semi-annual
evaluations, summative evaluations, as well as input from patients, ancillary staff or the program’s
clinical competence committee. Feedback regarding deficiencies should be outlined for the
resident/fellow, either in an evaluation form or a letter of concern.
Letter of Deficiency:
If a resident/fellow has been identified as having a deficiency, it is expected
that he/she will receive routine structured feedback in order to identify and correct the issue. If the
Program Director deems that routine structured feedback is not effecting the necessary improvement,
or if the Program Director determines that the deficiency is significant enough to warrant something
more than routine feedback or a letter of concern, the Program Director may elect to issue a Letter of
Deficiency. This letter provides the resident/fellow with a) notice of the deficiency; and b) an
opportunity to correct the deficiency. As much as possible, a Letter of Deficiency should describe the
observed deficiency(ies), and the expected academic standard. The Letter of Deficiency should also
include a timeline for reassessment or reevaluation.
A Letter of Deficiency must be cosigned by the Program Director and the DIO/Chair of the GMEC.
The Program Director will continue to provide the resident/fellow with feedback consistent with the
Letter of Deficiency. If the resident/fellow satisfactorily resolves the deficiency(ies) noted in the Letter of
Deficiency within the designated time frame and continues to perform acceptably thereafter, the period
of unacceptable academic performance does not affect the resident’s/fellow’s intended career
development.
Failure to Correct the Deficiency: If the Program Director determines that the resident/fellow has failed
to satisfactorily correct the deficiency and/or improve his/her overall performance to an acceptable
level, the program director, with input from the clinical competence committee, may elect to take
further action which may include:







Issuance of a new Letter of Deficiency
Non-promotion to next PGY level
Repeat of a rotation(s) that may extend the required period of training
Extension of resident’s/fellow’s defined training period
Denial of credit for previously completed rotations
Non-renewal of resident’s/fellow’s contract
Termination from the program
A decision not to promote a resident/fellow to the next PGY level, to extend a resident’s/fellow’s
contract, to extend a resident’s/fellow’s defined period of training, to not renew a resident/fellow’s
contract, and/or to terminate the resident’s/fellow’s participation in a residency/fellowship program
would all be considered actions with potential impact on the trainee’s career development. The
resident/fellow will receive written notice for any of the above actions. Actions may require disclosure
to others upon request, including but not limited to privileging hospitals, licensure or specialty boards.
If a resident/fellow is subject to an action, he/she must be notified of this in writing. Such notification
must be signed by the Program Director and the DIO/Chair of GMEC. Any resident/fellow who is not
being promoted, or whose contract is not being renewed should be notified of this in writing at least
four months prior to the end of the resident’s/fellow’s current contract.
Due Process and Request for Review: A resident/fellow who is subject to an action may request a
review of the decision as described in the Due Process and Resident Complaint Policy. A copy of the Due
Process and Resident Complaint Policy should be available to any resident/fellow who is subject to an
action.
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
AWAY ROTATION POLICY
An away rotation is a rotation to any institution or location for which the Office of Graduate
Medical Education does not have an ongoing relationship as by an affiliation agreement and/or
for which Avera McKennan Hospital or Sanford USD Medical Center cannot claim the
resident/fellow on their cost report.
PROCEDURES
a) Resident/fellow must be in good standing with his/her program in order to be considered
for and participate in an away rotation.
b) All away rotations must have written approval of the resident’s Program Director and the
DIO/Chair of GMEC at least 90 days prior to the start of the away rotation. To obtain
approval, complete Form 170A – Application for Away Rotation – and submit to the
Program Director.
c) A letter of agreement must exist with the receiving program/institution accepting
responsibility for training, supervision, evaluation, and compliance with duty hours.
d) Residents/fellows are allowed to participate in one away rotation per program year. This
away rotation may not be taken during the first or last block of a program year, except
under approved circumstances.
e) To be approved, the away rotation must have specified goals and objectives that have
educational value that meets/exceeds the standards of the ACGME.
f) Malpractice coverage will be continued for the resident/fellow during the away rotation.
However, certain states and countries pose difficulties concerning coverage. In certain
cases, additional malpractice insurance covering the resident/fellow will be required from
the away rotation site or the resident/fellow. Please see the DIO/Chair of GMEC with
questions.
g) Expenses related to travel – lodging, meals, and other related expenses are the
responsibility of the resident/fellow.
h) International rotations will not be approved to a country that is listed by the U.S. State
Department under “Travel Warning.” Special attention should be considered regarding
expenses and malpractice insurance as noted above.
i) Upon completion of the away rotation, either Form 170CE (evaluation for clinical
rotation) or Form 170RE (evaluation for research rotation) must be completed and
submitted to the Program Director within 15 days. When possible, the resident/fellow
should also present an oral summary of the away rotation educational experience to the
GME Committee.
Adopted Date: 2007
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
COUNSELING SERVICES POLICY
The goal of the program is to support each and every resident/fellow in obtaining the skills necessary to
enter practice successfully. Recognizing that impairments do happen, it is important that the
resident/fellow understand that the end result desired is remediation of the impairment and a
functioning physician at the end of counseling and/or treatment.
It is desirable that a resident/fellow engaged in behavior that adversely affects him/her will recognize the
need for remediation and seek help. The health plan provided to all residents/fellows includes confidential
counseling services.
All residents/fellows have access to the South Dakota Health Professionals Assistance Program which has
been set up by the state to provide a non-disciplinary option for substance abuse issues.
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
DISABILITY SERVICES – ACCOMMODATIONS POLICY
All programs sponsored by the Sanford School of Medicine will follow the University of South Dakota’s
Disability Services Policy on Accommodation.
It is the policy of the University of South Dakota (USD) – in accordance with Section 504 of the
Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 – to ensure that no qualified
person shall be denied access to, participation in, or the benefits of any program or activity operated by
the university because of a disability. Disabled persons who have met the academic and technical
standards for admission to or participation in university programs shall receive the reasonable and
appropriate accommodations needed to insure equal access to educational opportunities, programs and
activities in the most integrated setting appropriate.
Reasonable accommodations will be made, as necessary, to prevent discrimination against qualified
applicants or resident/fellows with disabilities. Reasonable accommodations are those that do not
fundamentally alter the nature of the program and can be provided without lowering academic and
other essential performance standards.
PROCEDURE
To be eligible for accommodations, a resident/fellow must contact and register with Disability Services
as soon as possible after admittance to USD-sponsored programs. Following registration with Disability
Services, the resident/fellow is required to submit medical or other diagnostic documentation of
disability and limitations. The resident/fellow may also be asked to obtain additional evaluations prior to
receiving requested accommodations. Each resident/fellow will be responsible for making timely and
appropriate disclosures and requests for accommodation, for keeping Disability Services informed about
the implementation of accommodations, and for actively participating in the securing of his/her
accommodations and auxiliary aids (including, when appropriate, applying for funding for specialized
support services from vocational rehabilitation agencies).
Delay on the part of the resident/fellow in registering with Disability Services, seeking accommodations,
or in meeting required conditions, may result in limiting the ability of USD to provide reasonable
accommodations.
Residents/fellows with Disabilities Rights
1. Residents/fellows have a right to expect all disability-related information to be treated
confidentially.
2. Disability Services is the only office designated to review disability documentation and
determine eligibility and appropriate accommodations.
3. Residents/fellows have a right to receive reasonable and appropriate accommodation in a
timely manner from faculty and Disability Services.
4. Residents/fellows have a right to appeal decisions regarding services and
accommodations.
Residents/fellows with Disabilities Responsibilities
1. Residents/fellows have a responsibility to self-disclose and provide Disability Services
with appropriate documentation of their disability.
2. Residents/fellows have a responsibility to initiate discussions with faculty concerning
accommodation requests.
3. Residents/fellows have a responsibility to initiate requests for specific accommodations
in a timely manner.
4. Residents/fellows have a responsibility to inform Disability Services if materials are
needed in an alternate format as soon as possible.
5. Residents/fellows have a responsibility to inform faculty and Disability Services
immediately when an accommodation is not being provided completely or correctly.
6. Resident/sfellows have a responsibility to notify faculty and Disability Services when an
accommodation is not being used or is no longer needed.
TECHNICAL STANDARDS FOR ADMISSION
Because the completion of residency signifies that the holder is a physician prepared for entry into the
practice of medicine, it follows that graduates must have the knowledge, skills, and ability to function in
a broad variety of clinical situations and to render a wide spectrum of patient care.
Candidates for admission must have somatic sensation and the functional use of the senses of vision and
hearing. Diagnostic skills will also be lessened without functional use of the senses of equilibrium, smell,
and taste. Additionally, candidates must have sufficient exteroceptive sense (touch, pain, and
temperature), sufficient proprioceptive sense (position, pressure, movement, stereognosis, and
vibratory) and sufficient motor function to permit them to carry out the activities described in the
sections that follow. They must be able consistently, quickly and accurately to integrate all information
received by whatever sense(s) employed, and they must have the intellectual ability to learn, integrate,
analyze, and synthesize data.
Such candidates must have abilities and skills of five varieties including: Observation; Communication;
Motor; Intellectual, Conceptual, Integrative and Quantitative abilities; and Behavioral and Social
Attributes. Technological compensation can be made for some disabilities in certain of these areas, but a
candidate should be able to perform in a reasonably independent manner. The use of a trained
intermediary means that a candidate's judgment must be mediated by someone else's power of
selection and observation.
Observation
The candidate must be able to observe demonstrations and experiments in the basic sciences, including
but not limited to, physiologic and pharmacologic demonstrations in animals, microbiologic cultures,
microscopic studies of microorganisms, and tissues of normal and pathologic states. A candidate must
be able to observe a patient accurately at a distance and close at hand. Observation necessitates the
functional use of the sense of vision and somatic sensation. It is enhanced by the functional use of the
sense of smell.
Communication
A candidate must be able to speak, to hear, and to observe patients in order to elicit information,
describe changes in mood, activity and posture, and perceive nonverbal communication. A candidate
must be able to communicate effectively and sensitively with patients. Communication includes not only
speech but reading and writing. The candidate must be able to communicate effectively and efficiently
in oral and written form with all members of the health care team.
Motor
Candidates must have sufficient motor function to elicit information from patients by palpation,
auscultation, percussion, and other diagnostic maneuvers. A candidate must be able to do basic
laboratory tests, carry out diagnostic procedures and read EKGs and X-rays. A candidate must be able to
execute motor movements reasonably required to provide general care and emergency treatment to
patients. Examples of emergency treatment, reasonably required of physicians are cardiopulmonary
resuscitation, the administration of intravenous medication, the application of pressure to stop
bleeding, suturing of simple wounds and the performance of simple obstetrical maneuvers. Such action
requires coordination of both gross and fine muscular movements, equilibrium and functional use of the
senses of touch and vision.
Intellectual, Conceptual, Integrative and Quantitative Abilities
These abilities include measurement, calculation, reasoning, analysis, and synthesis. Problem solving,
the critical skill demanded of physicians, requires all of these intellectual abilities. In addition, the
candidate must be able to comprehend three dimensional relationships and to understand the spatial
relationships of structures.
Behavioral and Social Attributes
A candidate must possess the emotional health required for full utilization of his/her intellectual
abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the
diagnosis and care of patients and the development of mature, sensitive, and effective relationships
with patients. Candidates must be able to tolerate physically taxing workloads and to function
effectively under stress. They must be able to adapt to changing environments, to display flexibility, and
to learn to function in the face of uncertainties inherent in the clinical problems of many patients.
Compassion, integrity, concern for others, interpersonal skills, interest and motivation are all personal
qualities that should be assessed during the admissions and educational process.
The Sanford School of Medicine reaffirms that no applicant will be excluded on the basis of sex, creed,
race or national origin. Otherwise qualified applicants with a disability will be considered in relation to
the guidelines listed above.
For additional information on services provided to resident/fellows with disabilities, contact Disability
Services in room 119 B of the Service Center Building or visit the Disability Services website.
Adopted Date: 2007
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
DISASTER POLICY
In the event of a disaster impacting the residency/fellowship programs sponsored by the Sanford School
of Medicine, the GMEC will work to protect the well-being, safety and educational experience of our
residents/fellows. Following declaration of a disaster, the GMEC working with the DIO and other
leadership will strive to restructure or reconstitute the educational experience as quickly as possible
following the disaster.
Once the DIO and GMEC determine that the sponsoring institution can no longer provide an adequate
educational experience for its residents/fellows, the sponsoring institution will, to the best of its ability,
arrange for the temporary transfer of the residents/fellows to programs at other sponsoring institutions
until such time as the Sanford School of Medicine is able to resume providing the educational
experience. Residents/fellows who transfer to other programs as a result of a disaster will be provided
an estimated time the relocation will be necessary. Should that initial time estimate need to be
extended, the resident/fellow will be notified identifying the estimated time of the extension. SSOM will
work with programs at other sponsoring institutions who accept residents/fellows to provide
continuation of salary and benefits.
If the disaster prevents the sponsoring institution from re-establishing an adequate educational
experience within a reasonable amount of time following the disaster, then the process of permanent
transfers will begin.
The DIO will be the primary institutional contact with the ACGME and AAMC regarding disaster plan
implementation and needs within the sponsoring institution.
In the event of a disaster affecting other sponsoring institutions of graduate medical education
programs, the program leadership at Sanford School of Medicine will work collaboratively with the DIO,
who will coordinate on behalf of the Sanford School of Medicine, to accept transfer residents/fellows
from other institutions. This will include the process to request complement increases with the ACGME
and CMS for funding that may be required to accept additional residents/fellows for training.
Adopted Date: 2007
Revised Date(s): 2012, 2014
GRADUATE MEDICAL EDUCATION
DISCRIMINATION/HARASSMENT POLICY
The institutions participating as training sites for the University of South Dakota Sanford School
of Medicine training programs have written policies in place for dealing with complaints relative
to discrimination or harassment of various types (i.e. race, sex, age, etc.). The procedure for
reporting grievances is delineated.
In addition, USD follows the policies set forth by the South Dakota Board of Regents, found
below. If a grievance is not handled to the satisfaction of a resident/fellow by the parent training
program, a complaint can be directed to the Director of Affirmative Action at 205 Slagle Hall
(605-677-5651) or the Vice President/fellow for Student Life at 218 Muenster University Center
(605-677-5331).
SOUTH DAKOTA BOARD OF REGENTS




Number 1:17: Sexual Harassment
Number 1:18: Human Rights Complaint Procedures
Number 1:19: Equal Opportunity, Non-Discrimination, Affirmative Action
Number 1:23: Employee-Employee and Faculty-Student Consensual Relationships Disability
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
DUE PROCESS AND RESIDENT COMPLAINT POLICY
Due Process, as described within, applies to actions that are taken as a result of academic deficiencies
and/or misconduct, and that may impact the intended career development of the resident/fellow. (See
Academic Improvement Policy and Professional Conduct and Misconduct Policy.) Residents/fellows will
receive written notice of intent when that resident’s/fellow’s agreement will not be renewed, when that
resident/fellow will not be promoted to the next level of training, or when that resident/fellow will be
dismissed. Complaint refers to the review of resident/fellow complaints or issues related to the work
environment, the program or faculty.
Academic Matters: A decision not to promote a resident/fellow to the next PGY level, to extend a
resident’s/fellow’s contract, to extend a resident’s/fellow’s defined period of training, to not renew a
resident’s/fellow’s contract, and/or to terminate the resident’s/fellow’s participation in a
residency/fellowship program would all be considered actions with potential impact on the trainee’s
career development. A review of the program’s decision to take an action for academic matters may be
requested by the resident/fellow. A written request for review must be submitted to the DIO/Chair of
GMEC within 14 days of learning of the action. Upon a request for review, the DIO/Chair of GMEC will
first determine whether the matter is reviewable under this policy and if so, the DIO/Chair of the GMEC
will then forward the resident file to the VP/Dean of SSOM.
At this time, the VP/Dean of SSOM may wish to ask questions of the resident/fellow and Program
Director. The VP/Dean of SSOM will then render a decision. This decision will be immediately effective,
binding and final and not subject to further appeal.
Misconduct Matters: A review of the decision to take an action for misconduct matters may be
requested by the resident/fellow. The review process will be the same as that for academic matters
(outlined above), with the following exception: The VP/Dean of SSOM will make a determination
whether the resident/fellow received appropriate notice and an opportunity to be heard regarding the
matter at hand, and whether the decision to take the action was reasonably made.
The procedures as outlined above shall not preempt the Medical Staff By-laws or personnel codes of the
hospitals and shall not preempt or limit any right of the hospitals under the Agreement With Physician
(resident/fellow contract) to immediately suspend a resident/fellow.
Complaint Matters: This refers to some cause of distress (such as an unsatisfactory working condition)
that is felt by the resident/fellow to present a reason for complaint, but does not impact intended
career development. Complaints must be dealt with in as confidential a manner as possible, and without
fear of retaliation. A complaint or incident should be reported to the resident’s/fellow’s Chief Resident
or attending physician. If the Chief Resident or attending is unable to help the trainee effectively resolve
the issue, the resident/fellow should take the problem to the Program Director for resolution. If
satisfactory resolution is still not achieved after the Program Director has become involved, the
resident/fellow may provide a written complaint report to the DIO/Chair of GMEC.
The DIO/Chair of GMEC will review the written complaint report and meet with the resident/fellow to
ensure that steps as outlined above for Complaint Matters were followed. He/she may then convene
other individuals deemed necessary to perform a reasonable inquiry and problem-solving process,
including but not limited to the complainant’s Program Director, hospital administrators, other
residents/fellows or faculty, and/or human resources personnel. The DIO/Chair of GMEC and/or other
appropriate participants will investigate all the issues associated with the complaint and will provide a
final and binding decision to the resident/fellow, unless precluded by confidentiality (i.e. if a complaint
culminates in a personnel action against a resident/fellow, faculty or staff member).
Adopted Date: 1997
Revised Date(s): 2012, 2014
GRADUATE MEDICAL EDUCATION
DUTY HOUR & FATIGUE MANAGEMENT POLICY
Duty hours are all clinical and academic activities related to the training program, including patient care
(both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer
of patient care, time spent in-house during call activities, and scheduled activities such as conferences.
Duty hours do not include reading and preparation time spent away from the duty site.
Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all inhouse call activities and all moonlighting. Residents/fellows must be provided with one day in seven free
from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call. One
day is defined as one continuous 24-hour period free from all clinical, educational, and administrative
duties. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour
(must be 8 hours) time period provided between all daily duty periods and after in-house call. If a
resident/fellow has had a 24-hour in-house duty shift, 14 hours free of duty must be provided.
The objective of on-call activities is to provide resident/fellows with continuity of patient care
experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the
normal work day, when resident/fellows are required to be immediately available in the assigned
institution. In-house call for PGY2 and above must occur no more frequently than every third night,
averaged over a four-week period.
Continuous duty periods for PGY1 must not exceed 16 hours. Continuous on-site duty for PGY2 and
above, including in-house call, must not exceed 24 consecutive hours. Residents/fellows PGY2 and
above may choose to remain beyond their scheduled period of duty to continue to provide care to a
single patient. Residents/fellows may remain on duty for up to four additional hours to participate in
didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of
medical and surgical care. No new patients may be accepted after 24 hours of continuous duty.
At-home call (or pager call) is defined as a call taken from outside the assigned institution. The
frequency of at-home call for residents/fellows is not subject to the every-third-night limitation. Athome call, however, must not be so frequent as to preclude rest and reasonable personal time for each
resident/fellow.
When residents/fellows are called into the hospital from home, the hours spent in-house are counted
toward the 80-hour limit. The Program Director and the faculty must monitor the demands of at-home
call in their programs and make scheduling adjustments as necessary to mitigate excessive service
demands and/or fatigue.
PROCEDURE
1. Residents/fellows should complete time records in New Innovations on a daily basis (including
in-patient hours, out-patient hours, vacation/sick, teaching time and so on for that month).
2. Individual programs and the GME office will review time records for accuracy.
If a resident/fellow misses the due date for this process or does not accurately complete the tracking as
required, Medicare funding may be in jeopardy. Any resident/fellow who violates this policy is
subject to the procedures outlined in the Professional Conduct and Misconduct Policy.
FATIGUE MANAGEMENT
Managing fatigue in residency/fellowship varies by individual. Sleep needs and habits are different for
every person, and those in training should understand their individual needs in this area.
Residents/fellows must develop strategies to combat the effects of sleep deprivation for their own
personal safety and that of their patients.
To help manage fatigue, the hospital systems provide quiet, clean call rooms for strategic napping.
Residents/fellows also have access to unlimited, free coffee and have the right to hire a taxi to take
them home and back the next day to retrieve their cars after they have had sufficient rest.
Residents/fellows will be reimbursed for this expense. Faculty have been trained to support
residents’/fellows’ needs concerning fatigue management, and trainees should contact their Program
Director or the GME office if they have struggles with sleep deprivation.
Adopted Date: 2004
Revised Date(s): 2012, 2014
GRADUATE MEDICAL EDUCATION
EVALUATIONS POLICY
EVALUATION OF RESIDENTS/FELLOWS
Resident/fellow performance is evaluated on a regular basis. Advancement to the next year of a
program must be based on evidence of satisfactory progressive scholarship and professional growth of
the trainee, including demonstrated ability to assume graded and increasing responsibility for patient
care. The Program Director, with input from members of the faculty, is responsible for the
determination that the resident/fellow has fulfilled this standard of professional growth.
The faculty must evaluate, in a timely manner, the residents/fellows whom they supervise. Evaluations
must be submitted through New Innovations where applicable. In addition, the program must demonstrate
that it has an effective mechanism for assessing resident/fellow performance throughout the program, and
for using the results to improve resident/fellow performance. Assessments should include:
a) The use of methods that produce an accurate assessment of resident’s/fellows’
competence in patient care, medical knowledge, practice-based learning and
improvement, interpersonal and communication skills, professionalism, and systemsbased practice.
b) The regular and timely performance feedback to residents/fellows that includes at least
semiannual written evaluations. Such evaluations are to be communicated to each
resident/fellow in a timely manner, and the evaluations are to be maintained in a record
that is accessible to each resident/fellow upon request.
c) The use of assessment results, including evaluation by faculty, patients, peers, self, and
other professional staff, to achieve progressive improvements in resident’s/fellow’s
competence and performance.
The Program Director must provide a final evaluation for each resident/fellow who completes the
program. This evaluation must include a review of the resident’s/fellow’s performance during the final
period of education, and should verify that the resident/fellow has demonstrated sufficient professional
ability to practice competently and independently. The final evaluation must be part of the
resident’s/fellow’s permanent record maintained by the institution.
EVALUATIONS BY RESIDENTS/FELLOWS
Each resident/fellow must evaluate the rotations, faculty, and program in a timely manner. As part of
this process, each resident/fellow should complete the survey conducted by the ACGME on an annual
basis in the time frame provided by the program. The final evaluation completed by residents/fellows is
the annual survey conducted by the GME which is electronically distributed in mid-May. The GME office
also provides a mid-year program evaluation for resident/fellows to complete.
EVALUATION OF FACULTY
The performance of the faculty must be evaluated by the program no less frequently than at the midpoint
of the accreditation cycle, and again prior to the next site visit. The evaluations should include a review of
their teaching abilities, commitment to the educational program, clinical knowledge, and scholarly
activities. This evaluation must include annual written confidential evaluations by residents/fellows.
Review of evaluations will include effectiveness of faculty teaching and performance.
EVALUATION OF THE PROGRAM
The educational effectiveness of a program must be evaluated at least annually in a systematic manner.
Representative program personnel (i.e., at least the Program Director, representative faculty, and one
resident/fellow) must be organized to review program goals and objectives, and the effectiveness with
which they are achieved. This group must conduct a formal documented meeting at least annually for this
purpose. In the evaluation process, the group must take into consideration written comments from the
faculty, the most recent report of the GMEC of the sponsoring institution, and the resident’s/fellows’
confidential written evaluations.
If deficiencies are found, the group should prepare an explicit plan of action, approved by the faculty and
documented in the minutes of the meeting. The program should use resident/fellow performance and
outcome assessment in its evaluation of the educational effectiveness of the program. Performance of
program graduates on the certification examination should be used as one measure of evaluating program
effectiveness. The program should maintain a process for using assessment results together with other
program evaluation results to improve overall.
Adopted Date: 2004
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
HUMANITARIAN ROTATION POLICY
A humanitarian rotation is a rotation to a part of the world that has a documented, acute need of
assistance for which a resident/fellow feels compelled to contribute their time and efforts. This
type of rotation may be combined with an away rotation if the criteria for that policy are met.
This rotation is considered a Leave of Absence from the program and the time away may extend
the length of training. In this situation, the resident does not have to exhaust vacation, sick, or
educational leave.
PROCEDURES
a) Resident/fellow must be in good standing with his/her program in order to be considered
for and participate in a humanitarian rotation.
b) All humanitarian rotations should have written approval of the resident’s/fellow’s
Program Director and the DIO/Chair of GMEC 30 days before the rotation start date. To
obtain approval, complete Form 170H – Application for Humanitarian Rotation – and
submit to the Program Director.
c) Residents/fellows are allowed to participate in one humanitarian rotation per program.
This rotation may not be taken during the first or last block of any program year, except
under special circumstances.
d) To be approved, the humanitarian rotation must be in conjunction with a recognized
organization that is regularly involved with humanitarian relief efforts. This organization
should offer evacuation insurance and foreign medical insurance for the protection and
safety of the resident/fellow. Proof of this insurance will be needed for final approval,
even if it has to be purchased by the resident/fellow separately.
e) Expenses related to travel, lodging, meals and other related expenses are the
responsibility of the resident/fellow.
f) While on this rotation, the resident will not receive the monthly stipend, but the
resident/fellow benefit package will be continued at the program’s expense.
g) Evacuation/International medical insurance should be purchased by the resident/fellow as
a precautionary measure while on this rotation.
Adopted Date: 2011
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
HUMANITARIAN ROTATION POLICY
A humanitarian rotation is a rotation to a part of the world that has a documented, acute need of
assistance for which a resident/fellow feels compelled to contribute their time and efforts. This
type of rotation may be combined with an away rotation if the criteria for that policy are met.
This rotation is considered a Leave of Absence from the program and the time away may extend
the length of training. In this situation, the resident does not have to exhaust vacation, sick, or
educational leave.
PROCEDURES
a) Resident/fellow must be in good standing with his/her program in order to be considered
for and participate in a humanitarian rotation.
b) All humanitarian rotations should have written approval of the resident’s/fellow’s
Program Director and the DIO/Chair of GMEC 30 days before the rotation start date. To
obtain approval, complete Form 170H – Application for Humanitarian Rotation – and
submit to the Program Director.
c) Residents/fellows are allowed to participate in one humanitarian rotation per program.
This rotation may not be taken during the first or last block of any program year, except
under special circumstances.
d) To be approved, the humanitarian rotation must be in conjunction with a recognized
organization that is regularly involved with humanitarian relief efforts. This organization
should offer evacuation insurance and foreign medical insurance for the protection and
safety of the resident/fellow. Proof of this insurance will be needed for final approval,
even if it has to be purchased by the resident/fellow separately.
e) Expenses related to travel, lodging, meals and other related expenses are the
responsibility of the resident/fellow.
f) While on this rotation, the resident will not receive the monthly stipend, but the
resident/fellow benefit package will be continued at the program’s expense.
g) Evacuation/International medical insurance should be purchased by the resident/fellow as
a precautionary measure while on this rotation.
Adopted Date: 2011
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
IMMIGRATION LAW POLICY
The Residency Corporation is committed to full compliance with federal immigration laws. These
laws require that individuals pass an employment verification procedure before they are permitted to
work. This procedure has been established by law and requires that every individual provide
satisfactory evidence of his/her identity and legal authority to work in the United States before
employment begins. Accordingly, new residents/fellows must go through this procedure on or before
their first day of training.
PROCEDURE
Residents/fellows will be required to complete the government issued I-9 prior to beginning their
program. I-9 forms will be distributed to all residents/fellows before orientation via New Innovations. In
addition to completing the I-9, each resident/fellow will need to provide documentation of their right to
work in the United States. Residents/fellows who are completing their programs on work visas must
maintain a current visa and provide annual documentation to the HR representative of their right to
work in the United States.
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
IMMUNIZATION POLICY
All residents/fellows must be in compliance with the Required Immunization Form before
starting their program. Proof of compliance should be submitted to the program via New
Innovations as soon as possible following acceptance to allow for missing immunizations to be
administered one month before training is scheduled to begin.
All residents/fellows are required to have an annual tuberculosis (TB) evaluation.
PROCEDURE
Avera McKennan Hospital and Sanford USD Medical Center will provide new residents/fellows
with a TB evaluation during orientation. Avera McKennan Hospital and Sanford USD Medical
Center will continue to provide annual TB evaluations for PGY2, PGY3, PGY4, PGY5, and
PGY6 resident/fellows. For any resident/fellow having a positive evaluation, the administering
hospital will provide follow-up case management protocol.
All other required immunizations are the responsibility of the resident/fellow to obtain.
Adopted Date: 2005
Revised Date(s): 2012, 2014
GRADUATE MEDICAL EDUCATION
JURY DUTY/CIVIC RESPONSIBILITY POLICY
The Residency Corporation will grant court leave to residents/fellows when they are summoned
to report for jury duty to any federal, state or municipal court or when they are subpoenaed to
testify as a witness concerning matters arising out of their professional job responsibilities.
Extended time away from the program and educational obligations may extend the
resident’s/fellow’s contract in order to meet all educational requirements.
PROCEDURE
a) Residents/fellows who submit a jury summons from a federal, state or municipal court or
who submit a subpoena to testify as a witness concerning their professional job
responsibilities are granted a maximum of two weeks court leave with regular pay to
serve in that capacity. After two weeks, the resident/fellow can elect to use his/her
vacation time or take leave without pay. The fee received for such services must be
endorsed to the Residency Corporation and submitted to the Assistant Director of Finance
to be eligible for paid court leave.
b) A resident/fellow who is called, summoned as a juror, or subpoenaed as a witness must
present to his/her Program Director the original summons or subpoena from the court to
qualify for paid court leave.
c) At the conclusion of such duty, a signed statement from the clerk of the court or other
evidence showing the actual time of attendance must be turned into the Program Director.
d) Court leave is intended to apply only to those times when the resident/fellow is needed
for court service. It is not considered as paid leave during the time period when the
resident/fellow has been excused from court service and does not return to work.
e) Should a resident/fellow be concerned about the time he/she could possibly be away from
a rotation and his/her education, a resident/fellow may request a letter from his/her
program explaining to the court the educational obligations of a resident/fellow
physician.
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
LIABILITY MANAGEMENT POLICY
It is the policy of the Residency Corporation to reduce, modify, eliminate and control conditions
and practices which might cause injury/damage to people or property and which might result in
financial loss. The DIO/Chair of GMEC will serve as liaison and advisor to the Residency
Corporation on Quality Assurance/Risk Management issues.
PROCEDURE
In order to maintain a system of reporting and documenting potential and actual liability claims
on a routine basis, certain steps must be followed:
a) The resident/fellow will notify their Program Director of incidents where there is a
concern about liability. The Program Director will then notify the DIO/Chair of GMEC,
who will fill out and keep on file a “Variance Report.”
b) The DIO/Chair of GMEC will appoint a Review Committee to review the medical record
and speak with the resident/fellow, faculty and other staff involved to develop a
communication strategy to work with the patient and family. A report will be kept on file
that documents pertinent facts from the medical record and from the discussions and will
include copies of any correspondence.
c) The DIO/Chair of GMEC will notify the Insurance Carrier Claims Department of any
potential claims.
d) Any letters from legal firms requesting medical records from a facility with a
resident’s/fellow’s name identified should be forwarded to the DIO/Chair of GMEC who
will send a copy to the Program Director, USD legal counsel and the Insurance Carrier
Claims Department.
e) The DIO/Chair of GMEC will meet with the Review Committee and USD legal counsel
to review the records prior to sending them to the requesting legal office.
f) The DIO/Chair of GMEC will keep an ongoing file of the case.
Incidents arising through resident/fellow activities at the VA hospital will be managed through
the VA system.
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
MOONLIGHTING POLICY
Moonlighting is work by the resident/fellow outside of his/her program. Appropriately
credentialed residents/fellows who are in good standing in their program and have written
approval of the Program Director may moonlight. PGY1 residents are not permitted to moonlight
under any circumstances. Please note that some programs prohibit moonlighting entirely.
Moonlighting is allowed during a resident’s/fellow’s free time and may not in any way interfere
with his/her educational responsibilities (i.e. rotation, hospital, clinic, or general duties) or
overall health. Residents/fellows who are completing their education on J-1 visas are not allowed
to moonlight at any time. Residents/fellows are not required to moonlight as part of their
program requirements.
All moonlighting must be counted toward the 80-hour weekly limit on duty hours. Moonlighting
will not be approved if there is a potential for a violation of duty hours.
The program will not provide professional liability insurance or any licensure or permits, such as
DEA number, for work performed by the resident/fellow outside the program. The
resident/fellow is responsible to ensure that professional liability insurance and licenses are
provided in each instance of moonlighting by the resident/fellow or his/her employer. All
moonlighting arrangements are between the resident/fellow and the physician or institution for
which he/she works.
PROCEDURE
Prior to moonlighting, the resident/fellow must obtain written permission from his/her Program
Director. The resident/fellow must submit a request detailing the moonlighting activities
including duration and frequency. The Program Director will subsequently either approve or
deny the request in writing. This documentation must become part of the resident’s/fellow’s
permanent file.
Residents/fellows who are granted moonlighting privileges will be monitored and will be
counseled for excessive moonlighting activity. If problems arise due to moonlighting, permission
to moonlight may be withdrawn by the Program Director at any time.
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
NON-COMPETITION POLICY
Neither the University of South Dakota Sanford School of Medicine nor any of its sponsored
residency/fellowship programs will require a resident/fellow to sign a non-competition guarantee
or restrictive covenant as part of his/her training.
Adopted Date: 2014
GRADUATE MEDICAL EDUCATION
PGY3 PROGRESSION POLICY
To progress to the PGY3 year, residents must pass Step 3 of the USMLE or Level 3 of the COMLEX-USA
exam.
a) All residents must take Step 3 of the USMLE or Level 3 of the COMLEX-USA exam by
the end of PGY1.
b) Failure to pass Step 3 of the USMLE or Level 3 of the COMLEX-USA exam by the end
of PGY2 will result in non-renewal of the resident’s contract.
c) Any resident who subsequently passes Step 3 of the USMLE or Level 3 of the
COMLEX-USA exam may be considered for reappointment.
Adopted Date: 2009
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
PHYSICIAN IMPAIRMENT POLICY
The University of South Dakota Sanford School of Medicine recognizes its responsibility to provide a
healthy environment for residents/fellows preparing themselves to become independent practitioners
in the healthcare profession. As healthcare professionals, residents/fellows are held to a high standard
of conduct.
USD SSOM and hospital partners are committed to protecting the safety, health, and welfare of
faculty, staff, residents/fellows, and students and those with whom they have contact with on
University and hospital property. In furtherance of this commitment, USD SSOM strictly
prohibits the illegal use, possession, sale, conveyance, distribution, and manufacture of the
following which are not being used by the resident/fellow pursuant to a valid prescription:
• Illegal drugs as defined by state and/or federal law
• Intoxicants
• Controlled substances as defined under state and/or federal law
In addition, USD SSOM strictly prohibits inappropriate substance use or addiction to the
following:
• Non-prescription drugs
• Prescription drugs
• Alcohol
To assist the residents/fellows in attaining their career goals and protecting the public, USD
SSOM will seek to use the services of the South Dakota Health Professionals Assistance
Program (HPAP). HPAP is a multi-disciplinary diversion program for chemically impaired
health professionals. HPAP provides a non-disciplinary option to confidentially and
professionally monitor treatment and continuing care of health professionals who may be unable
to practice with reasonable skill and safety if their illness is not appropriately managed. The
intent of this policy is to assist the resident/fellow in the return to a condition which will allow
them to competently and safely achieve their goal of becoming an independent healthcare
professional, with an emphasis being placed on deterrence, education, and reintegration. All
aspects of this policy are to be applied in good faith with compassion, dignity, and to the extent
permitted by law, confidentiality.
REFERRAL TO HPAP
Upon the occurrence of an event deemed by the DIO to warrant a referral to HPAP, the
resident/fellow may be referred to HPAP for testing, treatment recommendations, and/or
monitoring. Events which may lead to a referral must be supported by credible evidence and may
consist of the following:
 Report of a possible violation by another resident/fellow, faculty member, or other person
with whom the resident/fellow interacts during scheduled working or learning hours at
any location;
 Observable phenomena, such as direct observation of an inappropriate use of alcohol,
drug use, and/or physical symptoms during scheduled working or learning hours at any
location;
 Manifestations of being under the influence of a substance of abuse, such as erratic
behavior, slurred speech, staggered gait, flushed face, dilated/pinpoint pupils, wide mood
swings, and/or deterioration of performance during scheduled working or learning hours
at any location;
 Credible information that a resident/fellow has caused or contributed to an accident as a
result of inappropriate substance use;
 Credible information that a resident/fellow has been charged with an offense associated
with the inappropriate use of alcohol or illegal substances;
 Conviction by a court for an offense related to the inappropriate use of alcohol or illegal
substances. This shall include any charged offense for which the resident/fellow received
a suspended imposition of sentence, deferred prosecution, or other treatment by the Court
which resulted in the resident’s/fellow’s criminal record in the matter being expunged.
TESTING BY HPAP
Upon referral, HPAP may determine that testing of the resident/fellow is necessary. If HPAP
determines that testing results are positive due to substance levels meeting or exceeding HPAP
established threshold values for both screening and confirmation studies, that information will be
reviewed by a Medical Review Officer (MRO). Refusal by the resident/fellow to comply with
the referral to HPAP may result in disciplinary action.
NON-COMPLIANCE
Upon non-compliance with HPAP, the following actions may be taken by the resident’s/fellow’s
training program or the GME office:
 Disciplinary action as set forth in the GME Professional Conduct and Misconduct Policy;
 Development of an Academic Improvement Plan (outlined in the GME Academic
Improvement Policy).
Adopted Date: 2014
GRADUATE MEDICAL EDUCATION
PROFESSIONAL CONDUCT AND MISCONDUCT POLICY
INTRODUCTION
Good working relationships, team work and appropriate ethical conduct are necessary among all
members of the health care team. All members of the team must treat others with respect,
courtesy and dignity and conduct themselves in a professional, honest and ethical manner.
Disruptive or unethical behavior is not acceptable.
Definitions:
a) Disruptive behavior: Behavior that is disruptive to team work and the delivery of good
care. Behavior that is unusual, unorthodox or different is not alone sufficient to classify
as disruptive behavior. Examples of inappropriate conduct might include, but are not
limited to: abusive or profane language; degrading, demeaning or aggressive comments;
yelling at patients, families and/or members of the health care team; inappropriate
physical contact; and behaviors of omission such as chronic and recalcitrant failure to
comply with stated program or hospital procedures or policies, answer pages, complete
medical records, etc.
b) Misconduct: Behavior deemed improper. Examples of misconduct include, but are not
limited to: HIPAA violations; intentional wrong doing; dishonesty; plagiarism or
academic dishonesty; threats and/or physical assaults; and violation of a law, practice
standard of program or hospital policy.
c) Illegal behavior: Behavior that results in a misdemeanor/felony charge must be selfreported to the Program Director or DIO within 48 hours.
PROCESS
Allegations of disruptive behavior or misconduct: Any individual who observes disruptive
behavior or misconduct by a resident/fellow should report this to the Program Director or to the
complainant’s supervisor who will then report it to the Program Director. Documentation of the
behavior should include 1) the date, time and location of the questionable behavior; 2) a
description of the behavior limited to direct factual observations; 3) circumstances that
precipitated the situation; 4) actual or expected consequences, if any, to patient care; 5) record of
any action taken to remedy the situation, and; 6) the name of the individual who is making the
report, as well as any other witnesses.
Upon receipt of a complaint regarding conduct of a resident/fellow, the Program Director should
conduct an inquiry, as follows:
a) Meet with the complainant or otherwise review the complaint.
b) If the Program Director deems the complaint to have merit, meet with the resident/fellow
to advise the trainee of the existence of the complaint, to give the trainee an opportunity
to respond to the allegations and to identify any potential witnesses to the alleged
disruptive behavior or misconduct.
c) The Program Director may consult with others as appropriate based on the issues and the
people involved (i.e. DIO/Chair of GMEC, legal counsel, administrator of appropriate
hospital, human resources personnel, etc.).
d) Behaviors or incidents occurring at a hospital site will be addressed by the Program
Director in conjunction with the hospital personnel as appropriate, according to the code
of conduct policy of the appropriate hospital. Incidents involving inappropriate sexual
comments or behaviors will be addressed by the Program Director in conjunction with
hospital personnel and/or USD SSOM staff as appropriate, according to the
Discrimination/Harassment Policy. Behaviors that indicate the presence of impairment in
the resident/fellow will be addressed according to the Physician Impairment Policy.
These may proceed simultaneously.
e) Upon consensus of the Program Director and DIO, the trainee may be removed from duty
(with or without pay) pending the outcome of the inquiry.
Inquiries will be conducted with due regard for confidentiality to the extent allowed. However,
full confidentiality cannot be guaranteed. Retaliation for reporting disruptive behavior or
misconduct or participating in an investigation of reported inappropriate behavior is strictly
prohibited.
Outcome of Inquiry: If the inquiry results in a finding that no inappropriate behavior occurred,
no action will be taken against the resident/fellow. If the resident/fellow was suspended during
the inquiry, he/she will be reinstated with full benefits and pay.
If the inquiry results in a finding that disruptive activity occurred that does not reach the level of
misconduct, it may be addressed in accordance with the Academic Improvement Policy as a
deficit in the area of professionalism.
If the inquiry results in a finding that a trainee participated in misconduct, the Program Director
(in consultation as appropriate with the DIO, hospital administrator, human resources personnel,
legal counsel or other individuals) shall determine what action is appropriate to remedy the
situation. The program may take one or more actions including, but not limited to:
 A verbal or written warning
 Education regarding appropriate behavior
 Election to not promote to next PGY level
 Suspension
 Non-renewal of contract
 Termination from the training program
A decision not to promote a resident/fellow to the next PGY level, to suspend a resident/fellow, to not
renew a resident’s/fellow’s contract and/or to terminate a resident’s/fellow’s participation in a training
program would all be considered actions with potential impact on the trainee’s career development.
Actions may require disclosure to others upon request, including but not limited to privileging hospitals,
licensure or specialty boards. If a resident/fellow is subject to an action as a result of misconduct, he/she
must be notified of this in writing. Such notification must be signed by the Program Director and the
DIO/Chair of GMEC.
Due Process and Request for Review: A resident/fellow who is subject to an action as a result
of misconduct may request a review of the decision as described in the Due Process and Resident
Complaint Policy. A copy of the Due Process and Resident Complaint Policy should be available
to any resident/fellow who is subject to an action.
Adopted Date: 1997
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
PROMOTION POLICY
Advancement to the next year of a training program must be based on evidence of satisfactory
progressive scholarship and professional growth of the resident/fellow, including demonstrated ability
to assume graded and increasing responsibility for patient care.
The program is required, by the Accreditation Council for Graduate Medical Education
(ACGME), to ensure its resident/fellows are competent in the six areas below to the level
expected of a resident/fellow based on his/her post graduate year (PGY). Residents/fellows must
demonstrate:
a) Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health.
b) Medical 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.
c) Practice-Based Learning and Improvement that involves investigation and evaluation
of their own patient care, appraisal and assimilation of scientific evidence, and
improvements in patient care.
d) Interpersonal and Communication Skills that result in effective information exchange
and teaming with patients, their families, and other health professionals.
e) Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.
f) Systems-Based Practice, as manifested by actions that 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.
PROCEDURE
The Program Director, with input from members of the faculty and a review of the resident’s/fellow’s
file, is responsible for the determination that the resident/fellow has adequately progressed in the
ACGME competencies to be promoted to the next level of training.
The resident/fellow must also renew and maintain a valid Residency License through the South Dakota
Board of Medical and Osteopathic Examiners.
Adopted Date: 2005
Revised Date(s): 2012, 2014
GRADUATE MEDICAL EDUCATION
RECRUITMENT, ELIGIBILITY, AND SELECTION POLICY
Applicants for a training program at the University of South Dakota Sanford School of Medicine must:
a) Be graduates of a medical school in the United States or Canada accredited by the
Liaison Committee on Medical Education (LCME) prior to beginning residency, or
b) Be graduates of a United States College of Osteopathic Medicine accredited by the
American Osteopathic Association (AOA) prior to beginning residency, or
c) If applying from outside the United States and Canada, have a current, valid certificate
from the Educational Commission for Foreign Medical Graduates (ECFMG), or
d) Have an unrestricted license to practice medicine in a United States licensing
jurisdiction, or
e) Be graduates of medical schools outside the United States who have completed a Fifth
Pathway program provided by an LCME-accredited medical school
and
f) Be eligible for a South Dakota Residency License as outlined by the South Dakota Board
of Medical and Osteopathic Examiners.
The criteria for selection, application process, and selection method are based on the South Dakota
Board of Regents “Report from the Task Force on Residency Admissions Process” and subsequent
recommendations for standardization by the “Interdepartmental Residency Task Force.” Applicants are
selected through the National Resident Matching Program (NRMP) where possible. The SSOM training
programs follow match policies set by the NRMP.
PROCEDURE
Applicants invited to interview will be informed in writing of the terms, conditions, and benefits of the
residency/fellowship program, either in effect at the time of the interview or that will be in effect at the
time of his or her eventual appointment. Information provided includes financial support, vacation and
other leaves of absence, professional liability, and insurance accessible to residents/fellows and their
eligible dependents. Residents will be selected from among eligible applicants based on their ability,
aptitude, academic credentials, communication skills, and personal qualities such as motivation and
integrity. In accordance with the South Dakota Board of Regents, the SSOM does not discriminate
against resident applicants on the basis of race, color, creed, national origin, ancestry, citizenship,
gender, sexual orientation, religion, age, or disability.
Adopted Date: 1994
Revised Date(s): 2012, 2014
GRADUATE MEDICAL EDUCATION
RESIDENT CLOSURE/REDUCTION POLICY
Should the program/corporation perceive the necessity to close a training program or reduce the
size of a program, the program/corporation will inform residents/fellows, GMEC, and the DIO of
a proposed closing date as early as possible. In the event of such a closure or reduction, the
program/corporation will make every effort to allow current residents/fellows to complete their
education. If any residents/fellows are displaced by such a closure or reduction, the
program/corporation will assist the resident/fellow in identifying a program in which they can
continue their education.
Should the Sanford School of Medicine, as the Sponsoring Institution, intend to close, it must
inform the residents/fellows, GMEC, and the DIO as early as possible.
Adopted Date: 1997
Revised Date(s): 2012, 2014
GRADUATE MEDICAL EDUCATION
SOCIAL MEDIA POLICY
This policy is to ensure protection of confidential and private information as well as encourage
exemplary professionalism regarding social media.
a) Do not violate the HIPAA privacy rule by sharing patient information or any information that
could potentially identify a patient. Any resident/fellow who violates the HIPAA privacy rule
is subject to the procedures outlined in the Professional Conduct and Misconduct Policy.
Please note that posting protected information is a federal offense in which significant fines
and/or arrest are likely. Please visit the U.S. Department of Health & Human Services site for
more information about the HIPAA privacy rule.
b) Do not share sensitive/private information relating to colleagues, SSOM, or the organizations
in which you will be training.
c) Photos of your workplace and elements of/from that workplace should never be posted or
transmitted without express written permission from your workplace. Even a seemingly
innocent picture of you with your colleagues may have identifying information in the
background.
d) Maintain personal information as personal and separate it from professional information. This
line is now blurred as you enter a highly regulated profession. Giving advice in these settings
could be interpreted as establishing a doctor/patient relationship. Be careful when speaking
from a personal perspective, that you disclaim that what you are communicating is a personal
opinion and does not necessarily reflect the views of SSOM or your training facility.
e) Use this type of communication judiciously. While there are many positive, professional uses
of social media, it can also be considered “addictive” in nature to the point of paralyzing your
efficiency and productivity.
Violations of this policy could result in disciplinary action under the professionalism guidelines
of your program, the SDBOME, local, and or federal authorities.
GRADUATE MEDICAL EDUCATION
SUPERVISION POLICY
Residents/fellows must be supervised at all levels of training at each training site. Residents/fellows are
assigned a faculty supervisor during each rotation. The faculty supervisor may be the patient’s attending
physician, the consulting physician, or the teaching attending physician, depending upon the role of the
faculty supervisor for a given patient. The responsibility for supervision extends to all resident/fellow
activity during the rotation of the faculty supervisor. The responsibilities of the faculty supervisor are as
follows:
1. Provide supervision, guidance, and education to their assigned residents/fellows.
a. Special attention should be given to overseeing residents/fellows in situations
involving care of a complex patient, patient transfer from an ICU, patient with
DNR status, or other end-of-life status.
2. Provide evidence in the patient medical records of supervision by the faculty supervisor.
3. Faculty supervisor must see the patient and write a note in the chart within 24 hours of
admission or consultation.
4. Faculty supervisor must countersign notes, orders, and write progress or consultation
notes where appropriate.
5. Although the faculty supervisor is not enjoined from writing orders, residents/fellows
should write all orders for patients assigned to them.
6. Faculty supervisors must provide the resident/fellow and program director with a
performance evaluation in a timely manner using program evaluation guidelines at
the completion of each rotation through New Innovations or another method
approved in advance by the program director.
Residents/fellows may at any time seek the advice of a fellow resident/fellow or an attending physician.
Residents/fellows may be supervised in their activities by more senior residents/fellows in the program.
Supervision may consist of observation, consultation, or personal assistance and can be direct and
person–to-person (both parties simultaneously present) or direct via telephonic or other
contemporaneous communication. Supervision can also be indirect via chart review or noncontemporaneous reporting, whether face-to-face or by other means. However, the attending physician
is ultimately responsible for the care of the patient and for appropriate resident/fellow supervision, and
must be readily available at all times.
In the case of PGY1 residents, supervision must be direct or indirect with direct supervision immediately
available (the supervising senior resident/fellow or attending physician is physically within the hospital
or other site of patient care, and is immediately available to provide direct supervision), unless the
specialty has specific rules that allow for other options.
Residents/fellows must convey directly to the attending physician any substantial change in the
condition or status of a patient under the care of that attending physician, including admission, transfer
to a hospital area providing a higher level of care, discharge (including those from the ER), and the
development of any complications.
The GME Office will provide the hospitals a photo composite with names of all residents/fellows, as well
as their currently assigned PGY levels. This list will be provided at least once each academic year, but
may be submitted more frequently to reflect the addition of residents/fellows or the change in status of
any given resident/fellow.
For further information, residents/fellows should consult their program’s supervision policy.
Adopted Date: 2013
Revised Date: 2014
GRADUATE MEDICAL EDUCATION
TRANSFER POLICY
Any resident/fellow seeking to transfer programs within the state of South Dakota must meet
with a review committee consisting of his/her current Program Director, the Program Director of
the program he/she wishes to transfer to, a representative from Sanford USD Medical Center, a
representative from Avera McKennan Hospital and the DIO/Chair of GMEC. This group will
inform the GMEC of the transfer request and make a recommendation to the committee
regarding the request. The GMEC will vote to approve or decline the transfer request.
Before accepting a resident/fellow transfer from another training program outside of South Dakota, the
USD SSOM Program Director must obtain:
a) a written or electronic verification of prior educational experience.
b) a summative, competency-based performance evaluation of the transferring
resident/fellow.
For any resident transferring from a USD SSOM training program to another out-of-state program prior
to completion of training, the USD SSOM Program Director must provide:
a) a timely written or electronic verification of residency/fellowship education.
b) a summative, competency-based performance evaluation for the resident/fellow.
Per ACGME Common Program requirements, residents who apply for transfer from another GME
program are subject to all elements in the policies addressing eligibility requirements and the selection
process.
Adopted Date: 2003
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
TRANSITIONS OF CARE POLICY
It is often necessary to transfer responsibility for, or hand off, a patient’s care from one physician to
another. Hand-off refers to the orderly communication of essential information that must occur during a
patient care transition. The information communicated during a hand-off must be accurate and
sufficiently complete in order to ensure the continuation of safe and effective patient care.
The general process for hand-offs that a resident/fellow should follow includes:
1. Hand-offs must follow a standardized approach and include the opportunity to ask and
respond to questions from members of the patient care team.
2. The hand-off must communicate essential information to facilitate continuity of care.
Hand-offs must occur when the patient is experiencing a change in care which includes a
change in physician (whether at shift change or new permanent duty assignment) or the
patient is being transferred or discharged.
3. End-of-shift hand-offs should occur at a regularly scheduled time as designated by the
program in conjunction with the hospital medical staff to minimize the number of
transitions.
4. Hand-offs should include both written and verbal communication.
5. When discharging a patient, it is important that the discharging physician communicate
with the physician who will be responsible for the patient’s continuance of care.
Specific program details involving transitions of care may be found in individual program’s
Transitions of Care policies.
Adopted Date: 2013
Revised Date: 2014
GRADUATE MEDICAL EDUCATION
VENDOR INTERACTION POLICY
Interactions with industry occur in a variety of contexts, including marketing of new pharmaceutical
products, medical devices, and research equipment, as well as on-site training of newly purchased
devices. These interactions must be ethical and must not create conflicts of interest that could endanger
patient safety, data integrity, or the integrity of education or training programs.
Consistent with the guidelines established by the American Medical Association Statement on Gifts to
Physicians, acceptance of gifts from industry vendors is discouraged. Any gifts accepted by
residents/fellows cannot be of substantial value. Accordingly, textbooks, modest meals, and other gifts
are appropriate only if they serve a genuine educational function. Cash payments cannot be accepted.
Residents/fellows cannot accept gifts or compensation for listening to a sales talk by an industry
representative. Residents/fellows cannot accept gifts or compensation for prescribing or changing a
patient's prescription.
Residents/fellows must consciously separate clinical care decisions from any perceived or actual benefits
expected from any company. It is unacceptable for patient care decisions to be influenced by the
possibility of personal financial gain.
Industry vendors are to follow the policies of our teaching institutions regarding their presence in
patient care and clinical areas. Industry vendors are permitted to visit residency/fellowship
administrative offices by appointment only. Appointments may be made on a per visit basis or as a
standing appointment for a specified period of time, with the approval of the Program Director or
department chair, or designated personnel issuing the invitation.
Vendor support of educational conferences involving resident/fellow physicians may be used, provided
that the funds are provided to the institution and not directly to the resident/fellow. The Program
Director should determine if the funded conference or program has educational merit. The institution
must not be subject to any implicit or explicit expectation of providing something in return for the
support. Financial support by industry should be fully disclosed by the meeting sponsor. The meeting or
lecture content must be determined by the speaker and not the industrial sponsor. The lecturer is
expected to provide a fair and balanced assessment of therapeutic options and to promote objective
scientific and educational activities and discourse.
Adopted Date: 2007
Revised Date(s): 2012
GRADUATE MEDICAL EDUCATION
VISA POLICY
The Sanford School of Medicine accepts the following types of visas:
1. J-1 Visa – Alien Physician: the standard visa for residents/fellows who are not United
States citizens or permanent residents. This visa is issued by the Education Commission
on Foreign Medical Graduates (ECFMG)
2. H-1B Visa: requires GME approval (read H-1B Visa Procedure below).
3. Permanent Residence Application or Pending Application: candidates must possess an
Employment Authorization Document (EAD) card. EAD cards must be renewed
annually.
Copies of approved visa documents/EAD card must be provided with a correctly processed I-9 form prior
to the agreement start date. Failure to meet this deadline voids the agreement and jeopardizes the
candidate’s ability to become a part of the program.
PROCEDURE
J-1 Visa – Alien Physician
Candidates must fill out the appropriate J-1 Application on the ECFMG website and submit to the
Program Coordinator on an annual basis before the expiration date listed on the DS-2019. Application
materials can be found on the ECFMG website.
If a resident/fellow with a J-1 visa wishes to do an elective or away rotation to a site other than Avera,
Sanford, or the VA, special permission must be obtained from ECFMG. Contact the GME office for more
information.
H-1B Visa Procedure
At the discretion of the individual training programs, the H-1B visa may be considered for candidates
who meet the eligibility and selection requirements and have passed the USMLE Step 3 exam. At the
time of interview, the program should provide all applicants with a copy of the institutional visa policy
and the program-specific information on offering H-1B visas.
Training programs are responsible for costs and fees associated with preparing and filing H-1B visas for
residents/fellows. The fee for expedited processing is the responsibility of the incoming resident/fellow.
Training programs are required to use outside legal counsel or the services of the HR department of
SSOM to navigate this process.
If a training program terminates or non-renews a resident/fellow appointment before the individual’s H1B visa expires, the training program is responsible under U.S. Citizenship and Immigration Services
regulations to pay the H-1B physician’s airfare back to his/her home country.
Moonlighting
a) Residents/fellows with J-1 visas are not allowed to moonlight.
b) Residents/fellows with H-1B visas must obtain a separate H-1B visa for each facility
outside of the training program.
Adopted Date: 2010
Revised Date(s): 2012