Background: The financial structure of Medicare GME training requires residents to work physically within the hospital system that provides the financial support for the educational experience. Resident rotations away for special educational activities, volunteering for underserved populations, and international experiences are not supported through traditional GME Cost Report funding. It is difficult to arrange away rotations, even within the same city, without dedicated financial support. Many Saint
Louis University faculty volunteer clinically outside of the United States and would welcome resident participation but lack a financial mechanism for such rotations. Prospective residents often ask about international or away electives during the interview process and indicate that the Saint Louis University mission of service is a reason for selecting our school and residencies. Many desire the opportunity to provide additional care to the underserved, generally outside of the United States, as a part of the training program. Some residents also desire specialized educational opportunities that are not available at our School or affiliated training hospitals. These rotations away require external stipend support not available through the current hospital or GME training budgets.
Rationale: The GME Office at Saint Louis University will provide support for a limited number of away electives for resident training. These rotations are intended to enrich the educational experience of a resident and the residency training program, expand SLU visibility in the community and internationally, and create unique opportunities for residents to provide care to the underserved.
Program Structure: Each academic year up to 12 residents will be allowed to engage in training outside of the Saint Louis University affiliated sites for a maximum of four weeks each. This is a competitive process which requires an application, approval, and supporting documentation. A committee will review the application and determine if funding and support will be provided by the GME office for this experience. Applications must be received at least two months in advance of the expected training period.
Funding Support: Up to 28 days (approximately $5000) per resident will be covered through the GME office for stipend, benefits, and malpractice coverage (if U.S.-based rotation) during the away rotation.
An additional travel allowance of up to $1000 will be provided to offset a portion of the cost of airfare/transit to an international location and up to $500 to a U.S.-based location. Trainees remaining in Saint Louis will not receive a travel allowance.
When partial existing funds are available for a rotation or travel, partial support may be provided by
GME to offset unfunded expenses. The resident and/or program will be responsible for lodging, meals, required vaccinations or prophylactic medications, incidental costs, and fees associated with processing, licensing, or credentialing at the away site, purchasing of international health insurance (mandatory) or additive malpractice coverage (optional). The resident’s training program will be responsible for any programmatic costs associated with the trainee’s absence. International health insurance is available for a minimal cost through Saint Louis University via the SLU Marketplace website: http://www.slu.edu/study-abroad-home/health-and-safety/international-health-insurance
This program will neither replace established funding mechanisms for resident away rotations, nor fund experiences that are a required component of the residency training program. This program is intended

to provide support for unique opportunities, resident-initiated experiences, or initial development of international training partnerships for resident education. This program is not intended to fund established or annual “senior year” away rotations for a department/program. External or departmental support is expected once PAR funding has been provided twice for the same site. . Denial of funding through this GME-supported program does not imply denial of approval by the GME Office for the away experience; other funding mechanisms should be pursued.
Program Requirements: Each training program may submit up to two applications for consideration during an academic year. Applications and supporting documentation must be completed prior to being considered by the review committee. Applications must clearly demonstrate the educational benefit to the trainee and program and the support of the program director and department. Upon return from the rotation, the trainee will be required to provide an educational presentation of the experience, complete a post-rotation report for the GME Office (see Appendix 1) and serve as a resource for other trainees who may be interested in away rotation experiences.
A local faculty advisor and an off-site supervisor must be identified for each away experience. The advisor will be responsible for assisting the resident with the application process, obtaining necessary supporting documentation, monitoring the resident’s participation in the away rotation, and ensuring an evaluation of the resident takes place. The off-site supervisor must complete an end-of-rotation evaluation and agree to the term established for the away rotation. The resident, faculty advisor, and program director are responsible for all planning, paperwork and travel arrangements.
A rotation description including goals and objectives, clinical responsibilities, and supervision and evaluation process must be created by the program director and an evaluation of the trainee must be performed at the end of the experience by the supervising clinician. When required, the program director must submit a program letter of agreement between Saint Louis University and the away site which outlines the resident responsibilities, educational activities, and supervision structure of the away rotation. The program director must complete any paperwork required by the away rotation site at least one month in advance of the start of the rotation. Those trainees holding visas or having travel restrictions must make arrangements with the GME Office to ensure the travel will not jeopardize his/her training status with the University.
The away rotation must not place undue clinical or service stress on other trainees or compromise patient care. Participating residents must not be required to extend residency training by participating in the away rotation. The away rotation must provide a certifiable educational experience as outlined in the ACGME Resident Review Committee Program Requirements for the trainee’s specialty.
Selection Process: Applications will be reviewed for merit and priority by the PAR Review Committee comprised of resident, faculty, and GME members. Applications will be reviewed for approval/funding twice each year (May 1 and November 1). A resident must be in good standing with the training program and the School and is eligible to participate in a GME supported away rotation only once while in training at Saint Louis University.
This program is intended primarily to fund experiences outside of the United States. On rare occasions
PAR funding may be provided for U.S.-based rotations. Trainees participating in U.S.-based rotations must obtain a temporary training license for the state in which the rotation will take place.
Trainees participating in U.S.-based rotations must also ensure that all paperwork and affiliation agreements for the accepting hospital/GME Office/University are completed in advance of the rotation.

These agreements can take several months to process. The trainee or program director must contact the GME Office prior to submitting an application for a U.S.-based rotation.
Priority will be given to those trainees who: are a PGY-2 or higher, utilize the full four-week rotation period, engage in clinical activities, accompany a Saint Louis University faculty on the rotation, provide care to an underserved population, work internationally, participate in a well-established governmental, educational or philanthropic program/organization, or engage in an educational activity that is not available at Saint Louis University affiliated training sites. The away rotation cannot take place in a restricted location, site of military conflict or area which would place the trainee in physical danger.

Name of Resident_____________________________________ PGY level__________
Department_________________________________________ Program_________________
SLU Faculty Mentor________________ ____Off-Site Supervisor/Evaluator______________________
Away Rotation Dates:_______________________________
Away rotation location: Country ___________________________ City_______________________
Away Rotation University/Organization/Program (if applicable)________________________________
Away Rotation Contact Information (phone, email, address) ______________________________
__________________________________________________________________________________
1.
Description of the Clinical Experience (approximately 350 words): Describe your actual clinical activities including number of patients seen, procedures/conditions treated, hours worked, clinical/physical working environment, interactions with other health care providers, and clinical locations.
2.
Describe the unique challenges, solutions, resources and learning opportunities of this clinical site (approximately 200 words).
3.
Describe how this experience will change your outlook or your practice of medicine
(approximately 100 words).
4.
Suggestions for future trainees interested in rotating at this location/country (optional).