PROGRAM LETTER OF AGREEMENT
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SPONSORING INSTITUTION (SI): INSERT “BRIGHAM & WOMEN’S HOSPITAL (BWH)” or
"MASSACHUSETTS GENERAL HOSPITAL (MGH)"
TRAINING PROGRAM: INSERT NAME OF TRAINING PROGRAM
AFFILIATE INSTITUTION (AFFILIATE): INSERT NAME OF PARTICIPATING SITE
FACULTY RESPONSIBLE FOR RESIDENT EDUCATION AND SUPERVISION
a) Program Director: The Training Program Director, INSERT FULL NAME AND DEGREE, at the SI has
overall responsibility for the quality of the educational experience, and retains authority over the trainee/s' activities at all participating institutions.
b) Local Director: INSERT FULL NAME AND DEGREE has administrative responsibility for the rotating
trainee/s, and is responsible for ensuring the achievement of educational goals and provision of appropriate trainee supervision at the Affiliate.
c) Faculty at the Affiliate: INSERT THE FACULTY WHO TEACH AND SUPERVISE RESIDENTS (LIST
INDIVIDUAL NAME/S OR GENERAL/GROUP PRACTICE NAME)
RESPONSIBILITIES FOR TEACHING, SUPERVISION, EVALUATION AND FEEDBACK
a) Dr. INSERT FIRST AND LAST NAMES and the Faculty at the Affiliate are responsible for ensuring that
each rotating trainee is provided verbal and written feedback regarding her/his performance, and that
the SI Program Director is provided with copies of written evaluations. Written feedback is to be provided to trainees at least INSERT # time(s) during the rotation.
b) Dr. INSERT FIRST AND LAST NAMES at the SI agrees to solicit feedback from rotating trainees regarding their supervision and the content and quality of the training experience at the Affiliate, and to
summarize and share this information with Dr. INSERT FIRST AND LAST NAMES at the Affiliate at
least annually.
c) Dr. INSERT FIRST AND LAST NAMES and the Faculty at the Affiliate are responsible for ensuring that
each rotating trainee is supervised in accordance with ACGME and RRC-specific requirements.
d) Dr. INSERT FIRST AND LAST NAMES at the SI will monitor resident supervision at INSERT NAME OF
PARTICIPATING SITE
CONTENT OF THE EDUCATIONAL EXPERIENCE
Both the SI and the Affiliate acknowledge the importance of graduate medical education and agree to support the goals of the training program. An explanation of the purpose of the rotation (i.e., the educational
goals and objectives to be attained at the Affiliate) is outlined in Attachment 1. Where the term of this
agreement is longer than one academic year, an update to Attachment 1 will be provided to the Affiliate by
the SI Program Director as needed.
DURATION OF THE EDUCATIONAL EXPERIENCE
a) The duration of the assignment(s) to the Affiliate is(are): INSERT THE DURATION OF THE ROTATION/S. A copy of the rotation schedule at the Affiliate for the first year of this Agreement is provided as
Attachment 2. Where the term of this Agreement is longer than one academic year an update to Attachment 2 will be provided to the Affiliate by the SI Program Director as needed..
b) This rotation at the affiliate is elective
required. DELETE EITHER "elective" or "required"
POLICIES AND PROCEDURES GOVERNING RESIDENT EDUCATION
Unless otherwise specified in this agreement, the Partners policies for graduate trainees govern resident
education at all sites. The Affiliate agrees to provide a written copy of any additional administrative policies,
procedures and/or rules that govern residents and which are applicable to rotating trainees to (1) the SI Program Director at the beginning of the academic year and (2) each trainee at the beginning of her/his rotation.
Where such administrative (non-clinical) policies, governing trainees at the Affiliate, conflict with those in
force at the SI, the latter will have precedence.
EMPLOYMENT OF TRAINEES
Trainees shall at all times remain employees of either (1) Partners HealthCare System, Inc. (PHS), for trainees in core residency programs or (2) the SI, for trainees in advanced subspecialty fellowship programs.
PHS/SI acknowledges exclusive responsibility for withholding and payment of any applicable taxes. Salary,
fringe benefits and professional and general liability insurance coverage for the trainees shall be provided directly to the trainees by PHS/SI.
CREDENTIALING
The SI agrees that each trainee placed at the Affiliate shall be credentialed by the SI in accordance with the
regulations of the Massachusetts Board of Registration in Medicine (243 CMR 3.05).
W ITHDRAWAL OF TRAINEES FROM THE ROTATION
Program Letter of Agreement, page 1 of 4
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Upon reasonable request by the Affiliate, the SI agrees it will promptly withdraw a trainee from the rotation.
The Affiliate agrees that it will provide the SI with a written explanation of the reason(s) for requesting the
withdrawal. A trainee who is removed from the rotation will have no appeal or other so-called due process
rights against the Affiliate.
TERM OF AGREEMENT
The term of this Agreement will begin on
, 2015 and end on,
201 , ENTER A TERM NO GREATER
THAN 5 YEARS unless sooner terminated as provided below. This Agreement may be terminated without
cause by either party with ninety (90) days' written notice to the other party. This Agreement may be terminated with cause by either party with thirty (30) days' written notice to the other party.
REIMBURSEMENT DELETE PARAGRAPH 13 IF THE AFFILIATE WILL NOT PROVIDE REIMBURSEMENT
The Affiliate agrees to reimburse PHS/SI for the costs of each trainee's salary, fringe benefits and professional and general liability insurance incurred during the rotation, as well as a portion of program overhead
costs. The Trainee Financial Agreement for the first year of this Agreement is provided as Attachment 3. (If
the term of this Agreement is for more than one year, PHS/SI will send the Affiliate a new Trainee Financial
Agreement at the beginning of each successive year.) PHS will invoice the Affiliate monthly. The Affiliate
agrees to pay PHS/SI within 30 days of issuance of the invoice. The Affiliate will owe PHS/SI interest at the
rate of 12% per year compounded annually for any amounts not paid within that time.
THE ABOVE TERMS AND CONDITIONS HAVE BEEN REVIEWED AND AGREED UPON BY THE UNDERSIGNED AUTHORIZED REPRESENTATIVES OF THE SPONSORING INSTITUTION AND THE AFFILIATE INSTITUTION:
SPONSORING INSTITUTION
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Program Director
Date: _________________
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Chief of Service/Department Chair
Date: _________________
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John Patrick T. Co, M.D., M.P.H.
Partners Director for Graduate Medical Education
Date: __________________
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Sr. Vice President for Finance/CFO (or designee)
Date: _________________
AFFILIATE INSTITUTION
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Director of Resident Education
Date: __________________
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(optional) Chief of Service/Department Chair
Date: _________________
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(optional) Designated Institutional Official for GME
Date: __________________
Program Letter of Agreement, page 2 of 4
ATTACHMENT 1
CONTENT OF THE EDUCATIONAL EXPERIENCE: PURPOSE OF THE ROTATION
Note to program: INSERT THE GOAL(S) AND LEARNING OUTCOMES FOR THIS ROTATION. THIS DOES NOT NEED TO
BE A CURRICULUM “DOCUMENT"; IT CAN BE A DESCRIPTIVE PARAGRAPH OR A REFERENCE TO A MORE THOROUGH EXPLANATION WITHIN THE PROGRAM CURRICULUM (e.g., provide the URL of a website with this information,
plus the specific location of the purpose of this rotation).
Program Letter of Agreement, page 3 of 4
ATTACHMENT 2
ROTATION SCHEDULE FOR AY 2015-2016, INCLUDING THE DURATION OF EACH ROTATION
Note to program: INSERT THE TRAINEE SCHEDULE FOR THE AFFILIATE HERE OR ADD THIS HEADING TO AN EXISTING SCHEDULE FOR INSERTION INTO THIS PLA. This information is used to reconcile Attachment 3 - Financial Trainee
Agreement, if seeking reimbursement, and is updated annually as an addendum to the existing PLA.
Program Letter of Agreement, page 4 of 4