February 09, 2016
PLA – UCSD – XXhospital
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PROGRAM LETTER of AGREEMENT
This Program Letter of Agreement (“PLA”) is an educational agreement that sets forth important
points between the XX training program at the University of California at San Diego (“UCSD”) and at
the XXhospital (for example; Veterans Administration Medical Center, San Diego (“VAMC”). Current
contracts and Institutional Agreements between the two institutions are not affected by this statement
of educational purpose. PLA is valid for 5 years from date of signing
1.
Responsible Persons
XX XX, MD
Program Director, XXXX
Professor of XXXXX
At UCSD:
XX XX
Program Coordinator
At XXhosp:
XX XX, MD
Residency/Fellow Site Supervisor
Professor of XXXX (or appropriate title)
As Program Director at UCSD, Dr. XX XX is responsible for the content and conduct of all educational
activities at all teaching sites including the XXhospital.
As Residency/Fellow Site Supervisor at the XXhospital, Dr. XX XX is responsible for the day-to-day
supervision and oversight of resident/fellow activities. This includes such activities as trainee
performance, scheduling sick leave, etc. The UCSD House Officer Policy and Procedure Document
shall apply to residents while at the XXhospital.
2.
Educational Goals and Objectives
The Goals and Objectives for the XXhospital rotation are attached.
The XXhospital rotation will provide educational opportunities in aspects of XXspecialty training. A
particular emphasis exists for providing experience with patients that have XXconditions and other
acute/chronic medical problems including XXconditions. The strengths of the XXhospital experience
include:

Large patient volume (as an example)

Specialty-specific referrals (as an example)

XX

XX
February 09, 2016
PLA – UCSD – XXhospital
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3.
Assignments
Residents/Fellows rotating at the XXhospital will be assigned as follows: (Briefly describe training
experience here; 2-3 sentences; inpatient, outpatient, clinic, unit, required to take call, length of
rotation/experience, what year of training, etc.).
Resident/Fellow salary, benefits and professional liability insurance are provided and paid by UCSD
with reimbursement from the affiliate pursuant to the institutional affiliation agreement between UCSD
and XXhospital. Residents/Fellows will be under the general direction of the policies outlined in the
UCSD House Officer Policy and Procedure Document to include the policies related to benefits and
leave time.
4.
Responsibility for Teaching, Supervision and Evaluation of Residents
While at the XXhospital, residents/fellows from UCSD will receive supervision and instruction from
members of the Department of XX. Residents/Fellows will be supervised in all of their activities
commensurate with the complexity of care being given and the resident's / fellow's own abilities.
Such activities include, but are not limited to the following:

Patient care in clinics/inpatient ward/emergency department

Conferences and lectures

Minor procedures such as XX

Interactions with administrative staff and nursing personnel
Resident’s/Fellows’ evaluations will be both formal and informal. Faculty members/Supervising
physicians with significant contact with a resident/fellow will complete an evaluation form at the
conclusion of the XXhospital rotation. UCSD residents/fellows shall complete evaluation forms for the
XXhospital rotation and the teaching faculty/supervising physicians after each rotation.
5.
Policies and Procedures for Education
The Program Director is responsible for the oversight of all resident/fellow activities. While at the
XXhospital, the resident/fellow will take an active role in searching for educational opportunities; but,
the responsibility for teaching, supervision and the formal evaluation of the resident’s/fellow’s
performance are the duties of the faculty/supervising physicians. The educational policies and
procedures governing resident/fellow activity will conform to the ACGME Essentials of Accredited
Residencies
including
the
Program
Requirements
and
Institutional
Requirements.
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PLA – UCSD – XXhospital
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6.
Duty Hours and Work Environment
While on rotation at XXhospital the following shall apply as outlined in the UCSD Housestaff Duty
Hours and Working Environment Policy approved by the UCSD Graduate Medical Education
Committee.
A. Duty Hours

Duty hours shall be limited to 80 hours per week, averaged over a four-week period, inclusive of
all in-House call activities. When a House Officer on-call from home or off-site must return to
the hospital, such time in the hospital shall be included in the 80 hour limit. All moonlighting
hours (both internal and external) are included in the 80 hour limit.

Each House Officer shall be scheduled for a minimum of one day free of all duty every week
when averaged over four weeks. One day free of all duty is defined as one continuous 24hour period free from all clinical, educational, and administrative activities. Particular attention
should be paid to individual Residency Review Committee program requirements in the event
the “one day in seven” is to be averaged over a shorter period, such as 1 week.
1) Maximum Duty Period Length
 Duty periods for PGY-1 residents (interns) must not exceed 16 hours in duration.
 Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24
hours of continuous duty in the hospital. Programs must encourage residents to use
alertness management strategies in the context of patient care responsibilities.
Strategic napping, especially after 16 hours of continuous duty and between the hours
of 10:00 p.m. and 8:00 a.m., is strongly suggested.
o Residents may be allowed to remain on-site in order to accomplish transitions in
care and to participate in didactic activities; however, this period of time must be
no longer than an additional four hours.
o Residents must not be assigned any additional clinical responsibilities after 24
hours of continuous in-house duty.
o Each program must consult with their individual RRC because further limitations
may be imposed.
o In unusual circumstances, residents, on their own initiative, may remain beyond
their scheduled period of duty to continue to provide care to a single patient.
Justifications for such extensions of duty are limited to reasons of required
continuity for a severely ill or unstable patient, academic importance of the events
transpiring, or humanistic attention to the needs of a patient or family. Under those
circumstances, the resident must:
 Appropriately hand over the care of all other patients to the team responsible
for their continuing care; and,
 Document the reasons for remaining to care for the patient in question and
submit that documentation in every circumstance to the program director.
The program director must review each submission of additional service, and
track both individual resident and program-wide episodes of additional duty.
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PLA – UCSD – XXhospital
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2) Minimum Time Off Between Scheduled Duty Periods
 Each House Officer shall have an adequate time for rest and personal activities.
 PGY-1 residents should have 10 hours, and must have eight hours, free of duty
between scheduled duty periods.
 Intermediate-level residents [as defined by the Review Committee] should have 10
hours free of duty, and must have eight hours between scheduled duty periods. They
must have at least 14 hours free of duty after 24 hours of in-house duty.
 Residents in the final years of education [as defined by the Review Committee] must
be prepared to enter the unsupervised practice of medicine and care for patients over
irregular or extended periods. While it is desirable that residents in their final years of
education have eight hours free of duty between scheduled duty periods, there may
be circumstances [as defined by the Review Committee] when these residents must
stay on duty to care for their patients or return to the hospital with fewer than eight
hours free of duty.
o
Circumstances of return-to-hospital activities with fewer than eight hours away from
the hospital by residents in their final years of education must be monitored by the
program director.
3) Maximum Frequency of In-House Call/Night Float/At Home Call
 PGY-2 residents and above must be scheduled for in-house call no more frequently
than every third night, when averaged over a four-week period.
 Residents must not be scheduled for more than six consecutive nights of night float.
 At-home call (pager call) is defined as call taken from outside the assigned institution.
o
The frequency of at-home call is not subject to the every third night limitation.
However, at-home call must not be so frequent as to preclude rest and reasonable
personal time for each resident. House Officers taking at-home call must be provided
with 1 day in 7 completely free from all educational and clinical responsibilities,
averaged over 4-weeks.
o
When House Officers are called into the hospital from home, these hours must be
counted toward the 80-hour limit.
o
Residents are permitted to return to the hospital while on at-home call to care for new
or established patients. Each episode of this type of care, while it must be included in
the 80-hour weekly maximum, will not initiate a new “off-duty period”.
o
The training program director must monitor the demands of at-home call and make
scheduling adjustments as necessary to mitigate excessive service demands or
fatigue.
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PLA – UCSD – XXhospital
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B. Work Environment
 Patient support services (IV, laboratory, transport, etc) must be provided in a manner
consistent with educational objectives and patient care.
 An effective laboratory, medical records and radiological information retrieval system
will be in place to provide appropriate conduct of the educational program and quality
and timely patient care.
 Appropriate security measures will be provided to residents/fellows, including parking
facilities, hospital grounds and related clinical facilities (e.g., medical office and
buildings).
February 09, 2016
PLA – UCSD – XXhospital
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Signature Page
XX XX, M.D.
UCSD Training Program Director
XX Program
Date
XX XX, M.D.
XXhospital Residency/Fellow Site Supervisor
XX Program/Department
Date
Sherry C. Huang, M.D.
Interim Associate Dean for Graduate Medical Education
and DIO
Date