POLICY MANUAL
2012-2013
INTERNAL MEDICINE
RESIDENCY PROGRAM
INDEX
CALL COVERAGE
COMMUNICATION
COMMUNITY SERVICE
CONTINUITY CLINIC
DAILY CONFERENCE ATTENDANCE
DRESS CODE
DUE PROCESS
DUTY HOURS
ELECTIVES
EVALUATION
FLOAT AND PERSONAL DAYS
HOUSESTAFF SELECTION
HOUSESTAFF SUPERVISION
LEAVE OF ABSENCE
MEDICAL DOCUMENTATION
MEDICAL RECORDS COMPLETION – RWJUH
MEDICAL RECORDS COMPLETION – UMCP
MOONLIGHTING
NATIONAL CONFERENCES
NON-TEACHING PATIENT COVERAGE
ORDER WRITING
PERFORMANCE DEFICIENCES
PHARMACEUTICAL INDUSTRY
PINCH HITTER USAGE
PROCEDURES
PROMOTIONS
RECOMMENDATION LETTERS
RESEARCH
SCHEDULING REQUESTS
SERVICES – RWJUH
SERVICES – UMCP
SICK DAYS
SUBSPECIALTY FELLOW AND INTERNAL MEDICINE RESIDENT INTERACTION
TEACHING SERVICE RESPONSIBILITIES FOR MEDICAL INTENSIVE CARE UNIT
SERVICE (ICU) AT RWJUH AND UMCP
TEACHING SERVICE RESPONSIBILITIES FOR MEDICAL TEACHING SERVICE
(MTS), CARDIOLOGY TEACHING SERVICE (CTS), ONCOLOGY TEACHING
SERVICE (OTS), NIGHT FLOAT AND BACK-UP AT RWJUH AND UMCP
TRANSITIONS OF CARE
TRAVEL POLICY
UMDNJ POLICY MANUAL
UNIVERSITY HOLIDAYS
VACATIONS
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Compliance with all UMDNJ policies is required. The UMDNJ
policy manual can be reviewed at the following site:
http://www.umdnj.edu/oppmweb/Policies/contents.html
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Policy Name: Dress Code Policy
Policy Number: 1
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
To ensure that residents appear professional at all times.
Policy:
All house staff must wear a clean white coat at all times.
Men - must wear a shirt and tie with slacks, even on weekends.
Women - must be neat and professional at all times.
Jeans, tee shirts, open-toed shoes, etc. are not acceptable attire.
Scrubs may only be worn during Night Float and during overnight ICU or
overnight floor call.
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Policy Name: Work Hour Policy
Policy Number: 2
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
To ensure that residents are well rested and able to provide safe, effective
patient care while maintaining compliance with the ACGME work hour rules.
Policy:
The work week for each resident will be restricted to a maximum of 80 hrs/week
when averaged over 4 weeks. This includes residency activities and
moonlighting hours irrespective of the site or type of assignment. Random duty
hour audits will be conducted and necessary adjustments made to ensure full
compliance.
When averaged over a 4 week rotation, residents must have at least 1 day in 7
free of residency related activities. A day off is defined as one continuous 24
hour period free from all clinical, educational, and administrative duties.
Each resident must have an 8 hour duty free period between all daily shifts and
after in-house call. They must also have at least 14 hours free of duty after 24
hours of in-house duty.
Continuous on-site duty, including in-house call, must not exceed 24 hours for
PGY 2 and PGY 3 residents. No new patients may be accepted after 24
continuous hours on duty.
Continuous on-site duty, including in-house call, must not exceed 16 hours for
PGY 1 residents.
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.
Residents will not be assigned to in-house overnight on call duty at a frequency
greater than every fourth night.
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Weekdays:
Residents on elective are to be at Board Review at 7:00 am.
Residents on service, if not at Board Review are required to be at sign in rounds
in the residency call room at RWJUH or residency lounge at UMCP at 7:00am.
Residents on elective may leave at 4:30pm or until all the work is done.
Residents on service may sign out no earlier than 4:30pm. (unless post overnight
call).
Residents in clinic may not leave clinic until all the residents at that clinic site and
day have seen all their patients, even if on call that day.
Weekends/Holidays:
Residents on elective are off, unless they are the pinch hitters for that period.
Residents on service are required to be at sign in rounds in the residency call
room at 8:00am.
Residents on service may sign out no earlier than 12:00pm.
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Policy Name: Non-Teaching Patient Coverage Policy
Policy Number: 3
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
To ensure that residents’ service responsibilities are limited to patients for whom
they have primary diagnostic and therapeutic responsibility, as per the ACGME
regulation.
Policy:
1. Residents will not respond to emergencies on non-teaching service patients
unless it is a code situation.
2. Residents will not place any orders on non-teaching service patients.
3. Residents will only admit those patients that who will remain on the teaching
services during their hospital admission.
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Policy Name: Medical Documentation Policy
Policy Number: 4
Approval by Program Leadership: 7/1/05
Amendment Date: 5/31/09
Purpose:
To ensure safe patient care and efficient communication among healthcare
providers.
Policy:
All resident progress notes, procedure notes and H&Ps must be dated, timed and
signed by the resident, with name and pager number printed legibly under the
signature.
All H&Ps must be co-signed by a senior resident and an independent brief
resident note must be included.
All progress notes written by a medical student must be accompanied by a
addendum from a resident or intern.
H&Ps written by medical students will not be accepted as part of the medical
record.
All patient interactions, family meetings and evaluations in a cross-coverage
situation should be clearly documented.
All notes written by residents and placed in the medical record are legal
documents and falsification of them is a criminal action.
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Policy Name: Order Writing Policy
Policy Number: 5
Approval by Program Leadership: 7/1/05
Amendment Date: 5/31/09
Purpose:
To ensure safe patient care by providing a single point of contact for medical
orders.
Policy:
In the non-emergency setting, residents must write all orders for patients under
their care, with appropriate supervision by the attending physician.
In an emergency setting, should an attending physician write an order on a
resident’s patient, the attending must communicate his/her action to the resident
or cross-covering resident in a timely manner.
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Policy Name: Daily Conference Attendance Policy
Policy Number: 6
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
To ensure that residents participate in the art, science, and business of medicine
curriculum.
Policy:
A. Board Review:
Board review is from 7:00am to 7:45am Monday – Friday from July – May.
It is held in MEB 108B at RWJUH and in the classroom next to the noon
report room in the 1st floor of Lambert House at UMCP. It is videoconferenced between the two sites.
All PGY-2 & 3 on RWJ floor service and night float are encouraged to
attend. All PGY-2 and PGY-3 residents on service on UMCP floor service
are encouraged to attend. PGY-2 & 3 residents on night float at UMCP are
REQUIRED to attend.
All PGY-1, 2 & 3 residents ON ELECTIVE are REQUIRED to attend and
MUST attend at their elective site.
Ideally, a resident should not miss board review unless there are
extenuating circumstances. If extenuating circumstances occur, a
resident may not miss more than two board review sessions during a two
week elective block or four board review sessions during a four week
elective block. These include days missed for personal days, sick days,
and interview days. Hospitalizations will not be counted. Interview days in
excess of the time allotted need to be approved by the chief resident.
Absences from board review in excess of the above will result in the
resident being placed on Academic Warning/Probation as outlined in
Policy #25. Additional offenses after the resident has been placed on
Academic Warning/Probation may result in dismissal proceedings.
B. Night Float Rounds:
At RWJUH, night float rounds will be held daily from 7:45 to 8:30am
except on holidays, weekends, and days of Grand Rounds conferences.
The attending will meet the team by MEB 108B.
At UMCP, night float rounds will be held daily from 8:00 to 8:30am except
on holidays, weekends, and days of Grand Rounds conferences. The
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senior night float resident will contact the attending to find out where they
will meet.
C. Conference:
EVERY resident is responsible for attending all conferences while on floor
service or in-house elective listed below and in case of conflict, please
contact the chief resident directly. Those residents on the oncology
service are encouraged to attend noon conference based upon census but
are required to attend Grand Rounds.
Every resident may be assigned to give Journal Club, CPC and/or M&M
conference during the year.
All Journal Club articles must be approved by the chief residents.
1. RWJUH:
Monday through Friday in MEB 108B unless otherwise stated. Please
follow times based on the monthly schedule for conferences.
a) Noon Report: Daily starting at noon.
b) Core Conference: Multiple times a week following Noon Report
and includes Journal Club.
c) Grand Rounds: Wednesdays from September - June in CAB
1302 from 8:00am to 9:00am.
d) Art of Medicine and Business of Medicine Conferences:
Occurring alternating months in MEB Room 108B, time to be
determined.
e) M&M: Occurring the last week of every month where each
service team presents
2. UMCP:
a) Noon Report: Monday, Wednesday, Thursday, and Friday in
Class Room #3 Lambert-1st floor at noon.
b) Grand Rounds: Tuesdays from September - June in Ground
Floor Conference Room A from 8:00am to 9:00am.
c) Art of Medicine and Business of Medicine Conferences:
Occurring alternating months, time to be determined. See monthly
schedules
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d) Core Conference: Multiple times a week following noon report.
See monthly schedules.
e) M&M: Occurring the last week of every month where each
service team presents appropriate cases
D. Clinic Conference: Residents will be assigned topics within the Outpatient
Johns Hopkins Internal Medicine Curriculum. Residents should review their
assigned topic prior to clinic and be prepared to moderate the discussion with
supervision by the clinic preceptor.
E. Failure to present a CPC/M&M/Journal club or any other scholarly activity: If a
resident is not prepared to present at conference, he/she will have to present that
conference at a later date. In addition, an extra conference presentation will be
assigned along with a written formal explanation regarding the event.
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Policy Name: Housestaff Selection Policy
Policy Number: 7
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
This policy ensures that the residency program selects the best qualified
individuals without discrimination.
Policy:
Applicants are selected based on their preparedness, abilities, aptitude,
academic credentials, communication skills, and personal qualities such as
motivation and integrity. The program does not discriminate with regard to
gender, race, age, religion, color, national origin, disability, or veteran status.
The selection protocol for all applicants involves review and verification of the
application with supporting documents and a formal interview process.
When applying for a PGY II or PGY III position, a letter of reference from the
applicant’s former program director will be required.
For admission to the PGY III year of training, the applicant must have passed
USMLE step 3, NBMOE Part III or COMLEX Level III. In addition, all applicants
must fulfill criteria for registration, permits, or licensure with the New Jersey
Board of Medical Examiners
Review the UMDNJ-Robert Wood Johnson Medical School Graduate Medical
Education Policy Manual, policy number I.1, for further details.
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Policy Name: Promotions Policy
Policy Number: 8
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
To establish minimum proficiency criteria for advancement to the next level of
training as determined by the Residency Promotions Committee.
Policy:
1. Proficiency Criteria for Determination of Advancement in Training
Advancement to PGY2 Level of Training:
Medical
1. Demonstrate knowledge needed to obtain a comprehensive history
Knowledge
and perform a physical exam, interpret basic laboratory studies, and
generate a differential diagnosis.
2. Demonstrate knowledge and application of the basic pathophysiology
and natural history of those diseases encountered in caring for one’s
patients.
3. Demonstrate knowledge of inpatient clinical parameters for patients
under one’s care, including generation of a diagnosis, the clinical course
and an updated problem list.
Patient Care
1. Demonstrate the skills needed to perform a comprehensive history
and physical exam, interpret diagnostic studies, and generate a
meaningful and timely patient care plan, including all orders.
2. Demonstrate the ability to synthesize, present and document
(including medical records) the above in the form of a meaningful timely
patient care plan.
3. Demonstrate the ability to recognize, assess and treat emergencies.
4. Demonstrate the ability to generate meaningful consultative requests
while understanding the relationships of consultants to the primary care
physician(s).
5. Perform procedures as indicated and with the necessary supervision.
Maintain accurate logs and web-based entry of procedures performed
as prescribed by the Procedural Committee of the Residency Program.
Interpersonal & Demonstrate the ability to communicate effectively with patients,
Communication families, colleagues, all members of the health care team and office staff
Skills
(residency, private office, and clinic).
Professionalism 1. Demonstrate a high standard of personal honesty and integrity.
2. Exhibit humanistic qualities in caring for the patients.
3. Demonstrate active participation in working and teaching rounds.
4. Respond to administrative requests, pages, and email communication
in a timely manner.
5. Accept reading and teaching assignments as prescribed by the senior
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Systems Based
Practice
Practice Based
Learning
resident, attending, or chief residents.
6. Record >80% attendance at all academic conferences and board
review with active participation.
7. Adherence to all program policies and requirements.
8. Demonstrate the ability to accept feedback related to any of the
competencies and demonstrate change.
1. Demonstrate an awareness of team structure and function.
2. Demonstrate the ability to identify resources within the local
healthcare delivery system with the sole aim of promoting patient care.
1. Demonstrate an interest and awareness in accessing resources
needed to incorporate evidence into the clinical decision making arena.
2. Demonstrate enthusiastic participation in the outcomes project aimed
at measuring and improving clinical parameters for select disease
modules.
Each of the above criteria in combination assess the ability of the intern to
transition into their role as TEAM LEADER where necessary skills in medical
knowledge, data gathering, clinical insight and critical thinking lend itself to
effective leadership and role modeling. Residents should use the milestones file
on the residency website as a guide to determine if they are meeting current
requirements.
2. Proficiency Criteria for Determination of Advancement in Training
Advancement to PGY3 Level of Training:
In addition to meeting the junior level proficiency criteria, PGY-2s must
demonstrate progression in the competencies as outlined below in order to
advance. Residents should use the milestones file on the residency website as a
guide to determine if they are meeting current requirements.
Medical
Knowledge
Patient Care
1. Display further expansion of medical knowledge, including evidencebased guidelines, specific disease-based recommendation and
refinement in history taking skills and physical exam signs using a selfdirected learning style.
2. Demonstrate evidence of outside reading.
1. Demonstrate the ability to construct, present and document a concise
and relevant resident note with greater emphasis on the clinical
assessment and care plan.
2. Accept responsibility and demonstrate familiarity with important
clinical parameters for patients under one’s care and when supervising
interns on other teams.
3. Demonstrate the ability of quick recognition, assessment and
treatment of emergencies, including role as code leader.
4. Demonstrate the ability to recognize and manage “new” clinical
problems, i.e. those scenarios not previously encountered.
5. Continue to perform procedures within one’s expertise while safely
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supervising interns/students with their procedural skills.
6. Demonstrate the ability to coordinate care between different settings.
Interpersonal & 1. Demonstrate the ability to communicate feedback in real time to
Communication interns and students on their data gathering skills, clinical assessment,
Skills
care plans and documentation.
2. Demonstrate progressive development of communication skills in the
arena of Bioethics and End of Life Care.
3. Demonstrate the ability to communicate effectively and directly with
consultants from within and outside the specialty of internal medicine.
Professionalism 1. Demonstrate a high standard of personal honesty and integrity.
2. While exhibiting humanistic qualities in caring for patients, function as
a role model to other members of the healthcare team.
3. Demonstrate ability to lead rounds by selecting cases and scenarios
for discussion, organizing structure and duration of rounds and helping
each member attain their individual educational objectives.
4. Accept reading and teaching assignments as prescribed by attending
physicians and chief residents.
5. Respond to administrative requests, pages and email communication
in a timely manner.
6. Record >80% attendance at ALL academic conferences and board
review with active participation.
7. Adherence to all program policies and requirements.
8. Demonstrate the ability to accept feedback related to any of the
competencies and demonstrate change.
Systems Based 1. Demonstrate effective leadership skills as team leader and patient
Practice
advocate in facilitating access to resources and care.
2. Demonstrate willingness to review and discuss all aspects of care,
including individual and system related errors.
3. Demonstrate utilization of cost effective “best practices” in all aspects
of patient care.
Practice Based 1. Demonstrate proficiency in accessing resources and establishing
Learning
guidelines in the practice of evidence based medicine.
2. Demonstrates the ability to utilize the principles of evidence based
medicine in the context of differing clinical scenarios.
3. Demonstrates a commitment to periodic self-assessment.
4. Demonstrates the ability to implement change when constructive
feedback is provided.
3. Proficiency Criteria for Graduation:
In addition to meeting the junior level proficiency criteria, PGY-3s must
demonstrate progression in the competencies as outlined below in order to
advance. Residents should use the milestones file on the residency website as a
guide to determine if they are meeting current requirements.
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Medical
Knowledge
Patient Care
Display mastery of knowledge related to disease prevention and
treatment in Internal Medicine.
1. Display mastery of skills related to disease prevention.
2. Demonstrate the ability to function effectively and efficiently in a
multitude of settings, from the office to the ICU.
3. Demonstrate a deep appreciation for the psychosocial complexities
inherent in the delivery of patient care.
4. Demonstrate the ability to identify and deal effectively with complex
ethical issues.
Interpersonal & 1. Demonstrate the ability to communicate effectively and directly with
Communication consultants from within and outside the specialty of Internal Medicine.
Skills
2. Demonstrate the ability to communicate effectively with the referring
physicians, third party payors, risk management, etc.
3. Exhibit mastery of concise, accurate and legible note writing.
Professionalism 1. Demonstrate a high standard of personal honesty and integrity.
2. While exhibiting humanistic qualities in caring for patients, function as
a role model to other members of the healthcare team.
3. Demonstrate a deeper understanding of the importance of the team
approach to health care delivery.
4. Demonstrate a continued commitment to community service.
5. Respond to administrative requests, pages and email communication
in a timely manner.
6. Record >80% attendance at ALL academic conferences and board
review with active participation.
7. Adherence to all program policies and requirements.
8. Demonstrate the ability to accept feedback related to any of the
competencies and demonstrate change.
Systems Based Demonstrate participation in various forums in the local environment
Practice
geared at improving systems and quality.
Practice Based 1. Display the ability to critically evaluate ones performance and
Learning
implement methods to enhance outcomes.
2. Display the ability to critically appraise literature.
Research,
1. Completion of research project as prescribed by the Residency
Procedures,
Research Committee.
Tests
2. Fulfillment of procedural competency as prescribed by the Residency
Procedural Committee.
3. Obtaining EKG certification through an EKG test.
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Policy Name: Recommendation Letter Policy
Policy Number: 9
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
One of the program’s primary obligations is to provide recommendation letters for
future positions. These letters are needed for fellowships, appointments to
hospitals’ medical staffs, entrance to board examinations, state licensure, etc.
Although it is our intention and desire to write a strong and favorable evaluation
for each resident, it should not be assumed to be automatic.
Policy:
Letters will be composed based on the following areas:
1. Academic excellence, scholarship, clinical competence (medical
knowledge, clinical skills, clinical judgment) and actual patient care.
2. Humanistic qualities.
3. Professional attitudes and behavior.
4. Moral and ethical behavior in the clinical setting.
5. Evaluation by peers, attending staff, and other members of the health care
team (e.g. nurses). Patient evaluation.
6. Medical record review and timeliness of completion of medical records.
7. Attendance and participation in all program activities such as morning
report, noon conference, board review sessions, and Grand Rounds.
8. Ability to be a team player.
9. Research efforts and accomplishments.
10. Community service is not required by the residency program. However, if
you volunteer to perform community service, it will be incorporated into
recommendation letters.
Once the recommendation letter is sent, it is the policy of the Residency Program
to issue periodic (every three to six months) follow-up letters to fellowship
directors stating the current level of your performance. It is expected that
residents demonstrate the same or improved performance after having obtained
a fellowship position. This policy will also apply to all future employers.
The letter of recommendation will include the program’s observations on each of
the above items along with any other pertinent matter. Please do whatever is
necessary to help produce a strong testimonial for yourself.
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Policy Name: Leave of Absence Policy
Policy Number: 10
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
This policy ensures that residents are aware of the sick leave provisions and their
possible effects on training completion and board eligibility.
Policy:
Residents enrolled in the categorical program are allowed sick leave (includes
maternity leave) OR vacation of up to 12 weeks over the three years of training in
accordance with the leave of absence policies established by the American
Board of Internal Medicine, effective June 1999. Residents are required to
extend their training to cover any days missed beyond the 12 weeks, in order to
be board eligible.
With 4 weeks of vacation scheduled yearly, any sick days taken may
proportionately shorten future vacation time or extend training beyond the
required duration of 36 months.
Residents who avail themselves of sick leave in accordance with university and
union policies should be aware that this does not necessarily ensure timely ABIM
board eligibility.
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Policy Name: Schedule Requests Policy
Policy Number: 11
Approval by Program Leadership: 7/1/05
Amendment Date: 05/31/09
Purpose:
The program recognizes the need for residents to have the opportunity to request
specific non-call days off in given months. This policy outlines the uniform policy
for granting such requests.
Policy:
1. All requests will be decided on a first come, first serve basis.
2. All requests must be made by email to rwjmsimchiefs@gmail.com, in the
following format:
Service:
Month:
Day:
3. Residents may only request one (1) day not to be on call per service month.
4. No requests will be honored after a written schedule is distributed unless in
the case of extenuating circumstances.
5. Residents are not permitted to submit requests seeking a specific colleague,
attending, rotation, or site.
6. Residents will automatically be scheduled such that they are not on call postnight float/overnight call from another service. This will take precedence over
other residents' requests for days not to be on call.
7. No days off will be granted on a residents clinic day unless prior approval
from the site chief is obtained.
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Policy Name: Medical Records Completion Policy- RWJUH
Policy Number: 12
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
This policy governs the maintenance of comprehensive, legible, and timely
medical records at RWJUH. In order to comply with regulations of the Joint
Commission on the Accreditation of Healthcare Organizations (JCAHO), all
discharge summaries must be completed rapidly after a patient’s discharge.
Policy:
1. All patients discharged from the Medical Teaching Service (MTS) REQUIRE a
discharge summary in Sunrise Clinical Manager.
2. The senior resident on a team has primary responsibility for completion of
discharge summaries and will be held responsible for delinquent charts.
3. Discharge summaries should be completed ON THE DAY OF DISCHARGE.
4. In the event that the senior resident is not present on the day of discharge, the
intern must complete the discharge summary that day.
5. The residency program will supply Health Information Management (formally
known as Medical Records) with a list of all residents’ and interns’ email
addresses. The resident will receive emails concerning their outstanding charts.
However, it is the primary responsibility of the resident to maintain a personal list
of charts that require completion and to complete these in a timely manner. The
resident should not wait to be notified by HIM that charts are delinquent.
6. If the residency program becomes aware that a resident has delinquent charts,
the resident will be contacted by the Chief Resident. The resident will be given
48 hours to complete the charts. Failure to complete the discharge summary
within 48 hours will result in the resident being placed on Academic
Warning/Probation as outlined in Policy #25.
7. Suspension of an attending physician secondary to a resident’s failure to
dictate discharge summaries will result in the resident being placed on Academic
Warning/Probation.
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Policy Name: Medical Records Completion Policy - UMCP
Policy Number: 13
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
This policy governs the maintenance of comprehensive, legible, and timely
medical records at UMCP. In order to comply with regulations of the Joint
Commission on the Accreditation of Healthcare Organizations (JCAHO), all
discharge summaries must be completed rapidly after a patient’s discharge.
Policy:
1. All patients discharged from a Medical Teaching Service (MTS) team require a
discharge summary to be completed in QCPR. Exceptions to this policy are
patients discharged by private attendings.
2. The senior resident on a team has primary responsibility for completion of
discharge summaries and will be held responsible for delinquent charts.
3. Discharge summaries should be completed ON THE DAY OF DISCHARGE.
4. In the event that the senior resident is not present on the day of discharge, the
intern must complete the discharge summary that day.
5. Senior residents will maintain a personal list of charts that require discharge
summaries during any service month.
6. If the residency program becomes aware that a resident has delinquent charts,
the resident will be contacted by the Chief Resident. The resident will be given
48 hours to complete the charts. Failure to complete the discharge summary
within 48 hours will result in the resident being placed on Academic
Warning/Probation as outlined in Policy #25.
7. Suspension of an attending physician secondary to a resident’s failure to
dictate discharge summaries will result in the resident being placed on Academic
Warning/Probation.
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Policy Name: Moonlighting Policy
Policy Number: 14
Approval by Program Leadership: 7/1/05
Amendment Date: 9/24/07
Purpose:
The opportunity to moonlight during residency is a privilege. PGY3 residents will
be permitted to moonlight exclusively during elective rotations as long as they do
NOT interfere with day schedules, pinch hitter list or program needs, if they meet
eligibility criteria listed below.
Policy:
Eligibility Criteria:
1. In-training exam scores ≥ 60th percentile.
2. Superior performance in all areas of clinical competence based on
evaluations and contents of the residents’ file.
3. Punctuality, attendance, and participation at all conferences, including
Board Review.
If a resident’s academic performance declines after being granted moonlighting
privileges, the residency program reserves the right to deny continued
opportunities for outside employment.
Eligibility status will be evaluated on a quarterly basis by the program director.
Mandatory duty hour documentation must be submitted when moonlighting and
must not exceed the 80 hour maximum work week.
A completed application for moonlighting privileges must be submitted to the
program for approval. Thereafter, any changes in the outside employment status
(different hospital, additional site, etc.) require prompt notification and completion
of additional paperwork.
It must be noted that seeking outside employment without prior consent form the
program director will result in termination, in accordance with university policy.
Further information can be obtained by accessing Section 3-2 of the UMDNJRWJ Medical School Graduate Medical Education Policy Manual at
http://www2.umdnj.edu/pgmeweb/index.html.
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Policy Name: Call Coverage Policy
Policy Number: 15
Approval by Program Leadership: 7/1/05
Amendment Date: 5/31/09
Purpose:
This policy ensures uniform guidelines for obtaining coverage of on-call
responsibilities.
Policy:
1. Residents may not arrange for coverage of any call in a given service month
unless extenuating circumstances with prior approval from site chief.
2. The service attending must be informed of and agree upon any changes to the
call schedule. They must be fully aware of which resident is covering their
patients at all times.
3. The covering resident must attend all required program activities and not
exceed the ACGME work hour limitation. For example, a resident who covers a
night of night float, will still be required to attend their elective/clinic and all
conferences the following day.
4. The site chief must grant final approval of any call changes. This will be done
via email only.
5. Switching calls among residents on the same rotation is not permitted unless
extenuating circumstances with prior approval from site chief. This will only be
allowed if there are no other alternatives.
6. Residents may not at any time develop arrangements over the course of the
year that would allow them to “bank” compensation days from fellow residents.
This applies to all service and elective rotations. For example, a resident MAY
NOT arrange to cover multiple residents over the course of the year with the
intention of asking for compensation on consecutive days.
7. No resident may take more than one consecutive day off of any rotation
without prior approval from the chief residents.
8. A pinch hitter may be used for floor coverage only if another pinch hitter has
been found to cover the pinch hitter schedule. This will require prior approval
from site chief and all pinch hitters on schedule must be available during their
designated weeks.
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Policy Name: Communication Policy
Policy Number: 16
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
This policy describes the process by which program information will be
disseminated.
Policy:
1. Each resident is required to identify a primary email account preferably
UMDNJ which will be the primary vehicle of communication.
2. All residents should also identify the phone numbers (home and cell), and
address to which information should be directed. It is the resident’s
responsibility to update his/her contact information.
3. Residents are responsible for checking their designated email address
frequently (daily is suggested) as information pertinent to the next day’s
events (i.e., cancellation of board review) and to UMDNJ will be
communicated this way.
4. Residents are responsible for checking the Angel website monthly for
updates on elective manual, syllabus, pinch hitter list, academic calendar,
etc.
5. All requests (float days, days not to be on call, call coverage) should be
emailed to the chiefs at rwjmsimchiefs@gmail.com. Verbal requests will
result in a response of “Email it to us.” This is done to ensure timely
responses to requests.
6. Residents must respond promptly (within 10 minutes) to all pages from the
chiefs or residency office. These pages will end with either: 732-2357741/7742, 609-497-4484.
7. Residents must not post any patient identifiable or protected information to
any social media websites. Additionally residents are reminded to conduct
all communication, including electronic, in a professional manner.
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Policy Name: Vacation Policy
Policy Number: 17
Approval by Program Leadership: 7/1/05
Amendment Date: 5/25/10
Purpose:
To ensure that each resident understands the options for scheduling vacation.
Policy:
There are two vacation options:
1. Two blocks of two weeks.
2. For residents applying for fellowship, they have the following option: one block
of two weeks, one block of one week and five float days (applicable to PGY2
residents, PGY3 residents, and PGY1 residents on the ABIM research pathway).
If the float days are not needed for interviews, the resident will receive the
remaining days as a block of days at the end of his or her third year. This will be
granted once the chief resident has a complete list of used float days.
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Policy Name: Float and Personal Day Policy
Policy Number: 18
Approval by Program Leadership: 7/1/05
Amendment Date: 5/25/10
Purpose:
This policy addresses float day and personal day usage throughout the academic
year.
Policy:
Personal days refer to the three personal days each resident is entitled to by
contract, and float days refer to the additional five days given to those residents
who elected to take only three weeks of scheduled vacation. The scheduling of
these days is up to the resident as per the float day usage policy below. Personal
days will not be carried over to the next academic year but float days may be
based upon the aforementioned criteria in Policy 17.
Float Day and Personal Day Usage
 On Service:
 Float days may be used on service for interviews only and rare
exceptions (e.g. family emergency such as sick relative or
childbirth) and as granted by the chief resident for other
emergent reasons.
 A maximum of two float days may be used per service month
with a maximum of six days off from work per month including
four regular days off. If a resident elects to use a float day on a
service month, he/she must find coverage from an appropriate
colleague who is not on pinch hitter. All of these changes need
to be approved by the site chief resident. Any additional time off
may necessitate a leave of absence (see Policy 10: Leave of
Absence).
 A resident may take a maximum of two consecutive days off
from work when interviewing.
 If float days are used on service, proof of interview must be
provided. If granted for other emergent reasons additional
documentation such as proof of travel must be provided.

On Elective:
 May be used for interviews, USMLE, national conferences for
which a resident does not have work being displayed and
personal reasons
 Maximum of one day in a two week elective
 Maximum of two days in a four week elective
 Maximum of two consecutive days off, except when taking
USMLE Step 3 and COMLEX Level 3
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

If the resident takes USMLE in a given elective block, he/she is
not permitted to take additional personal days.
If a resident is interviewing during that year, it is expected that
all personal days be reserved for that purpose. If a resident has
used more than the allotted float/personal days during interview
season AND used days earlier in the year not associated with
interviews, a second year resident may be subject to lose
vacation days during their third year and a third year resident
may need to have remediation of that time prior to graduation.
USMLE Step 3 and COMLEX Level 3:
 Residents will get 3 additional personal days to take the
USMLE Step 3 or the COMLEX Level 3
 Two days to take the exam and one day either pre-or
post test
 USMLE STEP 3 and COMLEX Level 3 must be taken
while on an elective and not on selective when it conflicts
with additional clinics.
 A resident cannot be on pinch hitter and planning to take
the USMLE STEP 3 unless coverage as dictated below
has been found by the resident taking the exam
Procedure for requesting usage of float/personal days
a. Notify site chief two weeks in advance.
b. Chief resident will review request, grant final approval and send
notification via email.
c. No request for personal days will be granted during GIM consults
elective. If a resident elects to use a float day on GIM consults for
interviews, he/she must find coverage from an appropriate
colleague who is not on pinch hitter.
d. Use of float days to be grouped together as vacation or for other
purposes will need approval from the site chief.
e. Emergent or urgent use of personal or float days require a phone
call to the site chief resident.
Please note that a request for personal days is not approved until e-mail
notification is received from the chief resident.
In way of unexcused absences, if it is confirmed that a resident was not present
on any day of an assigned rotation without prior approval from the chief
residents, the resident will be placed directly on Academic Warning/Probation
and may be grounds for dismissal proceedings.
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Policy Name: National Conference Policy
Policy Number: 19
Approval by Program Leadership: 7/1/05
Amendment Date: 5/20/10
Purpose:
The residency program encourages and rewards residents who are selected to
present at national conferences. This policy governs the scheduling of national
conference attendance.
Policy:
If the resident is on elective, they are excused for the conference from elective
duties. The program will provide up to three days of professional time to present
at the conference, which will not be counted against personal days.
If the resident is on service, the program will provide up to three days of
professional time to present at the conference. This will entitle the resident to a
total of seven days off from work for the month including his or her regular four
days off. A resident may not be out for more than three consecutive days during
service. The call schedule will be arranged so that no calls are missed. If a call
must be missed, the site chief resident will determine who covers that call. It will
first fall to back-up but if backup is not available, a pinch hitter may be pulled and
no payback required if and only if eight weeks advance notice was given.
Clinics will be canceled on a case by case basis determined by the chief resident
and program leadership. If a resident is invited to present at the conference,
eight weeks advance notice must be given to the chief resident. Residents may
not miss clinic to attend a conference where they are not presenting.
National conference attendance is permitted only if you are a presenter.
Vacation/Personal days should be used if residents choose to attend a national
meeting as an attendee.
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Policy Name: Pinch Hitter Policy
Policy Number: 20
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
This policy governs the usage of the pinch hitter system.
Policy:
1. For USMLE Step 3, every attempt should be made to schedule time off
during an elective. Each resident is entitled to get three days to take the
USMLE Step 3. If a pinch hitter is used, equivalent pay back is required.
2. For COMLEX exams, which are only offered in December and June, every
attempt should be made to take the exam while on elective. If this is not
possible, and a resident is on service, a pinch hitter will be pulled.
Payback is not required as the exam is only offered at specific times.
3. Bereavement leave due to the death of an immediate family member does
not require payback.
4. Approved time to present at a national conference during a service month
does not require equivalent payback.
5. The pinch hitter list is not written in the order that residents will be pulled,
but no resident will be pulled for a second time before others on the list
are called.
6. Residents may seek coverage for their time on the pinch hitter list. To
switch pinch hitter coverage, the resident on the pinch hitter list must notify
the chief residents and provide a number where he/she can be reached. In
addition, you must email the chief residents at rwjmsimchiefs@gmail.com
and inform them of the switch.
7. Failure to return a call within ten minutes while on pinch hitter will place
the resident in the number 1 position on the pinch hitter list for an
additional 2 weeks on their next elective. They will also be required to
provide equivalent payback to the person pulled in their place. The chief
residents will attempt to contact the person on pinch hitter by all contact
numbers prior to pinching someone else.
8. Residents assigned to pinch hitter must be able to arrive for clinical duties
within ninety (90) minutes of pinch notification by the chief resident.
9. If the chief resident is not notified of any pinch coverage switches, the
person originally assigned for pinch hitter will be held responsible for any
problems that occur with coverage.
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Policy Name: Required Procedure Policy
Policy Number: 21
Approval by Program Leadership: 7/1/05
Amendment Date: 7/17/09
Purpose:
Residents must know the indications, contraindications, complications, and
limitations in designated procedural skills and develop technical proficiency in
those designated procedural skills. Documentation of a physician’s procedural
experience is a requirement for credentialing with hospitals and healthcare
organizations.
Policy:
In order to perform procedures independently and graduate from the program
each categorical resident must complete the following:
1. Take and pass a written exam that contains questions pertaining to
techniques, indications, benefits and risks, and alternative options for
Central Line Placement, Thoracentesis, Paracentesis, Lumbar Puncture
and Arterial Cannulation.
2. The written exam must be completed and submitted in order to be granted
credit or supervisory status for any of the above mentioned procedures.
3. Maintain Advanced Cardiac Life Support (ACLS) certification throughout
the residency. It is the resident’s responsibility to make sure that all
certification and documentation is current and that a copy of their issued
card is in their residency file in the residency office. The residency
program will reimburse for ACLS course costs.
4. Procedures:
Procedure
Recommended to
graduate
Required to perform
independently
(Technical
Proficiency)
Obtain arterial blood gas
5
0
Nasogastric Intubation
3
0
Breast Exam
3
0
Pelvic/Pap Exam
5
0
Rectal Exam
5
0
Abdominal Paracentesis
3
2
Lumbar Puncture
5
3
Central Line Placement*
5
3
Thoracentesis
5
3
Arterial Line
2
2
*For Central Line Placement a resident must have been rated competent
to perform independently on an internal jugular or subclavian placement
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by at least one attending, fellow, or chief resident. Only one of the three
required procedures can be a femoral placement.
Interns are required to provide documentation of performance of the
following procedures in order to advance to the PGY 2 level:
 2 arterial lines
 2 paracenteses
 3 central lines (in any location)
The above numbers are merely the minimum requirements.
Resident’s personal comfort and skill level should guide the ability to
supervise or perform any procedure independently, after the minimum
standards established for performing a procedure independently have
been met.
Documentation is required in the medical record for any invasive
procedure performed. Procedure notes must be dated, timed, and signed
with the resident’s name and beeper number legibly printed. The
procedure note should also include the procedure, the indication for the
procedure, the operators, patient consent, the technique and the route
used, a brief description of the procedure and complications of the
procedure. The RWJ MICU time out form may substitute for a procedure
note as long as there is documentation in the chart saying to see time out
sheet.
Documentation with the residency program is required for advancement.
This will be done by submitting procedure slips to the residency office.
Once a resident is certified to perform independently or to supervise
others, additional procedures and the resident’s role in the procedure (i.e.
acting independently or supervising others) should continue to be
documented. A monthly report will be generated to all hospitals indicating
each resident’s certification status and supervisory abilities.
Each resident is strongly advised to maintain a personal ABIM Log Book
for their own records.
5. Any resident who sustains a work-related injury while doing a procedure
must send an e-mail to Peggy Morgan at morganma@umdnj.edu outlining
the following:
a. Outline of incident
b. Date
c. Time
d. Hospital site
e. Ongoing treatment
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Policy Name: Research Requirement Policy
Policy Number: 22
Approval by Program Leadership: 7/1/05
Amendment Date: 6/1/09
Purpose:
To ensure that residents demonstrate acceptable scholarly activity during their
training. The quality of the research performed by each resident will be part of the
composition recommendation letters for future positions.
Policy:
In order to graduate from the program each resident must perform and complete
scholarly activity defined as:
1. Completion of either: Hypothesis-based projects leading to new information,
comprehensive case reports, literature reviews of clinical and research topics,
or Internal Review Board Proposal. The final report of the project could be an
abstract, a poster, a paper in a peer review publication, or an oral
presentation at a regional meeting, at a national meeting, or at Residency
Research Day.
2. Each resident is expected to have made a significant intellectual and practical
contribution to the research project.
3. If a resident elects to take a research elective, he or she may only take four
weeks consecutively and six weeks total. At the end of each two or four week
block of research, he/she will be expected to give a noon conference
powerpoint on his/her progress.
4. At graduation the Medicine Residency Certificate with Distinction in Research
will be awarded to select residents. The Medical Residency Certificate with
Distinction in Research acknowledges original research undertaken during
the period of Residency in Medicine at UMDNJ-Robert Wood Johnson
Medical School. It is not awarded for research done prior to acceptance to
residency and cannot be granted for work credited toward any degree. This
work may be carried out in any field appropriate to Internal Medicine where
objective, critical inquiry can be made.
a. The operation of the program will be supervised by the Committee on
Residency and Fellowship Research. This Committee will be the arbiter of
the appropriateness of research proposals. Committee members with a
scientific or personal conflict with any project will be recused from the
review process.
b. Both PGY-2 and PGY-3 residents from those residents starting after July
1, 2004 are eligible to apply for the Certificate with Distinction in Research.
In each year, applications from residents regardless of their year of
training will be considered together. When a resident expresses an
interest in participating in the program, the resident will submit a proposal
or a letter of intent to apply by December 1st of the PGY-2 or PGY-3 year.
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c. Research may be performed at any academic institution or other site
where the resident was approved to do research at the time of submission
of the application.
d. The research project will consist of an original research question or
hypothesis that can be tested. For clinical studies, the written report
should be written as an article published in Annals of Internal Medicine.
Guidelines for preparation of the paper should follow those on the journal's
website (www.annals.org) and viewing Authors/Reviewers. For laboratory
based research projects, the report should follow the instructions of The
Journal of Clinical Investigation (www.jci.org).
1) All research projects are expected to be hypothesis-driven.
2) With few exceptions, the substance of the research should be
prospective in nature and be concentrated in an area in which the
resident's research sponsor has an area of interest/expertise.
3) The resident will be expected to be involved with all aspects of data
generation and documentation.
4) A paper that consists only of a review of the work of others is excluded.
e. Final decisions concerning whether or not a paper meets the program's
criteria will be made by the Residency and Fellowship Research
Committee.
f. Residents are required to participate in a yearly Resident and Fellowship
Research Day where their research experience is shared with their fellow
residents.
g. Residents will be only be considered if they are in good academic and
professional standing with the Department of Medicine and UMDNJRobert Wood Johnson Medical School.
h. Criteria for merit of the project:
1) Written report: importance of the questions, originality, scientific
validity, written presentation
2) Research Sponsor Information: Completed by the sponsor and
provides a brief description of the resident's project and the precise
role the resident played in the project. If other individuals participated
in the design of the project, collection of data, or analysis of the results,
please include their specific contributions. Sponsor should include
his/her CV with this report.
3) BIOGRAPHIC SKETCH: On a separate page, provide a summary of
your education (beginning with your undergraduate degree) and your
previous research experience. Include a list of your publications, if any.
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Policy Name: Community Service Policy
Policy Number: 23
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
To improve the health status of residents in NJ and to be a positive, recognizable
symbol of the RWJ Medicine Residency Program’s commitment to the
community.
Policy:
The involvement of ALL interns, residents & fellows in at least one community
service event/year is encouraged.
Projects include community education events, health fairs, blood drives, cancer
awareness events, mentoring and charity walks/runs.
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Policy Name: Continuity Clinic Policy
Policy Number: 24
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
To ensure that residents will develop their own office based practice. Residents
will provide comprehensive, continuous, coordinated, and timely patient care.
They will develop a knowledge base of common out-patient conditions, disease
management and preventive medicine. Each resident should develop an
understanding of the doctor-patient relationship, and the skill necessary to
coordinate, organize, and monitor care in conjunction with other health care
providers.
Policy:
1. Clinic Assignments: Please refer to the Clinic Assignment Schedule for
individual clinic assignments.
These assignments will remain in effect for the duration of training in the
Residency program.
There will be an orientation for all incoming categorical interns & new
residents at their assigned clinic site to be determined by the program
leadership.
Clinic sessions will start the following day or the following Monday if the
orientation falls on a Friday for ALL residents.
2. Clinic Attendance and Scheduling: Patients will be booked three months in
advance, and last minute changes CANNOT be accommodated.
a. In the rare event when there is a change in the resident’s schedule for
the purpose of a fellowship interview, that resident is responsible for
finding replacement coverage. In case of a true emergency, the clinic staff
will attempt to contact patients and cancel their visits. The scheduling chief
resident must approve of all changes.
b. Residents are not required to report to their clinic during:
1. Night Float rotations: If the first day of night float coincides with
the same day as a resident’s clinic day, the resident is expected to
attend clinic prior to starting his/her night float shift. If the last
morning of night float coincides with a resident’s clinic day, he or
she does not need to attend that afternoon.
2. MICU rotations
3. CCU rotations
4. University Holidays and Scheduled Vacation.
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c. Please note that Float days, Personal days or Compensation days
cannot be taken on clinic days. Rare exceptions may be granted for
fellowship interviews (see box below: fellowship interviewing policy).
d. It is the sole responsibility of each resident to verify with his/her
respective Clinic Scheduler the dates which he/she will not be reporting to
their Clinic. Failure to verify the Clinic scheduler of the above-mentioned
dates with a six-week minimum advance notice, will require the resident to
attend the session(s) in question.
e. Authorization for any Clinic cancellation outside of the rules above will
require advanced approval by the Scheduling Chief Resident and the
Clinic Directors.
3. Pre-clinic Conference: Continuity clinic sessions start with a pre-clinic
conference at 1:15pm sharp. For each week, a resident will lead the conference
based on a topic from the Hopkins outpatient curriculum (to be distributed
separately). In addition, residents may create opportunities to share and answer
clinical questions surrounding uncommon presentations in common disease
states or unique challenges faced when providing preventive services to special
populations
4. In an effort to improve our practice, residents must select patients with
hypertension, diabetes and hyperlipidemia to follow over their residency. They
will track HgbA1c, LDL and blood pressure longitudinally.
5. Labs or other diagnostic tests ordered: Residents are responsible for following
up on patient labs.
Residents are expected to check labs within one week after they are
performed, and whenever they are back in the clinic. If a resident will be
away from clinic, arrangement should be made with the clinic preceptor to
check on laboratory and diagnostic test results.
When lab tests are ordered, patients should be told that they will be
contacted with results within 2-3 weeks (phone or mail), but directed to call
the office if they do not receive results within this period. NOTE: This may
not be the policy at all sites due to system related differences.
Residents must document all correspondence with patients, even
regarding normal lab values, so that preceptors know these results have
been addressed. In the case of critical lab values, the preceptor and clinic
site staff will respond rapidly, most likely before a resident returns to clinic.
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Continuity clinic is an important educational experience. If there are any
problems or issues with any aspect of continuity clinic, please speak with
the clinic preceptor, chief residents, or Program Directors.
6. Missing clinic or canceling clinic without approval by the chief resident is
unacceptable and is grounds for dismissal.
7. All residents must complete a minimum of 130 distinct half-day outpatient
sessions, devoted to the longitudinal care of the residents’ panel of patients.
In order to meet this requirement residents will need to attend additional clinic
sessions which will occur on a day different from their regularly assigned
clinic day. These extra clinics will be assigned during elective/selective time.
The resident is responsible for knowing about and attending these extra
clinics.
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Policy Name: Policy for Handling of Core Competency and
Performance Deficiency
Policy Number: 25
Approval by Program Leadership: 7/1/05
Amendment Date: 6/26/09
Purpose:
To ensure that residents understand the mechanisms by which an identified
academic deficiency(ies) will be addressed. Disciplinary action can be
progressive or alternatively, based on the nature of the deficiency, the Program
Leadership and Promotions Committee may pursue ANY of the actions
described below.

Concern Card:
A concern card can be put in a trainee's file by any person who comes in contact
with the resident on a clinical or academic basis. This includes program directors,
chief residents, teaching attendings, private attendings, fellows, fellow residents,
other members of the healthcare team or administrative staff. The Program
Leadership and Promotions Committee has the authority to make this a
permanent part of a resident's record if deemed necessary.

Academic Advisement with Plan for Corrective Action:
A trainee may be placed on Academic Advisement for failing to meet
expectations during training in any competency domain. The corrective action
plan will include a problem definition, a specific corrective action plan, and a
timeline for demonstrating corrective change. This may include, for example,
increased supervision, repetition of rotation, referral for professional help, etc.
The corrective action plan devised by the Program Leadership and Promotions
Committee will identity person (s) who will be responsible for implementing and
monitoring the outcomes. Failure to achieve the stated outcome in the timeline
allotted will result in Academic Warning or Dismissal proceedings if deemed
necessary.

Academic Warning/Probation:
Academic Warning is a condition that reflects serious concern on the part of the
Program Leadership and Promotions Committee when a trainee has
demonstrated behavior consistent with performance deficiencies in any
competency domain, has failed to follow policies and procedures outlined by the
program (ex: attendance policy,) or has failed to act on the corrective action plan
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designed for that resident. Academic Warning is reserved for deficiencies
considered significant enough to undermine the training program's expectations
and standards. A formal meeting and letter will be issued in such cases with a
corrective action plan.
The placement of a resident on Academic
Warning/Probation will be reported to state licensing bodies, future employers
and fellowship directors. A resident will remain on Academic Warning/Probation
for a minimum one year period or until the training completion date if that is less
than one year. Additional offenses committed while the resident is on Academic
Warning/Probation may result in dismissal proceedings.

Dismissal:
A resident may be dismissed from the training program for the reason or reasons
listed below. Reasons for dismissal include, but are not limited to, the following:
a. Obtaining unsatisfactory evaluations in any one of the components of
clinical competence for three rotations in an academic year.
b. Obtaining marginal evaluations in any one of the components of clinical
competence for five rotations in an academic year.
c. Failure to satisfy the conditions for removal from Academic Warning
d. Deliberate falsification of official records or required program
information.
e. Inability to complete residency requirements.
f. Absence of the personal qualifications and attributes deemed necessary
to perform the duties of the medical profession.

Appeals Process:
In accordance with the GME appeals process from RWJMS GME Policy Manual,
(1) The house officer may appeal the program director's adverse academic
decision to an Ad Hoc Appeal Committee, established as indicated below, or to
the residency program's standing Committee on Housestaff Evaluation (or its
equivalent). This appeal must be made in writing to the program director within
five working days of having received notification of termination or an adverse
action. (2) If the house officer submits a timely notice of appeal, the director shall
schedule a meeting of the residency program Committee on Housestaff
Evaluation or convene the Ad Hoc Appeals Committee. The Ad Hoc Appeals
Committee, if created, should consist of [not fewer than five] faculty members of
the division, department of the group, or departments responsible for the
program. The faculty members selected for this purpose shall be experienced
faculty in the area of graduate medical education. The number of members of
the Ad Hoc Committee shall be large enough to be representative of the faculty
of the division, department or group of departments responsible for the program.
The committee considering the house officer's appeal should include at least one
house officer. (3) The house officer may request to meet with the Committee in
person and be accompanied at the hearing by a faculty member or fellow house
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officer who may act as an advisor. If a CIR representative has not previously
determined that the matter at issue is academic, the house officer may also be
accompanied by a representative of the CIR who shall not participate in the
proceedings. (The CIR representative's only role in the hearing is to make a
determination whether the matter under discussion is a bona fide issue of
academic performance.) The program director will also be present at the hearing
at which time he or she shall set forth the circumstances leading to the planned
adverse action or the reasons for which the house officer has been dismissed.
Following the presentation, the house officer and/or their advisor shall be
permitted to set forth whatever information the house officer wishes the
Committee to consider as reasons to vacate the decision to endorse the adverse
action or to dismiss the house officer. (4) Following the hearing before the
Committee, the Committee will immediately confer and, following deliberations,
advise the Department Chair in writing of its recommendation and the reasons for
that decision of the Chair shall be final. If the Department Chair is the Program
Director, the decision of the Committee shall be final. This decision shall be
conveyed to the house officer in writing. The Chair shall provide copies of the
notice of adverse action or dismissal to the associate or assistant dean
responsible for graduate medical education.
.
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Policy Name: Sick Day Policy
Policy Number: 26
Approval by Program Leadership: 7/1/05
Amendment Date: 9/24/07
Purpose:
This policy governs absence from work due to illness.
Policy:
1. The site chief and elective coordinator must be notified as soon as possible.
2. A physician’s note (not from a resident or fellow) must be provided if a resident
is absent from work for more than two consecutive days. There may be
circumstances where a physician’s note may be required even if absence is from
a single day of work. (ex. Suspected misuse of sick leave policy)
3. In the event that a pinch hitter is used to cover for a resident absent secondary
to illness, payback will not be required. However, payback is strongly suggested
as a matter of professional courtesy.
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Policy Name: University Holiday Policy
Policy Number: 27
Approval by Program Leadership: 7/1/05
Amendment Date: 06/25/07
Purpose:
This policy addresses pay offered to residents for working on designated
university holidays.
Policy:
1. Residents or interns working on university holidays will be paid one tenth of
their biweekly pay. Those not on call are required to stay until 12:00 NOON or
until their work is completed.
2. In the event that the holiday is a pick-up day for the team, both members will
come in and will be paid one tenth of their biweekly pay.
3. At the start of each month, when submitting days off, each service team will
tell the site chief who will be rounding on a holiday. If a team is not on call or
pick-up, only one member of the team may work and receive holiday
compensation.
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Policy Name: Due Process Policy
Policy Number: 28
Approval by Program Leadership: 7/1/05
Amendment Date: 9/24/07
Purpose:
This policy describes the process for disputing an academic disciplinary action.
Policy:
1. Discuss the action in question with the Program Director, Internal Medicine
Residency.
2. In the event that a satisfactory resolution cannot be reached, the resident may
appeal to an Ad Hoc Appeals Committee appointed by the Program Director or
his/her designee. (refer to GME manual, section on Appeals Process)
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Policy Name: RWJUH Service Policy
Policy Number: 29
Approval by Program Leadership: 7/1/05
Amendment Date: 7/22/11
Purpose:
To expose residents to a wide spectrum of diseases in multiple settings (i.e.
MICU, floor, night float and oncology floor).
Policy:
A. Services
It is the responsibility of residents to play an active role in all patient encounters.
(Take a thorough history and physical exam, present case to attending, discuss
management and document appropriately in the chart.) Residents must follow
the policies on progress notes, clinics, dictations, work hours, pinch hitter,
evaluation, coverage, sign-out/transitions of care, etc. as mentioned above.
1. FLOOR SERVICE:
a. Medical Teaching Service (MTS): 5 general medicine teams consisting
of two or more residents each responsible for the care for patients without
a primary cardiology presentation or oncology diagnosis.
1) Includes patients without a primary care physician with privileges at
RWJUH or patients who receive primary care through RWJMG (not
consults).
2) Composed of residents and a service attending (i.e. Program
Directors, chief residents or university faculty members)
3) Teams admit every 5th day and begin admitting from 7:00 am
(8:00am on weekends/holidays) until 7:30 pm. They may hold patients
after 7:30 pm and pass them onto night float for admission. Patients
received prior to 7:30 pm will not be admitted by night float; the primary
team will stay and finish that admission with the help of night float as
needed. Patients admitted by night float will be redistributed to the
pickup team the following morning.
a) Accept max two admissions per hour from ER but if called to
admit then able to give attending name for booking purposes.
b) Each intern must not be assigned more than five new patients
per admitting day. An additional 2 new patients may be assigned if
the on call team has either a sub-intern or psychiatry intern. A
further two patients may be assigned if they are in-house transfers
from the medical service.
c) Each intern must not be assigned more than eight new patients
in a 48 hour period.
d) Each intern must not be responsible for the ongoing care of more
than 10 patients.
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e) A supervising resident; when supervising one intern must not be
responsible for the ongoing care of more than 14 patients; when
supervising more than one intern must not be responsible for the
ongoing care of more than 20 patients.
f) The supervising resident, must not be responsible for the
supervision or admission of more than 10 new patients and 4
transfer patients per admitting day or more than 16 new patients in
a 48 hour period.
g) Preliminary admission orders to be placed within one hour of call
from ER attending
h) If attending does not wish to accept patient, the ER attending
must be called by the attending or the attending must be notified
prior to the resident discussing the case with the ER attending
i) Transfers from outside hospitals and from other services must be
accepted directly by an attending physician
j) No internal medicine housestaff will be provided for patients with
stroke/neurological disease only as there is a neurology service
except in the MICU.
k) No internal medicine housestaff for patients with Family Practice
attendings except in the MICU, unless that physician does not
admit to RWJUH.
l) Anyone under the age of 21 without a primary medicine doctor
goes to Pediatrics
m) No internal medicine housestaff for pregnant patients with
exception in the MICU. All such patients will receive GIM consults
if the chief complaint is primarily medicine related.
n) Patients with fractures admitted to RWJUH will be admitted
either to the orthopedic or General Internal Medicine (GIM) services
depending on their comorbidities:
i. If the GIM medical attending, after discussion with the medical
resident and, if necessary, the orthopedic attending, feels the
patient is stable and may proceed to surgery without delay, the
patient should go to the orthopedic service and GIM will consult.
ii. If the medical attending feels the patient is unstable medically,
requires further medical evaluation or optimization before
surgery, then the patient should go to the GIM medical service
with orthopedics consulting.
iii. Any disagreements should be resolved between the GIM
medicine and orthopedic attendings directly and should not
involve the ER staff or either resident team.
o) The senior resident fills out a screening log every time on call.
4) Saturday/Holiday Call: The following call schedule applies for
Saturday and holiday calls
a) Senior residents will arrive at 8am and work a continuous 24
hour shift until 8am the following morning at which time they will
leave.
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b) The on-call intern will arrive at 8am and work a 12 hour shift until
8pm. During this time they will admit patients with the supervision
of the on-call senior as well as take sign outs and provide cross
coverage for the four non-call teams.
c) At 8pm the following day’s pickup team’s intern will report and
work a 16 hour shift until 12noon the following day. They will admit
patients with the on-call senior and provide cross-coverage.
Patients admitted from 8pm to 8am will be followed by the pickup
team.
5) Pickups: Pickup occurs every 5th day by a team different than the
previous day on-call team.
a) Redistribution should occur:
i. if pickup team’s census will be greater than 14
ii. if there are more than six pickups
iii. if non-call teams are at less than six patients
b) Order of Redistribution:
i. First, subspecialty, then GIM (GIM to GIM teams), and finally
service patients
c) Redistribution should not be conducted in such a way that gives
any other team more new patients than the pickup team unless this
cannot be avoided given current census
d) The admitting team may pickup a patient if it is a bounceback or
all other teams have a census of 14 patients
6) ICU Transfers:
a) Transfers from MICU/CCU:
i. The day team will write a transfer note if a patient requires
housestaff and is anticipated to transfer prior to leaving for the
day. The on call ICU intern will notify the appropriate resident
when a bed is assigned: #2250- UPCC go to MTS, UCG go to
MTS with MTS attending approval of teaching quality, and CINJ
or unassigned liquid malignancy patients go to OTS.
ii. Whomever is holding 2250/2251 at the time the bed outside
of the ICU is assigned takes the patient (regardless of when the
patient was put up for transfer)
iii. Floor team should see the patient, review the chart/transfer
note, write a brief accept note, notify the attending, and change
the attending of record (if necessary) with admitting (ext 8602).
b) Transfers to MICU/CCU:
i. For floor patients with housestaff the MTS/OTS teams act as
unit screeners. These residents should stabilize the patient,
write a transfer note, place the initial unit orders, and call
#2373/2374 (CCU/MICU screener) to get a unit bed assigned.
ii. Responsibility remains with floor teams until patient physically
in unit or ICU resident takes over (including codes).
7) Sign offs: It is intended that the majority of patients followed by
resident teams will be followed from admission through discharge.
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When it is necessary to sign-off of a patient, sign-offs will be performed
according to the following guidelines:
a) Only university group subspeciality patients can be considered
for sign-off.
b) Indications for Sign-off:
i. High Census: A team census greater than 14 (or >10 going
into a call day). Complexity of other patients being covered by
the team may also be considered.
 The order of sign-offs will be based on
value/appropriateness of patient as a teaching case.
 For example, a patient awaiting placement will be
considered for sign-off before a patient with
diagnoses/workup established before patients with
investigation/workup in preliminary stages.
ii. Physician of record unavailability: Each physician of record
has the responsibility to communicate effectively and frequently
with the resident staff participating in the care of these patients.
iii. Patient refuses to be seen or examined by the resident team.
c) When signing off on a patient the resident is responsible to notify
the attending of record and the patient’s nurse and to write a note in
the chart stating that residents have signed off on the patient’s
care.
8) Faculty Admissions:
a) Patients without a physician with privileges at RWJUH will be
admitted to the medical service team admitting on that day.
b) Any subspeciality patients presenting with that same
subspeciality complaint followed by a faculty subspeciality
attending will be admitted to their service unless otherwise
approved by the chief resident
1. If subspeciality attending feels that the patient is
sick enough to warrant housestaff coverage, then
that can be approved through the chief resident
2. If the chief complaint falls out of the jurisdiction of
the subspeciality attending, that patient will be
admitted to the medical teaching service.
9) Transitions of Care:
a) In an attempt to minimize the number of transitions in patient
care, to ensure and monitor effective, structured handover
processes to facilitate both continuity of care and patient
safety, and to ensure that residents are competent in
communicating with team members in the handover process,
we require residents to adhere to the following guideline
regarding transitions of care:
b) All patients cared for by the Medical Teaching Service must
have a written sign out completed using the hospital intranet
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system only. Signouts should be kept secure as they
contain protected health information.
c) Sign out should include the following:
a. Patient name, attending physician, consultants, drug
allergies/adverse reactions and code status.
b. A brief description of the reason for admission
c. A list of active problems and the treatment plan, as well
as any anticipated issues and possible solutions
d. Any recent procedures or tests
d) Sign out must be updated on a daily basis to reflect changes in
the patient’s clinical course.
e) Transitions of care must be done face-to-face between the
outgoing and incoming resident in compliance with all HIPAA
regulations.
f) The on-call and coverage schedules for residents and
attendings on teaching service is available on the hospital
intranet
2. ONCOLOGY TEACHING SERVICE (OTS):
a. One team consisting of two residents, one oncology fellow, and an
attending CINJ oncologist. The CINJ oncologist attending and oncology
fellow assigned to OTS are responsible for the direct supervision of the
residents and assist the residents in direct patient care.
1) Leukemia/Lymphoma Service: Responsible for the care of patients
with known hematologic malignancies including leukemia, lymphoma,
myeloma, etc., admitted for oncology related issues.
b. Any CINJ patient with a known liquid malignancy admitted with an
oncology-related issue.
1)OTS does not follow: Bone Marrow Transplant patients, patients
admitted to the MICU, Private Oncology pts, Hematology service
patients (Hematology service patients needing house staff should be
admitted to MTS).
c.,A resident must not be responsible for the ongoing care of more than 12
patients. The resident must not be responsible for the admission of more
than 10 new patients and four transfer patients per admitting day or more
than 16 new patients in a 48 hour period.
d. The GIM consult resident will cross-cover and admit for liquids from
4:30-8:00 pm Monday through Friday.
1) On days when GIM consult resident is in clinic, one resident from
liquids will continue to cover their service and GIM consults after
4:30 until the GIM resident returns.
e. On weekends, the on-call liquid resident will cover and admit for liquids
as well as do GIM consults.
f. On holiday weekends, RWJ GIM will be asked to cover a Sunday call if
the holiday involves a Monday or Friday and Saturday overnight call if it
involves Thanksgiving.
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g. Transitions of Care:
a) In an attempt to minimize the number of transitions in patient
care, to ensure and monitor effective, structured handover
processes to facilitate both continuity of care and patient safety,
and to ensure that residents are competent in communicating
with team members in the handover process, we require
residents to adhere to the following guideline regarding
transitions of care:
b) All patients cared for by the Oncology Teaching Service must
have a written sign out completed using the hospital intranet
system only. Signouts should be kept secure as they contain
protected health information.
c) Sign out should include the following:
a. Patient name, attending physician, consultants, drug
allergies/adverse reactions and code status.
b. A brief description of the reason for admission
c. A list of active problems and the treatment plan, as well
as any anticipated issues and possible solutions
d. Any recent procedures or tests
d) Sign out must be updated on a daily basis to reflect changes in
the patient’s clinical course.
e) Transitions of care must be done face-to-face between the
outgoing and incoming resident in compliance with all HIPAA
regulations.
f) The on-call and coverage schedules for residents and
attendings on teaching service is available on the hospital
intranet
3. MEDICAL INTENSIVE CARE UNIT SERVICE (MICU):
a. One month rotation of four senior residents and two interns. There are
two teams, each composed of two residents and one intern. For the first
two weeks, one resident from each team and one intern are assigned to
day shift and the other two residents are assigned to night shift For the
last two weeks the senior residents switch day and night shift
responsibilities. Day shift residents are expected to be present from 7am
to 7pm. Night shift residents are expected to be present from 6pm-12
noon the following day.
1) MICU patients are defined as those patients admitted to the MICU
who have a non-cardiac reason for being admitted to the ICU (i.e.
septic shock, GI Bleed, etc) or a UPCC primary attending
b. Admission assignment:
1) Back-up will admit for the MICU from 7 am to 12 pm on weekdays
and will hold #2374 during this time.
2) One resident will hold #2374 from 12 pm to 6pm daily.
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a) This resident will be responsible for leaving the ICU to screen
patients if necessary. Residents should encourage their intern to
accompany them on screens whenever possible.
b) Whoever is on call for the day will hold #2376 from 7am – 6pm
c) All admissions will be assigned in a trickle system to each team
with caps of 14.
4) Each intern must not be assigned more than five new patients per
admitting day: an additional two patients may be assigned if they are
in-house transfers from the medical service.
5) Each intern must not be assigned more than eight new patients in a
48 hour period.
6) Each intern must not be responsible for the ongoing care of more
than 12 patients.
7) A supervising resident; when supervising one intern must not be
responsible for the ongoing care of more than 14 patients; when
supervising more than one intern must not be responsible for the
ongoing care of more than 24 patients.
8) The supervising resident must not be responsible for the supervision
or admission of more than 10 new patients and 4 transfer patients per
admitting day or more than 16 new patients in a 48 hour period.
9) In the event that the MICU teams are capped with a total of greater
than 28 patients, the CCU team will be responsible for covering MICU
patients. Preferentially these patients will be non-UPCC patients.
10) In the event that the CCU team is capped with a total of greater
than 14 patients, the MICU may be responsible for covering CCU
patients. Preferentially these patients will be non-UCG patients.
c. Night shift:
1) Each resident will do two weeks of night shift during their rotation.
The MICU night shift resident is responsible for admitting for the MICU,
cross-covering MICU patients, and holding beepers #2374/2376.
2) Over a two week period, night shift will be shared by two residents
alternating 18 hour shifts from 6pm-12noon the following day.
3) The MICU night shift resident will be expected to attend night-time
intensivist rounds, and MICU attending rounds and didactics.
4) The MICU night shift resident will be responsible for the care of any
UPCC patients admitted during that shift as well as presenting these
patients on attending rounds.
d. Weekends/Holidays:
1) One member from each team is off each weekend/holiday day. The
other member of the team is responsible for rounding on their patients
and ensuring an accurate transition of care to the night shift member.
2) The senior resident will screen for the entire MICU and the intern will
act as cross-coverage.
3) On weekends, the MICU night shift is responsible for screening from
7am-12noon in order to allow the day shift to round.
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4) On Sunday when the CCU senior resident is off, the MICU senior
resident will also be responsible for screening for the CCU.
e. Clinic: Residents will be excused from all outpatient clinic
responsibilities while on critical care rotations.
f. Days off: Each intern gets 4 days off per month. These days are
assigned and will be one weekend day per week. Each senior resident
will get one weekend day off per week of days shift. While on night shift
senior residents get alternating nights off.
g. Education:
1) Residents and interns will receive didactics Monday, Tuesday, and
Thursday from UPCC attending while in the ICU.
2) Rounds will take place as follows:
a) Attending rounds Monday through Friday 10:30 am to 12 pm
b) Sign-out rounds from 6pm to 7pm on MICU patients led by
residents occurring at bedside
c) Interdisciplinary rounds Monday, Wednesday, and Friday from
9:30 am to 10:00 am.
h. Intensivists: Every night, critical care physicians are in the MICU to help
care for patients and will round with the night shift residents from 9-10 pm.
Their role should be to assist in caring for new and existing patients. They
may also supervise procedures. It is each resident’s responsibility to notify
the attending physician regarding all care that you render to the patient,
and to document what has been done, even when assisted by the
intensivist.
i. ICU Transfers: (See ICU transfer policy above for more details).
j. Transitions of Care:
a) In an attempt to minimize the number of transitions in patient
care, to ensure and monitor effective, structured handover
processes to facilitate both continuity of care and patient safety,
and to ensure that residents are competent in communicating
with team members in the handover process, we require
residents to adhere to the following guideline regarding
transitions of care:
b) All patients cared for by the MICU Service must have a written
sign out completed using the hospital intranet system only.
Signouts should be kept secure as they contain protected health
information.
c)
Sign out should include the following:
a. Patient name, attending physician, consultants, drug
allergies/adverse reactions and code status.
b. A brief description of the reason for admission
c. A list of active problems and the treatment plan, as well
as any anticipated issues and possible solutions
d. Any recent procedures or tests
d) Sign out must be updated on a daily basis to reflect changes in
the patient’s clinical course.
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e) Transitions of care must be done face-to-face between the
outgoing and incoming resident in compliance with all HIPAA
regulations.
f) The on-call and coverage schedules for residents and
attendings on teaching service is available on the hospital
intranet
4. CORONARY CARE UNIT SERVICE (CCU):
a. Two week rotation of two senior residents and one intern. For the first
week one resident and the intern are assigned to days and the other
resident is assigned to night shift. The following week the residents switch
day and night shift.
1) CCU patients are defined as those patients admitted to the CCU
who have a cardiac reason for being admitted to the ICU (i.e.
cardiogenic shock, congestive heart failure, arrthymia, etc) or a UCG
primary attending
b. Admission assignment:
1) Back-up will admit for the CCU from 7 am to 12 pm or until rounds
are done daily and hold #2373 during this time.
2) When the CCU resident is on call they will hold beeper #2373 from
12 pm to 7pm on weekdays. When the CCU intern is on call the MICU
resident will hold beeper #2373 and will be responsible for screening
the CCU. The CCU intern is encouraged to accompany the resident
on any screens if possible.
3) Each intern must not be assigned more than five new patients per
admitting day: an additional two patients may be assigned if they are
in-house transfers from the medical service.
4) Each intern must not be assigned more than eight new patients in a
48 hour period.
5) Each intern must not be responsible for the ongoing care of more
than 12 patients.
6) A supervising resident; when supervising one intern must not be
responsible for the ongoing care of more than 16 patients
7) In the event that the MICU teams are capped with a total of great
than 32 patients, the CCU may be responsible for covering MICU
patients. Preferentially these patients will be non-UPCC patients.
8) In the event that the CCU teams are capped with a total of great
than 14 patients, the MICU may be responsible for covering CCU
patients. Preferentially these patients will be non-UCG patients.
c. Day call occurs from 3-7pm split between intern and resident.
1) The CCU resident will be on call twice during the week. The CCU
resident on call is responsible admitting for the CCU, cross-covering
CCU patients, and holding beepers #2373 & 2375.
2) The CCU intern will be on call three times during the week and is
responsible for cross-covering CCU patients, admitting CCU patients
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with the MICU day shift resident, and holds beeper #2375. The MICU
day shift resident will hold beeper #2373.
d. Night shift:
1) Each resident will do one week of night shift during the two week
rotation. The CCU night shift resident is responsible for admitting for
the CCU, cross-covering CCU patients, and holding beepers
#2373/2375.
2) Night shift will consist of Sunday – Friday 7pm-7am.
3) The CCU night shift resident will be expected to attend nighttime
intensivist rounds in the MICU.
e. Weekends:
1) The CCU resident will be on call for 24 hours on Saturday from 7 am
to 7am the following day. The resident is responsible for admitting
CCU patients, cross-covering CCU patients, and holding pagers
#2373/2375
2) The CCU intern will be on call on Sunday from 7am to 7pm. The
intern is responsible for cross-covering CCU patients, admitting CCU
patients with the MICU on call resident, and holding pager #2375.
f. Days off:
1) Each intern gets two Saturdays off in the two week period
2) The CCU day shift resident will get the Sunday after their 24 hour
call off
3) The CCU night shift resident will get one Saturday night off
g. Education:
1) The CCU team will round with the attending from 9:30-11:30am
Monday through Friday.
2) The CCU team will receive didactics from the UCG fellow 3 x week
from 11:30-12 pm.
3) The CCU team will also conduct sign-out rounds at 7pm on CCU
patients occurring at bedside to transfer care from day shift to night
shift.
h. Intensivists: Every night, critical care physicians are in the MICU to help
cover patients and will round with the night shift residents from 9-10 pm.
Their role should be to assist in caring for new and existing patients. They
do not care for CCU patients. They may supervise procedures. It is each
resident’s responsibility to notify the attending physician regarding all care
that you render to the patient, and to document what has been done, even
when assisted by the intensivist.
i. ICU Transfers: (See ICU transfer policy above for more details).
j. Transitions of Care:
a) In an attempt to minimize the number of transitions in patient
care, to ensure and monitor effective, structured handover
processes to facilitate both continuity of care and patient safety,
and to ensure that residents are competent in communicating
with team members in the handover process, we require
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b)
c)
d)
e)
f)
residents to adhere to the following guideline regarding
transitions of care:
All patients cared for by the CCU Service must have a written
sign out completed using the hospital intranet system only.
Signouts should be kept secure as they contain protected health
information.
Sign out should include the following:
a. Patient name, attending physician, consultants, drug
allergies/adverse reactions and code status.
b. A brief description of the reason for admission
c. A list of active problems and the treatment plan, as well
as any anticipated issues and possible solutions
d. Any recent procedures or tests
Sign out must be updated on a daily basis to reflect changes in
the patient’s clinical course.
Transitions of care must be done face-to-face between the
outgoing and incoming resident in compliance with all HIPAA
regulations.
The on-call and coverage schedules for residents and
attendings on teaching service is available on the hospital
intranet
5. NIGHT FLOAT SERVICE:
a. Hours: 8pm to 8:30am Sunday through Friday Nights, Saturday and
Holidays off
b. Two teams of 1 intern and 1 resident
1) Admitting Resident holds pagers 2250 (MTS Admissions)
2) Admitting Intern holds personal pager
3) 2nd Resident holds 2251, 2252 (OTS admissions and coverage,
general medicine consults)
4) 2nd Intern holds 2253 (MTS cross-covering)
c. BEEPER LIST:
1) #2250: Admits general medicine patients to the 5 MTS teams,
code team responder. This resident is responsible for filling out
screening log every night.
2) #2251: Admits and cross-covers OTS Liquids team and code
team responder. This resident is responsible for filling out an OTS
screening log and census sheet every night.
3) #2252: Does all GIM consults. This resident must check with
GIM attending on all consults to verify whether the consult should
be completed or held overnight. Resident cannot hold a consult
overnight without approval from GIM attending.
4) #2253: Cross covers patients on 5 MTS teams and code team
responder and is responsible for filling out the census sheet every
morning.
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d. When a GIM attending is listed as the on-call attending, call the GIM
service (908-685-3736) for admissions and patient issues. If the service is
unable to contact that attending, have the service call Dr. Carson or Dr.
Ferreira directly.
e. If issues arise with a patient, call the patient’s attending, NOT the oncall attending except for GIM where the intern should call the service
directly.
6. BACK-UP SERVICE:
a. Specific responsibilities:
1) Attend board review and other conferences
2) Cross-cover from afternoon sign-outs for MTS until NF begins.
3) Admit for MTS when on call resident in clinic
4) Provide 7am-12 pm MICU/CCU screening on weekdays. All
patients will be signed out to teams in real time.
5) Back-up will attend UPCC rounds Monday, Tuesday, and
Thursday and UCG rounds Wednesday and Friday unless a patient
was admitted for either attending earlier that day in which case s/he
should attend those ICU rounds.
6) Assist with procedures, admissions, etc. Back-up should only be
asked to help with admissions when a team has three or more
patients waiting.
7) Assist interns on days when MTS residents are off as needed for
guidance
8) Hold pager #2253 daily and respond to all Code Blue alerts.
7. GENERAL INTERNAL MEDICINE (GIM) CONSULTS:
a. Specific responsibilities:
1) Attend board review and other conferences
2) Do new GIM consults from 7:45 am to 7:30 pm
3) Round on all existing GIM patients
4) Cross-cover and admit for liquid oncology from 4:30-8 pm
Monday through Friday
5) Take Sunday call for OTS on a Monday or Friday holiday
weekend
6) Take Saturday overnight call for OTS on Thanksgiving weekend
7) Hold GIM consult pager # 2252
b. These patients are not cross-covered by house staff at night/weekends.
All calls should be referred to GIM answering service.
B. Call Schedule
There is a call schedule for each academic month that can be located on
www.amion.com. The monthly attending coverage schedule can be found on the
Angel website. It is the resident’s responsibility to check the call schedule and to
know when he/she is either on call or covering for another resident.
Each resident must leave his/her pager on until 8pm even if he or she is not on
call and respond to pages within 10 minutes.
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C. Conference/Clinic Requirements
Residents must attend all required educational activities of the program including
noon conference, noon report, Business of Medicine, Art of Medicine, Grand
Rounds, etc promptly as per the white schedule sheet. All PGY-3 residents on
night float, oncology teaching service and floor service are strongly encouraged
to attend Board review.
Attend weekly continuity clinic as assigned.
D. Daily Schedule
1. Weekday:
a. Floor service:
7:00-7:45am Board Review for residents
7:00am Sign in rounds in Resident Lounge
9:45 – 11:45am Attending Rounds
12:00 – 1:30pm Noon Report/Core Conference/Journal Club
4:30pm (or later) Sign out to Backup Resident once all work including
discharge summaries and procedures are completed
8:00pm On call resident and backup sign out to Night Float in Resident
Lounge
Additional Conferences: Grand rounds on Wednesday morning @ 8:00
am from September to June, Art of Medicine conferences and
Business of Medicine conferences as scheduled
b. Oncology Service
7:00-7:45am Board Review for residents
7:00am Sign in rounds in Resident Lounge
9:45 – 11:45am Attending Rounds
12:00 – 1:30pm Noon Report/Core Conference/Journal Club
4:30 pm (or later) Sign out to GIM consult resident once all work
including discharge summaries and procedures are completed
Additional conferences: As noted above
c. Medical Intensive Care Unit service:
7am Sign in rounds in MICU conference room
9:30am- Interdisciplinary rounds
10:30am: MICU didactics
11am-12:15pm: Teaching rounds
6:00-7:00pm Transition of care with MICU night shift
7pm-7am Night shift resident admits and cross-covers MICU
d. Coronary Care Unit service:
7am Sign in rounds in MICU conference room
9:30am-11:30am-Teaching rounds
11:30am-12pm: CCU didactics
7pm Transition of care with CCU night shift
7:30 pm-7am Night shift resident admits and cross-covers CCU
e. Night Float:
7:00am Sign in rounds in Resident Lounge
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7:45am Night Float Rounds/Morning Report- MEB Lobby
8:00pm On call resident and back up sign out to Night Float in
Resident Lounge
f. Back-up:
7:00am Board Review for residents
7:00am-12 pm Screens for CCU/MICU, Attends UPCC rounds
M/T/Th, Attends CCU rounds W/F
12:00 – 1:30pm Noon Report/Core Conference/Journal Club
1:30-4:30pm Follows daily coverage schedule found on white
coverage sheets (MTS Floor coverage)
4:30pm (or later) Accepts sign-outs from MTS teams
8:00pm Backup resident signs out to Night Float in Resident Lounge
g. GIM Consults:
7:00am Board Review for residents
7:00am-12 pm Round on existing GIM consults
12:00 – 1:30pm Noon Report/Core Conference/Journal Club
1:30-4:30pm New GIM Consults
4:30pm (or later) Accepts sign-outs from liquids oncology teams
4:30-8 pm Cross-covers and admits for liquid oncology
8:00pm Backup resident signs out to Night Float in Resident Lounge
2. Weekend/ Holiday:
a. Floor service/Oncology service:
8:00am Sign in rounds in Resident Lounge
12:00pm (or later) Sign out to Resident holding 2253 where all work
including discharge summaries and procedures are completed
8:00pm (on Sundays only) the Night Float Residents get sign out
rounds in Resident Lounge
On weekends and holidays the oncology teaching service covers
itself (see white sheet for schedule)
b. Medical Intensive Care Unit service:
7:00am Sign in rounds in MICU conference room
6:00-7:00pm Transition of care with MICU night shift
7:00pm-12:00pm Cross-cover and admit for MICU.
c. Coronary Care Unit service:
7:00am Sign in rounds in MICU conference room
7:00am-7:00am (on Saturdays only) on call CCU resident admits and
cross covers CCU
7:00am-7:00pm (on Sundays only) CCU intern cross covers CCU
and admits new CCU patients with MICU resident
d. Night Float:
8:00am Saturday morning sign in rounds in Resident Lounge
8:00pm Sunday evening sign out rounds in Resident Lounge
e. Backup: Off
g. GIM consults: Off except holiday weekends and Thanksgiving (see
above for details)
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E. Bounce Backs
If you have taken care of a patient at any time during the month, and they again
require care, they will revert to your team the following morning. An exception to
this would be if another team has a low census and wishes to keep the patient
with the consent of their attending.
F. Beeper Schedule:
 2250 Medical Teaching Service (MTS) Admissions
 2251 Oncology Teaching Service (OTS) Leukemia/Lymphoma (Liquids)
Admissions and Cross Coverage
 2252 GIM Consults
 2253 MTS Cross Coverage
 2373 CCU Screener
 2374 MICU Screener
 2375 CCU Cross-coverage
 2276 MICU Cross Coverage
 2250,2251,2253, 2373, 2374, 2375, 2376 are code pagers
 If at any point a code pager is lost by a resident or intern, that resident or
intern is responsible for paying for a new pager for that service.
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1. Floor Weekday Coverage:
Time
2250
7am On call MTS
4:30pm
Resident or
Backup Resident
when on call
resident in clinic
from 12:00pm
4:30pmOn call MTS
8pm
Resident
8pm –
NF Resident 1
7am
2. Floor Weekend Coverage:
Pager
2250
8amOn Call MTS
8pm
Resident
8pm-8am
On Call MTS
Resident
3. ICU Weekday Coverage:
Time
2373
7am Back-up
12pm
12 pm CCU Day
7pm
Resident
7pm –
7am
CCU Night Shift
Resident
2251
OTS Liquids
Resident
2252
GIM Consult
Resident
2253
Backup resident or
intern when on call
Resident or back up in
clinic from 12:00pm
GIM Consult
Resident
NF Resident
2
GIM Consult
Resident
NF Resident
2
Backup
2251
On Call OTS
Liquids
Resident
On Call OTS
Liquids
Resident
2252
On Call OTS
Liquids
Resident
On Call OTS
Liquids
Resident
2253
On Call MTS Intern
2374
Back-up
2375
CCU Intern
2376
MICU Intern
MICU
Resident
On call CCU
team
member
CCU Night
Shift
Resident
MICU Intern
MICU Night
Shift
Resident
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NF Intern 2
Pickup MTS Intern
MICU Night Shift
Resident
4. ICU Saturday/Holiday Coverage:
Time
2373
2374
7am CCU Resident
MICU Night
12pm
Shift
Resident
12 pm CCU Resident
MICU Day
7pm
Shift
Resident
7pm–
CCU Resident
MICU Night
7am
Shift
Resident
4. ICU Sunday Coverage:
Time
2373
7am MICU Night Shift
12pm
Resident
12pm 7pm
7pm-7am
MICU Day
Resident
CCU Night Shift
Resident
2374
MICU Night
Shift
Resident
MICU Day
Resident
MICU Night
Shift
Resident
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2375
CCU
Resident
2376
MICU Intern
CCU
Resident
MICU Intern
CCU
Resident
MICU Night Shift
Resident
2375
CCU Intern
2376
MICU Intern
CCU Intern
MICU Intern
CCU Night
Shift
Resident
MICU Night Shift
Resident
Policy Name: UMCP Service Policy
Policy Number: 30
Approval by Program Leadership: 7/1/05
Amendment Date: 7/22/11
Purpose:
To expose residents to a wide spectrum of diseases in multiple settings (i.e. floor,
and night float).
Policy:
A. Services
It is the responsibility of residents to play an active role in all patient encounters
including taking a thorough history and physical exam, presenting case to
attending, discussing management and documenting appropriately in the chart.
Residents must follow the policies on progress notes, clinics, dictations, work
hours, pinch hitter, evaluation, coverage, signouts/transitions of care, etc. as
mentioned above.
1. FLOOR SERVICE:
Medical Teaching Service (MTS): 5 general medicine teams consisting of one
resident and one intern each responsible for the care for non-critically ill
patients.
1) Each resident team will be assigned a teaching attending
2) During weekdays teams will be assigned to early call every 5 th day and
admit service/pick-a-doc patients from 7am-3pm. Private admissions will
be distributed to the non-call teams by the Medical admitting resident
(MAR) from 7am-3pm. ICU transfers will be accepted by the pickup team
until 3pm
3) During weekdays teams will be assigned to late call every 5th day and
admit service/pick-a-doc/private patients/ICU transfers from 3pm-7:30pm.
Admissions called for after 7:30pm may be passed on to night float.
4) Early and late call teams will each have a cap of 5 new admissions.
Night float team will have a cap of 7 new admissions with the night float
intern doing the first 5 admissions and the senior resident doing the extra
2. Once the admission cap is reached all service/pick-a-doc admits will be
done by housedoc and distributed to MTS teams the next morning
5) Admitting physicians must call beeper #580 with admissions.
6) Saturday/Holiday Call: The following call schedule applies for Saturday
and holiday calls
a) Senior residents will arrive at 8am and work a continuous 24
hour shift until 8am the following morning at which time they will
leave.
b) The on-call intern will arrive at 8am and work a 12 hour shift until
8pm. During this time they will admit patients with the supervision
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of the on-call senior as well as take sign outs and provide cross
coverage for the four non-call teams.
c) At 8pm the following day’s pickup team’s intern will report and
work a 16 hour shift until 12noon the following day. They will admit
patients with the on-call senior and provide cross-coverage.
Patients admitted from 8pm to 8am will be followed by the pickup
team.
d) There is a cap of 5 new patients from 8am-8pm and another 5
new patients from 8pm-8am. Service/pick-a-doc patients that
require admission above this cap will be done by the housedoc as
noted above.
7) Pickups: The pick-up team will take patients admitted by night float.
a) If more than five patients are admitted overnight, night float resident
will redistribute the remainder of pick-ups to the team.
b) The pickup team will first pickup until their total census is at least
six. The non-call teams will then be given patients to reach a minimum
census of six. The night float resident will decide this redistribution.
b) If the pick-up team reaches a census of 14, the night float resident
will redistribute patients at their discretion.
c) All ICU transfers will be taken by the pick-up team until 3pm on
weekdays and 12pm on weekends. ICU transfers from 3-7:30pm will
be taken by the late call team.
8) Signing off: There can be no signing off of private attending patients
unless discussed with and approved by the site chief resident. There is no
signing off of service or pick-a-doc patients.
9) ICU transfers:
a) Transfers to MICU/CCU:
1) Floor team maintains primary care of patient until the intensivist
takes over or the patient moves to ICU. Service attending will
discuss case with intensivist prior to transfer.
2) Floor team is responsible for stabilizing the patient and writing
the transfer note.
3) If a private patient needs to go to the ICU, the private attending
must page the appropriate intensivist or cardiologist. The
intensivist or attending cardiologist must accept a patient before
they can be transferred to the ICU.
b) Transfers from MICU/CCU:
1) All patients leaving the ICU will have housestaff coverage except
those private attendings who do not have housestaff privileges.
ICU transfers will be accepted by the pick-up team until 3:00, and
then by the long call team until 7:30pm.
2) ICU attending will notify floor attending who will then notify #580
3) Floor team responsibility: To call admitting to change attending’s
name if necessary, notify attending, see the patient, and write a
brief accept note.
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10) Non-housestaff to housestaff transfers may only be accepted after
evaluation for teaching value by MAR (backup)
11) Bounce Backs: If you have taken care of a patient at any time during
the month, and they again require care from a medical teaching service
team, they will revert to your team the following morning. An exception to
this would be if another team has a low census and wishes to keep the
patient.
12) ACGME Limits
a) Each intern must not be assigned more than five new patients
per admitting day: an additional two patients may be assigned if
they are in-house transfers from the medical service.
b) Each intern must not be assigned more than eight new patients
in a 48 hour period.
c) Each intern must not be responsible for the ongoing care of more
than 10 patients.
d) A supervising resident; when supervising one intern must not be
responsible for the ongoing care of more than 14 patients; when
supervising more than one intern must not be responsible for the
ongoing care of more than 20 patients.
e) The supervising resident, when supervising more than one
intern, must not be responsible for the supervision or admission of
more than ten new patients and four transfer patients per admitting
day or more than 14 new patients in a 48 hour period.
13) Discharge Summaries: All patients discharged from a MTS service
must have a discharge summary entered in QCPR by the residents.
Exceptions to this are patients who are discharged with a private
attending.
14) Days off: Four days off allowed per month where the resident cannot
take off long call days, pick-up days, and post-call day. The chief resident
needs to be notified by the floor resident at the start of the month.
15) Holidays: Only one member of the team should be present on holidays
unless on long call or pick-up. Notify the chief resident at the start of each
month which member of the team will be present.
16) Transitions of Care:
a) In an attempt to minimize the number of transitions in patient
care, to ensure and monitor effective, structured handover
processes to facilitate both continuity of care and patient safety,
and to ensure that residents are competent in communicating
with team members in the handover process, we require
residents to adhere to the following guideline regarding
transitions of care
b) All patients cared for by the Medical Teaching Service must
have a written sign out completed using the hospital intranet
system only. Signouts should be kept secure as they contain
protected health information.
c)
Sign out should include the following:
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a. Patient name, attending physician, consultants, drug
allergies/adverse reactions and code status.
b. A brief description of the reason for admission
c. A list of active problems and the treatment plan, as well
as any anticipated issues and possible solutions
d. Any recent procedures or tests
d) Sign out must be updated daily to reflect changes in the
patient’s clinical course.
e) Transitions of care must be done face-to-face between the
outgoing and incoming resident in compliance with all HIPAA
regulations.
f) The on-call and coverage schedules for residents and
attendings on teaching service are available on the hospital
intranet.
3. NIGHT FLOAT SERVICE: Two week rotation consisting of one senior resident
and one intern. The senior resident is assigned to admit floor patients and help
the intern with cross covering duties. The intern is assigned to cross cover and
help with floor admissions.
a. Hours: 8pm to 8:30am Sunday through Friday Nights. Night float has
Saturday night and Holidays off.
b. There is a cap of seven new admissions, and two ICU transfers
c. Redistribution of overnight admissions is according to night float. See
pickup policy above.
d. Night float will attend board review (7-7:45am) and night float rounds (88:30 am) daily.
4. BACK-UP SERVICE:
a. Specific responsibilities:
1) Attend board review and other conferences
2) Back-up will act in role of MAR between 7am-3pm, and will hold 580
and receive calls on all new admissions. Will give all service and picka-doc admits to early call team. Will give private admits to other teams
(except late-call) based on census. At 3pm will give 580 to late-call
team. When back up is in clinic, the early call resident will serve MAR
role until 3pm.
3) Cross-cover from afternoon sign-outs until night float arrives
4) Assist floor teams with procedures, admissions, etc.
5) Assist interns on days when senior residents are off as needed for
guidance
6) Help the long call team with admissions from 12:00 pm– 8 pm.
Back-up is only to help admitting team if there are three or more
patients waiting.
7) Cross cover the housestaff patients on floors between 4:30pm8:00pm.
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9) No Backup on weekends/holidays.
B. Call Schedule
There is a call schedule for each academic month that can be located on
www.amion.com. The coverage schedule can be found on the Angel website. It
is the resident’s responsibility to check the call schedule and to know when
he/she is either on call or covering for another resident.
Please leave your pager on until 8pm even when you are not on call and respond
to pages from “609-497-4484”.
C. Conference/Clinic Requirements
Residents must attend all required educational activities of the program including
noon conference, noon report, Grand Rounds, Art of Medicine, Business of
Medicine, etc. promptly as per the conference schedule. All PGY-3 and PGY-2
residents on night float, floor service and MICU are strongly encouraged to
attend Board Review.
Residents must attend weekly continuity clinic and assigned additional clinics
(except when post night float call or post-overnight call).
D. Daily Schedule
1. Weekday:
a. Floor service:
7:00 – 7:45 am Board Review for residents
7:00am Sign in rounds in Resident Lounge
10:45 – 11:45am Attending Rounds
12:00-1:30 pm Noon Report and Noon Conference
4:30pm (or later) Sign out to Backup Resident where all work must be
done
8:00pm On call resident and backup signs out to Night Float in
Resident Lounge
Additional Conferences: Grand Rounds Tuesday from September to
June 8:00 am, Art of Medicine/Business of medicine to be detailed in
monthly schedule
c. Night Float:
7:00am Board Review for residents
7:00am Sign in rounds in Resident Lounge
8:00 – 8:30 am Night Float Rounds
8:00pm Residents sign out to Night Float in Resident Lounge
d. Back-up:
7:00 am Board Review
12-1:30 pm Noon Report/Noon Conference
1:30-8:00pm Follows daily coverage schedule found on white coverage
sheets (MICU, Floor coverage)
4:30pm (or later) Gets sign-outs from teams
8:00pm Backup resident signs out to Night Float in Resident Lounge
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2. Weekend/ Holiday:
a. Floor service:
8:00am Sign in rounds in Resident Lounge
12:00pm (or later) Sign out to Resident holding #560 when all work is
done
8:00pm (on Sundays only) sign out to Night Float Residents in
Resident Lounge
c. Night Float:
8:00am Saturday morning sign in rounds in Resident Lounge
8:00pm Sunday evening sign out rounds in Resident Lounge
d. Backup: Off
F. Beepers:
• 580 - Admitting resident (floor/code beeper)
• 560 - Floor cross cover (housestaff pts.)/code beeper
• 510 – Chief Resident
• 400 – house doc
•
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1. Weekday Schedule:
Time
7am - 3pm
580
Backup Resident
560
Early call resident
3pm - 8pm
Late call resident
(BU resident while on-call
resident at clinic)
8pm – 7am
Night Float Floor resident
Backup resident (Assigned
intern from 12:00pm while
on-call resident or back-up
at clinic)
Night Float intern
580
On-call resident
560
On call intern
On-call resident
Pick-up intern
580
On-call resident
560
On-call intern
Night Float Floor resident
Night Float intern
2. Saturday/Holiday Schedule:
Time
8am – 8pm
8pm – 8am
3. Sunday Schedule:
Time
8am – 8pm
8pm – 7am
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Policy Name: Elective Policy
Policy Number: 31
Approval by Program Leadership: 7/1/05
Amendment Date: 6/9/11
Purpose:
Residency electives are designed to expose residents to different medical
subspecialties and educational areas that will enhance their medical knowledge
and ability to care for patients. This policy governs the activities necessary to
maximize the elective experience.
Policy:
Expectations of a resident on elective:
1. Review pertinent elective material (schedule, goals and objectives) in the
elective manual located on the residency website prior to starting the elective.
2. Demonstrate self-directed learning through independent reading about the
diseases encountered during the elective.
3. Contact elective director 2-3 days prior to start of elective to confirm
schedule
4. Report to the elective on time and maintain a professional demeanor at all
times.
5. Attend all required educational activities of the program as per the elective
schedule sheet.
6. Attend weekly continuity clinic and additional clinics as scheduled.
7. Play an active role in patient encounters. (Take a thorough history and
physical exam, present case to attending, discuss management, and
document appropriately in the chart.)
8.Keep personal pager on from 7am to 5pm fully charged and respond
immediately to all pages in a timely manner.
9. Contact chief resident and elective director if unable to attend elective (e.g.
Float day, personal day, sick day, interview, etc).
Of note, any resident who wants to complete an away elective must first submit a
proposal including advisor, method of evaluation, goals and objectives, activity,
and hours of the week to the chief residents and Program Director for approval.
The program leadership will decide whether this elective is appropriate based on
previous elective activity. It is expected for the resident to attend weekly
continuity clinic unless prior approval from the chief residents.
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Policy Name: Evaluation Policy
Policy Number: 32
Approval by Program Leadership: 7/1/05
Amendment Date:
Purpose:
Evaluations are used to assess the academic performance of residents on a
continuing basis and to determine whether residents are making satisfactory
academic progress. Academic matters include acquisition of knowledge related
to the discipline as well as all aspects of the development of clinical and
professional skills necessary for effective functioning as a health care
professional. Evaluations are also used to help the residency program improve
on its ability to train the residents.
Policy:
All residents are evaluated through a 360° evaluation process.
Residents evaluate the Residency Program, hospital sites, clinic, clinical
outcomes, attendings, and other residents through the E*value system.
Residents will be notified through email that an evaluation is outstanding. Please
complete them promptly.
Residents may view their own evaluations using E*value. Residents will not be
able to view their own evaluation until they have completed all outstanding
E*value evaluations.
For detailed information on evaluations please see the Evaluation Manual found
on the residency website.
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Policy Name: Pharmaceutical Industry Interaction Policy
Policy Number: 33
Approval by Program Leadership: 7/1/05
Amendment Date: 5/25/10
Purpose:
The paramount purpose of our residency is to prepare physicians for a lifetime of
practice within their discipline. In the current system of healthcare, physicians
will need to develop their own attitudes toward the pharmaceutical industry.
Policy:
We have decided to restrict interaction of residents during work hours with
pharmaceutical representatives under the following conditions:
1) All materials disseminated to residents must be of an educational basis.
Books, articles, reference cards, PDA software, grants and such are
examples.
2) Interaction between the pharmaceutical industry and housestaff will be
prohibited during duty hours.
3) All other pharmaceutical representative access must be approved by the
Program Director.
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Policy Name: Housestaff Supervision Policy
Policy Number: 34
Approval by Program Leadership: 1/11/06
Amendment Date:
Purpose:
To ensure that residents are directly supervised by board certified physicians at
all times.
Policy:
All medicine housestaff must be under appropriate guidance, education and
direct supervision of board certified internists on all ward, critical care,
ambulatory medicine and subspecialty medicine rotations. This is effected via
direct communication in a timely and professional manner.
When rotating through specialties outside the scope of internal medicine,
residents must be supervised by board certified attending physicians practicing
those specialties.
Attending physicians must take primary responsibility for interfacing with the
involved housestaff to comply with the educational objectives of the rotation,
which include but is not limited to individual patient care management.
Failure of an attending physician to comply with this policy may result in the
removal of assignment of housestaff for that physician and his/her group.
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Policy Name: Subspecialty Fellow and Internal Medicine
Resident Interaction Policy
Policy Number: 35
Approval by Program Leadership: 1/12/05
Amendment Date:
Purpose:
To delineate the responsibility of patient care between subspecialty fellows and
internal medicine residents.
Policy:
Medicine residents are responsible for initiating and implementing diagnostic,
therapeutic, dispositional and educational plans on all patients on their service,
once they have discussed with the attending of record, subspecialist of record or
his/her designate (i.e. fellow or nurse practitioner).
Medicine resident teams are responsible for the overall day to day patient
management, including all order writing. Subspecialty fellows, when involved in
the case, assume supervisory responsibility as a “junior attending physician” and
will be available on a daily basis to provide guidance as needed. This is to the
exclusion of when a resident’s service cap is exceeded (as found in the RWJUH
service policy above). In that instance, the subspecialty fellow will assume the
responsibility of the day to day patient management for the number of patients
that exceeds the resident’s service cap (as found in the RWJUH service policy
above).
Subspecialty fellows must be available for immediate consultation on any patient,
when an initial consultation is requested or when a patient’s status changes.
Subspecialty fellows must provide guidance for the performance of procedures,
as indicated above in the procedures policy, by the medical residents.
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Policy Name: Teaching Service Responsibilities for Medical
Teaching Service (MTS), Oncology Teaching Service (OTS),
Night Float, GIM Consults and Back-up at RWJUH and UMCP
Policy
Policy Number: 36
Approval by Program Leadership: 1/19/05
Amendment Date: 5/25/10
Purpose:
To ensure that residents understand their responsibilities and expectations when
on MTS, CTS, OTS, Night Float, GIM consults and Back-up at RWJUH and
UMCP.
Policy:
A. Expectations of a PGY 1 Resident on Teaching Service:
1. Medical Knowledge
a. Educate other members of the team.
1) Follow-up on assigned literature searches
2) Play a supervisory role for the third year medical students
a) Teach 3rd year med students on a case by case basis
b) REVIEW student progress notes WITH the student and then co-sign
c) CRITICALLY evaluate and provide feedback to students on a
regular basis
d) Discuss differential diagnosis and disease process
e) PLEASE contact Dr. Kim or Dr. Walker with any questions/problems
regarding students
b. Demonstrate enthusiasm for learning through independent reading.
2. Patient Care
a. Responsible for all assigned patients.
1) Have knowledge of current medications and daily vital signs.
2) Follow up results of all labs (including trends), diagnostic tests, and
consult reports.
b. Perform assigned tasks with supervision from senior residents.
c. Learn how to formulate a differential diagnosis
d. Learn how to analyze and manage clinical problems
e. Give appropriate informed consent in a manner patients understand.
f. Ensure satisfactory completion of reasonable tasks at the end of the
shift/day with appropriate signouts and transfer of care.
g. Involve patients in developing mutually acceptable investigation and
treatment plans
h. Encourage participation in appropriate disease prevention or screening
programs
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3. Interpersonal and Communication Skills
a. Relay organized oral case presentations.
b. Perform full history & physical examinations on new patients and daily
progress notes on assigned patients.
1) Write comprehensive, accurate and legible notes
c. Dictate discharge summaries on the day of discharge if resident is in
clinic or has the day off.
d. Present choices and recommendations to patients in an appropriate
manner to ensure informed consent
1) Avoid jargon and use familiar language
2) Use interpreters appropriately
3) Give clear information and feedback to patients and share information
with relatives when appropriate
4) Importance of patient confidentiality
5) Respect the patient’s choice(s) and wish(es)
6) Act with empathy and sensitivity
e. Deal with dissatisfied and difficult patients/relatives
f. Effectively interact with health care providers in the care of each patient
g. Hand over the care of the patient safely (signouts)
h. Understand your personal role within the team and interact appropriately
with team members
4. Professionalism
a. Answer pages in a timely fashion.
b. Maintain a professional demeanor at all times.
1) Recognize the importance of punctuality and attention to detail
c. Acts with empathy, honesty and sensitivity towards the patient
1) Maintain awareness of patient dignity, confidentiality and cultural/ethnic
issues
2) Recognize the importance of: involving patients in decisions, offering
choices and respecting patient’s views
3) Adopt a non-discriminatory attitude to all patients and recognizes the
patient’s needs as an individual
e. Demonstrate timely documentation and chart completion
f.. Be eager to learn and show a willingness to learn from colleagues
h. Be willing to seek advice of other residents, chief residents, program
directors, department chair, attendings and regulatory authorities
5. Systems Based Practice
a. Begin to understand the indications for ordering diagnostic tests and
calling consults
b. Learn to communicate effectively with consultants, nurses, ancillary staff,
patients and family members.
1) Ensure that notes are accessible to all members of the team and
patients under certain circumstances
2) Have respect for colleagues
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c. Understand circumstances dictating need for chaperone
d. Work as a part of a team.
1) Demonstrate the ability to communicate effectively with other team
members
6. Practice Based Learning and Improvement
a. Learn how to critically appraise and tailor evidence to the clinical context
b. Understand the role of appraisal and of assessment
1) The intern evaluates the resident using E-Value.
2). The intern evaluates the attending, using E-Value, on the basis of
teaching interest and effectiveness, medical knowledge, physical exam
teaching skills, emphasis on cost-effectiveness, and degree of
availability.
3) Demonstrate improvement using feedback
c. Random chart audits and mini-CEXs will be performed.
B. Expectations of a PGY 2 on Teaching Service:
1. Medical Knowledge
a. Educate other members of the team.
1) Perform literature searches and bring pertinent articles for discussion
2) Teach practical management to interns and sub-Is
3) Play a supervisory role for the third year medical students
a) Select appropriate patients for students
b) Ensure that students carry 2-4 patients at ALL times
c) REVIEW All student progress notes WITH the student and then
co-sign
d) CRITICALLY evaluate and provide feedback to students on a
regular basis
e) Discuss differential diagnosis and disease process
f) PLEASE contact Dr. Kim or Dr. Walker with any
questions/problems regarding students
b. Demonstrate enthusiasm for learning through independent reading.
c. Identify symptom patterns and the physiological basis of physical signs.
d. Understand how to prioritize patients/clinical tasks and utilizing the
appropriate decision making capacity in the clinical investigation and
management of these tasks.
2. Patient Care
a. Assume supervisory responsibility for all patients on the team (you have to
know all patients on your team!).
b. Effectively lead the team
1) Delegate tasks appropriately among the members of the team.
2) Organize and lead rounds effectively including work rounds WITH
the intern.
3) Manage time appropriately.
4) Foster teamwork.
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c. Identify and synthesize problems and learn how to formulate a differential
diagnosis
d. Analyze and manage clinical problems
e. Give appropriate informed consent in a manner patients understand.
f. Ensure satisfactory completion of reasonable tasks at the end of the
shift/day with appropriate signouts and transfer of care.
g. Involve patients in developing mutually acceptable investigation and
treatment plans
h. Encourage participation in a appropriate disease prevention or screening
programs
i. Recognize critically ill patients and when in-patient care is not required
3. Interpersonal and Communication Skills
a. Relay organized oral case presentations.
b. Write accurate, legible and meaningful notes and other documentation..
c. Dictate discharge summaries on the day of discharge.
d. Present choices and recommendations to patients in an appropriate
manner to ensure informed consent
1) Avoid jargon and use familiar language
2) Use interpreters appropriately
3) Give clear information and feedback to patients and share information
with relatives when appropriate
4) Importance of patient confidentiality
5) Respect the patient’s choice(s) and wish(es)
6) Act with empathy and sensitivity
e. Deal with dissatisfied and difficult patients/relatives
f. Effectively interacts with health care providers in the care of each patient
g. Hand over the care of the patient safely (signouts)
4. Professionalism
a. Answer pages in a timely fashion.
b. Maintain a professional demeanor at all times.
1) Recognizes the importance of punctuality and attention to detail
c. Recognize the impact of physical problems on psychological and social
well being
d. Act with empathy, honesty and sensitivity towards the patient
1) Maintain awareness of patient dignity, confidentiality and cultural/ethnic
issues
2) Recognize the importance of: involving patients in decisions, offering
choices and respecting patient’s views
3) Adopt a non-discriminatory attitude to all patients and recognizes the
patient’s needs as an individual
e. Demonstrate timely documentation and chart completion
f. Has realistic expectations of tasks to be completed by self and others
g. Be eager to learn and show a willingness to learn from colleagues
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h. Be willing to seek advice of chief residents, program directors, department
chair and regulatory authorities
5. Systems Based Practice
a. Communicate effectively with consultants, nurses, ancillary staff, patients
and family members.
1) Ensure that notes are accessible to all members of the team and patients
under certain circumstances
2) Recognize the benefits of prompt communication with primary care and
timely dictation
3) Have respect for colleagues
b. Order diagnostic tests and consults appropriately.
c. Understand circumstances dictating need for chaperone
d Work as a part of a team.
1) Demonstrate ability to communicate effectively with other team members
e. Identify local resources for assistance
1) Demonstrate the ability to access and refer patients to tools that aid in
patient education of disease, treatment and outcomes
f. Involve other health care providers as appropriate
6. Practice Based Learning and Improvement
a. Actions should reflect learning from previous experiences
1) Tailor evidence to the clinical context
2) Critical appraisal of evidence
b. Understands the role of appraisal and of assessment
1) The resident evaluates the intern using E-Value.
2). The resident evaluates the attending, using E-Value, on the basis of
teaching interest and effectiveness, medical knowledge, physical exam
teaching skills, emphasis on cost-effectiveness, and degree of
availability.
3) Demonstrate improvement using feedback
c. Random chart audits and mini-CEXs will be performed.
C. Expectations of a PGY 3 on Teaching Service:
1. Medical Knowledge
a. Educate other members of the team.
1) Perform literature searches and bring pertinent articles for discussion
2) Teach practical management to interns and sub-Is
3) Play a supervisory role for the third year medical students
a) Select appropriate patients for students
b) Ensure that students carry 2-4 patients at ALL times
c) REVIEW All student progress notes WITH the student and then cosign
d) CRITICALLY evaluate and provide feedback to students on a regular
basis
e) Discuss differential diagnosis and disease process
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f) PLEASE contact Dr. Kim or Dr. Walker with any questions/problems
regarding students
b. Demonstrate enthusiasm for learning through independent reading.
c. Identify symptom patterns and the physiological basis of physical signs.
d. Understand how to prioritize patients/clinical tasks and utilizing the
appropriate decision making capacity in the clinical investigation and
management of these tasks.
2. Patient Care
a. Assume supervisory responsibility for all patients on the team (you have to
know all patients on your team!).
b. Effectively lead the team
1) Delegate tasks appropriately among the members of the team.
2) Organize and lead rounds effectively including work rounds WITH the
intern.
3) Manage time appropriately.
4) Foster teamwork.
c. Identify and synthesize problems and learn how to formulate a differential
diagnosis
d. Analyze and manage clinical problems
e. Give appropriate informed consent in a manner patients understand.
f. Ensure satisfactory completion of reasonable tasks at the end of the
shift/day with appropriate signouts and transfer of care.
g. Involve patients in developing mutually acceptable investigation and
treatment plans
h. Encourage participation in a appropriate disease prevention or screening
programs
i. Recognize critically ill patients and when in-patient care is not required
3. Interpersonal and Communication Skills
a. Relay organized oral case presentations.
b. Write accurate, legible and meaningful notes and other documentation..
c. Dictate discharge summaries on the day of discharge.
d. Present choices and recommendations to patients in an appropriate
manner to ensure informed consent
1) Avoid jargon and use familiar language
2) Use interpreters appropriately
3) Give clear information and feedback to patients and share information
with relatives when appropriate
4) Importance of patient confidentiality
5) Respect the patient’s choice(s) and wish(es)
6) Act with empathy and sensitivity
e. Deal with dissatisfied and difficult patients/relatives
f. Effectively interacts with health care providers in the care of each patient
g. Hand over the care of the patient safely (signouts)
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4. Professionalism
a. Answer pages in a timely fashion.
b. Maintain a professional demeanor at all times.
1) Recognizes the importance of punctuality and attention to detail
c. Recognize the impact of physical problems on psychological and social
well being
d. Act with empathy, honesty and sensitivity towards the patient
1) Maintain awareness of patient dignity, confidentiality and cultural/ethnic
issues
2) Recognize the importance of: involving patients in decisions, offering
choices and respecting patient’s views
3) Adopt a non-discriminatory attitude to all patients and recognizes the
patient’s needs as an individual
e. Demonstrate timely documentation and chart completion
f. Has realistic expectations of tasks to be completed by self and others
g. Be eager to learn and show a willingness to learn from colleagues
h. Be willing to seek advice of chief residents, program directors, department
chair and regulatory authorities
5. Systems Based Practice
a. Communicate effectively with consultants, nurses, ancillary staff, patients
and family members.
1) Ensure that notes are accessible to all members of the team and patients
under certain circumstances
2) Recognize the benefits of prompt communication with primary care and
timely dictation
3) Have respect for colleagues
b. Order diagnostic tests and consults appropriately.
c. Understand circumstances dictating need for chaperone
d Work as a part of a team.
1) Demonstrate ability to communicate effectively with other team members
e. Identify local resources for assistance
1) Demonstrate the ability to access and refer patients to tools that aid in
patient education of disease, treatment and outcomes
f. Involve other health care providers as appropriate
6. Practice Based Learning and Improvement
a. Actions should reflect learning from previous experiences
1) Tailor evidence to the clinical context
2) Critical appraisal of evidence
b. Understands the role of appraisal and of assessment
1) The resident evaluates the intern using E-Value.
2). The resident evaluates the attending, using E-Value, on the basis of
teaching interest and effectiveness, medical knowledge, physical exam
teaching skills, emphasis on cost-effectiveness, and degree of
availability.
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3) Demonstrate improvement using feedback
c. Random chart audits and mini-CEXs will be performed.
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Policy Name: Teaching Service Responsibilities for Medical
Intensive Care Unit Service (ICU) at RWJUH Policy
Policy Number: 37
Approval by Program Leadership: 1/19/05
Amendment Date: 5/25/10
Purpose:
To ensure that residents understand their responsibilities and expectations when
on ICU at RWJUH.
Policy:
A.
Expectations of a PGY-1 on ICU Teaching Service
1. Medical Knowledge
a. Educate other members of the team.
1) Follow-up on assigned literature searches
2) Play a supervisory role for the third year medical students
a) Teach 3rd year med students on a case by case basis
b) REVIEW student progress notes WITH the student and then co-sign
c) CRITICALLY evaluate and provide feedback to students on a regular
basis
d) Discuss differential diagnosis and disease process
e) PLEASE contact Dr. Kim or Dr. Walker with any questions/problems
regarding students
b. Demonstrate enthusiasm for learning through independent reading.
c. Adhere to ICU rounding and conference schedule.
d. Review with attending, fellow and residents all deaths that occur during the
month.
e. To learn the basic tenets of stabilization of critically ill patients.
f. To become proficient in various procedures, particularly central line
placement and ACLS
2. Patient Care
a. Responsible for all assigned patients.
1) Have knowledge of current medications and daily vital signs.
2) Follow up results of all labs (including trends), diagnostic tests, and
consult reports.
b. Perform assigned tasks and procedures with supervision from senior
residents, fellows and intensivists.
c. Learn how to formulate a differential diagnosis
d. Learn how to analyze and manage clinical problems
1) To recognize changes in clinical status of patients from stable to unstable
and vice-versa
e. Give appropriate informed consent in a manner patients understand.
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f. Ensure satisfactory completion of reasonable tasks at the end of the
shift/day with appropriate signouts and transfer of care.
g. Involve patients in developing mutually acceptable investigation and
treatment plans
3. Interpersonal and Communication Skills
a. Relay organized oral case presentations.
b. Perform full history & physical examinations on new patients and daily
progress notes on assigned patients.
1) Write comprehensive, accurate and legible notes
c. Dictate discharge summaries on the day of discharge if resident is in clinic
or has the day off.
d. Present choices and recommendations to patients and families in an
appropriate manner to ensure informed consent
1) Avoid jargon and use familiar language
2) Use interpreters appropriately
3) Give clear information and feedback to patients and share information
with relatives when appropriate
4) Importance of patient confidentiality
5) Respect the patient’s and family’s choice(s) and wish(es)
6) Act with empathy and sensitivity
e. Deal with dissatisfied and difficult patients/relatives
f. Effectively interact with health care providers in the care of each patient
g. Hand over the care of the patient safely (signouts)
h. Understand your personal role within the team and interact appropriately
with team members
4. Professionalism
a. Answer pages in a timely fashion.
b. Maintain a professional demeanor at all times.
1) Recognize the importance of punctuality and attention to detail
c. Act with empathy, honesty and sensitivity towards the patient
1) Maintain awareness of patient dignity, confidentiality and cultural/ethnic
issues
2) Recognize the importance of: involving patients in decisions, offering
choices and respecting patient’s views
3) Adopt a non-discriminatory attitude to all patients and recognizes the
patient’s needs as an individual
e. Demonstrate timely documentation and chart completion
f. Be eager to learn and show a willingness to learn from colleagues
h. Be willing to seek advice of other residents, chief residents, program
directors, department chair, attendings and regulatory authorities
5. Systems Based Practice
a. Begin to understand the indications for ordering diagnostic tests and calling
consults
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b. Learn to communicate effectively with consultants, nurses, ancillary staff,
patients and family members.
1) Ensure that notes are accessible to all members of the team and patients
under certain circumstances
2) Have respect for colleagues
3) To learn to work within a multidisciplinary team to provide care to a
critically ill patient.
c. Understand circumstances dictating a need for a chaperone
d. Work as a part of a team.
1) Demonstrate the ability to communicate effectively with other team
members
6. Practice Based Learning and Improvement
a. Learn how to critically appraise and tailor evidence to the clinical context
b. Understand the role of appraisal and of assessment
1) The intern evaluates the resident using E-Value.
2). The intern evaluates the attending, using E-Value, on the basis of
teaching interest and effectiveness, medical knowledge, physical exam
teaching skills, emphasis on cost-effectiveness, and degree of availability.
3) Demonstrate improvement using feedback
c. Random chart audits and mini-CEXs will be performed.
B.
Expectations of a PGY 2 on ICU Teaching Service:
1. Medical Knowledge
a. Educate other members of the team.
1) Perform literature searches and bring pertinent articles for discussion
2) Teach practical management to interns and sub-Is
3) Play a supervisory role for the third year medical students
a) Select appropriate patients for students
b) Ensure that students carry 2-4 patients at ALL times
c) REVIEW All student progress notes WITH the student and then co-sign
d) CRITICALLY evaluate and provide feedback to students on a regular
basis
e) Discuss differential diagnosis and disease process
f) PLEASE contact Dr. Kim or Dr. Walker with any questions/problems
regarding students
b. Demonstrate enthusiasm for learning through independent reading.
c. Identify symptom patterns and the physiological basis of physical signs.
d. Understand how to prioritize patients/clinical tasks and utilizing the
appropriate decision making capacity in the clinical investigation and
management of these tasks.
e. Adhere to ICU rounding and conference schedule.
f. Review all deaths that occur during the month.
g. To recognize changes in clinical status of patients from stable to unstable
and vice-versa.
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h. To expose residents to patients with unstable, life-threatening medical
illnesses.
i. To learn the basic tenets of stabilization of critically ill patients
j. To become proficient in various procedures, particularly central line
placement and ACLS.
2. Patient Care
a. Assume supervisory responsibility for all patients on the team (you have to
know all patients on your team!).
b. Effectively lead the team
1) Delegate tasks appropriately among the members of the team.
2) Organize and lead rounds effectively including work rounds WITH the
intern.
3) Manage time appropriately.
4) Foster teamwork.
c. Identify and synthesize problems and learn how to formulate a differential
diagnosis
d. Analyze and manage clinical problems
e. Give appropriate informed consent in a manner patients understand.
f. Ensure satisfactory completion of reasonable tasks at the end of the
shift/day with appropriate signouts and transfer of care.
g. Involve patients in developing mutually acceptable investigation and
treatment plans
h. Recognize critically ill patients and when in-patient care is not required
3. Interpersonal and Communication Skills
a. Relay organized oral case presentations.
b. Write accurate, legible and meaningful notes and other documentation..
c. Dictate discharge summaries on the day of discharge.
d. Present choices and recommendations to patients in an appropriate
manner to ensure informed consent
1) Avoid jargon and use familiar language
2) Use interpreters appropriately
3) Give clear information and feedback to patients and share information
with relatives when appropriate
4) Importance of patient confidentiality
5) Respect the patient’s choice(s) and wish(es)
6) Act with empathy and sensitivity
e. Deal with dissatisfied and difficult patients/relatives
f. Effectively interacts with health care providers in the care of each patient
g. Hand over the care of the patient safely (signouts)
4. Professionalism
a. Answer pages in a timely fashion.
b. Maintain a professional demeanor at all times.
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1) Recognizes the importance of punctuality and attention to detail
c. Recognize the impact of physical problems on psychological and social
well being
d. Act with empathy, honesty and sensitivity towards the patient
1) Maintain awareness of patient dignity, confidentiality and cultural/ethnic
issues
2) Recognize the importance of: involving patients in decisions, offering
choices and respecting patient’s views
3) Adopt a non-discriminatory attitude to all patients and recognizes the
patient’s needs as an individual
e. Demonstrate timely documentation and chart completion
f. Has realistic expectations of tasks to be completed by self and others
g. Be eager to learn and show a willingness to learn from colleagues
h. Be willing to seek advice of chief residents, program directors, department
chair and regulatory authorities
5. Systems Based Practice
a. Communicate effectively with consultants, nurses, ancillary staff, patients
and family members.
1) Ensure that notes are accessible to all members of the team and patients
under certain circumstances
2) Recognize the benefits of prompt communication with primary care and
timely dictation
3) Have respect for colleagues
4) To learn to work within a multidisciplinary team to provide care to a
critically ill patient.
b. Order diagnostic tests and consults appropriately.
c. Understand circumstances dictating need for chaperone
d. Work as a part of a team.
1) Demonstrate ability to communicate effectively with other team members
e. Identify local resources for assistance
1) Demonstrate the ability to access and refer patients to tools that aid in
patient education of disease, treatment and outcomes
f. Involve other health care providers as appropriate
6. Practice Based Learning and Improvement
a. Actions should reflect learning from previous experiences
1) Tailor evidence to the clinical context
2) Critical appraisal of evidence
b. Understands the role of appraisal and of assessment
1) The resident evaluates the intern using E-Value.
2). The resident evaluates the attending, using E-Value, on the basis of
teaching interest and effectiveness, medical knowledge, physical exam
teaching skills, emphasis on cost-effectiveness, and degree of availability.
3) Demonstrate improvement using feedback
c. Random chart audits and mini-CEXs will be performed.
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C.
Expectations of a PGY 3 on ICU Teaching Service:
1. Medical Knowledge
a. Educate other members of the team.
1) Perform literature searches and bring pertinent articles for discussion
2) Teach practical management to interns and sub-Is
3) Play a supervisory role for the third year medical students
a) Select appropriate patients for students
b) Ensure that students carry 2-4 patients at ALL times
c) REVIEW All student progress notes WITH the student and then cosign
d) CRITICALLY evaluate and provide feedback to students on a regular
basis
e) Discuss differential diagnosis and disease process
f) PLEASE contact Dr. Kim or Dr. Walker with any questions/problems
regarding students
b. Demonstrate enthusiasm for learning through independent reading.
c. Identify symptom patterns and the physiological basis of physical signs.
d. Understand how to prioritize patients/clinical tasks and utilizing the
appropriate decision making capacity in the clinical investigation and
management of these tasks.
e. Adhere to ICU rounding and conference schedule.
f. Review all deaths that occur during the month.
g. To recognize changes in clinical status of patients from stable to unstable
and vice-versa.
h. To expose residents to patients with unstable, life-threatening medical
illnesses.
i. To learn the basic tenets of stabilization of critically ill patients
j. To become proficient in various procedures, particularly central line
placement and ACLS.
2. Patient Care
a. Assume supervisory responsibility for all patients on the team (you have to
know all patients on your team!).
b. Effectively lead the team
1) Delegate tasks appropriately among the members of the team.
2) Organize and lead rounds effectively including work rounds WITH the
intern.
3) Manage time appropriately.
4) Foster teamwork.
c. Identify and synthesize problems and learn how to formulate a differential
diagnosis
d. Analyze and manage clinical problems
e. Give appropriate informed consent in a manner patients understand.
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f. Ensure satisfactory completion of reasonable tasks at the end of the
shift/day with appropriate signouts and transfer of care.
g. Involve patients in developing mutually acceptable investigation and
treatment plans
h. Recognize critically ill patients and when in-patient care is not required
3. Interpersonal and Communication Skills
a. Relay organized oral case presentations.
b. Write accurate, legible and meaningful notes and other documentation..
c. Dictate discharge summaries on the day of discharge.
d. Present choices and recommendations to patients in an appropriate
manner to ensure informed consent
1) Avoid jargon and use familiar language
2) Use interpreters appropriately
3) Give clear information and feedback to patients and share information
with relatives when appropriate
4) Importance of patient confidentiality
5) Respect the patient’s choice(s) and wish(es)
6) Act with empathy and sensitivity
e. Deal with dissatisfied and difficult patients/relatives
f. Effectively interacts with health care providers in the care of each patient
g. Hand over the care of the patient safely (signouts)
4. Professionalism
a. Answer pages in a timely fashion.
b. Maintain a professional demeanor at all times.
1) Recognizes the importance of punctuality and attention to detail
c. Recognize the impact of physical problems on psychological and social
well being
d. Act with empathy, honesty and sensitivity towards the patient
1) Maintain awareness of patient dignity, confidentiality and cultural/ethnic
issues
2) Recognize the importance of: involving patients in decisions, offering
choices and respecting patient’s views
3) Adopt a non-discriminatory attitude to all patients and recognizes the
patient’s needs as an individual
e. Demonstrate timely documentation and chart completion
f. Has realistic expectations of tasks to be completed by self and others
g. Be eager to learn and show a willingness to learn from colleagues
h. Be willing to seek advice of chief residents, program directors, department
chair and regulatory authorities
5. Systems Based Practice
a. Communicate effectively with consultants, nurses, ancillary staff, patients
and family members.
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1) Ensure that notes are accessible to all members of the team and patients
under certain circumstances
2) Recognize the benefits of prompt communication with primary care and
timely dictation
3) Have respect for colleagues
4) To learn to work within a multidisciplinary team to provide care to a
critically ill patient.
b. Order diagnostic tests and consults appropriately.
c. Understand circumstances dictating need for chaperone
d. Work as a part of a team.
1) Demonstrate ability to communicate effectively with other team members
e. Identify local resources for assistance
1) Demonstrate the ability to access and refer patients to tools that aid in
patient education of disease, treatment and outcomes
f. Involve other health care providers as appropriate
6. Practice Based Learning and Improvement
a. Actions should reflect learning from previous experiences
1) Tailor evidence to the clinical context
2) Critical appraisal of evidence
b. Understands the role of appraisal and of assessment
1) The resident evaluates the intern using E-Value.
2). The resident evaluates the attending, using E-Value, on the basis of
teaching interest and effectiveness, medical knowledge, physical exam
teaching skills, emphasis on cost-effectiveness, and degree of availability.
3) Demonstrate improvement using feedback
c. Random chart audits and mini-CEXs will be performed.
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Policy Name: Academic Travel Process Policy
Policy Number: 38
Approval by Program Leadership: 6/1/07
Purpose:
This policy addresses the process each resident must follow prior to traveling to
a regional or national conference.
Policy:
The following steps must be taken before attending an academic conference at
which a resident is presenting:
1. Prior to accepting an invitation to present at an academic conference, the
resident must obtain approval by Dr. Sharma.
2. 8-10 weeks prior to travel, the resident needs to fill out the Travel Approval
form and return it to Kim Inzano. Along with the form, all documentation
for the trip should be provided including the conference itinerary, title of
resident’s presentation, hotel arrangements and flight plans. The approval
form can be obtained from Kim in the Residency Office (phone# 732-2357742, fax#732-235-7427)
3. The Residency Office will forward the approval form along with supporting
documents to Jean Feeney in the Ethics Office. The Ethics Office
generally takes about 4 weeks to give approval.
4. Once approval is obtained, Kim Inzano will notify the resident. At which
time, the resident must fill out the Travel Advance form and submit it to
Kim along with any other supporting documents needed. On this form,
question #3, asking if the resident will be staying at the conference
designated hotel, must be checked yes or no. If yes, the university will
pay for the cost of the hotel. If no, the university will only pay $100 per
diem. If the resident is not staying at the conference designated hotel and
the cost will be more than $100/day, he or she must send a memo to Dr.
Kostis at the time of filling out this form stating the cost and the justification
for staying at the non-conference designated hotel. For question #4, the
resident should enter the university allowance for meals which is
equivalent to $45/day. Again, if anything more than that amount is
entered, a memo must be sent to Dr. Kostis with justification for the
amount entered.
5. If the above timeline is followed properly, a check will be issued for up to
90% of the projected cost of the trip prior to travel. The remaining 10%
will be reimbursed upon the resident’s return.
6. If there is a delay in approval, a check advance will not be issued.
Instead, the resident will be reimbursed upon his or her return.
7. After returning, the resident must fill out a travel expense report detailing
all expenses for which he or she would like to be reimbursed. All receipts
must accompany this form.
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For a more detailed explanation of the university policy please click the link
below:
http://www.umdnj.edu/oppmweb/Policies/HTML/financial/00-01-50-10_00.html
Expenses will not be reimbursed if you fail to comply with the university policies.
Policy Name: Transitions of Care
Policy Number: 39
Approval by Program Leadership: 05/17/2012
Amendment Date: n/a
Purpose:
To ensure and monitor effective, structured handover processes to facilitate both
continuity of care and patient safety, and to ensure that residents are competent
in communicating with team members in the handover process, we require
residents to adhere to the following guidelines regarding transitions of care:
Policy:
Transitions of Care:
1) In an attempt to minimize the number of transitions in patient care, the
residency program has a structured nightfloat (general medical floors) and
night shift (Intensive Care Units) system.
2) All patients cared for by the Medical Teaching Service must have a written
sign out completed using the hospital intranet system only. Signouts should
be kept secure as they contain protected health information.
3) Sign out should include the following:
a) Patient name, attending physician, consultants, drug allergies/adverse
reactions and code status.
b) A brief description of the reason for admission
c) A list of active problems and the treatment plan, as well as any anticipated
issues and possible solutions
d) Any recent procedures or tests
4) Sign out must be updated on a daily basis to reflect changes in the patient’s
clinical course.
5) Transitions of care must be done face-to-face between the outgoing and
incoming resident in compliance with all HIPAA regulations.
6) All interns will be introduced to the process of signouts during the Clinical
Skills Initiative rotation in July-August of the academic year with periodic
overviews during monthly orientation.
7) To assess competency in communication related to transitions of care, sign
out “mini CEX’s” will be performed by the senior resident or attending at
random and feedback provided.
8) The on-call and coverage schedule for residents and attendings is available
on the hospital intranet.
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