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PoliciesandProceduresManualLastUpdate6/13/201708:30AM Page1

InternalMedicine ResidencyTrainingProgram

PoliciesandProceduresManual

2017‐2018

EffectiveJuly1,2017


TableofContents

I. DEFINITIONSANDDESCRIPTIONS II. PROGRAM OVERVIEW A. DEPARTMENT LEADERSHIP 1. Chair 2. ViceChair 3. ProgramDirector 4. AssociateProgramDirectors 5. CoreFaculty 6. ProgramStaff

B. SPONSORINGINSTITUTION C. AFFILIATEDINSTITUTIONS 1. Hospitals 2. Clinics

D. LEVELSOFTRAINING E. APPOINTMENTANDREAPPOINTMENT 1. Appointment 2. ReappointmentandPromotion

F. STRUCTUREOFTHEPROGRAM G. SCHEDULES 1. MonthlySchedules 2. VacationsandTimeOff 3. ReadyReserve/JeopardyCall 4. SickLeave/LeaveofAbsence 5. LeaveofAbsence 6. MilitaryLeave 7. FamilyandMedicalLeave(FMLA) 8. Holidays 9. ReportingTime‐Off

H. SUPERVISIONPOLICY 1. General 2. InpatientServices 3. OutpatientServices 4. ProceduresPerformedbytheResident

I. ROLESANDRESPONSIBILITIESOFRESIDENTS 1. MedicalRecordsandClinicalDocumentation

J. EXPOSURETOINFECTIOUSDISEASES K. EVALUATIONANDADVANCEMENT 1. ResidentEvaluations 2. RotationEvaluations 3. PeerEvaluations 4. AttendingEvaluations


5. ResidentSelf‐Evaluations 6. SixMonthEvaluations 7. ClinicalEvaluationExercise 8. In‐TrainingExam 9. PreandPostTests

10. EvaluationCriteria 11. ProblemsandComplaintsaboutEvaluation 12. Retaliation L. MedicalLicensure 1. DEAANDDPSNUMBERS

M. EDUCATIONALMEETINGSANDCONFERENCES 1. ResidentCaseConferences 2. CoreCurriculumLectures 3. GrandRounds 4. SeniorSeminar 5. BoardReviewConference 6. MultidisciplinaryWeek

N. PROFESSIONALATTIREANDETIQUETTE O. MOONLIGHTING P. DUTYHOURS 1. Policy 2. On‐CallActivities 3. SubspecialtyProgramRequirements 4. Professionalism,PersonalResponsibility,andPatientSafety

Q. GRIEVANCES R. CORRECTIVEAND/ORADVERSEACTIONS 1. SummaryActionswhenResidentMayPoseaThreattoPatientSafety 2. AcademicActions 3. Non‐AcademicActions 4. DutytoReport

S. CONDITIONSOFSEPARATION 1. Resignation 2. Separation 3. Termination

T. PAGERS U. EMAIL V. LABCOATS W. PARKING X. HIPAA Y. DISASTERPREPAREDNESSPLAN Z. Conclusion


I. DEFINITIONSANDDESCRIPTIONS Resident: The term “Resident” encompasses all Internal Medicine and Internal Medicine Pediatrics Program Residents from PGY1 to PGY 4. Intern: The term “Intern” refers to trainees who are going into or are currently in their first year of training as a PGY1. Upper Level: The term “Upper Level” refers to trainees in their 2nd year of training to their 3rd year for Categorical and additionally 4th year for Internal Medicine Pediatrics Residents. Program: The term “Program” refers to the Internal Medicine Residency and/or the combined Internal Medicine and Pediatrics training program(s). Sponsoring Institution: The term Sponsoring Institution refers to McGovern Medical School at the University of Texas Health Science Center at Houston. UTHealth: The term UTHealth is an alternative name for McGovern Medical School at the University of Texas Health Science Center at Houston.

II. PROGRAM OVERVIEW

ThemissionoftheUniversityofTexasHoustonInternalMedicineProgramistoprepareeachResidentforasuccessfulcareerasageneralinternalmedicinephysician.WestrivetoprovideanexcellentfoundationforeachResidentsothatnomatterthecareerpaththatischosen,he/shewillhavetheabilitytoexcel.Trainingencompassesdevelopmentofahighlevelofclinicalskills,aswellasastrongfundofknowledgeofthepathophysiology,manifestations,andprinciplesoftreatmentofdiseasesgenerallyseenbyinternists.InternalMedicineisadisciplineencompassingthestudyofhealthpromotion,diseaseprevention,diagnosis,care,andtreatmentofmenandwomenfromadolescencetooldage,duringhealthandallstagesofillness.Intrinsictothedisciplinearescientificknowledge,thescientificmethodofproblemsolving,evidencebaseddecisionmaking,acommitmenttolifelonglearning,andanattitudeofcaringthatisderivedfromhumanisticandprofessionalvalues. OneofthefundamentalprinciplesofInternalMedicinetrainingistheprogressivelyincreasingdegreeofresponsibilitythatResidentsaregivenforthecareofpatients.Theprinciplesofpatientcaredemandthattheattendingphysicianretainultimateresponsibilityforthewelfareofhisorherpatients,however,thisruleallowsdelegationofauthoritytotheResidentsformanagementofpatientsonadaytodaybasis.Attendingphysicianswilldelegateprogressivelymoreandmoreauthoritytothehouseofficerasheorsheprogressesthroughthetrainingprogram.AcceptanceofthisresponsibilityrequiresthattheHousestaffhavetimetoassessthepatient,todevelopareasonableformulationofthepatient’sproblems,andtoproposeaplanofmanagement.Withtheconcurrenceoftheattendingphysician,theplanofmanagementmaythenbeundertakenbytheResident.Additionally,theattendingphysicianhasanobligationtoteachgeneraland/orsubspecialtyinternal


medicinetotheResidents.Thisteachingisbestcarriedoutinthecontextoftheimmediateclinicalsituation.TheattendingphysicianandResidentsshouldworktogetherforthebenefitofthepatient. Throughouttheirtraining,Residentsareexposedtoseveraldifferentkindsofclinicalexperiences.AtMemorialHermannHospital,M.D.AndersonCancerCenter,theMichaelE.DeBakeyVAMedicalCenter,andLyndonB.JohnsonGeneralHospital,thereareinpatientservicesstaffedbyfulltimefaculty.AtMemorialHermanntherearealsopatientsunderthecareofvoluntaryfacultiesoftheUniversityofTexasMcGovernMedicalSchool.Therearerotationsthroughgeneralandsubspecialtyinpatientservicesandoutpatientclinics,medicalintensivecare,coronarycareunitsandemergencyrooms. Thefirstyearresidentservesasaninternoninpatientservices,outpatientclinics,emergencydepartmentsandcriticalcareunits.Theupperlevelscheduleconsistsofacombinationofinpatientservicesandcriticalcareunits,outpatientclinics,andsubspecialtyconsultationservices.Theconsultationservicesallowtheresidenttodevelopin‐depthknowledgeaboutspecificareasofinternalmedicineandpermitclosepersonalinteractionswithmembersofthefaculty.Furthermore,residentscanparticipateinsomespecializedtechnicalproceduresduringtheirsubspecialtyrotations.Thereisalsotheopportunitytorotatethroughgeneralinternalmedicineconsultations,duringwhichtheresidentactsasaconsultanttootherdepartments. Inschedulingrotations,weconsiderfourfactors.Firstandmostimportantiseducationalvalue.Overthethreeyears,theresidentshouldrotatethroughmostorallofthemajormedicalsubspecialties.ThesecondistherequirementoftheAmericanBoardofInternalMedicinethattherebeatleasttwenty‐fourmonthsof“meaningfulpatientresponsibility”inthethreeyearresidency.Thethirdfactoristhepreferenceoftheresidentforparticularsubspecialties.Thefourthistherequirementforstaffingofourinpatientandsubspecialtyconsultationservices.Wetrytoarrangeforeachresidentareasonablemixtureofthevariousexperiencesavailableinthistrainingprogram.

A. DEPARTMENT LEADERSHIP Ourfacultystrivestobedistinguishedforitsscientific,clinicalandteachingexcellenceinallmajordisciplineswithinthebroadfieldofinternalmedicine.AttainmentofthisgoalrequirestheoperationofanexcellentResidenttrainingprogram.Therefore,theresidencyprogramisofthehighestdepartmentalpriority.AllphysiciansonthefacultyareexpectedtoteachandmakecontributionstotheResidencytrainingprogram.

1. Chair Dr. David D. McPherson is Chairman, Department of Internal Medicine,Professor and Director of the Division of Cardiology, Executive Director –CenterforClinicalandTranslationalSciences,heistheholderoftheJamesT.andNancyB.WillersonChair,andMedicalDirectoroftheHeartandVascularInstituteattheUniversityofTexasHealthScienceCenteratHouston. In2006hewasrecruitedtotheUniversityofTexasHealthScienceCenteratHoustontoheadtheDivisionofCardiology.HewasappointedtheWillersonChairof


InternalMedicinein2008withamandatetodirect,lead,andexpandtheDepartmentintoanewdecadeofAcademicAchievement.

2. ExecutiveViceChair

Dr.KevinFinkelisExecutiveViceChairofMedicine,professoranddirectoroftheRenalDiseaseandHypertensiondivisionattheMcGovernMedicalSchoolattheUniversityofTexasMedicalHoustonHealthScienceCenter(UTHealth).Dr.Finkelisa1990graduateofNorthwesternUniversity‐FeinbergSchoolofMedicineinChicago,IllinoiswherehecompletedhisInternalMedicineresidency.In1994,Dr.FinkelcompletedhisRenalDiseasefellowshipatBarnesHospital/WashingtonUniversitySchoolofMedicineinSt.Louis

Missouri.Dr.FinkelhasbeenawardedtheDean’sTeachingExcellenceAwardmultipletimesandisactiveintheeducationofstudent,residents,andfellowsatMcGovernMedicalSchool.

3. ViceChairforEducation

TheultimateresponsibilityforadministrationoftheeducationalprogramsinInternalMedicinerestswiththeViceChairofMedicineforEducation,Dr.PhilipR.Orlander.Dr.OrlanderreceivedhisundergraduatedegreefromNewYorkUniversityandwasawardedhismedicaldegreefromtheFreeUniversityofBrussels,Belgium.HecompletedhisinternshipandresidencytraininginInternalMedicineatSt.Raphael’sHospital,NewHaven,CT.HisEndocrinologyfellowshiptrainingwasatSt.Raphael’sHospital,NewHaven,

CT,andattheUniversityofArizona,Tucson,AZ.Dr.OrlanderiscertifiedinbothInternalMedicine(1979)andEndocrinology,DiabetesandMetabolism(1981)andmaintainscurrentcertificationinbothareas.HeiscurrentlylicensedinTexaswithMedicalStaffappointmentattheMcGovernMedicalSchoolattheUniversityofTexasMedicalHoustonHealthScienceCenter(UTHealth).

Dr.OrlanderhasbeeninstrumentalintheeducationoftheInternalMedicineResidentssincehisappointmentasAssistantProfessorwiththeMcGovernMedicalSchoolattheUniversityofTexasMedicalHoustonHealthScienceCenter(UTHealth)in1983.In1991,hewaspromotedtoAssociateProfessorandbecametheprogramdirectorfortheEndocrinology,DiabetesandMetabolismfellowship.HewaspromotedtoProfessorin1997,andDivisionDirectorofEndocrinology,Diabetes,andMetabolismin1993.In2005,hebecameVice‐ChairmanofInternalMedicineforEducationandwasnamedInterimChairmanoftheDepartmentofInternalMedicineinMay2007.

Dr.OrlanderhashadastronginterestinMedicalEducation,bothattheundergraduateandpostgraduatelevel.HewascoursedirectorforPhysicalDiagnosisfrom1991to2004,ChairmanoftheCurriculumCommitteefrom1993to1998,from2002‐2007,andwasnamedAssistantDeanforCurricularAffairsin2005.HeisamemberofAlphaOmegaAlphaandwaselectedtotheUniversityofTexasAcademyofHealthScienceEducationin2006.HeistherecipientoftheHerbertL.andMargaretW.DupontMasterClinical


TeachingAward,theAwardforHumanisminMedicine,andmultipleDean’sExcellenceinTeachingAwards.

4. ProgramDirector

Dr.JenniferL.SwailsistheGMECapprovedProgramDirectorforInternalMedicine.Dr.SwailsreceivedherbachelorinsciencedegreeinbiologyfromDavidsonCollegeandherdoctorateinmedicinefromWeillCornellMedicalCollege.ShecompletedresidencytraininginInternalMedicineandprimarycareandBrighamandWomen’shospitalandthenjoinedthefacultyoftheMcGovernMedicalSchoolattheUniversityofTexasHealthScienceCenteratHoustonin2012.Herroleinvolvesdirectpatientcareinboththeinpatient

andoutpatientsettings,aswellasqualityimprovementandmedicaleducation.Dr.Swailsisboardcertifiedininternalmedicine(2012)andmedicalquality(2017).SheisamemberofPhiBetaKappaandAlphaOmegaAlphahonorsocieties,andwasinductedintotheAcademyofMasterEducatorsin2015.In2016,Dr.SwailsreceivedaUTsystempatientsafetygranttodevelopacurriculumtoteachteamworkskillstostudentsthroughoutthehealthsciences.Shewaschosenbythemedicalschoolclassof2017tobethecommencementspeaker,atwhichtimeshereceivedtheMcGovernawardforoutstandingclinicalteacher.

Responsibilities of the Program Director TheProgramDirectoradministersandmaintainsaneducationalenvironmentconducivetoeducatingtheHousestaffineachoftheACGMEcompetencies:PatientCare,MedicalKnowledge,PracticeBasedLearningandImprovement,InterpersonalandCommunicationSkills,Professionalism,andSystem‐BasedPractice.TheProgramDirectorinitiatesandmonitorsthedidacticandclinicaleducationatallparticipatingsitesand,continuallyevaluatingtheeffectivenessoftheteaching/learningenvironment.AsapprovedbytheProgramDirector,thelocaldirectorateachparticipatingsiteisaccountableforResidencyEducationandisevaluatedregularlytoensurethatthebesteducationqualityisachievedateachsite.TheProgramDirectorisalsoresponsibleforapprovingfacultyforteachingofHousestaff.Facultyarereviewedannuallyandgivenasummaryreviewoftheirperformancefortheprecedingyearbasedontheconfidentialandanonymousresidentevaluationsandcomments.

5. AssociateProgramDirectors

TheProgramDirectorisaidedintheadministrativeandclinicaloversightoftheeducationalprogramby7AssociateProgramDirectorsasfollows:


GabrielAisenberg,MD

AssociateProgramDirectorProgramSiteDirector,LBJHospitalAssistantProfessorofMedicineDivisionofGeneralMedicine

JammieBarnes,MD

AssociateProgramDirectorAssistantProfessorofMedicineDivisionofRheumatology

RobbyWesley,DO

AssociateProgramDirectorAssistantProfessorofMedicineDivisionofGeneralMedicine

ReneeFlores,MD

AssociateProgramDirectorAssistantProfessorofMedicineDivisionofGeriatricsandPalliativecare

PhilipOrlander,MD

AssociateProgramDirectorViceChairforEducationProfessorofMedicineDivisionofEndocrinology

KatieB.Guttenberg,MD

AssociateProgramDirectorAssistantProfessorofMedicineDivisionofEndocrinology


MarkA.Farnie,MD

AssociateProgramDirector InternalMedicine/PediatricsProgramDirectorProfessorofMedicineDivisionofGeneralMedicine

EachAssociateProgramDirectorisaclinicianwithbroadknowledgeof,experiencewithandcommitmenttoInternalMedicineasadiscipline,patientcenteredcare,andtothegeneralisttrainingofresidents,andholdcurrentcertificationfromtheAmericanBoardofInternalMedicineinInternalMedicineandifapplicable,his/herrespectivesubspecialty.EachAssociateProgramDirectorreportsdirectlytotheProgramDirector.Eachwillcommitanaverageof20hoursperweektotheadministrativeandeducationalaspectsoftheeducationalprogram. 6. CoreFaculty

TheresidentsintheInternalMedicineResidencyenjoytheexpertiseof12institutionallybasedcorefacultymemberswhonotonlyserveascorefaculty,butalsoasthesubspecialtyeducationcoordinators.ThesefacultyareexpertcompetencyevaluatorswhoworkcloselywiththeProgramDirectorandAssociateProgramDirectorsindevelopmentandimplementationoftheevaluationsystemandinteachingandadvisingtheHousestaff.EachcorefacultyisABIMcertifiedinInternalMedicineand,ifapplicable,his/herrespectivesubspecialty,andareclinicallyactiveinbothdirectpatientcareandobservationofresidentsintheirpatientcare.EachcorefacultymemberisaccountabletotheProgramDirectorforcoordinationoftheresidents’subspecialtyeducationalexperiencesinordertoaccomplishthegoalsandobjectivesinthesubspecialty. ThecorefacultyalsoparticipateintheInternalMedicinementorshipprogramavailabletointernstohelpguideandadviseinterns,andHousestaffasawhole,aboutcareerandeducationalgoals.


CoreFaculty

AmeeAmin,MD DivisionofEmergencyMedicine‐Hospitalist

NeelShah,MDDivisionofEndocrinology

AnnelieseGonzalezDivisionofOncology

SalmanArain,MD DivisionofCardiology

RodrigoHasbun,MDDivisionofInfectiousDisease

BrandyMcKelvyDivisionofPulmonaryand

CriticalCare

ReenaChokshi DivisionofGastroenterology,HepatologyandNutrition

AleksandraDeGolovine,MDDivisionofRenalDiseaseand

Hypertension

SujithCherian,MDDivisionofPulmonaryand

CriticalCare

ShilpanShah,MD DivisionofHematology

SaherRabadi,MDDivisionofGeneralMedicine

AbhijeetDhoble,MDDivisionofCardiology

7. ProgramStaff

ThemainHousestaffofficeislocatedintheMedicalSchoolBuilding,MSB1.134andhousestheclericalstaffresponsiblefortheoperationoftheprogram. MelanieJ.Carver ProgramCoordinator InternalMedicineResidencyProgram UTHoustonMedicalSchool 6431Fannin,MSB1.134 Houston,Texas77030 Ph(713)500‐6526 F(713)500‐6530

[email protected]

DanaL.FosterProgramCoordinatorInternalMedicineResidencyProgramUTHoustonMedicalSchool6431Fannin,MSB1.134 Houston,Texas77030 Ph(713)500‐6522 F(713)500‐[email protected]

MicaelaVillegasProgramCoordinatorInternalMedicineResidencyProgramUTHoustonMedicalSchool6431Fannin,MSB1.134 Houston,Texas77030 Ph(713)500‐6536 F(713)500‐[email protected]

PhyllisMartinProgramCoordinatorInternalMedicineandPediatricsResidencyProgramUTHoustonMedicalSchool6431Fannin,MSB1.126 Houston,Texas77030 Ph(713)500‐6536 F(713)500‐[email protected]

B. SPONSORINGINSTITUTION

TheInternalMedicineResidencyProgramissponsoredbyUTHealthandestablishedunderthedepartmentofInternalMedicine.TheSponsoringInstitutionprovidestechnicalandprofessionalpersonnel as required by Housestaff and as delegated by McGovern Medical School at theUniversity of Texas Health Science Center at Houston’s Handbook of Operating Procedureshttps://www.uth.edu/hoop/.


ThemissionofMcGovernMedicalSchoolistoprovidethehighestqualityofeducationandtraining of future physicians for the State of Texas, in harmony with the State's diversepopulation, and to conduct the highest caliber of research in the biomedical and healthsciences.Theinstitutionaimstoprovideaneducationalenvironmentstressingprimarycareandqualitycare,andtoprepareadvancedResidentstoserveallpatientsinneed,whatevertheir means, to make contributions to the understanding, prevention and treatment ofdiseaseandinjury,andtopursuealifetimeofstudysothattheywillremainthebestpossiblepractitionersofmedicine.Thefulfillmentoftheacademicmissionrequirestheprovisionofexemplary clinical services, primacy of prevention, leadership in research and researchtraining,andcontinuingeducationofgraduatesandotherhealthcareproviders.

TheMcGovernMedicalSchool ispartofTheUniversityofTexasHealthScienceCenteratHouston, a comprehensive health science center located in the world‐renowned TexasMedicalCenter.Theinstitution,onbehalfofitsadministrationandfaculty,assumesultimateeducational responsibility for all of the graduate medical education programs under itssponsorship.Tothatend,theinstitutioniscommittedtoexcellenceinbotheducationandpatient care and will provide an ethical and scholarly environment for these activities.Through theAssociateDean forEducationalPrograms incollaborationwith theGraduateMedicalEducationCommittee, the institutionwill ensure substantial compliancewith theAccreditationCouncilforGraduateMedicalEducation(ACGME)InstitutionalRequirementsand enable the ACGME accredited‐programs to achieve substantial compliance with theInstitutional,Commonandspecialty‐specificProgramRequirementsandtheACGMEPoliciesandProcedures.Inordertoprovideeffectiveeducationalexperiencesforresidentsthatleadtomeasurableachievementofeducationaloutcomes,theinstitutionwillprovideappropriateclinical venues for resident education through agreements with approved patient carefacilities.Therein, the institutionwillprovideguidanceandsupervisionofresidentswhilefacilitatingtheirprofessional,ethicalandpersonaldevelopmentandwillfurtherensurethatthepatientcareprovidedbyresidentsissafeandappropriate.Theinstitutioniscommittedtoprovidingthenecessaryeducational,financialandhumanresourcesnecessarytosupportgraduatemedicaleducation.

C. AFFILIATEDINSTITUTIONS

1. Hospitals TheResidentsintheInternalMedicineResidencyProgramenjoyaccesstofacilitieslocatedintheworldrenownedTexasMedicalCenter.Specifically,hospitalsaffiliatedwithUTHealthforthepurposeoftheInternalMedicineResidencyTrainingProgramincludes:

a. MemorialHermannHospital‐TMC b.LyndonB.JohnsonGeneralHospital(HarrisCountyHospitalDistrict) c. TheUniversityofTexasM.D.AndersonCancerCenter d.TheMainlandAllergyandImmunologyClinic. e. TheMichaelA.DeBakeyVAMedicalCenter

2. Clinics Clinics/AmbulatorySettingsaffiliatedwithUTHealthforthepurposeoftheResidencyTrainingProgramsinclude:


a. UniversityofTexasProfessionalBuilding(UTPhysicians) b.UTHSC‐HCenter(WestLoopBellaireClinic) c. ThomasStreetClinic(HarrisCountyHospitalDistrict) d.QuentinMease(HarrisCountyHospitalDistrict) e. LyndonBJohnsonHospitalClinic(HarrisCountyHospitalDistrict) f. TheMichaelA.DeBakeyVAMedicalCenter

D. LEVELSOFTRAINING

ProgressivelevelsoftrainingintheProgramaredesignatedasPostGraduateYear(“PGY”)1through3forCategoricalResidents.AftertheinitialPGY‐1appointmentterm,thePGYleveltowhichaResidentisappointedwillbedeterminedbytheProgramDirector,inconsultationwiththeGraduateMedicalEducationofficeandClinicalCompetencyCommittee,basedontheResident’s level of education, experience, demonstrated ability, clinical performance, andprofessionalism. Eachresidentwillbeexpectedtoexcelinthecompetencybasedmedicalcurriculum. EachResidentisexpectedtoadvanceincompetencyastheyprogressinPGYlevelwiththeinternbeginningatthelevelofanovice.Theinternisnotexpectedtoexercisediscretionaryjudgmentinthefirst4–6monthsofresidency.Thenoviceinternshouldadheretostandardrulesandbegin tomaster theverybasicpartof treatmentanddiagnosis. This stagewillrequire extensive supervision by attendings and upper level residents. As the internprogresses to the last sixmonths of the intern year, he/she should be at the level of anadvancedbeginner.Heretheinternshouldbeabletomakeconnectionstothebiggerpicturebyusingattributesoraspectsasguidelinesinlieuofstrictadherencetorules.Theadvancedbeginnerwilllookataspectsseparatelyandtreatassuch.DuringthefirstsixmonthsasaPGY2aresidentbegin toexhibitcompetence inclinicalacumenandpractice. ThePGY2Residentshouldbeabletoconducthis/heractionsinthecontextofalongtermgoalinsteadof as separate part of the puzzle. The Resident should be able to achieve efficiency andorganizationwithhis/herplansandexecutethemwithlimitedsupervision.BytheendofthePGY2Year,beginningofPGY3level,theResidentshouldbeconductinghimself/herselfataproficientlevel,wherethesituationsencounteredareperceivedaswholes,ratherthanpartstobetackledoneatatime.ThePGY2inthefinalmonthsofhis/hertrainingshouldbeabletotreatunderstandardcircumstancesandadjustasappropriate.InthefinalmonthsofthePGY3level,theresidentshouldbeoperatingatthelevelofanexpert.TreatmentofapatientshouldnowbeintuitivetotheResidentwithstandardrulesandmaximsusedintreatment,butmorethanrules,animplicitunderstandingoftreatment.

E. APPOINTMENTANDREAPPOINTMENT

1. Appointment

ApplicantstotheInternalMedicineProgrammustmeetoneofthefollowingminimumcriteriatobeeligibleforappointmenttotheProgram:

● GraduatesofUnitedStatesorCanadianmedicalschoolsaccreditedbytheLiaisonCommitteeonMedicalEducation(LCME).


● GraduatesofcollegesofosteopathicmedicineintheUnitedStatesaccreditedbytheAmericanOsteopathicAssociation(AOA).

● GraduatesofmedicalschoolsoutsidetheUnitedStatesandCanadawhomeetoneofthefollowingqualifications:

(a)HavereceivedacurrentlyvalidcertificatefromtheEducationalCommissionforForeignMedicalGraduates(ECFMG)priortoappointment,or,

(b)HaveafullandunrestrictedlicensetopracticemedicineinaUSlicensingjurisdictioninwhichtheyaretraining.

● GraduatesofmedicalschoolsoutsidetheUnitedStateswhohavecompletedaFifthPathwayprogramprovidedbyanLCMEaccreditedmedicalschool.

Generally,aNoticeof(Re‐)Appointmentwillbeissuedtoan“on‐cycle”ResidentnoearlierthanfourmonthspriortotheResident’sproposedstartdate.Theappointmentwillgenerallyextend foraperiodencompassing thePGYyear, (typically12months);ResidentsmaybeappointedforshortertimeperiodsatthediscretionoftheProgramDirector.Residentsmaynot have concurrent agreements, appointments, and/or contractswith other hospitals orinstitutionswhile under appointment to the Program. To be fully effective, theNotice ofAppointment is signed by the Resident and an authorized representative of the MedicalSchoolonbehalfoftheFoundation.

**OnlyJ‐1Visasareissued.

2. ReappointmentandPromotion

Promotion to the next level of training and/or reappointment is made annually at thediscretionoftheProgramDirector. Thedecisiontopromoteand/orreappointaResidentwillbebasedonperformanceevaluationsandanassessmentoftheResident’scompetenceand readiness to advance (including, but not limited to attainment of the ACGMECompetenciesattherespectivelevelofeducation,experience,demonstratedability,clinicalperformance,andprofessionalism).

Inordertoreceivecreditforamonth,aResidentmustactivelyparticipateinatleasttwo(2)weeks of the month. Credit for a rotation will only be given to those Residents whosuccessfullypassthemonth.Anyrotationswherearesidentreceivedanoverallratingbelowtheirexpectedperformancelevelwillneedtoberepeated.Aninternwho,intheopinionofthe Program Director and Chairman or other pertinent faculty is not prepared for theresponsibilitiesofanupperlevelresident,may,atthediscretionoftheProgramDirector,beofferedtheopportunitytoextendhisorherinternshipuptooneyear.InternswhofailtosuccessfullycompletetherepeatofaPGY‐1yearwillnothavetheircontractrenewed.

In instances where a Resident will not be promoted and/or reappointed, the ProgramDirectorwillprovidetheResidentwithawrittennoticeofintentnottopromoteand/ornottoreappointnolaterthanfourmonthspriortotheendoftheResident’scurrentappointmentterm.However,iftheprimaryreason(s)forthenonpromotionand/ornon‐reappointmentoccur(s)withinthefour‐monthperiodprecedingtheendofappointmentterm,theProgramDirectorwillprovidetheResidentwithasmuchwrittennoticeoftheintentnottopromoteand/orreappointascircumstanceswillreasonablyallow.


F. STRUCTUREOFTHEPROGRAM TheInternalMedicineResidencyProgramvalueseducationofourResidentsaboveallandthepoliciesoftheProgramhavebeendevelopedtoreflectthis.Educationalexperiencesoftheprogramincludeinteractionswithstudents,residents,fellowsandattendingphysicians,aswellasothermembersofdisciplinaryteamsincludingNurses,PhysicianAssistantsandadministrativepersonnel.

The Internal Medicine Residency Program consists of 36 months of Graduate MedicalEducation.Thereareatleast32rotationsavailableforResidentsintheProgramandeachresidentcanexpectanexperienceinthefollowingrotations:

IntensiveCareUnitMHH/LBJ* GeriatricandPalliativeCareMHH/LBJ AmbulatoryMHH/LBJ GastroenterologyConsultsMHH/LBJ GeneralMedicineWardsMHH/LBJ/VA HematologyConsultsMHH/LBJ/MDA EmergencyRoomLBJ* InfectiousDiseasesConsultMHH CoronaryCareUnitMHH* PulmonaryConsultsMHH/LBJ/SLEH HepatologyWardsMHH RenalConsultsMHH/LBJ OncologyConsultsMHH/LBJ RheumatologyConsultsMHH/LBJ CardiologyConsultsMHH/LBJ/SLEH AllergyandImmunologyConsults EndocrinologyConsultsMHH

EachgraduatingResident that successfullycompletes theprogramwillbecompetentandqualifiedtositfortheInternalMedicineCertificationexam

*IntensiveCareUnit:Totalrequiredemergencymedicineexperiencewillnotexceed3monthsina3‐yearresidency.TotalRequiredcriticalcareexperiencewillnotexceed6monthsina3‐yearresidency.Ifaresidentrequestscriticalcareelectives,thetotalexperiencemaynotexceed8months.

G. SCHEDULES

1. MonthlySchedules

EachResidentsscheduleisformulatedsothatbytheendoftraining,theResidentwillhavecompleted36months (includingvacation time)of accreditedgraduatemedical educationandwillbeeligibletositfortheBoardsuponcompletionoftheprogram.Theeducationaleffortsoffacultyandresidentsaredesignedtoenhancethequalityofpatientcare,andtheeducationoftheresidents.Atleast1/3oftheresidencytrainingoccursintheambulatorysettingandatleast2/3occursintheinpatientsetting.

BeginningJune24ofeachacademicyear,Resident’sschedulesarepostedonAMIONforthefull academic year (http://www.amion.com; password uthim) and updated as needed.Changesshouldberequestedthreeweeksaftertheinitialscheduleisreleased.Threeweeksafter the Residents are notified of the posting of the initial schedule, eachResident shallreviewhis/herindividualscheduleandmakeanynecessaryrequestsforchangeswiththeappropriateschedulingchief.Afterthethreeweeksforschedulechangeshaspassed,therewill be no changesmade upon request unless there is an emergency or adjustments arerequiredbasedontheneedsoftheschedulingchief. Shouldtherebeavalidemergency,arequestmustbemade inwriting totheschedulingchief. AllchangesarereviewedbytheAssistant Chiefs of Service and the ProgramDirector because of the needs for staffing ofservices,andtherequirementsoftheAmericanBoardofInternalMedicineandtheACGME.


2. VacationsandTimeOff Residentsarepermittedtheequivalentofthree(3)calendarweeksofvacationeach12monthappointmentterm. InadditiontotheseallotteddaystheProgramallowseachResident2daysadministrativedays(onceayear)aroundanAmbulatoryrotationweekend. These2daysaregivenonafirstcome,firstservebasis.

Resident’s must coordinate vacation scheduling with the Internal Medicine ResidencyProgram, aswell aswith theAssistant Chief of Service in charge of scheduling to ensureadequatecoverageofservices.Nomorethantwo(2)consecutiveweeksofvacationmaybetakenwithoutpermissionfromtheProgramDirector.Thevacationscheduleisincorporatedintotheyearlymasterschedule.Residentsarenoteligibletoaccumulateannualvacationandunusedvacationdoesnotrolloverfromoneacademicyeartothenext.Resident’sleavingtheProgramwillnotbecompensatedforunusedvacation.

Residents are provided with one day in seven free from all educational and clinicalresponsibilities,averagedoverafour‐weekperiod.Thisisnotincludedinreportedvacation.ItistheobligationoftheResidentwhoisofftocoordinatewithhis/herteammemberstoensurethatdaysoffarestaggeredandnotmorethanoneinternisawayatatime.Patientsofaresidentwhoareoffshouldbecoveredbyotherresidentsontheteam.

Requestsforachangeinvacationscheduleshouldbeturnedintotheappropriateschedulingchief before the beginning of the academic year. Any request for a change in requestedvacationtimeissubjecttotheapprovaloftheappropriateschedulingchiefandtheProgramDirectorortheProgramDirectorsdesignee.

ResidentsarenotallottedextratimeoffforcompletionofUSMLEStepexamsorattendingclasses,orotherelectiveendeavors.Forsituationswhereoutsideobligationsinterferewithyour ability to complete your requiredworkwithin the program,Residentsmust ask forvacation inadvanceorarrange theirowncoverageandnotify theappropriateschedulingchiefandtheProgramDirectorortheProgramDirectorsdesignee.Ifnocoverageisfoundby the resident, they must report to their assigned duties that day. It is a breach ofprofessionalism not to show up to your required rotation without notifying all of theappropriate personnel including but not limited to the scheduling chief and the ProgramDirectorortheProgramDirectorsdesignee.Eachresidentisresponsiblefordiscussingthepolicyof time‐offwithhis/herattendingat thebeginningof themonthtoensurethat theattendingpolicieswithregardstotimeoffarealsomet.

TheInternalMedicineResidencyProgramAdministrationsupportsPGY3Residentsintheirendeavors to find opportunities to interview for fellowships/job positions. This supportmust be balanced with the need to comply with educational requirements of theProgram.Duringtherecruitmentmonthsforfellowships,Residentswillbeallowedtotakeofftimefromtheirscheduledrotationsforamaximumof7daystotal,withadvancednoticetothechiefresidentswhichmustincludethedatesrequestedandthenameoftheindividualsecuredtocovertherequestedtimeoff.EachResidentrequestingtimeoffforinterviewsisresponsible for arranging coverage for the time he/she will be off. Chiefs will not beresponsibleforarrangingcoverage.Therequestedtimeoffshouldnotbecontiguouswitheach other. Residents will be expected to use any scheduled days off to cover the timerequested.


3. ReadyReserve/JeopardyCall TheReadyReserveisbackupcallforemergencysituationsonly.Thisisnotconsidered“at‐home call.” Every day there are 3 Upper Levels and 2 Interns that are on a designatedJeopardyrotationforatwoweekperiod. IfaResidenthasanemergencysituationwherehe/she cannot take call, the appropriate chiefwill pull someone from theReadyReserverotation.Assoonasitisknownthataresidentwillnotmakeittowork,theChiefResidentmustbeinformedbypagingthemat22001.Noothermodeofcommunicationisacceptableotherthantelephoneconversation(i.e.,texting,emailing,andvoicemailsarenotappropriateformsofcommunication).Ifyoudonotinformthechiefresidentsappropriately,thenyouwillbeexpectedtoshowupforyourrotationuntilcoverageisfoundforyou.Inaddition,anyabsencesformorethan24hourswillrequireaphysicianvisitandnote(thiscanbeyourPCP,theERorthestudenthealthcenter).

4. SickLeave/LeaveofAbsence Paidsickleaveaccruesatarateofone(1)dayeachmonthandmayaccumulatetoamaximumofthirty(30)days.Paid sick leave carries forward from year to year; however, unused sick leave remaining as of the date of separation from the Program is forfeited without compensation.

Residents are not eligible for UT Health “sick leave pool” leave. The program is responsible for tracking Residents' sick leave through the GMEIS system. All requests for sick leave must be approved by the appropriate scheduling chief, Program Director/Program Director’s designee, and reported to the appropriate Residency Coordinator.

5. LeaveofAbsence In theeventan illnessexceeds accumulatedpaid sick leaveandvacation time, a leaveofabsencewithoutpaymaybegrantedbytheProgramDirector.

AllrequestsforLeaveofAbsencemustbeapprovedinadvancebytheProgramDirectorinaccordance with applicable state and federal laws and accreditation requirements. AnextendedLOA,whichexceedsthetwelve(12)weekallotment,maynecessitateresignationfromtheProgram.TheResidentmayseekreappointmenttotheProgramatalaterdate. LOAmaybecomprisedofpaidleave(includingbothpaidsick leaveandvacation)and/orleave without pay (LWOP). When LOA is requested for a medical reason (includingpregnancy), the eligible Resident must exhaust all accumulated paid sick leave andaccumulatedvacationpriortobeginninganyLWOP.

6. MilitaryLeave A Resident who voluntarily enlists in one of the branches of the armed forces and is called to serve, or who is a member of one of the reserve branches of the armed forces, Texas National Guard, or the commissioned corps of the Public Health Service, or a Resident who voluntarily or involuntarily leaves his or her employment position to undertake certain types of service in the National Disaster Medical System, who is called to active duty by the President of the United States during an emergency, or who is called for annual tours of duty, will be entitled to no more than 15 days paid military leave during the Resident's appointment period. Residents must notify their Program Director as soon as they become aware of their military orders and provide the Program Director with a copy of such orders. Military leave over 15days shall be considered unpaid leave. On completion of military duty, the Resident must report back to his or her regular program.


7. FamilyandMedicalLeave(FMLA) ConsistentwiththeFederalFamilyandMedicalLeaveActof1993(FMLA),theUniversityofTexasSystem–MedicalFoundationwillgrantupto12calendarweeksofleaveina12‐monthperiodtoresidents.Familyandmedicalleavemaybegrantedforoneormoreofthefollowingreasons:

● Birthofson/daughterandcareaftersuchbirth; ● Placementofson/daughterforadoptionorfostercare; ● Serioushealthconditionofspouse,child,orparentofresident;or ● Serioushealthconditionofresident(unabletoperformthefunctionsofhisor

herposition)

The duration of LOAmust be consistent with satisfactory completion of training (credittoward specialty board qualification), which will be determined by each department inconsultationwiththeGMEoffice.

A Resident may continue his/her personal insurance coverage and dependent insurancecoverage’sduringaperiodofLOAathis/herownpersonalexpense.Arrangementsforthesepremiumpaymentsmustbemadepriortothecommencementoftheleave.Theprogramisresponsible forpaymentof theresident’sportionof thepremiumwhentheLOAqualifiesundertheFamilyMedicalLeaveAct.

TheInternalMedicineResidenttakingFMLAwillbepaidforanappropriateamountofleavetime,beginningwithsickleaveandanyremainingvacation.Aftertheseaccumulationshavebeenexhausted,theresidentwillbeputonLeaveofAbsence(LOA).OncetheresidenthasbeenputonLOAhe/shewillnotreceivehis/hermonthlystipend.Thedepartmentwillpayforbenefitsonlywhenallsickleaveandvacationhasbeenexhausted.

Thefirstfour(4)weeksofleaveareconsistentwiththeABIMpolicyandthereforenomakeuprotationsarerequired.TheABIMallowsupto3monthsleaveforvacationtime,parentalleave,orillnessina36monthtrainingperiod.Residentsmaytakeuptoonemonthperyearoftraining.Trainingmustbeextendedtomakeupanyabsencesexceedingtheonemonthperyearoftraining.

TheProgramtriestomaintainaflexibleandreasonablepolicyconcerningmaternityleave.Asrearrangementofscheduleswilllikelybenecessary,youmustnotifytheprogramdirector,aswell as one of the residency coordinators, as soon as you know that youmay have asituationthatwillrequireFMLAandorgreaterthan2weeksoftimeoff.

8. Holidays ResidentsarenotsubjecttotheUTHealthholidayschedule.AnyholidaystakenareatthediscretionoftheProgramDirectorbasedonstaffingneedsforfullcoverageofservicesthatwillbeoperatingduringany“holiday”period.Timeoffmustbeapprovedinadvance.

9. ReportingTime‐Off BeginningJuly1,2016,ResidentswillberequiredtoreporttimeoffinNewInnovations.Thisincludesscheduledvacationsandsicktime.ReportingoftimeoffinNewInnovationsdoesnotnegatetheobligationssetforthaboveinsectionG,subsection1‐8.


H. SUPERVISIONPOLICY

Degrees of supervision are utilized by the Program as follows to ensure that limitedautonomyanddecisionmakingisavailableastheResidentgraduatesthroughthelevelsofeducation.

Direct Supervision – the supervising physician is physically present with theresidentandpatient. IndirectSupervision

o withdirectsupervisionimmediatelyavailable–the supervisingphysicianisphysicallywithinthehospital orothersiteofpatientcare,andisimmediately availabletoprovideDirect Supervision.

o withdirectsupervisionavailable–thesupervising physicianisnotphysicallypresentwithinthehospital orothersiteofpatientcare,butisimmediately availablebymeansoftelephonicand/orelectronic modalities,andisavailabletoprovideDirectSupervision.

Oversight–Thesupervisingphysicianisavailabletoprovidereviewof procedures/encounterswithfeedbackprovidedaftercareisdelivered.

1. General TheultimateresponsibilityforthesupervisionoftheResidentswithintheProgramrestswiththeProgramDirector.He/shemonitorsresidentsupervisionatallparticipatingsites.TheProgram Director, in conjunction with the Associate Program Directors, elects qualifiedfaculty toprovide appropriateDirect Supervisionof residents and interns inpatient careactivities. At thebeginningof each rotation, theHousestaffwillbe introduced tohis/herattendingwhowillbean identifiable,appropriately‐credentialedandprivilegedattendingphysicianwhoisultimatelyresponsibleforthatpatient’scareandfortheDirectSupervisionof the resident and intern. Each site and rotation has adequate faculty to instruct andsupervisealltheresidentsassignedtotherotationandlocation.Thenumberoflearnersoneachservicewillbe limitedso thatattendingshaveadequate timetoeffectively teach theHousestaff. Residents are provided with rapid reliable systems for communication withsupervising faculty. Facultyscheduled tosuperviseona rotationare required toprovideresidentswithcontinuoussupervisionandconsultation.

Overthecourseofthe36monthsofresidency,eachresidentmustdemonstrateproficiencyineachof thecriticalclinicalskills tobeallowed increasingresponsibility inpatientcare,leadership,teaching,andadministration.Theseskillsinclude,butarenotlimitedto,usingappropriateinterviewandexaminationtechniques,documentingtheencounterinatimelymanner, ordering invasive diagnostic and therapeutic studies, ordering high riskmedications,andperformingcommonprocedures.ResidentsmustthenbecertifiedbytheattendingafterDirectSupervisionoftheprocedurepriortoperformingorsupervisingtheprocedure.AnelectroniclogwillbekeptofallproceduresandsignedoffbytheappropriateindividualintheUniversity’sNewInnovationssystem.Regardlessofthesiteortimeofday,anattendingphysicianmustIndirectlySuperviseproceduresbybeingphysicallypresentat


thesitetobeabletohelpifDirectSupervisionisnecessarywithprocedures.Theacademichospitalistmayservethispurposeattimesthatthedesignatedattendingisnotonsite.Forallothermedicaldecisionmaking,anattendingphysicianmustbeeasilyavailablebyphoneatalltimes.Whenonarotationwhereafellowispresent,theResidentandInternmayalsobe directly supervised by him/her in procedures and patient carematters only after theattending has certified that the Resident is competent to perform and supervise theprocedure. Residentsandfacultymembersareresponsibleforinformingpatientsoftheirrespectiverolesineachpatient’scare.

Overall delegation of progressive authority is assigned by the Program Director. TheProgramdirectorhasentrustedtheauthoritytodetermineappropriateauthoritywithinarotation to theattending facultyon service,directly supervising the resident and intern’spatientcareinteractions.AttendingsareallowedtodelegateportionsofcaretoResidentsbasedontheneedsofthepatientandtheskillsoftheresident,however,allmedicaldecisionsarereviewedbytheattendingphysician.TheprogressiveauthoritythatnecessarilycomeswithadvancementinPGyearisdeterminedsolelybytheProgramDirectorafterreviewofevaluationsandcommentsbasedonthe6ACGMEcorecompetencies.

Therearecertaincircumstancesandeventsinwhichresidentsmustcommunicatewiththeappropriatesupervisingfacultymembers.Thosecircumstancesinclude,butarenotlimitedtoasignificantchangeinthepatient’sstatus,aneedforahighriskprocedureortreatment,aconcernonatreatmentdecision,andanyactthatmayimpactpatientsafety(Cardiacarrest,rapidresponse,etc.).Housestaffshoulduse their judgmentonanyother issues thatarise,howeverifthereisanyquestionabouttheseriousnessofacircumstance,itshouldalwaysbeaddressedwiththeattending.

2. InpatientServices Theinpatientservicesareorganizedsoastoprovidehigh‐qualitymedicalcare,allowingthehousestafflimitedautonomyforindependentdecision‐makingwhileallowingtheattendingthe opportunity to directly and indirectly supervise the residents, ensuring appropriatepatientcare.Thefollowingareinpatientrotations:

● GeneralMedicineWardTeam(MHH;LBJ;VA) ● CardiologyConsultsorInpatientWardService(MHH;LBJ)

● CoronaryCareUnit(CCUMHH) ● EndocrinologyConsults

● IntensiveCareUnit(ICUMHH;LBJ) ● GastroenterologyConsults(MHH;LBJ)

● RenalConsults(MHH,LBJ) ● Hematology/OncologyConsults(MDA;MHH;LBJ)\

● Hepatology(MHH) ● PulmonaryConsults(MHH;LBJ)

● EmergencyRoom(LBJ) ● RheumatologyConsults(MHH;LBJ)

● StrokeService(MHH) ● GeneralMedicineConsults(LBJ)


3. OutpatientServices

The following is a list of outpatient services:

● Neurology ● AllergyandImmunology

● Geriatrics ● Ambulatory

● OncologyatMDA ● Continuity Clinics

4. ProceduresPerformedbytheResident

EachResidentwillneedDirectSupervisionwhileperforminganyprocedureuntilhe/shehascompletedorassistedin5ofthefollowing:

1. Residentmustdemonstratecompetenceandsafeperformanceof: ● ACLS (Current ACLS Certification) ● Drawing Venous Blood (Central Line) ● Drawing arterial blood (Arterial Line) ● Pap smear and endocervical culture ● Placing a peripheral venous line

2. Residentmustunderstandindications,complications,preparation,result,interpretationof:

● Abdominalparacentesis ● Arthrocentesis ● EKG ● Lumbarpuncture ● PAcatheterplacement ● Intubations ● Arteriallineplacement ● Centralvenouslineplacement ● Incisionanddrainageofanabscess ● Nasogastricintubation ● Thoracentesis

I. ROLESANDRESPONSIBILITIESOFRESIDENTS Asaconditionofappointment,theResidentisrequired,amongotherthings,to:

● ServeasassignedathospitalsaffiliatedwiththeProgram; ● Acceptandperformtheduties,responsibilities,androtationsassignedbythe

ProgramDirector; ● MeettherespectiveResidencyTrainingProgram'sstandardsforlearningand


advancement,includingtheobjectivelymeasureddemonstrationoftheacquisitionofknowledgeandskillsasdefinedbytheProgramandtheACGMEMilestones;

● ActivelyparticipateinallaspectsoftheirtrainingasdirectedbytheProgramDirector;

● AbidebyTheUniversityofTexasSystemBoardofRegents’RulesandRegulations,allapplicableUTHealthpoliciesassetoutintheGMEHandbookofOperatingProcedures(HOOP)(whichmaybefoundathttps://www.uth.edu/hoop/,allapplicableMedicalSchoolpoliciesandProgramrequirementsandguidelines,allMedicalStaffBylaws,andallproceduralrules,administrativepolicies,andotherapplicablerulesandregulationsofthehospitalstowhichtheResidentisassigned;

● Participateasamemberofhospital,departmental,andinstitutionalcommitteesas directedbytheProgramDirector; ● Conducthimselforherselfinaprofessionalmannerinkeepingwithhisorher positionasaphysician;and, ● MeetallotherconditionsoutlinedinthisPoliciesandProceduresHandbook,the

GMEResidentHandbook,orasotherwiserequiredbytheProgramDirectorand/orDepartmentChair.

Internsareresponsibleforthefollowing:

● Initialevaluationofallpatients,includingassimilationofoldrecordsandoutsideinformation;

● Developingaplanforeachpatienttopresenttohis/herUpperLevel;

● Communicatingwiththepatientandfamilyabouttreatmentplans,consultations,risksandbenefitsofproceduresandmedications,andotheraspectsofcare;

● Gettingwrite‐upsonthechartnolaterthan8:00a.m.followingacallday.

Theprimaryrolesoftheupperlevelincludesupervisionandeducation.Thisiscomprisedofthefollowing:

● SeeingeverypatientonthedayofadmissionandwritinganUpperLevelAddendum

1. UpperLevelAddendumrequiresaHPI,pertinentPMH,Meds,andPE,alongwiththeResident’sAssessmentofthepatient’sillnessandtheteam‐formulatedplan.ThisisnotintendedtobeafullH&P.

2. WhenworkingwithanAI,ResidentmustwriteoutafullandcompleteHistoryandPhysical,onlyMedicalStudents’ReviewofSystemsmaybereferredtointheResidentnote.AllotheraspectsoftheH&PmustbeindependentlydocumentedbytheResident.

● ReviewandapprovediagnosticandtreatmentplanswiththeinternseverydaypriortoAttendingRounds

● Reviewpatients'progressdaily,givingfeedbacktotheinternonprogressnotes,orderwriting,anddischargeplanning

● AssumingcompleteresponsibilityofInterns’patientsonInterndaysoff

● Organizingandplanningattendingrounds,meetingswithconsultants,andotherteachingopportunities


● Settingtimeasideforteachingmedicalstudents,includingreviewingwrite‐upsandgivingtimelyfeedbackinapositivelearningenvironment

● Creatinganatmospheresuchthattheinternisencouragedtoaskforhelpwhenappropriate

● DirectlyandIndirectlysupervisingprocedures

● Interactingwithnursesandotherpersonnelinawaythatrespectsallmembersofthehealthcareteamandencouragestheirinput

● Beingcertainallmembersoftheteamarefamiliarwiththecurrentliteratureregardingtheirpatients

● AResidentwillnotsupervisemorethan10newadmissionsincludingin‐housetransfers;andnomorethan16newpatientsina48hourperiod

● AResidentwillnotberesponsiblefortheongoingcareofmorethan14patientswith1PGY‐1or20patientswith2PGY‐1s

● ParticipatinginAmbulatorycurriculumonthedayofcontinuityclinic.

1. MEDICALRECORDSANDCLINICALDOCUMENTATION

Itistheresponsibilityofeveryhouseofficertocompleteallmedicalrecordsinatimelymanner.TheWardresidentisultimatelyresponsibleforalldocumentationcompletedbytheteamduringhis/hermonthwhetheritisdocumentedbyhimself/herself,aninternoractingintern(4thyearMedicalStudent).ItistheresponsibilityofthewardResidenttocompleteadmissionhistoryandphysicalexaminationsanddischargesummarydictations.Internsshoulddictatedischargesummariesonthedaythepatientisdischarged.Ifadischargesummarybecomesdelinquent,therecordwillbeturnedovertothewardresidentforcompletion.Medicalstudents,including4thyearstudents,mustnotdictatedischargesummaries.Notificationofincompletechartswilloccuronaregularbasis,andtheintern/residentmustthencompletethosechartswithin1week.Failuretodosowillresultindisciplinaryaction.

Itistheresponsibilityofconsultingresidentstocompleteconsultationnotedictationswithin24hoursofperformingtheconsultation.

J. EXPOSURETOINFECTIOUSDISEASES NeedleStickandOtherExposures–IncludingBodyFluids 1. IfyouhaveaneedlestickorotherbodyfluidexposuregototheMemorialHermann

HospitalEmergencyRoom.Theattendingwillinstructyouastothecourseofactiondependinguponthetypeofexposureyouhavehad.For24‐hourimmediateassistance,information,orcounselingcontact713‐951‐8013(pager)andleavemessage.Yourcallwillbehandledimmediately.

2. YoumustcompleteaFirstReportofInjuryForm.Thisformestablishesthe

eligibilityforWorkersCompensationInsurance.TheFirstReportofInjuryFormwillbeavailablethroughtheERattending.


3. Forfollow‐upitwillbenecessaryforyoutobeseenintheUTStudentHealthServicesClinic.Follow‐upwillbedeterminedbytheECAttending.

4. IfyouaresignificantlyexposedtoHIVandyouchoosetotakeprophylactic

antiretroviralmedications,theywillbeprescribedandmadeavailableattheMemorialHermannPharmacy.ThePharmacywillbilltheMedicalFoundationiftheprescriptioniswrittenbyanERattendingorthephysicianintheFamilyPracticeHealthClinic.

5. ItisYOURresponsibilitytofollowtheabovestepsandcompleteallformsfor

incidentreporting.Follow‐upwiththehealthclinicismandatorytobeincompliancewithworker’scompensationregulations.ThisisveryimportantsothatclaimscanbefiledwithWorker’sCompensationandnotbilledtoyou.

K. EVALUATIONANDADVANCEMENT Residentsmustsuccessfullycompleteclinicalanddidacticrequirementsinordertobepromotedtothenextlevelaswellastosuccessfullycompletetheprogram.Thedecisiontoappointandreappointwillbebasedonperformanceevaluations,participationinconferencesandlectures,masteryofthesixcorecompetenciesdelineatedbytheACGME,andanassessmentoftheresident’sreadinesstoadvance.

Eachattendingisremindedthatatthebeginningofthe4weekblock,he/sheistogooverthegoalsandobjectiveswithhis/herResident(s)andexplicitlyoutlinewhatisexpectedoftheResidentthroughoutthemonth.After2weeksontherotation,eachresidentshallmeetwiththeirattendingphysicianstoreviewhis/herprogress.Attheendofthe4weekblock,theresidentandattendingshallmeettoreviewtheevaluation.Oneachrotation,theResident’sperformanceisevaluatedbytheattendingphysicianthroughanon‐lineevaluationsystem,NewInnovations.Beforeanevaluationisconsideredcomplete,itmustbeacknowledgedorprotestedon‐linebytheresident.

Residentevaluationsareavailableonlinebytheendoftherotationandemailreminderswillbeautomaticallysenttoeachresidentandattending.Theattendingwillfillouthisorherevaluationontheresidentandtheresidentwillfilloutanevaluationonboththeattendingandtherotation.Whenaresidenthascompletedhis/herevaluationoftheattending,he/shewillbeabletoviewthecommentsmadebytheattendingphysicianapplicabletotherotation.Residentsaregiventheopportunitytorespondtocommentsmadebytheattending,iftheywish.

Residentswillalsobeaskedtoevaluateotherresidents,interns,fellowsandmedicalstudentsthattheyworkwitheachmonth.

TheonlineevaluationsystemdevelopedbyUTHealthcanbefoundat:www.new‐innov.com/uth

EvaluationofadvancementoftheResidentsisperformedbytheChairmanandProgramDirectors,withtheadviceoftheClinicalCompetencyCommittee.Thesereportskeptintheresident’spermanentfileintheResidencyProgramoffice.Aresidentmayreviewthatfileanytimeheorshewishes.ProgressofresidentsisreviewedregularlybytheResidencyClinicalCompetencyCommittee,whichmeetsmonthly.


1. ResidentEvaluations Residentevaluationswillbeassignedforeach4weekblockandarecompletedbytheappropriateattending.TheevaluationsareananalysisoftheResidentsperformanceduringthemonthbasedonthemilestonesineachofthe6ACGMEcorecompetencies.Theseevaluationsareassigned7daysafterthebeginningofeachrotation.Anyrotationswherearesidentreceivedanoverallratingof“Unsatisfactory”willneedtoberepeated.

2. RotationEvaluations Rotationevaluationsareassignedforeach4weekblockandcompletedbytheResident.TherotationevaluationsareanopportunityfortheResidenttoevaluatetheirexperienceoneachrotationwithanassessmentofpatientdiversity,workload,responsibility,andsupervisionamongstotherthings.TheProgramDirectorutilizestheseevaluationsinhis/herreviewoftheProgramscurriculum.

3. PeerEvaluations Peerevaluationsareassignedforeach4weekblockandcompletedbytheResidentonhis/herpeersconductthroughouttherotation.Itiscompletedandsubmittedbyteammembersthatrotatedwiththeresidentfortherotationandcanbesubmittedconfidentially.Theseevaluationsarereviewablebytheindividualbeingevaluatedhowever,ifitissubmittedanonymously,neitherthereviewingResidentnoranyProgramDirectororadministratorwillnotbeabletodeterminewhosubmittedtheevaluation.

4. AttendingEvaluations Attendingevaluationsareassignedforeachblock.ResidentswillevaluatetheirattendingforthetimeperiodthattheResidentworkedwithhim/her.ThisevaluationcanbecompletedanonymouslybytheResidentandgagestheattending’savailability,teachingability,patientcareandprofessionalism,medicalknowledge,supportfortheresidentandattendingfeedback.

5. ResidentSelf‐Evaluations Thisself‐assessmentiscompletedbytheresidentattheendofhis/hertraininganddiscussedwiththemintheirendofyearevaluationmeetingwiththeProgramDirector.TheprogramDirectorhasalsocompletedanassessmentoftheResidenttocompare.

6. SixMonthEvaluations TheseevaluationsarecompletedbytheProgramDirector/AssociateProgramdirector,andareprovidedtotheResidentatleastsemiannuallyandeachResidentisprovidedfeedbackabouttheirprogressintheprogram.ThesummarypresentedtotheResidentdetailstheresident’sprogressovertheprevioussixmonthperiod,mostespeciallyinregardstotheACGMEmilestones.Careercounselingisalsodiscussedinthismeeting.ThismeetingisdocumentedintheACGMEsystem,andacopyofthemeetingdetailsareplacedintheResident’sfile.


7. ClinicalEvaluationExercise DuringthePGY‐1year,theclinicalskillsofeachresidentwillbeformallyevaluatedbyamemberofthefaculty.Thisexerciserequiresthatthefacultymemberobservetheresidentperformahistoryandphysicalexamination,andthendiscussthediagnosisandplansformanagementwiththehouseofficer.Iftheevaluatingphysicianbelievesthatfurtherimprovementofclinicalskillsisdesirable,theexercisewillberepeatedatlaterstagesoftraining.SatisfactorycompletionoftheClinicalEvaluationExerciseisrequiredbeforewewilldeclarethehouseofficertobeeligiblefortheexaminationoftheAmericanBoardofInternalMedicine.

EachresidentwillreceiveanemailwithinthefirstweekofSeptemberwiththeCEXformattachedwhichwillincludeinstructionsforcompletionandwillbeduenolaterthanthelastdayofOctober.Itistheresident’sresponsibilitytoprintouttheform,takeittotheassignedclinicattending,orhospitalattending,andhaveitcompleted.Afterboththeattendingandresidentsignit,itshouldbedeliveredtotheProgramCoordinators.

8. In‐TrainingExam TheIn‐TrainingExaminationbytheAmericanCollegeofPhysiciansismandatoryforallresidents.ItisadministeredinAugust/Septemberofeveryyear,andallcategoricalresidentswillsitfortheexameachyear.Youwillbeexcusedfromclinicaldutiesonthatdayandyouwilltakethe9hourexaminafulldaysession(withscheduledbreaks).

9. MKSAP

ResidentsarerequiredtocompleteMKSAPassignmentsduringeachambulatoryblock,whichmustbeuploadedtoBlackboardorCanvas(EducationManagementSoftware).CompletionofthesetestsismandatoryasapartoftheAmbulatoryCurriculum.

10. EvaluationCriteriaAnumberoffactorsareconsideredwhenassessingresidents.Evaluationsarebasedonthe6ACGMEcorecompetencies:patientcare,medicalknowledge,systembasedpractice,practicebasedlearningandimprovement,professionalism,andinterpersonalandcommunicationskills.Thefollowingtoolsareutilizedwhenassessingaresident.

Patient Care

Competency Milestone Evaluation Tool Gathers and synthesizes essential and accurate information to define each patient's clinical problem(s).

➢ Manages patients using clinical skills of interviewing and physical examination.

➢ Appropriately uses laboratory and imaging techniques.

PC-A1-4PC-B1-4 PC-C1

● Monthly Resident Evaluations

● Peer Evaluations

● Student Evaluations

● 360 Summary


● Continuity Clinic Evaluations

● CEX Develops and achieves comprehensive management plan for each patient.

➢ Synthesise all available data, including interview, physical examination, and preliminary laboratory data, to define each patient’s central clinical problem.

➢ Develop prioritized differential diagnosis, evidence based diagnostic and therapeutic plan for common inpatient and ambulatory conditions.

➢ Modify differential diagnosis and care plan based on clinical course and data as appropriate.

PC-C1-3 ● Monthly Resident Evaluations



● 360 Summary ● Continuity Clinic

Evaluations ● CEX

Manages patients with progressive responsibility and independence.

➢ Manage patients in a variety of health care settings to include the inpatient ward,critical care units, the ambulatory setting and emergency setting.

➢ Manage undifferentiated acutely ill and severely ill patients.

PC-F1-10 ● Monthly Resident Evaluations




Evaluations Skill in performing procedures.

➢ Demonstrates competence in the performance of procedures mandated by the ABIM.

PC-D1 ● Monthly Resident Evaluations

● Continuity Clinic Evaluations

● Procedure Logs Requests and provides consultative care.

➢ Patient Care ○ Recognize when to seek additional

guidance. ○ Manage patients as a consultant to

other physicians.

PC-G1-2 ● Monthly Resident Evaluations




Evaluations

Medical Knowledge

Competency Milestone Evaluation Tool Clinical Knowledge.

➢ Core knowledge of General Internal Medicine and its subspecialities.

○ Demonstrate a level of expertise in the knowledge of those areas

MK1 ● Monthly Resident Evaluations



appropriate for an internal medicine specialist.

○ Demonstrate sufficient sufficient knowledge to treat medical conditions commonly managed by internists, provide basic preventative care and recognize and provide initial management of emergency medical problems.



Evaluations ● CEX ● Pre and Post

Tests ● ACP Grades

Knowledge of diagnostic testing and procedures.➢ Common modalities utilized in the practice of

Internal Medicine. ○ Demonstrates sufficient knowledge to

interpret basic clinical tests and images, use common pharmacotherapy and appropriately use and perform diagnostic and therapeutic procedures.

MK2 ● Monthly Resident Evaluations




Evaluations ● CEX ● Pre and Post

Tests ● ACP Grades ● Procedure Logs

System Based Practice

Competency Milestone Evaluation ToolWorks effectively within an interprofessional team (e.g peers, consultants, nursing ancillary professionals, and other support personnel).

➢ Work in interprofessional teams to enhance patient safety and improve patient care quality.

SBP-B1-4 ● Monthly Resident Evaluations



● 360 Summary ● Continuity

Clinic Evaluations

Recognizes system error and advocates for system improvement.

➢ Improving healthcare delivery. ○ Advocate for quality patient care and

optimal patient care systems. ○ Participate in identifying system errors

and implementing potential system solutions.

○ Recognize and function effectively in high quality care system.

SBP-C1-5 ● Monthly Resident Evaluations



● 360 Summary ● Conference

Evaluations ● QI Project

Identifies forces that impact the cost of healthcare, advocates for and practices cost effective care.

SBP-D1-4SBP-E1-4

● Journal Club


➢ Cost effective care for patients and populations. ○ Incorporate considerations of cost

awareness and risk benefit analysis in patient and/or population-based care as appropriate.

● Morning Report Evaluations

● Conference Evaluations

Transitions patients effectively within and across health delivery systems.

➢ Work in teams and effectively transmit necessary clinical information to ensure safe and proper care of patients including the transition of care between settings.

SBP-A1-3 ● Monthly Resident Evaluations




Clinic Evaluations

Practice based Learning and Improvement

Competency Milestone

Evaluation Tool

Monitors practice with a goal for improvement.➢ Identify strengths,deficiencies, and limits in

one’s knowledge and expertise. ➢ Set learning and improvement goals.

PBLI-G1 ● Monthly Resident Evaluations

● Resident Self-Assessment

Learns and improves via performance audit.➢ Systematically analyze practice using quality

improvement methods, and implement changes with the goal of practice improvement.

PBLI-F4 ● Monthly Resident Evaluations


Learns and improves via feedback.➢ Incorporate formative evaluation feedback into

daily practice.

PBLI-F1 ● Monthly Resident Evaluations


Professionalism

Competency Milestone

Evaluation Tool

Has professional and respectful interactions with patients, caregivers and members of the interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and support personnel)

➢ Provide timely, constructive feedback to colleagues.

○ Communicate constructive feedback to other members of the healthcare team.

P-C1-2P-F6 P-F7




● 360 Summary


○ Recognize, respond to, and report impairment in collegues or substandard care via peer review process.

➢ Serve as a professional role model for more junior colleagues (e.g students, interns, etc.).

➢ Recognize the need to assist colleagues in the provision of duties.

Accepts responsibility and follows through on tasks..

➢ Maintain accessibility. ○ Respond promptly and appropriately to

clinical responsibilities including but not limited to calls and pages.

○ Carryout timely interactions with colleagues, patients, and their designated caregivers.

➢ Demonstrate personal accountability. ○ Ensure prompt completion of clinical,

administrative, and curricular tasks.

P-D1-2P-F3




● 360 Summary ● Coordinator

Evaluation ● Conference

Evaluations and Attendance

Responds to each patient’s unique characteristics and needs

➢ Patient Centeredness ○ Respect for patient privacy and

autonomy. ○ Sensitivity and responsiveness to a

diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

P-I1-2P-J1-2




● 360 Summary ● Patient

Evaluations Exhibits integrity and ethical behavior in professional conduct.

➢ Physicianship ○ Demonstrate compassion, integrity, and

respect for others. ○ Responsiveness to patient needs that

supersedes self-interests. ○ Accountability to patients, society, and

the profession.

P-A1-4P-B1-4




● 360 Summary ● Coordinator

Evaluation

Interpersonal and Communication Skills

Competency Milestone Evaluation Tool Communicates effectively with patients and caregivers.

➢ Communicate effectively with patients, family, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.

ICS-A1-8ICS-B1-3 ● Monthly

Resident Evaluations





Clinic Evaluations

Communicates effectively in interprofessional teams (e.g. peers, consultants, nursing, ancillary professionals and other support personnel).

➢ Works effectively as a member or leader of a healthcare team or other professional group.

➢ Act in a consultative role to other physicians and health professionals.

ICS-C1-2ICS-D1-3 ICS-E1-3





Clinic Evaluations

Appropriate utilization and completion of health records.

➢ Maintain comprehensive, timely, and legible medical records.

ICS-F1ICS-F2


11. ProblemsandComplaintsaboutEvaluation Ifaresidentreceivedanunsatisfactoryevaluationfromanyattendingphysician,oneoftheprogramdirectorswilldiscussthematterbothwiththeattendingphysicianandthehouseofficer.Theoutcomeofthesemeetingswillbeimprovedunderstandingofwhatisexpectedofthehouseofficerand,ifnecessary,plansforimprovementofperformance.Writtenrecordsofthesediscussionswillbekeptinthehouseofficer’sfile.Ifthereareissuesthatcomeupduringarotation,theresidentshoulddiscussitfirstwiththeattendingandthen,ifnecessary,withaprogramdirector.

Intheeventthatapatient,houseofficer,facultymember,memberofthehospitaladministrationornursingstaffregistersacomplaintregardingamemberoftheResident,thatcomplaintwillbeinvestigatedthoroughly.Ifthereappearstobesubstancetothecomplaint,thehouseofficerwillbeaskedtodiscussthesituationwithoneoftheprogramdirectors.Ifdesired,thehouseofficermaywriteaformalrebuttalwhichwillbecomepartofhisorherrecord.Iftheprogramdirectorconcludesthatthecomplaintwasunjustified,nofurtherrecordwillbemaintainedoftheincident.Ifitisconcludedthattherehasbeenmisconductwarrantingdisciplinaryaction,thatactionwillbesubjecttotherulessetforthbytheMedicalFoundationandoutlinedexplicitlyintheresident’scontract.

12. Retaliation TheProgramencouragesResidentsandAttendingstoopenandhonestlyevaluateasisappropriateinthespiritofconstructiveevaluation.Thisprogramdoesnottolerateretaliation.Shouldaresidentfeelthathe/sheisbeingretaliatedagainstforanyreason,thisshouldbereportedtoaProgramDirectorimmediatelyforreviewandproperaction.


L. MedicalLicensure EligibilityrequirementsforTexasMedicallicensurearefoundinChapter163oftheTexasMedicalBoardsrules.Themajorrequirementsforcompletionofeither60hoursofpre‐medicaleducationorcompletionoftherequiredpre‐medicaleducationofthecountrywherethemedicalschoolislocated,graduationfromaU.S.orCanadianmedicalschooloranacceptableunapprovedmedicalschool,andyoumusthavepassedanexaminationacceptabletotheBoard.Licensureinformationmaybeobtainedfromthehousestaffoffice.CompleteinformationaboutlicensurecanbefoundontheTexasMedicalBoardwebpage.HousestaffshouldobtainavalidTexasMedicalLicenseassoonaspossible. Requirementsinclude:

● Completionof12monthsofInternalMedicineInternshipforUSorCanadianMedicalSchoolGraduates,orcompletionof24monthsofInternalMedicineforallothers.

● CompletionandMasteryofUSMLEStep3● CompletionandMasteryofJurisprudenceExam● CompletionofFormLbytheprogram

Ifyouarelicensedwhilestillcompletingresidencytraining,youmustmaintainyourlicenseandensurethattheResidencyProgramhasyourcurrentinformation.Ifyouallowyourlicensetoexpire,youwillbeunabletoperformyourResidencydutiesuntilitisrenewed.

1. DEAANDDPSNUMBERS

InstitutionalDrugEnforcementAdministration(DEA)numbersareassignedbytheaffiliatedhospitaltotheResident.TheinstitutionalDEAnumberallowsprescription‐writingprivilegesforonlyeducationaltrainingprogramactivities.InstitutionalDEAnumbersarenotvalidfor"externalmoonlighting"oranyotheractivitiesoutsideoftheeducationaltrainingprogram.InstitutionalDepartmentofPublicSafety(DPS)numbersareassignedtoResidentsthatholdaTexasMedicalBoardPITpermits.ThesenumbersareassignedbytheGMEOfficeincoordinationwithaffiliatedhospitals.TheDPSnumberallowsprescription‐writingprivilegesforcontrolledsubstancesonlyaspartofeducationaltrainingprogramactivities.DPSnumbersarenotvalidfor"externalmoonlighting"oranyotheractivitiesoutsideoftheeducationaltrainingprogram.

OnceaResidentobtainsafull,unrestrictedTexasmedicallicense,thelicensedResidentmustapplyforandobtainindividualDPSandDEAnumbers.AllfullylicensedResidentsare responsibleforobtainingtheirownindividualDPSandDEAnumber

M. EDUCATIONALMEETINGSANDCONFERENCES TheProgramhastakengreatcareinputtingtogetheracomprehensivelistofdidacticlecturesandconferencestohelpyouinyourstudies.Scholarlyactivitiesareencouragedamongtheresidents.PartofthisisattendanceatnationalmeetingsforInternalMedicineoritssubspecialties.Residentswhowishtoattendmedicalorscientificmeetingsmustobtainpriorapprovalfromtheirattendingphysiciansandtheprogramdirector.Coverageforyourabsencefromservicemustbearrangedbytheresidentaheadoftimeandislimitedtotwo


days.TheAssistantChiefsofServicewillnotpullresidentsfromtheJeopardyCallRotationtoprovidecoverageforaresident’sdutieswhiletheyareaway.

ThereareseveralInternalMedicineconferencesheldweekly.AttendancebyResidentsismandatoryandwillbemonitoredwithsign‐insheets.Failuretomaintain80%attendancetoNoonConferenceandMorningReport,excludingdaysoff,postcalldays,orattendancetoasubspecialtyconference(heldattheexactsametimewithdocumentation)willresultinpunitiveaction.

Conferenceattendancewillbetalliedfromthefirstofeachblocktothelastdayofeachblock.Cumulativeattendanceratewillbeavailableonthe5thdayofthefollowingblock.Anyhousestaffwithlessthan80%attendanceratewillbesubjecttoacallfromtheprogramdirector,andthisviolationwillbedocumentedintheresident’smilestoneperformanceassessmentofprofessionalism. Thesemandatoryconferencesareasfollows:

1. ResidentCaseConferences These conferences include intern conference, sub-specialty conference, post-call morning reports, and morning case conference. Conferences occur at all hospitals and will be clinical case presentations by the residents or interns scheduled for that day. Attendance at these conferences is required and will count toward your total attendance for the block. TheseconferencesaredesignedtobolstercriticalthinkingonthepartoftheResidentsbydevelopingpresentationskillsaswellasrefiningtheirclinicalapproachtopatientproblems.ResidentsandInternsareresponsibleforpresentingclinicalcasesfordiscussion.

2. CoreCurriculumLectures Thisone‐yearseriesoflecturesisdeliveredbytheCoreFaculty/CoreFacultydesignee.EachsubspecialtypresentsoncommonlyseendiseaseprocessesinInternalMedicineandthesepresentationsaredesignedtoprepareResidentsforpracticeaswellasfortheAmericanBoardofInternalMedicineCertifyingExamination.Thesestructuredconferencesalongwithconsistentreading,attendanceatotherconferencesandpatientcarehelpprepareResidentsfortheBoardexamination.

3. GrandRounds InternalMedicineGrandRoundsareheldonThursdaysat12pmintheMedicalSchool,room2.103.ThesepresentationsaregivenbymembersofUTHealthfacultyorbyvisitingprofessors,concerningimportantandrelevanttopicsinInternalMedicine.ThisconferenceissimultaneouslybroadcasttoLBJhospital.

4. SeniorSeminar Everyyear,theseniorresidentspreparenoonconferencesthatconsistofareviewofatopic.Thesubjectmattermaybeanytopicrelevanttoclinicalmedicineorthebasicscienceswhichrelatetomedicineordeliveryofhealthcare.ThepresentingresidentsareexpectedtousethePowerPointpresentationformatandtodistributehandoutsoutliningthesubjectandcontainingpertinentbibliographies.Eachresidentwillpresentonceduringhis/her


PGY‐3yearandselectafacultymentortoassistwiththispresentation.ResidentsmaybeexemptfromthisrequirementiftheyhavepresentedatanACPconferenceorhaveapublicationduringtheirresidency.

5. BoardReviewConference TheprogramhassetupthislectureseriestoincludehighyieldboardreviewtopicsandboardreviewquestionstofacilitatestudyingandmasteryoftheAmericanBoardofInternalMedicineCertificationExam.

N. PROFESSIONALATTIREANDETIQUETTE

Resident’sshouldalwaysdressandbehaveinsuchawayastoearntherespectofpatients,nurses,students,fellowphysicians,andotherhospitalpersonnel.Whitecoatsshouldbewornonthewardsandintheclinic;thenamesembroideredonthecoatsshouldbeclearlyandeasilyvisible.Residentsareexpectedtodressinwell‐fittingprofessionalattireandtodemonstrategoodpersonalhygieneandcleanliness.Scrubsmaybewornonweekendsand“afterhours”duringoncallshifts.

O. MOONLIGHTING MoonlightingisdefinedasanypatientcareserviceaResidentperformsasafullylicensedphysicianwherehe/shereceivesfinancialcompensationasaresultofthoseservices.MoonlightingoccursoutsideoftheInternalMedicineResidencyProgramandResidentsassignmentsfromtheProgramarenotincludedinMoonlighting.Residentsarenotrequirednoraretheyencouragedtoengageinprofessionalactivitiesoutsidetheeducationalprogram.Moonlightingmustnotinterferewiththeabilityoftheresidenttoachievethegoalsandobjectiveoftheprogram.

EveryresidentwhowishestoengageinmoonlightingmustprovidewrittennotificationoftheirintentandparticipationtotheProgramDirectorandreceiveapprovalfromtheProgramDirector.Thisrequestandapproval/disapprovalwillbecomepartoftheResident’sfile.Failuretonotifytheprogramdirectorofmoonlightingactivitieswillresultindisciplinaryaction.TheProgrammayrevokeapprovalorinitiatecorrectiveactionintheeventoutsideprofessionalactivityinterfereswiththeabilityoftheResidenttosatisfactorilyfulfilltheobligationsoftheProgram.

ResidentsarerequiredtobeindependentlylicensedforunsupervisedmedicalpracticebytheStateofTexasandbeingoodstandingwiththeResidencyProgrambeforetheycanconsidermoonlighting.Aphysician‐in‐trainingpermitdoesnotentitletheResidenttoengageinprofessionalactivities(i.e.,medicalpractice)outsidetheeducationalprogram.Moonlightingisprohibitedduringstandardworkhoursandshouldbelimitedtonomorethan3‐4nightspermonth,andcannotinterferewithperformanceofone’sclinicalandacademicduties.Allmoonlightingwillcounttowardtheresident’stotaldutyhoursandresidentsmaynotexceed80hoursworkedperweek.


TheUniversityofTexasHealthScienceCenterdoesnotprovideliabilitycoverageformoonlightingactivities.Itistheresponsibilityofthehiringinstitutiontodeterminewhethertheresidenthastheappropriatelicensureinplace,whetheradequateliabilitycoverageisprovidedandwhethertheresidenthastheappropriatetrainingandskillstocarryoutassignedduties.

Internsarenotpermittedtomoonlightunderanycircumstances.

P. DUTYHOURS DutyHoursaredefinedasallclinicalandacademicactivitiesrelatedtotheresidencyprogram,i.e.,patientcare(bothinpatientandoutpatient),administrativedutiesrelatedtopatientcare,theprovisionfortransferofpatientcare,timespentin‐houseduringcallactivities,andscheduledacademicactivitiessuchasconferences.Dutyhoursdonotincludereadingandpreparationtimespentawayfromthedutysite.Thereisnocall,eitherinpatientorat‐home,duringthisresidencyprogram. NightFloatisdefinedasarotationoreducationalexperiencedesignedtoeithereliminatein‐housecallortoassistotherresidentsduringthenight.Residentsassignedtonightfloatareassignedon‐sitedutyduringevening/nightshiftsandareresponsibleforadmittingorcross‐coveringpatientsuntilmorninganddonothavepost‐floatdaytimeassignments.Rotationsmusthaveaneducationalfocus.Residentsmustnotbescheduledformorethansixconsecutivenightsofnightfloat.Programsmustfurtherabidebyanyprogramspecificrequirements.

1. Policy Dutyhoursmustbelimitedto80hoursperweek,averagedoverafour‐weekperiod,inclusiveofallin‐housecallactivitiesandallmoonlighting.DutyperiodsforPGY‐1residentsmustnotexceed16hoursinduration.DutyperiodsofPGY‐2residentsandabovemaybescheduledtoamaximumof24hoursofpatientcareinthehospital,with4additionalhoursforeducationalactivities.Theprogramencouragesresidentstousealertnessmanagementstrategiesinthecontextofpatientcareresponsibilities.Strategicnapping,especiallyafter16hoursofcontinuousdutyandbetweenthehoursof10:00p.m.and8:00a.m.,isstronglyencouraged.

(i) Residentsmaybeallowedtoremainonsiteinordertoensurethat effectivetransitionsoccur,howeverthisperiodoftimemustbeno longerthananadditionalfourhours. (ii)Inunusualcircumstances,residents,ontheirowninitiative,may remainbeyondtheirscheduledperiodofdutytocontinuetoprovide caretoasinglepatient.Justificationsforsuchextensionsofdutyare limitedtoreasonsofrequiredcontinuityforaseverelyilloranunstable patient,academicimportanceoftheeventstranspiring,orhumanistic attentiontotheneedsofapatientorfamily.

a.Underthosecircumstances,theresidentmust: i.appropriatelyhandoverthecareofallotherpatientstothe teamresponsiblefortheircontinuingcare;and, ii.documentthereasonsforremainingtocareforthepatient


inquestionandsubmitthatdocumentationinevery circumstancetotheprogramdirector.

b.Theprogramdirectormustrevieweachsubmissionofadditional service,andtrackbothindividualresidentandprogram‐wide episodesofadditionalduty.

Residentsmustbescheduledforaminimumofonedayfreeofdutyeveryweekwhenaveragedover4‐weeks.Athomecallcannotbeassignedonthesefreedays.Onedayisdefinedasonecontinuous24‐hourperiodfreefromallclinical,educational,andadministrativeactivities.

MinimumTimeOffBetweenScheduledDutyPeriods:PGY‐1residentsshouldhave10hours,andmusthaveeighthours,freeofdutybetweenscheduleddutyperiods.Intermediate‐levelresidentsshouldhave10hoursfreeofduty,andmusthaveeighthourbetweenscheduleddutyperiods.Theymusthaveatleast14hoursfreeofdutyafter24hoursofin‐houseduty.Residentsinthefinalyearsofeducationmustbepreparedtoentertheunsupervisedpracticeofmedicineandcareforpatientsoverirregularorextendedperiods.Thispreparationmustoccurwithinthecontextofthe80‐hour,maximumdutyperiodlength,andone‐day‐off‐insevenstandards.Whileitisdesirablethatresidentsintheirfinalyearsofeducationhaveeighthoursfreeofdutybetweenscheduleddutyperiods,theremaybecircumstanceswhentheseresidentsmuststayondutytocarefortheirpatientsorreturntothehospitalwithfewerthaneighthoursfreeofduty.Circumstancesofreturn‐to‐hospitalactivitieswithfewerthaneighthoursawayfromthehospitalbyresidentsintheirfinalyearsofeducationmustbemonitoredbytheprogramdirector.PGY‐2residentsandabovemustbescheduledforin‐housecallnomorefrequentlythaneverythirdnight,averagedoverafour‐weekperiod.PGY‐2residentsandabovemustnotbeassignedadditionalclinicalresponsibilitiesafter24hoursofcontinuousduty

DutyHoursareformallymonitoredthroughtheInstitutionalGMEISsystemandeachResidentisrequiredtosubmittheirdutyhoursonamonthlybasis.

2. On‐CallActivities At‐homecall(pagercall)isdefinedascalltakenfromoutsidetheassignedinstitution.At‐HomeCallmaynotbescheduledontheresident’sonefreedayperweek(averagedoverfourweeks).At‐homecalldoesnotoccurduringtheMedicineResidency.

1.Timespentinthehospital(exclusiveoftraveltime)byresidentsonathomecallmustcounttowardsthe80hourperweeklimit. 2.Thefrequencyofat‐homecallisnotsubjecttotheeverythirdnightlimitation,butmustsatisfytherequirementfor1dayin7freeofdutywhenaveragedovera4‐weekperiod. 3.At‐homecallmustnotbesofrequentortaxingastoprecluderestorreasonablepersonaltimeforeachresident.Theprogramdirectorandthefacultymustmonitorthedemandsofat‐homecallintheirprogramsandmakeschedulingadjustmentsasnecessarytomitigateexcessiveservicedemandsand/orfatigue. 4.Residentsarepermittedtoreturntothehospitalwhileonat‐homecalltocareforneworestablishedpatients.Eachepisodeofthistypeofcare,whileitmustbeincludedinthe80‐hourweeklymaximum,willnotinitiateanew“off‐dutyperiod”.


In‐housecalldoesnotoccurmorefrequentlythaneverythirdnight,averagedovera23four‐weekperiod.Continuouson‐siteduty,includingin‐housecall,willnotexceed24consecutivehourshoweverResidentsmayremainondutyforuptosixadditionalhourstoparticipateindidacticactivities,transfercareofpatients,conductoutpatientclinics,andmaintaincontinuityofmedicalandsurgicalcareasappropriate.

3. SubspecialtyProgramRequirements Whileonasubspecialtyrotation,nonewpatientsmaybeacceptedafter24hoursofcontinuousduty.At‐homecall(pagercall)isdefinedascalltakenfromoutsidetheassignedinstitution.Thefrequencyofat‐homecallisnotsubjecttotheeverythirdnightlimitation.However,at‐homecallmustnotbesofrequentastoprecluderestandreasonablepersonaltimeforeachresident.Residentstakingat‐homecallmustbeprovidedwith1dayin7completelyfreefromalleducationalandclinicalresponsibilities,averagedovera4‐weekperiod.Whenresidentsarecalledintothehospitalfromhome,thehoursresidentsspendin‐housearecountedtowardthe80‐hourlimit.

4. Professionalism,PersonalResponsibility,andPatientSafety AllResidentsandInternsintheInternalMedicineResidencyProgrammustappearfordutyappropriatelyrestedandfittoprovidetheservicesrequiredofpatients.Thisisnotonlyimportantforprofessionalaspectsofyourjobbutalsotoensurepatientsafetywhileyouarepracticingpatientcare.TheS.A.F.E.Rprogram,providedbytheGMEoffice,isarequiredpresentationthateachHousestaffofficermustviewandunderstand.ThispresentationisdesignedtoeducateResidentsandInternstorecognizethesignsoffatigueandsleepdeprivation,educateinalertnessmanagementandfatiguemitigationprocesses,helpswithideasonhowtomitigatepatientcareproblemsthatstemfromfatigue.ResidentsandInternsarestronglyencouragedtonotifytheattendingand/orProgramDirectorofissueswithfatiguewhilecompletingpatientcareresponsibilitiesandencouragestheuseofstrategicnappingtofighttheeffectsoffatigueonPatientCare.SleepfacilitiesareprovidedatallsiteswhereaResidentorInternrotatesandmayfindthemselvesinasituationwherethepatientcarequalityiscompromisedbyexcessivesleepiness. 5.ReportingDutyHours Allresidentsmustreporttheirdutyhoursmonthly.ResidentswillreportdutyhoursbyloggingintoNewInnovationsandenteringthetimeworked.Dutyhourswillbeconsideredlatebythe5thdayofthefollowingmonth.(Example:DutyhoursforJulywillneedtobesubmittednolaterthanAugust5th.)Aresidentwillbeconsideredtobenotcompliantintheprogramifdutyhoursaredelinquent.Shouldresidentbecomeroutinelydelinquenttheassociateprogramdirectorand/orprogramdirectorwillbenotifiedandfurtherdisciplinaryactionmaybepursued.


Q. GRIEVANCES TheProgramDirectorisresponsibleforensuringcompliancewiththegrievanceanddueprocessprocedure,aswellastheinstitutionalrequirementsfoundintheGMEResidentHandbook.Grievancesmayinvolvepayroll,hoursofwork,workingconditions,clinicalassignments,andissuesrelatedtotheprogramorfaculty,ortheinterpretationofarule,regulation,orpolicy.Thegrievanceprocessisnotintendedtoaddressanyaspectoftheevaluationofacademicorclinicalperformanceorprofessionalbehavior,orotheracademicmattersrelatingtofailureoftheresidenttoattaintheeducationalcompetenciesoftheProgram.

IfaResidenthasagrievance,heorsheshouldfirstattempttoresolveitbyconsultingwith(1)theChiefResident;(2)theProgramDirector;or(3)theDepartmentChairperson.IfthematterisnotresolvedtotheResident’ssatisfaction,theResidentshouldthenpresentthegrievanceinwrittenformtotheDIOthroughtheGMEoffice.

AgrievancesubcommitteeoftheGMECappointedbytheDIOwillbeassignedtoreviewthegrievance.TheResidentmaybeinvitedorpermittedtoappearbeforethesubcommitteeatthediscretionofthesubcommittee.AfterthegrievancesubcommitteehasreviewedallinformationsubmittedinwritingorinpersonbytheResident,adecisionwillbecommunicatedinwritingtotheResidentandotherappropriate,involvedpersons.Thedecisionofthesubcommitteeisfinal.

R. CORRECTIVEAND/ORADVERSEACTIONS

1. SummaryActionswhenResidentMayPoseaThreattoPatientSafety UnderanycircumstancesinwhichtheProgramDirectorortheclinicaldepartment’s EducationCommitteedeterminesthattheunsatisfactoryperformanceand/oranyconductofaResidentmayconstituteanimmediatethreattopatientsafety,theProgramDirectormayreassignorsuspendtheResidentpendingadeterminationbytheProgramDirectorregardingtheabilityoftheResidenttocontinueintheProgram.IftheProgramDirector'sdeterminationregardingwhethertheResidentisabletocontinueintheProgramisappealed,theappealshallbeconductedundertheprovisionsfor"AcademicActions"below,exceptthattheResidentneednothavebeenprovidedprior"noticeandguidance"regardingtheconductpromptingthesummarysuspension.

2. AcademicActions IntheeventaResidentencountersdifficultymeetingand/ormaintainingperformancestandardsastheypertaintotheACGMECompetencies,aswellas/orprofessionalbehaviorstandards(“academicdifficulty”),theProgramDirectorwillnotifytheResidentthathis/herperformanceisunsatisfactory.Likewise,ifaResidentishavingacademicdifficulty,he/sheshouldseektheguidanceandadviceoftheProgramDirector.

IfaftertheResidenthasbeennotifiedabouthisorherunsatisfactoryperformance,andbeenofferedadvice,guidance,and,ifappropriate,acorrectiveplan,butcontinuestobelessthansatisfactory,theProgramDirector,athisorherdiscretion,maytakeappropriateacademiccorrectiveand/oradverseaction.Corrective/adverseactionsinclude,butarenotlimitedtoremedialassignments,lettersofwarning,probation,suspension,non‐promotion,non‐reappointment,ordismissalfromtheProgram.


IncaseswhereaResidenthasbeennotifiedofnon‐promotion,non‐reappointment,suspension,ordismissalandbelievesthatsuchactionwasleviedwithouttheappropriatenoticeandguidancethatwouldhaveenabledtheResidenttoimprovehisorherperformancepriortothecorrective/adverseaction,theResidentmayrequestthatasubcommitteeoftheGMECbeestablishedtoreviewsuchaction.TheResidentmustmakeawrittenrequestforreviewofthisdecisiontotheDIOwithin14daysofthedatethattheacademiccorrective/adverseactioninquestionwasleviedagainsttheResident.

Thesubcommitteereviewwillgenerallybescheduledwithin30daysoftheresident'srequestforahearing.ThehearingpanelwillconsistofatleastthreemembersoftheGMEC.TheDIOwilldeterminethedateofthehearinginconsultationwiththeresidentandprogramleadership.Thehearingwillbepresidedoverbythechairpersonselectedbythesubcommittee.Theconductofthehearingisatthediscretionofthechairperson.

ThereviewbytheGMECsubcommitteeisrestrictedsolelytothedeterminationofwhethertherequisitenoticeandguidancewasprovidedbytheProgramDirectortotheResident.

Afinaldecisionwillbemadebyavoteofthesubcommitteeandwillbecommunicatedtotheresidentwithin10workingdaysafterthehearing.Within10daysafterthepartieshavebeennotifiedofthedecision,eitherpartymaygivewrittennoticeofappealtotheDeanoftheMedicalSchool.TheCommittee’sdecisionwillbereviewedbytheDean,whomayacceptorrejecttheCommittee’sdecisionormayrequirethattheoriginalhearingbereopened.TheactionoftheDeanshallbecommunicatedinwritingtotheResidentandProgramDirectorassoonasreasonablypossible.ThedecisionoftheDeanisfinal.

3. Non‐AcademicActions Intheeventallegationsofunethicalconduct,scholasticdishonesty,theft,oranyconductprohibitedbyUTHealth,TheUniversityofTexasSystem,federal,state,orlocallawareleviedagainstaResident,theProgramDirectorortheFoundationmaytakecorrective/adverseactionagainsttheResident,including,butnotlimitedtoterminationoftheappointmentoftheResidentpriortotheendoftheappointmentterm.

IfallegationsareleviedagainsttheResidentthat(ifconfirmed)maysubjecttheResidenttocorrective/adverseaction,theProgramDirectorwillconductaninvestigationintotheallegationsincooperationwiththeGMEOfficeorotherappropriateoffice(s).Iftheinvestigationsubstantiatestheallegations,noticeoftheallegationswillbedeliveredbytheProgramDirectortotheResidentviahanddeliveryorcertifiedmailwithacopytotheGMEoffice.

UponreceiptofanoticeofallegationsfromaProgramDirector,theGMEofficewillpromptlyprovideacopyofthefollowingprocedurestotheResident. IftheResidentdoesnotdisputetheallegations,heorshewillbeaskedtosignaWaiverofHearingandadisciplinarypenaltymaybeassessedbytheProgramDirectororDepartmentChairperson.IftheResidentdisputestheallegations,oriftheResidentadmitstheallegationsbutconteststhepenaltytobeassessed,heorshemayrequestahearingbeforeaDisciplineCommitteeappointedbytheDIO.

TheDisciplineCommitteewillconsistofthreemembers,oneofwhomwillbeaResidentmemberfromaResidencyTrainingProgram.TheCommitteewillselectitspresidingchairperson.TheResidentwillbegivenatleast10daysnoticeofthedate,time,andplace


forsuchhearing,andnamesofthemembersoftheCommittee.Thenoticewillincludeawrittenstatementoftheallegationsandasummarystatementofevidenceallegedtosupportsuchallegations.ThenoticeshallbedeliveredinpersonorbycertifiedmailandregularU.S.mailtotheResidentattheaddressappearingintheProgramrecords.

TheResidentmaychallengetheimpartialityofanymember(s)oftheCommitteeuptothreeworkingdayspriortothehearing.Thechallengedmember(s)oftheCommitteeshallbethesolejudgeofwhetherheorshecanservewithfairnessandobjectivity.Intheeventamemberdisqualifieshimselforherself,asubstitutewillbechosen. Atahearingontheallegations,theProgramrepresentativehastheburdenofgoingforwardwiththeevidenceandtheburdenofprovingtheallegationsbythegreaterweightofthecredibleevidence.Thefollowingshallapply:

1. EachpartywillprovidetotheGMEofficeacompletelistofallwitnesses,a

briefsummaryofthetestimonytobegivenbyeach,andacopyofalldocumentstobeintroducedatthehearing.EachpartywillbeprovidedcopiesoftheabovebytheGMEofficepriortothehearing.DeadlinesconcerningthesubmissionofmaterialswillbesetandcommunicatedbytheGMEoffice.

2. Eachpartywillhavetherighttoappearandpresentevidenceinperson.TheResidentmayhavelegalcounselpresentoutsideofthehearingroom;however,noattorneyswillactuallyappearasanadvocateforeitherparty.

3. Eachpartywillhavetherighttoexaminewitnessesonrelevantmatters. 4. Thehearingwillberecorded.Ifeitherpartywishestoappealthefindings,the

recordwillbetranscribedandbothpartieswillbeallowedtopurchaseacopyofthetranscript.

TheCommitteewillrenderandsendtobothpartiesawrittendecision,andatitsdiscretionmayimposeapenaltyorpenalties.

EitherpartymayappealanactiontakenbytheCommitteeinaccordancewiththefollowingprocedures:

Within14daysafterthepartieshavebeennotifiedofthedecision,eitherpartymaygivewrittennoticeofappealtotheDeanoftheMedicalSchool.Ifthedecisionissentbymail,thedatethedecisionismailedinitiatesthe14‐dayperiod.TheCommittee’sdecisionwillbereviewedbytheDeansolelyonthebasisofthetranscriptandevidence,ifany,consideredatthehearing.Inorderfortheappealtobeconsidered,allnecessarydocumentation,includingwrittenargument,mustbefiledbytheappealingpartywiththeDeanwithin14daysafternoticeofappealisgivenandthetranscriptisavailable.

TheDeanmayapprove,reject,ormodifytheCommittee’sdecisionormayrequirethattheoriginalhearingbereopenedforthepresentationofadditionalevidenceandreconsiderationofthedecision.TheactionoftheDeanshallbecommunicatedinwritingtotheResidentandProgramDirectornomorethan30daysaftertheappealandrelateddocumentshavebeenreceived.ThedecisionoftheDeanisfinal.


4. DutytoReport TheTMBrequiresallResidentswithPITpermitstoreport,inwriting,thefollowingcircumstancestotheExecutiveDirectoroftheBoardwithin30daysoftheiroccurrence:

● theopeningofaninvestigationordisciplinaryactiontakenagainstthePITpermitholder byanylicensingentityotherthantheTexasMedicalBoard;

● anarrest,fine(over$250),chargeorconvictionofacrime,indictment,imprisonment,

● placementonprobationorreceiptofdeferredadjudication;or ● diagnosisortreatmentofaphysical,mentaloremotionalconditionwhichhas

impairedor couldimpairthePITpermitholder’sabilitytopracticemedicine.

Failuretocomplywiththeprovisionsofthischapter(22Tex.Admin.Code,Section171)or Tex.Occ.Code,Sec.160.002and160.003maybegroundsforcorrectiveaction,includingdisciplinaryaction.

S. CONDITIONSOFSEPARATION

1. Resignation

AResidentmayresignfromaProgrambyprovidingatleast30days'writtennoticeofhis/herintenttoresign.TheResident’sresignationmustbesubmittedtotheProgramDirector.Allconditionsofappointmentwillterminateontheeffectivedateoftheresignation.AtthediscretionoftheProgramDirector,aresignationmaybeacceptedeffectiveimmediately,notwithstandingtheproposedeffectivedateprovidedbytheResident.

2. Separation

Separationmayoccurattheendofanappointmenttermunderanycircumstancesinwhichreappointmentdoesnotoccur,includingsuccessfulgraduationfromtheprogram.

3. Termination

AResident’sappointmentmaybeterminatedpriortotheendoftheappointmentterm.AResidentsoterminatedwillgenerallyreceivecompensationequivalentto90days'salary.

T. PAGERS Residentsareissuedapersonalpager,forwhichtheyarefinanciallyresponsibleforthelossordamageof.InadditiontothepagerissuedbytheProgram,HousestaffmaybeissuedahospitalpagerduringrotationsatMDAnderson.ResidentsarerequiredtowearyourUTpagerandleaveitonatalltimesunlessonvacationoryourdayoff.

Residentsarerequiredtoreturnallpagesinatimelymanner(i.e.under5minutes).Itisunderstoodthattherearetimeswhenyoumaybeinthemiddleofaprocedure,atthosetimes,pleasereturnpagesassoonaspossible.

Whenpaging,pleaseexercisepagercourtesy,whichistoputthefull10digitnumberintothepager,hittheasteriskbutton(*)andputyourpagernumberin,beforehittingpound(#)tosendthepage.


Thepagersystemsareasfollowsforeachhospital:

MemorialHermannandLBJPagers: Dialtelephonenumber713‐605‐8989.Afterthebeep,enterthe5–digitbeepernumber.Then,enterthereturnnumberandpressthe#sign.OrcalltheHermannPageOperatorat713‐704‐4884.

M.D.AndersonPagers: Fromanoutsideline,dial713‐792‐7333,then####. Froma792or794line,dial2‐7333,then####. Wheninstructed,enterthecallbacknumber. M.D.AndersonPageOperator:713‐792‐7090

U. EMAIL Aftersatisfyingallprerequisites,completingallpaperworkrelevanttoappointmentandsigningtheUserResponsibilities&AccountabilityAcknowledgmentForm,aResidentwillbeassignedaUTHealthe‐mailaddressandallowedpermitteduseofUTHealthcomputerresources,particularlye‐mail,duringthedurationoftheirappointment.ResidentsaresubjecttoandshallabidebythetermsofallapplicableinformationtechnologypoliciesandguidelinescontainedintheUTHealthHOOP(see,e.g.,HOOPPolicies98,132,175‐181,and198).AlluseoftheUTHealthinformationtechnologynetwork,includingaccesstoanduseoftheinternetandUTHealthemailisaprivilegethatmustnotbeabused.Anyprohibitedorinappropriateuseofthenetworkand/orthee‐mailsystemmayresultinthewithdrawalofsuchprivilege,andmaybegroundsforadditionaladverseaction,uptoandincludingdismissalfromtheProgram.

TheUTHealthemailwillbetheonlyemailaddressthattheProgramwilldisseminateinformationtoandthrough.ItistheResident’sresponsibilitytocheckhis/herUTHealthaccountonaregularbasiswiththerecommendationbeingdaily.Residentswillbeheldresponsibleforanyinformationdisseminatedviaemail,regardlessofwhetheritischeckedfrequentlyorinfrequently.TheUTHealthe‐mailisweb‐basedandcanbereachedbyanycomputerconnectedtotheinternetatthefollowingURL:https://webmail.uth.tmc.edu/.Ifyouexperienceproblemswithyouraccountorpassword,pleasecontacttheUTHealthHelpDeskat713‐486‐4848. Residentsareencouragedtodisseminateinformationtoeachotherviaemailintheformofinterestingarticles,etc.However,onemustremembertobeHIPAAcompliantinusingone’semail.Youmaynotincludepatientnamesormedicalrecordnumbersinemails.Youmustalsomakesurethatwheneveryouareemailingpresentationsorradiographicstudiesthatnamesandmedicalrecordnumbers,inadditiontoaccensionnumbersareremovedfromx‐raysandotherstudies,eveniftheyareimbeddedinpowerpointpresentations.


Inaddition,pleasebejudiciousinusingtheReplyAllfunctionofemail.Pleasebecarefulaboutyourwordingofinformation,especiallyaboutotherindividuals—beawarethatyouremails(evendeletedones)arearchivedandwrittencommentsaboutothersmaybeconsiderlibel.

V. LABCOATS Twothree‐quarterlengthcoatsaresuppliedtoeachResidentthroughthePrograminthefirstappointmentyear,andoneadditionalcoatissuppliedineachsubsequentyearoftraining.InformationaboutlaundryservicesisavailablefromtheHousestaffOfficelocatedatMSB1.134.

W. PARKING

SubsidizedparkingisavailabletoResidentsintheUTProfessionalBuildingandPrairieViewA&Mparkinggarages.AllResidentswillbegivenanopportunitytosignupforparkingatresidentorientation;acopyoftheparkingpolicyandruleswillbeprovidedatthattime. Residentswhosignupforparkingmustdosofortheentireacademicyear.Residentswhocancelparkingduringtheacademicyeararenoteligibletore‐enrolluntilthefollowingopenenrollmentperiodandarenotentitledtoanyrefunds.Residentswhopermituseoftheirparkingcardbyanyotherindividual(s)orotherwiseattempttocircumventtheparkingsystemwillloseallparkingprivilegesforthedurationoftheirresidency/fellowship.

ParkingatLBJwillbeprovidedatnocosttoUTHousestaff.However,youwillstillneedtobeidentifiedwithaUTIDBadgeandyourvehiclewillneedtobeidentifiedwithadecal.

Thesecurityofficewillmaintainthedecals.WhenaUTHEALTHHousestaffpresentstheirIDBadge,theappropriatedecalwillbeissuedandthebadgewillbecodedwithaccesstotheapplicableparkinglots.EachUTHEALTHHousestaffwillbeissuedadecalbasedupontheirworkclassification.

X. HIPAA TheHealthInsurancePortabilityandAccountabilityAct(HIPAA)wasenactedinanefforttoprotectpatientsfromunauthorizeddisclosureoftheirprotectedhealthinformation.ResidentsintheProgramarechargedwithknowingtheinformationcoveredundertheActaswellascomplyingwiththerulesandregulations.HIPAAviolationsareprohibited.EachResidentmayonlyutilizepatientinformationwithintheguidelinesoftheAct.

Y. DISASTERPREPAREDNESSPLAN Intheeventofanaturaldisasteroremergency,allResidentsandInternsrotatingontheInternalMedicineServicearerequiredtoabidebythetermsoftheofficialUniversityofTexas‐HoustonInternalMedicineResidencyProgramDisasterPlan.

AllresidentsandinternswillbenotifiedthatthedisasterplanisgoingintoeffectviaapageandanemailbytheInternalMedicineOfficeortheAssistantChiefsofServiceOffice(ACS).Thepageandemailwillstatethetimeanddatethattheplanisgoingintoeffect.ThedisasterplanwillremainintoeffectuntilnotifiedtothecontrarybytheInternalMedicineOfficeortheACS’s.


Allessentialpersonnelwillberequiredtoremainintheirassignedlocations.Ifyoufeelyoucannotstayduetopersonalorfamilyconcernsyouneedtofindcoverageforyourassignedduty.YourcoverageneedstobeapprovedbytheAssistantChiefsofServicepriortoyourbeingexcused.

ResidentsandInternsontheservicewillbeexcusedwhenthedisasterplantakeseffect.Allsubspecialtypatientsneedtobecheckedouttotheirrespectivefelloworattending.Returntoworkimmediatelyafterthedisasterplanisnolongerineffect.

Forresidentsandinternsrotatingonessentialservices,thefollowingplanwillbeactivated: 1. AllresidentsandinternsON‐CALLandPRE‐CALLonthedaythedisasterplanis

activatedarerequiredtoreporttotheirassigneddutiesimmediately. 2. Residentsandinternswillrotateworking12hourshiftsuntilthedisasterplanisno

longerineffect. 3. ForWardTeams‐therewillbetwoWardTeamsondutyatatimeineachhospital.

WardteamsmustdividethepatientsfromALLwardservicesequallyandroundonthemonthemonadailybasis.Thecross‐coverandadmittingdutieswillthenbedividedamongstthetwowardteamsondutyin12hourshifts.

4. RenalWardsatHermannandLBJwillbecoveredbytheRenalFellow. 5. TheERatLBJwillbecoveredbyalloftheresidentsandinternsscheduledforthe

dayandnightshiftsonthedaythedisasterplanisactivated.Theywillrotatedutiesin12hourshifts.

6. CCU/CardiologyatHermannwillfunctionsimilartotheWardTeams(seenumber3).

7. MICUatHermannandLBJwillrotatedutiesin12hourshifts.

Z. Conclusion EachResidentshallreviewthisPolicyandProcedureManualandcomplywithallprovisions.ShouldaResidenthaveanyquestionsaboutthisManual,pleasecontacttheProgramDirectorimmediately.EachResidentispresumedtohavereadandunderstoodthisPolicyandProceduremanual,inconjunctionwiththeGMEHandbook,unlesshe/sheschedulesameetingwiththeProgramDirectortodiscussanyquestionsorconcerns.

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Effective July 1, 2017€¦ · 2005, he became Vice‐Chairman of Internal Medicine for Education...

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