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1 Scott & White Medical Center - Temple Graduate Medical Education Texas A&M Health Science Center College of Medicine HOUSE STAFF HANDBOOK This handbook serves as a general reference for all House Staff enrolled in a S&W GME Program. Please note the term House Staff and Residents/Fellows are interchanged throughout handbook. When appropriate, House Staff Policies were derived from a specific ACGME Common Program Requirement appropriate for that policy. Revised January 2018: This edition of the House Staff Handbook supersedes all previous editions and is in addition to all BSWH policies. Reviewed and Approved GMEC Policy Subcommittee Date: 11/30/2017 Updated: January 22, 2018 If additional information is needed, please contact: Graduate Medical Education Scott & White Memorial Hospital TAMU II – Suite 407 2401 South 31st Street Temple, Texas 76508 (254) 724-2232 or (800) 299-4GME
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Scott & White Medical Center - Temple Graduate Medical Education

Texas A&M Health Science Center College of Medicine

HOUSE STAFF

HANDBOOK

This handbook serves as a general reference for all House Staff enrolled in a S&W GME Program. Please note the term House Staff and Residents/Fellows are interchanged throughout handbook. When appropriate, House Staff Policies were derived from a specific ACGME Common Program Requirement

appropriate for that policy.

Revised January 2018: This edition of the House Staff Handbook supersedes all previous editions and is in addition to all BSWH policies.

Reviewed and Approved GMEC Policy Subcommittee Date: 11/30/2017 Updated: January 22, 2018

If additional information is needed, please contact: Graduate Medical Education

Scott & White Memorial Hospital TAMU II – Suite 407

2401 South 31st Street Temple, Texas 76508

(254) 724-2232 or (800) 299-4GME

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http://healthcare-professionals.sw.org/graduate-medical-education/graduate-medical-education TABLE OF CONTENTS

GME STAFF AND PROGRAMS ................................................................................................................................ 4 House Staff Council, Ombudsman …………………………………………………………………………………………………………………… 6 INSTITUTIONAL POLICIES Resident Selection/Recruitment ............................................................................................................................. 6 Visas………………………………………………………………………………………………………………………………………………………………… 8 Supervision and Accountability .............................................................................................................................. 9 Well Being ……………………………………………………………………………………………………………………………………………………….12 Fatigue Mitigation…………………………………………………………………………………………………………………………………………….13 Clinical Responsibilities, Teamwork, and Transitions of Care ……………………………………………………………………………13 Clinical Experience and Education…………………………………………………………………………………………………………………….13 Evaluation………………………………………………………………………………………………………………………………………………………..15 Milestones……………………………………………………………………………………………………………………………………………………….17 Testing (Academic Performance Evaluation) … .................................................................................................... 17 ACGME Core Competency Expectations of Residents………………………………………………………………………………………18 Professional Competence/Conduct………………………………………………………………………………………………………………….19 Disciplinary Action/Due Process ........................................................................................................................... 19 Employee Health .................................................................................................................................................. 21 Occupational Safety/Safe Choice.......................................................................................................................... 21 Parking .................................................................................................................................................................. 22 Medical Licensure ................................................................................................................................................. 22 Rotation Change Day ............................................................................................................................................ 24 Pagers ................................................................................................................................................................... 24 Recruitment .......................................................................................................................................................... 24 Life Support Certification ...................................................................................................................................... 24 Program Completion ............................................................................................................................................ 27 Risk Management Seminars ................................................................................................................................. 27 Religious Accommodations .................................................................................................................................. 28 Disability Accommodations .................................................................................................................................. 28 Visiting Residents .................................................................................................................................................. 29 GME Disaster Policy .............................................................................................................................................. 30 Credentialing of Physicians for Bedside Procedures including House Staff ......................................................... 31 RESIDENT POLICIES House Staff Responsibilities.................................................................................................................................. 31 Appointment Letters/Agreement ......................................................................................................................... 32 Stipends/Payroll.................................................................................................................................................... 32 Call Quarters ................................................................................................................................................. 33 Call Meals ............................................................................................................................................................. 33 House Staff Attire ................................................................................................................................................. 33 Grievance/Problem-Solving Procedure ................................................................................................................ 34 Non-Discrimination and Sexual Harassment ........................................................................................................ 35 Moonlighting ........................................................................................................................................................ 36 Promotion/Reappointment/Advancement .......................................................................................................... 37 Physician Impairment/Substance Abuse .............................................................................................................. 37 Counseling Support Service .................................................................................................................................. 38 SWADDLE…………………………………………………………………………………………………………………………………………………………39 Program Closure/Reduction ................................................................................................................................. 40

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LEAVE POLICIES Leave ................................................................................................................................................................... 41 (PTO) Vacation Leave ............................................................................................................................................ 41 Sick Leave.............................................................................................................................................................. 42 Maternity Leave .................................................................................................................................................... 42 Paternity Leave ..................................................................................................................................................... 42 Family Medicine Leave Act ................................................................................................................................... 42 Bereavement Leave .............................................................................................................................................. 43 Interview Leave .................................................................................................................................................... 43 Personal Leave of Absence ................................................................................................................................... 43 Professional Leave of Absence ............................................................................................................................. 44 Military Leave ....................................................................................................................................................... 44 Educational Leave ................................................................................................................................................. 45 Miscellaneous Time .............................................................................................................................................. 45

INSURANCE POLICIES/EMPLOYMENT BENEFITS Insurance .............................................................................................................................................................. 46

Short-Term Disability ............................................................................................................................................ 46 Long-Term Disability ............................................................................................................................................. 47 Flexible Spending .................................................................................................................................................. 47 Thrive/Wellness Program ..................................................................................................................................... 47 Professional Liability ............................................................................................................................................. 47 Student Loan Deferment ...................................................................................................................................... 47

EDUCATION ENHANCEMENT BENEFITS Education Material Allowance .............................................................................................................................. 48 Research Presentations ........................................................................................................................................ 48 Professional Organization Activities ..................................................................................................................... 50 Required External Rotations ................................................................................................................................. 50 International Rotation Policy……………………………………………………………………………………………………………………………50 MISCELLANEOUS Personnel File ....................................................................................................................................................... 52 Notary Services ..................................................................................................................................................... 52 Photograph ........................................................................................................................................................... 52 Program Completion ............................................................................................................................................ 52 Publications .......................................................................................................................................................... 53 Schedules .............................................................................................................................................................. 53 Voluntary Termination ......................................................................................................................................... 53 Exit Clearance ....................................................................................................................................................... 53

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GME STAFF & PROGRAMS Administrative and educational support for Graduate Medical Education programs is provided by the Scott & White Systems Academic Operations and, more specifically, the Graduate Medical Education Administration Office under the supervision of the Director of Graduate Medical Education (GME). GME Administration provides training and support to Program Administrators necessary to function as department coordinators. GME Administration is housed in the TAMHSC-COM Education Building at Scott & White, Office Suite 407.

Department/Program Name Position EXT (254)724-

GME Office Christian Cable, M.D., MHPE DIO, GME; Chair, GMEC Medical Director, GME

24-2886

GME Office Ravindranath Kallur, Ph.D., MPA Associate DIO; Sr. VP for Education

24-2525

GME Office Peggy Peters, M.Ed. Director, GME 24-4505

GME Office Linda Billingsley Executive Assistant 24-2232

GME Office Dee’D Ferman Data Specialist II 24-9290

GME Office Vacant Accounting Assistant II 24-2485

GME Office Trina Thompson GME Program Administrator

24-4320

Program -ACGME Program Director Program Administrator EXT

Anesthesia Russell McAllister, M.D. Kayla Link 24-5306

Anesthesia – CT William Culp, M.D. Kayla Link 24-5306

Anesthesia-Pain Management

Christopher Burnett, M.D. Heather Boyd 24-5306

Dermatology Kathleen Fiala, M.D. Lacey Pitt 21-7313

Emergency Medicine Dorian Drigalla, M.D. Cindy Rush 24-5815

Family Medicine John Manning, M.D. Angel Moss 21-8401

Internal Medicine Austin Metting, M.D. Barbara Edwards 24-2364

Carol Bandas 24-8797

IM- Cardiovascular Disease

Chris Chiles, M.D. Mylessa Wheeler 24-0108

IM - Clin. Cardiac Electrophysiology

Javier Banchs, M.D. Mylessa Wheeler 24-0108

IM - Interventional Cardiology

Scott Gantt, D.O. Mylessa Wheeler 24-0108

IM - Endocrinology Veronica Piziak, M.D. Cindy Blundell 21-0686

IM - Gastroenterology Raymond Duggan, D.O. Shelia Gardner 24-8845

IM - Hematology/Oncology

Sherronda Henderson, M.D. Shelia Gardner 24-8845

IM - Infectious Disease Alan Howell, M.D. Janet Chlapek 24-7633

IM - Nephrology Nimrit Goraya, M.D. Cindy Blundell 21-0686

IM - Pulmonary Disease/Critical Care

Shekhar Ghamande, M.D. Janet Chlapek 24-7633

Neurology Sally Borucki, M.D. Robin Hill 24-5390

Neurosurgery Jason Huang, M.D. Robin Hill 24-5390

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Ob/GYN Belinda Kohl-Thomas, M.D. Andrea Rankin 24-7588

Female Pelvic Medicine & Reconstructive Surgery

Paul Yandell, M.D. Andrea Rankin 24-7588

Ophthalmology Kenneth Lao, M.D. Heather Boyd 24-1058

Orthopedics Douglas Fornfeist, M.D. Samantha “Sam” Smith 24-5455

Otolaryngology Gerhard Hill, M.D. Robin Wilson 24-7315

Pathology Kathleen Jones, M.D. Wanell Eshun 24-7354

Cytopathology Lina Liu, M.D. Wanell Eshun 24-7354

Hematopathology Willie Koss, M.D. Wanell Eshun 24-7354

Pediatrics Stephen Ponder, M.D. Kessiah Foster 23-5063

Neonatology M. Beeram, M.D. Kessiah Foster 23-5063

Plastic Surgery Robert Weber, M.D. Stacy Brister 24-0630

Psychiatry V. Maxanne Flores, M.D. Dorothy Winkler 24-1768

Child & Adolescent Psychiatry

Kyle Morrow, M.D. Dorothy Winkler 24-3874

Radiology (Diagnostic) James. B. Schnitker, M.D. Lisa Harris Pates 24-4507

Vascular and Interventional Radiology

Bradley Dollar, M.D. Lisa Harris Pates 24-4507

Radiation Oncology Niloyjyoti Deb, M.D. Sharon Seelson 24-0836

Surgery (General) Scott Thomas, M.D. Nicole Liles 24-2366

Urology Patrick Lowry, M.D. Elaine Stone 24-1695

Vascular Surgery William Bohannon, M.D. Elaine Stone 24-1695

Program – Round Rock Program Director Program Administrator EXT

Family Medicine Patricia Lopez-Gutierrez, M.D. Kaitlin McCoy 512-244-5729

Internal Medicine Rakesh Surapaneni, M.D. Monica Odom 512-509-3412

Program – NON-ACGME Program Director Program Administrator EXT

Clinical Health Psychology Louis Gamino, Ph.D. Tina Miller 24-3874

Clinical Health Psychology in Grief Bereavement

Louis Gamino, Ph.D. Tina Miller 24-3874

Psychology Internship Louis Gamino, Ph.D. Tina Miller 24-3874

Endocrine Surgery Terry Lairmore, M.D. Robin Wilson 24-7315

Headache Duren Ready, M.D. Robin Hill 24-5390

Pharmacy Jon Herrington, Pharm.D. Paul Godley, Pharm.D.

Samera Hall 24-2524

Podiatry Douglas Murdoch, D.P.M. Michelle Felix 23-5750

Radiation Physics Geethpriya Palaniswaamy, M.D. Sharon Seelson 24-0836

Surgical Pathology V.O. Speights, D.O. Wanell Eshun 24-7354

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HOUSE STAFF COUNCIL (HSC) The House Staff Council is a group of your peers, mostly chief residents, who discuss any issues/concerns of interest to the House Staff. Additionally, the HSC provides a forum for residents and fellows to receive the most up-to-date information regarding GME and hospital-related news. The HSC is led by a president and vice president, who are your liaisons to hospital administration.

President Gibbs Wilson, M.D. Pager: 2989 Vice President Chris LaSeur, M.D. Pager: 0669

OMBUDSMAN The position of Ombudsman for Graduate Medical Education (GME) was developed to promote a positive climate for residency and fellowship education. The Ombudsman will serve as an independent, impartial, informal, and confidential resource for residents and fellows with training-related concerns.

Ombudsman Robert Greenberg, M.D. [email protected] Pager: 888-731-6794

Ombudsman Erica Ward, M.D. Office: 254-935-4051 Ombudsman John Pliska, M.D. Pager: 762-0835 Ombudsman Chris Chiles, M.D. Pager: 0284 Ombudsman Paul Mansour, M.D. Pager: 2255

INSTITUTIONAL POLICIES

POLICY HOUSE STAFF SELECTION/RECRUITMENT (IR.IV. A)

TAMHSC-COM/S&W graduate medical education programs shall select applicants who meet the qualifications for eligibility set forth by the Accreditation Council for Graduate Medical Education (ACGME). Applicants with one of the following qualifications are eligible for appointment.

All prerequisite post-graduate clinical education required for initial entry or transfer into ACGME-accredited residency programs must be completed in ACGMGE-accredited residency programs, or in Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency programs located in Canada. Residency programs must receive verification of each applicant’s level of competency in the required field using ACGME or Can MEDS Milestones assessments from the prior training program.

A physician who has completed a residency program that was not accredited by ACGME, RCPSC, or CFPC may enter an ACGME-accredited residency program in the same specialty at the PGY-1 level and, at the discretion of the program director at the ACGME-accredited program may be advanced to the PGY-2 level based on the ACGME Milestones assessments at the ACGME-accredited program. This provision applies only to entry into residency in those specialties for which an initial clinical year is not required for entry.

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Eligibility Requirements – Fellowship Programs

All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, or in a RCPSC-accredited or CFPC-accredited residency program located in Canada.

Fellowship program must receive verification of each entering fellow’s level of competency in the required field using ACGME or CanMEDS Milestones assessments from the core residency program.

Fellow Eligibility Exception

A Review Committee may grant the following exception to the fellowship eligibility requirements:

o An ACGME-accredited fellowship program may accept an exceptionally qualified applicant, who does not satisfy the eligibility requirements listed in Sections III.A.2 and III.A.2.a of the CPR), but who does meet all of the following additional qualifications and conditions:

Assessment by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty; and

Review and approval of the applicant’s exceptional qualifications by the GMEC or a subcommittee of the GMEC; and

Satisfactory completion of the United States Medical Licensing Examination (USMLE) Steps 1, 2, and 3 and;

For an International graduate, verification of Educational Commission for Foreign Medical Graduates certification; and

Applicants accepted by this exception must complete fellowship Milestones evaluation (for the purposes of establishment of baseline performance by the Clinical Competency Committee), conducted by the receiving fellowship program within six weeks of matriculation. This evaluation may be waived for an applicant who has completed an ACGME-International accredited residency based on the applicant’s Milestone evaluation conducted at the conclusion of the residency program.

If the trainee does not meet the expected level of Milestones competency following entry into the fellowship program, the trainee must undergo a period of remediation, overseen by the Clinical Competency and monitored by the GMEC or a subcommittee of the GMEC. This period of remediation must not count toward time in fellowship training.

Eligibility Requirements – Residency Programs

Graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME)

Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA)

Graduates of medical schools outside the United States and Canada who have received a

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currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) or have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction

Graduates of medical schools outside the United States who have completed a Fifth Pathway program provided by an LCME-accredited medical school

Furthermore, House Staff must have passed the USMLE Step II and Step II CSA, or equivalent (e.g. COMLEX), prior to beginning their training. Any exceptions to this policy must be obtained in writing from the Designated Institutional Official (DIO). Programs should select from among eligible applicants on the basis of their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation and integrity. Programs must not discriminate with regard to sex, race, age, religion, color, national origin, disability or veteran status. In selecting from among qualified applicants, programs are encouraged to participate in an organized matching program, such as the National Resident Matching Program (NRMP), where available. For Non-ACGME training programs, please see below.

Podiatry Residency – Selection criteria is based upon being a graduate of a podiatric medical school in the United States accredited by the Council on Podiatric Medical Education (CPME). Psychology Internship - The Scott & White Psychology Internship Program encourages applications from doctoral psychology candidates (PhD, PsyD, or EdD) enrolled in APA/CPA-accredited clinical or counseling graduate programs. It is the policy of the program to provide equal educational opportunity to persons regardless of race, ethnic background, gender, religion, or creed. Applicants must be U.S. citizens. Prior to starting the internship year, candidates must have completed all graduate coursework, completed all comprehensive examinations, maintained a cumulative graduate grade point average of 3.0 or better, proposed their dissertation/clinical research project, be in good standing as evidenced by their DCT letter of recommendation, completed a minimum of 500 total combined intervention and assessment practicum hours and received their master’s degree by the start of the internship year. Pharmacy Residency – For applicants pursuing a Pharmacy Residency: Selection criteria is based upon a degree from a college of pharmacy approved by the Accreditation Council for Pharmacy Education (ACPE), Texas pharmacy licensure eligibility, citizen of the United States, green card holder and authorized to work in the United States are encouraged to apply. VISAs Residents in BSWH (CTX) ACGME-accredited programs and other Allied Health Programs, who are not United States citizens, must have lawful permanent resident (LPR) status or a nonimmigrant visa that is appropriate for graduate medical education. The preferred visa is the J-1 visa status, sponsored by the ECFMG. All international medical graduates (IMGs) who are graduates of non-LCME medical schools must obtain an ECFMG Certificate before entry into residency programs. The ECFMG certificate provides assurance to residency programs, and to the people of the U.S., that IMGs have met minimum standards of eligibility required to enter programs.

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Under truly exceptional circumstances a residency or fellowship program may wish to train a resident or fellow who is presently holding an H-1B from another training program or who may otherwise be eligible for H-1B sponsorship. The CTX GME Program may consider H-1B sponsorship if certain conditions are met. The program must demonstrate the need for the H-1B Visa by justifying the need.

Administrative and financial costs associated with support of the H-1B visa is significantly greater than the J-1 Visa, and the decision to financially support a resident or fellow’s H-1B visa will rest with the training program and the associated department. If a program is willing to undertake these costs and the regulatory and compliance requirements associated with H-1B visa status, the program director must submit a written Request for H-1B Sponsorship to the GME Office. The written request must be signed by the program director and the department chair and must be made at least thirty (30) days before the match list is submitted. The request must include all relevant justifications including total number of applicants interviewed, number the program plans to rank, the information regarding total number of US graduates, as well as the number of J-1 and H-1 applicants. The request will be reviewed by the Designated Institutional Office (DIO) within ten (10) working days of its receipt by the GME Office and a decision will be communicated to the program director. In the event of a negative decision, the program director may appeal the decision to the CMO of the hospital. The CMO’s decision shall be final. Approval for H-1B Sponsorship will be for the duration of the proposed program only. The program director must await approval of the request before committing to the applicant. Anticipated steps in the process include the following:

All customary GME requirements have been met – applicant has been interviewed and found to be qualified for the program.

Request for H-1B Sponsorship – If request is approved, the program director will work with the Legal Department to begin the process.

End of House Staff Recruitment/Selection Policy

POLICY SUPERVISION and ACCOUNTABILITY (CPR VI.A.2)

The following are the procedural requirements for graduate medical education pertaining to the supervision of House Staff. The provisions are applicable to all patient care services including, but not limited to: inpatient care, outpatient care, community and long-term care facilities, and the performance and interpretation of all diagnostic and therapeutic procedures. 1.

a. All TAMHSC-COM/S&W programs follow the Common Program Requirements of the Accreditation Council for Graduate Medical Education (ACGME) which state that, “Although the attending physician is ultimately responsible for the care of the patient, every physician shares in the responsibility and accountability for their efforts in the provision of care. Effective programs, in partnership with their Sponsoring Institutions, define, widely communicate, and monitor a structured chain of responsibility and accountability as it relates to the supervision of all patient care. Supervision in the setting of graduate medical education provides safe and effective care to

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patients; ensures each resident’s development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine; and establishes a foundation for continued professional growth.”

2. Roles and Responsibilities (CPR VI.A.2.a) Each patient must have an identifiable and appropriately-credentialed and privileged attending physician (or licensed independent practitioner as specified by the applicable Review Committee) who is responsible and accountable for the patient’s care.

The information must be available to residents, faculty members, other members of the healthcare team, and patients.

Residents and faculty members must inform each patient of their respective roles in that patient’s care when providing direct patient care.

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members.

The program director must evaluate each resident’s abilities based on specific criteria, guided by the Milestones.

Faculty members functioning as supervising physicians must delegate portions of care to residents based on the needs of the patient and the skills of each resident.

o Faculty supervision assignments must be of sufficient duration to assess the knowledge and skills of each resident and to delegate to the resident the appropriate level of patient care required by their patients.

Senior residents or fellows should serve in a supervisory role to junior residents in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual resident or fellow.

Each resident must know the limits of their scope of authority, and the circumstances under which the resident is permitted to act with conditional independence.

Initially, PGY-1 residents must be supervised either directly, or indirectly with direct supervision immediately available.

3. Graduate Levels of Responsibility a. As part of their training program, House Staff should be given progressive responsibility for the care of the patient. The determination of a House Staff’s ability to provide care to patients without a senior staff present, or to act in a teaching capacity, is based on the documented evaluation of the House Staff’s clinical experience, judgment, knowledge, and technical skill. It is the decision of the senior staff which activities the House Staff can perform within the context of the assigned levels of responsibility.

The senior staff is responsible for ensuring the over-riding consideration be the safest and most effective care of the patient.

b. Supervision Levels: are defined as

1. Direct Supervision - the supervising physician is physically present with the House Staff and patient.

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2. Indirect supervision - a. with direct supervision immediately available - the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision. b. with direct supervision available the supervising physician is not physically present within the hospital or other site of patient care, but, is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.

3. Oversight - the supervising physician is available to provide review of Procedures/encounters with feedback provided after care is delivered.

c. Each House Staff must know the limits of his/her scope of authority, and the circumstances under which he/she is permitted to act with conditional independence. PGY1 House Staff should be supervised either directly or indirectly with direct supervision immediately available. Senior House Staff or Fellows should serve in a supervisory role of junior House Staff in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual House Staff or Fellow.

4. Documentation of Supervision of House Staff

a. If a situation arises where the nursing staff is unsure of House Staff’s appropriate level of supervision, the nursing staff should contact the supervising senior staff directly.

b. Documentation of House Staff’s required level of supervision should be documented in New Innovations (Residency Management Suite).

5. Emergency Situations An "emergency" is defined as a situation where immediate care is necessary to preserve the life of, or to prevent serious impairment of the health of a patient. In such situations, any House Staff assisted by medical personnel will, consistent with the informed consent, be permitted to do everything possible to save the life of a patient or to save a patient from serious harm. The appropriate senior staff must be contacted and apprised of the situation as soon as possible. The House Staff must document the nature of that discussion in the patient's record.

6. Medical Officer of the Day (MOD)

a. House Staff who are board-certified or board certifiable (eligible) may be privileged as independent practitioners for purposes of MOD coverage. Privileges sought and granted may only be those delineated within the general category for which the House Staff is board certified or board certifiable. b. House Staff who are appointed as such outside the scope of their training program must be fully licensed, credentialed, and privileged for the duties they are expected to perform. In this capacity, they are not working under the auspices of a training program and must meet the requirements for appointment. Specialty privileges, which are within the scope of the House Staff’s training program, may not be granted.

7. Monitoring Procedures The Designated Institutional Official is responsible for ensuring that each Residency/Fellowship Program Director participates in the monitoring process. Periodic review of this monitoring procedure is included in institutional oversight of each residency training program. Additionally, incidents and risk events with complications involving House Staff care are reviewed by supervising staff.

End of Supervision and Accountability Policy

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POLICY WELL BEING (CPR VI.C.)

In the current healthcare environment, residents and faculty members are at increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician. Self-care is an important component of professionalism; it is also a skill that must be learned and nurtured in the context of other aspects of residency training. Programs, in partnership with their Sponsoring Institutions, have the same responsibility to address well-being as they do to evaluate other aspects of resident competence. This responsibility must include:

Efforts to enhance the meaning that each resident finds in the experience of being a physician, including protecting time with patients, minimizing non-physician obligations, providing administrative support, promoting progressive autonomy and flexibility, and enhancing professional relationships;

Attention to scheduling, work intensity, and work compression that impacts resident well-being;

Evaluating workplace safety data and addressing the safety of residents and faculty members;

Policies and programs that encourage optimal resident and faculty member well-being; and, o Residents must be given the opportunity attend medical, mental health, and dental care

appointments, including those scheduled during working hours.

Attention to resident and faculty member burnout, depression, and substance abuse. The program, in partnership with its Sponsoring Institution, must educate faculty members and residents in the identification of the symptoms of burnout, depression, and substance abuse, including means to assist those who experience these conditions. Residents and faculty members must also be educated to recognize those symptoms in themselves and how to seek appropriate care. The program, in partnership with its Sponsoring Institution, must

o Encourage residents and faculty members to alert the program director or other designated personnel or programs when they are concerned that another resident, fellow or faculty member may be displaying signs of burnout, depression, substance abuse, suicidal ideation, or potential for violence.

o Provide access to appropriate tools for self-screening; and, o Provide access to confidential, affordable mental health assessment, counseling, and

treatment, including access to urgent and emergent care 24 hours a day, seven days a week.

There are circumstances in which residents may be unable to attend work, including but not limited to fatigue, illness, and family emergencies. Each program must have policies and procedures in place that ensure coverage of patient care in the event that a resident may be unable to perform their patient care responsibilities. These policies must be implemented without fear of negative consequences for the resident who is unable to provide the clinical work.

End of Well-Being Policy

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POLICY FATIGUE MITIGATION (CPR VI.D)

Programs must:

Educate all faculty members and residents to recognize the signs of fatigue and sleep deprivation;

Educate all faculty members and residents in alertness management and fatigue mitigation processes; and

Encourage residents to use fatigue mitigation processes to manage the potential negative effects of fatigue on patient care and learning.

Each program must ensure continuity of patient care if a resident is unable to perform their patient care responsibilities due to excessive fatigue. The program, in partnership with its Sponsoring Institution must ensure adequate sleep facilities and safe transportation options for residents who may be too fatigued to safely return home.

End of Fatigue Mitigation Policy

POLICY CLINICAL RESPONSIBILITIES, TEAMWORK, AND TRANSITIONS OF CARE (CPR VI.E)

Clinical Responsibilities – The clinical responsibilities for each resident must be based on PGY level, patient safety, resident ability, severity and complexity of patient illness/condition, and available support services. Teamwork – Residents must care for patients in an environment that maximizes communication. This must include the opportunity to work as a member of effective inter-professional teams that are appropriate to the delivery of care in the specialty and larger health system. Transitions of Care – Programs must design clinical assignments to optimize transitions in patient care, including their safety, frequency, and structure; Programs, in partnership with their Sponsoring Institutions, must ensure and monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety; Programs must ensure that residents are competent in communicating with team members in the hand-over process; Programs and clinical sites must maintain and communicate schedules of attending physicians and residents currently responsible for care; Programs must ensure continuity of patient care in the event that a resident may be unable to perform their patient care responsibilities due to excessive fatigue, illness, or family emergency.

End of Clinical Responsibilities, Teamwork, and Transitions of Care Policy

POLICY CLINICAL EXPERIENCE AND EDUCATION (CPR VI.F.)

Programs, in partnership with their Sponsoring Institutions, must design an effective program structure that is configured to provide residents with educational and clinical experience opportunities, as well as reasonable opportunities for rest and personal activities. Each residency and fellowship program will comply with ACGME, Institutional, and Program Requirements regarding duty hours. All programs must monitor work hours on an ongoing basis. Additionally, monitoring of duty hours will be conducted by review of RRC Anonymous Surveys, monthly institutional duty hours’ reports, and any incidents/occurrences brought to the attention of the GME Office. These formal policies must apply to all institutions to which the House Staff rotates.

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Providing House Staff with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and House Staff well-being. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on House Staff to fulfill service obligations. Didactic and clinical education must have priority in the allotment of House Staffs' time and energies. Duty hour assignments must recognize that Faculty and House Staff collectively have responsibility for the safety and welfare of patients. 1. Maximum Hours of Clinical and Educational Work per Week (CPR: VI.F.1)

a. Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting.

2. Mandatory Time Free of Clinical Work and Education (CPR: VI.F.2) The program must design an effective program structure that is configured to provide residents with educational opportunities, as well as reasonable opportunities for rest and personal well-being.

1. Residents should have eight hours off between scheduled clinical work and education periods. 2. There may be circumstances when residents choose to stay to care for their patients or return

to the hospital with fewer than eight hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements.

a. Under those circumstances, the House Staff must: i. Appropriately hand over the care of all other patients to the team responsible

for continuing their care; and, ii. Document the reasons for remaining to care for the patient in question and

submit that documentation in every circumstance to the program director. b. The program director must review each submission of additional service, and track

both individual House Staff and program-wide episodes of additional duty. 3. Residents must have at least 14 hours free of clinical work and education after 24 hours of in-

house call. 4. Residents must be scheduled for a minimum of one day in seven free of clinical work and

required education (when averaged over four weeks). At home call cannot be assigned on these free days.

3. Maximum Clinical Work and Education Period Length (CPR: VI.F.3)

1. Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.

2. Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education.

3. Additional patient care responsibilities must not be assigned to a resident during this time.

4. Clinical and Educational Work Hour Exceptions (CPR: VI.F.4) 1. In rare circumstances, after handing off all other responsibilities, a resident, on their own

initiative, may elect to remain or return to the clinical site in the following circumstances: a. to continue to provide care to a single severely ill or unstable patient b. humanistic attention to the needs of a patient or family; or, c. to attend unique educational events

(These additional hours of care or education will be counted toward the 80-hour weekly limit.)

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5. Moonlighting (CPR: VI.F.5)

Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program, and must not interfere with the resident’s fitness for work nor compromise patient safety. a. Because residency education is a full- time endeavor, the Program Director must ensure that

moonlighting does not interfere with the resident’s fitness for work, nor compromise patient safety.

b. Time spent by House Staff in internal and external moonlighting must be counted toward the 80-hour maximum weekly work hour limit and be monitored by the program.

c. PGY-1 residents are not permitted to moonlight. 6. In-House Night Float (CPR VI.F.6)

a. Night float must occur within the context of the 80-hour and one-day-off-in seven requirements. b. The maximum number of consecutive weeks of night float and maximum number of months of night

float per year, is specified by the Review Committee. 7. Maximum In-House On-Call Frequency (CPR VI.F.7)

a. Residents must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).

9. At-Home Call (CPR VI.F.8)

a. Time spent in the hospital by House Staff on at-home call must count towards the 80-hour maximum weekly work hour limit. The frequency of at-home call is not subject to the every-third-night limitation but must satisfy the requirement for one-day-in-seven free of duty when averaged over four weeks.

1) At-home call must not be as frequent, or taxing, as to preclude rest or reasonable personal time or each House Staff. 2) House Staff are permitted to return to the hospital while on at-home-call to provide direct care for new or established patients. These hours of inpatient patient care must be included in the 80-hour maximum weekly limit.

End of Clinical Experience and Education Policy

POLICY EVALUATION (CPR V)

Each residency/fellowship program must utilize New Innovations for implementing their evaluation of House Staff, the faculty and the residency/fellowship program.

a. The program director must appoint the Clinical Competency Committee (CCC) b. At a minimum, the Clinical Competency Committee must be composed of three members of the program faculty. c. The program director may appoint additional members of the Clinical Competency Committee.

i. The additional members must be physician faculty members from the same program, or other programs or other health professionals who have extensive contact and experience with the program’s residents in patient care and other healthcare settings.

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ii. Chief Residents who have completed core residency programs in their specialty, and are eligible for specialty board certification, may be members of the CCC.

d. There must be a written description of the responsibilities of the CCC. e. The Clinical Competency should:

i. Review all resident evaluations semi-annually; ii. Prepare and ensure the reporting of Milestones evaluations of each resident semi-annually

to ACGME; and, iii. Advise the program director regarding resident progress; including promotion, remediation,

and dismissal. iv. Document progressive resident performance improvement appropriate to educational level;

and, v. Provide each resident with documented semiannual evaluation of performance with feedback

f. The evaluations of resident performance must be accessible for review by the resident. If a House Staff performs unsatisfactorily, notification must be timely. It is the responsibility of the House Staff to follow up with any questions that he/she may have regarding the evaluation. Summative Evaluation (CPR V.A.3)

The specialty-specific Milestones must be used as one of the tools to ensure residents are able to practice core professional activities without supervision upon completion of the program.

The program director must provide a summative evaluation for each resident upon completion of the program.

This evaluation must: a. Become a part of the resident’s permanent record maintained by the institution, and must be accessible for review by the resident

Faculty Evaluation (CPR V.B.) At least annually, the program must evaluate faculty performance as it relates to the educational program. These evaluations should include a review of the faculty’s clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, and scholarly activities. This evaluation must include at least annual written confidential evaluations by the residents. Program Evaluation and Improvement (CPR V.C.) The program director must appoint the Program Evaluation Committee (PEC). The Program Evaluation Committee:

a) Must be composed of at least two program faculty members and should include at least one resident;

b) Must have a written description of its responsibilities; and, c) Should participate actively in:

a. Planning, developing, implementing, and evaluating educational activities of the program;

b. Reviewing and making recommendations for revision of competency-based curriculum goals and objectives;

c. Addressing areas of non-compliance with ACGME standards; and, d. Reviewing the program annually using evaluations of faculty, residents, and others.

The program, through the PEC, must document formal, systematic evaluation of the curriculum at least annually, and is responsible for rendering a written, annual program evaluation.

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The program must monitor and trach each of the following areas:

resident performance faculty development graduate performance, including performance of program graduates on the

certification examination; program quality; and the program must give the residents and faculty the

opportunity to evaluate the program confidentially and in writing at least annually. use the results of the residents’ and faculty assessment with other program

evaluation results to improve the program; monitor progress on the previous year’s action plan(s).

The PEC must prepare a written plan of action to document initiatives to improve performance in one or more of areas of the Program Evaluation, as well as delineate how they will be measured and monitored.

The action plan should be reviewed and approved by the teaching faculty and documented in meeting minutes.

Milestones As required by the ACGME, each program must have incorporated the specialty-specific Milestones into their curriculum. Milestones are, in part, to be used to set the expectation of performance as well as assess the clinical skill-set of each resident. The Milestones will be a part of each program’s Self-Study Evaluation. Testing As a part of the House Staff’s professional conduct or academic performance evaluation, a Program Director may request testing appropriate to the area of concern to assist in determining the course of action to be taken. The goal of the testing is to identify strengths and weaknesses for effective remediation. Before testing is undertaken, the involved House Staff must agree to this testing. The House Staff will be provided with the results. The results will become part of the program’s confidential file in the office of the Designated Institutional Official and may be available to the Program Director, with the consent of the House Staff. Graduate Medical Education Administration (GME) will arrange for these tests and cover the costs of the testing. Once the testing and analysis is complete, GME is under no obligation to provide support for treatment, ongoing therapy or remedial education that might be recommended by the testing and analysis. The Americans with Disabilities Act may be applicable if specific requirements are met.

End of Evaluation Policy

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ACGME CORE COMPETENCY EXPECTATIONS OF RESIDENTS (CPR IV.A) Residents are expected to:

Medical Knowledge o Demonstrate knowledge of established evolving biomedical, clinical, epidemiological and

social-behavioral sciences, and apply this to patient care

Practice-Based Learning and Improvement o Demonstrate the ability to investigate and evaluate their care of patients, to appraise and

assimilate scientific evidence, and to continuously improve patient care o Residents are expected to develop skills and habits to meet the following goals:

Identify strengths, deficiencies, and limits in one’s knowledge and expertise; Set learning and improvement goals; Identify and perform appropriate learning activities; Systematically analyze practice using quality improvement methods, and

implement changes with the goal of practice improvement; Incorporate formative evaluation feedback into daily practice; Locate, appraise, and assimilate evidence from scientific studies related to their

patients’ health problems; Use information technology to optimize learning; and, Participate in the education of patients, families, students, residents and other

health professionals.

Interpersonal and Communication Skills o Communicate effectively with patients, families, and the public, as appropriate, across a

broad range of socioeconomic and cultural backgrounds; o Communicate effectively with physicians, other health professionals, and health related

agencies; o Work effectively as a member or leader of a healthcare team or other professional group; o Act in a consultative role to other physicians and health professionals; and, o Maintain comprehensive, timely, and legible medical records

Professionalism o Expected to demonstrate compassion, integrity, and respect for others; o Responsiveness to patient needs that supersedes self-interest; o Respect for patient privacy and autonomy; o Accountability to patients, society and the profession; and o Sensitivity and responsiveness to a diverse population, including but not limited to

diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Systems-Based Practice o Expected to work effectively in various healthcare delivery settings and systems relevant

to their clinical specialty; o Coordinate patient care within the healthcare system relevant to their clinical specialty; o Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or

population-based care as appropriate; o Advocate for quality patient care and optimal patient care systems; o Work in inter-professional teams to enhance patient safety and improve patient care

quality and, participate in identifying system errors and implementing potential systems solutions

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POLICY PROFESSIONAL COMPETENCE/CONDUCT

TAMHSC-COM/S&W House Staff will conduct themselves professionally and perform their assigned duties with integrity, commitment, skill and efficiency consistent with the highest principles of medicine.

I. Professional Competence Professional competence will be questioned if the House Staff demonstrates academic deficiencies in

knowledge, skills, and attitudes or clinical performance. II. Professional Conduct Conduct of the House Staff will be questioned for commitments of unlawful acts, violations of

institutional codes of conduct, breach of professional ethics or otherwise endangering patient health or safety. Examples include, but are not limited to the following. Violation of state or federal law Forgery, alteration or misuse of hospital documents or records Conduct that significantly interferes with hospital teaching, research, or administration of

House Staff’s education

Illegal use, possession and/or illegal sale of drug, narcotic, or other controlled substances as defined in the Texas Controlled Substance Act Inappropriate or unprofessional behavior toward colleagues, hospital staff, students, patients,

or families of patients III. Failure to comply with professional competence and/or conduct may result in disciplinary action.

End of Professional Competence/Conduct Policy

POLICY DISCIPLINARY ACTION/DUE PROCESS (IR.IV.C-D)

House Staff whose professional competence or conduct is not satisfactory will be subject to disciplinary action initiated by the Program Director and endorsed by the Division Director and/or Department Chairman.

House Staff who wishes to dispute any disciplinary action taken against him/her may initiate the appeal process described in Section 2 of this Policy GME-107. House Staff may not utilize the Grievance/Problem-Solving Procedure described in Policy GME-R07 to dispute disciplinary action.

1. Initiation of Disciplinary Action The House Staff in question will meet with at least two senior staff members of the department responsible for his/her training. One of the departmental representatives should be the Program Director, unless prohibited by extenuating circumstances. During the meeting, a written document that includes a detailed, itemized description of any issues regarding behavior, patient care, medical knowledge, practice-based learning and improvement, interpersonal/communication skills, professionalism, and/or system-based practice will be supplied to the resident/fellow. The written material(s) should describe:

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a. The date of the meeting b. Nature of concern(s) c. Disciplinary action to be taken which may include:

Remediation

Probation

Non-advancement in academic year

Suspension

Dismissal (including non-renewal of contract) d. Duration of disciplinary action (if other than dismissal) or effective date (if dismissal) e. Requirements for successfully completing any period of remediation or probation, including a

description of methods and conditions of enhanced monitoring of the House Staff’s conduct and/or clinical/ academic activities. Enhanced monitoring should include (1) specific goals/objectives developed for the House Staff and (2) periodic, written assessments of the House Staff during the specified period.

Discussions and written documents pertaining to the issues should center on specific behaviors. A copy of documentation supplied to the House Staff shall be marked “CONFIDENTIAL” and forwarded to the Scott and White Chief Academic Officer (“CAO”) and the Designated Institutional Official (“DIO”).

2. Appeal Process A review of the disciplinary action may be initiated by either (a) the House Staff, or (b) the CAO and/or DIO. Such review must be initiated (as described below) within ten (10) calendar days of the date of the meeting as specified in Section 1(a) above.

a. Review Initiated by CAO/ DIO The CAO and/or the DIO may initiate a review process of the disciplinary action if the action is felt to be inappropriate. In such cases, within ten (10) calendar days of the date of the meeting as specified in Section 1(a) above, the CAO and/or DIO shall appoint a committee that consists of a program director from another program, a department head from a different department, a chief resident from another program, a peer selected by the House Staff who is the subject of the disciplinary action, and the GME Ombudsperson to review the circumstances leading to the imposition of the disciplinary action and make recommendations. The committee may request the House Staff, the House Staff’s program director or others who have interacted with the House Staff meet with the committee to discuss the documented issues. The committee’s recommendations will be reported to the DIO and the CAO. The CAO will make a final decision regarding whether the disciplinary action will stand, be revoked, or be modified in some manner.

b. Review Initiated by House Staff If the House Staff disagrees with the disciplinary action, he/she should submit a written request for review to the CAO and/or DIO within ten (10) calendar days of the date of the meeting as specified in Section 1(a) above. Upon receipt of the House Staff’s written request for review, the CAO and/or DIO

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shall appoint a committee composed of the membership of the committee described in Section 2(a) above. The CAO will coordinate the review process and function as a non-voting member of the committee. The committee will be charged with reviewing the circumstances leading to the imposition of the disciplinary action. The committee may request the House Staff, the House Staff’s Program Director or others who have interacted with the House Staff meet with the committee to discuss the documented issues. The committee’s recommendations will be reported to the DIO and the CAO. The CAO will make a final decision regarding whether the disciplinary action will stand, be revoked, or be modified in some manner.

End of Disciplinary Action/Due Process Policy

Employee Health Employee Health requires the following annually:

Influenza vaccine

TB Screening Flu Vaccination

a) Free influenza vaccines are offered at work – locations, dates and times will be posted on https://www.mybaylorscottandwhite.com/services/flu/Pages/default.aspx

b) If you get your influenza vaccine outside of Memorial Hospital (i.e., VA, Santa Fe Clinic), you must complete the Flu Proof of Vaccine form and attach documentation of the vaccination administration

c) If you plan to apply for an exemption, you must complete the appropriate form and submit it for approval before the influenza vaccination deadline.

Other required immunizations and other EH requirements (completed as part of the On-boarding process)

Mask Fit

Hep B

TDAP

MMR

Varicella Employee Health is located on the ground floor, AG-72, between the Cafeteria elevators and the Emergency Room. They may also be reached at 254-724-2934 or [email protected] Occupational Safety / Safe Choice If you experience a work-related injury (i.e., needle stick), please report to your supervisor immediately. There is a process in place to ensure you get the appropriate medical care dependent upon the incident. For further information, please visit: https://www.mybaylorscottandwhite.com/services/safe-choice/Pages/default.aspx or contact the Safe Choice Department On-Call Person at 1-877-415-0005.

Select option 5, if you have questions.

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PARKING

S&W Parking Policy and S&W campus parking map: All House Staff will be issued a blue parking sticker. Blue parking stickers are for “Blue” Employee/General Staff Parking Lots. Parking in any of the Patient/Visitor Lots is never permitted unless the House Staff is being seen as a patient.

When utilizing the services of Scott & White as a patient, House Staff may park in patient parking spaces. An Exception to Parking Policy Card must be placed on the dashboard visible to a security officer indicating he/she is at Scott & White as a patient.

All House Staff vehicles must be registered with the Security Department within five (5) calendar days of employment and changes in vehicle status (new license tags, additions, deletions) must be reported to the Security Department within five (5) calendar days. The parking sticker must be displayed on the exterior of the rear window, lower left corner. If the vehicle is a convertible or has removable top vehicle, the permit is placed on the lower right-hand side of the windshield. Only one parking space per resident is to be used. Vehicles must be parked in clearly marked/designated parking spaces. Fire Lane or Handicapped Parking violations are under the jurisdiction of the Temple Fire Department and the Temple Police Department and will be enforced by them respectively. The Security Department Intranet site:

http://insite.sw.org/web/InSite/iwcontent/private/supportservices/html/intra-supportservices_security.html

is available for required forms, maps and institutional parking policies. Any questions, problems, or concerns regarding parking or the parking policy may be referred to the Security Department at extension 24-2344. MEDICAL LICENSURE To participate in a TAMHSC-COM/S&W graduate medical education program, House Staff is required to hold either a Texas Medical Board (TMB) Physician-In-Training Permit or a Texas [Full] Medical License. It is the responsibility of the House Staff to make sure they maintain a current TMB PIT or TMB Medical License. A Physician-In-Training (PIT) Permit:

Must be applied for on-line by each House Staff at least 90 days prior to the anticipated start of the House Staff’s postgraduate training

Is issued with effective dates corresponding with the beginning and ending dates of the House Staff’s training program as reported to the board by the S&W TMB liaison.

Is relative to the program by which the House Staff was hired; must be changed when House Staff transfers between programs.

It is the responsibility of the resident to contact the TMB when they are transferred to a new hospital.

S&W is responsible for the cost of the PIT, however, if House Staff has let their PIT expire; they are responsible for renewal costs.

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A Texas Medical License: Refer to the Texas Medical Board. Board Rules. http://www.tmb.state.tx.us/page/laws-main-page The physician is responsible for the cost of the Texas Medical License. To participate in a Scott & White program beyond the first 12 months, House Staff must be eligible for licensure by having passed a U.S. licensure examination (USMLE III or equivalent), although licensure in Texas, is not mandated. Extension of the time period may be negotiated on an individual basis if the House Staff has taken and not passed USMLE III in the first 12 months of the program.

The director of each TAMHSC-COM-S&W postgraduate training program shall report in writing to the executive director of the Texas Medical Board the following circumstances within thirty (30) days of the director’s knowledge for any physician-in-training permit holder:

(1) if a physician did not begin the training program due to failure to graduate from medical school as scheduled or for any other reason(s);

(2) if a physician has been or will be absent from the program for more than 21 consecutive days (excluding vacation leave, family, or military leave) and the reason(s) why;

(3) if a physician has been arrested after the permit holder begins training in the program;

(4) if a physician poses a continuing threat to the public welfare as defined under Tex. Occ. Code §151.002(a) (2), as amended;

(5) if the program has taken final action that adversely affects the physician’s status or privileges in a program for a period longer than 30 days;

(6) if the program has suspended the physician from the program;

(7) if the program has requested termination or terminated the physician from the program, requested or accepted withdrawal of the physician from the program, or requested or accepted resignation of the permit holder from the program and the action is final.

Duties of PIT Holders to Report:

(a) Failure of any PIT holder to comply with the provisions of this chapter or the Medical Practice Act §160.002 and §160.003 may be grounds for disciplinary action as an administrative violation against the PIT holder.

(b) The PIT holder shall report in writing to the executive director of the board the following circumstances within thirty days of their occurrence:

(1) the opening of an investigation or disciplinary action taken against the PIT holder by any licensing entity other than the TMB;

(2) an arrest, fine (over $250*), charge or conviction of a crime, indictment, imprisonment, placement on probation, or receipt of deferred adjudication; and

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(3) diagnosis or treatment of a physical, mental or emotional condition, which has impaired or could impair the PIT holder's ability to practice medicine.

A copy of the medical license or current basic permit must be provided to the GME program administrator. If a name change occurs during the House Staff’s training, the House Staff must contact the GME Office and provide proper documentation reflecting such name change. It is the responsibility of the House Staff to contact the Texas Medical Board and get an updated PIT with their corrected name. Any House Staff allowing his/her license to expire or who fails to provide a current copy of his/her license to the GME program House Staff, who are no longer licensable, or who fail to take appropriate action to renew their license, will be discharged. Permit holders or program directors with questions about reporting requirements can contact Pre-Licensure, Registration and Consumer Services at (512)305-7030, (800) 248-4062-within Texas, by fax at (888)550-7516, or by email at [email protected] ROTATION CHANGE DAY It is the policy of the Department of Graduate Medical Education to change rotations on the first workday of the month. Weekends and holidays are not considered workdays. This policy is applicable to all departments except those with rotations to be a specific number of weeks. However, when the new academic year begins, the start date will always be July 1. PAGERS House Staff may be issued local pagers. House Staff may request long range pagers. This should be done through House Staff’s department administration office and if the training program requires House Staff to travel to outlying clinics beyond the SWMH pager range. The training site should be included in the program block schedule and curriculum. RECRUITMENT It is the goal of TAMHSC-COM/S&W GME for all programs to be successful. Resources have been allotted to assist in recruitment and modernization of programs.

LIFE SUPPORT CERTIFICATION To participate in Texas A&M-Scott & White graduate medical education programs in patient care areas, House Staff must acquire and maintain appropriate life support certifications including, but not limited, to Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) prior to employment at S&W. Pediatric Advanced Life Support (PALS) and Advanced Trauma Life Support (ATLS) AS DIRECTED BY THE American Heart Association. If house staff are unable to acquire life support certification ATLS prior to employment at S&W, the course will be offered for a fee and, therefore, not reimbursable if taken outside of S&W. It is the House Staff responsibility to maintain certification. Documentation of current certification is required for GME House Staff personnel file and it must be American Heart Association (AHA) accredited. Off-Service House Staff and Visiting House Staff must have current life support certifications as required by specialty prior to start of rotation

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REQUIRED CERTIFICATIONS BY SPECIALTY

SPECIALTY BCLS ACLS PALS ATLS NEONATAL RESUSCITATION

FCCS

(Certification Length) 2 yrs 2 yrs 2 yrs 4 yrs 2 yrs 4 yrs

Anesthesiology X X X X X

Anesthesiology-CT X X X

Anes-Pain Mgt. X X

Cardiology X X

Cytopathology

Dermatology X PGY-1 Yr

Diagnostic Radiology X X

Emergency Medicine X X X X X X

Endocrinology

Family Medicine X X X X X X

FPMRS X X X

Gastroenterology X X

General Surgery X X X X X

Hematopathology

Hem Onc

Infectious Disease

Internal Medicine X X X

Intv’l Cardiology X X

Neonatology X X

Nephrology X X

Neurology X PGY-1Yr

Neurosurgery X PGY-1Yr

OB/Gynecology X X X

Ophthalmology X PGY-1 Yr

Orthopedics Surgery X PGY-1 Yr X X

Otolaryngology X PGY-1 Yr X X

Pathology

Pediatrics X X X X

Plastic Surgery X PGY-1 Yr

Podiatric Surgery X X

Psychiatry/CAP

Psychology-Clinical

Psychology-Grief/Bereavement

Pulmonary/CC X X X

Radiation Oncology

Urology X X X X

Vascular Surgery X X

Vasc Intv’l Radiology X X

If life support certification lapses house staff is required to attend, at their own expense, the next available course to be recertified, regardless of clinical duties or assignments. House Staff who fail to recertify in the first available course will be placed on administrative leave.

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ACLS/PALS/FCCS

1. Go to http://www.bswhealth.md/cme

2. Click on “ALS Course”

3. Click on “Find a Course”

4. Click on “Register” to enroll in the course you desire.

5. Click on “Event Materials” for handouts, maps, etc. as well as important course information

including a required pre-test.

6. Once on the Activity Registration screen, enter your username and password if you have a

profile. If you do not have a profile, enter your email address and click “I am a new user” to set

up a profile (this will only have to be done once).

7. Click “Sign In”.

8. Under Registration fees, select applicable registration type.

9. Under Payment, select Interdepartmental Transfer (Note: An actual Interdepartmental Transfer

is not required for SW Residents & SW Fellows).

ACLS/PALS/FCCS: If a registrant doesn’t provide the required documentation prior to the course, all necessary paperwork must be turned in on the day of the course to receive an ACLS/PALS card once the course is complete.

If a registrant registers for a Renewal ACLS/PALS course, they must have a valid ACLS/PALS card.

If a registrant registers for a Full Course ACLS/PALS course, they must have a valid BLS card.

Copies of ACLS/PALS or BLS cards should be given to your program administrator upon receipt. PALS– Shirley Cockrell [email protected] (254)724-5804 ACLS/FCCS–Breana Anderson [email protected] (254)724-3197 *ATLS - Shirley Cockrell [email protected] (254)724-5804 *(send email and she will send a registration form to register for course) Neonatal Resuscitation Program (NRP) Cheryl Loughran [email protected] BLS BLS Certification must be maintained for all physicians requiring ACLS Certification. Basic Life Support Registration at Scott & White Memorial Hospital – Temple is now scheduled through PeoplePlace, type in web browser - myPeoplePlace.com – Login with UserID and Password (Same as your system login) Click on Learning – Login in again Left side of website – Search / Search Learn Center – Type in BLS Temple All Available BLS classes will come up (Sample below)

LIFESUP - Basic Life Support (BLS) - Temple Memorial - 6/25/2018 8:00 AM & 01:00 PM

Status: Not Enrolled

Type: ILT Session Coordinators:

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BLS- Dianne Burkes [email protected] (254)724-2884 PROGRAM COMPLETION A postgraduate medical education program is not considered completed by a house staff until he/she has fulfilled all the days specified in his/her appointment letter and he/she has completed all steps of the program and institutional requirements, including exit clearance. Failure to complete these steps will jeopardize eligibility for Specialty Board Examination, at the discretion of the Program Director. Upon the satisfactory completion of a House Staff’s training, a certificate attesting the type of training, length, and signature of the Program Director, shall be awarded to each House Staff. RISK MANAGEMENT SEMINARS All House Staff are required to satisfy the institutional policy on Risk Management education. Below are the requirements dependent upon your PGY-level. PGY-1: Two Live/In Person and ELM Modules: Coordination of Patient Care: Hand-off and Co-Provider Communication and Resident Fatigue: Risk Management PGY-2: 1 Live/In Person and ELM Modules: Coordination of Patient Care: Hand-off and Co-Provider Communication and Resident Fatigue: Risk Management PGY-3 and above including Fellows: ELM Modules: Coordination of Patient Care: Hand-off and Co-Provider Communication and Resident Fatigue: Risk Management

ELM Access (For current users)

Go to http://SWsw.elmexchange.com

House Staff will log-in using their e-mail address.

The temporary password is elm123 (the House Staff will be prompted to create a new password for future access).

Click on Go to My Courses to be directed to your classroom

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New User?

Go to http://SW.elmexchange.com

Click the link to register

Select your facility or group from the dropdown menu and fill out the short form

Click on Go to My Courses to be directed to your classroom Need Username/Password or Technical Assistance?

Call 888-315-4356 Email: [email protected]

Click here to have a password reset link emailed to you Click the Help button on the upper right of your screen from any course page!

RELIGIOUS ACCOMMODATIONS It is the policy of TAMHSC-COM/S&W residency and fellowship programs to accommodate, whenever possible, requests from House Staff to honor religious requirements. Requests should be made well in advance and all efforts will be made to structure call schedules to accommodate those requests. However, to ensure high-quality patient care and patient safety, such accommodations cannot be guaranteed. House Staff, with the approval of their Chief Resident and/or Program Director, may elect to plan with their peers to schedule observances of religious holy days. House Staff should use PTO (Paid Time Off) for time away from patient care duties more than the number of holidays observed by the institution. Residents requesting any accommodation for religious requirements should work through their Chief Resident and/or Program Director. If such accommodations cannot be agreed upon, the House Staff should contact the GME Administrative Office, the House Staff Ombudsman or Scott & White Human Resources. DISABILITY ACCOMMODATIONS TAMHSC-COM/S&W is committed to providing equal opportunities for qualified House Staff with disabilities in accordance with state and federal laws and regulations.

An otherwise qualified House Staff with a disability is defined as any person who has a physical or mental impairment that substantially limits one or more of a person's major life activities, who has a record of such impairment or is regarded as having such impairment, and is otherwise capable of performing and participating in a residency/fellowship program with reasonable accommodation.

TAMHSC-COM/S&W may take steps to provide reasonable and necessary auxiliary educational aids to otherwise qualified residents/fellows with a disability. Reasonable accommodations may be made unless doing so would cause undue hardship on the operations of the hospital/clinic, an alteration or modification to a program to the extent that it changes the fundamental nature of that program or a direct threat to the safety of the individual or others. Auxiliary aids may include, but are not limited to, various methods of making orally delivered materials reasonably available to residents/fellows certified as having a disability by a licensed physician; TAMHSC-COM/S&W is not required to provide attendants, individually prescribed devices, readers or interpreters for personal use or study, or other devices or services of a personal nature. Academic requirements essential to the residency/fellowship program being pursued by the resident/fellow or that relate directly to licensing requirements may not be modified.

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A request for accommodation may be made at any time during residency training. In order for the resident to receive maximum benefit from his/her residency training time, requests for accommodation should be made in writing to the program director as early in the training process as possible. Upon receipt of the request, the program director is expected to meet with the resident/fellow to acknowledge the request and explain the process.

The program director, necessary institutional staff, the Designated Institutional Official, and the Chief Academic Officer will coordinate with the resident/fellow to determine whether the requested accommodation would be effective, reasonable, and enable the resident to perform the essential functions of the position and achieve the essential educational goals and program objectives, or make a good faith effort to negotiate another accommodation.

All medical-related information will be kept confidential and maintained separately from other resident records. However, key faculty and program administrators may be advised of information necessary to make the determinations they are required to make regarding a request for accommodation. Employee Health personnel may be informed, when appropriate, if the disability might require emergency treatment or if any specific procedures are needed in the case of fire or other evacuations. Government officials investigating compliance with the ADA may also be provided relevant information as requested.

Once an individual has been approved for specific accommodations, and has subsequently received those accommodations, that individual should be held to the same essential performance standards as all other trainees. Focus should be on the trainee’s performance in all evaluations. Written evaluations should not mention disabilities or accommodations for disabilities in any way. TAMHSC-COM/S&W does not notify potential residency or fellowship programs or other employers about an individual’s disabilities without specific permission from the trainee. VISITING RESIDENTS

In support of the educational mission of the institution, House Staff in good standing from an accredited training program outside S&W may be accepted for clinical rotations integrated into one of the S&W-sponsored residency or fellowship programs for medical education. A “clinical rotation” is defined as participation in patient care and educational activities under the supervision of S&W clinical faculty members for the purposes of acquiring medical knowledge and experience applicable toward satisfaction of educational requirements. The presence of visiting residents or fellows must not interfere with the appointed House Staffs’ education.

House Staff wishing to participate in a clinical rotation at Scott & White should visit the Completing a Visiting Resident/Fellow Rotation page on the GME website. All the necessary forms and information as well as contact information can be found there. Some programs may require a personal interview or additional documentation prior to acceptance. Each program will communicate directly with the applicant concerning the application and review process. Visiting residents must also have current life support certifications as required by specialty prior to start of rotation. GME Administration Office will process paperwork, badge requests, etc.

An appropriate affiliation agreement or program letter of agreement must be finalized prior to beginning a clinical rotation at Scott & White; a copy of the agreement must be forwarded to the Director of Graduate Medical Education to be placed in the file.

Visiting residents must adhere to the policies and procedures of Texas A&M Health Science Center-COM and Scott & White while participating in a rotation at Scott & White Memorial Hospital or an affiliated medical center.

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POLICY

GME DISASTER (IR.IV.M)

In the event of a disaster impacting the graduate medical education programs sponsored by TAMHSC-COM/S&W, the GMEC will protect the well-being, safety and educational experience of residents enrolled in our training programs.

A disaster as defined by the ACGME is an event or set of events causing significant alteration to the residency experience at one or more residency programs. When warranted, the ACGME Executive Director, with consultation of the ACGME Executive Committee and the Chair of the Institutional Review Committee, will make a declaration of a disaster. A notice will be posted on the ACGME website with information relating to ACGME response to the disaster. The ACGME will provide, and periodically update, information relating to the disaster on its website.

In the event of any occurrence, the GMEC, working with the DIO and TAMHSC-COM S&W institutional leadership, will strive to restructure or reconstitute the educational experiences as quickly as possible following the disaster.

Insofar as a program or TAMHSC-COM/S&W cannot provide at least an adequate educational experience in a prompt manner to maximize the likelihood that residents/fellows will be able to complete program requirements within the standard time required for certification in that specialty, the DIO and GMEC will make the determination that transfer to another program is necessary.

Resident transfers may be: 1. temporary transfers to other programs/institutions until the S&W residency/fellowship

program can provide an adequate educational experience for each of its residents/fellows or 2. permanent transfers may be arranged if the disaster prevents TAMHSC-COM/S&W from re-

establishing an adequate educational experience within a reasonable amount of time following the disaster.

The DIO, GMEC, and TAMHSC-COM/S&W institutional leadership will make its best effort to ensure that transfer decisions are made expeditiously to minimize interruptions in residency training and maximize the likelihood that each resident will complete his residency year in a timely manner. If more than one program/institution is available for temporary or permanent transfer of a resident, the transferee preferences of each resident must be considered by the TAMHSC-COM/S&W DIO and GMEC. The DIO will be the primary institutional contact with the ACGME and the Institutional Review Committee Executive Director (see ACGME institutional requirements). Program directors and House Staff Officers should contact the appropriate Residency Review Committee Executive Directors with information and/or requests for information. TAMHSC-COM S&W programs will be responsible for establishing procedures to protect the academic and personnel files of all residents from loss or destruction by disaster. Electronic documentation is encouraged.

End of GME Disaster Policy

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POLICY CREDENTIALING OF PHYSICIANS FOR BEDSIDE PROCEDURES INCLUDING HOUSE STAFF

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members. (CPR VI.A.2.d)

1. The Program Director must evaluate each resident’s abilities based on specific criteria, guided by the

Milestones. 2. Faculty members functioning as supervising physicians must delegate portions of care to residents based on

the needs of the patient and the skills of each resident. 3. Each House Staff member has the responsibility of knowing the limits of their scope of authority, and the

circumstances under which the resident is permitted to act with conditional independence. When rotating on another service, you should let your supervisor know your level of ability.

4. The institution may define bedside procedures which can be performed by residents or fellows without

direct staff supervision if certified as competent in those procedures by their program directors through defined objective criteria consistent with progressive responsibility appropriate to residents’ level of education, competence, and experience. Each program will define criteria for procedure competence in their policies or curriculum. The list of bedside procedures will be generated by the office of the Chief of Staff.

5. Residents’ credentialing status (approved procedures’ status), can be verified by utilizing New Innovations. New Innovations / Credentialing will be updated by the Program Director and/or Core Faculty as resident successfully demonstrates competence in said procedure(s).

End of Credentialing of Physicians for Bedside Procedures…Policy

RESIDENT POLICIES HOUSE STAFF RESPONSIBILITIES The goal of the residency program is to provide residents with an extensive experience in the art and science of medicine to achieve excellence in the diagnosis, care, and treatment of patients. To achieve this goal, the resident agrees to do the following: 1. Under the supervision of the program director, assume responsibilities for the safe, effective and

compassionate care of patients, consistent with the resident's level of education and experience. 2. Participate fully in the educational and scholarly activities of the residency program and, as required,

assume responsibility for teaching and supervising other residents and medical students. 3. Develop and participate in a personal program of learning to foster continued professional growth

with guidance from the teaching staff. 4. Participate in institutional programs, committees, councils, and activities which actions affect his/her

education and/or patient care involving the medical staff as assigned by the program director, and adhere to the established policies, procedures, and practices of Scott & White Memorial Hospital and its affiliated institutions.

5. Annually participate in the confidential and written evaluation of the program and its faculty. 6. Enter and approve duty hours via New Innovations as established by the institution.

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7. Apply cost containment measures in the provision of patient care. 8. Keep patient charts, records, and reports up to date and signed always. 9. Adhere to ACGME institutional and program requirements. 10. Participate in an educational program regarding physician impairment, including substance abuse,

and receive instruction in quality assurance/performance improvement and patient safety. 11. Demonstrate professionalism always. 12. Maintain current TMB Physician-in-training Permit or TMB Medical License relating to specialty. 13. Maintain required certifications for [sub]specialty. 14. Annual Learning Compliance Modules 15. Employee Health required vaccinations (immunizations) APPOINTMENT LETTERS/AGREEMENTS (I.R. IV.B.1) The association of the House Staff officer and TAMHSC-COM/S&W is formalized by a written agreement of appointment. Sample letters can be found on the GME Website/For Applicants/Sample Appointment Letters. Applicants who are invited for interview are provided a copy, and/or the website address of the appointment letter that includes financial support. A copy of the sample letter, House Staff handbook, salaries and benefits are available on the Scott & White Graduate Medical Education website. Continuation of appointment is subject to satisfactory performance of training expectations and adherence to institutional policies. Satisfactory results of substance abuse testing are a condition of employment for all Scott & White senior medical staff, house staff, and employees. STIPENDS/PAYROLL House Staff are paid by Scott & White Memorial Hospital on two-week intervals. Paydays are Friday. The gross amount of each biweekly paycheck is calculated by dividing the annual stipend stated in a resident's/fellow's appointment letter into 26 pay periods. NOTE: For IRS purposes, the remuneration to a resident/fellow is considered salary. There is an increase for each progressive level of training. Any increase in base rate granted by the hospital during an academic year will be allocated to house staff on the effective date regardless of stipend quoted in his/her current appointment letter.

Pay levels are determined by the following guidelines:

1. House Staff stipends are defined by the level of training in their current program (their functional level of their current training).

2. An exception of up to one year’s credit is possible for service performed as chief resident in the TAMHSC-COM-S&W training system.

3. The pay schedule increases to a PGY-8 level. Any training beyond PGY-8 is paid at the PGY-8 level. 4. Pay levels are reviewed annually by the GMEC and the Steering Committee. 5. Direct deposit is utilized for distribution of payroll. Direct deposit is implemented upon

employment and terminated with employment termination 6. Payroll information may be accessed electronically on the BSWH-PeoplePlace Website. Login will

be necessary after clicking link.

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CALL QUARTERS Adequate and appropriate sleeping quarters are available for house staff that are required by their medical training program to remain overnight in the hospital. The call-room suite has assigned rooms with one call-back room which is first-come, first-served. There are computers and printers in the call-room suite. If in-house call is required at affiliated training institutions, sleeping quarters are provided by and located at that institution. Call the GME Office at 24-2232 any issues/concerns regarding the call-room suite. CALL MEALS Meals are provided in the hospital cafeteria and McLane’s Children’s Hospital for House Staff when on 24-hour hospital duty. Each month, based on the call assignment, an amount is credited to that resident’s meal card for each House Staff assigned call. The amount allowed is a maximum of $7.50 for each meal. Two meals are allowed per weekday call, three for weekend in-house call, and one meal for home call. Credit will be based on the weekly call schedule. All meal account balances will rollover quarterly. At the end of each quarter, balances are wiped clean and replenished on the 1st of each month (January-March) (April-June) (July-September) (October-December). Call meal accounts are closed at midnight on the last day of the month. Any remaining funds will be returned to the program’s cost center. To obtain a Scott & White supplied meal while on duty, the House Staff must present his/her meal card to the cafeteria cashier. Utilization of call meal account must comply with terms agreed upon by House Staff Association and Food & Nutrition. Noncompliance with the system will be reported to GME Administration for appropriate action. Lost or stolen identification cards should be reported to the GME Administration Office, extension 24-4505. Replacement cards are $5 and will be ordered by the Program Administrator. Replacement cards will be obtained through the cashier in the Cafeteria unless otherwise specified.

POLICY HOUSE STAFF ATTIRE

House Staff should dress and behave as a member of the professional team. General attire will be neat, clean, moderate in style, and appropriate for the professional type work performed. Extremely casual styles (such as blue denim jeans) is not permissible. Hair must be maintained in a clean and neat manner. Hairstyles will be appropriately controlled so as not to interfere with work or patient care. Facial hair should be well trimmed and neat. Jewelry will be conservative and worn in a manner that will not interfere with work activities. Your Employee ID Badge must always be worn. Check with your program as to when and where lab coats must be worn. No nonprofessional pins, insignias, buttons, tags, etc., are to be worn on the laboratory coat in patient care areas. S&W GME will reimburse up to $38.00 toward the cost of lab coat(s) for each new House Staff; however, with the noted exception of the Pediatric residents who will be reimbursed up to $38 toward the cost of a soft-shell embroidered jacket that is to be worn while at McLane’s Children’s Hospital and/or McLane’s Children’s Clinics.

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Scrubs may be worn for call duty or on units or services determined by the program as appropriate for scrub attire. Operating Room, Pavilion, and Labor and Delivery scrubs are available in designated dispensing machines for all House Staff working within these areas. These institutionally provided scrubs are not to be worn off premises. All House Staff are expected to return the institutionally owned scrubs into the designated return units. Any House Staff seen off campus wearing institutionally owned scrubs will be reported to their Department Chairperson or Program Director. It will be considered theft of Scott & White property for any House Staff to wear institutionally owned scrubs off campus. Individuals caught in such a situation will be billed for the scrubs and/or fined. Failure to pay, or make the appropriate restitution, will lead to disciplinary actions. Upon each entry to the surgical suite, all House Staff are expected to be properly dressed in freshly laundered clean and neat scrubs, including pants and shirt, clean cap or hood, which contains and covers all hair. Caps may be homemade if they fully cover the hair.

End House Staff Attire Policy

POLICY GRIEVANCE/ PROBLEM-SOLVING PROCEDURE (I.R. IV.C.1.b)

TAMHSC-COM/Scott & White encourages House Staff to bring to the attention of Program Directors concerns or complaints about work-related conditions. To aid in prompt and constructive problem solving, House Staff shall be provided with the opportunity to present such information through a formal procedure. NOTE: The grievance/problem-solving and confidential grievance procedure as described here is not to be used by a House Staff to dispute disciplinary action that has been initiated against him/her.

Many problems result from misunderstandings or lack of information and can generally be resolved by discussing them with the Program Director.

If verbal discussion with the Program Director does not result in a satisfactory solution to the issue, the House Staff may submit the problem in written form to the Program Director as soon as possible. The Program Director will meet again with the House Staff to discuss the issue and will present a written reply to the House Staff as soon as possible.

If the House Staff is not satisfied after receiving the Program Director’s written reply, the House Staff may request a meeting with the Department Chairman and provide (1) his/her written complaint to the Program Director describing the issue, (2) the Program Director’s written reply, and (3) a written explanation as to why the House Staff believes the Program Director’s reply is not satisfactory. This documentation must be submitted to the Department Chairman within two weeks from the date of the Program Director’s written reply to the resident/ fellow. The Chairman will respond in writing after interviewing the resident/fellow. The Chairman may choose to interview other individuals including the Program Director.

If the issue is not satisfactorily resolved at this point, the resident/fellow may pursue further action by providing copies of all written material and a written response to the Chairman’s letter, to the DIO within two weeks of the date of the Chairman’s written reply. The DIO will further evaluate the complaint and, may choose to form an ad hoc committee consisting of no fewer than three (3) individuals to review the issues. The committee membership should include an House Staff Ombudsperson. The committee shall

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review all pertinent information and conduct interviews necessary to reach a decision about the grievance. The committee’s recommendations will be forwarded to the DIO and the Chief Academic Officer for final resolution. House Staff who initiated the grievance will be notified of the outcome as well.

All information concerning a House Staff’s problem/complaint should be received in confidence, and the issue should be discussed only with those involved in the process or who can provide necessary information.

Complaints of discrimination or harassment may be addressed through this procedure or by contacting the Director of Employee Relations section of Human Resources.

Confidential Grievance Procedure

At times, the House Staff may have concerns that are outside the Program Director’s jurisdiction or for which the House Staff wishes to not include the Program Director or Department Chairperson. The House Staff may communicate these concerns to the Ombudsperson who may take the problem directly to the DIO. The DIO may follow the aforementioned procedure of choosing an ad hoc committee to review the concerns and reach a resolution.

End of Grievance/Problem-Solving Procedure

POLICY NON-DISCRIMINATION AND SEXUAL HARASSMENT (I.R. IV.H.3)

Staff members and their work environment should be free from all forms of unlawful harassment and intimidation. S&W does not permit staff members to engage in unlawful discriminatory practices, sexual harassment, or harassment based on race, color, religion, sex (gender), national origin, age, disability or status as a veteran. Unlawful harassment by any staff member, supervisor, department head or person doing business with S&W is strictly prohibited.

Harassment is verbal or physical conduct that denigrates or shows hostility toward an individual because of their race, color, religion, sex (gender), national origin, age, disability, or status as a veteran. Sexual harassment consists of unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature that creates an offensive or hostile work atmosphere. Staff members who believe that they are being sexually harassed, or harassed based on race, color, religion, sex (gender), national origin, age, disability, or status as a veteran should immediately report their concerns to their Program Director, the DIO, the Vice Dean of TAMHSC-COM, or the Director of Employee Relations in Human Resources at S&W. The complaint will be promptly investigated and, if it is determined that harassment has occurred, S&W will take appropriate disciplinary action, up to and including discharge of the offending staff member. No staff member will be retaliated against for filing a complaint. All complaints will be handled in confidence.

End of Non-Discrimination and Sexual Harassment Policy

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POLICY MOONLIGHTING (I.R. IV.J.1)

Employment and/or conducting of a medical practice outside the scope of a GME program (“moonlighting") is generally discouraged, as such activity may interfere with training assignments.

A. Prior Approval of Program Director Required Program Directors must be made aware in writing in advance of any employment undertaken by any

House Staff so that the Program Director may determine the intensity of the activity and its impact on sleep and fatigue which may impact resident/fellow learning. If the Program Director grants permission for the House Staff member to engage in moonlighting, he/she must do so in writing, and this information will be made part of the House Staff’s folder.

If, in the judgment of the Program Director or the Graduate Medical Education Committee, outside

employment interferes with, or, otherwise detrimentally affects a House Staff’s completion of assigned duties or responsibilities, academic performance or professional conduct, curtailment or discontinuance of outside employment may be made a condition for continuation of his/her training program.

B. Moonlighting Hours All pre-approved moonlighting hours, internal and external, will be accounted for and counted toward

the 80-hour weekly duty hour limit and logged in New Innovations. PGY1 residents are not permitted to moonlight.

C. Insurance Coverage House Staff who contemplate moonlighting should be aware that Scott & White’s professional liability

insurance only covers incidents which occur within the scope of an approved Texas A&M/Scott & White GME program, or which are undertaken on behalf of Scott & White. Therefore, House Staff who moonlight are advised to obtain professional liability insurance individually and/or through their outside employers.

NOTE: House Staff participating in “in-house” moonlighting activities at Scott & White facilities or at

Scott & White-sponsored facilities will be credentialed by the facility in which they are moonlighting, and may be covered under Scott & White’s professional liability insurance policy subject to the prior approval of the GME Director and the Scott & White Department of Risk Management.

D. Specialty Training Programs Each residency/fellowship training program must have their own Moonlighting Policy as a supplement

to this GME Institutional Policy; each policy should be consistent with ACGME guidelines for duty hours. These policies must be distributed to House Staff and faculty.

End of Moonlighting Policy

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POLICY PROMOTION/REAPPOINTMENT (IR.IV.C.1)

The determination to reappoint or not to reappoint House Staff is made by the Program Director with consideration of the Clinical Competency Committee review. The CCC review is based on successful completion of the current year and milestone/evaluation of readiness for advancement to higher responsibility. All PGY-1 residents are expected to successfully complete USMLE Step 3, or its equivalent, prior to July 1 of their PGY-2. Those who have not successfully passed are subject to recommendations of the program’s CCC regarding time-frame to successfully complete Step 3. Alternatively, the Program Director, Resident, and DIO may structure a time-frame for completion of Step 3. However, no resident is exempt from successful completion of USMLE-3 or its equivalent. Information and links to the Step 3 application are available on the Medical Licensing Examination page of the FSMB website.

House Staff not being reappointed to the next year of training should be notified in writing by the program director four (4) months prior to the ending date of the current agreement of appointment. If the primary reason for the non-renewal occurs within the four months prior to the end of the agreement of appointment, programs must provide the House Staff with as much written notice of the intent not to renew as the circumstances will reasonably allow, prior to the end of the agreement of appointment. Written notification of disciplinary or remedial action constitutes compliance with this policy. House Staff must be allowed to implement the institution’s grievance procedures if they have received a written notice of intent not to renew the agreements of appointment. House Staff who do not plan to continue in the succeeding year of their training program should notify the program director in writing four (4) months prior to the ending date of their current appointment or as early as the decision to not continue is made.

End of Promotion/Reappointment Policy

Revised January 2018

PHYSICIAN IMPAIRMENT/SUBSTANCE ABUSE (I.R. IV.H.2) The abuse of controlled substances by physicians, especially House Staff in training, looms as a major concern for Graduate Medical Education Programs as this problem leads to the destruction of professional careers, personal and family life and even loss of life itself. It is the responsibility of TAMHSC-COM/S&W Graduate Medical Education programs to inform House Staff: 1. About the facts and problems associated with chemical dependency; 2. About programs of intervention, support and treatment for the individual and their families suffering

from this problem; 3. About follow-up support after the acute treatment program has been completed. Chemical dependency is a disease that can be treated and from which the chemically dependent professional can recover. Re-entry of these highly trained medical professionals into the active practice of medicine may be in the best interest of the physicians as well as society.

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S&W performs routine drug screening at the beginning of residency training. As part of the orientation process at the beginning of training, information about the S&W substance abuse policy and the Employee Assistance Program is presented to House Staff. A House Staff with a substance abuse problem who wants help can contact his/her Program Director, Department Chairman, Program Administrator or the GME Administration office. The individual who was contacted will notify both the Program Director, Department Chairman and GME Director. An appropriate referral for examination and treatment will be made according to S&W procedures. Alternatively, a House Staff may be identified as or suspected of performing professional duties under the influence of legally or illegally obtained stimulant, sedative or other psychoactive drugs through the gathering and submission of evidence to the Program Director. The Program Director may then consult the Director of Human Resources regarding the best plan of action. If sufficient evidence has been obtained to justify an intervention the Program Director, Department Chairman, and representative from S&W Employee Assistance Program will determine the evaluations that should take place according to guidelines outlined in the S&W Supervisory Guide. Should a substance abuse problem be proven, the House Staff member may be referred to the most appropriate level of treatment. After the acute treatment program is completed, depending upon the recommendations of the treating clinician, the resident may or may not be reinstated as an active member in the residency program. Should a decision be made to reinstate the House Staff member, reintroduction into the clinical workplace will be done in a controlled fashion. It is recognized that the greatest chance for successful treatment and rehabilitation occurs when the recovering resident returns to a warm and supportive environment. The S&W Employee Assistance Program will assist in the continuing care and follow-up with a specific rehabilitative discharge plan. This process will be specified by a written agreement involving the House Staff, the treating clinician, the involved GME Program Director and the DIO. The contract will include such details as access to controlled substances, random drug testing and regular attendance at self-help programs such as Alcoholics Anonymous. Any failure on the part of the House Staff to adhere to the contract may result in disciplinary action up to and including discharge. Any GME Program’s specific policy on substance abuse, or the impaired professional, will be more relevant to the unique program and will supersede this policy. Also, the Americans with Disabilities Act may be applicable if specific requirements are met. COUNSELING SUPPORT SERVICES Scott & White recognizes that increasing responsibilities of House Staff require sustained intellectual and physical effort. On occasion, these responsibilities result in stresses on the individual or family requiring extra support. This support is provided through multiple resources. The S&W Health Plan Psychiatric coverage includes acute and situational evaluation and therapy, as well as long-term care by psychiatrists, psychologists and social workers. Comprehensive medical care is provided by the S&W Health Plan. Referral for services not connected with S&W (for confidentiality reasons) can be obtained through the Designated Institutional Official in the Graduate Medical Education Administrative Office. Neuropsychological testing can be offered when professional conduct or academic performance has resulted in consideration of Disciplinary Action. The Physician Impairment Policy deals specifically with support for physicians who are identified as being compromised due to substance abuse

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SWADDLE (Staff Well-Being Assistance During Difficult Life Events) As our employees strive to live our mission, sometimes unexpected and inexplicable outcomes occur, and the very individuals delivering care become the ones in need of support. When second victim/healthcare adversity happens "what if" questions abound and feelings of helplessness, vulnerability and fear are common. The SWADDLE team is here to support you and/or your staff through unanticipated events and difficult times that occur in the workplace with understanding, compassion and complete confidentiality.

What is second victim/healthcare adversity?

Second victim is when something unanticipated occurs in the healthcare setting, and staff members involved are negatively affected.

Healthcare adversity can be a claim, lawsuit, deposition, difficult disclosure, or board complaint. Individual peer support through the “SWADDLE Team.” Selected staff members, many who have

experienced second victim/healthcare adversity, receive training in active listening and psychological first aid and are available to support their peers with complete confidentiality.

Prevention and education seminars, including compassion fatigue, secondary traumatic stress, mindfulness and stress.

What types of second victim/healthcare adversity does SWADDLE support?

Medical errors Unexpected/traumatic patient outcomes Difficult disclosures, claims and lawsuits Outside agency complaints (i.e., Texas Medical Board, Board of Nursing, etc.)

Internal crisis, mass casualties and disasters that impact staff resilience Individual peer support through the "SWADDLE team"

What SWADDLE does not do:

o Promise or ensure continued employment o Promise that disciplinary action will not be imposed o Give legal advice o Authorize time off from work or utilization of Baylor Scott & White paid benefits o Provide verbal or written support to be used by the employee in seeking leave under

FMLA, general medical leave, short-term disability, or long-term disability o Assist with employee/manager conflict o Act as an advocate or agent for the employee

Resilience Rounds (RR) is an engagement/community building opportunity offered through SWADDLE and is open to all BSWH employees. Resilience Rounds scheduled bi-monthly on the third Wednesday from 12:00-1:00 in the Mayborn Auditorium. It begins with an educational component on a current healthcare issue or topic (~20-30 mins). Afterward, a confidential facilitated group discussion occurs with the audience.

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Contact SWADDLE System Director or Staff Support

254-724-6813 or 254-724-4127 Mon. - Fri., 8 a.m. - 5 p.m.

Email: [email protected]

Other additional counseling services available through Chaplain’s Office and EAP (Employee Assistance Program) 24/7

1-866-605-4700 www.achievesolutions.net/baylor

POLICY PROGRAM CLOSURE/REDUCTION (IR.IV.N)

The purpose of this policy is to address the closure of institutions, training programs, or the reduction of House Staff positions. The closure or reduction may result for several reasons, such as loss of program or institution accreditation or change in care delivery systems. TAMHSC-COM Scott & White has no reason to believe such a program/institution closure or loss of accreditation will occur; however, in view of the remote possibility, the following policy will apply.

Procedure

1. In case of closure, reduction, or loss of accreditation, S&W will make every effort to provide House Staff with treatment equal to that provided to other staff affected by the event. This will include notification to the Graduate Medical Education Committee (GMEC), the Program Directors, and the House Staff of a projected closing or reductions at as early a date as possible.

2. S&W will make every effort to allow those House Staff in the program to complete their education at S&W and the affiliated hospitals. If possible, payment of stipends and benefits will continue to the conclusion of the current letter of appointment.

3. If any House Staff is displaced by the program or there is a reduction in the number of House Staff in a program, S&W will assist the House Staff in enrolling in an ACGME-accredited program(s) in which they can continue their graduate medical education.

4. Provision will also be made for the proper disposition of residency education records, including appropriate notification to licensure and specialty boards.

5. S&W will also inform House Staff of adverse accreditation actions taken by the Accreditation Council for Graduate Medical Education (ACGME) that may result in closure or reduction of residency positions in a reasonable period after the action is taken.

6. The GMEC will supervise the implementation of this policy.

End of Program Closure/Reduction Policy

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POLICY LEAVE POLICIES (IR.IV.G.1)

LEAVE All leave must be documented with a completed Absence Request Form. Absence Request forms are available from your GME Program Administrator. Completion of absence forms should be done in accordance with the individual GME Programs’ attendance policy. Absence request forms will be maintained by the program and become a part of the personnel file. Prolonged leave from the graduate medical education program may result in inadequate time in the program to fulfill education requirements. Absence from the program for more than 21 consecutive days (excluding Vacation Time, family, or military leave) must be reported to the Texas Medical Board. These issues must be discussed and approved by the individual Program Director. When additional time is needed to fulfill Board requirements, a new appointment letter must be issued with the new dates. If you need to request a leave due to your own serious health condition, to care for a seriously ill family member, to bond with a new child, for military service or other reasons, call the Absence Center. (NOTE: It is the responsibility of the House Staff to notify the Absence Center when applying for a leave of absence.)

Absence Center 844-511-5762

[email protected] For Frequently Asked questions:

Absence Center Resources

While you are on a Leave of Absence, your access to BSWH Systems will be limited. Please confer with BSW PeoplePlace for further information.

Please note that all PTO must be exhausted before being placed on an absence without pay. Other insurance premiums may not continue during intervals of leave without pay. Consultation with BSWH PeoplePlace is necessary to delineate these issues and address other benefits. Paid Time Off (Vacation) DAYS All leave must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be documented within your program. Three weeks (15 work days) per academic year are granted to all House Staff. Paid Time Off/Vacation Leave allotments on external rotations at institutions other than S&W are included. Leave is discouraged during the months of June and July and in some programs prohibited. If vacation leave is necessary during this period, request should be made a minimum of six weeks in advance. Paid time off for House Staff is available from the start date of a training program. Paid Time Off will not be carried forward to the next year. House Staff will not be compensated for unused vacation leave.

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House Staff receives regular pay for Holidays observed by Scott & White and is not deducted from paid time leave:

New Year’s Day

Memorial Day

Independence Day

Labor Day

Thanksgiving Day

Christmas Day SICK LEAVE All leave must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. House Staff is granted 13 days paid sick leave per year for personal illness. Paid sick leave may not be “borrowed” from subsequent years. Upon exhausting available paid leave, sick and vacation, House Staff needing additional leave time will be placed on leave without pay and may be required to make up training time lost at the end of the medical training program if so determined by his/her Program Director. Unused sick leave will not be carried over to subsequent training years. House Staff will not be compensated for unused sick leave. MATERNITY LEAVE Maternity Leave Plan applies to any female employee who initiates a continuous leave due to childbirth and elected Short-term Disability (STD) coverage. The benefit will begin as of the child’s date of birth assuming the seven-consecutive calendar day elimination period has already been met and will continue for up to five weeks. Eligible employees may not receive more than 100% of the base salary when the maternity and the short-term disability plans are added together. Contact the Absence Center for further information. PATERNITY LEAVE Paternity leave must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. Paternity leave must be supported by a completed Absence Request Form provided by your program. FAMILY MEDICAL LEAVE ACT (FMLA) To be eligible for FMLA, you must first have the approval of your Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be supported by a completed Absence Request Form provided by your program. You must also contact the Absence Center; see section on “Leave.” According to the Family Medical Leave Act of 1993, employees who have worked at least 12 months and have completed at least 1250 hours of work during the 12 months preceding the effective leave of absence date are entitled to 12 weeks of “job-protected” leave per year for qualified medical leave (birth/adoption of a child; spouse, child or parent with serious health condition; or serious health condition of employee).

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Notice should be provided to employer in writing 30 days in advance for foreseeable leave to avoid undue disruption of operations and as soon as practical for unforeseeable leave. The written notice includes the GME Absence Request Form and the S&W FMLA Medical Certification Form. Married employees with both husband and wife working for S&W are eligible for a combined total of 12 weeks of FMLA leave for Parental Leave.

The employee is entitled to the same or an equivalent position when returning from leave. House Staff should, however, be aware that leave more than that allowed by the Accreditation Council for Graduate Medical Education Residency Review Committee and/or the specialty board for their training program may result in extension of training time beyond the projected completion date. BEREAVEMENT LEAVE An employee is eligible for bereavement pay for a maximum of two (2) bereavement events per calendar year. Each event cannot exceed three (3) days and a maximum of thirty-six (36) hours based on authorized daily work hours. Employees who need additional time off may request to use PTO. If PTO has been exhausted, an employee may request unpaid leave for the additional time off. Bereavement Leave is for the following designated individuals:

Spouse

Child/Step-Child

Parent/Step-Parent

Brother/Sister

Grandparents

Grandchild

Father-in-Law/Mother-in-Law

Son-in-Law/Daughter-in-Law INTERVIEW LEAVE Interview leave must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be supported by a completed Absence Request Form provided by your program. All Interview leaves must be documented within the program. Each upper level House Staff is allowed five (5) total days of leave with pay, during training at Scott & White, to interview for fellowships or practice opportunities. Interview leave is available only during the “junior” and “senior” years of training and must have prior approval of the Program Director. Additional interview leave may be granted at the discretion of the Program Director. This leave is expressly intended for only fellowship or job interviews. Other related activities are not applicable to this leave. PERSONAL LEAVE OF ABSENCE A Personal Leave of Absence must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be supported by a completed Graduate Medical Education Absence Request Form. All leave must be documented within the program.

Requests for leaves of absence will be evaluated on the merits of the request and will be granted or denied in accordance with applicable state and federal laws and accreditation requirements.

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A leave of absence may be comprised of paid leave and/or leave without pay. When the leave of absence is requested for medical reasons (including pregnancy), the leave must be compliant with the Sick Leave Policy as applicable. Paid sick leave may be utilized only if the leave is for medical reasons. The total length of a leave of absence must be consistent with satisfactory completion of training (credit toward specialty board qualification), which will be determined by the individual programs. Leave without pay may necessitate payment by the House Staff for medical insurance coverage during the stipulated period of leave. Arrangements should be made with the Human Resources Benefits office prior to beginning the leave, if necessary, for the House Staff to pay premiums. PROFESSIONAL LEAVE OF ABSENCE A Professional Leaves of Absence must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be supported by a completed Graduate Medical Education Absence Request Form. All leave procedures must be documented within the program. Occasionally, unique educational opportunities arise for which a House Staff may wish to interrupt the usual course of graduate medical education training; for example, a year of research training. Although this concept is supported by Scott & White Graduate Medical Education in general, the decision to grant extended leave from a training program rests with the individual program and department with which the House Staff is associated. Program Directors should consider the long-range effects of such leave on educational and budgetary planning. Professional leave of absence may be comprised of Paid Time Off and/or leave without pay. Before any leave without pay may begin, all accumulated Paid Time Off must be exhausted. The total length of a leave of absence must be consistent with satisfactory completion of training (credit toward specialty board qualification) which will be determined by the individual programs. Leave without pay may necessitate payment by the House Staff for medical insurance coverage during the stipulated period of leave. Arrangements should be made with the Human Resources Benefits office prior to beginning the leave, if necessary, for the House Staff to pay premiums. MILITARY LEAVE Military leave must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be supported by a completed Graduate Medical Education Absence Request Form. All leave procedures must be documented within the program. Participation in the National Guard or military reserve activities is allowed but must be coordinated with, and approved by, the house officer’s Program Director. Absences for participation in this activity are charged to leave without pay or may be charged to Paid Time Off, if desired. When benefit time is depleted, they will be placed in a leave without pay status.

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A House Staff inducted, ordered, or enlisted into active service will be placed on leave of absence status effective the date of written orders to report. When released from military obligations, House Staff has 90 days to notify Program Director to request reinstatement into training program. During the leave of absence, medical and dental coverage may be continued. When in an unpaid status, the House Staff is responsible for full payment of premium. EDUCATIONAL LEAVE Educational leave must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be supported by a completed Graduate Medical Education Absence Request Form. All Educational leave (conference) must be documented within the program. Five (5) days of educational leave are granted to all House Staff annually to attend educational conferences or meetings of their choice. Additional time may be granted by Program Director for attendance at meetings of professional organizations in which residents occupy official positions as officers or representatives (i.e., official representative to the TMA resident section). Attendance must have prior approval of the Program Director and be supported by documentation describing the meeting/conference, i.e., brochure, registration, etc. Unused educational leave may not be carried forward to the next year. MISCELLANEOUS TIME Miscellaneous Time [Leave] must be approved by the House Staff’s Program Director and attending physician on the service that will be affected by the leave, if applicable. All leave must be supported with a completed Graduate Medical Education Absence Request Form. Absences for these types of requests are not charged to PTO or educational leave but must be requested on the GME Absence Request Form for appropriate approval:

Presenting papers at professional conferences/meetings* Presenting poster exhibits at professional conferences/meetings* Time off to take a licensure examination Participation in non-required conferences provided at Scott & White* Attendance at courses required by training program. Attendance at meetings of professional organizations in which House Staff occupy official positions as

officers or representatives (e.g. official representative to the TMA resident section).

*Such leave must have documentation of acceptance of presentation and date(s) of required attendance and letter of support from the Program Director. Leave is granted only once for the presentation of the same paper at different meetings. Travel funding for presentation of research papers should be requested at least 30 days prior to the meeting.

End of Leave Policies

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INSURANCE POLICIES/EMPLOYEE BENEFITS Information related to salary and benefits can be managed through PeoplePlace or by calling 1-844-41-PLACE (75223). INSURANCE Medical insurance coverage is provided for the House Staff employees at a shared cost to the House Staff, dependent upon health plan.

Baylor Scott & White Health offers three medical plan options:

http://www.bswhbenefits.com/

BSWH Health Reimbursement Account (HRA)

BSWH Health Savings Account (HSA)

BSWH Preferred Provider Organization (PPO) Dependent coverage (parent/child(ren), couple, and family) is available. New dependents (spouses and/or children, step-children, etc.) may be added to Health Plan coverage by notifying the PeoplePlace. Employees must submit a Life Event within 30 days of the qualifying life event in PeoplePlace by selecting the Benefits tile, or contact PeoplePlace 844-41-PLACE (75223) for assistance. Coverage is effective on the day of the event (i.e., birth date, marriage date). Group Hospital Income Plan coverage is provided to House Staff covered by the SWEMP at no additional cost. Coverage is for the House Staff employee only. Prescription Drug Benefits are dependent upon the election of your health insurance plan. Dental insurance is an optional benefit. Detailed information on medical benefits coverage and premium rates is available PeoplePlace. There are two optional dental plans you can enroll in to help cover dental costs for yourself and your family: the MetLife Dental PPO and the MetLife Dental PPO Plus. BSWH provides Basic Life with supplemental ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) insurance at no cost. Coverage may be purchased on a voluntary basis. Coverage may include spouse and children. Details on AD&D benefits coverage and premium rates are available through Human Resources. Temporary and Long-term disability insurance is provided by SWHC to physician and non-physician House Staff. SWHC provides salary continuation for disabled House Staff for 150 days. SHORT-TERM DISABILITY (STD) PLAN Safety and support for the staff at BSWH is a very high priority, and this includes providing some level of financial security should something unexpected occur. Short-term Disability may be taken for females wishing to extend their maternity leave as well as those healthcare needs involving longer periods of recovery. If you wish to have STD, you must enroll in the STD plan. Disability insurance can provide income when you need it most, and a Short-Term Disability Plan would cover you even if you do not have Paid Time Off vacation leave available. The BSWH-paid Short- Term Disability Plan replaces 60 percent of salary with no weekly salary maximum. STD benefits begin on the eighth calendar day of disability and can continue through the 180th day. Staff Members must access available sick leave until benefits begin.

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LONG-TERM DISABILITY (LTD) PLAN BSWH-paid coverage is for salaries of up to $250,000 per year for full-time Staff Members. Benefits will replace 60 percent of salary. LTD benefits begin on the 181st day of disability and can continue until Normal Social Security Retirement Age in certain circumstances. LTD coverage begins on the first day of employment. FLEXIBLE SPENDING The BSWH Flexible Spending Plan is an employee benefit that allows payment of health and dental insurance premiums, out-of-pocket medical/dental care, and dependent childcare expenses with tax-free dollars, i.e., these expenses are deducted from gross pay before federal income and Social Security taxes are paid. Participation is voluntary. An opportunity to enroll in the plan is initially presented at orientation. Pre-tax deductions for health and dental premiums are automatic after the initial year of enrollment; however, enrollment in the medical/dental and childcare reimbursement account must be renewed annually. Elections made at the time of enrollment cannot be changed during the year except in the event of change in employment or family status. THRIVE/WELLNESS PROGRAM House staff and their spouses can enroll in the Wellness Program. Only employees are eligible for the $30 per pay period credit toward the cost of the medical premium. To learn more about the requirements to receive THRIVE credit, please visit www.thriveforwellness.com (Note: Your requirements will change after your initial year.) Employees and their spouses can earn up to $375 in Thrive rewards. PROFESSIONAL LIABILITY BSWH fully provides professional liability insurance for House Staff which covers their activities at Scott and White and when on educational assignment in affiliated hospitals and clinics. The program of self-insurance covers up to $1,000,000 for each occurrence/$3,000,000 aggregate per annum. Coverage for training activities will continue upon program completion on the condition that the physician shall cooperate fully, return to Temple for conferences, depositions and trial, and be available in Temple as needed in the judgment of Scott and White defense counsel. Failure to cooperate, as set forth above, shall be grounds for denying defense and for denying coverage on the claim, at the sole options of Scott and White. STUDENT LOAN DEFERMENT

Certain undergraduate and medical school loans can be deferred for part or all a House Staff’s training period. The Program Administrator of the residency program or The Office of Graduate Medical Education is authorized to sign deferment and forbearance forms. If you have loan deferment forms that need to be completed, please complete your portion and bring them to the Program Administrator. After certifying your information, the Program Administrator will mail them for you and keep a copy in your file. Copies of the forms will be kept within the House Staff’s permanent GME file. Deferment is the temporary postponement of your monthly student loan payment obligation. Interest will continue to accrue on your Unsubsidized and Grad Plus loans, but interest will not accrue on subsidized loans.

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Forbearance is the temporary postponement or reduction of your monthly student loan payment obligation. During forbearance interest accrues on the entire balance of your student loans including your subsidized loans. House Staff will need to contact servicer(s) to obtain the required documents to postpone monthly payments. If you are unsure of whom your loans servicer(s) is visit the National Student Loan Data System (NSLDS) at www.nslds.ed.gov. EDUCATION ENHANCEMENT BENEFITS

POLICY EDUCATION MATERIAL ALLOWANCE

An educational allowance of $500 is made available to all House Staff upon employment and is at the discretion of the program and according to BSWH Policy. Upon submission of original itemized receipts and approval of the Program Director, House Staff may receive reimbursement for purchases of medical texts, resource materials, and certain medical equipment. (Please note the following are not an approved educational expense: Android phone/Accessories, iPhone/Accessories, Apple iPad Mini/Accessories, Apple iPad Air/Accessories, Apple iPad Pro/Accessories, Droid Tablets, Notebooks, Electronic book readers, Kindle, Computer hardware, Laptop, Dragon Headset, Dragon PowerMic. If the allowance is not used for above-mentioned materials, it may be used for payment to professional organizational activities or research presentations trip allowance.

RESEARCH PRESENTATIONS (RESEARCH TRAVEL AWARD POLICY)

The Research Travel Award allows residents and fellows to present scholarly activity at regional and national meetings where the resident or fellow is an author. Visit http://researchers.sw.org/academic-research-development/internal-funding to learn more about Academic Research Opportunities and how to apply for a Research Travel Award.

Request for research travel award must be submitted no more than 30 days after abstract acceptance notification or will not be eligible for research travel award.

Reimbursement requests must be completed within 30 days after travel or travel will not be reimbursed.

PGY-1 Residents will be eligible to present a single case report.

PGY-2 or higher-level trainees will not be eligible to present a single case report

Resident are eligible for a total of two travel awards within each fiscal year of which could be: o One travel award for poster presentations during each year of training of $2,000 o Two travel awards for podium or workshop presentations during each year of training for

$2500

All scholarly activity supported by the Research Travel Award must be mentored by a staff physician or established investigators in the residency or fellowship program or by the office of Academic Research and Development.

Appropriate regulatory review must be obtained for research projects supported by the research travel fund.

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Travel outside of 48 contiguous United States is disallowed. Exceptions for extraordinary scholarship require pre-approval by the GME DIO and VP of Academic Research before submitting an abstract. National meetings in large Canadian cities (e.g. Toronto) may be considered.

You must book your travel, hotel through Carlson WagonLit or you will not be reimbursed.

Concur/Carlson Wagonlit (CWT) is only for BSWH travelers (do not use Concur for personal use, i.e. spouse airline tickets). You are encouraged to add your program administrator as “Delegate” to both your travel (Carlson WagonLit) arrangements and your business (Concur) expense reporting.

Contact: www.carlsonwagonlit.com

email at [email protected] (866)749-9640

Car Rentals are not permissible.

Hotel reimbursement is allowable the night before a meeting and through meeting completion

Hotel reimbursement is not allowable the night of meeting completion unless returning flights are not available (in general, noon or early afternoon ending requires return that day)

o Documentation required if returning flights are not available on day of meeting completion

Meals reimbursed at the amounts per the BSWH Travel Policy (NOTE: Overnight stay is required for meal reimbursement) https://www.mybaylorscottandwhite.com/services/policies/Pages/default.aspx

Meals reimbursement are only for traveler’s meals (not spouses, children, etc.)

Request reimbursement for individual meal total not for total allowable amount Post Travel After travel, all reimbursements will need to be submitted through Concur with copies of approval letter, airfare itinerary, hotel receipt, (if hotel room is shared, traveler should only put their portion of the hotel), and prior reimbursements included in the final expense report no later than 30 days following the completion of travel. For the reimbursement title, please put “Travel Award – Dates of Travel)”

To receive reimbursement, original receipts must be submitted through Concur no later than 30 days following the completion of the travel or it will not be reimbursed.

All reimbursements will be charged to the traveler’s home cost center The Travel Awards are not associated with CME; therefore, when completing your

reimbursements through Concur DO NOT select CME.

Step 1: Connect to Concur Website: https://www.concursolutions.com/ User ID: Your Company email address ([email protected]) Password: First Time Login = BSWH + last 4 digits of your Social Security # (Ex: BSWH6789) Step 2: Set up your profile Personal Information Enter telephone contact information Verify your email address (click on the “verify” link) Add an emergency contact

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* If someone makes a reservation on your behalf, add them under “Assistants and Travel Arrangers”

Expense Settings Enter your banking information. All expense reports are reimbursed via direct deposit and this field is required.

* If someone will be completing reimbursements on your behalf, add them as an expense delegate

Other Settings Activate E-Receipts Click Mobile Registration to get started with the mobile app and to set a pin Concur help is online at https://www.mybaylorscottandwhite.com/services/finance/financial_services/travel_business_expenses/Pages/default.aspx Step 3: Download Mobile Apps to your smart phone: Concur and/or ExpenseIt * Copies of itemized receipts are required for all lodging, meals, commercial transportation, airport parking, taxi service, and any other allowable incidental costs. Professional Organization Activities (RESEARCH TRAVEL AWARD POLICY) House Staff may apply for one Professional Travel Award to fulfill obligations of official positions as officers or committee members of a professional organization at one national or one state meeting per academic year. Pre-authorization is required, and requests must be submitted at least 30 days prior to first day of travel. All hotel and travel arrangements must be booked through Carlson WagonLit. www.carlsonwagonlit.com or email at [email protected] The time away is charged to miscellaneous time, not VACATION LEAVE or education leave. All allowable itemized receipted expenses will be reimbursed up to $1,500. An absence request form must be submitted for all travel indicating Program Director’s approval of leave and be supported by documentation describing the meeting and officer status for official positions as officers or committee members. Reimbursement will be paid as outlined in the Research Travel Award Policy. Allowed days are described in the “House Staff Leave” section of this handbook. REQUIRED EXTERNAL ROTATIONS For required courses of one month or longer, housing will be arranged and covered in full by the department. INTERNATIONAL ROTATION POLICY

Residents/Fellows participating in a training Program at SWMC, who are interested in completing an International elective rotation, must follow the guidelines below. All Residents/Fellows are encouraged to do a formal presentation on their international clinical experience either within their program and/or department.

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16.1 Eligibility Criteria for International Elective Rotation

a. Residents must be in their second year of training b. Fellows must be in their second year of training c. Residents/Fellows must have the approval of their Program Director; if Program Director is

not the advisor for International Rotation, a faculty advisor must be assigned d. Goals and objectives must be clearly outlined for the experience e. The onsite international faculty member who will complete the evaluation must be identified

in advance f. July is excluded g. Pre-requisites:

i. Must meet conference attendance requirements ii. No incomplete rotation/educational units

iii. Evidence of compliance with documentation of procedures and medical records must be up to date

iv. Must have taken In-service exams as appropriate v. Must have completed post rotation/educational unit tests where applicable

vi. Must have a call free month available for the international rotation/educational unit (PD has the discretion for approval)

vii. Resident must accept there may be additional, but within the guidelines of the ACGME Duty Hour Rules, on-call shifts upon their return to SWMC.

16.2 Travel Criteria

a. The international elective must be approved by the Program Director b. Country of travel should not be listed on the state department travel warning sites c. Resident/Fellow must have all travel documentation in order

i. Complete the International Medicine Personal Information Sheet and return to the GME Department.

ii. Copy of the passport iii. Copy of visa (if applicable) iv. Travel insurance v. Risk and release form

vi. Documentation of immunization d. Resident/Fellow will be provided information regarding US Embassy/consulate, travel registration

and other relevant information 16.3 Return from Travel

a. Resident/Fellow must have an appointment set with an Occupational Safety Specialist through the Safe Choice Program immediately upon return. This should be within 24 hours or before returning to regular work schedule

b. Upon return, must meet with PD to review the experience and to confirm that all goals and objectives of the rotation/educational units as stated are met

End of International Rotation Policy

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MISCELLANEOUS PERSONNEL FILE A permanent file for each House Staff is maintained by the program. This file contains evaluations prepared by the supervisory staff and other healthcare professionals. As required by the ACGME, it will include a final summative evaluation completed by your Program Director and reviewed by you prior to your graduation [termination]. Additionally, your file will retain other academic, professional, and biographical information. NOTARY SERVICES There are several GME Program Administrators and GME Office Staff that can assist you with getting your documents notarized. Please call to make sure they are available to notarize your documents. External: (254)724-

Linda Billingsley , GME Office 24-2232

Stacy Brister, Plastic Surgery 24-0630

Heather Boyd, Ophthalmology 24-1058

Shae Byrd, GME Office 24-2485

Janet Chlapek, Nephrology, ID 24-7633

Michelle Felix, Podiatry 23-5750 (External-935-5750)

Dee’D Ferman, GME Office 24-9290

Kessiah Foster, Pediatrics 23-5063

Shelia Gardner, Hem Onc, Gastroenterology 24-8845

Nicole Liles, Surgery 24-2366

Andrea Rankin, OB-Gyn 24-7588

Cindy Rush, Emergency Medicine 24-5815

Samantha Smith, Orthopaedics 24-5455

C. Elaine Stone, Urology, Vascular Surgery 24-1695

Trina Thompson, GME Office 24-4320

Mylessa Wheeler, Cardiology 24-0108

Dorothy Winkler, Psychiatry 24-1768

Kaitlin McCoy, Family Medicine Round Rock 28-5729 (512-244-5729) PHOTOGRAPH Each House Staff will have his/her photograph on file with the BSWH Biomedical Communications Department (Photography). Photographs will be taken in conjunction with GME Orientation or at the time the House Staff begins training, should it be off cycle from the annual June orientation session. PROGRAM COMPLETION A postgraduate medical education program is not considered completed by a House Staff until he/she has fulfilled all the days specified in his/her appointment letter and he/she has completed all steps of the clearance protocol. Failure to do so will jeopardize eligibility for Specialty Board Examination, the discretion resting with the Program Director. Upon the satisfactory completion of training, a certificate attesting the type and length of training is awarded to each House Staff.

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PUBLICATIONS Scholarly investigations by House Staff are encouraged. To be eligible for publication, manuscripts prepared by House Staff must be reviewed and approved by the Division Director and the Department Chairman or their designees. The Publications Office in the Research and Education Division is available to assist authors in preparing manuscripts for submission to journals. Services available include manuscript formatting and editing, acting as liaison with Biomedical Communications/Illustrations to prepare figures, and corresponding with editors/publishers. When an article is accepted for publication, the Publications Office will order and maintain reprints for distribution. SCHEDULES Service and call schedules are maintained in the Department of Graduate Medical Education. Changes in those schedules should be confirmed by the Program Director and reported to the GME Program Administrator as promptly as possible. On-line call scheduled can be found at http://insite.sw.org/web/InSite/iwcontent/private/oncallschedules/html/intra-oncallschedules.jsp VOLUNTARY TERMINATION Termination of training is to be discussed with, and approved by, the Program Director. An official letter of resignation must be submitted and kept on file with the program. House Staff is not eligible for pay for unused Paid Time Off or Extended Illness Bank (EIB). EXIT CLEARANCE Each House Staff is required to complete an Exit Clearance Form upon separation from Scott & White for any reason. Exit Clearance forms can be obtained from your Program Administrator and must be returned to Program Administrator when completed. This includes any items that should be returned to the Central Texas Veterans Healthcare System (CTVHS).

Please contact Peggy Peters, GME Office, with any suggested changes for the House Staff Handbook.


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