Main-manual

Department of Anesthesiology Resident Manual

TABLE OF CONTENTS

Preface Graduate Medical Education Mission Residency Program Information General Description Lectures and Conferences Faculty Advisor Program Meetings with the Program Director Anesthesiology Faculty Members Evaluation of Faculty by Residents Periodic Reporting Obligations of Residents Evaluation of Residents by Faculty and Others Criteria for Advancement in Training Level ACGME General Competencies Facilities Libraries Lockers Mail and Postings Employee Health Service Logistics Parking Identification Badges White Coats Pagers and the Paging System Hospital and Laboratory Information Systems On-Call Duties at Hahnemann University Hospital Duty Hours and Call Requirements Resident Call Structure at HUH General O.R. call Obstetric Anesthesia call Late call Faculty Call Structure Employment Information Policies Last Revised, November, 2009

1

PREFACE This manual contains an introduction for new resident and fellow trainees to the Department of Anesthesiology at Drexel University College of Medicine, including several important policies and procedures. Because the Department is dynamic, information contained in printed versions of this manual becomes outdated quickly. If you are reading a printed copy of this manual, kindly check the on-line version at the Departmental website, using the Administrative Resources tab. Your years of training will go by quickly. You need to acquire a large amount of clinical expertise and theoretical knowledge in that time. The faculty of the Department will guide you in obtaining both, and in the proper balance; however, only by taking an active role in your education, will you succeed in learning both basic and advanced anesthesia knowledge and skills, and develop the competencies for life-long learning so essential to your career. You must set aside adequate time for study from the beginning of your training. Guard it jealously; use it effectively. Make daily reading a habit as routine as brushing your teeth; if you read only 1 page every day, you would cover more than 1100 pages by the end of 3 years of training. Now imagine how much you will learn by reading for 2 hours every day, unless on call. This is the amount you need to cover for success. Start today! Your faculty advisor can help you devise a reading plan for your 3 years. You cannot fail if you follow it. Also, utilize resources on the web, particularly the Drexel University Library website. Review material periodically; repetition enhances memory.

GRADUATE MEDICAL EDUCATION MISSION Residency education in the Department of Anesthesiology will result in physicians who are competent consultants in anesthesiology, able to complete the certification process of the American Board of Anesthesiology (ABA) successfully. This education will meet the standards of the Accreditation Council for Graduate Medical Education (ACGME) and specifically address the Anesthesiology Residency Review Committee’s (RRC) requirements for Residency Education in Anesthesiology published by the ACGME in the Graduate Medical Education Directory. The Department of Anesthesiology produces anesthesiologists who are: 1) safe, independent anesthesia providers 2) flexible, effective team members 3) viewed as consultants by their physician peers 4) experienced in the variety of practice settings for consultant anesthesiologists 5) effective communicators 6) versed in economic and ethical issues relevant to anesthesiology 7) life long learners 8) consultants that understand the application of research methods to clinical practice. Members of the Departmental Clinical Competency Committee Michael Green, DO Assistant Professor and Chair of the Clinical Competency Committee Mian Ahmad, MD Assistant Professor and interim Chair Jay Horrow, MD, MS Professor, Program Director

2

Michelle Murtha, MGA Melissa Brodsky, MD Susan Kaplan, MD Marcus Zebrower, MD

Academic Coordinator, non-voting member Assistant Professor Associate Clinical Professor Associate Professor

Members of the Departmental Education Committee Mian Ahmad, MD Assistant Professor and Chair of the Education Committee Gary Okum, MD Associate Professor, Clinical Pathway Director for Medical Students Joseph Berger, CRNA Student Nurse Anesthetist Education Coordinator Navneet Grewal, MD Instructor Michael Green, DO Assistant Professor, Associate Program Director Jay Horrow, MD, MS Professor, Program Director The residency program in Anesthesiology at Drexel University College of Medicine is accredited by the Council on Graduate Medical Education of the American Medical Association. Residents are supervised by faculty at a maximum ratio of 1:2.

RESIDENCY PROGRAM INFORMATION GENERAL DESCRIPTION Preliminary Year The Department of Anesthesiology in collaboration with Drexel University College of Medicine’s Departments of Medicine and Surgery offers a preliminary (PGY1) education in surgery. Preliminary education in Internal Medicine is offered in collaboration with Mercy Fitzgerald Hospital in Darby, PA. This enables qualified applicants to obtain medical training in preparation for the three-year educational experience in anesthesiology. Clinical Base Year In the future the Department will offer a Clinical Base Year that forms a 4-year continuum with the years of Clinical Anesthesia training. More information on the structure of this continuum will appear here as it becomes available. Clinical Anesthesia Years 1-3 Following a preliminary or clinical base year or its equivalent, anesthesiology residents complete three years of clinical anesthesia curriculum as outlined by the American Board of Anesthesiology (applicants are encouraged to obtain the American Board of Anesthesiology Booklet of Information, American Board of Anesthesiology, 4101 Lake Boone Trail, Suite 510, Raleigh, NC 27607-7506). In the first Clinical Anesthesia Year (CA-1) an initial orientation under the supervision of faculty members will be followed by a board based introduction to anesthesia patient care of increasing complexity. The CA-2 year furthers that progression of resident knowledge and skill with increasing more complex cases and specialty experiences in critical care, pain management, and in cardiothoracic, neurosurgical, obstetric, and pediatric anesthesia. The CA-3 year allows residents to select advanced training experiences, which focus on

3

one of two areas. Residents in the Advanced Clinical Track complete a minimum of six months of advanced anesthesia training. They may spend the remaining six months in advanced anesthesia training or in one to three selected subspecialty rotations. Residents may train in one anesthesia subspecialty for at most six months during the CA-1 through CA-3 years. While all specialty areas are available for CA-3 concentration, particular strengths of the Drexel University College of Medicine Residency Program currently include cardiothoracic, obstetric, and pediatric anesthesia. The Clinical Scientist Track consists of clinical training in combination with research experience. (All residents participate in clinical research beginning in the CA-1 year as part of clinical research teams formed mid-way through that year and continuing to the end of the CA-3 year.) Residents interested in pursuing the Clinical Scientist Track must be enrolled in an ACGME-accredited anesthesiology program and remain active in the educational component of the program while pursuing research. There are two options for fulfilling the requirements of this track. Please see your ABA Booklet for more details. LECTURES AND CONFERENCES Residents enjoy a rich and diverse out-of-the-O.R. teaching schedule. Attendance at teaching functions is mandatory for all residents present at work on a given day. The teaching curriculum features an integrated structure, so that all teaching components follow a monthly theme. See the departmental website for a full appreciation of the Integrated Curriculum. In the Fall, Winter, and Spring (45 weeks) the program provides 4 hours of conferences each week: morning Grand Rounds (1 hour), morning text review (1 hour), morning key word review (½ hour), and a 1.5 hour afternoon conference with weekly rotating themes. Grand Rounds and afternoon conference continue through the summer. An additional 20 morning conferences, 45-minutes each, over the 1st 6 weeks of training provide basic information to new residents. Although the 6-week summer orientation lecture series targets CA-1 residents, all residents are invited and encouraged to attend. GRAND ROUNDS. Grand Rounds topics cover not only the ABA Content Outline over the course of 3 years, but also include presentations by Visiting Professors (approximately 5 per year) on topics relevant to anesthesiology and critical care. The Department faculty prepare and present the vast majority of these lectures. Arrangement of topics into monthly themes yields a concentrated effort on specific topics, with repetition using multiple teaching modalities to suit a variety of learning styles. KEY WORDS. Morning Key Word Review utilizes a list of phrases supplied by the InTraining Examination Council. Each phrase corresponds to a question answered incorrectly by a sizeable number of trainees. Phrases are organized as much as possible according to monthly topic, and assigned in rotating fashion to residents. At each session, two or three residents so assigned present briefly (<10 minutes) on the subject. An assigned faculty moderator assures appropriate coverage of the material. MORNING FULL-DEPARTMENTAL CONFERENCE. Material varies from week to week. Each conference occurs once a month. • Morbidity & Mortality Conference. In classic style, we review cases referred from both within the department and outside the department for discussion of 4

improved practice and best practices. Residents benefit from discussions by all faculty, CRNAs, residents, and students. • Case Conference. Another weekly session each month uses a case-based approach, presented by a resident and discussed by all department personnel. A case description and relevant reading is distributed well in advance, to facilitate discussion. Cases typically follow the current topic covered by the Integrated Curriculum. • Journal Club. Odd-numbered months use an important evidence-based medicine article, with a list of question to guide the discussion. All departmental personnel participate, with emphasis on the elements of evidence-based medicine, good clinical trial design, and statistical analysis. Everyone receives the article for discussion at least one week in advance, along with the study sheet containing questions to guide the discussion. In even-numbered months, two residents each present the interesting articles appearing in a recent issue of an anesthesia journal (assigned in advance). All departmental personnel participate in the discussions. ADDITIONAL MONTHLY CONFERENCES (weekly in mid-afternoon – residents are relieved from clinical work to attend) • Text Review. The text review conference series uses one selected text in anesthesiology as the basis for bi-weekly readings relevant to the monthly teaching topic. The department Education Committee determines when to supplement readings in the selected text with additional materials; they select and incorporate them into the weekly assignments. At each text review conference, a faculty member leads the residents in a discussion of the reading. Residents MUST come to the conference having read the assignment and prepared for discussion. • Q&A. Every month contains one weekly session reviewing multiple choice questions similar to those that appear on the In-training /Written ABA Examination. • Simulation Sessions. About six sessions per year focusing on different aspects of Anesthesiology from very basic in the summer to more advanced latter in the year. Multi-disciplinary sessions are also incorporated. • Oral Board Review Sessions. Structured to follow the ABA format for oral board examination. Done on a monthly basis. Eight residents are examined per session in two different locations done by a number of rotating faculty. Residents are given immediate feedback for improvement on presentation skills and medical knowledge. • Chair’s Rounds. The Chair chooses the format and content of this session. Previous sessions have included didactic presentations, Socratic discussions, review of multiple choice questions, and workshops. FACULTY ADVISOR PROGRAM New residents are assigned a faculty advisor for the first six months of training, after which they may select a new faculty advisor. All residents have an opportunity to select a different advisor every July. The program provides faculty-resident interaction outside the classroom and the operating room, in support of training activities, professional growth, and personal development. It strives to develop an atmosphere of trust and confidentiality between residents and faculty. The program also provides informal feedback (see below regarding formal feedback) to faculty on residents’ perceptions of the training program to help make curriculum and educational activities more effective.

5

MEETINGS WITH THE PROGRAM DIRECTOR Each resident meets with the Program Director every 3 months, at which time the following are reviewed and discussed: • Case log • Evaluations • Test scores • Plans for scholarly activity • Interactions with faculty advisor • Suggestions for program improvement For each topic, the discussion focuses on past and current performance and plans for continuing improvement. The meeting includes time to discuss any additional topics or areas of concern of the trainee. A written summary of the meeting is agreed and signed by both the Program Director and the trainee, with copies to the resident’s training folder and to the resident. ANESTHESIOLOGY FACULTY SPECIALTY INFORMATION Our faculty possess a wide range of expertise. Below is a list of faculty members categorized by areas of specialization. Please use these individuals as resources in their specific areas. Airway Management Mian Ahmad, MD Alex Zonshayn, MD Ambulatory Anesthesia Melissa Brodsky, MD Bryan Chambers, MD Jack Shutack, DO Cardiothoracic Anesthesia Jack Cohen, MD Jay Horrow, MD, MS Nagaraj Lingaraju, MD Vance Nielsen, MD Gary Okum, MD Alex Zonshayn, MD Michael Green, DO Critical Care Navneet Grewal, MD Neuro Anesthesia Jerry Levitt, MD OB Anesthesia Susan Kaplan, MD Marcus Zebrower, MD Parmis Green, DO Orthopedic Anesthesia

6

Mian Ahmad, MD Melissa Brodsky, MD Vincent Odenigbo, MD Pain Management Jerry Levitt, MD Dan Nasr, MD Wes Prokop, MD Alex Zonshayn, MD Pediatric Anesthesia Faculty at St Christopher’s Hospital for Children

Regional Anesthesia Maria Muñoz-Allen, MD Jack Cohen, MD

EVALUATION OF FACULTY BY RESIDENTS At least once a year, residents evaluate the faculty in written, anonymous fashion. The evaluation includes quantitative scores on a variety of desired faculty behaviors and qualities; an overall score; and provision of unstructured comments. All faculty see summary statistics (i.e., de-identified) of the scores for individual questions; each faculty member sees their personal results. The Program Director or Chariman meets with each faculty member to discuss their results and suggest improvements where appropriate. The most recent survey employed a web-based instrument. In addition, residents rate faculty encountered on each rotation as a part of their evaluation of their monthly rotations (see evaluation forms). PERIODIC REPORTING OBLIGATIONS OF RESIDENTS ACGME WEBSITE. Residents regularly track their clinical cases using a website specifically designed by the ACGME. These case logs provide details on the total number of cases performed by anatomic region, by technique, by patient age, and with additional details for certain subspecialty areas such as ambulatory anesthesia and pain management. The Program Director expects residents to update their electronic case logs on the ACGME website monthly or more frequently, and reviews them individually with each resident at quarterly meetings. AMERICAN BOARD OF ANESTHESIOLOGY. The ABA requires minimum numbers of various types of cases (e.g., traumas, intracranial, epidurals) for acceptance into the examination system of the Board. Most of the needed information derives from the information entered into the ACGME website. However, residents should keep personal logs of all cases in order to assure that they can assure adherence with all ABA requirements by the end of their training. EVALUATION OF RESIDENTS BY FACULTY The faculty complete evaluations of each resident’s performance at the end of each training period, based on the goals and objectives for their level of training, in the framework of the 6 ACGME competencies. The Program Director reviews these

7

evaluations whenever completed, and provides immediate intervention when appropriate. The Program Director reviews all evaluations for each resident, newly completed in a 3-month period, at the resident’s quarterly meeting (see below). Should a resident’s performance not meet predetermined expectations, the Program Director and faculty advisor devise and implement a remediation plan to build and/or enhance the needed skills. Residents may not participate in elective or specialty rotations at other institutions without the necessary cognitive, clinical, and technical skills. Click here to view evaluation forms for all rotations. The department implements the Anesthesia Knowledge Test (AKT) during day one of training of the CA-1 year. Residents take the AKT again upon completion of the first 30 days, 6 months, and 18 months of training. All residents are required to take these examinations. Test results may initiate mandatory remedial measures for areas of weakness. The department also requires residents to take the Anesthesia In-Service Training Exam every March. Residents who have completed their CA-1 year by June of the same year must achieve at least a 25-percentile score for the American Medical School Graduates at their respective level of training (CA-1, CA-2, or CA-3). Failure to achieve this level of competence may result in denial of 6-month competency by the Departmental Clinical Competency Committee. ABA policy requires that the Department certify every six months the level of clinical competence of each resident. The Department Clinical Competency Committee meets every 6 months for this purpose. It considers all information regarding a resident in confirming or denying competence. The committee members have discussed and agreed that clinical competence depends upon a minimum level of knowledge, as demonstrated by standardized tests. EVALUATION OF RESIDENTS BY OTHERS In selected, appropriate rotations, nursing personnel and/or patients (or their guardians) also evaluate residents. Click here to view evaluations forms. CRITERIA FOR ADVANCEMENT IN TRAINING LEVEL Please also see the Policy section regarding Departmental process. The knowledge, skills, and performance criteria noted below may or may not appear in the goals and objectives sections of individual rotations or on the periodic evaluation forms of residents by faculty. Because they represent important milestones in development as a competent anesthesiologist, the department expects residents to achieve these milestones or undergo remediation procedures that may involve prolongation of the training period. Objectives for 6-month and yearly milestones are keyed to evaluation forms for the Hahnemann University Hospital General O.R. rotations for those time periods. End of Second Month Knowledge: • Complete assigned readings in Clinical Anesthesiology (Morgan, ed.) • Score at least 25th percentile on one month Anesthesia Knowledge Test Skills: • Maintain an airway in an anesthetized patient with no anatomical airway problems 8

• • •

Perform laryngoscopy and oral tracheal intubation in most anesthetized patients Perform spinal anesthesia for uncomplicated surgical procedure in healthy patients Obtain intravenous access on the majority of patients without assistance

Performance: • Present ASA Physical Status I or II patients to an attending anesthesiologist in a concise manner including all important anesthetic factors and problems • Formulate and present an anesthetic plan for PS I or II patient for routine surgery • Set up anesthesia machine with full safety check and equipment • Set up anesthesia monitors • Anesthetize a PS I or II patient for uncomplicated surgical procedure with close supervision, but without assistance; includes induction, maintenance, emergence and transfer to PACU • Communicate patient status effectively to nursing and surgical personnel • Pass ACLS Objectives: End of Six Months Medical Knowledge: 1. Complete assigned readings in Clinical Anesthesiology (Morgan, ed.) 2. Score at least 25th percentile on 6-month Anesthesia Knowledge Test 3. Apply fundamentals of anesthesia induction agents and volatile anesthetics to patient care 4. Apply basics of neuromuscular blocking drugs and reversal agents 5. Apply pharmacology of vasoactive drugs 6. Apply scientific basis of monitoring and anesthetic equipment 7. Cite scientific evidence for the value of a pre-operative evaluation Practice-based Learning: 8. Use occasional quizzes to identify areas for targeted reading 9. Contribute at least one case report to Case conference or Morbidity & Mortality conference Patient Care: 10. Perform airway maintenance and intubation without assistance most of the time 11. Place intravenous catheters with minimal assistance 12. Place arterial and central venous catheters with assistance 13. Provide regional anesthesia with supervision, and without assistance Interpersonal and Communication Skills: 14. Communicate effectively with patients, nurses, surgeons, and support staff 15. Present in a concise, organized fashion at conference 16. Keep legible and accurate pre-, intra- and post-operative notes Systems based practice: 17. Utilize hospital information systems to acquire patient information 18. Utilize the departmental website for orientation to clinical services, rotation and residency objectives, and review of didactic material.

9

Professionalism: 19. Punctual attendance at departmental conferences. 20. Well-groomed appearance and appropriate dress when interacting with patients, colleagues, and other health care professionals. 21. Demonstrate respect for patients, families, peers, other health care professionals, and other hospital workers. Objectives: End of First Year Medical Knowledge: 1. Comprehensive understanding of hypnotics, volatile anesthetics, opioids, and neuromuscular blocking agents 2. Demonstrate advance preparation for all conferences by informed participation 3. Score at least 25th percentile for American Medical Graduates finishing CA-1 year in the In-Training examination Practice-Based Learning: 4. Use the internet to obtain additional information on complex medical and/or anesthetic issues 5. Participate in and demonstrate understanding of departmental process-improvement initiatives 6. Participate in departmental research team activities Patient Care: 7. Plan and perform general anesthesia techniques without assistance, with supervision 8. Perform all basic monitoring techniques, including arterial and central venous pressure monitoring, without assistance 9. Perform spinal and epidural anesthesia in most patients without assistance 10. Perform two other regional anesthetic blocks with supervision Interpersonal and Communication Skills: 11. Communicate effectively risks and benefits of various anesthetic techniques to a receptive patient 12. Present a complicated patient in a concise, organized fashion 13. Discuss with other medical professionals additional pre-operative preparation needed for a patient Systems based practice: 14. Demonstrate cost consciousness in selection of anesthetic plan 15. Utilize consultation appropriately to optimize patient care Professionalism 16. Provide high quality care to all patients regardless of their ethnicity, status, gender, disability, or demeanor 17. Act as a role model to medical students interested in pursuing a career in anesthesiology End of Two Years Medical Knowledge: 1. Demonstrate advance preparation for all conferences by informed participation

10

2. Complete assigned readings in sub-specialty texts 3. Demonstrate familiarity with content of major anesthesiology journals, i.e., Anesthesiology and Anesthesia and Analgesia 4. Score at least 25th percentile on the AKT-18 and also for American Medical Graduates finishing CA-2 year in the In-Training examination 5. Explain physiology and anesthesia issues relevant to subspecialty areas of OB, Neuroanesthesia, Pediatric anesthesia, Cardiothoracic, Pain Management, and Critical Care Practice-Based Learning: 6. Participate in research team activities 7. Use a case-based paradigm to guide readings in sub-specialty texts Patient Care: 8. Perform all general anesthesia and monitoring techniques without assistance 9. Perform spinal, epidural and major nerve blocks with success most of the time 10. Perform technical procedures in pediatrics (i.e. IV insertion, caudal, regional blocks) 11. Manage ICU patients with attending assistance 12. Demonstrate ability to function appropriately in emergent situations Interpersonal / Communication Skills: 13. Actively teach medical students in the operating room and Maternal Care Unit 14. Present effectively at resident and subspecialty conferences Systems Based Practice: 15. Use experience in critical care to modify intra-operative anesthetic choices for optimal patient care 16. Partner with consultants to avoid inappropriate medical tests in critical care and preoperative preparation Professionalism: 17. Hone bedside manner to decrease peri-operative anxiety of patients and families 18. Treat colleagues and helpers with respect End of Three Years Medical Knowledge: 1. Demonstrate comprehensive knowledge of anesthesiology via Socratic dialog and at Mock Oral examinations 2. Explain selection of basic statistical tests for different types of data 3. Provide rationale for selection of any given anesthetic drug or technique Practice-Based Learning: 4. Critically analyze studies in the anesthesia literature using evidence-based medicine techniques 5. Complete a team-based anesthesia research project. Patient Care: 6. Successfully supervise the anesthesia care team for most patients / procedures 7. Provide anesthesia care in emergency cases with poise and confidence 11

Systems-Based Practice 8. Participate in and explain the rationale, methods, results, and positive impact of a departmental process improvement initiative 9. Compare any two anesthetic plans on a cost-effective basis Interpersonal and Communication Skills: 10. Effectively teach medical students fundamentals of anesthesia 11. Explain and defend publicly the methodology and results of a completed anesthesia research project Professionalism: 12. Master the ABA qualities and attributes of a consultant in anesthesia 13. Be viewed as a respected anesthesiology consultant by physicians in other departments ACGME GENERAL COMPETENCIES The residency program must require that its residents obtain competence in the six areas listed below to the level expected of a new practitioner. Programs must define the specific knowledge, skills, behaviors, and attitudes required and provide educational experiences as needed in order for their residents to demonstrate the following: 1. Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 2. Medical knowledge about established and evolving biomedical, clinical, and cognate (eg, epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. 3. Practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care. 4. Interpersonal and communication skills that result in effective information exchange and collaboration with patients, their families, and other health professionals. 5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. 6. Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. General Competencies At its February 1999 meeting, the ACGME endorsed general competencies for residents in the areas of: patient care, medical knowledge,

12

practice-based learning and improvement, and interpersonal and communication skills, professionalism, systems-based practice. Identification of general competencies is the first step in a long-term effort designed to emphasize educational outcome assessment in residency programs and in the accreditation process. During the next several years, the ACGME’s Residency Review and Institutional Review Committees will incorporate the general competencies into their Requirements. The following statements will be used as a basis for future Requirements language. If you have any questions, comments and other requests for assistance, please address them to [email protected]. ACGME GENERAL COMPETENCIES Vers. 1.3 (9.28.99) The residency program must require its residents to develop the competencies in the 6 areas below to the level expected of a new practitioner. Toward this end, programs must define the specific knowledge, skills, and attitudes required and provide educational experiences as needed in order for their residents to demonstrate the competencies. PATIENT CARE Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: • • • • • • • • •

communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families gather essential and accurate information about their patients make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment develop and carry out patient management plans counsel and educate patients and their families use information technology to support patient care decisions and patient education perform competently all medical and invasive procedures considered essential for the area of practice provide health care services aimed at preventing health problems or maintaining health work with health care professionals, including those from other disciplines, to provide patient-focused care

MEDICAL KNOWLEDGE Residents must demonstrate knowledge about established and evolving biomedical,

13

clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to: • •

demonstrate an investigatory and analytic thinking approach to clinical situations know and apply the basic and clinically supportive sciences which are appropriate to their discipline

PRACTICE-BASED LEARNING AND IMPROVEMENT Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to: • • • • • •

analyze practice experience and perform practice-based improvement activities using a systematic methodology locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems obtain and use information about their own population of patients and the larger population from which their patients are drawn apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness use information technology to manage information, access on-line medical information; and support their own education facilitate the learning of students and other health care professionals

INTERPERSONAL AND COMMUNICATION SKILLS Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to: • • •

create and sustain a therapeutic and ethically sound relationship with patients use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills work effectively with others as a member or leader of a health care team or other professional group

PROFESSIONALISM Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to: •

demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going

14

• •

professional development demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

SYSTEMS-BASED PRACTICE Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to: • • • •

•

understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources practice cost-effective health care and resource allocation that does not compromise quality of care advocate for quality patient care and assist patients in dealing with system complexities know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance

15

FACILITIES LIBRARIES Each training site features a library containing anesthesiology texts relevant to the training needs of residents at that site. Trainees have access to those texts at all times during their duty hours. Each site also provides trainee access to electronic resources, including texts, journals, and literature searches. The dedicated Anesthesiology Classroom at Hahnemann University Hospital (7322 New College Building) contains relevant, comprehensive texts and journal issues in anesthesiology and closely related fields, several computers with broadband internet access and printers, and classroom materials. All trainees have access to the facility at any time. Journals published since 1995 are specifically NOT kept because they are available on-line. Anyone removing material from the room must so inform the department academic coordinator, so that it may be tracked and returned. Copying equipment, available at all times to all trainees, resides in the departmental offices in the adjacent corridor. The Obstetric anesthesia workroom, located in the Maternal Health Unit of Hahnemann University Hospital, contains the latest print edition of a reference obstetric anesthesia text, and broadband web access via a dedicated computer. Each trainee, via their Drexel University identification number, may access the DrexelMed Library resources from any web-access portal, world-wide. Resources include electronic texts for all major medical disciplines and access to most medical journals. Examples of information available in this fashion include the latest editions of: • Miller’s Anesthesia text • Clinical Anesthesiology (Morgan, Mikhail, Murray, eds.) • Goodman & Gilman’s The Pharmacological Basis of Therapeutics as well as dozens of journals in anesthesiology, and hundreds beyond it. A full-resource medical library on site at Drexel University College of Medicine (2 nd Floor, New College Building) provides full reference materials, an extensive book and journal collection, copying and scanning facilities, study and conference rooms, a computer training room, and organized instruction in electronic literature searches. LOCKERS Each of the department’s residents and fellows receives a locker at the base facility in Hahnemann University Hospital, and secure gender-appropriate changing facilities, when needed, at other sites. MAIL AND POSTINGS Every trainee receives an electronic mail (e-mail) account on the drexelmed website, accessed via the URL https://webmail.drexelmed.edu. Most communications occur electronically. Residents should check their departmental e-mail account at least once each day during the workweek and at least once each weekend. In addition, each resident or fellow receives surface mail and miscellaneous communications via an individual mailbox in the department offices, at 7502 New College Building. Trainees should check the mailbox daily when on site, weekly when on

16

nearby rotations, and empty it completely every month or more frequently. A board immediately outside the Anesthesia Classroom/Library (7322 NCB) posts important departmental teaching schedules and visual summaries of recent departmental research efforts. Another board outside the departmental offices contains additional schedules and information of interest to all department members, viz., faculty, CRNAs, trainees, and support staff. A third board near the mailboxes contains communication and other information. The alert trainee will scan these boards daily when on site, to keep informed of valuable opportunities. EMPLOYEE HEALTH SERVICE Health Care services are available through the Hospital’s ER care, which is located on the first floor of the North Tower Building. Follow-up care, counseling for needle-stick incidents, and immunizations are handled by Student Employee Health Services (ext. 7820).

LOGISTICS PARKING Free parking is a privilege. The GME office provides free parking for those residents and fellows who provide evidence of a valid driver’s license and automobile registration. Current regulations require parking at or above level 7 of the Wood Street Garage; random verification identifies violators. Frequent violators lose parking privileges. I.D. BADGES Identification badges prepared by the Security Department must be worn at all times while in the hospital. Restricted access to select patient care areas, including the Maternal Care Unit and Intensive Care Units, requires swiping this badge. Please attach the Hospital’s mission statement to your ID badge. WHITE COATS The GME office provides three white coats to each new resident and 1 coat per year after that if needed. Each trainee is responsible for laundering their white coats and for wearing a clean coat. Trainees may not wear green scrub suits outside the surgical or obstetric care areas without covering them with a white coat. TRAINEES MAY NOT ENTER OR LEAVE THE HOSPITAL WEARING A SCRUB SUIT. Removal of scrub suits from the hospital constitutes theft. PAGERS AND THE PAGING SYSTEM AT HAHNEMANN UNIVERSITY HOSPITAL • Each resident receives a personal pager for use throughout the training period. (In addition, residents may carry fixed-ID pagers when on duty, and for responding to trauma events or pain therapy issues.) • Residents are expected to be available by pager from 6:00 AM until 7:00 PM, or until dismissed, if dismissal is after 7PM. • If a pager is broken or left at home, the attending running the schedule, the Departmental receptionist, and the Academic Coordinator must be informed at the start of the day. • Trainees may exchange a depleted battery for a new one in the 8th floor workroom. • Any member of the department who misplaces or loses his/her pager must

17

reimburse the department for its replacement. To Page from inside HUH / DUCOM: 1. Dial 53 and follow the verbal directions, which are: 2. Enter the 5-digit ID # of the person you want to page, followed by the # sign 3. Enter your call back extension followed by the pound (#) sign 4. Hang up your telephone To Page from outside the hospital, dial 215-762-PAGE (7243) and follow the verbal directions (same as above). You may also access the page operator directly at 215-7627000. HOSPITAL INFORMATION AND LABORATORY INFORMATION SYSTEMS Computer systems are available for accessing up-to-the-minute patient location and laboratory results. All medication and other patient orders are written through the computer system. You will receive instruction on the use of these systems.

ON CALL DUTIES AT HAHNEMANN UNIVERSITY HOSPITAL DUTY HOURS/CALL REQUIREMENTS Each resident typically begins the day at 6:30 AM by setting up the assigned operating room. Anesthesiology residents take both overnight and “late” calls in rotation, with the number of calls varying somewhat from month to month. Trainees on call in-house for 24 hours receive the next 24 hours free of obligations. The program adheres strictly to all ACGME regulations regarding: • Hours on duty per week (<80, when averaged over a 4-week period) • Days per week assigned overnight call (no more than 2.5 per week, averaged over 4 weeks) • Maximum number of continuous hours worked (no more than 30 hours) • 24-hour periods completely free from all educational and clinical responsibilities (at least 4 over a 4 week period; exclusive of reading at home) • Time off between duty shifts (at least 10 hours) • If released from work between 8:30 – 10:30 pm report time for the following morning is at 8:30 am to ensure at least 10 hours off. • If released from work after 10:30 pm then the resident is excused from clinical duty the following day. Residents must report to the Program Director any instance or request that does not conform to ACGME specifications. RESIDENT CALL STRUCTURE AT HAHNEMANN UNIVERSITY HOSPITAL The attending faculty anesthesiologist in house (1st call) holds complete privilege and responsibility for managing the call team. This person may assign, re-assign, or otherwise distribute clinical responsibilities and assignments to residents, CRNAs, and faculty serving other call duties (2nd call, 3rd call, etc.). It is best to follow the 1st call faculty directives at all times; discussion regarding controversial decisions may follow at a later time with the departmental leadership.

18

Engage the Clinical Service Chief immediately, however, should a serious ethical question arise regarding loss of life, limb, or sight. Sleeping rooms are located on the 10th & 12th floors of the South Tower at HU. Please keep them clean and in good condition. The Chief Residents create and manage the on-call schedule. Changing the on-call assignments after the schedule is published requires notification of multiple offices within the department and the hospital. For this reason, the department utilizes a clear, written record of call changes. Click here for the form (.pdf version). GENERAL OR CALL (HUH pager 42141) 1. Emergency surgical cases and “STAT” pages. 2. Carries the code pager and may carry the trauma pager. 3. Completes late cases and emergencies; helps in OB as needed. 4. Coordinates changes in anesthesia orders dictated by changes in the OR schedule. 5. Performs pre-anesthetic evaluation on cases added to the schedule. 6. Notifies the anesthesiologist on-call of any emergency case. 7. Reports to the Anesthesiologist running the schedule at the end of the call period. OB CALL (HUH pager 41755) 1. Available in-house for emergency cases and “STAT” pages. 2. Carries the OB pager and may carry the pain pager. 3. Covers OB cases; assists with late cases and emergencies as needed. 4. Assists with changes in anesthesia orders dictated by changes in the OR schedule. 5. Performs pre-anesthetic evaluation on cases added to the schedule. 6. Notifies the anesthesiologist on-call of all C-sections and new labor analgesia cases. 7. Reports to the anesthesiologist running the schedule at the end of the call period. LATE-CALL 1. Stay until released by 1st call faculty anesthesiologist. 2. Perform pre-anesthetic evaluation on cases added to the schedule 3. Complete late cases and emergencies; helps in OB as needed. 4. Available by pager to return to the hospital to help with emergencies. FACULTY CALL STRUCTURE The 1st call faculty anesthesiologist remains in house and takes responsibility for managing the entire call team. The 2nd call faculty anesthesiologist remains in the hospital until relieved by the 1st call faculty anesthesiologist, and may return at any time to assist the call team. On weekdays, 3rd and 4th call faculty anesthesiologists remain in house to assist in clinical duties until relieved by the 1st call faculty anesthesiologist.

EMPLOYMENT INFORMATION CERTIFICATE OF SERVICE At the end of the training period, the hospital Graduate Medical Education office issues a certificate of service to each trainee demonstrating satisfactory performance during the

19

period of appointment. LICENSURE All physicians-in-training must obtain and maintain an active Pennsylvania State Board of Medicine Training License. The Pennsylvania State Board of Medical Education and Licensure requires all physicians-in-training at the PGY-3 and higher levels or training be licensed in the Commonwealth of Pennsylvania (in addition to having an active Medical Training License). CONTRACTS Contracts are signed and renewed each July 1st. For those starting midyear, contracts expire June 30th. MALPRACTICE INSURANCE Residents and Fellows in the Department of Anesthesiology are covered through Hahnemann University Hospital’s malpractice liability insurance.

POLICIES SUBSTANCE ABUSE POLICY Please consult your Hahnemann University Hospital Resident Manual for the details of this hospital policy. Our department also has a substance abuse policy that addresses concerns of anesthesiologists specifically. On orientation day and at least once each year, residents view the “Wearing Masks” video presentation. Additional educational sessions occur each year. The department Wellness Committee oversees these activities and the substance abuse policy. We treat substance abuse with the utmost seriousness. You should always feel free to approach your faculty advisor, Program Director, or Chair with any concerns you may have about yourself or any other healthcare provider. Confidential help is readily available.

Original: 05/05 Review: 03/07 Subject:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

SUBSTANCE ABUSE POLICY

POLICY: The Department of Anesthesiology abides in full by the policies of the Graduate Medical Education Office of Hahnemann University Hospital and those of the Hospital with respect to controlled substances and other drugs of abuse. In addition, the department strives to detect substance abuse early, and to direct expeditiously any impaired caregivers to treatment. The hospital policy prohibits the selling, purchasing, dispensing, manufacturing, distributing, diverting, stealing, using, possessing and/or being under the influence of non-medically indicated

20

prescription or non-prescription drugs or illegal substances, and/or alcohol on hospital premises, on breaks, on lunch or while conducting hospital business off premises. Further, the hospital policy encourages employees with substance abuse problems to voluntarily seek treatment. PURPOSES To identify department members who are impaired by use of drugs or alcohol. To direct any impaired department members to rehabilitative treatment for substance abuse. To maintain quality patient care, a safe working environment, and the health of department members. DEFINITION OF TERMS Drug: any legal or illegal substance (including over-the-counter medication, prescribed medication, alcoholic beverages, un-prescribed controlled substances, or any other substances) which potentially affects one’s ability to perform duties or which potentially affects the safety and/or well-being of patients, employees, or others. Substance Abuse: the use or misuse of any drug or alcohol in a manner which may reduce effectiveness or pose an unsafe condition in the work environment. Wellness Committee: a group composed of at least one member from faculty, nurse anesthesia, and residents, not to exceed 7 named members, charged with designing and implementing strategies for maintaining the health and vigor of departmental members. The chair of the department serves as an ex officio member of the Wellness Committee and appoints all its members. PROCEDURES 1.

Detection of impaired caregivers. • Every member of the department has a responsibility to know the signs of impairment, as taught at departmental conferences and in videos and publications of the American Society of Anesthesiologists. The department will provide educational sessions to transmit, reinforce, and assess knowledge of department members in this regard (see item 5 below). The signs include, but are not limited to, the following: i. absenteeism/lateness ii. always wearing long sleeves or cover-gowns iii. arriving earlier than others in the morning iv. volunteering for additional work that provides access to controlled substances v. noted change in interaction with staff or patients vi. impairment in job performance vii. unaccounted drugs missing from hospital stock viii. indications of inappropriate medication dosing ix. lethargy, slurred or incoherent speech, or speech which differs from the usual x. unusual odor on breath xi. departures from usual behavior xii. new errors in judgment that jeopardize patient care xiii. on-the-job accidents xiv. lack of manual dexterity or unusual trembling xv. lack of coordination in body movement xvi. inappropriate response to stimulus xvii. verbal abuse and boisterous behavior toward others xviii. threats of physical harm toward self or others xix. emotional instability and/or hostility xx. sudden, unprecedented change in mood xxi. drastic change in dress or appearance.

21

• Department members who suspect another department member, at any position or rank, of impairment should NOT approach that individual immediately, but rather contact one of the following individuals immediately: i. The chair of the department Wellness Committee ii. Any member of the department Wellness Committee iii. The clinical service chief of the department iv. The chair of the department v. The program director or vice chair of the department • Any one of the individuals listed above may request an alleged impaired department member to submit to a witnessed interview for purposes of identifying an alleged impairment. This action originates from a report of signs of impairment. The interview may result in a request for urine, blood, or hair sample for subsequent analysis. • The department Wellness Committee will discuss and implement, if they deem appropriate, a mechanism by which department members may privately record their legal use of prescription medications, in order to pre-document this legal use in the event of a subsequent request for urine, blood, or hair sampling. 2. Responsibilities of Department Members. Please refer to the hospital substance abuse policy regarding hospital employees’ and supervisors’ responsibilities, all of which apply. The policy covers requested medical examination, release from duty, disciplinary action, leave of absence, and more. 3. Referral for treatment. The department will strongly advise any impaired member to enter a treatment program. Impaired caregivers will be referred to the Physicians’ Health Programs of the Pennsylvania Medical Society for placement. Another equally capable program may be substituted. 4. Return to Work. The department views every impaired physician individually. Some should never return to anesthesiology, some are fit to do so, and some require additional therapy before a trial period of return to work. The Wellness Committee, in collaboration with an impaired department member’s treating physicians, and other engaged parties, if applicable, such as the Graduate Medical Education office, will determine whether or not a particular individual will be recommended to Human Resources for return to work. 5. Education Efforts. The Wellness Committee will provide educational sessions for departmental members at least twice each year, covering scientific and social aspects of addiction, including detection of impaired physicians, departmental policy, and hospital policy.

VACATION / MEETING POLICY Please request vacation or time off in writing on the appropriate “Request for Time Off” form, available in a mailbox slot in the residents’ mailboxes section in the main anesthesiology mailroom. All vacation requests are handled as outlined in the Vacation Policy in this manual. Vacations are not approved without the appropriate signatures. The American Board of Anesthesiology (ABA) allows a maximum absence of 20 working days per year, including vacation and all illness, whether unforeseen or known. Absences, for any reason, beyond those permitted by the ABA, will prolong your training. Training prolonged by even one day beyond September 30th will, under current ABA criteria, postpone eligibility for the written examination until the following August. In addition, the ABA permits up to 5 days each year for attendance at a scientific meeting. However, only a few trainees will earn this opportunity; awarding time in this category rests with the Program Director. Vacation is not appropriate during the first two weeks of the Pediatric Anesthesia or the PACU rotation, or while on STICU unless otherwise approved.

22

Especially in the CA-2 year, residents are strongly encouraged to distribute their vacation time amongst rotations by taking at least one week of vacation while serving at an affiliate institution. Senior residents should note that time spent interviewing for fellowship or jobs comes from the vacation time allowance. Dedication to patient care dictates a limit on the number of trainees taking vacation at any one time. Expect popular times to fill early. The department will honor family emergencies if appropriately documented; however, possession of airplane tickets does not justify exceptional treatment. Terminal vacation is generally not granted. REPORTING YOURSELF AS SICK Sick time is granted according to hospital personnel policy (also see above regarding ABA maximum). If coming to work with a particular medical condition would endanger you or your patients, you should report yourself as sick. ANY OTHER BASIS FOR REPORTING YOURSELF AS SICK VIOLATES PROFESSIONAL ETHICS AND MAY IMPACT POORLY ON YOUR EVALUATIONS. In selected cases, the Program Director may request independent verification of illness or other reasons for not reporting to work. Our patients depend on us every day. When we cannot work, our colleagues bear the burden to lessen the impact on patient care. Early notification allows time to adjust schedules or obtain additional personnel. Please make every effort to inform the department as soon as you realize you cannot report to work, as follows: • Prolonged absence (e.g., parturition, elective surgery): schedule a meeting in advance via the Academic Coordinator to discuss plans with the Program Director • Illness developing before 3PM: inform the anesthesiologist running the schedule • Illness developing between 3 and 11PM: inform the 1st call faculty anesthesiologist • All non-prolonged absences: leave a message BEFORE 6AM each day as follows: o 215-762-6239. Provide name, date, your illness, and callback telephone number; call only for all rotations at Hahnemann University Hospital. o 215-762-7922. Provide the same information; make this call regardless of your rotation assignment (SCHC, Abington included !). • DO NOT CALL THE OPERATING ROOM DESK OR THE PACU.

Original: 05/05 Review: 03/07 Subject:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

DUTY HOURS AND FATIGUE

23

POLICY: The Department of Anesthesiology abides in full by the policies of the Graduate Medical Education Office of Hahnemann University Hospital and institutes additional measures, if needed, to support and protect residents in the Anesthesiology Training Program and their patients from the adverse effects of prolonged resident duty hours and fatigue. PROCEDURES: 1. The Department and all residents in the Anesthesiology Residency Training Program shall abide by the policy and procedures set forth in GME Policy 19, entitled “Work hours, on-call, and on-call rooms.”

2.

When working at Hahnemann University Hospital, residents shall record the time each day when they are relieved of duty in the log book in the Anesthesiology Work Room (8th floor, North Tower). Residents shall respond promptly to departmental staff requests to clarify, correct, or explain entries in the log book that are inconsistent with on call or other departmental work schedules. 3. Any changes in the on-call and late duty schedule, regardless of reason, must not violate any of the following guidelines for duty hour limitations: •

• • • • •

Less than 80 hours per week averaged over 4 weeks; At least 1 day in 7 free of patient care responsibilities, averaged over 4 weeks; On-call responsibilities less frequently than 1 day in 3, averaged over 4 weeks; No more than 24-hours of continuous patient care responsibilities; No more than 30-hours of continuous duty; 10 hour minimum rest period between duty periods;

4. The Department monitors resident work hours regularly. When an apparent violation of the work hour policy is detected, the resident, his/her advisor, and Clinical Service Chief of the department will review the data demonstrating a violation. The advisor will author a written report from all three participants to the Program Director within one week of the meeting with the following minimum content: • • •

the circumstances leading to the apparent violation; any impact the event had on subsequent resident performance; recommendations to prevent a repeat occurrence.

5. Every year, every resident must complete an at-home study module on resident fatigue, complete the accompanying 5-question multiple choice quiz, and score at least 80% on that quiz. Residents scoring less than 80% must re-take the examination until they score at least 80%. 6. Residents who feel drowsy at the conclusion of their duty hours should take a restorative (30-90 min) nap prior to operating a motor vehicle. Occupation of the call room for this purpose shall not be considered a violation of GME Policy 19, point 7.

Original: 05/07

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR

24

Review:

Subject:

DREXEL UNIVERSITY COLLEGE OF MEDICINE

RESIDENT DISMISSAL

POLICY: The Department of Anesthesiology shall abide by all Hospital GME policies regarding dismissal of residents from the training program. PROCEDURES: 1. Per Hospital GME Policy GME 14, the Program Director, with assistance from other individuals or offices as indicated by GME 14 procedures 2 and 3, will classify the action as ACADEMIC or EMPLOYMENT. 2. For ACADEMIC ACTIONS, the Program Director will follow the sequence of actions listed in GME 14 Appendix A. 3. For EMPLOYMENT ACTIONS, the Director in the Office of GME will follow the sequence of actions listed in GME 14 Appendix B. 4. GME 14 Appendix A item 5(c) permits the Program Director to impose termination (dismissal) as a disciplinary action. GME 17 details the appeal process available to trainees. 5. The Program Director shall notify the American Board of Anesthesiology and/or the ACGME, as applicable, of any action involving suspension without pay or termination (dismissal). REFERENCE: Hahnemann University Hospital Graduate Medical Education Policies GME 14 and GME 17, the policies therein, being incorporated in and considered a part of this departmental policy.

Review:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

Subject:

CHAIN OF RESPONSIBILITY AND SUPERVISION

Original: 05/07

Page 1 of 1

POLICY: The Department of Anesthesiology shall abide by all Hospital and University GME policies governing supervision of residents in training. The chain of responsibility will be determined by the Program Director, with ratification by the Department Clinical Competency Committee and Department Education Committee. PROCEDURES: 1. For all clinical matters, the ultimate supervisors of residents in training shall have clinical

25

privileges as attending physicians in the institution at which clinical work occurs. Therefore, a resident in training may NEVER take sole responsibility for supervising another trainee. 2. Residents in anesthesia training at all levels may supervise clinical care of a patient by medical students, student nurse anesthetists, or other personnel in training positions, including residents in other training programs rotating through the department of anesthesiology regardless of training level, only with the knowledge and permission of the attending anesthesiologist responsible for the care of that patient. 3. Senior residents in anesthesia training may supervise clinical care of a patient by junior residents in anesthesia training only with the knowledge and permission of the attending anesthesiologist responsible for the care of that patient. Responsibility for care of that patient ultimately resides with the attending anesthesiologist. 4. Residents in training at any level shall report to the Program Director any instance of potential or actual compromised patient care resulting from inadequate or inappropriate supervision of trainees, including themselves. When the Program Director is not available, e.g., nights, weekends, vacation, etc., report to the attending anesthesiologist in house, who shall report to the Program Director upon his/her return.

********END OF POLICY*************

Original: 05/07 Review: Subject:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

RESIDENT PROMOTION

POLICY: The Department of Anesthesiology shall promote residents from one level of training to the next level of training, or withhold such promotion, based on clearly defined criteria and clearly defined process. Residents shall have access to the criteria and process and be informed of revisions in a timely manner. PROCEDURES: 6. The on-line, electronic, resident manual shall list the criteria for promotion of resident trainees at defined milestones in their training. The Program Coordinator shall maintain the on-line resident manual current with these criteria. 7. The Department Clinical Competency Committee (“Committee”) shall determine the criteria for promotion at defined milestones and inform the Program Coordinator whenever these criteria are revised. 8. The Committee shall meet at appropriate times, based on the milestones the Committee sets, to determine whether or not each resident meets criteria for promotion.

26

9. The Committee may, at its discretion, set remediation criteria and/or plans to allow a resident to achieve promotion pending satisfaction of specific criteria. Promotion may be retroactive to milestone dates or may be delayed until remediation is completed, based on the Committee’s plan. Whenever possible, remediation plans should try to prevent the need to retract an action taken with the American Board of Anesthesiology regarding a resident’s clinical competency status. 10. The Program Director will inform each resident of the decision of the Committee regarding promotion. 11. Denial of promotion at a milestone constitutes an Academic corrective Action subject to Policy GME 14 Appendix A. Corrective Action may take the form of written feedback, of a written corrective action plan, and/or as a formal warning with probation. Corrective Actions may be grieved according to Policy GME 14 Appendix A part 6. REFERENCE: Hahnemann University Hospital Graduate Medical Education Policies GME 14, the policy therein, being incorporated in and considered a part of this departmental policy.

Original: 05/03 Revision: 06/06 Subject:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

PRE-OPERATIVE EVALUATIONS

INTRODUCTION AND DEFINITIONS: Anesthesia care benefits from advanced knowledge of the patient’s co-morbid conditions, a history and physicial examination, and results of relevant laboratory tests. The patient benefits from a discussion of the risks and benefits of options for anesthetic care. A pre-operative interview permits the patient to participate in the choice of anesthesia, and provide informed consent for that choice and for alternative choices. POLICY: 1. The responsibility for a pre-operative interview rests with the assigned trainee, even when post-call or returning from a rotation at another site, or when another caregiver conducts the interview, even if in accordance with procedure agreed by house staff, faculty, and CRNAs. 2. Anesthesia faculty exercise their supervisory responsibility for patient care via a discussion with either the assigned trainee or the caregiver conducting the pre-anesthetic interview. PROCEDURE: 1. Whenever possible, the trainee administering anesthesia to a patient will interview the patient in advance of the procedure on the previous day or before that time. 2. A trainee may ask another anesthesia caregiver (faculty, trainee, or CRNA) to conduct the pre-anesthesia interview for them. This delegation may occur overtly and individually, or implicitly by procedures agreed by house staff, CRNAs, and faculty. Regardless, the trainee must speak with their delegate regarding the patient, and the trainee holds full responsibility for the quality of the interview.

27

3. The trainee discusses the patient’s status and anesthetic plan with the assigned faculty anesthesiologist in advance of the procedure, preferably the evening prior. 4. Should a proper pre-operative visit not occur because of lack of attention to this policy, the faculty anesthesiologist may administer the anesthetic without the trainee’s participation, i.e., ban the trainee from participation in the case; in this instance, the trainee may be denied credit for that day of training. Although not a vacation or sick day, the day will not count towards ABA certification.

Original: 05/03 Revision: 06/06 Subject:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

Page 1 of 1

POST-OPERATIVE EVALUATIONS

INTRODUCTION AND DEFINITIONS: Consultant anesthesiologists detect, diagnose, and treat post-operative complications related to anesthesia. A post-operative visit facilitates these activities. POLICY: 1. The responsibility for a post-operative interview rests with the trainee who induces anesthesia, even when another caregiver relieves the trainee prior to the procedure’s conclusion. 2. Anesthesia faculty exercise their supervisory responsibility for patient care by discussing the post-anesthetic interview with either the assigned trainee or another caregiver conducting it. PROCEDURE: 1. Whenever possible, the trainee administering anesthesia to a patient admitted to the hospital will interview the patient within 48 hours after the procedure. a. Patients sent home the day of surgery will be contacted by operating room personnel. b. For patients sent home the morning after surgery, before post-operative visits can occur, assessment of post-operative complications occurs via the PACU discharge note. 2. A trainee may ask another anesthesia caregiver (faculty, trainee, or CRNA) to conduct the post-anesthesia interview for them. This delegation may occur overtly and individually, or implicitly by procedures agreed by house staff, CRNAs, and faculty. Regardless, the trainee must speak with their delegate regarding the patient, and the trainee holds full responsibility for the quality of the interview. 3. The caregiver conducting the post-anesthesia interview documents the visit by either: a. Placing an executed, approved yellow post-operative visit label, in the patient’s chart; or b. Writing a note in the Progress Notes section of the patient’s chart. 4. The caregiver conducting the post-operative interview places their signature, their name printed legibly underneath or beside it, and their pager ID number on their documentation. 5. The trainee discusses the patient’s post-operative status with the faculty anesthesiologist who supervised them during the conduct of the procedure. 6. The caregiver conducting the post-anesthetic interview will report in writing any

28

anesthetic complications using Departmental morbidity and mortality forms. 7. The caregiver conducting the interview reports any mortality or major morbidity, e.g., epidural hematoma, occurring with 24 hours of operation orally to the Chief of Service, or in his/her absence, to the Chair.

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

Original: 05/07 Review: Subject:

RESIDENT SELECTION

POLICY: The Department of Anesthesiology shall abide by all Hospital employment policies and all Hospital and University GME policies governing selection of residents in the training programs. The selection process will be determined by the Program Director, with ratification by the Department Clinical Competency Committee and Department Education Committee. PROCEDURES: SECTION A.

THE NATIONAL RESIDENT MATCHING PROGRAM

5. The Department shall participate in the National Resident Matching Program (NRMP) each year. The Program Coordinator shall prepare and file all applications, renewals, invoices, fees, and correspondences to ensure Departmental participation in the NRMP process. 6. In July of each year, the Program Coordinator, Program Director, and their assistants and delegates will review and update the content of the Departmental website to ensure that it presents the Residency Program accurately. 7. The Program Coordinator will update public information regarding the Department’s Residency training programs at least yearly in a timely fashion to ensure accurate portrayal of the program to prospective applicants. 8. Beginning in September and occurring no less frequently than every week, the Program Coordinator will provide a list of applicants to the Program Director and his/her assistants, including detailed information from each applicant, according to specifications provided by the Program Director. For example, a spreadsheet containing Name, Date and City of Birth, Name of Medical School, and United States Medical Licensing Examination scores or equivalent, might form the requested data for each applicant. 9. The Program Director and his/her assistants shall select from the list of applicants those individuals invited to appear for an interview. The Program Coordinator shall provide each prospective interviewee with a list of dates for interview and schedule the candidates for interview. 10. Each year, the Program Director shall assemble a team of interviewers to conduct interviews of applicants for a given NRMP cycle. The team shall consist of no less than 4 and no more than 10 individuals, at least one of whom shall be a resident in good standing in the program. A subset of this interview team, sized appropriately for the number of candidates appearing,

29

shall actively interview on any given interview day. 11. Each interviewer shall provide a rating or ranking of each candidate independent of those assigned by other interviewers. Details of the process (range of scores, definitions of categories, rating v. ranking, etc.) shall be determined no later than October 1 of each year. 12. The interview team shall meet as a group to discuss the candidates interviewed for purposes of identifying candidates the Department will not place on its rank list(s) to the NRMP. 13. The Program Director and his/her assistants shall use the interview scores to create the rank list(s) for the NRMP; the Program Coordinator will enter the list(s) to the NRMP; the Program Director will certify the list. 14. The Department will offer an employment contract to the candidates who match to the program, in accordance with NRMP guidelines, barring extenuating circumstances such as, but not limited to, undisclosed felony or substance abuse.

SECTION B.

SELECTION OF RESIDENTS OUTSIDE THE NRMP PROCESS

1. From time to time, openings in the training programs occur that warrant selection of a resident at a time not synchronous with the NRMP process or for a level of training other than entry level. For these circumstances, the department will select residents outside the NRMP process. 2. The Department may choose to select a subset of residents who enter the training programs from outside the NRMP process. This choice must be ratified by the Clinical Compentency Committee. 3. The Program Coordinator will provide a list of applicants for the position(s) to fill outside the NRMP process, including information specified by the Program Director in fashion similar to that of item A (4) above. The applicant list derives from unsolicited requests received by the department, augmented by names provided through professional contacts, word of mouth, or other means. 4. The Program Director will assemble an interview team of no more than 4 individuals. When possible, one individual shall be a resident in the training program in good standing. The interview team shall interview one or more candidates for the open position(s), meet in conference following the interviews, and provide a ranked list of names for the Program Director to use in filling the open position(s). REFERENCE: Hahnemann University Hospital Graduate Medical Education Policy GME 10, the policies therein, being incorporated in and considered a part of this departmental policy. ********END OF POLICY*************

Original: 05/05 Revision: 06/06

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

Page 1 of 1

30

Subject:

AIRWAY MANAGEMENT OF THE TRAUMA PATIENT

INTRODUCTION AND DEFINITIONS: Trainees in Anesthesiology and those in Emergency Medicine both need experience in managing the airway of trauma patients. Departmental responsibility depends on the patient’s time of arrival. POLICY: 1. Level 1 trauma patients receive airway management from attending anesthesiologists, from CRNAs, from trainees who have completed the clinical continuum in anesthesiology, or from anesthesiology trainees in their CA3 year of training. 2. Proper patient care requires communication among anesthesia care providers, trauma attendings and trainees, and emergency room house staff and personnel. PROCEDURE: 1. The CA3 resident on call or CRNA will respond to pages on the Trauma pager for level-1 trauma, emergency airway management calls, and cardiopulmonary arrest (“code”) calls from the Emergency Room. When no CRNA or CA3 resident is available to hold the Trauma pager, an attending anesthesiologist will respond to Trauma pages, 2. Upon arrival in the Emergency Room, the responding anesthesia caregiver will so identify themselves to the Emergency Medicine (EM) or Trauma Attending in charge. 3. From 1900 to 0700 hrs, the EM senior resident retains primary responsibility for airway management, under supervision of the EM and/or Trauma Attending. The anesthesia responder consults and/or assists, as requested by the supervising EM or Trauma Attending. 4. From 0700 to 1900, the anesthesia responder retains primary responsibility for airway management. The CRNA or CA3 anesthesia resident will establish the airway, as needed. Should the CRNA or CA3 anesthesia resident require assistance, that person will call the anesthesia Attending, situation permitting, or stand aside and transfer responsibility for airway management to the EM or Trauma Attending.

Review: 06/06

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

Subject:

CORRECTIVE AND DISCIPLINARY ACTIONS

Original: 05/05

Page 1 of 5

INTRODUCTION AND DEFINITIONS: The Department of Anesthesiology follows the policy and procedures of the Hahnemann University Hospital Graduate Medical Education office. For that reason, that policy appears here. POLICY: Hahnemann University Hospital and Drexel University College of Medicine recognize that the Program Directors, Department Chairs, Hospital administration, and the Directors in the Office of Graduate Medical Education have authority to take corrective and/or disciplinary action against a house staff member for academic, behavioral, or clinical care issues as well as issues relating to

31

terms and conditions of employment. This policy establishes the standards and procedures that will be followed by the Hospital and DUCOM when initiating corrective and disciplinary actions against a house staff member. Under this policy, there are two categories of corrective and/or disciplinary action:

(1) Academic Action: A corrective or disciplinary action is considered to be an “Academic Action” whenever it involves the house staff member’s academic or clinical performance in the graduate medical education program. Academic Actions are initiated and processed by DUCOM. Academic Action is determined by the Program Director who oversees the graduate medical education program. Examples of matters that are considered Academic Action include, but are not limited to: •

• • • •

Failure to meet academic or educational requirements and expectations for house staff members i. Failure to meet patient care needs appropriately ii. Not achieving adequate level of medical knowledge iii. Not behaving in a professional manner iv. Not communicating with staff, colleagues or patients appropriately v. Failure to comply with systems based practice vi. Failure to achieve competency in practice based learning Use of inappropriate clinical judgment Not meeting research expectations of program Not teaching medical students appropriately Failure to comply with the program’s administrative requirements such as data collection, reporting, etc.

(2) Employment Action. A corrective or disciplinary action is considered an “Employment Action” whenever a house staff member engages in, makes or exhibits acts, statements, demeanor or professional conduct, either within or outside the Hospital, which is, or is reasonably likely to be, detrimental to patient safety or to the delivery of quality patient care, disruptive to the Hospital’s operations or an impairment to the community’s confidence in the Hospital, and/or is non-compliant with the policies and regulations of either the Hospital and/or DUCOM’s graduate medical education program. Employment Actions are initiated and processed by the Hospital. Examples of matters that are considered Employment Actions include, but are not limited to: • • • • • • • • • • •

Disruptive behavior Engaging in illegal discrimination or harassment Breach of patient confidentiality Criminal activity of any sort Use of illegal drugs Working under the influence of drugs or alcohol Reckless endangerment of life, limb or property Violent or aggressive behavior Theft of hospital materials, supplies or property Unprofessional behavior Altering medical records

PROCEDURES: 1. All Hospital or DUCOM physicians, faculty, staff and administrators who have concerns about the academic or employment performance of a house staff member should notify the

32

Program Director or a Director in the Office of Graduate Medical Education (GME Office). The Program Director and the GME Office will promptly notify each other of concerns that are received about a house staff member. 2. For any severe incidents (academic, behavioral or clinical) involving a house staff member, the following individuals or offices will be notified of the incident as well: a. b. c. d. e.

Program Chair Associate Dean for Graduate Medical Education Director of Human Resources at HUH HUH Legal Department DUCOM General Counsel’s Office

3. The first step in any corrective or disciplinary action is to determine if the problem is an Academic Action or an Employment Action or both. This determination is made initially by the Program Director or GME Office Director who initiates. In cases where there is question about how to classify the action, the Associate Dean for Graduate Medical Education and the Director of Educational Development and Support will be consulted and determine how the action should be classified. This determination will dictate which process will be followed. 4. The steps to be utilized for Academic Actions are set forth in Appendix A and for Employment Actions in Appendix B. 5. Corrective Action. Ordinarily, corrective action is a process intended to inform the house staff member of deficiencies in academic, behavioral or clinical care performance in order to provide the house staff member with an opportunity to correct such deficiencies before more serious disciplinary action is instituted.

a.

Single Complaint: Corrective Actions for Academic Actions are determined by the Program Director and for Employment Actions by a Director in the GME Office. These informal early interventions should be conducted in private and are designed to correct and remediate a problem as early as possible. Corrective actions are intended as an educational experience aimed at improving the house staff member’s performance in a particular area. All proceedings should be documented and kept in the house staff member’s permanent department file or GME Office file in accordance with this policy.

b.

Multiple Complaints and/or Severe Complaint: A more formal counseling session should be conducted whenever more than one complaint or a single severe complaint has been received regarding a house staff member which reflects either a pattern of unacceptable behavior or action or a severe complaint. The Program Director should report to the Chair of the Department and review the problem and discuss strategies for improvement as well as outlining a time period for such improvement. The Office of Graduate Medical Education should be informed that there is a problem.

c.

Acceleration of Disciplinary Process. For multiple complaints or single complaints of a severe nature, the Program Director or the GME Office may elect to skip the Corrective Action step and proceed immediately to Disciplinary Action. d. All proceedings must be documented and kept in the house staff member’s permanent department file. 6. Disciplinary Action Disciplinary Action can be imposed when previous Corrective Actions have failed to adequately remediate deficiencies in academic, behavioral or clinical care performance; when more then one

33

Corrective Action has previously been taken against a house staff member; or when a single severe incident has been reported. Disciplinary Action may take one or more of four forms: (a) Written Reprimand: A reprimand will be a written warning to the house staff member stating that his/her behavior does not meet expectations. This letter will state the deficiencies for which the house staff member is being reprimanded. It shall further provide the duration of the reprimand; what, if any, assistance may be made available to help the house staff member in meeting expectations; detail the mechanism of evaluation to determine improvement and inform the house staff member of the potential consequences if expectations are not met. A letter of reprimand should be taken seriously as an official warning which allows the house staff member an opportunity to correct behaviors during the period noted. If the behavior is not corrected, the house staff member’s conduct could ultimately result in his/her suspension or termination. (b) Suspension without pay: A suspension period without pay may be imposed by the Program Director or the Director of Educational Development and Support. Time off will not be credited towards the completion of the residency experience and may result in temporary suspension of the right to practice medicine in the Commonwealth of Pennsylvania. This action will become part of the house officer’s permanent record at the State Licensing Board, an event which must be reported on all future applications and verifications for training, licensure, or hospital privileges. If at the end of this suspension designed to resolve the matter, the Director of Educational Development and Support (for Employment Actions) or the Program Director (for Academic Actions) may extend the suspension without pay or progress to a termination. (c) Termination: A termination constitutes that action taken by the Hospital or DUCOM, through the Program Director (for Academic Actions) or Director of Educational Development and Support (for Employment Actions), by which the house officer is entirely and irrevocably relieved of his/her responsibilities within the Hospital and dismissed from the residency program. After the date of the termination, the house officer will no longer be a student of the DUCOM program or an employee of the Hospital. All salary and other employment benefits shall cease immediately on the date of termination. (d) Other Penalty or Sanctions: As determined by the Program Director (for Academic Actions) or GME Office Director (for Employment Actions). 7. The following individuals must be notified of any Disciplinary Action regarding a house staff member: a. Program Director b. Department Chair c. Director of Educational Development and Support in the Office of Graduate Medical Education d. Associate Dean for Graduate Medical Education e. Director of Hospital Human Resources Department 8. All disciplinary action must be reported to the Graduate Medical Education Committee (GMEC). 9. Retention of Records: All materials related to a Disciplinary Action and Disciplinary Action proceedings will remain in the house staff member’s GME Office and department files and will be reported accordingly where required by the State and when release of information is granted by the house staff member. All Disciplinary Action obligations must be fulfilled before the house staff member will receive the official certificate of completion of training.

34

APPENDICES: Flow Charts for Corrective and Disciplinary Actions A. Academic Actions Sequence:

1. Problem identified by Program Director 2. Corrective Action: Program Director attempts to correct internally by a. Written feedback to house staff member; b. Written Corrective Action Plan put into effect; c. Warning and Departmental Probation: A warning and departmental probation is a form of Corrective Action and will be in writing to the house staff member. This letter will state the deficiencies for which the house staff member has been counseled and given warning. It shall further state a period of time of probation; what, if any assistance may be made available to help the house staff member in meeting expectations; detail the mechanism of evaluation to determine improvement; and inform the house staff member of the possible consequences if expectations are not met. A warning letter should be taken seriously as it allows the house staff member an opportunity to correct behaviors during the period of probation. If the behavior is not corrected, the house staff member’s conduct and behavior could ultimately result in Disciplinary Action with reprimand, suspension or termination. “Warning and departmental probation” files are kept in the department only and are not reportable unless disciplinary action, noted below, is warranted; and/or d. Other penalty or sanction as determined by the Program Director. 3. If issue is resolved to satisfaction of the Program Director, the matter goes no farther. If not resolved in the department or repeats, Disciplinary Action may be taken by the Program Director. 4. Only Disciplinary Action, not Corrective Action, may be appealed by the house staff member per GME 17. Corrective Action may be grieved by the house staff member by following the appeal process below. 5. Disciplinary Action at level of Department – Program Director may impose any of the following: a. b. c. d.

Written reprimand Suspension without pay Termination Other disciplinary penalty or sanction as determined by the Program Director.

6.

Corrective Actions may be grieved by the house staff member to the Department Chair first and, if not satisfied with the decision, may be further grieved to the Associate Dean for Graduate Medical Education and then to the Dean if necessary. The decision of the Dean is final and concludes the grievance process.

7.

Disciplinary Actions may be appealed by the house staff member per the process outlined in House Staff Manual - Policy and Procedure GME 17.

35

8.

9.

The implementation of a Corrective or Disciplinary Action will not be stayed or halted merely because the action is being grieved or appealed by the house staff member. All proceedings must be documented and kept in the house staff member’s file.

B. Employment Actions Sequence:

1. Problem identified by Hospital personnel 2. Corrective Action: Hospital attempts to correct internally by Director in the Office of GME meeting with house staff member to understand problem and give feedback Written Corrective Action Plan put into effect Department Program Director and Chair notified Associate Dean for Graduate Medical Education notified House staff member may be given written Warning If issue resolved, goes no farther. If not resolved or house staff member repeats, Disciplinary Action is required. 2. Disciplinary Action at level of Office of GME – any of the following: a. b. c. d.

Written reprimand; Suspension without pay; Termination; Other disciplinary sanction as determined by a GME Office Director

3. Only Disciplinary Action, not Corrective Action, may be appealed by the house staff member per process in Fair Treatment Process outlined in the Hahnemann University Hospital Employee Handbook. House staff members are encouraged to use the Hospital’s Open Door Policy to discuss any problems, concerns or disputes regarding Corrective Action. 4. Final recommendation made by the Fair Treatment Committee and sent to the Hospital CEO. 5. Final decision by the Hospital CEO with a copy to the Associate Dean for Graduate Medical Education and Dean. 6. End point: If house staff member is not satisfied with final decision by the Hospital CEO, then house staff member may pursue Final and Binding Arbitration by the American Arbitration Association using steps as noted in the Tenet Employee Handbook.

Reference:

Original: 05/05

2005-6 Hahnemann University Hospital Graduate Medical Education Housestaff Manual

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR

Page 1 of 1

36

Review: 06/06

DREXEL UNIVERSITY COLLEGE OF MEDICINE

Subject:

TEMPORARY ADMINISTRATIVE LEAVE

POLICY: Both Hahnemann University Hospital and/or Drexel University College of Medicine reserve the right to temporarily suspend a house staff member from academic or clinical responsibilities in order to enforce compliance with both the clinical and educational duties of being a house officer when the presence of the house staff member at the Hospital or DUCOM may pose a threat to self or others or is appropriate in order to allow an internal investigation into allegations of serious misconduct against the house staff member pending initiation of Corrective Action or Disciplinary Action. PROCEDURES: The period of Temporary Administrative Leave should normally be no longer than necessary for the completion of an investigation or until it is determined the house staff member no longer poses a threat to self or others. The decision to impose a Temporary Administrative Leave is made by the Program Director for Academic Actions and by a Director in the GME Office for Employment Actions. In no event may the period of Temporary Administrative Leave exceed thirty (30) days. The GME Office shall determine whether the period of Temporary Administrative Leave will be with or without pay.

Original: 05/05 Review: 06/06 Subject:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

Page 1 of 1

GRIEVANCES

POLICY: Hahnemann University Hospital and Drexel University College of Medicine assure an educational environment in which house staff members may raise and resolve issues or complaints and can have grievances without fear of intimidation or retaliation applicable to their graduate medical education programs. PROCEDURES: 1. Academic Matters. Should a house staff member have a complaint or grievance against the program or DUCOM concerning an academic or clinical matter, the house staff member shall first submit a written grievance to his or her Program Director within thirty (30) days of the occurrence

37

of the matter being grieved. If the grievance is not resolved by the Program Director to the satisfaction of the house staff member within ten (10) days after its submission, then the house staff member may appeal in writing to the Program Chair. If the grievance is not resolved by the Program Chair to the house staff member’s satisfaction within ten (10) days after the appeal is submitted, then the house staff member may appeal in writing to the Associate Dean for Graduate Medical Education. The Associate Dean for Graduate Medical Education will make a decision on the appeal within ten (10) days of receipt. The decision of the Associate Dean for Graduate Medical Education will be the final decision within DUCOM on the grievance. 2. Employment Matters. Non-academic actions of employment, including, but not limited to salary, benefits, insurance, discrimination and sexual harassment shall be adjudicated through the Tenet Employee Fair Treatment Process as detailed in the House Staff Employment Agreement, House Staff Manual and Tenet Employee Handbook. House staff members are encouraged to use the Hospital’s Open Door Policy to discuss any problems, concerns or disputes regarding Corrective Action. 3. Confidentiality. Grievance proceedings shall be considered confidential and not disclosed by the Hospital and DUCOM except to persons with a need to know or to respond to the house staff member’s disclosure of the proceedings.

Original: 05/05 Review : 06/06 Subject:

DEPARTMENT OF ANESTHESIOLOGY POLICY AND PROCEDURE FOR DREXEL UNIVERSITY COLLEGE OF MEDICINE

Page 1 of 2

APPEALS OF DISCIPLINARY ACTIONS AND NON-REAPPOINTMENT

POLICY: Appeals of Disciplinary Actions imposed by Hahnemann University Hospital or the Drexel University College of Medicine shall use the procedures set forth in this policy. PROCEDURES: 1. Appeal of Academic Actions or Non-reappointment Decisions: The following is the institutional procedure to be used for appeals by a house staff member of Academic Actions imposed pursuant to GME 14 or for the appeal of a decision to non-renew a house staff member’s appointment in the program: a. In order to commence an appeal of an Academic Action or non-reappointment, the house staff member must submit a signed written request (not e-mail) for an appeal of the decision to the Department Chair within fifteen (15) business days from receipt of written notification of the Disciplinary Action or notice of nonreappointment. The house staff member’s written request must include a full and detailed explanation of the reason(s) why the decision should be reversed. b. The appeal shall be submitted to an Ad-Hoc Departmental Hearing Committee (Ad Hoc Committee). The Ad Hoc Committee will be appointed by the Department Chair and shall consist of two (2) members of the teaching faculty from the house staff member’s department, and one (1) senior house staff

38

c.

d.

e. f. g.

h.

member from the program. The Committee shall elect a member from the group to preside at the hearing. A house staff member may challenge the appointment of a member of the Ad Hoc Committee by proving to the Department Chair that the member has actual bias or prejudice against the house staff member. If the Department Chair determines the challenge is merited, he or she shall appoint another member to serve on the Ad Hoc Committee. However, the mere fact that an Ad Hoc Committee member has previously worked with, supervised or evaluated the house staff member shall not prove adequate grounds for removal of an appointed member. The Committee shall convene the hearing within ten (10) business days of the house staff member’s written request and shall notify the house staff member in writing of the date, time and place for the hearing as soon as reasonably possible, but not less than seventy-two (72) hours in advance of the hearing unless the house staff member shall waive such requirement in writing. The house staff member and his or her Program Director or designee shall have the opportunity to be present at the hearing and each shall present such information or materials (oral or written) as they wish to support their case. Each party may also request that witnesses be permitted to present information to the Ad Hoc Committee. Such requests must be made by submitting to the Chair of the Ad Hoc Committee at least twenty four (24) hours prior to the start of the hearing a written list of the proposed witnesses and a description of the information the witnesses are expected to provide. The Ad Hoc Committee shall rule on such requests and may, on its own initiative, request the attendance of other persons to give information. However, the Ad Hoc Committee has no authority to compel the attendance of any witnesses. The Ad Hoc Committee may limit introduction of documents or information by the parties or witnesses on grounds of relevancy, repetition or for other good cause. Parties shall be present at all times during the hearing but are not permitted to directly question each other or witnesses during the hearing. The Director of Educational Development and Support will be present to advise the Chair of the Ad Hoc Committee and to ensure the process is followed. No other representatives for the parties shall be present during the hearing. Unless the Ad Hoc Committee rules otherwise, each party must submit all written documents it wishes to present at the hearing to the Chair of the Ad Hoc Committee at least twenty-four (24) hours prior to the start of the hearing. Each party shall be permitted to review all materials submitted to the Ad Hoc Committee prior to and during the hearing. No party shall be permitted to make a recording or transcription of the hearing. The Ad Hoc Committee may adjourn a hearing to a later date(s) if it determines such action is necessary in order to permit a full presentation of information on the appeal. Any and all procedural matters arising before or during the hearing will be determined by majority vote of the members of the Ad Hoc Committee. A majority vote of the Ad Hoc Committee shall decide the issue(s) before it. The Ad Hoc Committee shall render a decision affirming, reversing, or modifying the action appealed. No party shall be allowed to vote or to participate in the Ad Hoc Committee’s deliberations. Regardless of the outcome of the hearing, the Ad Hoc Committee will provide the house staff member and Program Director with a written statement of its decision and the reason(s) for such decision within ten (10) business days from the date of the conclusion of the hearing. If written materials are submitted to the Ad Hoc Committee, such materials shall be appended to the Ad Hoc Committee’s report. The house staff member or Program Director may appeal the Ad Hoc Committee’s decision to the Graduate Medical Education Committee (GMEC) within ten (10) business days of receipt of the Ad Hoc Committee’s decision by written notification to the Associate Dean for GME specifying the reason(s) for the appeal.

39

i.

The Associate Dean for Graduate Medical Education or, in his or her absence, the Chair of the GMEC, will appoint a GMEC Sub-committee (“Sub-committee”) to be convened to evaluate any such appeal. This Sub-committee shall consist of two-graduate medical education training Program Directors and a senior house staff member from programs other than the program involved in the appeal. The Sub-committee shall elect a member from the group to act as chair. j. The Sub-committee shall review the findings of the Ad-Hoc Departmental Hearing Committee and may, at its option, request the house staff member, the Program Director, and any other persons it deems necessary to appear before the Sub-Committee or to provide additional written information or documents to the Sub-committee. The Director of Educational Development and Support will be present to advise the Chair of the Sub-committee and to ensure the process is followed. No other representatives of the parties shall be present during any appearance before the Sub-committee. Any and all procedural matters arising before or during the review will be determined by majority vote of the members of the Sub-committee. k. Upon completing its review, the Sub-committee shall by the majority vote of its members recommend whether the decision of the Ad Hoc Committee should be affirmed, reversed, or modified. l. A written report should be prepared by the Sub-committee chair and submitted to the GMEC at its next meeting date. m. The GMEC will review the Sub-committee report and issue its decision in writing within a reasonable time which will not exceed thirty (30) business days from the submission of the Sub-Committee report. n. The opinion and decision of the GMEC will be final. o. An appeal may be made to the Dean with a briefing by the Associate Dean for Graduate Medical Education. 2. Appeal of Employment Actions: For Appeals of Disciplinary Actions imposed from Employment Actions, the house staff member will follow the Tenet Fair Treatment Process outlined in the Employee Handbook.

40