Department of by ka23jTy

VIEWS: 0 PAGES: 48

									 Hennepin County
  Medical Center
  Department of
Emergency Medicine




 Resident Manual
      2009
          1
                     TABLE OF CONTENTS

MISSION STATEMENT                                     4
RESIDENCY BACKGROUND                                  4
EVALUATIONS
  Resident                                             5
  Off-Service Rotation                                 5
  Emergency Medicine Rotation                          5
     Shift                                             5
     Certified Courses                                 6
     Core Content Lecture                              6
  Overall                                              6
     Faculty Council                                   6
     Educational Committee                             6
     Conference Attendance                             6
     Emergency Medicine Required Reading Curriculum    6
     Written Examinations                              7
     Core Competency Assessment                        7
     360 Degree                                        8
     S-DOT                                             8
  Semi-Annual                                          8
  Annual Examinations                                  8
     In-Training Examination                           8
     Department Oral Board Examination                 8
PROCEDURES                                             9
CRITICAL CARE CASE LOGS                               10
RESIDENT PROMOTION, GRADUATION AND DISMISSAL          11
DUE PROCESS                                           12
RESIDENT EVALUATION OF THE RESIDENCY PROGRAM
     Faculty                                          13
     Curriculum                                       13
     Conference                                       13
CONFERENCE SCHEDULE AND ATTENDANCE REQUIREMENTS       14
PATIENT FOLLOW-UPS                                    15
DUTY HOURS
  Oversight                                           16
  Tracking                                            16
  Emergency Medicine Rotations                        16
  Non-Emergency Medicine Rotations                    16
  Moonlighting                                        17
  Extracurricular Activities                          17

                                      2
EMERGENCY DEPARTMENT SCHEDULING                                     18
     Scheduling Intervals                                           18
     Vacation and Academic Leave Request Procedure and Guidelines   18
     Resident Schedule Requests                                     19
     Resident On Call on Last Night of Rotation                     20
     Schedule Distribution Guidelines                               20
     Orientation and ED Provider Training Guidelines                20
     Schedule Distribution Guidelines                               20
     Annually Prohibitive Dates for Vacations and leaves            21
RESIDENT RESPONSIBILITIES AND SUPERVISORY LINES OF
PATIENT CARE
  Patient Care Responsibilities                                     22
  Faculty                                                           22
  Fellows                                                           22
  PGY-3                                                             22
  PGY-2                                                             23
  PGY-1                                                             23
RESIDENT TEACHING RESPONSIBILITIES                                  24
RESIDENT SCHOLARLY ACTIVITY REQUIREMENT                             25
RESIDENT RESEARCH MANUAL                                            25
SELECTIVES                                                          26
  HCMC Selectives                                                   26
  Outside HCMC Selectives                                           26
  Unacceptable Selectives                                           27
STRESS MANAGEMENT AND RESIDENT WELLNESS                             28
MISCELLANEOUS                                                       29
POLICIES
  Conference Attendance                                             30
  Vacation and Time Off                                             31
  Unexpected Short Term Leave                                       33
  Family and Medical Leaves of Absence (EM)                         35
  Moonlighting                                                      36
  Academic Leave - Conference and Presentation Travel               37
  Hyperbaric Oxygen Chamber Call                                    38
  Off-Site Elective Rotations (Institutional)                       39
   Leaves of Absence (Institutional)                                42
   Resident Duty Hours Logging (Institutional)                      44
   Dress Code (Institutional)                                       45




                                                  3
MISSION STATEMENT OF DEPARTMENT OF EMERGENCY MEDICINE

We, the faculty of the Department of Emergency Medicine, strive to excel as leaders in the
specialty of Emergency Medicine. We are devoted to providing excellent care at any time, to any
patient in need of emergency medical services both in the Emergency Department and in the
greater community. We are determined to optimize the medical care and well being of all patients
by working within the Medical Center in a spirit of cooperation.

We are committed to educational excellence in training physicians, students of medicine, allied
health professionals, and the lay public in the prevention and management of acute illness or
injury.

We will advance the quality of emergency care everywhere by contributing new knowledge and
skills obtained through active biomedical research and innovation in the practice of Emergency
Medicine.

RESIDENCY BACKGROUND

In the late 1960's and early 1970's, the Emergency Department at Hennepin County General
Hospital was challenged to meet the needs of its area residents for improved emergency health
care. In 1971, Claude Hitchcock, M.D., then Chief of Surgery, appointed one of his staff
surgeons to head the new Department of Emergency Medicine as a section of the Department of
Surgery. Ernest Ruiz, M.D., who accepted the position, served as the Department of Emergency
Medicine's Chief of Service until his resignation in July 1992. When Dr. Ruiz accepted that
position, he realized that many major challenges lay ahead. Hildred Prose, R.N., the Emergency
Department nursing director at that time, provided invaluable support in meeting those
challenges and helped develop the programs that were to have a great impact on the hospital and
the community.

In 1971, Dr. Ruiz read an article in a magazine (he thinks it was Newsweek) about a new training
program at Cincinnati in Emergency Medicine. Dr. Ruiz thought this was an excellent idea and
took steps toward starting a new training program in Emergency Medicine at Hennepin. Two
surgery residents, Robert Long, M.D., and Patrick Lilja, M.D., chose to become the first residents
of Hennepin County General Hospital's new residency program in this specialty. It was only the
second such Emergency Medicine residency program available in the United States in 1972. The
residency has flourished since that time. Graduates have accepted leadership positions in many
of the busiest hospitals in the country, ensuring many improvements in emergency care
throughout their communities and beyond.




                                                               4
EVALUATIONS

RESIDENT EVALUATIONS

A resident is evaluated at the end of each rotation by the medical staff. Evaluations are returned to
the Program Director, maintained in the resident’s file, distributed to the residents, and are
reviewed at the resident’s semi-annual evaluation.

In addition; the annual ABEM in-training examination, departmental oral boards, animal
procedure lab, 360 degree evaluations, CORD standard direct observational assessment tool, and
input from departmental faculty are utilized in reviews. The Program Director and his/her
designee meet with each resident on a semi-annual basis, and based on the resident’s progress,
may promote the resident to the next year of training. Residents may also be placed on
suspension, probation, or dismissed based on the judgment of the Program Director. Residents
have access to an appeal mechanism and due process as outlined in their contract and in
accordance with the institutional policy.

OFF-SERVICE ROTATION EVALUATIONS

EM Residents will have an evaluation completed for every off-service rotation performed. These
off-service rotation evaluations will be performed primarily by the attending physician who is
directly supervising the resident. Specific areas such as patient care, clinical judgment, physical
examination, medical knowledge, practice-based learning and improvement, interpersonal and
communication skills, case presentations, record keeping, professionalism, systems-based practice,
and overall clinical competence will be numerically assessed. Evaluations will be performed in
either written or electronic (New Innovation’s Residency Management Suite) formats. All written
evaluations will be entered in electronic form after receipt by the Department. Written off-service
rotation evaluations will be placed into the resident’s permanent individual file. These files will
be kept in a locked and confidential cabinet. Residents will be able to view their individual file at
any time. Residents are encouraged to view their off-service rotations as soon as they arrive in
their file. All evaluations will be accessible on-line at www.new-innov.com. Evaluations will
track class comparisons and longitudinal progress of the individual resident.

EMERGENCY MEDICINE ROTATION EVALUATIONS

Resident assessments will be sought from department faculty in the form of Shift Evaluations.

        SHIFT EVALUATIONS
Emergency Medicine Faculty will receive an electronic general competency-based shift evaluation
form three times weekly. Rotating, competency based, evaluations will be solicited from faculty
working with EM residents in the Emergency Department for all shifts during that day. A
numerical grading system will be used, and specific comments are encouraged. All evaluations
will be accessible on-line at www.new-innov.com.



                                                                5
Residents are encouraged to be proactive in their education, seeking timely feedback on their
performance.

       CERTIFIED COURSES
All EM residents are evaluated whenever they participate in an organized didactic course,
including APLS, ACLS, ATLS, BLS, ACLS Instructor, and BLS Instructor. Residents are
expected to pass all of these courses.

        CORE CONTENT LECTURE EVALUATIONS
All EM residents will have a written evaluation performed on their lecture presentations. This
consists of a compilation of feedback from conference participants


OVERALL EVALUATIONS

Residents will be evaluated on their participation and responsibility in all other aspects of their
training, including Hyperbaric Oxygen Call, conference participation, and conference preparation
(e.g. critical care, chief complaint, journal club).

       FACULTY COUNCIL EVALUATIONS
EM residents’ progress, particularly when concerns arise from the above evaluation methods, or
based upon individual faculty experience, will be discussed at faculty council meetings on an as
needed basis.

        EDUCATIONAL COMMITTEE EVALUATIONS
Prior to resident semi-annual reviews, resident progress will be evaluated and assessed by the
Educational Committee. Key areas of individual resident strengths and areas to improve will be
identified and future goals and objectives will be defined.

        CONFERENCE ATTENDANCE
EM residents will have their conference attendance monitored and compiled. It is the resident’s
responsibility to insure they have been signed into each conference they attend. Residents are
expected to have a conference attendance rate of >70% in order to successfully complete the
training program, >75% attendance is encouraged. Please refer to the specific conference
attendance policy.

         EMERGENCY MEDICINE REQUIRED READING CURRICULUM
This curriculum is designed to facilitate a structured reading schedule during your three years of
Emergency Medicine training. The Ruiz Reading Group will systematically guide you through the
Tintinalli text and Educational Reading Curriculum will guide you through the Rosen’s (and
Roberts and Hedges) textbooks. All residents are strongly recommended to complete these during
their training in order to adequately prepare for clinical practice as well as the Board Certification
examination.



                                                                 6
Online CORD testing has been associated with the annual reading assignments. Residents are
required to perform and submit all of the associated tests prior to their semi-annual reviews.
Residents who display adequate comprehension of the material with scores of >75% on the annual
ABEM In-Training examination may choose to continue with the suggested testing but will not be
required to submit for review.

Residents who score under the 16th percentile for their level of training will be required to submit
CORD tests on a monthly basis with Key Learning Objectives from each assigned chapter. These
will be submitted and reviewed with the resident’s faculty advisor and/or Program Director.

        WRITTEN EXAMINATIONS
A weekly quiz based upon that week’s Core Content lecture will be given and should be taken
prior to the start of the lecture. Other periodic written examinations may be given and grades
utilized for evaluation purposes. The web site http://www.cordtests.org is available to all EM
residents nationally, and has system specific and practice in-training examinations that may be
taken at the resident’s leisure. Your ID and password will be provided to you, or are available
from the Program Coordinator. There are two types of internet tests, “practice” and “scored.” A
“practice” test gives you the answer and reason for the answer. The “scored” tests do not provide
immediate resident feedback and the results of the test are automatically emailed to the Program
Director. You are urged to take both practice and scored internet tests. Your results are not being
evaluated, but the fact that you took the test and are utilizing the service is noted. The scored tests
are required as a component of the reading curriculum outlined above.

        CORE COMPETENCY ASSESSMENT
There are a number of forms that will need to be completed by residents in order to document the
teaching and successful completion of the general competencies during your training process. The
current forms are as follows:

       HCMC Critical Care Conference Brief Lecture Form
       HCMC Morbidity and Mortality Root Cause Analysis Form
       HCMC Morbidity and Mortality Case Form
       HCMC Core Content Conference Form
       HCMC Chief Complaint Conference Form
       HCMC Journal Club Overview Form
       HCMC Radiology Discrepancy Review Form
       HCMC Resident Quality Assurance Review Form
       HCMC Systems Based Practice Form
       Reading Group Form
       Pediatric Case Conference Form

In addition, all case and didactic presentations, literature reviews, and other educational/academic
projects should be copied or emailed to the Program Coordinator for review and tracking in the
resident’s academic portfolio.



                                                                  7
        360 DEGREE EVALUATIONS
Residents will have 360 degree evaluations performed once per year by emergency medicine
nurses, nursing assistants, and health unit coordinators. These evaluations will focus on
professionalism, interactions with patients, and resident performance within the Emergency
Department healthcare team.

       S-DOT (STANDARDIZED DIRECT OBSERVATIONAL ASSESSMENT TOOL)
Residents will have a minimum of one S-DOT evaluation performed each academic year.
Additional observational assessments will be performed as needed based on resident performance.



SEMI-ANNUAL EVALUATIONS

Each resident will meet with either the Program Director or an Associate / Assistant Program
Director at least twice per year in a formal evaluation and feedback process. The results of all of
the above resident evaluation methods will be provided to the resident. These evaluations occur in
December and January, and May and June of each year. More frequent formal evaluation and
feedback will be done as needed on an individual basis.

Residents and faculty are encouraged to approach each other informally to provide on-the-job
feedback as often as possible.

Residents are encouraged to view their individual residency folder and various “reports”
(conference attendance, evaluation summaries, and procedure logs) on www.new-innov.com
frequently, and not wait for their semi-annual evaluations.

ANNUAL EXAMINATIONS

        IN-TRAINING EXAMINATION
All EM residents will take the annual in-service examination. The results of this examination will
be used in evaluating individual resident performance. Residents are expected to score above the
16th percentile for their individual post graduate training year.

        DEPARTMENTAL ORAL BOARD EXAMINATION
All EM residents will participate in the department oral examination. The results of this
examination are utilized to evaluate the resident. EM PGY-1 residents have not generally
participated in this type of examination and as result, more emphasis is placed on the experience
rather than performance. Passing grades are anticipated from the EM PGY-2 and PGY-3
residents.




                                                               8
PROCEDURES

All EM residents will have a computerized procedural database log with oversight by the Program
Director.

Residents are expected to use EPIC to enter and track all of their HCMC based procedures
EXCEPT vaginal deliveries, and use Procedure Logger on www.new-innov.com for
procedures performed on patients outside of the hospital and for recording vaginal
deliveries. This includes North Memorial and Region’s Hospital (if applicable) rotations.
Progress in the number and type of procedures will be analyzed by the Program Director and
provided to the resident during their semi-annual review.

The following is a list of procedures (and number) that are required by the Emergency Medicine
Residency Review Committee for successful completion of an Emergency Medicine training
program. All procedures performed by residents should be logged and tracked for patient care and
training experience without regard to RRC gradutation requirements.

              Procedure                       Number Required*
              Adult medical resuscitation             45
              Adult trauma resuscitation              35
              Cardiac pacing                          06
              Central venous access                   20
              Chest tubes                             10
              Conscious sedation                      15
              Cricothyrotomy                          03
              Disclocation reduction                  10
              Intubations                             35
              Lumbar Puncture                         15
              Pediatric medical resuscitation         15
              Pediatric trauma resuscitation          10
              Pericardiocentesis                      03
              Peritoneal lavage                       03
              Vaginal delivery                        10

* Numbers include both patient care and laboratory simulations




                                                             9
CRITICAL CARE CASE LOGS

Residents will also be provided a computerized summary of the number and types of critical care
cases managed in the Emergency Department. A stabilization case database will be kept for the
residents. It will contain all of the pertinent details of each individual stab case. The stabilization
case database will divide cases into those directed (primarily done as a PGY-3) and those
participated in (primarily as a PGY-1 and PGY-2).

Make sure that you have your name in EPIC as being either the PMP or Senior Resident in order to
receive credit that you were present.




                                                                  10
RESIDENT PROMOTION, GRADUATION, AND DISMISSAL

The decision to promote residents to the EM PGY-2, EM PGY-3, or to graduate from the program
are made during the May/June semi-annual resident evaluation. The decision to promote or
graduate a resident is based on all of the above listed evaluation data. No single criteria is utilized
(e.g., In-training Examination Results) as a benchmark for promotion or graduation. However, the
most important data utilized in the decision to not promote or not graduate a resident is the
judgment of the Program Director, Chief of Service, and the faculty based on the clinical
competence of the resident. Based on the sum total of all the evaluation data available, the
Program Director will make the final promotion/graduation decision. In the event of a possible
“no promotion” or “no graduation” decision by the Program Director, the Program Director will
discuss the decision with the Chief of Service, Assistant Chief of Service, and the Assistant
Program Director. Additionally, the Program Director will present the issue at a Faculty Council
meeting for discussion among all faculty before the decision is finalized.

Possible actions taken after complete resident evaluation include; continuation of the training
program as planned, resident remediation, probation, additional training requirements (residency
extension), suspension, and dismissal.

All residents enter into an annual contract with Hennepin County Medical Center, regardless of the
expected duration of their training program. These annual contracts must be signed and received
PRIOR to March 1st. Emergency Medicine positions are ongoing "categorical" positions, PGY1
through PGY3. The Emergency Medicine residency consists of 36 months of training. Emergency
Medicine/Internal Medicine “combined” positions consist of 60 months of training. Residents will
be promoted from each level of training after satisfying all requirements for that training level and
offered subsequent annual contracts through program completion unless:

       They are dismissed or their contracts are not renewed based on academic performance
which is below satisfactory;
       They are dismissed or their contracts are not renewed based on non-academic behavioral
violations;
       They are ineligible for a continued appointment at the time renewal decisions are made
based on failure to satisfy licensure, visa, immunization, registration or other eligibility
requirements for training; or
       Their residency program is reduced in size or closed.

Program closure or reduction in number of positions is addressed in the institutional policy. In the
event of program closure or reduction, the Department of Emergency Medicine will make every
effort to assist the residents in locating another training program to complete their residency.

RESIDENT DISMISSAL

The Department of Emergency Medicine adheres to the institutional policy for residency

                                                                 11
dismissal outlined in the institutional (HCMC) resident manual.

DUE PROCESS

Prior to the imposition of institutional probation, suspension, or dismissal from the program, a
resident shall be afforded:

I)      Written notice by the resident’s Program Director of the charges which may result in
discipline or dismissal, whether for academic or non-academic violations.

II)    An opportunity for the resident to meet with the Chief of Service or his/her designee to
respond to the discipline or dismissal.

III)    After the meeting, the Chief of Service or his/her designee shall determine the appropriate
action. The resident shall be notified in writing of the decision within five business days.

IV)    The resident may, within 30 calendar days after receiving notice, file a notice of appeal in
writing with the Medical Director of Hennepin County Medical Center.

V)    Following the receipt of a notice of appeal, a panel of three persons selected by the
Medical Director shall be convened.

VI)    At the appeal, the resident shall have the right to an advisor, who may be a fellow
resident, faculty member, or any other advisor of the resident’s choice.

VII) The resident shall have the right to present evidence, written or oral, including testimony
from witnesses whose attendance he/she is able to arrange. Cross-examination of the witnesses
will be permitted. The proceedings of the appeals hearing shall be recorded.

VIII) The appeal panel shall have the right to adopt, reject, or modify the previous decision.
The panel shall notify the resident of its decision in writing.

IX)    The appeal panel’s decision shall be final. No further appeal process is available.




                                                               12
RESIDENT EVALUATION OF THE RESIDENCY PROGRAM

       FACULTY EVALUATION
Residents will be required to complete an annual evaluation of each Emergency Medicine faculty
member. This evaluation will be provided to each resident in electronic format on www.new-
innov.com. The evaluations will be anonymous. Individual faculty evaluations will be collated,
summarized, and provided to the respective faculty member as well as to the Chief of Service.

        CURRICULUM EVALUATION
Residents will be provided the opportunity to complete an anonymous annual evaluation of each
rotation performed during the academic year. This evaluation will be provided to each resident
in electronic format on www.new-innov.com. Each Resident’s Meeting will have an allotted
time to discuss and evaluate specific rotations.

        CONFERENCE EVALUATION
Residents will be provided the opportunity to complete an anonymous annual evaluation of each
conference type provided during the academic year. This evaluation will be provided to each
resident in electronic format on www.new-innov.com. Each Resident’s Meeting will have an
allotted time to discuss and evaluate specific conferences.




                                                             13
CONFERENCE SCHEDULE

*Required Conferences
      WEDNESDAYS
             12:00pm                 Week of the Month
                                     1. Pediatric Case Conference*
                                     2. Career Seminars
                                     3. Pediatric Subspecialty Conference*
                                     4. EM / Cardiology Conference

       THURSDAYS
            6:30am - 7:30am          Ruiz Reading Group (mandatory for PGY-1 residents)
            7:30am -12:00pm          1. Critical Care (Stab) Conference*
                                     2. Core Content Lecture*
                                     3. Rotating*:
                                             a. Research/Toxicology
                                             b. Specialty (EKG, Radiology)
                                             c. Morbidity & Mortality (including Root Cause Analysis)
                                             d. Written Board Review
                                             e. Oral Board Review
                                             f. Interactive Review
                                             g. Chief Complaint Conference

               12:00pm – 1:00p       Small Group Interactive Sessions or Resident Meeting*

        SOCIAL JOURNAL CLUB*
First Tuesday of every month at 7:00 pm at a faculty member’s home.


        CONFERENCE ATTENDANCE REQUIREMENTS
Residents are expected to attend all scheduled conferences when not conflicted by critical patient
care activities. All off service departments are aware of the conference block on Thursday
morning. Residents are relieved of all non-critical patient care responsibilities on Thursday’s
from 7:30am to 12:00pm. Please keep in mind that patient care is our primary responsibility
followed immediately by your medical education.

The overall conference attendance requirement is >70% for your residency tenure. > 75%
conference attendance is encouraged. Please refer to the conference attendance policy for
specific details.




                                                               14
PATIENT FOLLOW-UPS
At the end of every month a form will be distributed to each resident who is rotating in the
Emergency Department. A list of patients seen during the rotation will be included. Follow-up
on five (5) admitted patients and five (5) discharged patients must be performed. Completed
forms must be returned to the Program Coordinator on a monthly basis. These will be reviewed
at the semi-annual evaluations.




                                                            15
DUTY HOURS
Please refer to the Institutional policy on duty hours compliance and documentation.

OVERSIGHT
It is the responsibility of the Program Director to review all rotations and resident schedules to
ensure that hours and responsibilities are appropriately assigned. The Program Director shall
immediately take whatever corrective action is needed to assure compliance with these policies
and procedures. It is the resident’s responsibility to notify the Program Director of any
irregularities of duty hours or supervision.

TRACKING
EM residents must log their actual duty hours (specified below) in the Duty Hours Module on
www.new-innov.com. This must be completed on a weekly basis. Failure to remain current with
duty hour tracking may result in loss of meal card privileges, parking privileges, suspension of
clinical privileges, probation, and/or termination.

EMERGENCY MEDICINE ROTATIONS
At a minimum, residents shall be allowed 1 full day in 7 days away from the institution and free
of any clinical or academic responsibilities.

While on duty in the emergency department, residents may not work longer than 12 continuous
scheduled hours. There must be at least an equivalent period of continuous time off between
work periods.

A resident should not work more than 60 hours per week seeing patients in the emergency
department, and no more than 72 total duty hours per week. Duty hours are comprised of all
clinical hours worked, conference time (within or outside the institution or educational program),
on-call hours actually spent within the institution, and internal moonlighting hours worked.

NON-EMERGENCY MEDICINE ROTATIONS
The Program Director must ensure that all residents have appropriate duty hours when rotating
on other clinical services, in accordance with the ACGME-approved program requirements of
that specialty.

Duty hours are defined as all clinical and academic activities related to the residency program;
i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the
provision for transfer of patient care, time spent in-house during call activities, and scheduled
activities such as conferences. Duty hours do not include reading and preparation time spent
away from the duty site.

       Duty hours must be limited to 80 hours per week, averaged over a four-week period,
        inclusive of all in-house call activities.



                                                                  16
      Residents must be provided with 1 day in 7 free from all educational and clinical
       responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as a
       continuous 24-hour period free from all clinical, educational, and administrative duties.

      Adequate time for rest and personal activities must be provided. This should consist of a
       10-hour time period provided between all daily duty periods and after in-house call.

      In-house call is defined as those duty hours beyond the normal work day, when residents
       are required to be immediately available in the assigned institution.

      In-house call must occur no more frequently than every third night, averaged over a 4-
       week period.

      Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours.
       Residents may remain on duty for up to 6 additional hours to participate in didactic
       activities, transfer of care of patients, conduct outpatient clinics, and maintain continuity
       of medical and surgical care.

      No new patients may be accepted after 24 hours of continuous duty.

At-home call is defined as call taken from outside the assigned institution. The frequency of at-
home call is not subject to the every-third-night limitation. At-home call, however, must not be
so frequent as to preclude rest and reasonable personal time for each resident. Residents taking
at-home call must be provided with 1 day in 7 completely free from all educational and clinical
responsibilities, averaged over a 4-week period.

When residents are called into the hospital from home, the hours residents spend in-house are
counted toward the 80-hour limit.

MOONLIGHTING
Moonlighting hours are tracked in two ways. Moonlighting hours must be recorded in each
resident’s duty hours tracking on www.new-innov.com. Additionally, department moonlighting
payroll records are reviewed periodically to ensure accuracy of reporting.

Please refer to the specific moonlighting policy for complete details.

EXTRACURRICULAR ACTIVITIES
Activities that fall outside the educational program may not be mandated, nor may they interfere
with the resident’s performance in the educational process as defined in the agreement between
the institution and the resident.




                                                                17
EMERGENCY DEPARTMENT SCHEDULING

                         Guidelines for the Resident (PMP) Schedule
                            Department of Emergency Medicine
                                          2009-2010

        All resident clinical scheduling in the Hennepin County Medical Center
        Emergency Department is made in compliance with ACGME, RRC-EM and
        Institutional guidelines.

        Scheduling Intervals
        The Emergency Department PMP schedule is made in seven (7) blocks. These
        blocks and deadlines for off-time requests are as follows:

           ED Schedule       HCMC Rotation Schedule Dates Time-Off Request
              Block             Blocks     Included in Block Deadline
                1                 1         6/24/09-7/19/09    5/15/09
                2                2-3        7/20/09-9/13/09    6/24/09
                3                4-5        9/14/09-11/8/09    8/10/09
                4                6-7         11/9/09-1/3/10    10/5/09
                5                8-9         1/4/10-2/28/10   11/30/09
                6               10-11        3/1/10-4/25/10    1/25/10
                7               12-13       4/26/10-6/24/10    3/22/10


        Departmental Notification

              Rotating Program Coordinators and/or Program Directors will be notified
               of approaching scheduling deadlines approximately 1 week in advance by
               email. Off service (rotating residents) should notify the Emergency
               Department Scheduling Team regarding any of their residents who are on-
               call the day before their EM rotation or have clinic responsibilities during
               their Emergency Medicine rotation at via e-mail at
               edschedulerequest@hcmed.org.

        Vacation and Academic Leave Request Procedure and Guidelines

              Deadlines for time-off requests are noted above.

              The EM department will notify the respective Program Directors or
               Coordinators via e-mail for departments with participating
               residents.Residencydirectors/coordinators will contact their respective
               residents regarding deadlines.

              Vacations are granted on a first come, first served basis.


                                                        18
      Vacations are granted in 7-day intervals only, from Monday to Monday.

      Vacation block availability can be obtained via email at
       edschedulerequest@hcmed.org.

      A HCMC Resident Request for Time Away from Service form must be
       RECEIVED in writing by the scheduling team on or before the deadline.
       Requests received after the deadline will be returned with no further
       consideration.

      Give or send the form to Nancy Newkumet in the Department of
       Emergency Medicine offices. The HCMC Interoffice mail code for the
       offices is EM 825.

      All vacations will be from 12:01 am on the declared START date through
       7:00 am of the RETURN date.

      Vacation request that are granted result in a reduction of shifts during the
       rotation.

Resident Schedule Requests - Single Day Requests

      Deadlines for single day requests must be submitted prior to the above
       time-off request dates.

      An email requesting single, non-consecutive single days off must be
       forwarded to edschedulerequest@hcmed.org. All single day requests start
       at 12:01 of the requested day off and the return time is 7:00 AM of the
       next day.

      Requests must be submitted by the resident. No phone or verbal requests
       will be accepted.

      The email link, edschedulerequest@hcmed.org can be used to prevent
       unacceptable turnaround times when changing services or departmental
       events. For example, this can be used to notify the ED scheduler that the
       resident will be post call on the first day of the rotation.

      Up to 1 request off PER BLOCK (not per month) can be honored.

      Single day requests off may not be used in conjunction with a vacation
       request. Additional requests off cannot be guaranteed during rotations in
       which vacation is requested.

      Requests for the last day of a rotation cannot be considered.




                                                19
      Requests using this format will not reduce the number clinical of shifts
       during a rotation.

Resident On-Call on the Last Night of Rotation

      It is the resident’s responsibility to notify Nancy Newkumet if they will
       beimmediately post call on the first day of the rotation. Residents who
       have last night call before they start their ED rotation will be protected as
       per ACGME, RRC-EM and HCMC Institutional guidelines.

      The ED should be notified withinthe deadlines outlined above.

      Residents will have scheduling consideration for “on call” activities when
       starting an ED rotation but NOT when leaving the rotation. When a
       resident is scheduled for the 10 PM to 7 AM shift on the last day of their
       ED rotation, it is their responsibility to notify the next service that they
       need protection on their first day, per HCMC policy.

      Per ACGME Duty Hour guidelines, residents may be scheduled for any
       ED shift after a 10 hour period out of the hospital.

Orientation Guideline for the Emergency Medicine Rotation

      All residents must attend an ED orientation session before working in the
       HCMC Emergency Department.

      ACGME and RRC-EM Duty Hour guidelines will be observed during
       orientation sessions.

Schedule Distribution Guidelines

      The schedule will tentatively be distributed 2 weeks prior to the start of the
       scheduling block noted above.

      After the initial schedule distribution, there will be a 3 day review period.
       During this time, scheduling concerns should be forwarded to
       edschedulerequest@hcmed.org.

      The schedule will be considered finalized after this 3 day period unless
       notified by the Emergency Department Scheduling Team.

      The final schedule will be distributed by Nancy Newkumet.

      HCMC residents will be paged to pick up their schedules from the
       Emergency Medicine offices.

      Non-HCMC residents may have their schedules emailed to them or they
       may pick the schedule up from the Emergency Medicine offices.

                                                 20
Annually Prohibitive Dates for Vacations and Leaves

Vacations and leaves will not be granted during the following intervals:

      The first and last 2 weeks of the academic year.

      Major Holidays, including:

           o   4th of July weekend

           o   Labor Day weekend

           o   Memorial Day weekend

           o   Thanksgiving week (Monday through Monday)

           o   December 21nd through January 3rd

      The Society for Academic Emergency Medicine (SAEM) Annual Meeting
       – May 31, 2010-June 7, 2010

      HCMC G1 Education Day (RED Training Day), TBA

      Semi-Annual Emergency Medicine Resuscitation Months, Blocks 1 and
       10




                                               21
RESIDENT RESPONSIBILITIES AND SUPERVISORY LINES OF PATIENT CARE

PATIENT CARE RESPONSIBILITIES
Resident patient care activities will always be supervised by faculty (EM or off-service). The
resident will be given patient care responsibilities commensurate with level of training and
demonstrated skills and experience. Faculty will be available at all times for consultation and
guidance. Adequate back-up will be available at all times in case of sudden and unexpected
patient or resident needs which jeopardize patient care.

FACULTY
Faculty are responsible for the evaluation and management of all patients presenting to the
Emergency Department for medical care, and for the supervision of all medical students and
residents in training. Faculty accomplish this by supervising the primary patient care delivered
by medical students, physician assistants, and residents, or by providing the medical care directly.
 Supervision of care entails knowing the history and physical examination of a given patient
either by direct contact with the patient or through a case presentation by a resident, and being
involved in the diagnostic and therapeutic management.

FELLOWS
The clinical responsibility given to fellows will be determined by the individual fellow and
departmental and institutional regulations regarding patient care. In general, fellows will
clinically function as junior faculty.

PGY-3 RESIDENTS
PGY-3 residents are the senior residents working in the emergency department. They are
responsible for the evaluation and management of all patients presenting to the emergency
department. PGY-3 residents accomplish this by supervising the primary patient care delivered
by medical students, physician assistants, and junior residents, or by providing the medical care
directly. Supervision of care entails obtaining a history and physical examination directly from
the patient, and being involved in all the diagnostic and therapeutic management decisions.

PGY-3 residents will be supervised by faculty. PGY-3 residents are expected to seek faculty
advice on the care of any patient as the need arises. PGY-3 residents will provide primary care
for all critically ill or injured patients.

PGY-3 residents have a significant teaching and administrative role in the emergency
department. They are expected to teach medical students and junior residents about the patients
they are managing. Administratively, PGY-3 residents are responsible for the management,
patient flow, and triage of the emergency department. They are also expected to provide primary
care for non-critical care patients in the emergency department when the need arises.




                                                                22
PGY-2 RESIDENTS
PGY-2 residents are junior residents working in the emergency department. They will have a
more independent role, and will be responsible for primary patient evaluation and management.
PGY-2 residents may provide medical care for non-critical and uncomplicated patients without
case presentation to a senior resident or faculty. PGY-2 residents are expected to manage
multiple patients at one time.

PGY-2 residents should present any complicated patient cases to either the senior resident or
attending faculty. Preferentially PGY-2 residents should present to the PGY-3 resident to assure
PGY-3 resident involvement and education. However, presentation to faculty is advisable during
high volume times. PGY-2 residents are required to notify the senior resident or staff whenever a
consultation or admission is planned. Additionally, PGY-2 residents should seek advice from the
PGY-3 resident or faculty whenever the need arises or complex decision making is required.

PGY-2 residents will assist the PGY-3 residents in the management of critically ill or injured
patients. The PGY-2 resident’s role in the stabilization room will be dictated by the supervising
PGY-3 resident. The PGY-2 resident may primarily manage a stabilization room case at the
discretion of the PGY-3 resident and faculty present. PGY-2 residents may perform procedures
commensurate with their level of training under close supervision of the PGY-3 resident and
faculty.

PGY-2 residents are not expected to directly supervise PGY-1 residents, medical students, or
physician’s assistants in the emergency department. PGY-2 residents will have limited teaching
responsibilities for the medical students and PGY-1 residents.

PGY-1 RESIDENTS
PGY-1 residents will provide primary care to non-critical patients in the emergency department.
They are responsible for performing a history and physical examination and formulating a
treatment plan. PGY-1 residents are expected to present every patient seen to either the senior
resident or faculty. Specifically, they are required to present and review every step of care with
either the senior resident or faculty on-duty. Preferentially, this case presentation should be to
the senior resident.

PGY-1 residents will participate in the stabilization room management of patients. This will be
accomplished by the direction and supervision of the senior resident attending the case. PGY-1
residents will be closely supervised in the stabilization room cases. Procedures performed by the
PGY-1 resident will be commensurate with their level of training.

PGY-1 residents are not expected to supervise medical students or physician’s assistants in the
emergency department. PGY-1 residents will have a limited teaching role while in the
emergency department, and will have limited administrative responsibilities.




                                                               23
RESIDENT TEACHING RESPONSIBILITIES

All residents will be expected to:

          Obtain instructor certification in ACLS.
          Teach ACLS courses after instructor certification.
          Teach the annual intern ACLS course.
          Teach medical students/interns in the animal lab on procedure days.
          Be responsible for Critical Care and Chief Complaint Conferences presentations
           during "Conference" week as senior resident.
          Present at Core Content, Social Journal Club, Stab Conference, Noon Conferences,
           and didactic sessions as scheduled.




                                                            24
RESIDENT SCHOLARLY ACTIVITY REQUIREMENT

Residents are required to complete a "scholarly" project during their residency. The scholarly
activity requirement may be met, but not limited to, one of the following. All scholarly activities
must have Program Director approval.

      Basic Science Research Study
      Prospective Clinical Research Study
      Retrospective Chart Review with completed manuscript
      Completed Literature Review with manuscript
      Completed Case Report with manuscript
      QA project with completed manuscript
      Examples of others:
          o Design and build new equipment
          o EM based podcasts
          o Videotape of procedures, x-ray reading, etc.

All projects should be accomplished in conjunction with a HCMC ED faculty. The Research and
Program Directors will monitor the progression of resident projects during their residency. See
the Research Manual for more details. PGY-3 residents will be expected to formally present
their project to the faculty and residents in the spring of their third year.


RESIDENT RESEARCH MANUAL

Drs. James Miner and Michelle Biros have compiled a resident research manual for your review.
It contains both general and specific guides to performing research at HCMC. You are
encouraged to familiarize yourself with this manual, even if you are not performing a research
project for your project requirement.




                                                               25
SELECTIVES

Selective time is scheduled for one (1) rotation block in the PGY-3 year. Various opportunities
exist within the current system for enhancing your education. Please feel free to talk to the
Program Director or faculty about selective opportunities.

You should have your selective requests in to the Residency Coordinator and approved by the
Program Director at least three (3) months prior to the scheduled start date of your selective.
The following is needed before approval of an elective:

      Goals and Objectives
      Supervisor
      Evaluator
      Schedule of Activities
      What activities you will be involved in during your rotation. Clinics, call (if applicable),
       rounds, etc.

HENNEPIN COUNTY MEDICAL CENTER SELECTIVES
The current established selective opportunities are as follows. Other selective rotations will be
considered on an individual basis by the Program Director.

      United Hospital Emergency Medicine
      Abbot Northwestern Emergency Medicine
      HCMC Radiology
      HCMC Quality Improvement and Patient Care Research
      HCMC Critical Care Rotation
      HCMC Forensic Medicine
      HCMC Toxicology
      HCMC Pit Boss
      HCMC Pediatric ED
      HCMC Educational Elective
      HCMC Aero-medical rotation
      Other HCMC clinical electives

OUTSIDE HENNEPIN COUNTY MEDICAL CENTER SELECTIVES
Selectives outside of HCMC will be considered under the following guidelines:

      HCMC is not able to provide the type or quality of selective that is wanted by the
       resident.
      The rotation needs to be performed within the curriculum confines of another academic
       department at the outside institution. It is preferred that this department be an Emergency
       Medicine department with a residency program in EM.


                                                                26
      The outside rotation should be well established as either an integral part of the outside
       academic departments curriculum or a selective of such a department.
      The outside rotation will not necessarily need the above stipulations if performed with an
       HCMC ED faculty. For example, a resident may elect to travel with faculty on an
       International Medicine Selective.

Two (2) International Medicine Selective opportunities are possible per year. These selectives
may be arranged through department contacts or with resources outside of the institution. No
financial resources for travel are currently available. International medicine selectives must be
supervised by a board certified Emergency Physician. These selectives have several pre-
requisites that must be met for academic credit, salary and benefit eligibility. Contact the
Program Director as early as possible when considering an International Medicine Selective; a
minimum of six (6) months is often necessary.

UNACCEPTABLE SELECTIVES
   Reading selectives
   Research publication preparation or presentation selectives
   Research selectives, unless specifically arranged with the Research and Program
    Directors that combine research and patient care linked directly to a specific patient.

Special Considerations
The Program Director may stipulate that a given resident do a certain selective as needed to help
correct any deficiencies in the residents training.

If a selective is not chosen with sufficient lead-time, one will be assigned by the Program
Director.




                                                                27
STRESS MANAGEMENT AND RESIDENT WELLNESS
It is our belief that residents should be able to receive their training and contribute their skills
without paying a high cost in personal health and well-being. Residency staff is well aware that
residency offers not only challenges but stresses as well, and each staff member is available to
talk with individual residents experiencing difficulties. In addition, the program offers several
components designed to provide a format for managing and responding to resident stress.

RESOURCES FOR STRESS MANAGEMENT

       RESIDENT ADVISOR
Each resident is assigned an advisor. The advisor serves as a resident advocate. They are also
encouraged to work with residents on adjustment/stress issues.

      EM FACULTY COORDINATORS FOR STRESS MANAGEMENT
Marc Martel, MD and Christine Kletti, MD

RESIDENT ASSISTANCE PROGRAM (RAP)
The Resident Assistance Program is an employee assistance program designed specifically for
residents and provided by the Sand Creek Group. The RAP is for residents, resident families,
attending faculty, department heads and supervisors, who need help in dealing with resident
related concerns.

Privacy is a primary concern. An outside firm provides our RAP services in a strictly
confidential manner. Written consent is required to disclose information.

There is no charge associated with assessment and short term counseling services provided
through the RAP program. When additional or more specialized services are indicated, you will
be referred to outside resources for help. In these cases, your RAP counselor will work with you
to locate appropriate, accessible, and affordable resources, based on your specific needs and
preferences. Health insurance plans most often provide some coverage for a variety of mental
health and chemical dependency concerns.

Examples of issues include: depression, debts, stress, career choice, relationships, and family
issues. Assistance is available 24 hours a day, 7 days a week at 651-430-3383 or 1-800-632-
7643.

PHYSICIANS SERVING PHYSICIANS (PSP)
PSP is an organization designed to assist physicians and their families in dealing with issues
around chemical abuse or dependency. Contact can be made with Diane Naas at 952-920-5582
for further information. The residency is always prepared to respond to individual needs, and we
invite you to bring these up at any time with your advisor or any other staff member.




                                                                 28
MISCELLANEOUS

Residents are responsible for paying Minnesota Medical License fees.

The department will pay for annual memberships (3 total years, 5 years for combined EM/IM
residents) in EMRA, SAEM, AAEM and ACEP during their residency tenure.

It is preferable to complete the step 3 examination by the end of your intern year. The step 3
examination must be completed by the end of your G-2 year to advance. HCMC does not pay
examination fees.

The department will purchase one textbook or PDA for each PGY-1 resident at the start of their
residency.




                                                              29
                              CONFERENCE ATTENDANCE

                                        PURPOSE
To ensure compliance with minimum requirements for didactic conferences as outlined by the
Emergency Medicine Residency Review Committee (RRC). To provide an outline of the
expectations of Emergency Medicine residents.

                                             POLICY
   1.   All Tuesday evening Journal Club, Wednesday Pediatric, and Thursday morning,
        conferences are mandatory.
   2.   When emergency medicine residents are rotating in the ED, the clinical schedule ensures
        resident attendance on Thursday. Additional conferences are attended as the clinical
        schedule allows.
   3.   Conference attendance must be at least 70% for each individual resident in order to
        maintain good standing and progress to the next level of training. 75% conference
        attendance is encouraged. Residents who are unable to progress will have their training
        extended directly proportional to this delayed progression.
   4.   PGY 1 residents will need to have a 70% conference attendance rate (all conferences and
        Reading Group) on March 1st of their intern year, or will not be allowed to attend the
        SAEM Annual conference.




                                                             30
                                 VACATION AND TIME OFF

                                            PURPOSE
To outline the resident’s role and responsibilities concerning vacation time and non-scheduled
time off.

                                         POLICY
PGY-1 residents receive two weeks (14 days) of vacation.

PGY-2 and PGY-3 residents receive three weeks (21 days) of vacation.

A week is defined as five weekdays and two weekend days. Residents should be available for
clinical responsibilities the other weekend days as usual, including possible in-house call.

Vacation must be taken in a one week (7 day block). These vacations start on Monday when in
the Emergency Department.

There will be no “carry-over” of unused vacation time between academic years.

It is the resident’s responsibility to ensure that patient care and teaching responsibilities are
covered in their absence, and to notify the service office in writing of the person(s) covering each
responsibility during the resident’s absence. A signed vacation request does not alleviate this
responsibility. Specifically, the department is not responsible to find/hire a moonlighter to fulfill
these obligations.

A written vacation request must be completed prior to leaving on vacation. It must include:

      Written approval from the service affected by the vacation.
      Written approval from the EM Program Director.
      Written approval from the EM Residency Coordinator.
      The Address/phone number at which the resident can be reached during vacation.

Vacation requests must be received at least 6 weeks prior to the beginning of rotations, or as
specified by the rotating department so call schedules can be arranged accordingly.

Vacation is not allowed when it precludes taking the annual Emergency Medicine in-training
examination.

Vacation is not allowed when it precludes taking the annual Departmental Oral Examination.

Residents are expected to spend duty hours (see previous definition), when they are not given a
specific clinical assignment, pursuing educational goals and objectives. This includes research,
preparing for and attending conferences and independent study. Residents should not be out of
town and out of reach of the service office during these times.

                                                                 31
Residents are expected to notify the Program Director and Program Coordinator if they
will be out of pager range for any reason PRIOR to leaving, electronic mail or voicemail
are acceptable.


SPECIAL VACATION CONSIDERATIONS AND EXCEPTIONS

*Block schedules and vacations will be selected in the Winter/Spring of the preceding
academic year.

PGY-1 YEAR
   Refer to Scheduling guidelines.
   No vacation last Wednesday of February.

PGY-2 YEAR
   Refer to Scheduling guidelines.
   No vacation last Wednesday of February.

PGY-3 YEAR
   Maximum two weeks from ED rotations
   If vacation time occurs during a Conference Week, the resident taking vacation is
     responsible for ensuring coverage of his/her teaching, lab, and conference responsibilities.
   No vacation over the last Wednesday of February.




                                                              32
         UNEXPECTED EMERGENCY DEPARTMENT SHORT TERM LEAVE

                                         PURPOSE
      To outline the individual and departmental roles and responsibilities concerning
unexpected Emergency Department short term leave.

                                                POLICY
The unexpected Emergency Department short term leave policy does not apply to short term
disability, rather clarifies unanticipated or recurrent missed clinical experiences not covered by
the Institutional Leave of Absence Policy.

Residents need to inform their program and the Emergency Department (ED) as soon as possible
to allow for the best planning and least inconvenience to the ED and program surrounding
unexpected Emergency Department short term leave. This includes medical illnesses and family
or personal emergencies. Emergency Department short term leave is defined as a leave that is
less than seven (7) days and/or less than 25% of the ED rotation. Short term leaves of more than
two (2) days must be discussed with the rotating resident’s Program Director in addition to the
ED administration. This policy applies to all unexpected short term leave of any duration less
than seven (7) days and does not apply to leaves of longer duration. Refer to the Institutional
policy on leaves of absence.

Residents who are unable to attend a scheduled shift in the ED must contact the Emergency
Medicine Chief Resident on call on the Chief Resident pager, 612-336-0040. The Chief Resident
must be contacted PERSONALLY as soon as possible prior to the start of the scheduled shift.
This pager number is also available through the ED at 612-873-3132. Coverage will be arranged
by the ED if this policy if utilized. A resident may choose to make coverage arrangements on
their own accord.

The Emergency Medicine Chief Residents will notify the ED rotation director, the Emergency
Medicine Program Director and a rotating resident’s Program Director of any leave taken.

If your leave encompasses two (2) or more shifts, you will be scheduled to work additional shifts
to avoid an “incomplete” grade on your rotation. In order to receive a formal rotation grade, at
least 75% of the originally scheduled number of shifts must be attended and the resident must be
present for at least 75% of the scheduled clinical experiences.

Emergency Department coverage will be arranged as follows;

       For PMP coverage, in descending order of availability:
             1. The PGY-2 Orthopedics resident will work the unexpected leave shift in place
             of their assigned clinical duties, preserving a minimum of 4 orthopedic shifts per
             week in compliance with ACGME duty hour guidelines.




                                                                33
               2. The PGY-3 resident on their elective rotation will work the unexpected leave
               shift in place of their assigned clinical shift up to a maximum of three (3) shifts
               per rotation.
               3. An available PMP will be sought for moonlighting coverage if neither of these
               residents is available. If more than one (1) shift needs to be covered in this
               manner, the resident taking short term leave will be expected to return coverage
               for a shift from the working PMP.
               4. If each of these mechanisms for coverage fails, an EM Chief Resident will
               cover the shift as a moonlighting PMP.

       For “pitboss” coverage, in descending order of availability;
              1. The PGY-3 resident on their elective rotation will work the unexpected leave
              shift in place of their assigned clinical shift up to a maximum (3) of three total
              PMP and senior resident shifts per rotation.
              2. The PGY-3 resident on STAB week will work the unexpected leave shift so
              long as it does not conflict with medical student lectures or procedure labs.
              3. An available PGY-3 resident will be sought for moonlighting coverage if
              neither of these residents is available. If more than one (1) shift needs to be
              covered in this manner, the resident taking short term leave will be expected to
              return coverage for a shift from the working PGY-3 resident.
              4. If each of these mechanisms for coverage fails, an EM Chief Resident will
              cover the shift as a moonlighting “pitboss”.

A PMP shift is defined as a clinical shift where the provider does not function as a supervisory
physician, for example, PMP TCA, TCB, or TCA (PGY1-3), ED Ortho, etc.

This policy is intended to be an outline for the emergent coverage of unexpected short term
leaves. Changes may be implemented at any time by the Emergency Department if necessary in
order to accommodate unanticipated circumstances.




                                                               34
                     FAMILY AND MEDICAL LEAVES OF ABSENCE

                                             PURPOSE
Please refer to the institutional policy on Family and Medical Leave. This policy further defines
Emergency Medicine Resident and Residency Program roles and responsibilities with respect to
extended leaves from training.

                                              POLICY
The resident shall inform the Program Director of any Family Medical Leave as soon as possible
to arrange scheduling. It is the responsibility of the Program Director and resident to ensure that
Board eligibility requirements are met appropriately during the residency period or alternative
training arrangements are made.

The RRC-EM rules stipulate that a resident must complete 46 weeks (6 weeks total of leave and
vacation) of training in any given academic year to be eligible for promotion and or graduation.
If this requirement is not met, the residents training must be extended beyond 36 months. This
applies to maternity, paternity, leaves of absence, sick time, vacation, and any other time spent
away from the residency.

Residents should expect to have their residency extended if the cumulative time away from
training exceeds seven days. The exact length of time to be made up will be at the discretion of
the Program Director. Likewise, how (the rotation) the resident spends his/her additional time is
left to the discretion of the Program Director. In general, residents should anticipate that their
additional time will be Emergency Department based.




                                                                35
                                       MOONLIGHTING

                                             PURPOSE
Define the resident’s responsibilities surrounding internal and external moonlighting.

                                              POLICY
A resident is not eligible to moonlight internally or externally unless approval has been obtained
from the Program Director in advance of these activities. Each external moonlighting site must
be pre-approved by the Program Director prior to clinical activities.

Moonlighting is not permissible if it precludes participation in residency related activities. This
includes, but is not limited to:

      All required conferences
      Conference week responsibilities
      Procedure lab

All moonlighting (internal and external) must be documented in the duty hours module on
www.new-innov.com.

Any resident may moonlight in the community provided:

      The resident has a valid Minnesota Medical license.
      Moonlighting does not interfere with residency activities, including research,
       administrative teaching, on-call responsibilities, and direct patient care responsibilities.
      Residents who are appropriately qualified may teach ACLS, ATLS in the community.
      Malpractice insurance is held (the responsibility of the resident).
      The Program Director has been informed of the residents’ intention to moonlight prior to
       the start of moonlighting activities. Information needed includes the place of work, the
       intended time period of work, and the proposed amount of moonlighting time.




                                                                36
                               ACADEMIC LEAVE
                      CONFERENCE AND PRESENTATION TRAVEL

                                            PURPOSE
Promote resident participation in national emergency medicine conferences and define resident
responsibilities.

                                            POLICY
The residency program will send all of the PGY-1 residents to the Annual SAEM Academic
Assembly meeting. The department will provide a $1000 stipend. Additional documentation
requirements will be provided prior to the annual meeting.

If a resident has a scholarly project accepted for presentation at a regional or national meeting,
the residency program will make every effort to provide a $500 stipend for travel.

If a resident holds an office in a national medical organization, and this role is approved by the
Residency Director, the residency program will make every effort to provide a $500 stipend for
travel necessary to fulfill the obligation to this office.

This policy, by necessity, may be changed without notice by the Residency Director or the Chief
of Service.

It is the responsibility of the resident to arrange coverage for clinical duties while attending a
meeting for either educational or administrative purposes. An official Academic Leave Request
form must be submitted and approved by the rotating service prior to making travel
arrangements.

One (1) Academic leave is allowed per year. Academic leave must be approved by the Program
Director.




                                                                 37
                     HYPERBARIC OXYGEN (HBO) CHAMBER CALL

                                             PURPOSE
To define resident on-call responsibilities as they pertain to the treatment of hyperbaric oxygen
patients.

                                            POLICY
Residents are expected to complete the HBO certification course prior to the completion of their
PGY-1 training. This course is held annually in the spring and dates are determined by Dr.
Gross. Medical clearance is required prior to the training “dive.”

If a resident is unable to dive due to medical reasons, the training course should be completed
excluding the dive experience.

PGY-2 and PGY-3 residents will cover HBO Call for up to four (4) weeks per year as arranged
by the Chief Residents.

HBO Call consists of “First Call” and “Second Call.” Residents on First or Second Call will be
available by pager at all times during their call week. They are expected to be available within
30 minutes of contact and able to dive or work in the ED.

If the First Call resident is unable to dive, it is their responsibility to coordinate, from the on call
list, the resident able to attend the dive. The exception to this is after a dive, a provider is unable
to dive again for a period of time determined by the length of that dive. In this case, it is the
resident’s responsibility to notify the ED of the time they are available to dive again in order to
shift dive responsibilities to the Second Call resident. If the resident has not notified the ED of
their inability to dive, they will be responsible for arranging coverage for the dive.

This process applies to the Second Call resident if they are unable to dive as a result of having
already performed a dive.

If a resident is unable to “dive” for medical reasons, on call responsibilities will be to replace
another able resident from their clinical duties in order to dive.

The HBO call schedule is available on line at:
http://www.hcmc.org/education/residency/emresidency/HyperbaricSchedule.htm

Any changes to the published schedule made more than 24 hours (and less than 7 days) prior to
the start of the call day need to be communicated to the Chief Residents by email. The hospital
operator needs to be notified of this change as well at 612-873-3000.

Any changes to the published schedule made less than 24 hours prior to the start of the call day
need to be communicated to the Chief Residents by direct contact. The hospital operator (612-
873-3000) and the ED (612-873-3132) need to be notified by phone.

                                                                   38
                             OFF-SITE ELECTIVE ROTATIONS
                                 (HCMC Institutional Policy)

                                           PURPOSE
To provide educational experiences, with curriculum not available at HCMC, that meet the
educational goals and needs of residents/fellows.

                                             POLICY
The hospital shall provide residents/fellows opportunities for off-site, elective rotations to meet
their educational goals and needs. These experiences shall be limited in number and shall be
experiences that cannot otherwise be obtained at HCMC. The hospital shall also support twelve
(12) months of out-of-country rotations to provide residents/fellows opportunities for off-site,
elective rotations for experiences that cannot be duplicated in the United States.

Medicare reimbursement regulations shall be strongly weighed in the approval/denial process of
all off-site, elective rotations. A rotation may not be approved if requirements are not met as
outlined below and on the “Request for Off-Site Elective Rotation Letter of Agreement” form
(request form). If a rotation is taken that has not been approved by the OMD, the resident may
not be paid a salary during the off-site rotation.


PROCEDURE

OFF-SITE ELECTIVE ROTATIONS WITHIN THE U.S.:
The Resident/Fellow shall:
       Obtain a request form.
       Complete the request form including specific educational objectives. (Volunteer
community service, visiting a country where a resident had medical training, trying out a
potential job or language training are not adequate objectives.)
       Obtain approval/signature on the request form from the Residency Program Director.
       Forward the request form to assure it arrives in the Office of the Medical Director (OMD)
no less than six weeks prior to the intended start of the rotation.
       Immediately prior to leaving for the off-site rotation, complete all available medical
records and meet any other requirements.
       Assure they have appropriate malpractice coverage for the rotation (refer to #7 on the
“Request for Off-Site Elective Rotation Letter of Agreement”).
       Perform any necessary follow-up, as directed by the OMD, to facilitate the receipt of all
required information and forms.

The Residency Program shall:
     Provide a request form to resident/fellow.
     Approve the educational rationale for the off-site rotation.
     Update master rotation schedule in Residency Management Suite (RMS).


                                                                39
The OMD shall:
       Review the request form for completeness and appropriateness.
       Forward the request form to the Administrative Manager for Graduate Medical Education
(GME) for review of all elements (including educational goals) and for signature.
       Forward the request form to the HCMC Medical Director for final approval signature.
       Send the resident/fellow a memo, which acknowledges receipt of request form and
indicates tentative approval or the denial of the request.
       Prepare the Letter of Agreement (LOA) and send it to the off-site location for their
signature. The off-site location signs the LOA and returns it to the OMD. This signed LOA
must be received by the OMD prior to the start of the rotation.
       If site does not return signed LOA two (2) weeks prior to the rotation start date, notify
resident/fellow who must follow up with the rotation site to facilitate receipt of the LOA.
       Upon final approval of the rotation, send a copy of the LOA (dated and stamped
“approved”) to the requesting resident/fellow and to the HCMC Residency Program Office and
retain the original.

OFF-SITE ELECTIVE ROTATIONS OUTSIDE THE U.S.:
A Resident/Fellow who has completed twelve (12) months of training at HCMC, is not on
probation and is in good standing shall:
       Obtain a request form.
       Complete the request form including specific educational objectives. (Visiting a country
where a resident had medical training, trying out a potential job or language training are not
adequate objectives.)
       Obtain approval/signature on the request form from your Residency Program Director.
       Forward the request form to assure it arrives in the Office of the Medical Director (OMD)
no less than six weeks prior to the intended start of the rotation.
       Perform any necessary follow-up, as directed by the OMD, to facilitate the receipt of all
required information and forms.
       Immediately prior to leaving for the off-site rotation, complete all available medical
records and meet any other requirements.

The Residency Program shall:
       Provide a request form to resident/fellow.
       Approve the educational rationale for the off-site rotation.
       If they have received requests above their quota, request an out-of-country rotation
position from another program.
       Update master rotation schedule in Residency Management Suite (RMS).

The OMD shall:
      For each academic year, set a quota for the number of out-of-country rotations that will be
allowed by each residency program. Annual quotas are: Emergency Medicine –2; Family
Medicine – 3; Internal Medicine – 3; Psychiatry – 2; Surgery – 2.

                                                               40
       Review the request form for completeness and appropriateness.
       Forward the request form to the Administrative Manager for Graduate Medical Education
(GME) for review and signature.
       Forward the request form to the HCMC Medical Director for final approval signature.
       Send the resident/fellow a memo, which acknowledges receipt of the request form and
indicates tentative approval or the denial of the request.
       Prepare the LOA and send it to the off-site location for their signature. The off-site
location signs the LOA and returns it to the OMD. This signed LOA must be received by the
OMD prior to the start of the rotation.
       If site does not return signed LOA two (2) weeks prior to the rotation start date, notify
resident/fellow who must follow up with the rotation site to facilitate receipt of the LOA.
       Upon final approval of the rotation, send a copy of the LOA (dated and stamped
“approved”) to the requesting resident/fellow and to the HCMC Residency Program Office and
retain the original.




                                                              41
                             Family and Medical Leave Guidelines
                                    (HCMC Institutional Policy)


A. Eligibility

Residents are eligible for a Family and Medical Leave Act (FMLA) leave of absence if they have
been employed by HCMC at least twelve months and have worked at least 1250 hours during the
twelve month period immediately preceding the commencement of the leave.

B. Reasons for Leave

Eligible Residents may request Family and Medical Act leave for one or more of the following
reasons:

1. The birth, adoption, or foster care placement of a child;

2. The employee’s own serious health condition;

3. To care for the employee’s spouse, parent or dependent child with a serious health condition.

C. Length of Leave

1. Eligible Residents may take up to twelve weeks of FMLA leave per rolling twelve month
period.

2. Leave may be taken on an intermittent or reduced work schedule basis when the leave is due to
a serious health condition. In some cases, Residents on an intermittent or reduced schedule leave
may be required to temporarily transfer to an alternative position with equivalent pay and
benefits which better accommodates their recurring periods of absence.

3. Leave that is taken in conjunction with birth, adoption or foster care placement must be taken
within one year of the birth, adoption or foster care placement.

D. Notification/Certification Requirements

1. Residents are required to provide their Program Director with at least thirty days notice of the
leave, except where the leave is not foreseeable and/or such notice is not practicable. In such
situations, Residents must provide notice as soon as practicable.

2. Residents requesting FMLA leave must complete an FMLA Certification of Healthcare
Provider. Re-certification of FMLA status may be required every thirty days, where appropriate.

E. Continuation of Benefits

Residents are eligible to continue to participate in the group medical plan as if they are actively at
work.


                                                                 42
F. Medical/Parental Leave Other Than FMLA

Residents not qualifying for FMLA leave may be eligible for leave under the Minnesota
Parenting Leave Act (MPLA). Such leave is for a period of up to six weeks in conjunction with
the birth or adoption of a child. To be eligible for such leave, Residents must work on average
twenty or more hours per week and must have been employed by HCMC for twelve consecutive
months immediately preceding the requested leave. If an employee seeks leave for medical or
parenting reasons and does not qualify for FMLA or MPLA leave, the resident may request a
Personal Leave.



INSURANCE: SHORT-TERM DISABILITY

Short-term disability insurance is provided, at no cost, to all residents through Northwestern
Mutual Life. Enrollment in the disability insurance plan is automatic with no application form
being required. Group Plan Number: S653911.

The plan has a 15-day beginning date. You must be disabled for 14 days before benefits begin.
The plan pays 70% of base income if disabled and benefits can be paid up to 11 weeks.
Maximum weekly benefit is $1,000.

You have “own occupation” coverage through the benefit period. There is no offset if you collect
Social Security Disability Benefits. The plan pays for both total and partial disability.
Pregnancies are covered for four weeks, C-sections six weeks, after the 14 day waiting period.


INSURANCE: LONG-TERM DISABILITY

Long-term disability insurance is provided, at no cost, to all residents through Northwestern
Mutual Life. Enrollment in the disability insurance plan is automatic with no application form
being required. Group Plan Number: L653911.

The plan has a 91-day beginning date. You must be disabled for 90 days before your benefits
begin. The plan pays 80% of base income if disabled and benefits can be paid to age 65. You
have “own occupation” coverage through age 65. There is no offset if you collect Social Security
Disability Benefits. The plan pays for both total and partial disability. The plan contains COLA
(cost of living adjustment) benefits.

For information and questions regarding your long-term disability insurance, please consult your
Group Insurance Certificate and Summary Plan Description or contact Bill Clark of
Northwestern Mutual Life at 952-806-9660.




                                                              43
44
Hennepin County Medical Center
Title: Dress Code

PURPOSE
The Dress Code policy establishes consistent dress code expectations for employees that
project an image that is professional and appropriate to the healthcare/healing
environment. Additionally, in some cases, the requirements are in accordance with
infection control principles. If any information in the policy and procedure conflicts in
any way with applicable collective bargaining agreements or legal requirements, the
collective bargaining agreement and/or legal requirements supersedes the information in
the policy and/or procedure; otherwise, Hennepin County Medical Center’s decisions as
to the interpretation of this information will be final and binding.

DEFINITIONS
Artificial nails: A substance or device applied to the nail for purposes of cosmetics,
strengthening or lengthening (including, but not limited to, acrylics, nail extenders,
bonded nails, wraps, gels, and/or porcelain tips). This does not include intact nail polish
on natural nails.

Designated staff permitted to wear ceil blue scrubs: Burn Center, Cardiac Cath Lab,
Dentistry, Labor and Delivery, MDs participating in sterile procedures, Nurse Midwife
Service, Pathology, Radiology (personnel involved in interventional procedures and who
may enter the Operating Room) and Sterile Central Supply and Surgical Services.

Direct Care Employee: Employees who touch patients in either the inpatient or
outpatient setting.

OSHA: Occupational Safety and Health Administration

Patient Care Support Employees: Employees who provide patient support or prepare
patient product. They may or may not directly touch the patient. Examples include, but
are not limited to, Bioelectronics, Environmental Services, Facilities Management, Food
And Nutrition Services, Interpreters, Laboratory, Nursing Assistants, Occupational
Therapy, Physical Therapy, Phlebotomy and Radiology.

Restricted Areas: Areas in the Operating Room where scrub suit attire is required for the
protection of the patient.


POLICY
General Requirements
1. Employees are expected to present a neat, clean, odor-free and well-groomed
appearance that is professional and appropriate to the healthcare/healing environment.


                                                 45
Clothing and shoes should be clean and in good repair. (Refer to unacceptable attire for
further clarification)

2. Employees must visibly wear a Hennepin-issued photo identification badge above the
waist and below the neckline. The photo must be visible and information on the badge
may not be altered.

3. Pursuant to OSHA requirements, the following areas must wear only closed-toed
shoes: inpatient and ambulatory patient care units; emergency medical services;
laboratory; radiology; pharmacy; food and nutrition services; environmental services;
security; and any other area where there is danger of foot injuries due to falling or rolling
objects and/or there is risk of feet being exposed to an electrical hazard. All other
employees may wear open-toed shoes provided they also wear socks or hose,
and the shoes are professional and appropriate to the work being done. If closed-toed
shoes are worn, employees are not required to wear socks/hose.

4. The use of scents is not permitted. Unacceptable scents include, but are not limited to,
cologne, perfume, scented body lotions, scented hair products and scented body wash.

5. For infection control reasons, direct care and patient care support employees must keep
their natural fingernails short, clean and healthy, and must not wear artificial nails, acrylic
overlays or “J” nails, nail jewelry or decals. Employees working with patients who are at
risk of acquiring infections should keep their natural fingernails no longer than one-
quarter inch long.

6. The use of jewelry must be limited to comply with infection control standards and to
what can be safely worn within the responsibilities of the job.

7. Facial piercings and tattoos must be discreet and appropriate to the health care / healing
environment. In some situations, employees may be required to remove or cover facial
piercings, replace facial jewelry with more discreet jewelry, and/or cover visible tattoos
while at work.

8. Inpatient Direct Care Employees (see Definitions) must wear a uniform or scrubs,
except those employees working in Psychiatry or Knapp Rehab may wear professional
casual attire to eliminate perceived emotional barriers between the patients and staff.
Green scrubs will be issued to residents and Emergency Department physicians.

9. For infection control reasons, ceil blue scrubs may only be worn as described below:

a. Ceil blue scrubs may be worn only by Designated Staff (see Definitions). These scrubs
are used for protection of the patient and are not considered personal protective apparel
for hospital staff. These will be hospital laundered only.


                                                  46
b. Staff who wear hospital issued ceil blue scrubs are expected to comply with the
following requirements:
        i. Scrubs should be donned in a designated dressing area of the facility upon entry
         or reentry to the facility.

       ii. If scrubs are worn into the organization from outside, they must be changed
       before entering Restricted Areas (see Definitions), except if walking directly from
       one building to another or in the case of a medical emergency.

       iii. Scrubs may not be worn outside for breaks.

c. A manager may approve the use of ceil blue scrubs if an employee’s regular
uniform/street clothes has become sufficiently soiled during their shift.

10. Lab Coats

a. Medical and resident staff may wear lab coats provided by the hospital.

b. Laboratory employees must wear hospital provided lab coats within their department
when working at a bench.

c. Other employees may wear employee-provided lab coats.

11. Barrier gowns (isolation gowns)

a. Barrier gowns are considered personal protective apparel and should be worn anytime
clothing may become soiled with blood or body fluids or when cleaning contaminated
equipment.

b. Barrier gowns should not be worn outside of the patient care area.

c. Barrier gowns should not be worn as an extra layer for warmth.

12. Lab coats, scrub suits or other clothing provided by Hennepin must be returned when
leaving employment or if transferring to a job within Hennepin that does not require or
permit such attire to be worn.

Unacceptable Attire
The following attire is considered unacceptable:
Shorts and mini-skirts
Halters and midriff-baring garments; sleeveless tops are unacceptable unless worn
under a jacket, sweater, scrubs, etc.
Sweatpants and leggings


                                                47
Sweatshirts and casual tee-shirts, with the exception of those with unit-specific or
Hennepin logos or during a Hennepin promotion or specific sponsored event
In patient care areas, it is not appropriate to wear items affixed to clothing (such as
buttons or lanyards) with words on them if the words reflect negatively on Hennepin or
any of its programs, or contain words that could cause customers to question the quality
of Hennepin’s care or programs.
For safety reasons, it is not appropriate for employees who provide direct patient care to
wear dangling jewelry or lanyards that do not break away.
Blue jeans, unless performing work related to building construction.
Clothing that is conspicuously transparent, unkempt, tight or revealing
Sandals that would be worn as beachwear, i.e., flip-flops, etc.
Attire that may reasonably be considered offensive to patients, visitors or other
employees.


Employees working in Emergency Medical Services, Food and Nutrition Services,
Security, and Surgical Services have additional dress code requirements. Contact the
department manager for information about those requirements.




                                                48

								
To top