Department of OB/GYN

Residency Policies and Procedures

INDEX

  1. Administrative Chief Residents
  2. Call Responsibilities
  3. Conference Attendance
  4. Clinical Experience and Education (Duty Hours)
  5. Eligibility & Selection of Residents
  6. Faculty Supervision of Resident Activity
  7. Sleep Deprivation, Fatigue Mitigation and Alertness Management Policy
  8. Leave, Vacation, & Absence Record
  9. Resident Responsibilities, Disciplinary Actions, Grievance Procedures
  10. Moonlighting
  11. Professional Conduct
  12. Professional Development Funds
  13. Progress & Promotion
  14. Resident Statistics
  15. Transitions of Care/Handover
  16. CREOG Remediation
  17. Quality Improvement
  18. Wellness

I. ADMINISTRATIVE CHIEF RESIDENTS

Each year, the Program Director with the concurrence of the Residency Education Committee, will select an Administrative Chief Resident. The Administrative Chief Resident will work closely with the Program Director on such issues as the Resident Call Schedule, conferences, resident leave, and orientation of new residents. Also, to ensure accurate presentation in the Morbidity and Mortality Conferences, to help plan the end of the year resident graduation banquet, and to communicate frequently with other residents and the faculty to ensure an atmosphere of cooperation, open mindedness, and mutual respect in the overall conduct of the program. The Chief Resident will receive a supplement to their salary for their efforts.

II. CALL RESPONSIBILITIES

Resident call responsibilities will be assigned by the Administrative Chief Resident with the concurrence of the Program Director. It is anticipated that the “call schedule” will be constructed at least six months in advance. Residents may change call responsibilities with the approval of the Administrative Chief Resident and Program Director. Call assignments will be made to ensure the Residency Program is compliant with the resident duty hour policies. The frequency of resident call responsibilities is enumerated below in the Call Guidelines Policy:

We must ensure compliance for all residents in the 80 hour work week, including 24 hours off each week. To accomplish this, the following guidelines are in place:

  1. Labor and Delivery
  2. Service turnover - weekends:
  3. Weekends:
  4. Friday PM – 1700
  5. Saturday/Sunday AM – 0600
  6. Saturday/Sunday PM – 1800
  7. Saturdays only: OB Chief is to be dismissed for home call; goal for dismissal is midnight (at the discretion of the on-call attending)
  8. Resident responsibilities for call shifts:
  9. Intern: On-coming, off-going and off-service residents share responsibility of MBU notes/rounding. Checkout MBU patients with chief (this means off-going intern checks out MBU patients prior to leaving to go home). Off-going interns are responsible for all discharge paperwork. If any reasonable discharge paperwork is not complete, notify the chief.
  10. Midlevel (Saturday/Sunday 0600-1800): Responsible for MFM rounding including antepartum and postpartum (excluding L&D patients). Responsible for giving full formal checkout to on-coming night team.
  11. Night float PGY3 (Thursday – Monday nights): Responsible for L&D rounding/notes. Responsible for giving full formal checkout to on-coming day team.
  12. OB Chief: On-coming resident is responsible for MBU rounds with interns, ensuring labor and delivery coverage while interns and mid-levels round.
  1. Gynecology/Gynecologic Oncology
  2. Service Turnover:
  3. Friday PM – 1700
  4. Saturday AM – 0600
  5. Sunday AM – 0600
  6. Sunday PM – 1800
  7. Resident Responsibilities:
  8. Consults, floor work, any OR cases
  9. GYN turnover email
  10. Keep GYO list updated
  11. Off-going resident:
  12. GYO – round and write notes for all patients on the service prior to service turnover
  13. Give full checkout on all GYN and GYO patients to on-coming resident
  14. On-coming resident:
  15. GYO – round with fellow in AM, typically 0630 or 0700, also round with the attending later in the morning if available
  16. GYN – Round at GSH prior to 0930 if possible. GSH patients are NOT to be treated as second-class patients because it is inconvenient to round on them. Tidying up GYN-ONC service does NOT take priority over GSH/Benign GYN patients.

Labor & Delivery Chief Home Call (Saturdays)

  • Primary goal is for Chief Residents to be dismissed by midnight; this is at the discretion of the on-call attending.
  • The Chief Resident is then on home-call and may be called back in if necessary.
  • PGY3 residents on Night Float will cover from Thursday to Monday for adequate coverage.

III. DIDACTIC ATTENDANCE

Residency program didactic sessions occur each Tuesday from 8:00am-12:00pm. Each “session” is one hour. Residents are required to attend 60% of these didactic sessions. Residents can use this time to schedule medical, mental health, and dental care appointments but must still meet the required 60%. Failure to meet this requirement will result in remediation involving but not limited to assigned readings and/or a case presentation. In addition, if a resident is not on an approved leave, post-call or attending patient care responsibilities, the resident must submit an absence request to miss didactics. Failure to do so will result in the resident having to use vacation time.

Didactic attendance is monitored via sign-in sheets which are logged in MedHub.

VI.CLINICAL EXPERIENCE AND EDUCATION (DUTY HOURS)

Residents and faculty members are educated concerning the professional responsibilities of physicians to support patient safety and assume personal responsibility by assuring fitness for duty, appropriate management of their time, recognition of impairment including fatigue, monitoring of patient care performance, and commitment to lifelong learning.

Duty hours are defined as all clinical and academic activities related to the training program including in-house clinical and educational activities and clinical work done from home.

It is the responsibility of all residents to log their duty hours as defined by the ACGME Program Requirements. This is part of the Professionalism Competency.

All residents are expected to have completed their duty hoursone week after the last day of each month. If they are not completed, they resident will be taken out of clinical duties and required to enter their hours. They will not return to clinical duties until this is completed.

The time away from clinical duties will be considered a Departmental formal disciplinary action and as such is reportable on future credentialing forms when requested.

Maximum Hours of Clinical and Educational Work per Week

Duty hours must be limited to 80 hours per week, averaged over a four week periods inclusive of all in-house clinical and educational activities and clinical work done from home.

Mandatory Time Free of Clinical Work and Education

Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). One day is defined as a continuous 24-hour period between all daily duty periods and after in-house call. Residents will be provided opportunities for rest and personal well-being. Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.

Residents should have eight hours off between scheduled clinical work and education periods.

Maximum Clinical Work and Education Period Length

Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments. Up to 4 hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education.Additional patient care responsibilities are not to be assigned to a resident during this time.

In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances:

  • to continue to provide care to a single severely ill or unstable patient.
  • humanistic attention to the needs of a patient or family.
  • to attend unique educational events.

All hours mentioned in addition to rare circumstances will be counted toward the 80-hour weekly limit.

Residents are encouraged to use alertness management strategies (see VII).

Maximum Frequency of In-House Night Float

Residents must not be scheduled for more than six consecutive nights of night float and must occur within the context of the 80-hour and one-day-off-in-seven requirements.

Maximum In-House On-Call Frequency

In-house call is defined as those duty hours beyond the normal workday when the Resident is required to be immediately available in the assigned institution. PGY-2 Residents and above must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).

At-Home Call

At-home call is defined as call taken from outside the assigned institution. Time spent in the hospital and patient care activities at home by Residents on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks. Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new “off-duty period”.

V.ELIGIBILITY AND SELECTION OF RESIDENTS

Application to Residency

The Obstetrics and Gynecology Residency Training Program at the University of Kentucky will accept applications only through the ERAS System. The Program will abide by its ethical and procedural rules. The ACGME’s “Institutional Requirements” for residency eligibility and selection will also be carefully followed.

  • Resident Eligibility: Graduates of LCME and AOA accredited schools are eligible. Additionally, graduates of medical schools outside the United States and Canada who meet one of the following requirements: (1) have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates prior to appointment, or (2) have a full and unrestricted license to practice medicine in a US licensing jurisdiction in which they are training. Graduates of medical schools outside the United States who have completed a fifth pathway provided by an LCME-accredited medical school.
  • Resident Recruitment: Completed applications from ERAS will be reviewed by the Program Director and/or members of the Residency Education Committee. Applications will be reviewed based on a candidate’s preparedness, eligibility, ability, aptitude, academic credentials and potential, communications skills, letters of recommendation and personal qualities such as motivation and integrity. The Program will not discriminate with regard to sex, race, age, religion, color, national origin, disability, or veteran status. After screening, specific applicants will be invited to interview.
  • After invitations to interview have been extended, and applicants have responded, a series of resident interview days will be established. Typically, there will be five to six half days devoted to this activity. Efforts are made to accommodate applicant convenience among the scheduled days.
  • On the evening before the interview day, invitees will be encouraged to attend a gathering which is sponsored by current resident physicians in the program. Faculty may also be present. The goal is to provide an opportunity outside of the medical center in which current residents, faculty and applicants can converse.
  • The interview day will include an overview of the various divisions and components of the program. Applicants for residency positions typically meet with two teams of interviewers which are composed of a faculty member and a resident. Additionally, all interviewees will interview with the Program Director and Chairman. Applicants will be discussed during a brief “post-interview” meeting of all resident and faculty interviewers for each specific day of interviews.

At the beginning of their day of interviewing, the Program Manager will give applicants information about stipends and benefits at the University of Kentucky, a copy of the current University of Kentucky contract, a copy of the Graduate Medical Education Resident and Fellow Handbook, as well as the “University of Kentucky Interviewee Information Items” which contains information about which they need to be aware. After being provided the required items, interviewees will be asked to confirm that they have received the information and sign a certifying statement to that effect. Additionally, they will be given a supplemental information form, and an authorization for release of information form.

  • Resident physicians as well as faculty physicians review all of the applicants who interviewed and develop separate “rank order” lists. The criteria outlined above (Resident Recruitment) as well as information learned during the interviews and ensuing discussions is used to construct the lists. The Program Director and/or the Residency Education Committee will carefully evaluate both lists and determine the final overall “ranking” for the program.
  • The Departmental ranking will be entered in the NRMP in accordance with their timeframes.
  • After Match results are known, the Department will communicate with and welcome the new residents.
  • In the event that the Residency Program does not fill of its positions through the Match, the program will, through personal communication and/or through the “scramble” attempt to identify suitable candidates. Positions unfilled in the Match may be offered to qualified applicants by our Program, but this offer will be made with a clear communication to the applicant, both verbally and in writing, that the appointment is contingent on the applicant meeting requirements, and passing a credential review.
  • Appointment is effected through execution of a contract between the applicant and the University of Kentucky.

VI. FACULTY SUPERVISION OF RESIDENT ACTIVITY

To ensure oversight of Residents supervision and graded authority and responsibility, the following classification of supervision are used:

  • Direct Supervision – the supervising physician is physically present with the resident and patient.
  • Indirect Supervision with direct supervision immediately available – the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision.
  • Indirect Supervision with direct supervision available – the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.
  • Oversight – the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Each patient, in the clinical learning environment has an identifiable, appropriately credentialed and privileged attending physician who is ultimately responsible for that patient’s care. This information is made available to Residents, faculty members, other healthcare providers and patients through the use of patient room white boards, the EMR, team schedules, etc.

Residents and faculty members should inform patients of their respective roles in each patient’s care with each encounter.

Faculty supervision assignments should be of sufficient duration to allow assessment of the knowledge and skills of each Resident and delegate to him/her the appropriate level of patient care authority and responsibility.

An appropriate level of supervision exercised through a variety of methods as defined above is in place for all Residents that care for patients. Faculty members functioning as supervising physicians are expected to delegate portions of care to Residents, based on the needs of the patient and the skills of the Resident.

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

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each Resident by PGY/level of training include:

PGY1:

Indirect supervision is allowed for:

Patient Management Competencies:

  • evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests
  • evaluation and management of post-operative patients, including the conductof monitoring, and orders for medications, testing, and other treatments
  • discharge of patients from the hospital
  • interpretation of laboratory results

Procedural Competencies, after competency is demonstrated:

  • Pap tests
  • STD testing
  • Digital cervical exams
  • Basic ultrasound for presentation

Direct supervision is required until competency is demonstrated for:

Patient Management/Procedural Competencies

  • Required for all surgeries and deliveries
  • Leep/Colposcopy
  • Endometrial/vulvar biopsy
  • IUD placement

Intermediate Resident:

Indirect supervision is allowed for:

Patient Management Competencies:

  • evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests
  • evaluation and management of post-operative patients, including the conductof monitoring, and orders for medications, testing, and other treatments
  • discharge of patients from the hospital
  • interpretation of laboratory results
  • transfer patients between hospitals

Procedural Competencies:

  • Pap tests
  • STD testing
  • Digital cervical exams
  • Basic ultrasound for presentation
  • Endometrial/vulvar biopsy
  • IUD placement

Direct supervision is required until competency is demonstrated for:

Patient Management/Procedural Competencies

  • Required for all surgeries and deliveries

PGY-3/4:

Indirect supervision is allowed for:

Patient Management Competencies:

  • evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests
  • evaluation and management of post-operative patients, including the conductof monitoring, and orders for medications, testing, and other treatments
  • discharge of patients from the hospital
  • interpretation of laboratory results
  • transfer patients between hospitals

Procedural Competencies: