Emory Family Medicine Residency Program

Handbook

2013

updatedUpdatedJanuary 30, 2013 by Dr. Schayes

Table of ContentsPage #

2-3

I.Introduction

A.Background...... 4

B.Mission Statement...... 5

C.Structural Framework...... 5

D.Principles of Family Medicine...... 5

E. ACGME Competencies……………………………………………………. 5

II.Curriculum Design

A.Overview...... 6

B.Morning Report...... 6

C.Conferences...... 6

D.Scholarly Project...... 7

E.Videotaping...... 9

F.Balint/Support Group...... 10

G.Maternity Care...... 10

H.Didactic Policy……………………………………………………………..11

I. Home visits………………………………………………………………...12

III.Policies and Procedures

A.Leave...... 14

B.CME and Book Money…………………………………………………….16

C.ABFM Policies...... 18

D.ACGME-Residency Review Committee (RRC) Requirements...... 18

E. Duty Hours………………………………………………………………….18

F.Moonlighting...... 19

G.Probation, Suspension, and Dismissal………………...... 20

H.Due Process and Appeal/Grievances……...... 21

I.Supervision...... 22

J.Resident Support...... 22

K.Dress Code...... 22

L.Consultations and Referrals...... 23

M.Resident Selection and Eligibility...... 23

N.Advisor/Advisee System...... 24

O.USMLE Requirements...... 24

P.GA Medical Licensure...... 25

Q.Medical Records...... 25

R.Medical Library/Informatics...... 26

S.Off-service Residents/Med Students/Physicians Assts. (PA) Students……26

T.Release of Information...... 26

U.Promotion...... 26

V. Professionalism...... 27

W.Graduation...... 28

1

X.Chief Resident Selection...... 28

Y.Documentation...... 30

Z.Electives...... 30

ZZ.In training Exam...... 31

IV.Clinical Duties

A.Family Practice Center...... 31

B.Family Medicine Inpatient Service...... 31

C.Call...... 32

V.Benefits...... 32

VI.Evaluation

A.Resident Evaluation...... 32

B.Rotation Evaluation...... 33

C.Faculty Evaluation...... 33

VII.Organizational Structure

A.Organizational Chart...... 354

B.Faculty Responsibilities...... …354

C.Residency Staffand Staff Responsibilities...... 354

D.Chief Resident Responsibilities...... 35

VIII.Faculty and Resident Information

A.Faculty...... Appendix P

B.Residents...... Appendix Q

C.Graduates...... Appendix R

XVIII.Appendices of Documents Appendices …...... 37

Appendix A – Organizational Chart

Appendix B – Rotation goals and objectives(on line)

Appendix C – Didactics attendance policy/expectations by rotation

Appendix D – Scholarly Project Checklist(on line)

Appendix E – Emory GME House Staff Policies and Orientation Manual (GME website:housestaff)

Appendix F – Leave Request Form (on line)

Appendix G – Emory tax-exempt form for purchases (Found in the Department Intranet site)

Appendix H – ABFM (American Board of Family Medicine) Policies:

Appendix I – ACGME-RC Program Requirements:

Appendix J – Institutional Requirements

Appendix K– Request to Moonlight form (GME website: Housestaff)

Appendix L – EFMRP requirements for promotion:

Appendix M – Elective request form

Appendix N – Educational Prescription

Appendix O – Rotation evaluation form (on line)

I. Introduction

  1. Background

The Emory Family Medicine Residency Program (EFMRP) is committed to training excellent family physicians, capable of practicing full spectrum family medicine in the 21st century. We accomplish this by carefully incorporating clinical activity, education, and scholarly activity within the clinical and academic setting of Emory University School of Medicine.

Our Family Medicine Center (FMC) comprises the Section of Family Medicine, an organization passionately committed to patients’ health through sharing of knowledge and the discovery of breakthrough healthcare. We believe in training our residents to educate themselves, their patients, and each other as we deliver healthcare. We believe in educating our residents as adult learners. It is therefore incumbent on residents to do self-evaluation to assess their goals, needs and progress. With the help of their family physician faculty advisors, residents learn to set objectives based on these goals, decide what experiences are needed to achieve them, and learn how to seek out knowledge as part of their continuing medical education. In turn, the residents, while caring for their patients, are taught to educate them about their healthcare and guide them as the patients make decisions regarding their own healthcare. As the residents progress through their training, they are taught and encouraged to educate each other, other healthcare providers, and the community through conferences, lectures, and community talks.

Family physicians actively lead the teaching of the residents in formal settings such as precepting, lectures, and on ward rounds. However, we believe that one of the most important methods of teaching is by being role models for the residents. The family medicine faculty set the standard as faculty members are providers of comprehensive care to the individual and the family. Faculty members see patients in the Family Medicine Centers, the hospital, perform procedures, and continue to deliver maternity services. Behavioral medicine faculty,, well versed in family systems, family theory, and counseling, assist by providing additional role modeling and teaching in behavioral medicine and mental health. Nursing and administrative personal also participate in the education of residents by guiding them through the process of seeing patients in the FMC, and by modeling how the FMC attends to individual patient and family needs.

The family physician faculty also guide the residents in how to be part of the healthcare team, demonstrating and teaching how to interact with consultants in other specialties, social services, nutrition services, physical and occupational therapy, and community resources.

The residency exists within the Department of Family and Preventive Medicine, part of the Emory University School of Medicine. As a new addition to this academic tradition, the Family Medicine Residency strives to make contributions to the discipline of family medicine and to other disciplines, through research and other scholarly activities, and through participating in the education of other members of the medical community.

It is through the careful combination of clinical care and academic endeavors that our enthusiastic faculty train Emory Family Medicine residents for practice in the 21st century.

  1. Mission Statement
  2. Our mission is to facilitate each resident’s growth as an individual and as a family physician.
  3. Guiding Values and Principles:
  4. To commit to lifelong learning.
  5. To practice medicine with integrity.
  6. To advocate for patients at all times.
  7. To promote autonomy while encouraging teamwork.
  8. To participate actively in the community.
  9. To respect diversity of culture and spirituality.
  10. To balance personal and professional lives.
  1. Structural Framework
  2. The EFMRP exists within the context of several administrative organizations. The organizational diagram is located in the Appendix section (Appendix A).
  1. Principles of Family Medicine
  2. Continuity of care
  3. Comprehensive and holistic service
  4. Cultural sensitivity
  5. Community orientation
  6. Cost-effectiveness
  7. Highest quality of care possible
  8. Patient Advocacy

E. ACGME Competency-based education

Residency education in the United States is governed by the Accreditation Council for Graduate Medical Education (ACGME). The ACGME has defined six competencies by which residency education is conducted and EFMRP complies with these competencies.

1. Patient Care - Gather data; order diagnostic tests; interpret data; make decisions; perform procedures; manage patient therapies; work with others to provide patient-focused care

2. Medical Knowledge - Fund of knowledge; active use of knowledge to solve medical problems

3. Practice-Based Learning & Improvement - Analyze practice performance and carry out needed improvements; locate and apply scientific evidence to the care of patients; critically appraise the scientific literature; use the computer to support learning and patient care; facilitate the learning of other health care professionals

4. Interpersonal & Communication Skills - Develop a therapeutic relationship with patients and their families; use verbal and non-verbal skills to communicate effectively with patients and their families; work effectively as a team member or leader

5. Professionalism - Demonstrate integrity and honesty; accept responsibility; act in the best interest of the patient; demonstrate sensitivity to patients' ethnicity, age, and disabilities.

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

  • compassion, integrity, and respect for others;
  • responsiveness to patient needs that supersedes self-interest;
  • respect for patient privacy and autonomy;
  • accountability to patients, society and the profession; and,
  • sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

6. Systems-Based Practice - Demonstrate awareness of interdependencies in the health care system that affect quality of care; provide cost-effective care; advocate for quality patient care; work with hospital management and interdisciplinary teams to improve patient care

II. Curriculum. Curriculum Design

  1. Overview
  2. During the three year course at EFMRP, the resident will achieve the followingGOALS:
  3. Learning to provide comprehensive, family-oriented primary care.
  4. Providing family-oriented maternity care.
  5. Training in procedural skills that allow the patient to stay with their primary physician.
  6. Learning behavioral medicine skills and resources for patient counseling and education.
  7. Practicing preventive medicine.
  8. Coordinating the health care team including other specialty physicians, allied health care providers, and community resources.
  9. Practicing evidence-based medicine.
  10. Learning community-oriented primary care.
  11. Learning practice management and administrative skills necessary in today’s changing healthcare systems.
  12. Learning to be an educator of patients, families, communities, other trainees, and self.
  13. Beginning the process of lifelong learning, including self-assessment.
  14. Providing an environment for residents to grow as physicians, individuals, and as a cohesive team.
  1. Specific Rotation Goals and Objectives

a. See individual rotation curricular descriptions (Appendices x DocumentsB).

  1. Morning Report
  2. Weekdays 7:30-8:30 a.m.
  3. Weekends 8:30-9:30 a.m.
  4. Residents taking 24 hour call for the service are required to be at Morning Report post-call.
  5. Weekend attendance is required of the resident group going off call and coming on call.
  6. If there are no admissions on call, it is the expectation that the team on call will present a learning topic.
  7. We emphasize teaching, and patient safety during handoffs at morning report.
  1. Conferences
  2. Residency didactic sessions are held Thursday from 8:00 a.m. to 12:00 p.m.
  3. Attendance at these sessions is required of all residents during all but specified rotations (Appendix DocumentsC).
  4. It is the resident’s responsibility to personally sign in and turn in evaluation forms after each didactic session.
  5. Didactic attendance is a mandatory component of the EFMRP.
  6. Patient Centered Medical HomeHuddle is held from 8:15 – 8:30 am and 1:15-1:30 p.m. every day. All residents are expected to attend when in clinic and not on call.
  7. Numerous other didactic conferences are available from all the departments at Emory. Attendance may be required when on certain rotations.

7. EFMRP places high emphasis on the quality of the didactics program. Our expectation is that residents who are scheduled to speak/present will do so in a professional and timely fashion. In the unfortunate situation in which a resident foresees that they will not be able to present (on vacation/CME/etc...), they will contact the Chief Residents:(Drs. Burkmar and HumpriesDeshmukh/Massoud and ) and the Residency DidacticsMD Coordinator (Dr. Lianne Beck, MD) to reschedule and make sure that their time will be covered with another well-prepared lecture. If the involved resident does not do this, the Program Director will institute a disciplinary measure to help the involved residents be aware of their breech of professionalism and common courtesy. This measure may take the form of:

a. Extra call

b. Forfeiture of book money

c. Forfeiture of CME money/time

d. Official letter of reprimand from the PD

e. Probation for repetitive occurrences and a letter of reprimand.

Professionalism is one of the ACGME six core competencies.

  1. Scholarly Project Procedure and Deadlines 20132-20143
  2. A scholarly project is required of each resident prior to completion of the residency. Residents will not be approved for graduation without the project being received in an acceptable manner.
  3. The goal of the scholarly project is to create a lifelong interest in scholarship and the skills needed to accomplish it. Such skills include:
  4. Ability to conduct a literature review
  5. Ability to design a research study
  6. Ability to critically evaluate research articles
  7. Ability to apply evidence-based medicine to the practice of medicine
  8. Ability to synthesize information
  9. Ability to communicate information to others
  10. Research or scholarship is a systematic attempt to test or develop knowledge. The audience for scholarly activity on the part of residents may be faculty, peers, medical students or the public.
  11. Production of scholarly work to fulfill the scholarly project requirement for the Emory Family Medicine program may be demonstrated in any of the following ways:
  1. A poster presentation presented at a preapproved regional or national conference
  2. A paper presentation presented at a preapproved regional or national conference
  3. Submission of a (complete) publishable quality manuscript

All residents are responsible for adhering to the deadlines below by submitting the relevant components in an email attachment to the following people: Ashley Owen PhD, Wayne Blount MD, the resident’s research advisor, and the resident’s academic advisor. Residents are to use the following email addresses for Ashley Owen and Wayne Blount: mailto:; .

Following are the three required deadlines for 20132:

PGY2 December 1.....Submission of Letter of Intent that has been preapproved by research advisor

PGY3 September 1.....Literature review, preapproved by research advisor

PGY3 December 1..... Final draft of project, preapproved by research advisor

Following are the three required deadlines for 20143:

PGY2 July 1.....Submission of Letter of Intent that has been preapproved by research advisor

PGY3 July 1.....Literature review, pre approved by research advisor

PGY3 December 1..... Final draft of project, preapproved by research advisor

All residents are free to offer their submissions prior to the deadlines. However, if a resident wishes to fulfill the scholarly project requirement by presenting a poster or paper at a conference, he or she is required to 1) obtain approval of the conference from his or her research advisor and 2) submit all three deadline components a) Letter of Intent, b) Literature Review, and c) final draft of project (preapproved

by his or her research advisor), within a minimum of 1 month prior to the conference date. Additionally, any evaluations/ written feedback offered to the resident in regard to the conference presentation must be scanned and emailed to the faculty listed above within 1 month of the presentation. Presentations that have not conformed to these guidelines will not meet the requirements for fulfillment of the scholarly project.

The consequence for missed deadlines is as follows: For each missed deadline, the resident, his or her research advisor, and the Chief Residents will be electronically notified of the need for an extra call assignment. For each additional week beyond the deadline that the resident has not submitted, an additional call assignment will be made.

All PGY3 residents must present their project in PowerPoint format at the annual Residency Research Symposium held in the Spring. If, for some reason, a resident is unable to present at this symposium, he or she must arrange to present the project at didactics. Both this internal didactics presentation and, if the resident is presenting at a regional or national conference, the external conference presentation must occur within a 6‐week window prior to graduation. If a resident’s presentation is not completed prior to this window, both receipt of a graduation certificate and release of letters to the American Board of Family Medicine will be delayed until the 6‐week window is achieved.

The Residency Research Coordinator (RC, Ashley Owen, PhD) will review each scholarly project at its inception to determine if it meets the requirement for the scholarly project. A project will be judged to be appropriately scholarly if it is suitable for submission to a peer-reviewed journal, or if it meets the following criteria (Glassick’s):

  1. Clear goals
  2. Adequate preparation
  3. Appropriate methods
  4. Significant results (does not imply statistical significance)
  5. Effective presentation
  6. Reflective critique
  1. Posters, presentations and other projects must be approved as scholarly projects by the RCprior to his/her presentation, in order to satisfy the residency requirement.
  2. For each project, a research advisor must be identified. The research advisor will monitor and document the resident’s progress using the Scholarly Project Checklist Appendix of Documentsshown in Appendix D). The resident will provide an updated copy of this form to the faculty advisor and the RC prior to each resident quarterly review.
  3. Scholarly project documents on final completion are to be electronically submitted to the Residency Program Director, Residency Research Coordinator (AshleyOwen PhD), Wayne Blount MD, Residency Program Coordinator, and the resident’s Research Advisor.
  4. A copy of the scholarly project will be placed in the resident’s portfolio.

E. Videotaping

  1. Videotaping is felt to be an integral part of residency education and all residents are expected to avail themselves of this tool.
  2. The goal of videotaping is to provide an effective method of learning and practicing progressively more refined patient interviewing techniques and communication skills. This instructional method and feedback system ensures competency in medical interviewing and professional communication skills.
  3. Each resident is assigned to videotape patient encounters and then meet with both faculty members and fellow residents to review the tapes. There will be two videotaping review cycles each academic year.It is expected that all residents will videotape twice during each academic year. The specifics of each assignment will be determined by the resident’s demonstrated level of proficiency and outlined on the Videotaping/Communication Skills Progress Report form at each videotape review session. The resident will be provided a copy of this progress report and one will be placed in the resident’s folder. Resident’s progress in medical interviewing, presentations, documentation, and other communication skills will be discussed at Resident Quarterly Review.
  4. The resident is responsible for the following:
  5. Obtaining the patient’s written consent to be videotaped on the appropriate form.
  6. See attached copy of patient consent form
  7. Completing the assigned videotaping of patient interviews and/or other learning experiences in the designated time frame.
  8. Unless otherwise specified, each resident is required to have two videotaped patient encounters ready for review
  9. Maintaining and having available the resident’s own DVCC tape, which is provided by the residency program, in order to complete videotaping requirement and to bring to review sessions.
  10. To maintain patient confidentiality, all recorded encounters on DVCC tapes must be kept in the designated locked file cabinet at the clinic at all times unless in use while either completing videotaping assignment, reviewing taped encounters in preparation for scheduled videotape review, or conducting scheduled videotape review.
  11. Knowing how to access, set-up, and operate camcorder as well as ensure that it is placed back in its secured location.
  12. Capturing both the resident’s face and the patient’s face (or other persons involved in dialogue) during the videotaped encounter.
  13. Previewing the videotaped encounters prior to scheduled review and being prepared to offer meaningful self-assessment prior to reviewing the tapes with both faculty and fellow residents.
  14. Residents should complete videotaped assignments well in advance as technical or logistical difficulties are not acceptable excuses for incompletion. If it is necessary for either a resident or faculty member to reschedule the review session for any reason other than an emergency, this needs to be arranged at least one week in advance. In case of an emergency, those persons scheduled to meet should be phoned or paged as soon as a delay is anticipated.
  15. No shows, inadequate notice of cancellation, tardiness at reviews, or incomplete assignments may result in additional number of videotaped assignments, a written report of unprofessional conduct, and/or extra call. Additionally, a written self-assessment will be required of anyone failing to complete the assignment on time. Failure to complete the assignment and review within the assigned quarter may result in academic probation.

F. Balint/Support Group