LSU Emergency Medicine Residency Handbook 2011-12

Revised June 2011, M. Haydel, MD

LOUISIANA STATE UNIVERSITY HEALTH SCIENCE CENTER – NEW ORLEANS

EMERGENCY MEDICINE RESIDENCY PROGRAM

POLICIES TO SUPPLEMENT LSUHSC HOUSE OFFICER MANUAL & ROTATION GUIDE

“Prepared For the Worst ~ Providing the Best”


TABLE OF CONTENTS LSU EM Residency Manual

Contents

INTRODUCTION 2

POLICIES – ACGME 3

ACGME Core Competencies 3

Core Competencies Guidelines 3

Core Competencies 3

Core Competencies & LSU EM 4

Resident Duty Hours and the Working Environment 8

Duty Hours - Emergency Medicine 10

POLICIES - LSUHSC 11

Ethics Code - LSUHSC Emergency Medicine Residency 11

Code Of Professional Conduct 12

Honor Code 12

Grievance Policy - Academic 13

Ombudsman 17

LSU Quality of care statement 18

Job Description - EM House Officer 19

House Officer I 19

House Officer II 19

House Officer III 20

House Officer IV 20

HOUSE OFFICER CONTRACT 22

COMPENSATION 23

INSURANCE 24

Health Plans 24

Disability Insurance 24

Medical Practice Liability Coverage 24

LEAVE: 24

Vacation Leave 24

Sick Leave 24

Maternity/Paternity Leave 24

Educational Leave 25

Military Leave 25

Leave of Absence 25

Family Leave 25

Pay Scales - LSUHSC House Officer 29

Emergency Fund for Residents 30

House Officer Selection and Eligibility LSUHSC 32

Campus Assistance Program 34

Fitness For Duty And Substance Abuse Policy 35

Work Related Injury/Illness 37

Dress Code 38

LIBRARY - LSUHSC 42

WELLNESS CENTER 45

HOUSE STAFF CLEARANCE FORM 46

POLICIES – Section of EM 49

Mission Statement 49

GOALS and OBJECTIVES 49

Role of the Residency in the Emergency Department 51

EM Residency Applicants 52

Residency Promotions 53

EMERGENCY MEDICINE YEAR END COMPETENCIES 53

PGY1 YEAR 53

PGY2 YEAR 55

PGY3 YEAR 56

PGY4 YEAR 57

Liaison & Oversight Policy 58

Dismissal Policy 59

Satisfactory Academic Standing 64

Evaluations 65

Monthly evaluation of Residents by Faculty 66

Annual evaluation of Faculty by Residents 68

Evaluation of Rotations by Residents 69

Evaluation of Program by Residents 70

6 month Evaluation of each Resident by Advisor 71

Yearly Eval and Final Exit Evaluation of Resident by Program Director 73

Faculty Advisors 81

Evaluation of Resident Documents Policy 81

Procedure and Patient Experience Documentation 82

Procedures And Resuscitations 82

Ultrasound 83

New Innovations 86

Educational Stipend 87

Travel Forms 88

Mailboxes/ Email 89

Beepers 90

Vacation 91

Yearly Schedule Requests 91

ED Schedules 92

Disaster Call 93

Disaster Call Scheduling 94

Disaster Call & Duty Hours 95

Code Grey – Hurricane Guidelines 96

Advanced Life Support Programs Policy 100

Moonlighting Policy 103

Call Room 104

Sick Leave 105

Conference Attendance Policy 106

Journal Club 107

Journal Club Literature Critique Form 109

M & M Presentations 110

Medical Records 113

Electronic Signature 113

Research Requirement 115

Resident's Research Proposal And Progress Form 116

Chief Resident Responsibilities 117

Chief Resident Questionnaire 117

Residency Curriculum 118

Model For Emergency Medicine 118

Reference Book Loan-Out Policy 119

Medical License 120

Louisiana License, Training Permit & STEP 3: 120

State Licensure 121

DEA number 121

NPI number 121

Notary 122

Guidelines To Rotations/Goals & Objectives 124

LSU Interim Public Hospital Emergency Department 125

ANESTHESIA & ENT 134

CHABERT Medicine Wards 139

EMS- New Orleans EMS 142

CHILDREN’S HOSPITAL 145

MICU 149

OB & ULTRASOUND 153

Intern Ultrasound Block 154

OLOL Pediatric ED 158

OCHSNER ED 161

OCHSNER ED-Pediatrics 167

SLIDELL ED 171

TOXICOLOGY 176

TRAUMA ICU 180

WEST JEFFERSON ED 183

WEST JEFFERSON PEDIATRIC ED & FASTTRACK 184

ELECTIVE 189

INTRODUCTION

Welcome to the LSU Emergency Medicine Residency Program. This LSU EM Policies To Supplement LSUHSC House Officer Manual & Rotation Guide is meant to augment the LSUHSC School of Medicine, Office of Graduate Medical Education, House Officer Manual. The House Officer Manual is updated each year and is available on the LSUSHC website at:

http://www.medschool.lsuhsc.edu/medical_education/graduate/HouseOfficerManual.asp

A hard copy of this manual is available in the emergency medicine offices and online at the LSU EM yahoo website. http://health.groups.yahoo.com/group/LSUEM/

POLICIES – ACGME

ACGME Core Competencies

Core Competencies Guidelines (ACGME 2007)

Core Competencies

The following are the 6 Core Competencies for ACGME accreditation purposes.

  1. Patient Care
  2. Medical Knowledge
  3. Practice Based Learning
  4. Interpersonal & Communication Skills
  5. Professionalism
  6. Systems Based Practice


Annual Competency Assessment – The programs must define competencies that are expected for each year of training taking into account the defined ACGME core competencies. Multiple tools may be used to evaluate these competencies. Competency evaluation of chief complaints, procedures, resuscitations and off-service rotations will be used as part of the annual competency evaluation.


Chief Complaint Competency - The RRC expects that programs will assess the competency of residents to handle key chief complaints in emergency medicine. At the time of program review, the program will demonstrate how it assesses resident competency for 3 chief complaints over the course of the training program. The program can use a variety of tools including direct observation, check-lists, simulations, etc.
Procedural Competency – The primary responsibility for the determination of procedural competency rests with the program director and the faculty. The RRC accredits programs, and does not certify or credential individuals.

The RRC expects programs to assess the competency of residents to perform key index procedures. At the time of program review, the program will need to demonstrate how it assesses competency of residents for 3 procedures.

Selected index procedures should consequentially impact patient care, and ideally facilitate competency assessment initiatives across disciplines. One of the selected procedures must be ED bedside ultrasound (PR V.B.2.b; appendix 1)

Resuscitation Competency – The RRC expects programs to assess resident competency in the resuscitation of critical patients. These include adult and pediatric medical and trauma resuscitations. At the time of program review, the program will demonstrate how it assesses competency in one type of resuscitation. The program may use a variety of techniques including simulations and direct observations.
Off-Service Rotations – The program should define measurable competency objectives for off-service rotations, how the objectives are assessed and remediated when necessary. At the time of program review, it is expected that measurable objectives and the tools used for evaluation will be available for half of the off-service rotations.

Core Competencies & LSU EM

The residency program must require that its residents obtain competence in the six areas listed below to the level expected of a new practitioner. Programs must cite examples how these competencies are taught and evaluated within the training program.

1.  Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Among other things, residents are expected to:

  1. Gather accurate, essential information in a timely manner.
  2. Generate an appropriate differential diagnosis.
  3. Implement an effective patient management plan.
  4. Competently perform the diagnostic and therapeutic procedures and emergency stabilization.
  5. Prioritize and stabilize multiple patients and perform other responsibilities simultaneously.
  6. Provide health care services aimed at preventing health problems or maintaining health.
  7. Work with health care professionals to provide patient-focused care.

Residency Experience: each clinical rotation and every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, ACLS/PALS/ATLS and teaching medical student anatomy labs.

Residency Assessments: Direct observation and documentation of Monthly and Yearly evaluations, simulation cases, oral board cases, Follow-up cases 360 evaluations.

2. Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Among other things, residents are expected to:

  1. Identify life threatening conditions, the most likely diagnosis, synthesize acquired patient data, and identify how and when to access current medical information.
  2. Properly sequence critical actions for patient care and generate a differential diagnosis for an undifferentiated patient.
  3. Complete disposition of patients using available resources.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, asynchronous learning modules, US, Tox, all orientations, ACLS/PALS/ATLS and teaching medical student anatomy labs.

Residency Assessments: National In-service Exam, Monthly and Yearly evaluations, 360 evaluations, oral board cases, simulation cases and journal club.

3. Practice-Based Learning: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices.

Among other things, residents are expected to:

  1. Analyze and assess their practice experience and perform practice-based improvement.
  2. Locate, appraise and utilize scientific evidence related to their patient’s health problems.
  3. Apply knowledge of study design and statistical methods to critically appraise the medical literature.
  4. Utilize information technology to enhance their education and improve patient care.
  5. Facilitate the learning of students and other health care professionals.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, journal club, teaching ACLS/PALS/ATLS and freshman anatomy labs.

Residency Assessments: Daily, Monthly and Yearly evaluation, 360 evaluations, oral board cases, simulation cases, journal club, Trauma Conference, Toxicology rotation, RSI forms, End of Year evaluations and Ultrasound QA.

4. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and professional associates.

Among other things, residents are expected to:

  1. Develop an effective therapeutic relationship with patients and their families, with respect for diversity and cultural, ethnic, spiritual, emotional and age-specific differences.
  2. Demonstrate effective participation in and leadership of the health care team.
  3. Develop effective written communication skills.
  4. Demonstrate the ability to handle situations unique to the practice of emergency medicine.
  5. Effectively communicate with out-of-hospital personnel as well as non-medical personnel.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, bedside teaching, ACLS/PALS/ATLS and teaching freshman anatomy labs.

Residency Assessments: Monthly, Yearly evaluation, 360 evaluations, oral board cases and simulation cases.

5. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.

Residents are expected to demonstrate a set of model behaviors that include but are not limited to:

  1. Treats patients/family/staff/paraprofessional personnel with respect.
  2. Protects staff/family/patient’s interests/confidentiality.
  3. Demonstrates sensitivity to patient’s pain, emotional state and gender/ethnicity issues.
  4. Able to discuss death honestly, sensitivity, patiently and compassionately.
  5. Unconditional positive regard for the patient, family, staff and consultants.
  6. Accepts responsibility/accountability.
  7. Openness and responsiveness to the comments of other team members, patients, families and peers.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, death notification, cultural competency, pain management, conflict resolution, AMA, teaching ACLS, PALS and ATLS.

Residency Assessments: Monthly, yearly evaluations, 360 evaluations, oral board cases and simulation cases.

6. Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Among other things, residents are expected to:

  1. Understand access, appropriately utilize and evaluate the effectiveness of the resources, providers and systems necessary to provide optimal emergency care.
  2. Understand different medical practice models and delivery systems and how to best utilize them to care of the individual patient.
  3. Practice cost-effective health care and resource allocation that does not compromise quality of care.
  4. Advocate and facilitate the patients’ advancement through the health care system.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, Disaster Drills, Hazmat, EMS, chart/EMS run report reviews, patient follow ups and CQI project (RSI sheets, radiology call backs and M & M)

Residency Assessments:Monthly, Yearly evaluations, 360 evaluations, oral board cases, simulation cases, Toxicology rotation, M & M and interesting case conference

Resident Duty Hours and the Working Environment

(update ACGME 2003)

Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents’ time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.

1. Supervision of Residents

a.  All patient care must be supervised by qualified faculty. The program director must ensure, direct, and document adequate supervision of residents at all times. Residents must be provided with rapid, reliable systems for communicating with supervising faculty

b.  Faculty schedules must be structured to provide residents with continuous supervision and consultation.

c.  Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.

2. Duty Hours

a.  Duty hours are defined as all clinical and academic activities related to the residency program, ie, 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 academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

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

c.  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 one continuous 24-hour period free from all clinical, educational, and administrative activities.

d.  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.