Appointment, Reappointment, Promotion, and Non-Renewal Policy

1. Resident appointment
2. Annual reappointment
3. Promotion
4. Academic standing
5. Non-promotion
6. Non-renewal
7. Program completion
8. Resident resignation

This policy is intended to ensure fair, consistent, and educationally appropriate oversight of resident progression in accordance with:

• ACGME Institutional Requirements
• Specialty board requirements
• Institutional policies
• Nevada licensure requirements

• ACGME-accredited residency and fellowship programs sponsored by UNR Med

• Clinical competency
• Professionalism
• Medical knowledge
• Patient care skills
• Systems-based practice
• Communication skills
• Administrative and professional responsibilities

Appointment, reappointment, promotion, and graduation are not automatic and remain contingent upon satisfactory performance and fulfillment of all institutional and programmatic requirements.

Residents are expected to demonstrate ongoing growth, competency progression, and professional conduct throughout training.

• Program selection processes
• Eligibility requirements
• Credentialing requirements
• Successful completion of onboarding requirements

Appointments are made for a period of one (1) academic year and are renewed annually at the discretion of the Program Director and institution.

All appointments are contingent upon:

• Continued program accreditation
• Availability of funding
• Institutional operational needs
• Maintenance of eligibility requirements
• Satisfactory academic and professional performance
• Meeting all conditions of employment as stated in the Terms of Appointment for Resident Physicians

Reappointment and promotion decisions are based upon the totality of the resident’s performance and progression within the training program.

Promotion to the next Program Year (PGY) level is not automatic or guaranteed.

Advancement requires recommendation by the Program Director in consultation with the Clinical Competency Committee (CCC).

To qualify for Reappointment and Promotion residents must:

• Demonstrate satisfactory academic progress
• Meet competency expectations
• Maintain professional conduct
• Successfully complete required rotations
• Complete required evaluations and administrative responsibilities
• Meet examination and licensure requirements
• Maintain good academic standing

The Program Director retains final responsibility for promotion and reappointment decisions subject to institutional oversight and applicable policies.

Residents are considered in good academic standing when they:

• Meet program competency expectations
• Demonstrate satisfactory professionalism
• Maintain compliance with institutional and clinical site policies
• Successfully complete required educational activities
• Successfully complete required administrative activities
• Maintain required licensure and credentialing eligibility
• Meet USMLE/COMLEX examination requirements
• Successfully complete remediation requirements, when applicable

Failure to maintain good academic standing may result in:

• Remediation
• Academic probation
• Delayed promotion
• Repeat or extended training
• Non-renewal
• Dismissal

Each residency and fellowship program shall maintain a Clinical Competency Committee (CCC) in accordance with ACGME requirements.

The CCC serves in an advisory role to the Program Director and assists in:

• Resident evaluation
• Milestone assessment
• Promotion recommendations
• Identification of deficiencies
• Remediation recommendations
• Assessment of readiness for graduation

Final decisions regarding:

• Promotion
• Reappointment
• Remediation
• Academic probation
• Graduation
• Non-renewal
• Dismissal

remain the responsibility of the Program Director.

Residents are evaluated using multiple measures of performance including, but not limited to:

1. Clinical Performance
   • Patient care
   • Clinical judgment
   • Procedural competency
   • Medical knowledge
   • Documentation quality
2. Professionalism
   • Ethical conduct
   • Reliability
   • Accountability
   • Communication
   • Collegiality
   • Responsiveness to feedback
3. Educational Requirements
   
   • Attendance at required conferences and didactics
   • Participation in educational activities
   • Completion of scholarly activities
   • Timely completion of evaluations and administrative tasks
4. Milestone Progression
   • Achievement of ACGME Milestones appropriate to level of training
   • Competency progression sufficient for advancement
5. Program-Specific Requirements
   • Specialty board requirements
   • In-training examinations
   • Program educational expectations
   • Clinical case requirements

No single evaluation or event shall automatically determine promotion unless specifically required by institutional policy, specialty board requirements, or licensing standards.

Prior to promotion to PGY-3 status all residents must successfully complete:

• USMLE Step 3; or
• COMLEX-USA Level 3

Official passing documentation must be received no later than the end of the PGY-2 academic year. For purposes of this policy, the end of the PGY-2 academic year is June 30. Failure to provide official passing documentation by the required deadline constitutes an academic deficiency.

All residents must successfully complete USMLE Step 3 or COMLEX Level 3 within three (3) attempts by the deadline stated above.

Residents who fail to meet this requirement:

• Shall not be promoted to PGY-3 status
• Will be subject to non-renewal or dismissal

Residents should review the USMLE Step 3 / COMLEX-USA Level 3 Policy for detailed information on exam responsibilities and requirements.

Academic deficiencies may include, but are not limited to:

• Unsatisfactory evaluations
• Professionalism concerns
• Failure to meet competency expectations, including ACGME milestones
• Failure to complete administrative responsibilities
• Examination deficiencies
• Failure to comply with institutional or program policies

Corrective actions for academic deficiencies may include:

• Educational Improvement Plan (EIP) (non-disciplinary)
• Remediation
• Academic probation*
• Non-promotion*
• Non-renewal of appointment*
• Dismissal*

Corrective actions are not required to occur progressively.

Depending upon severity or patient safety concerns, programs may proceed directly to higher levels of corrective action.

Actions noted with (*) are subject to a due process appeal pursuant to the UNR Med GME Corrective Action, and Due Process Policy.

A resident may be required to:

• Repeat all or part of an academic year
• Delay promotion
• Extend training

when competency expectations or program requirements have not been satisfactorily achieved.

Such decisions are made by the Program Director in consultation with the CCC.

Repeat or extended training may occur due to:

• Academic deficiencies
• Missed training caused by program absence
• Failure to meet competency milestones
• Examination deficiencies
• Professionalism concerns

Required extended training due to missed training and content as a result of leave and/or absences is not subject to due process appeal.

Residents shall receive written notice of non-renewal in accordance with ACGME Institutional Requirements.

Notice should generally be provided no later than four (4) months prior to the end of the current appointment period whenever possible.

If the primary reasons for non-renewal arise within the four-month period, as much notice as reasonably possible shall be provided.

The written notice shall include:

• Basis for the non-renewal
• Effective date
• Information regarding due process rights
• Applicable appeal timelines

Residents receiving notice of non-renewal may request review under the UNR Med GME Corrective Action, and Due Process Policy.

Successful completion of a residency or fellowship program and receipt of a certificate of completion require:

• Satisfactory completion of all educational requirements
• Achievement of competency expectations
• Satisfactory professionalism
• Completion of required scholarly and administrative activities
• Satisfaction of specialty board eligibility requirements
• Recommendation of the Program Director

The Program Director, in consultation with the CCC, determines readiness for graduation and board eligibility.

Residents must obtain and maintain:

• Employment authorization, including valid visa status
• Hospital credentials
• Required medical licensure
• DEA eligibility, when required
• Eligibility to participate at affiliated clinical sites

Failure to obtain and maintain these requirements and conditions of appointment constitutes an administrative eligibility issue rather than an academic disciplinary matter.

The resident or fellow will be informed if administrative eligibility is not obtained or maintained and will be given a reasonable opportunity to provide a response and additional information to the Program Director and the GME Office. The resident or fellow will be provided with a reasonable amount of time, as determined by the program director and GME Office, to resolve the issue. The resident or fellow may be placed on administrative leave while the administrative issue is pending. Failure to resolve the issue and achieve administrative eligibility may result in:

• Rescinding the offer of appointment
• Suspension
• Non-renewal
• Dismissal

Resident resignations must:

• Be submitted in writing
• Be submitted at least thirty (30) calendar days prior to the effective date whenever
  possible
• Be submitted to the Dean or designee and the Associate Dean of Graduate Medical
  Education

A resignation becomes effective upon written acceptance by the Dean or designee.

Residents may revoke a resignation in writing. Any revocation must be received by the Dean or designee within three (3) working days following written acceptance unless otherwise prohibited by institutional policy.

A copy of the resignation shall be forwarded to the Office of Graduate Medical Education

Programs are expected to maintain contemporaneous documentation regarding:

• Evaluations
• Academic actions
• Remediation decisions and progress
• CCC recommendations
• Promotion decisions
• Professionalism concerns
• Resident performance

Documentation must be sufficiently detailed to support:

• Educational oversight
• Accreditation compliance
• Due process review
• Institutional reporting obligations