Resident Policies
Purpose
To ensure that residents in the University of Nevada, Reno School of Medicine Family Medicine Residency Program maintain an acceptable level of attendance at residency activities and conferences.
Assigned Rotations
All residents will attend their rotations unless on approved leave. All leave must be submitted and checked, as there are several rotations that do not allow vacation. The resident must make all attempts to contact their preceptor or senior resident at least 1 week prior to the start of the rotation to establish the expected schedule.
Didactics
All residents and students are to report to the weekly didactic session. Punctual arrival is expected. Residents who are repeatedly late will be discussed at the education committee and/or CCC in regards to professionalism, with actions taken as appropriate. Interns are expected to attend all didactic sessions and make every attempt to arrange for coverage of duties while attending the sessions. The Hospital Resident(s) and faculty are strongly encouraged to attend the weekly didactic session and attendance will be left to the faculty to decide. Medical students on the hospital service rotation MUST be released in sufficient time to attend didactics. Residents are exempt from didactics, and when on approved leave or on rural rotations.
Balint Group
Residents are required to attend a monthly Balint group session. All expected absences require notification of the group leader prior to the start of the session.
Reviewed and approved by CCC: 10/10/2023
Purpose
To ensure that residents in the University of Nevada, Reno School of Medicine Family Medicine Residency Program maintain an acceptable level of reporting work hours consistently throughout the week.
Policy
All residents must:
- Log Resident Work Hours at least once weekly
- Keep sick and annual leave up-to-date in Workday and New Innovations
- Notify Program Director and Coordinators of any schedule changes
- Respond to all e-mails and updates sent by coordinators regarding duty hours
- After three requests via e-mail or text with no action, the delinquency will be reviewed by the CCC and appropriate disciplinary action will be determined.
Per the ACGME
- Programs must have a system for tracking resident work hours and document the number of hours each resident works each week.
- Each program must have a written policy and procedure regarding work hours consistent with this institutional policy and must submit that departmental policy and annual updates of that policy to the Office of Graduate Medical Education each July. See Resident Handbook/Work Hours/Duty Hours
Reviewed and Approved by CCC: 10/10/2023
1. Elective rotations are used to develop areas of special interest; or, in special cases, to make up unsatisfactory performance in a previous rotation.
2. The resident will select their elective rotation with the advice and approval of the Resident's Faculty Advisor, the Residency Coordinator and the Program Director/Associate Director.
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- In the event that elective time is used to make up previous unsatisfactory performance, the elective will be assigned by the Program Director in lieu of the resident's choice.
3. Time missed from required rotations may be used to make up using Elective Block time.
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- In the event that elective time is used for time missed from required rotations, the elective will be assigned by the Program Director in lieu of the resident's choice.
4. An Elective Selection form
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- Elective rotations between July - December must be selected by June 15th.
- Elective rotations between January - June must be selected by November 15th.
5. It is the resident's responsibility to confirm the rotation including dates, activities, goals and objectives with the rotation preceptor prior to submitting a completed form.
6. The Elective Selection form requires approval of the resident's faculty advisor and the residency coordinator before being submitted to the program director. It is the resident's responsibility to get these approvals completed prior to the deadlines.
7. If resident misses the deadline
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- Program Director will assign an Elective rotation.
- No changes are permitted
8. Changes for previously scheduled elective rotations
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- Special circumstances will be considered.
- The resident requesting the change will need to complete a Rotation Selection form.
- Changes will require the approval of the resident's faculty advisor, residency coordinator and program director.
9. Out-of-local area and international elective rotations
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- Residents must provide 9 months' notice and approval to ensure all necessary legal documents are in place for the rotation.
- Policies for away rotations must also follow guidelines as stated in the UNRMED Resident physician handbook.
- International elective rotation will take more time to arrange
Reviewed and Approved by CCC: 10/10/2023
Request Procedure Considerations:
Ideally requests will be submitted well in advance of the requested time:
- Vacation, CME, and Conference leave requests
- 16 weeks in advance
- Away electives
- 24 weeks in advance
- As soon as possible, if the above timelines cannot be met (See below “Late Requests”)
Several factors will be considered prior to approval of a resident’s leave request, including but not limited
to:
- The quantity of used and remaining leave time.
- Rotation schedule because leave is not permitted during some rotations.
- The number of other residents requesting leave during the same dates
Request Procedure
- The Resident completes the leave request in WorkDay (Menu/Time off/Request/ Time off). Please be sure to fill in the comments with the brief details about your planned leave.
- Send an email to the following with the complete details of your leave request, please be
sure to include:
a. fmschedules@unr.eduFamily Medicine Residency Coordinator(s) **Please be sure to email both coordinators, if there is more than one. - Leave is reviewed by the Residency Coordinator(s) for approval.
- Leave is scheduled into the official/online schedule.
- The resident is responsible for checking the official/online schedule to ensure that the leave is scheduled correctly.
a. Approximately one week after submission the official/online schedule should be completed.
b. If the request is not scheduled correctly, the resident should immediately email the Residency Coordinator(s) and fmschedules@unr.edu with the concern.
Note: It is the resident’s responsibility to ensure that their schedule is correct in the official/online schedule system. Even if the scheduling error is an administrative mistake, it is the resident’s responsibility to check their schedule and notify administration of errors – this includes but is not limited to the fmschedules@unr.edu, Residency coordinator(s), Program Director, clinic scheduler, rotation contact person, and anyone else who might be affected by the error. If the resident fails to check the official/online schedule to confirm that the leave is correctly scheduled, and the mistake is discovered after patients are scheduled, the leave will be denied, even if the resident originally submitted the leave request correctly and in a timely manner.
Denials
The Resident is notified by email by fmschedules@unr.edu if the request is denied. The Program Director is available to discuss disputes regarding leave requests. The Program Director’s decision is final.
Late Requests
All requests for leave should be submitted in a timely manner according to the guidelines above. Any late requests may not be granted as small schedule changes can have a large impact on the FMC operations.
In the event a leave request is submitted after the schedule is completed or the deadline for requests has passed for the requested timeframe - the request requires approval of the clinic scheduler, Program Director, FMC Medical Director, and Department Chair before the schedule will be changed.
Revised 10/10/2023 by the Clinical Competency Committee (CCC)
1. Any moonlighting activities (internal or external) must be approved by the Program Director and Clinical Competency Committee (CCC).
a. Approval for moonlighting privileges may be granted by the Program Director on a case-by-case basis after reviewing the resident’s rotation evaluations, test scores, CCC review, and the resident's general performance in residency.
b. In general, only residents that have successfully completed the PGY1 and PGY2 years may be approved for moonlighting privileges.
2. Residents must complete a moonlighting request form, see New Innovations, and provide all requested information, including but not limited to an unrestricted Nevada medical license, malpractice insurance, and independent DEA certificate. Additional requirements may need to be completed depending upon the specific moonlighting request.
3. Once a resident obtains approval from the Program Director and CCC, approval must then be obtained from the appropriate medical board, if applicable.
4. Any moonlighting resident is responsible for adherence to the University of Nevada, Reno School of Medicine's Graduate Medical Education (GME) policy on Moonlighting. Please refer to the GME Moonlighting Policy, which supersedes the department policy.
5. All moonlighting activities will be monitored by the Program Director, CCC, and faculty advisor.
a. The resident engaged in moonlighting must submit employment locations and hours worked to the program director via New Innovations.
6. If it is determined that any moonlighting activities have interfered with the resident’s performance in residency the moonlighting privilege will be revoked. Also review the ACGME Institutional Requirements – Moonlighting (included on Moonlighting Request Form in New Innovations).
Revised 10/10/2023 by Clinical Competence Committee (CCC)
Policy On Progressive Authority, Responsibility, Conditional Independence and Supervisory Role
Residents at all levels are monitored and evaluated to determine the proper level of responsibility and degree of supervision required. The following progression applies on all services that family medicine residents work throughout residency. Residents are monitored and progressed in a step-wise manner as described below. Monitoring and documentation of resident competency and supervisory abilities is achieved through a variety of methods, including:
1. Residents are observed performing all procedures.
2. Residents log their procedures using New Innovations.
3. Residents are observed and evaluated by faculty as they teach and supervise junior residents and students.
Entering PGY1 residents have direct supervision for all patient interactions for at least the first six months of internship/residency.
PGY1 residents may progress from direct supervision to indirect supervision with direct supervision immediately available based on resident review by the Clinical Competency Committee (CCC) after six months internship/residency.
Postgraduate Year Two (PGY2)In order to progress to the PGY 2 level, residents must have demonstrated the ability to work with indirect supervision with direct supervision available as determined by the CCC.
Postgraduate Years Three and Four (PGY3 and PGY4)PGY3 and PGY4 residents are progressing towards independent practice and therefore have continued progression in their conditional independence, authority, responsibility and supervisory role of learners.
Also, see the University of Nevada Reno School of Medicine Graduate Medical Education (GME) Resident Handbook, section on resident job descriptions.
Revision 10/10/2023 by Clinical Competency Committee (CCC)
- A research elective may be granted at the request of the resident with approval by the resident’s advisor and PD
- Research electives will generally be limited to 4 weeks or less
- In the request for such an elective, the resident must have a written plan and an explanation of what is planned to be accomplished during this elective, including why dedicated elective time is needed
- The resident must identify a faculty supervisor who has agreed to take the responsibility of overseeing and evaluating participation in the elective.
- The resident must turn in a written report at the conclusion of the rotation (preferably something for presentation or publication submission). The report must be reviewed by the faculty supervisor and uploaded into the resident’s portfolio in New Innovations.
Revised: 10/2023 RDW
A key component to transitions of care, sometimes called “sign out” or “hand-overs”, is to reliably and efficiently transmit important information about the patient from one physician or care team to another. While there are many settings and many methods for achieving this, some have been found to be more reliable than others. For the Family Medicine Hospital Service, the following methods are to be used for transitions of care:
1. All patients are to be entered in the appropriate inpatient list by the hospital residents and/or the admitting resident, as appropriate, and are to be updated daily.
a. The resident will document and update necessary items in the “handoff summary” column of the patient
list
b. The hospital attending shall review the patient information with the hospital residents daily. The attending may provide feedback and instruction on the information provided.
2. All patients are to be discussed at each “transition of care” by the physician(s) going off service and the physician(s)
coming on service. If possible, this should be done “face to face”, but may be by telephone.
a. If by telephone, both parties should have a copy of the current patient information for easy reference and updating as needed.
3. Faculty may discuss complicated patients during their transitions in care.
4. Residents will be monitored on their “transitions in care” by faculty to ensure competency. At least one monitored transition will be documented in the resident scorecard. It is the residents’ responsibility to ensure this documentation.
Revised: 9/2023: Williams
Deciding to call your attending should not be a scary prospect! If you have questions – CALL. As you progress through your residency you will become more comfortable managing cases without calling and so there is some decision making flexibility residents have as to when to call.
- Please be prepared to give a concise, but complete presentation when you call. Your assessment and plan is (as always) the most important part. Be prepared to discuss orders.
- Faculty may want to meet you in the ER or at patient bedside to go over the admission, so plan accordingly.
- Discuss all unstable patients with an attending physician at the time of admission.
- Discuss all obstetrical patients with an attending physician or certified nurse midwife at the time of evaluation.
- Discuss any ICU transfers or significant deteriorations in patient status with an attending as soon as possible.
- At the end of your night shift you must call the attending on for the day (even if NOT the attending who was on with you during the night) for transition of care. You should also discuss any important phone calls.
- Please remember, it is NOT a sign of weakness to call your attending. If a resident ever feels the attending is anything short of helpful and cooperative or if the resident feels he or she was shamed for calling, it should be reported to program administration or department chair as soon as possible.
Revised: 10/10/2023: McCarthy