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.
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.
All residents and students are to report to the weekly didactic session. Punctual arrival is expected and those 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 also expected to attend all didactic sessions and make every attempt to arrange for coverage of duties while attending the sessions. PGY1 are also expected to attend all didactics sessions and make every attempt to arrange 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. All students present on the hospital service rotation MUST be relased in sufficient time to attend didactics. Again those exempt from didactics are those who are on approved leave or on rural rotations.
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: 09/08/2020
To reflect an appearance of professionalism to our patients, colleagues, community, and affiliated training institutions.
NOTE: Renown Regional Medical Center, the Veteran's Administration Medical Center and St. Mary's Regional Medical Center each have a qualified Dress Code. The expectations listed below are minimum standards. You will also encounter specific standards in some preceptor offices.
Hair must be clean, neatly combed, and well groomed.
Male residents must be clean-shaven with the exception of professionally groomed mustaches and beards.
Fingernails must be cleaned and kept at a level not to interfere with patient care.
Perfume and cologne must be used sparingly, so as not to have an unpleasant affect on patients or co-workers.
Must be appropriate professional business attire. Tank tops, T-shirts, Jeans (of any color), sweat pants, shorts, sweat shirts are not permitted.
Foot Wear: sandals or other open-toed shoes are not permitted for safety reasons. Tennis shoes, running shoes or other types of "sneakers" are not permitted. Foot covering is required (ie: socks, stockings, nylons, etc.).
When residents are on rotations requiring surgical scrubs as attire, scrubs may be worn in the Family Medicine Center ONLY when worn with an appropriate White Coat. Scrubs are not standard acceptable attire. White Coats must be clean and well pressed. Permanent stains such as Iodine, blood, meconium, coffee, chocolate, etc are NOT acceptable.
Non-Compliance With These Policies
It is the responsibility of the resident to be aware of, and to be compliant with, this policy statement. Residents who are in violation of this policy will be given a warning and may be sent home to make the necessary changes. If there are repeated violations or disregard of this policy, the resident will be sent home and the period of absence will be deducted from personal leave time. Frequent occurrences from the same resident will result in further disciplinary action determined
Reviewed and Approved by CCC: 09/08/2020
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.
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 must be able to document the number of hours each resident works each week.
Each program must have a written policy and procedure regarding work hours that is 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 by CCC: 9/08/2020
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.
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.
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. AnElective Selection form
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
Program Director will assign an Elective rotation.
No changes are permitted
8. Changes for previously scheduled elective rotations
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
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
For any time away from the program, (i.e., rotations or scheduled clinics at FMC), have a Leave Request Form filed in advance of the leave requested. The only exception to this will be for sick leave, for which the Program Administrator and the Center Manager/Nursing Supervisor must be notified (complete a Sick Leave Request, email and voicemail) that day. Do not attempt to schedule yourself out of the FMC Clinic Schedule (the front office personnel are to direct you elsewhere). Complete a Leave Request Form, give it to the Program Administrator, Cheryl Baldovi-Manville – for processing that day, and the appropriate and applicable FMC staff will be informed/schedules adjusted for future leave.
It is of utmost importance that sick leave ONLY be used for times when you are ill and cannot work (or are contagious and want/need to protect patients and staff), when a family member is ill and you need to be home to care for him or her, or for doctor appointments for you and/or immediate family. Sick leave and annual leave may also be used for conditions covered under the Family Medical Leave Act as per University and Federal Policy.
Missing FMC Clinics or rescheduling patients have an effect on many areas at the FMC: Front Office phones, Front Office rescheduling, Front Office Medical Records – Charts, Nurses Schedules and Patient Rooms, Preceptor Schedules, and Administrative Schedule Changes. Please be mindful and considerate of your patients, the front office and nursing staff, attending faculty, and the administration when scheduling personal appointments or requesting Leave. Sixteen weeks of advance notice are required for Annual Leave. If more than two senior residents are already scheduled out, your request may not be granted, or you may be asked to make changes in the time requested. The Family Medicine Center Schedule is carefully balanced for optimal patient care, resident training, and faculty supervision; subtle changes directly affect the operation and financial stability of this non-profit clinic.
Since you are on a salaried stipend and have Call responsibilities, etc., each request for doctor or dentist visits of 1-2 hours duration will be posted and used for schedule changes. Regular Leave (vacation, sick) will be posted, as will Administrative Leave (e.g., Board Exams); however, only vacation and sick time will be deducted from your annual Leave Allotment. This is meant to be fair and equitable to all residents.
We are striving to offer efficient and cost contained services to all. Our public image is reflected in the way we operate the Family Medicine Center, of which YOU are an integral part. Your cooperation is expected and is appreciated.
You will inform preceptors in advance of the rotation of your participation with their office. Their evaluation of your rotation includes attendance, interest, skills and patient care.
The ACGME reviews or audits the course of events during Accreditation Review, and accurate records are necessary. The reviews include program office files, medical records and hospital records. Our accreditation review will be this year in the spring. In addition, Human Resources audits all Leave Records for FMLA (Family Medical Leave Act) – e.g. paternity/maternity leave.
Reviewed and approved by CCC: 09/08/2020
Resident Completes a Leave Request Form and submits it to the clinic AMION scheduler (currently Conrad Wong). The resident then emails the clinic scheduler and residency coordinator with a brief summary of the leave requested.
16 weeks in advance for vacation, CME, and conference leave requests
24 weeks in advance for out of town electives
As soon as possible if the above timelines cannot be met (See “Late Requests”)
Leave is reviewed by the Residency Coordinator for approval
Leave is scheduled into AMION.
Used/Remaining leave time is calculated and considered
Rotation schedules are checked to ensure that vacation is permitted
Number of requests for the requested timeframe is considered
Resident is notified by email from coordinator the reason for any denials.
Program Director available to discuss disputes with Coordinator and resident. Program Director decision is final.
The resident is responsible for checking the online AMION schedule to ensure that the leave is scheduled appropriately.
Approximately one week after submission the AMION schedule should be completed
If not scheduled appropriately, the resident should email the AMION scheduler and residency coordinator with the concern.
If the resident fails to check AMION to confirm the leave is appropriately scheduled, and the mistake is discovered after patients are scheduled, the leave will be denied, even if the resident originally submitted the leave request appropriately and timely.
It is the residents responsibility to ensure that their schedule is appropriate in the AMION 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.
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 have 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
The request requires approval of the Program Director, FMC Medical Director, or Department Chair before the schedule will be changed
Upon approval, the change will be communicated to the Program Director, Residency Coordinator and Department Administrator via email. The email should include the reason for the late request and the reason for the approval.
Any moonlighting activities (internal or external) must be approved by the Program Director. Approval for moonlighting privileges may be granted by the Program Director on a case by case basis based on evaluations, scores, a full faculty review and the resident's performance in residency. In general, only residents in the third year of training may be approved for moonlighting privileges.
Once a resident obtains approval from the program, approval must then be obtained from the appropriate medical board.
Any moonlighting resident is responsible for adherence to the University of Nevada, Reno School of Medicine's Policy on Outside Employment of Resident Physicians which is documented for review in the Resident Handbook.
All moonlighting activities will be monitored by the Program Director and the Family Medicine faculty. Any moonlighting resident must submit employment locations and hours worked to the program director. If it is determined that any moonlighting activities have interfered with the residents performance in the program, the moonlighting privilege will be revoked.
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 on unless specifically stated otherwise. This includes Family Medicine, Internal Medicine, Surgery, Obstetrics, and Pediatrics. 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.
Residents are observed doing all procedures.
Residents log their procedures using New Innovations.
Residents are observed and evaluated by faculty as they teach and supervise junior residents and students.
All entering residents have taken and passed Step 1 and 2 USMLE, including the Clinical Skills exam, demonstrating competency (as determined by the USMLE) on both medical knowledge and patient interactions. Initially entering residents have DIRECT SUPERVISION for all patient interactions for the first six months.
PGY1 residents may progress from direct to indirect supervision with direct supervision immediately available based on resident review by the Clinical Competency Committee (CCC) after six months.
In order to progress to the PGY 2 level, residents must have attained the necessary skills listed and demonstrate the ability to work with indirect supervision with direct supervision available as determined by the CCC.
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.
04/10/2018 by Clinical Competency Committee (CCC)
You must have a written plan with a research question, and an explanation of what you will accomplish during this elective, including why you need dedicated elective time to accomplish this.
Research electives must be approved by your advisor and the PD (this is true of all electives, but will be enforced more tightly for research electives).
You must turn in a written report (preferably something for presentation or publication submission).
You CANNOT use this to complete your FPIN or other required activities.
Vacation IS permitted on this elective.
All students of the University of Nevada, Reno School of Medicine are required to do a rotation in Family Medicine in their third year. Every 6 weeks we will have a new group of students. They have their Clinical Reasoning in Medicine (CRIM) Clerkship didactics on Tuesday afternoons and have a Family Medicine didactic on Thursday from 1:30 to 2:30. These are mandatory for the students, so don’t assign them tasks during these times (such as admissions)
Family Medicine Center
Students are to see patients in the Center after hospital rounds in the morning (if there is time) and in the afternoons.
They should work with ONE provider each half day, working with faculty first, then 3rd and 2nd year residents. They should not work with interns.
Students should spend 10 minutes doing a focused H&P on a patient, 15 minutes for new patients. They are then to present the case briefly to the provider. Each patient must be seen by the provider and pertinent exams repeated. The student then writes a progress note and signs it. Notes must be reviewed by the provider and co-signed. Students may write out prescriptions under supervision, but cannot sign them.
Family Medicine Inpatient Service
Students take call from 8am to 8am.
Call students in for admissions and obstetrical deliveries. They are to write a formal H&P and daily progress notes on their patients. They must do a formal presentation at rounds on Monday or Friday.
They may write orders under direct supervision. These orders must be immediately cosigned by a resident or attending.
Students are not allowed to dictate H&Ps, procedures, or discharge summaries.
Students are evaluated by all of the faculty and residents they work with. The standard form is attached as well as the criteria for Honors, High Pass, Pass, Marginal and Fail performance. All evaluations go into a composite, so your personal evaluation is kept anonymous. Please try to make comments where appropriate and required. Thank you.
IS permitted on this elective.
A key component to “sign out” or “hand-overs” of patient care 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 patient hand-overs:
All patients are to be entered in the online patient database by the hospital residents and/or the admitting resident, as appropriate, and are to be updated daily.
The hospital attending shall review the patient information with the hospital residents daily. The attending will provided feedback and instruction on the information provided.
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.
If by telephone, both parties should have a copy of the current online patient information for easy reference and updating as needed.
Faculty will discuss complicated patients during their transitions in care.
Residents will be monitored on their “transitions in care” by faculty to ensure competency.
Patient hand-overs will be discussed, taught and modeled at weekly hospital rounds reports.
04/10/2018 by Clinic Competency Committee (CCC)
Renown Women's Health Medical Group University of Nevada, Reno School of Medicine Family Medicine Resident Program Renown Regional Medical Center
These guidelines are intended to facilitate assigning, attending and following up on unassigned obstetrical patients that come to Labor and Delivery, and to maintain intra-partum and postpartum continuity of care for such patients.
Four subsets of Walk-ins are listed below. All are assumed to be at least 20+s weeks gestational age, or of a gestational age felt to be better served on Labor and Delivery.
Upon admission to triage or Labor and Delivery under the Renown Women's Health OB/GYN Physician on call (face sheet), the initial call from the L & D or Triage Nurse should go to the Family Medicine senior (PG 2 or PG 3) resident on call for the Family Medicine Hospital Service.
The resident is expected to respond to the call in a timely manner and perform a bedside H & P, as soon as possible. (Of course imminent deliveries, emergencies, or timely order issues may be directed to the OB/GYN on call)
Type 1: Patient at or near term, in labor, and needing delivery this hospitalization
The resident is expected to manage and take responsibility for the patient, under the supervision of the OB/GYN faculty, throughout the L & D process.
For postpartum care of vaginal delivery patients, the Family Resident, under the guidance of the OB/GYN faculty is responsible for rounds and follow-up. The chart should clearly be labeled "Renown's Women's Health".
Type 2: Not in labor, not requiring admission, but needing an evaluation and outpatient follow up (OB check)
The resident is expected to make arrangements for appropriate work up and appropriate follow up under the supervision of the OB/GYN faculty. This would include any/all prescriptions, and clear instructions for the patient to follow-up in Family Medicine Continuity Clinic or Renown Pregnancy Center. If the patient resides outside of the Reno/Sparks area, every effort should be made to arrange for such services with an appropriate provider near the patient's residence.
Type 3: Not in active labor and requiring admission/observation for an obstetrical complication, but not likely to deliver in the next 24 hours (such as bleeding, preeclampsia, SROM, rule out pre term labor).
The resident should complete the admission history and physical and admission orders under the supervision of the OB faculty. After consultation with the OB faculty, the resident and OB faculty will determine whether the patient will be admitted for delivery or obstetrical intervention. If not, the patient will be discharged to an outpatient clinic such as the family needed, the patient will be followed and managed by Renown Women's Health OB/GYN faculty on call. If discharged and stable the patient may be seen at either Family Medicine or the Pregnancy Center.
Type 4: Not in labor but requiring admission for a non-obstetrical problem (such as pyelonephritis, gallstones or renal stones).
The resident should complete the admission history, physical and admission orders under the supervision of the family medicine faculty. The patient then will be the responsibility of the family medicine hospital team supervised by the family medicine faculty member for subsequent care. Consultation with the OB/GYN faculty will be requested and performed as necessary.
School of Medicine Family Medicine OB-Continuity Clinic patients are admitted under the Family Medicine Faculty member and followed and managed exclusively by the resident assigned to the patient. For delivery it is expected that the Family Medicine Faculty will be in attendance to assist the resident.
If the faculty member is unavailable or the delivery is imminent, the Renown Women's Health OB/GYN on call will assist the resident or perform the delivery. As these patients are assigned to the Family Medicine Clinic, they will be followed in the postpartum period by the family Medicine Service, even if a Cesarean Section is required.
Deciding to call your attending back-up 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.
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 to go over the admission, so plan accordingly.
Discuss all unstable patients and ICU admissions 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.
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.