Resident Appointment and Reappointment

Introduction
1. Appointment to GME Programs is based upon the selection process of the individual programs and occurs annually for the University fiscal year. Other conditions of appointment are addressed in Title IV, Chapter 7, Section 2 of the Board of Regents Handbook.
2. Reappointment to the next PGY level is dependent on the resident's satisfactory performance and evaluation in all aspects of the Program requirements as well as passage of the necessary USMLE steps leading to unrestricted licensure.
3. Notwithstanding the provisions of NSHE Code section 5.9.1, notice of non-reappointment must be given no later than 4 months prior to the ending date of the current contract:
  1. If the primary reason(s) for non-reappointment occur(s) within the 4 months prior to the ending date of the current contract, then the resident will be given as much notice of non-reappointment as the circumstances reasonably allow prior to the ending date of the contract
  2. All notifications of non-reappointment must be in writing
  3. A resident who has received a notice of non-reappointment may seek review of the
    non-reappointment through the University of Nevada, Reno School of Medicine Resident Due Process Policy
4. A program may require additional time of training for the resident for academic performance reasons, or to make up for excessive leave time away from the program.
Procedure
1. The term of appointment is for 12 months.
2. Advancement to the following PGY- level is not automatic and must be recommended by the program director.
3. The program director may withdraw an offer based on a resident's performance at any time prior to the new agreement date.
4. Residents on remediation or probation must fulfill the requirements specified in their conditions for remediation or probation before they will be advanced.
5. To assist the program director in making such decisions, each program will have a clinical competency committee. The Clinical Competency Committee in its given role will assist the Program Director regarding reappointments.
  1. Process:
    1. Be comprised of program faculty (at least 3) and if needed faculty from other departments where the resident has received training. Embedded chief residents may not participate on clinical competency committees. Extra - year chief residents may participate on the committee but not vote.
    2. Meet at least semiannually or more frequently as determined by the program director.
    3. Keep minutes or complete individual documentation for each resident which is placed in their respective portfolios/files and can be available for review by the Associate Dean for GME.
    4. Meet in emergency session if requested by the program director.
  2. Function:
    1. Help decide the advancement of residents as well as proper interventions for residents who are not progressing satisfactorily.
    2. Assess milestones and competence based on program specific rubrics (www.acgme.org) and report semiannually to the ACGME (beginning July 1, 2013 for EM, IM and Pediatrics and July 1, 2014 for all other programs).
    3. Make specific recommendations to the program director for actions to be taken with respect to academic or professional remediation.
    4. Follow all requirements specifically articulated in the ACGME common program requirements section on evaluation.
6. The conclusions of the program director based on individual evaluations, semi-annual progress reports and all other available information will provide the basis for determining whether a resident is ready for advancement to the subsequent year of the program or for graduation from the program. Information will include but is not limited to:
  1. Attendance and participation in formal didactic program.
  2. Successful completion of scheduled clinical rotations with evidence of increasing responsibility and clinical proficiency in patient management.
  3. Professional attitude and behavior that includes attention to work responsibilities, ethical behavior, timely and accurate completion of administrative responsibilities, and a humanistic and compassionate approach to patient care.
  4. Completion of all required clinical performance outcome requirements and all necessary evaluation activity.
  5. All designated in-training examinations as required by the program with completion of remediation if scoring below the 30th percentile nationally.
  6. Completion of USMLE/COMLEX examinations as below:
    - All residents must successfully complete USMLE or COMLEX Step 3 (no more than 3 attempts) by the end of the 18^th month (end of 6^th month of PG2 year) of their residency with passing scores received no later than the end of their 20^th month (end of 8^th month of PG2 year) to be considered for promotion and reappointment to the PG3 year.
    - Any resident for whom a certificate of passing Step 3 has not been received from either the USMLE or COMPLEX by the end of their 20^th month will be given a notice of non-reappointment.
    - Any resident who does not pass USMLE or COMLEX Step 3 exams after 3 attempts will be given a notice of non-reappointment.
    - Any resident who has more than two failures on the Step 3 exam of the USMLE or COMLEX cannot get an unrestricted license to practice medicine in Nevada.
7. Remediation, academic and/or professional, will be based on the following for all levels of trainees and determined by individual programs:
  1. Poor performance on the ITE i.e. less than the 30th percentile or based on individual ITE scoring will automatically place residents in academic remediation.
  2. Unsatisfactory performance in program evaluations.
  3. Professional misconduct (Nevada revised statutes NRS 630.301 through 630.3066, are attached as Appendix II for definition of professional misconduct).
  4. Any failure to adhere to program requirements established by individual programs and their directors.
8. The specific criteria for resident evaluation and promotion must be consistent with the requirements of the Residency Review Committee, the Specialty Board, or other agencies that promulgate educational standards for certification of that discipline. Residents are encouraged to access information regarding their specialty specific boards.
9. Any failed remediation for any resident will result in review by the standing GMEC Resident Performance Committee, who will review the allegations, conduct an investigation, and if necessary, request a hearing of said actions. This review will be part of the institution's progressive performance review.
  1. Step 1 - review by the department's performance review committee and remediation assigned.
  2. Step 2 - review by the GMEC performance review committee and assessment made.
  3. Step 3 - appeal to the Dean for final decision (if requested by the resident in question).
10. Inappropriate use of information systems or information technology violates UNR Med policies and is grounds for disciplinary action to include dismissal/termination from the program. (See Email Policy and Social Media Policy)
11. Options for continuing training in the program include:
  1. Promotion to the next year.
  2. Promotion to the next year depending on fulfilling specific academic performance expectations, remediation, or psychological counseling.
  3. Repetition of all or part of the immediate past academic year (non-promotion).
  4. Leave without pay.
  5. Non-renewal of appointment or suspension.
12. Programs must maintain clear criteria for advancement and competence that are detailed and explicit to the resident. Careful records must be kept to evaluate resident progress. Detailed documentation of performance is critical and the importance of this cannot be overstated. Copies of resident evaluations must be available in the residents' own personnel file maintained in the respective departmental offices.
13. The Graduate Medical Education Agreement
  1. A resident may choose to decline to renew an offered agreement for the following year by not signing and returning the agreement.
  2. The resident will remain in good standing during the remainder of the current agreement without prejudice and will perform the usual resident functions until the end of the term of the agreement at which time the resident's affiliation with the program will end.
14. Due Process
  Any resident enrolled in a multi-year program who, under normal circumstances would receive an agreement for the following academic year, and is denied due to the action of the program director as described in the sections listed above, is entitled to due process, including all grievances, as described in the due process policy.
15. Resident Resignation
  1. All resignations by a resident must be in writing and be submitted to the appointing authority (the Dean) at least 30 calendar days in advance of its effective date. The resignation must be accepted in writing by the dean or his/her designee.
  2. If a resignation is tendered verbally or is conveyed to an employee other than the dean, the resignation must still be accepted in writing by the dean or his/her designee.
  3. A resignation should indicate an effective date. If the resignation does not specify an effective date, the resignation shall be effective on the fourth working day after acceptance and this date must be reflected in the written acceptance.
  4. Once a resident's resignation is accepted by the dean, the resident shall have three working days after such acceptance to revoke the resignation. Thereafter, the resident may not revoke the resignation, regardless of the effective date set forth in it. A revocation of a resignation must be in writing and must be delivered to the dean within the foregoing time period to be effective.
  5. The decision of the dean not to accept a request to rescind a resignation more than three working days after its written acceptance is not subject to grievance or appeal processes.
  6. A copy must be forwarded to the Office of Graduate Medical Education.
  7. Immediate notification of resident's status MUST be made to the Nevada State Board of Medical Examiners.