Sleep & Fatigue Policy
The Department is committed to be in compliance with all duty hour policies. Residents are required to complete the sleep & fatigue module in M Learning. The powerpoint presentation on sleep & fatigue will be sent out to each resident yearly as well as being available on line in the “S” drive titled Sleep/Fatigue.
Leave of Absence Policy
Leaves of absence (with or without pay) are covered by Article XVI of the UM HO Agreement.
The Department of Urology has defined the following additional provisions as part of the institutional Leave of Absence Policy for residents:
1. Leaves of Absence requests will be submitted to the Department Chair or the Program Director. The request will be evaluated to assure compliance with the Urology RRC criteria to ensure that the leave will not put the resident in non-compliance with the requirements for completion of the training program. The request must also being in compliance with the House Officers Association Agreement , the Family Medical Leave Act, the GME Institutional Leave of Absence policy.
2. It will be the responsibility of the resident requesting the leave to submit the request with in a timely fashion to minimize the effect of their leave on the other residents.
3. It is the responsibility of the resident requesting the leave to meet with the Program Director and the Department Chair to ascertain the effect the time off will have on the completion of the Urology training program requirements.
4. Leaves for purposes of professional development or skill enhancement outside of the training program shall be considered as “Personal Leaves”.
5.Leaves for purposes of remediation of academic deficiencies outside of the training program will be considered as “Personal Leaves”.
6. A resident who believes that his/her request for leave of absence has been unfairly denied may appeal the decision of the Department Chair/Program Director through the grievance process provided in the Article XXII of the HO Agreement or through the procedures for Appeal of Academic Decisions, whichever is applicable.
Questions regarding this policy can be directed the GME Leave of Absence Policy
Resident Promotion Policy
Residents are promoted yearly based on a consensus evaluation of the resident by the faculty with the final decision the responsibility of the Program Director. Each resident will co-sign along with the Program Director/Chairman a yearly contract.
Resident Dismissal & Grievance Policy
Disciplinary hearings may be conducted by one or more persons, appointed by the Chairman of the Department. The hearing officer or committee may have an adviser, who may be an attorney.
A resident accused of misconduct shall be given notice of the specific allegations, copies of all documents provided to the hearing officer or committee, a copy of these procedures, and notice of the date, time, and location of the hearing.
At the hearing, the resident will be given an opportunity to appear and present his or her case. The resident shall be permitted to review all documents and written statements considered by the hearing officer or committee and may question any witnesses who testify. The resident also may present evidence and witnesses on his or her behalf. Each witness will be asked to affirm that his or her testimony will be truthful.
If the resident fails or refuses to appear, the hearing officer or hearing committee may either deem the absence to be an admission that the resident committed the acts alleged or may proceed to hear the case and make findings and recommendations without the resident’s participation.
The resident may be accompanied at the hearing by a personal advisor, who may be an attorney; however, the advisor may not participate directly in the proceedings, but may only advise the resident. For example, the advisor may not question witnesses or make presentations. Except in extraordinary circumstances, the personal advisor may not appear in lieu of the resident’s appearance.
The Chairman may appoint an individual to represent the position adverse to the resident. This individual shall have the same rights as the resident, including rights to be present and review evidence, call and question witnesses, and have an advisor.
The hearing shall be closed to the public and may be tape-recorded. The resident shall be provided with a copy of the tape. Witnesses may only be present during the time of their testimony.
The hearing officer or hearing committee shall deliberate in private. Decisions shall be made based on a preponderance of the evidence.
After reviewing the case, the hearing officer or hearing committee shall submit a report to the Chairman. The report shall include a brief summary of the factual findings and recommendations for sanctions or other actions, if any. The resident shall be provided with a copy of the report.
The Chairman shall review the report and decide what action to take. The decision shall be communicated to the resident.
The resident may appeal the decision of the Chairman in accord with Department of Urology appeals process for house officers. Further, appeal, beyond the Department, may be available in accord with the GME Program grievance procedures.
Resident Supervision Policy
It is the department’s general policy that all surgical procedures will be supervised by the physical presence (direct supervision) of a faculty. Exceptions to this policy can only be made as described below after consultation with and approval by the supervising faculty. The resident must contact the supervising faculty for this approval prior to each procedure. Given the progression of learning and experience during the sequential years of training, the following table provides the progressive level of procedures which may be conducted under the faculty’s supervision, but do not require physical presence (without direct supervision) in all situations. At all times the faculty is fully responsible for all aspects of patient care.
It is not the intent of this policy to have any of these procedures conducted without the physical presence of a faculty for it is only in that situation where the resident can obtain more instruction. It is the intent of this policy to allow residents to proceed if they are experienced and the faculty is in agreement for the purposes of improving the overall management of the anesthetic care. Under no circumstances should a resident proceed with any procedure unless they have been well-trained and are experienced in performing that procedure and they have received approval by the supervising faculty member.
Also see GMEC Institutional Global Supervision policy: Approved December 2010
RESIDENT TRAVEL GUIDELINES
Attendance at national meetings by residents in the Department of Urology is encouraged. The purpose of these guidelines is to help ensure that residents actively participate in research and demonstrate the Department’s commitment to those residents who present their research at local, regional and national meetings.
The department will cover the cost of up to two (2) such presentations annually. The meetings that qualify are: AUA and NCS. Other meetings may be approved from time to time on an individual basis. In order to be reimbursed, these exceptions need to be approved in advance. Reimbursement will include the following: airfare, registration, lodging (to include the day before, day of and day after), food, and ground transportation to and from the airport. Any additional days must be covered by the resident. The exact sums of allowances change from time to time, per IRS and University guidelines. It is the responsibility of the resident to adhere to current limits.
CCC COMMITTEE
This committee shall be comprised of the PD (Chair), representative faculty and residents. The charge of this committee is:
1) Oversee the educational function of the residency training program. This committee and its members will act as the liaison for proposed changes and recommendations from faculty and residents regarding the educational program.
2) Review the curriculum and offer suggestions for improvement in the curriculum.
3) Provide a yearly evaluation of the educational process. This evaluation will be presented to the year-end faculty review meeting and/or retreat.
4) Provide input on resident activities (department-sponsored educational and recreational activities).
Members will serve at the request of the Chair. Resident members are selected for their leadership skills, innovative ideas, interest in education, and communication skills. Residents must be in good standing with the department both academically and professionally. Faculty are selected based on their interest in education, and willingness to participate on the committee.
Policy 04-06-041: Exhibit A University of Michigan Hospitals and Health Centers Faculty and Clinical Program Trainees Institutional Requirements for January 1, -- December 31, 2007
Each faculty member is responsible for completing the institutional requirements and providing documentation to their Department Chair/Service Chief within a reasonable interval after first being employed at the UMHHC and, in subsequent years, by the time of each annual performance review. Each clinical program trainee is also responsible for completing the institutional requirements and providing documentation to their Graduate Medical Education Program Director within a reasonable interval after first being employed at the UMHHC and annually thereafter.
Institutional requirements are as follows:
Clinical Program Trainees
Mandatories to be completed upon hire:
UMHS Compliance
HIPAA Training
Critical Incident Review
Fire Safety **NEW** (must be completed between 1/1/07 and 4/30/07)
Infection Control - Body Substance Precautions and Tuberculosis
Patient Safety: Medication Reconciliation
Sleep, Alertness, Fatigue Education
Abuse & Neglect Education
UM-CareLink Training
Sleep, Alertness, Fatigue Education
Hazard Communication/Right to Know
Patient Safety Program
Restraints
BLS module or American Heart Association Certification Card*
Disaster Emergency Management*
Safe Medical Device Act Protocol*
Mandatories to be completed annually:
UMHS Compliance
Critical Incident Review
Fire Safety
Infection Control - Body Substance Precautions and Tuberculosis
Patient Safety: Medication Reconciliation
Sleep, Alertness, Fatigue Education
† Requirements are to be completed at the time of initial employment and as needed to maintain competency.
* Requirements are specific to the program or clinical setting and should be determined by the Department Chairman and/or GME Program Director.
+ Required for all Faculty with admitting privileges who serve as the “attending of record” on an inpatient service inpatient like venue.
There are a variety of mechanisms available to meet each requirement. Your Clinical Department Administrator or Graduate Medical Education Program Director is a valuable resource to assist you in completing the requirements.
Revised: Executive Committee on Clinical Affairs, December12, 2006
Patient Transfer Protocol
Transition of Care
Transitions of care are critical elements in patient safety and must be organized such that complete and accurate clinical information on all involved patients is transmitted between outgoing and incoming individuals and/or teams responsible for that specific patient or group of patients. All programs must have a written process in place for ensuring the effectiveness of transitions. Options selected should include reporting and communicating exam findings, laboratory data, any clinical changes, family contacts and any change in responsible attending physician. On-call shifts should be scheduled to optimize a minimum number of transitions and there should be documentation of the process used to finalize the schedule.
Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.
In all instances, the program director and faculty are required to monitor residents’ alertness and encourage use of alertness management strategies as they continue in their patient care management responsibilities. Each program is required to educate residents on alertness management tools and also to develop and maintain program-level policies regarding transition of patient care that includes faculty, residents and other essential health care providers.
Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.
Residents may, on their own initiative, remain beyond a scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. The resident must appropriately hand over the care of all other patients to the team responsible for their continuing care; and document the reasons for remaining to care for the patient in question. Documentation of every overstay circumstance must be submitted to the program director.
The program director must review each submission of additional service, and track both individual resident and program-wide episodes of additional duty. These events will be monitored institutionally to ensure that they are not so frequent as to reflect violation of the duty hours limits.
Hospital-to-hospital
Hospital-to-hospital patient transfers must be between attending physicians at the outside institution and a Urology faculty member who will be responsible for subsequent patient care. Transfers will be coordinated via the “UMHS Transfer Office”. Residents will be notified of any transfer by the faculty assuming care and responsibility of the patient. It is the faculty’s responsibility to inform the chief resident of their particular service and/or the resident on-call of the transfer.
Hospital-to-hospital transfers of patients (especially complex patients) are recommended to arrange transfer during normal business hours. ICU-ICU transfers will be arranged between the ICU service here at the UMHS and the ICU service at the outside institution. Urology will be consultants for such patient transfers.
Outside Emergency Department-UMHS
Emergency room transfers for direct Urology evaluation must be arranged between the outside ER staff and the “on-call” Urology staff. If the patient is already a known patient of the UMHS Department of Urology, the patient’s Urology faculty will coordinate transfer.
UMHS In-house
Inpatient transfers to a different service must be approved by the Urology faculty of record. Inpatients requiring transfer to units for intensive care monitoring (monitored bed, step down unit, ICU) must be approved by the assigned Urology faculty. Transfer of patients to higher acuity units must be approved by the Urology faculty of record. In the instance in which the faculty is not available, either the covering faculty of the division or the “on-call” faculty will assume that responsibility.
ICU Transfer
Patients who are deemed candidates for ICU monitoring require the approval of the attending faculty. In instances where the attending faculty may not be available, the on-call faculty will assume responsibility of approval of ICU admission. Patients in the ICU will be followed by the Urology service and will assume primary care once the patient is deemed fit for transfer to general bed care.
DNR and end-of-life Determination
Determination of end-of-life care and DNR status is the responsibility of the attending faculty. Orders in the patient records must be generated and /or signed by the attending. Changes in DNR status must also be modified only by the attending. Residents at all levels are encouraged to be in attendance at these patient-attending, patient-family-attending interactions.
