Policies

Purpose

Circumstance may arise in which a department/division/institute would wish to ask a resident/fellow to perform clinical duties that are outside their normal duties. In such a situation, it would be fair and appropriate to provide remuneration for this work. The purpose of this policy is to describe the principles to be used by a program director to develop a policy for their program and determine if compensation is allowable.

Principles

1. Each program that wishes to provide compensation for additional work under this policy must develop their own policy consistent with this policy, institutional policy, ACGME/RRC requirements, and relevant state/federal law, which provide details of the process for allocating these duties and the remuneration. This policy should be distributed to the residents and fellows of the program and be available for their review.
2. Additional Work policies should be used only for brief and self-limited staffing needs. The requests may not extend beyond 90 days.
3. All requests for Additional Work must be provided to the Office of Graduate Medical Education. The request must include a justification for the additional work, a description of the duties and compensation, and the plan for solving the service-need issue.
4. All requests will be forwarded to the GMEC for review. A decision for acceptance or rejection of the request will be determined by a simple majority of the voting GMEC members.
5. Any Additional Work requests that are accepted will not be subject to extension beyond the 90-day period.
6. The Graduate Medical Education Committee reserves the right, after review, to terminate any Additional Work policies felt not to comply with this policy or to otherwise not serve the best interests of the residents/fellows or the institution.
7. Residents and fellows cannot be paid for doing additional work that would, under other circumstances, be part of their training. This would include such things as taking call or covering a shift for another resident who has become sick, injured, or is on vacation/leave.
8. Under no circumstances can a resident or fellow be required or obligated to take on additional work under this policy.
9. Under no circumstances can a resident or fellow violate ACGME work hour rules by taking on additional duties.
10. Remunerated work hours performed under this policy must be tracked and included as duty hours.
11. The program director must indicate that the resident is in good standing and that this additional duty will not interfere with their didactic training or educational needs (e.g., this would not be appropriate for a resident who is on academic probation and needs to spend more time reading).
12. Residents and fellows cannot work outside their scope of practice, i.e., they must be appropriately supervised by qualified faculty. Fellows can work independently in the area of their qualified underlying specialty, consistent with hospital policy concerning licensure and privileging.

Approved by GME Committee: Jan. 14, 2013
Revised: July 2018

Maximum Hours of Clinical and Educational Work per Week

• Clinical and education work hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting.

Mandatory Time Free of Clinical Work and Education

• Resident should have eight hours off between scheduled clinical work and education periods.
• Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
• Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days.

Maximum Clinical Work and Education Period Length

• Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.
  • Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. Additional patient care responsibilities must not be assigned to a resident during this time.

Clinical and Educational Work Hour Exceptions

• In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances: to continue to provide care to a single severely ill or unstable patient; humanistic attention to the needs of a patient or family; or, to attend unique educational events
• These additional hours of care or education must be counted toward the 80-hour weekly limit.
• A Review Committee may grant rotation-specific exceptions for up to 10 percent or a maximum of 88 clinical and educational work hours to individual programs based on a sound educational rationale.
  • In preparing a request for an exception, the program director must follow the clinical and educational work hour exception policy from the ACGME Manual of Policies and Procedures

Moonlighting

• Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program, and must not interfere with the resident’s fitness for work nor compromise patient safety.
• Time spent by residents in internal and external moonlighting (as defined in the ACGME Glossary of Terms) must be counted toward the 80-hour maximum weekly limit.
• PGY-1 residents are not permitted to moonlight.
• For additional details, see GME Moonlighting Policy.

In-House Night Float

• Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements. (The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the Review Committee.)

Maximum In-House On-Call Frequency

• Resident must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).

At-Home Call

• Time spent on patient care activities by residents on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every-third-night limitation but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks.
  • At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident. (The Review Committee may further specify under any requirement in.)

Revised: July 14, 2023

Maintaining a culture of respect in our clinical learning environment is a core value of Penn State Health Milton S. Hershey Medical Center. With input from our trainees, as well as faculty, nursing staff, medical students and others, we have developed a set of expected behaviors in our professional interactions. We also have provided examples of behaviors that we believe are not conducive to a productive educational experience.

Learn about Penn State Health’s commitment to a Culture of Respect in Education and its CORE policy here

In the event of a local or national disaster or public health emergency, Penn State Health Milton S. Hershey Medical Center will continue to provide salary, benefits, professional liability coverage, and resident/fellow assignments. (IV.N.1.) Trainees in ACGME accredited programs are considered essential personnel. In the event of a disaster, all residents and fellows shall report to work as scheduled unless personally notified by their supervisor or if reporting to work would put the resident at extreme risk. In the event that such a disaster or its after effects warrant reduction or closure of a program(s), then the Reduction/Closure Policy will take effect.

If, because of a disaster, an adequate educational experience cannot be provided for each resident/clinical fellow the sponsoring institution will:

• Arrange temporary transfers to other programs/institutions until such time as the residency/fellowship program can provide an adequate educational experience for each of its house officers/fellows.
• Create Emergency GME Affiliation agreements retroactive to the date of the disaster to incorporate new host hospitals, even if the host hospital is outside the affected area.
• Cooperate in and facilitate permanent transfers to other programs/institutions. Programs/institutions will make the keep/transfer decision expeditiously so as to maximize the likelihood that each resident will complete the resident year on schedule.
• Inform each transferred resident of the minimum duration of his/her temporary transfer, and continue to keep each resident informed of the minimum duration. If and when a program decided that a temporary transfer will continue to and/or through the end of a residency year, it must so inform each such transferred resident.

The Designated Institutional Official (DIO) will notify the ACGME Institutional Review Committee Executive Director with information and/or requests for information. When appropriate, the DIO will contact executive directors of specific residency review committees (RRCs).

Within ten days after the declaration of a disaster, the DIO will contact the ACGME to discuss due dates that the ACGME will establish for the programs:

• To submit program reconfigurations to the ACGME, and
• To inform each program’s house officers of resident transfer decisions.

The due dates for submission shall be no later than 30 days after the disaster unless other due dates are approved by the ACGME.

Approved by GME Committee: January 11, 2023
Revised: May 14, 2012; Nov. 25, 2013

Purpose

To define allowable expenditures related to Graduate Medical Education-Educational Supplement Funds (expense account 690240) for residents and fellows.

Definition

Graduate Medical Education Educational Supplement Funds (GME ESF) is a specific form of
financial support to help residents and fellows learn about new and developing areas of their field. This includes activities such as professional conferences, written publications, online programs, and other media forms.

Procedure

1. During the annual budget process GME ESF funds are approved for each applicable training program.
2. Allowable GME ESF Fund expenditures for residents and fellows include:
   • Professional conferences and related travel expenses
   • Medical books, professional literature, medical journals/magazine subscriptions (including electronic books and subscriptions)
   • Professional licensing exam fees
   • Individual membership dues and fees to Professional Organizations/Societies, if Penn State Health Milton S. Hershey Medical Center does not pay separate organizational membership dues to the same Professional Organization/Society
3. Departments/Employees must follow established Accounts Payable policies &procedures for payment/reimbursement of GME ESF allowable expenditures.

Reviewed: December 2011
Revised: June 2023

This Grievance and Due Process Policy shall be utilized for academic or other disciplinary actions that could result in suspension, dismissal, non-renewal of contract, non-promotion to the next level of training or other action that could significantly affect a resident’s intended career development (the “Grievance Review Process”). This policy also sets forth the manner in which resident complaints related to the clinical learning environment, the program or faculty will be addressed. Any Resident or Fellow serving in an ACGME accredited program at Penn State Health Milton S. Hershey Medical Center (“PSHMC”) may seek resolution of grievances under this Grievance and Due Process Policy.

Academic or Other Disciplinary Actions

All residents and fellows participating in an ACGME accredited program shall be afforded the opportunity to have reviewed, in the manner set forth below, any of the following decisions:

• non-renewal of the Resident Agreement
• non-promotion to the next year of the training program
• suspension from the training program
• dismissal for cause

The process described in this document is designed to provide appropriate review of actions that may adversely affect a resident’s or fellow’s status while at the same time ensure patient safety, quality of care and the proper conduct within the training programs. The resident/fellow is NOT entitled to legal representation at any point in the Grievance Review Process.

Program-Level Review

The following process for review of an academic or other disciplinary action shall be available to the resident or fellow:

1. Upon receipt of a decision from either the Clinical Competency Committee (CCC), the Program Director or the Department Chair, resulting in the suspension or dismissal from the training program, non-promotion to the next level of training or the non-renewal of the Resident Agreement, the resident/fellow may request the opportunity to present, in person, to the CCC their appeal of the decision. The resident/fellow must make this request to their respective Program Director, in writing, within seven (7) days of receiving the notice of the decision. The resident/fellow presentation to the CCC shall occur within fifteen (15) business days of receipt of the request to the Program Director unless a later date is mutually agreed to by all parties. The resident/fellow shall be provided with the opportunity to present oral and written statements in support of the appeal.
2. If the CCC upholds the initial decision and the Program Director is not a member of the CCC, the resident/fellow will have the option of making an appeal to the Program Director for the respective Program.
3. If the Program Director is a member of the CCC or, upon review, the Program Director upholds the CCC decision, the resident/fellow will be given the opportunity to make the final Program Level Review appeal to the Department Chair.
4. If the resident/fellow waives all or any remaining steps in the process afforded under the Program Level Review or if the initial decision is upheld and all procedural steps of the Program Level Review have been exhausted, the Program Level Review has been concluded. If the resident/fellow does not make a timely request for the GME Level Review, the decision resulting from the Program Level Review shall be final and binding on the resident/fellow and Program, and shall conclude the Grievance Review Process.
5. The Program Director shall establish a reasonable and appropriate time frame for the completion of the Program Level Review when the process is initiated by the resident/fellow.

Graduate Medical Education-Level Review

Upon the conclusion of the Program Level Review, the resident/fellow may request the initiation of the applicable GME Level Review, as set forth below. The resident/fellow must make this request to the GME Office in writing within seven (7) days of the conclusion of the Program Level Review. Failure to do so shall constitute waiver of resident’s or fellow’s opportunity for the applicable GME Level Review. If initiated, the decision resulting from the GME Level Review shall be final and binding on the resident/fellow and Program, and shall conclude the Grievance Review Process.

1. Non-renewal of Contract or Non-promotion in the Training Program: The resident/fellow will meet with the Vice Dean for Educational Affairs or the Associate Dean for Graduate Medical Education, as determined by the GME office, to review the grievance. Prior to this meeting, the Vice Dean or Associate Dean will have the opportunity to review all relevant documents, including formative and summative evaluations and other assessments of the trainee, and consult with representatives of the Program to ensure consideration of information needed for an appropriate and informed decision. In the event a mutually agreeable resolution of the grievance is not possible, within seven (7) days following this meeting, the Vice Dean or Associate Dean will issue, in writing, his/her decision, concluding the GME Level Review and Grievance Review Process. In the event that both the Vice Dean and the Associate Dean have been involved in the direct evaluation of the resident/fellow in his/her training experience, an appropriate administrative designee will be determined.
2. Dismissal for Cause or Suspension from the Training Program: The resident/fellow will meet with a Graduate Medical Education Appeals Board comprised of a senior resident/fellow, two senior faculty members, a program director, and a representative of the Dean’s office (Vice Dean for Educational Affairs, Associate Dean for GME/DIO, Associate DIO) to hear the appeal. The members of the Appeals Board will not hold an appointment in the same Department or Program as the resident/fellow in question and will be chosen by the GME office. The resident/fellow will be afforded the opportunity to present any relevant information in reference to the dismissal or suspension during this time frame, including oral and written statements in support of the appeal. The members of the Appeals Board will have access to all relevant documents, including formative and summative evaluations and other assessments of the trainee in question during their discussions and deliberations. The Department Chair or designee shall be responsible for presenting evidence in support of the dismissal or suspension. Specific procedures applicable to the appeal may be adopted by the Appeal Board and furnished to the resident/fellow and Department Chair. The decision of this GME Appeals Board will be presented, in writing, to the resident/fellow within seven (7) days of the meeting, concluding the GME Level Review and Grievance Review Process If the resident/fellow’s Appeal is upheld, the GME Appeals Board will provide direction to the Program on reinstatement, and make recommendations pertaining to focused education, re-mediation and continuing trainee assessment, as appropriate.

Complaints Related to the Work Environment, Program or Faculty

In the event a resident/fellow in an ACGME accredited training program at PSHMC has concerns or complaints about their program or educational learning environment, it is recommended they first address these issues with the Program Director and/or Department Chair of their respective program. If the resident/fellow believes real or perceived conflicts of interest would preclude or render unproductive such a discussion, it is recommended they engage the designated Graduate Medical Education Ombudsperson(s) for advice and counsel on the most appropriate course of action to address their concerns (e.g., reporting mechanisms through the Culture of Respect in Education, Human Resources, Title IX requirements, Graduate Medical Education Office).

If at any time the resident/fellow is uncomfortable with these discussions or unsatisfied with previous counseling or recommendations, the Associate Dean for Graduate Medical Education will be available to meet with the resident/fellow, directly, to resolve the concern.

Approved by GME Committee: January 11, 2023

Well-Being Leave of Absence / Call-off

There are circumstances in which residents may be unable to attend work, including but not limited to fatigue, illness, family emergencies, and medical parental or caregiver leave. Each program must allow an appropriate length of absence for residents unable to perform their patient care responsibilities.

Residents must report their absence to the program director and/or immediate supervising physician at the time of occurrence. Each program must have a policy/procedure in place to ensure coverage of patient care and ensure continuity of patient care

Request for Leave

Residents and fellows must request a written and timely Leave of Absence to the Residency or Fellowship Program Director and the Residency or Fellowship Program Coordinator. For non-emergent leave, the request should be submitted at least 30 days prior to the anticipated leave date, or at the earliest date available.

A Leave of Absence request for emergent leave should be provided to the Residency or Fellowship Program Director and Residency or Fellowship Program Coordinator as soon as possible following the emergency.

Resident and fellows who are requesting Medical, Parental, and Caregiver Leave must submit the appropriate request for the Family and Medical Leave Act (FMLA) to AbsenceOne.  Residents/fellows who are employed for less than one year will be denied FMLA via AbsenceOne. However, all trainees must apply for FMLA. If denied by AbsenceOne, per the ACGME, trainees are entitled to Medical, Parental, and Caregiver leave per this policy. The GME Leave of Absence Policy supersedes the employee FMLA policy.

Personal Time Off (PTO)*

Each resident is granted 15 to 20 working days of Personal Time Off (PTO) each contract year in keeping with program, departmental, specialty board, and ACGME Review Committee requirements.  Interviewing, relocation, and educational trips are to be included in this time.

Medical, Parental and Caregiver Leave*

The ABMS establishes requirements for candidates to become eligible for Initial Certification, including standards for training. ABMS policies accommodate reasonable leaves of absence from residency and fellowship training for personal or familial needs, including the birth and care of a newborn, adopted, or foster child (“parental leave”); care of an immediate family member (child, spouse or parent) with a serious health condition, as defined by FMLA, (“caregiver leave”); or the trainee’s own serious health condition (“medical leave”) to support trainee well-being while maintaining ABMS responsibility to establish high standards for training and the shared responsibility of ABMS and training programs for assessing a candidate’s suitability for Initial Certification.

ABMS member boards have established policy requirements for time away from training for purposes of parental, caregiver, and medical leave in addition to allowed time away for vacation. All ABMS policies must be followed. The ABMS policy details time away from training; it does not detail salary payment or benefits.

All requirements of the ACGME trainee’s respective ABMS Member Board and ACGME Review Committee requirements must be satisfied to complete training. A Leave of Absence in excess of ABMS Member Board may cause the training period to be extended in order to satisfactorily complete eligibility requirements to participate in examinations by the relevant certifying board. Extension of training is at the discretion of the Program leadership. Residents and Fellows are encouraged to refer to the specialty board for specific details.

Salary Payment/Benefits

1. Residents/fellows will be provided with a minimum of six weeks of approved medical, parental, and caregiver leave(s) of absence for qualifying reasons that are consistent with applicable laws at least once and at any time during an ACGME-accredited program, starting with the first day resident/fellow is required to report;
2. Residents/fellows will receive full salary and benefits for the first six weeks of the first approved medical, parental, or caregiver leave(s) of absence taken;
3. Residents/fellows will be permitted to preserve one week of paid time off reserved for use outside of the first six weeks of the first approved medical, parental, or caregiver leave(s) of absence taken; any additional time off, including vacation time during the contract year, beyond the six weeks of approved leave and preserved one week of paid time off, will be unpaid;
4. Residents/Fellows and eligible dependents will continue to receive health and disability insurance benefits during any approved medical, parental, or caregiver leave(s) of absence; these benefits will be paid during the paid leave. If additional unpaid leave is taken, the trainee will be billed for the costs of the benefits.
5. Residents/Fellows may request a maximum of twelve weeks of medical, parental, and caregiver leave. The first six weeks of the twelve weeks of leave will be with full pay and benefits;
6. Residents/Fellows who are provided with six weeks of approved medical, parental, and caregiver leave and preserve one week of paid time off for use outside of the six weeks of first approved leave will receive no additional paid vacation time during the contract period.
7. If the period of leave bridges two consecutive contract periods, the amount of paid and unpaid leave will be allocated proportionately, including available and preserved vacation time.

Personal Leave*

A personal leave may be granted to a resident upon review of the circumstances by the Program Director. All eligible PTO time for that contract year must be used during this period.  The period of personal leave time that is not covered by PTO time will be unpaid.

Professional Leave*

A professional leave of absence may be granted to a resident upon review of the circumstances by the Program Director. All eligible vacation time for the contract year must be used during this period. The period of professional leave that is not covered by vacation time will be unpaid.

Effect of Leave

All requirements of the residency training program must be fulfilled prior to the completion of training. The Program Director, with the CCC, is responsible to notify the Resident or Fellow as to the effect of leave on their training timeline. Residents and Fellows may be required to extend their length of training to meet all residency program requirements. The Residency Review Committee for the training program and the Residency/Fellowship Program Director determine the length of training to be completed following a leave of absence.

*All requirements of the residents’ respective ABMS member Board and ACGME Review Committee requirements must be satisfied.

Approved by GME Committee: Nov. 22, 2010
Revised: Feb. 24, 2014
Revised: April 11, 2017
Revised: Feb. 18, 2021
Effective: July 1, 2021
Revised: April 13, 2022
Effective: July 1, 2022
Reviewed: Oct. 11, 2023

This policy outlines the details of the Woodward Scholars program, which allows postgraduate trainees at Penn State Health Milton S. Hershey Medical Center to pursue a graduate certificate or master of education degree in adult education for health professions from Penn State Harrisburg.

The Woodward Scholars program allows trainees who wish to pursue a clinical educator pathway to receive additional training and mentorship in adult education during their GME training. Eligibility criteria for trainees, as well as descriptions of the responsibilities of the Office of Graduate Medical Education, the Woodward Center for Excellence in Health Sciences Education and individual departments in support of the program are listed below.

• Enrollees must be at the PGY-2 level or above at the time of entry. Enrollees should be in good academic standing and have assurance from their program director that they will receive schedule adjustments to allow them to attend courses.
• Up to 25 participants will be selected annually.
• Participants must be actively employed at the beginning and end of the semester. Trainees who are not selected may still enroll in courses via Penn State Harrisburg and will qualify for a tuition discount if they cover the tuition costs themselves. In these cases, if the department covers costs, it will be charged 100 percent of the tuition costs.
• Enrollees will need to apply to appropriate Penn State Harrisburg program. The Woodward Center will provide instructions to interested trainees on how to do this.
• All enrollees will begin the program with the certificate program, which is 12 credits.
• The trainee will receive a 75 percent tuition discount. The department will be asked to support the remainder of the certificate costs. The trainee will receive the individual bill at the beginning of the semester via LionPath. The trainee is responsible for paying income tax on the full tuition amount.
• Upon completion of the certificate, trainees can continue in the program for a master’s degree. Small scholarships ($1,000 to $3,000) may be available on a competitive basis for trainees in the master’s degree program; the department is expected to provide the remainder of funding.
• Enrollees who complete their training prior to degree completion but stay on faculty or in the area can continue with coursework, or credits can be transferred to allow them to complete the degree elsewhere.

Approved by GME Committee: July 18, 2020

Intent

Each Graduate Medical Education program may permit moonlighting provided that such moonlighting complies with this policy and ACGME (Accreditation Council for Graduate Medical Education) requirements. Because residency and fellow education is a full-time endeavor, each program director must ensure that moonlighting, whether internal, external or additional work, does not interfere with the ability of the residents/fellows to achieve the goals and objectives of the educational program and does not adversely affect patient safety or trainee well-being. Moonlighting shall not be approved if the program director believes such activities may interfere with the residents’ ability to perform their obligations and duties in the residency program. Resident will be monitored by the sponsoring institution and the program director for effect of these activities upon performance. Authorization to moonlight will be withdrawn if the program director determines such adverse effects exist.

Definitions

• Moonlighting: Clinical services provided outside of the required assignments of the training program.
• External moonlighting: Voluntary, compensated, medically-related work performed outside the institution where the resident is in training or at any of the program’s related participating sites. These services may be billable or non-billable.
  • Inside a Penn State Health facility: i.e., Hershey Medical Center maternal and fetal medicine fellow who works in labor and deliver at Holy Spirit Hospital. See “External moonlighting at Penn State Health facility” below.
  • Outside a Penn State Health facility: i.e., Hershey Medical Center cardiology fellow who works as a hospitalist at UPMC Pinnacle. Trainee must follow steps in the “All moonlighting activities” section below.
• Internal moonlighting: Voluntary, compensated, medically-related work (not related with training requirements) performed within the institution where the resident is in training or at any of the program’s related participating sites. (i.e. Hershey Medical Center hematology/oncology fellow who provides services on the internal medicine inpatient ward). These services are not billable.
• Additional work: Compensation for additional work within the same program as the trainee covering for an uncovered service. Additional work must be on a temporary basis and cannot exceed 90 days.

Requirements and procedures

All moonlighting activities

• Residents are not required to engage in moonlighting activities for the institution. Under no circumstances can a resident or fellow be required or obligated to take on additional work under this policy.
• The sponsoring institution or the program may prohibit moonlighting.
• PGY-1 residents are not permitted to moonlight.
• A resident must be a U.S. citizen or permanent resident to moonlight. (Residents on J1 or H1B Visa are not eligible to moonlight.)
• Trainees must have prior written consent from the program director to moonlight.
  • Trainee must complete request on New Innovations.
  • Program Director will approve or deny request electronically.
  • Request will be sent to GME office for final review.

Note: For all moonlighting, the program director’s determination in this regard shall be final and does not fall within the scope of the Grievance and Due Process Policy.

• Trainees who are authorized to moonlight must submit the number of duty hours for each institution in New Innovations on a weekly basis. All hours, both the hours worked as part of the training program and moonlighting hours, must be logged.
• Moonlighting will be covered by malpractice insurance only if it meets the following conditions:
  • The moonlighting is performed at an institution or physician practice within the Penn State Health system.
  • The resident/fellow is practicing at the moonlighting location within the scope of their training and in their specialty or qualified underlying specialty.
  • The moonlighting is within the scope of the ACGME’s duty hours rules.
• The Graduate Medical Education Committee reserves the right, after review, to terminate any moonlighting activities felt not to comply with this policy or to otherwise not serve the best interests of the trainees or the institution.

External moonlighting at Penn State Health facility

• The fellow must have an unrestricted license to practice medicine in the Commonwealth of Pennsylvania.
• The trainee will receive compensation through the institution where the services are provided.
• The trainee must be credentialed by the Penn State Health Medical Staff Office if performing billable services.

Additional work

• Trainees cannot work outside their scope of practice, i.e., they must be appropriately supervised by qualified faculty. Trainees can work independently in the area of their qualified underlying specialty, consistent with hospital policy concerning licensure and privileging.
• Trainees cannot be paid for doing additional work that would, under other circumstances, be part of their training. This would include such things as taking call or covering a shift for another resident who has become sick, injured, or is on vacation/leave.
• All requests for additional work must be provided to the Office of Graduate Medical Education. The request must include a justification for the additional work, a description of the duties and compensation and the plan for solving the service-need issue.
• All requests will be forwarded to GMEC for review. A decision for acceptance or rejection of the request will be determined by a simple majority of the voting GMEC members.
• Any additional work requests that are accepted will not be subject to extension beyond the 90-day period.

Approved by GME Committee: Jan. 14, 2021

Penn State Health Milton S. Hershey Medical Center, nor any of its ACGME-accredited programs will require a resident/fellow to sign a non-competition guarantee or restrictive covenant.

Approved By GME Committee: January 11, 2023

Residents and fellows may desire to take an elective rotation at an outside institution within the United States or abroad. Such away elective rotations should have as its primary goal an educational focus that cannot be obtained at Penn State Health- Penn State Milton S. Hershey Medical Center. During the elective rotation, Penn State Health/ Penn State Health Milton S. Hershey Medical Center will continue to pay the resident’s or fellow’s salary, benefits, and malpractice insurance as currently provided. Malpractice coverage is not provided for rotations outside the United States. All other associated expenses (housing, meals, travel, etc.) will be the responsibility of the resident/fellow. Additional malpractice insurance beyond the current coverage will not be provided by Penn State Health or Penn State Health Milton S. Hershey Medical Center.

Requirements and Process

1. The “Application for Off-Site ‘Away’ Elective Rotation” must be completed by the trainee and signed/approved by the applicant’s Program Director and the Associate Dean for Graduate Medical Education and DIO (or his designee). All requests must be received by the Graduate Medical Education Office at least 60 days before the beginning of the rotation to be considered for approval. If it is submitted with less than 60 days, there is a chance the necessary agreements cannot be completed and the rotation may not be allowed.
2. The preceptor at the outside elective site must provide a letter agreeing to accept the resident/fellow for the time period requested, agreeing to the stated goals and objectives of the rotation, and agreeing to complete an evaluation of the resident’s/fellow’s performance during the rotation and to send this evaluation to the resident’s Program Director.
3. No more than one elective away month may be taken per resident/fellow during their training period. Exceptions may be granted by the Designated Institutional Official (DIO).
4. Elective rotations to countries either on the U.S. State Department’s Travel Warning list or those with U.S. Treasury OFAC restrictions will not be permitted.
5. If an individual is currently a trainee working for Penn State Health Milton S. Hershey Medical Center on a VISA, please note that VISA regulations do not permit work at locations other than Penn State Health Milton S. Hershey Medical Center.

Application for off-site (away) elective rotation

To be completed electronically using the application form.

Revised by GME Committee: Nov. 1, 2024

For the purposes of this policy, “impairment” is the inability of a resident to physically or mentally meet their responsibilities because of physical illness or injury, psychiatric or behavioral illness, fatigue, dependency on alcohol and/or controlled substances or overuse of same or other condition.

Program directors, faculty and other medical center professionals are encouraged to be observant for signs of impairment from alcohol, drugs, psychiatric or medical disorders among residents.

When impairment is suspected, the appropriate program director or department chair should be informed and should utilize available resources to investigate the situation and take appropriate actions, including intervention, when warranted.

It is the institution’s goal to provide intervention and rehabilitation for impaired residents and to support them during the process. However, dismissal is possible if the resident refuses such.

Resources available to program directors, department chairs, faculty or residents with respect to impairment include ComPsych, the Office for Professional Mental Health, the Department of Psychiatry and Behavioral Health, professional counseling services and the Pennsylvania Medical Society’s Physicians Health Programs.

If a resident requires a Leave of Absence (LOA), refer to the Graduate Medical Education Leave of Absence Policy.

Approved by GME Committee: Nov. 25, 1997
Revised: Sept. 18, 2000; May 3, 2004; June 16, 2008; Aug. 11, 2021
Reviewed: Aug. 11, 2021

It is required that all residents attend Resident as Educator (RaE) sessions in order to appropriately participate in the education of learners and develop skills as effective educators.

Definitions

The goal of the Residents as Educators (RaE) sessions is to instruct all Penn State Health residents in evidence-based basic teaching skills to prepare them for working with all learners.

Principles

The content for the RaE sessions will include but not be limited to the following:

• Recognize ways to promote a positive learning climate
• Discuss competencies and ways to locate rotation specific learning objectives
• Examine the teaching evaluation tool components.
• Commit to reviewing and collaborating learning goals with their learners.

Procedures

• All residents will complete/attend the scheduled GME orientation. Participation will be recorded and tracked by the Office of Graduate Medical Education.
• Residents are expected to complete/attend scheduled CORE GME development sessions. Participation will be recorded and tracked by the Office of GME.
• Residents will be encouraged to complete an evaluation after each GME RaE development session. These evaluations will be used to improve future offerings.
• Program Directors who choose to embed parts of RaE into their existing curriculum are required to submit materials for review and approval by the Woodward Center for Excellence in Health Sciences Education each academic year. This will be tracked by the Office of GME in collaboration with the Woodward Center.

Approved by GME Committee: April 17, 2017

Resident or Fellow Evaluation

Each training program shall have a comprehensive resident or fellow evaluation system in place. This evaluation system shall provide objective assessments of competence in patient care, medical knowledge, practice‐based learning and improvement, interpersonal and communication skills, professionalism and systems‐based practice. A component of this evaluation system will be criteria that document progressive resident improvement in their respective milestones appropriate for each resident’s level of training. The resident or fellow must have access to each program’s evaluation/promotion criteria and policies.

Promotion

The program administration, in collaboration with the Clinical Competency Committee, will make decisions regarding each resident or fellow’s promotion to the next year of training. Those decisions will be based upon the evaluation criteria developed by the program. While it is expected that trainees will promote to the next level of responsibility annually, residents or fellows that fail to meet the program’s criteria for promotion will not be advanced solely on the basis of time served.

Failure to Promote

A decision by the program to not promote a resident or fellow to the next level of training will necessarily be accompanied by one of two recommendations: a) Retain the resident or fellow at the current level of training for a specified period of time prior to re‐evaluation, or b) Dismiss the resident or fellow from the training program. In either instance, the resident or fellow has the right to appeal this decision, as outlines in the Grievance and Due Process policy. IV.D.1.b)

Non-Renewal of Contract

In situations where a resident or fellow is not making adequate progress towards advancement to the next level of training, the program may decide against renewal of the trainee’s contract. In this situation, it is expected that the resident or fellow will receive at least 90 days advance written notice. If the reason for non‐renewal of contract occurs within the 90 days prior to the end of the current contract, it is expected that the program will provide the resident or fellow with as much written notice of its intent not to renew as the circumstances will reasonably allow. IV.D.1.a) As with all actions adversely affecting a physician in training, the trainee has the right to appeal this decision as outlined in the Grievance and Due Process policy.

Approved by GME Committee: January 11, 2023

Penn State Health Milton S. Hershey Medical Center recognizes the need and benefits of Graduate Medical Education and sponsors programs, which emphasize personal, clinical and professional development. The Graduate Medical Education Committee ensures that its training programs are in substantial compliance with the institutional and special requirements of the Accreditation Council for Graduate Medical Education (ACGME) and its individual Residency Review Committees. These circumstances and procedures also apply in the event of institutional closure.

1. Circumstances that may lead to reduction in size or closing of a training program:
   • Failure of the training program to correct concerns and/or comply with recommendations of the GME Committee
   • Failure of the training program to correct citations of the ACGME
   • Decreased financial or educational resources to support the training program
2. Procedure:
   • Penn State Health Milton S. Hershey Medical Center will inform the GME Committee, the Designated Institution Official (DIO), and residents as soon as possible when it intends to reduce the size of a program, close a program or close the institution. (IV.O.1.)
   • The residents currently training in the program will be notified immediately.
   • Every attempt will be made to reduce the number of positions over a period of time so residents already in the program can complete their education at Penn State Hershey Medical Center.
   • If this is not possible, the program director and the DIO will assist the residents in enrolling in an ACGME-accredited program in which they can continue their education. (IV.O.2.)

Approved by GME Committee: January 11, 2023
Revised: March 12, 2007; Nov. 16, 2009; Feb. 24, 2014

Eligibility and Selection of Residents

It is the policy of Penn State Health Milton S. Hershey Medical Center and its sponsored residency programs to adhere to the guidelines published by the Accreditation Council for Graduate Medical Education (ACGME).

1. Resident eligibility: Each applicant must meet one of the following qualifications to be eligible for appointment to ACGME-accredited programs, subject to additional qualifications as may be specified in specialty/subspecialty-specific program requirements:
   • Graduation from a medical school in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME).
   • Graduation from a college of osteopathic medicine in the United States; accredited by the American Osteopathic Association (AOA); or
   • Graduation from a medical school outside of the United States and Canada, and meet one of the following conditions: Holds a currently valid certificate from the Educational Commission for Foreign Medical Graduates prior to appointment, or,
   • Holds a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction in which he or she is training; or,
   • Has graduated from a medical school outside the United States and completed a Fifth Pathway* program provided by an LCME-accredited medical school.

   Candidates of Penn State Health Milton S. Hershey Medical Center residency programs (applicants who are invited for an interview) are informed, in writing or by electronic means, the terms, conditions, and benefits of appointment to the ACGME-accredited program, either in effect at the time of the interview or that will be in effect at the time of their eventual appointment. The information provided includes: eligibility requirements, financial support; personal time off; parental, sick, and caregiver leaves of absence; professional liability, hospitalization, health, disability and other insurance accessible to residents/fellows and their dependents.

2. Nepotism and Relationships among applicants: Persons are considered to be in positions of inherent unequal authority when one individual has the indirect or direct ability to influence the selection of applicant, rank order list, evaluations, and/or career progress of the family member, or related person; or whose relationship to the family member or related person creates an actual or perceived conflict of interest. In an effort to eliminate any actual or perceived conflicts of interest from arising in the training program, a current employee, faculty member, or senior leader of the program may not be in a position of unequal authority over a family member or related person. As a result, the program shall not consider the application or interview any applicant if doing so will result in a current employee in a position of unequal authority to another.
3. Transfer of Residents:
   • Residents who transfer from another ACGME training program must meet the Resident eligibility requirements noted above.
   • Residents who transfer into Penn State Health Milton S. Hershey Medical Center must have the formal summative letter from their previous program(s) for the file. This includes residents who have completed previous training or are transferring without completing previous residency training.
4.  Resident Salary and Benefits: Penn State Health Milton S. Hershey Medical Center in collaboration with each ACGME-accredited program and its participating sites, will provide all appointed residents/fellows with financial support and benefits to ensure each resident is able to fulfill the responsibilities of their educational program(s).
5.  Agreement of Appointment: Penn State Hershey Medical Center provides each resident with a written Resident Agreement outlining the terms and conditions of appointment. The Graduate Medical Education Committee monitors the implementation of these terms and conditions by the program directors. Penn State Health Milton S. Hershey Medical Center and the program directors ensure that residents adhere to established practices, policies, and procedures in all institutions to which residents are assigned. The Resident Agreement includes or provides a reference to the following IV.C.2:
   • Residents’ responsibilities;
   • Duration of appointment;
   • Financial support;
   • Conditions for reappointment;
   • Grievance procedures and due process;
   • Professional liability insurance;
   • Health and disability insurance;
   • Leaves of absence;
   • Clinical and Educational Work Hours;
   • Moonlighting;

*Footnote for 1.b.iii:

A Fifth Pathway program is an academic year of supervised clinical education provided by an LCME-accredited medical school to students who meet the following conditions:

• have completed, in an accredited college or university in the United States, undergraduate premedical education of the quality acceptable for matriculation in an accredited United States medical school;
• have studied at a medical school outside the United States and Canada but listed in the World Health Organization Directory of Medical Schools;
• have completed all of the formal requirements of the foreign medical school except internship and/or social service;
• have attained a score satisfactory to the sponsoring medical school on a screening examination; and
• have passed either the Foreign Medical Graduate Examination in the Medical Sciences, Parts I and II of the examination of the National Board of Medical Examiners, or Steps 1 and 2 of the United States Medical Licensing Examination (USMLE).

Approved by GME Committee: January 11, 2023

All residents and their patient care activities at training programs sponsored by Penn State Health Milton S. Hershey Medical Center must be supervised by an attending physician who has clinical privileges in the area they are supervising. The description of the role, responsibilities, and patient care activities of each resident are program-specific but must be documented for each residency-training program and must be available for faculty to review.

Each program must have a mechanism in place that includes the Clinical Competence Committee, to make decisions about the promotion of residents in that particular program. All residents at training programs sponsored by Penn State Health Milton S. Hershey Medical Center must have training licenses and must be permitted to write patient care orders. Hershey Medical Center assures regular communication between the Graduate Medical Education Committee (GMEC) and the Medical Staff Executive Committee through the appointment of the Designated Institution Official (DIO) to the Medical Staff Executive Committee. In addition, the Chief Medical Officer and the Executive Director also serve on the GMEC. These dual appointments result in effective communication about patient safety and quality of patient care, as well as the related educational and supervisory needs of residents.

The program director must ensure oversight of resident supervision and graded authority and
responsibility using the following classification of supervision:

Direct Supervision: VI.A.2.c).(1).(a)* the supervising physician is physically present with the resident during the key portions of the patient interaction; or, VI.A.2.c).(1).(a).(i)* PGY-1 residents must initially be supervised directly, only as described in VI.A.2.c).(1).(a).* VI.A.2.c).(1).(b) the supervising physician and/or patient is not physically present with the resident and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technology.*

Indirect Supervision: VI.A.2.c).(2) the supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available to the resident for guidance and is available to provide appropriate direct supervision.

Oversight: VI.A.2.c).(3) the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

The GMEC’s responsibilities include monitoring residency programs’ supervision of residents and ensuring that supervision is consistent with ACGME requirements and the following:

1. The provision of safe and effective patient care.
2. The educational needs of the residents.
3. Progressive responsibility appropriate to the resident’s level of education, competence, and experience.

Approved by GME Committee: January 11, 2023

Penn State Health and Penn State College of Medicine are fully committed to the education of health care professionals and providers as part of its core mission. This includes, but certainly is not limited to, allocation of substantial resources to support the educational programs, including those in graduate medical education. Penn State Health and Penn State College of Medicine will continue to provide the educational environment and opportunities to meet the needs of all students and trainees.

Graduate Medical Education Programs will ensure the progression of responsibilities through demonstrated clinical experience, knowledge and skill. Penn State Health and Penn State College of Medicine are committed to and responsible for promoting patient safety and resident well-being and to providing a supportive educational environment.

Graduate Medical Education Committee

The Graduate Medical Education (GME) Committee is committed to offer graduate medical education programs in which physicians in training develop personal, clinical and professional competence under the guidance and supervision of the faculty and staff.

The GME Committee oversees the education, research and patient care practices of residents and fellows throughout Penn State Health Milton S. Hershey Medical Center. The Committee ensures that each residency and fellowship program provides quality educational experiences and meets the requirements set forth in the ACGME Special Requirements for each accredited program. Further, the Committee monitors and coordinates issues applicable or common to all programs, such as those raised by external accreditation agencies (AMA, AAMA, ACGME, NRMP).

The GME office offers reimbursement for round trip transportation costs to help ensure you, the hardworking Residents and Fellows, get home safely after work!* This reimbursement is available to any Resident (or Fellow) that elects to use a transportation service to get home instead of driving their vehicle while fatigued. (III.B.7.d).(3))

The process is simple. Choose an app-based service (Uber, Lyft, Mytaxi, etc.) for the trip home, rest up and then use the service again to pick up your car at a later point in time. Email both receipts to the GME office within 10 business days of the travel date. The receipt must show the trip address from a valid training site to the resident’s verifiable home address (listed in New Innovations).

ACGME Common Program Requirements (Residency)

VI.D.3. The program, in partnership with its Sponsoring Institution, must ensure adequate sleep facilities and safe transportation options for residents who may be too fatigued to safely return home.

Reimbursement Instructions

• Double-check that your receipt contains the following information – starting location, ending location, time/date, your name, total fare amount.
• Forward both receipts (trip home and return trip) to the GME office (gme@pennstatehealth.psu.edu) within 10 business days of travel.
  The receipt must show the trip address from a valid training site to the resident’s verifiable home address (listed in New Innovations).
• The GME office will review and approve/deny the request. If approved, the reviewer will sign & date the receipt and return to the program coordinator for processing.
• The resident/fellow (or proxy) will add the receipt to XM and submit for approval to Accounts Payable under the GME cost center 111.1000.4970.

Approved by GME Committee: January 11, 2023

The Pennsylvania State Board of Medicine licensing regulations require all resident physicians participating in an ACGME accredited training program to pass the USMLE Step III exam prior to beginning the Post Graduate Year (PGY) three (3) level of training. The resident is responsible for giving their program a copy of the official USMLE Step III score report.

Resident physicians in their intern year of residency training are required to take the USMLE Step III exam during the PGY-1 year. If the exam is not taken during the PGY-1 year, the resident will not be permitted to advance to a PGY-2 position and may be dismissed for cause from the program.

Resident physicians who take but fail the USMLE Step III exam during their PGY 1 year will be permitted to advance to a PGY-2 position and will have the opportunity to retake the exam during the first 6 months of their PGY 2 year of training. Resident physicians, who have not passed the USMLE Step III exam a minimum of four months prior to the end of their PGY-2 year of training, will not be permitted to continue in the residency program after the conclusion of the PGY-2 year of training. In keeping with the USMLE/NBME policy, the total number of attempts allowed per Step is four (4). Any resident who has attempted a USMLE Step exam four (4) or more times and have not passed are ineligible to apply for further USMLE Step exams.

A PGY-2 resident (or higher) who desires to transfer to Penn State Health Milton S. Hershey Medical Center must provide evidence of passing the USMLE Step III exam prior to being accepted into the program.

Approved by GME Committee: Jan. 11, 2023
Revised: Sept. 15, 2003; Sept. 18, 2006; Sept. 10, 2007; July 19, 2010; Sept. 13, 2010; Feb. 24, 2014

Penn State Health Milton S. Hershey Medical Center requires any non-US citizen wishing to participate in a United States graduate medical education program to possess a visa that permits direct patient care. Penn State Health Milton S. Hershey Medical Center accepts the J-1 Training Visa for the non-US citizens who are entering ACGME training programs.

The visa application should be submitted well in advance of the anticipated date of enrollment. To obtain further information, contact American embassies, consulates, or United States district offices of the Immigration and Naturalization Service.

Non-US citizen resident physicians must secure a visa allowing direct patient care and be permitted to enter the United States in compliance with the Department of Homeland Security regulations. In accordance with Section 4.4 of the Resident Agreement, the resident physician will forfeit their position in the Residency Program of Penn State Health Milton S. Hershey Medical Center if they are ineligible or unable to be physically present and perform the duties associated with their position as of the first day of the Resident Agreement period, for any reason. Any signed contracts or previous agreements are null and void at that time.

Approved by GME Committee: Sept. 20, 2004; Jan. 11, 2023

The following policies are available for view on the policy portal. Penn State Health/Penn State College of Medicine login is required.

• HR74 Americans with Disabilities Act Policy
• HR07 Conflict Resolution and Employee Complaints
• HR11 Sexual Harassment
• HR38 Personal Behavior and Communication Standards
• HR44 Pre-employment Drug Testing
• HR68 Background Checks (including Self-Disclosure of Criminal Charges and Offenses)
• HR86 Complaints of Unlawful Discrimination or Harassment
• HR87 Personal Use of Social Media
• A-89 HAM Industry Relations Policy
• A-24 HAM Resident Meal Program
• A-42 HAM Uniform and Scrub Suit Policy
• PSCOM-100 Culture of Respect in Education (C.O.R.E. Document)
• PSH-SC-12 Vendor Representative Visitation

Visit the Policy Portal (login required) to read these policies.

Human Resources policies can be requested from the GME office at gme@pennstatehealth.psu.edu.