Additional Work Policy
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.
- 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.
- Additional Work policies should be used only for brief and self-limited staffing needs.
- The Graduate Medical Education Committee, via the Graduate Medical Education Office, must be informed of all instances in which this policy is implemented. This notification must include a justification for the additional work, a description of the duties and compensation, and the plan for solving the service-need issue.
- 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.
- 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.
- Under no circumstances can a resident or fellow be required or obligated to take on additional work under this policy.
- Under no circumstances can a resident or fellow violate ACGME work hour rules by taking on additional duties.
- Residents must be a US Citizen or Permanent Resident to be eligible for additional work. (Residents on J1 or H1B Visa are not eligible for additional work.)
- Remunerated work hours performed under this policy must be tracked and included as duty hours.
- 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).
- 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
Off-Site “Away” Elective Rotation Policy
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 Milton S. Hershey Medical Center. During the elective rotation, 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 Hershey Medical Center.
Requirements and Process:
- The Application for Off-Site ‘Away’ Elective Rotation must be printed, completed and signed/approved by the applicant’s Program Director and the Associate Dean for Graduate Medical Education and DIO (or his designee), then returned to the Graduate Medical Education Office. 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.
- 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.
- No more than one elective away month may be taken per resident/fellow during their training period. Programs that require four years or more of residency training may offer one additional away elective month. Exceptions may be granted by the Designated Institutional Official (DIO).
- 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.
Revised by GME Committee: Jan. 27, 2014
C.O.R.E. (Culture of Respect in Education)
Maintaining a culture of respect in our clinical learning environment is a core value of our institution 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.
As you interact with others during your training, you may witness or experience behaviors that are suboptimal. If you believe that an encounter violates our core values for a respectful working environment or if you feel that you or others have been the object of mistreatment in the clinical or non-clinical settings, we would like you to help us to address these concerns in the appropriate fashion. There are many opportunities for you to do so, including; a discussion with the individual that you believe has been the source of disrespect or mistreatment, your Program Director or others in your Program’s administration, the Department Chair or Associate Chair responsible for education within the department, your mentor(s), the Associate Dean for Graduate Medical Education/DIO or the Associate DIO, or the GME ombudspersons. See contact information for those people here.
Types of Mistreatment
Several types of behavior constitute mistreatment. Learn more about different types of mistreatment here.
Reporting a Concern
The Mistreatment Reporting Form is a confidential way to report a concern. You can choose to identify yourself or to remain anonymous. We ask that you provide as much detail of the incident or pattern of behavior as possible to assist us in investigating your concerns.
Whether you elect to identify yourself or not, please understand that we will investigate and follow up each report of mistreatment in a comprehensive fashion while maintaining your confidentiality.
We appreciate your time and effort in helping us achieve the highest degree of respect in our everyday interactions. We are firmly committed to providing a clinical learning environment that allows each learner to reach the milestones necessary in their training to become a competent, compassionate physician.
In the event of a local or national disaster or public health emergency, Penn State Health and Penn State College of Medicine will continue to provide financial and administrative support for its GME programs through the disaster. 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: March 12, 2007
Reviewed: June 16, 2008
Revised: May 14, 2012; Nov. 25, 2013
Duty Hour Policy
Resident Duty Hour Policy for Penn State Health Milton S. Hershey Medical Center provides residents with a sound academic and clinical education that is carefully planned and balanced with concerns for patient safety and resident well-being. Appropriate limits are placed on duty hours to foster high-quality education and to promote patient safety. Each residency program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents’ time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
Duty Hours: Duty hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences.
- Residents must not be scheduled for more than 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. Individual programs may request an increase of up to 10 percent in the 80 hour per week limit if they can provide a sound educational rationale.
- Residents must have at least one full (24-hour) day out of seven free of all educational and clinical patient care duties, averaged over four weeks. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. At home call cannot be assigned on these free days.
- Duty periods of PGY-1 residents must not exceed 16 hours in duration. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.
- PGY-2 residents and above may be allowed to remain on-site in order to accomplish effective transitions of care; however, this period of time must be no longer than an additional four hours.
- Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty. In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled duty period to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reason of require continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient family. Each such instance must be documented in writing by the resident and the Program Director. *See Common Program Requirements VI.G.4.b).(3).(a-b).
- PGY-1 Residents should have 10 hours, and must have 8 hours free of duty between scheduled duty periods.
- Intermediate-level residents [as defined by the Review Committee] should have 10 hours free of duty, and must have 8 hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty.
- Residents in the final years of education [as defined by the Review Committee] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. *See Common Program Requirements VI.G.5.c).(1-1a)
On-Call Activities: The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal workday when residents are required to be immediately available in the assigned institution.
- PGY-2 residents and above must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).
- Residents must not be scheduled for more than six consecutive nights of night float.
- Time spent in the hospital by residents on at-home call must count toward the 80-hour maximum weekly hour 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 duty 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.
- Residents are permitted to return to the hospital while on at-home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new “off-duty period.”
High-Quality Education and Safe and Effective Patient Care:
- Didactic and clinical education must have priority in the allotment of residents’ time and energies;
- On-call schedules for attending/teaching staff must be structured to provide that supervision and faculty support/consultation is readily available to residents on duty;
- Duty hour assignments in teaching settings must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients;
- Faculty and residents must be educated to recognize the signs of fatigue and to apply preventive and operational countermeasures. The program director and teaching faculty must monitor residents for the effects of sleep loss and fatigue, and respond in instances when fatigue may be detrimental to resident performance and well-being. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 pm and 8:00 am, is strongly suggested.
- Programs must provide residents appropriate backup support when patient care responsibilities are especially difficult and prolonged, and if unexpected needs create resident fatigue sufficient to jeopardize patient care during or following on-call periods.
- Penn State Health Milton S. Hershey Medical Center will promote patient safety and education through duty hour assignments and faculty availability.
- Each residency program must establish written policies governing resident duty hours that foster education and the safe care of patients. Duty hours must be consistent with the ACGME requirements, all applicable RRC Program Requirements, and must apply to all institutions to which residents rotate.
- When an increase to duty hours is granted, up to 10 percent above the 80-hour weekly limit, the program must develop written protocols to be approved by the Graduate Medical Education Committee that detail the process for providing an educational rationale for the increase.
- Policies on patient care activities outside the educational program (moonlighting) will be provided to residents. Because residency education is a full-time endeavor, the program director must ensure that moonlighting does not interfere with the ability of the resident to achieve the goals and objectives of the educational program. PGY-1 residents are not permitted to moonlight. All moonlighting activities must be approved by the Program Director (in writing) and monitored by the Program.
- Programs must have procedures and policies in place to monitor and support the physical and emotional well-being of residents to promote an educational environment and safe patient care.
- Demands of home call must be monitored in the programs, and scheduling adjustments made as necessary to address excessive service demands and/or fatigue.
- Patient care support services for IV, phlebotomy, and transport activities must be available to reduce resident time spent on these routine activities.
- All Programs must actively monitored their residents’ duty hours and provide written explanations for any deviations from the requirements. A monthly report will also be reviewed and signed by the Associate Dean of Graduate Medical Education. This report will be presented to the Graduate Medical Education Committee on a quarterly basis. If necessary, the Associate Dean will meet with the program director concerning any violations.
- A report will be presented annually to the Board of Directors on program and institutional compliance with the duty hour standards.
Approved by GME Committee: July 2, 1996
Revised: Nov. 25, 1997; Sept. 18, 2000; May 3, 2004; June 16, 2008; March 14, 2011; Feb. 24, 2014
Allowable Expenditures for Graduate Medical Education Educational Support Funds for Residents and Fellows
To define allowable expenditures related to Graduate Medical Education-Educational Suppmt Funds (expense account 690240) for residents and fellows.
Graduate Medical Education Educational Suppmt 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.
- During the annual budget process GME ESF funds are approved for each applicable training program.
- 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
- Personal use items related to medical education or patient care activities ( e.g.,
iPads or a tablet device that is for personal use, and that will be owned by the purchaser). The following rules/regulations apply:
- The reimbursement will be reported as income to the resident/fellow and they will pay personal income tax on the item (as required by law). They will be reimbursed in their paycheck and applicable taxes will be deducted. The device is a “common or listed property” personal device, as classified by the IRS. Their W2 will reflect the reimbursement at the end of the year.
- Residents must have money in their current-year CME/ESP/book fund account to purchase the tablet. The resident may use part of their ESF fund to buy the tablet – and be reimbursed for only a part of the device. For example, if they purchase a higher-end tablet for $799 but only have $300 in their account, they may be reimbursed for the $300.
- Residents are not required to purchase any particular type of tablet, nor are they required to purchase a tablet at all.
- The tablet will belong to the resident. If the resident loses the tablet there will be no further reimbursement. Also, residents will be liable for any protected or sensitive information that is stored on the tablet. The best advice is to not store ANY such information on the personal tablet.
- Permission for such purchases must be approved by the resident’s Program Director and the appropriate fonns submitted to the GME Office. (The resident must show a proof of purchase receipt.)
- Departments/Employees must follow established Accounts Payable policies &procedures for payment/reimbursement of GME ESF allowable expenditures.
Reviewed: December 2011
Revised: December 2011
Grievance and Due Process Policy
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 (“HMC”) 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: 1) non-renewal of the Resident Agreement, 2) non-promotion to the next year of the training program, 3) suspension from the training program or 4) 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:
- 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.
- 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.
- 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.
- 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.
- 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 (“GME”) 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.
- 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.
- 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: July 18, 2014
Leave of Absence Policy
Request for Leave: Resident physicians must request a Leave of Absence for non-emergent leave at least 30 days prior to the anticipated leave date. The Request for Leave should be a written notice to the Residency Program Director and the Residency Program Coordinator.
A Leave of Absence request for emergent leave should be provided to the Residency Program Director and Residency Program Coordinator as soon as possible following the emergency.
Resident physicians who are requesting Medical/Parental or Family Leave must submit the appropriate request for the Family and Medical Leave Act (FMLA) to FMLASource.
Vacation*: Each resident is granted 15 to 20 working days of paid leave each year in keeping with program, departmental and Residency Review Committee requirements. Interviewing, relocation and educational trips are to be included in this time.
Medical/Parental/Family Leave*: A resident may request a maximum of twelve weeks of family leave. The first six weeks minus any vacation leave already used will be with full pay and benefits, and will include any remaining vacation leave for the contract period. The remainder of the twelve weeks will be without pay; however benefits will be billed at the employee rate.
Paid leave is provided on a consecutive basis until exhausted or the resident returns to the program. Paid leave may be required to be taken in one block of time at the discretion of the program director. If the period of leave bridges two consecutive contract periods, the amount of paid and unpaid leave will be allocated proportionately, including available vacations days.
Personal Leave*: A personal leave may be granted to a resident upon review of the circumstances by the Program Director. All eligible vacation time for that year must be used during this period. The period of personal leave time that is not covered by vacation 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 academic 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 is responsible to notify the Resident as to the effect of leave on their training timeline. Residents may be required to extend their length of training to meet all residency program requirements. The Residency Review Committee for the residency program and the Residency Program Director determine the length of training and training to be completed following a leave of absence.
*All requirements of the residents’ respective Board must be satisfied. Board requirements will take precedence over institutional leave of absence policies, when applicable. Specific specialty Board information can be accessed through the PSHMC internet, the Graduate Medical Education office, or the Program Office. (Institutional Requirements: IV.G.I)
Approved by GME Committee: Nov. 22, 2010
Revised: Feb. 24, 2014; Feb. 23, 2015
External Moonlighting: Voluntary, compensated, medically-related work performed outside the institution where the resident is in training or at any of its related participating sites. (ACGME definition 2013 Glossary of Terms)
Internal Moonlighting/Additional Work: Voluntary, compensated, medically-related work (not related with training requirements) performed within the institution where the resident is in training or at any of its related participating sites. (ACGME definition 2013 Glossary of Terms)
The following principles must be followed for all types of 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.
- Residents must be a US Citizen or Permanent Resident to moonlight. (Residents on J1 or H1B Visa are not eligible to moonlight.)
- If the Resident elects to externally moonlight, by working outside the scope of the educational activities and regularly assigned duties, professional liability insurance coverage is not provided by Penn State Health Milton S. Hershey Medical Center.
- Residents must have prior written consent from the program director to moonlight. A written statement of permission from the Program Director will be placed in the resident file. The statement of permission must indicate that the resident is in good standing and that this additional duty will not interfere with their didactic training or educational needs. Moonlighting shall not be approved if the program director believes such activities may interfere with the residents’ ability to perform his/her 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 and adverse effects may lead to withdrawal of permission.
Please note: For external 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.
- All moonlighting activities (external and internal/additional work) must be counted and logged in accordance with the Duty Hour Policy.
- 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.
- For internal moonlighting/additional work, 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.
- Each program that wishes to provide compensation for internal moonlighting/additional work under this policy must develop a program specific policy consistent with this 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. The Graduate Medical Education Committee, via the Graduate Medical Education Office, must be informed of all instances in which this internal moonlighting/additional work is occurring. This notification must include a justification for the additional work, a description of the duties and compensation, and the plan for solving the service-need issue.
- Fellowship Moonlighting Compliance – the following pertains only to requests by fellows and/or departments that request moonlighting within the department that is sponsoring the fellowship and would include billing for services during these duties.
- The fellow must be “board certified” in the core specialty for which they are moonlighting, and all expected moonlighting activities must be included in the scope of practice for that specialty.
- All costs of training for the fellow – salary and benefits – must be paid by the department for the entire time of training and will not be reimbursed by the Office of Medical Education.
- The department must present their request for the expected time of moonlighting by the fellow (percent FTE) to the Faculty and Clinical Workforce Committee (FCWC) for approval prior to the initiation of the fellowship.
- All moonlighting hours must be documented in keeping with the Office of GME policy and in compliance with the ACGME requirements of training.
- 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.
Approved by GME Committee: Sept. 21, 2015
Revised: August 2016
Non-Competition (Restrictive Covenant) Policy
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: Feb. 24, 2014
Physician Impairment & Substance Abuse Policy
For the purposes of this policy, “impairment” is the inability of a resident to physically or mentally meet his or her responsibilities because of physical illness or injury, psychiatric or behavioral illness, 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 our 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 the ComPsych, the Student Mental Health Service, the Department of Psychiatry, professional counseling services and the Pennsylvania Medical Society’s Physicians Health Programs.
Approved by GME Committee: Nov. 25, 1997
Revised: Sept. 18, 2000; May 3, 2004; June 16, 2008
Reviewed: Feb. 24, 2014
Preparing Residents as Educators (RaE) Policy
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.
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.
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.
- 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
Promotion/Renewal of Appointment (Including Non-Promotion and Non-Renewal)
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.
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 outlined in the Grievance and Due Process policy.
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. 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: Feb. 23, 2015
Reduction or Closure
Penn State Health Milton 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.
- 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
- 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.
- 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 Health Milton S. 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.
Approved by GME Committee: Sept. 18, 2000
Revised: March 12, 2007; Nov. 16, 2009; Feb. 24, 2014
Resident/Fellow Recruitment Policy
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).
- 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: financial support; vacations; parental, sick, and other leaves of absence; professional liability, hospitalization, health, disability and other insurance accessible to residents/fellows and their dependents.
- 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.
- 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).
- Agreement of Appointment: Penn State Health Milton S. 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:
- 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;
- Duty Hours;
*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: (1) 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; (2) have studied at a medical school outside the United States and Canada but listed in the World Health Organization Directory of Medical Schools; (3) have completed all of the formal requirements of the foreign medical school except internship and/or social service; (4) have attained a score satisfactory to the sponsoring medical school on a screening examination; and (5) 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: Feb. 24, 2014
Resident Supervision Policy
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. These documents must be maintained in the residency directors’ offices. 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: The supervising physician is physically present with the resident and the patient.
Indirect Supervision: a) With direct supervision immediately available – the supervising physician is physically in the hospital or other site of patient care and is immediately available to provide Direct Supervision; b) With direct supervision available – the supervising physician is not physically present in the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities and is able to provide Direct Supervision
Oversight: 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:
- The provision of safe and effective patient care.
- The educational needs of the residents.
- Progressive responsibility appropriate to the resident’s level of education, competence, and experience.
Approved by GME Committee: Dec. 15, 2014
Statement of Commitment to Graduate Medical Education
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).
USMLE Step III Policy
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.
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.
A PGY-2 resident (or higher) who desires to transfer to Penn State Health must provide evidence of passing the USMLE Step III exam, including uploading test scores via the secure New Innovations system, prior to being accepted into the program.
Approved by GME Committee: Sept. 15, 2003
Revised: Sept. 18, 2006; Sept. 10, 2007; July 19, 2010; Sept. 13, 2010
Reviewed: 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 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 3.3 of the Resident Agreement, the resident physician will forfeit their position in the Residency Program of Penn State Hershey 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
Revised: June 18, 2008; July 11, 2011
Reviewed: Feb. 24, 2014
The following policies are available for view on the Infonet, accessible to on-campus users at Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine. Login is required.
- HR74 Americans with Disabilities Act Policy
- HR07 Conflict Resolution and Complaints of Unlawful Discrimination and Harassment
- HR11 Sexual Harassment
- HR38 Personal Behavior and Communication Standards
- A-89 HAM Industry Relations Policy
- A-24 HAM Resident Meal Program
- A-42 HAM Uniform and Scrub Suit Policy
- MS-12 Culture of Respect in Education (C.O.R.E) Policies on Respectful Treatment of Students and Trainees
Visit the Policy Portal (internal users only) to read these policies.