Policies

form).

viii. Translation of all documents by Certified Translation Services listed above not in English.

ix. All documents shall be from original source (or transmitted through ERAS in accordance with standard ERAS policy).

4. RESIDENT TRANSFERS:

Physicians may enter the Residency Program at the second-year postgraduate level only after successful completion of one of the following:

a. One clinical year of training in a program in internal medicine, family practice, or pediatrics accredited by the Accreditation Council for Graduate Medical Education (ACGME);

b. A transitional year program accredited by the ACGME;

c. One year of an ACGME-accredited residency in a clinical specialty requiring comprehensive and continuous patient care.

For physicians entering at the PGY-II level after completion of such a program, PGY-I training may be credited toward the 48-month requirement.

To determine the appropriate level of education for Residents who are transferring from another residency program, in addition to the requirements listed in Section 3, the Program Director must obtain written or electronic verification of previous educational experiences and a summative competency-based performance evaluation of the transferring Resident. Verification must include evaluation of professional integrity of the transferring Resident.

This documentation must be received prior to the transferring resident being accepted into the program. Those residents selected at the second postgraduate year or above must have satisfied the training objectives for reaching that level of training.

The applicant must provide the relevant permissions for release of information regarding previous training experiences in order to be considered for the selection process. Board Certification in Internal Medicine, Family Medicine, or Pediatrics is considered adequate documentation of 4 months of primary care, satisfactory performance evaluation, and a certificate of professional integrity from the previous program. The complete application for the transferring Residents will be reviewed and then submitted to the Educational Policy Committee to determine if the candidate is eligible for consideration.

For Residents transferring into this program, educational program must be sufficiently individualized so that he/she will have met all the educational and clinical experiences of the program, as accredited, prior to graduation.

For Residents transferring out of this Residency Program prior to completion, the Program Director must provide timely written or electronic verification of previous educational experiences and a summative competency-based performance evaluation of the transferring resident. Verification must include evaluation of professional integrity of the Resident transferring to another program, including a child and adolescent psychiatry program.

5. EMPLOYMENT PROCESSING:

a. Physical Examination:

The Hospital requires Residents to submit report of a physical examination and certificate of medical fitness prior to any patient contact. The Hospital provides each Resident with the required complete physical examination.

b. Drug and Alcohol Testing:

The Residents will be in compliance with the District of Columbia’s drug and alcohol testing laws in order to protect themselves and insure safety of their patients.

c. Social Security Cards:

Documentation of a social security number as evidenced by a Social Security Card issued by the Social Security Administration is a requirement for employment with the District of Columbia Department of Mental Health.

d. CPR/AED Certification:

Residents are responsible for maintaining their certification in cardiopulmonary resuscitation (CPR) and automatic electronic defibrillator (AED). Arrangements will be made for the initial training either during the orientation schedule or as soon as possible after the beginning of the academic year. Thereafter, notices will be posted regarding dates for recertification classes in CPR and it will be the Residents’ responsibility to enroll and attend these classes as necessary. Each Resident will provide the Residency Program with copies of their current CPR and AED certification verifications for inclusion in their official training folders.

e. Pagers:

The Hospital shall make available long-range pagers for on-call Residents who are not required to be in The Hospital. General maintenance and service shall be provided by The Hospital, provided that evidence of mistreatment is not present. Temporary replacements will be made available to the Residents while on-call.

f. Identification Badge:

All Residents are required to wear official Hospital-issued badges at all times while on duty. If a badge is not visible security officers or any members of management may stop a Resident and request identification. Identification (ID) badges are issued by the Department of Mental Health to Resident and remain the property of The Hospital. ID badges must be worn to enter and/or exit the building and at all times while on The Hospital premises. The initial badge is issued free of charge. A badge which is turned in as badly worn or damaged will be replaced free of charge. In the event of job or name change, a new badge will be issued free of charge. There is a charge for replacement of lost or stolen badges. To replace a lost or stolen badge, the Resident must obtain a properly completed access control form and a Cashier’s receipt and take it to Security. Upon termination from The Hospital, Residents are required to return the ID badge to their Program Director prior to issuance of final check.

g. Emergency Notification Information:

Residents shall complete and sign a standard emergency notification form, which shall indicate current home address and telephone number of Resident, at least two next of kin/ significant individual to be notified in case of emergency, address for indicated next of kin/significant individuals, and physician to be notified.

6. RESIDENT LICENSURE POLICY:

The purpose of this policy is to comply with District of Columbia Municipal Regulations Title 17, Chapter 46 regarding pre-licensure practice by students and postgraduate physicians. Residents have the responsibility for familiarizing themselves with the postgraduate physician trainee licensure requirements of D.C. law and regulations, and for obtaining requisite licenses.

Generally, the D.C. Board of Medicine defines a Postgraduate Physician as a person who holds a degree in medicine or osteopathy who is enrolled in a postgraduate clinical training program prior to licensure in any jurisdiction in the United States. The D.C. Board of Medicine allows a Postgraduate Physician to practice medicine in a clinical training program approved by the ACGME or the Board, if he/she is a graduate of an accredited US or Canadian medical or osteopathic school, or holds a valid ECFMG certificate. Postgraduate Physicians (Residents) are required to enroll with the D.C. Board of Medicine Postgraduate Physician Trainee Enrollment (PPTE) Program. However, there are certain exceptions. The Resident may practice under the PPTE Program for a maximum of five (5) years.

a. For graduates of US and Canadian medical schools the five-year period shall begin with the graduation from medical school.

b. For graduates of foreign medical schools other than Canadian medical schools, the five-year period begins at the beginning of an approved US postgraduate training program.

If the Resident has at any time been licensed in D.C. or any other jurisdiction in the US, the Resident must have a D.C. medical license in order to participate in a residency program unless the Resident is an IMG who became licensed in jurisdiction that required less than three (3) years of U.S. postgraduate training required from an IMG to be licensed in D.C. A copy of the District of Columbia Municipal Regulations, Title 17, Chapter 46 can be obtained by calling (877) 672-2174 or by visiting the District of Columbia Board of Medicine website at http://dchealth.dc.gov where the information is available under the link “Professional Licensing.” Residents are required to comply with the above-mentioned Municipal Regulations. Violation of the Act will result in disciplinary action that may lead to termination.

In order to ensure that the Resident does not become noncompliant with the D.C. Municipal Regulations midway through the academic year, The Hospital requires prospective and current Residents who are graduates of US medical schools to obtain a D.C. license four (4) years after graduation. Also, prospective and current Residents who are International Medical Graduates (IMG) must obtain a D.C. license after four (4) years of beginning graduate medical education in the United States.

7. CONDITIONS OF APPOINTMENT:

a. Financial Support:

The compensation provided to the Residents should be sufficient to ensure that Residents are able to fulfill their educational programs. The annual compensation will be determined in accordance with the Collective Bargaining Agreement, and will be indicated in the yearly Residency Agreement contract.

b. Contracts:

A written agreement (Residency Agreement) outlining the terms and conditions of the appointment will be provided to the Resident. The format of the agreement will be provided to the Graduate Medical Education Committee for review and approval for sufficiency. As a minimum, the agreement shall comply with the ACGME Institutional Requirements.

c. Benefits:

The Resident is eligible to receive the following benefits according to the applicable Comprehensive Merit Personnel Act (CMPA) rules as implemented by DMH Personnel rules and regulations, and Employee Benefits determined by the District of Columbia Office of Personnel. Detailed information on these benefits is posted on http://dchr.dc.gov and is also available by calling Saint Elizabeths Hospital Human Resources Office at 645-9900:

i. Health insurance

ii. Dental and Optical coverage

iii. Group Life Insurance

iv. Flexible Spending Account which includes Dependent Care Account and Healthcare Spending Account

v. Short-term Disability Insurance

vi. 457 Deferred Compensation Programs

vii. Employee Assistance Program

viii. Direct Deposit

ix. Savings Bond Program

x. District of Columbia Credit Union

xi. D.C. College Savings Plan

xii. Residents may be eligible for Workers Compensation, health insurance bridge coverage as mandated by the Temporary Continuation of Coverage (TCC), and Unemployment Insurance.

d. Leave:

See Section 13

e. Educational Benefits:

The Hospital provides leave and reimbursement to permit Residents to attend educational conferences and to take exams to satisfy licensure requirements. Details are discussed in the Collective Bargaining Agreement.

f. Mail:

The Hospital agrees to provide Residents with mailboxes located in Barton Hall building within The Psychiatry Residency Training front office mail room # 200. It is specifically agreed that The Hospital assumes no liability, financial or otherwise for stolen, lost or damaged mail and/or packages and the Resident agrees that he/she will hold The Hospital harmless from any claims, actions, or proceedings by any Resident arising from stolen, lost or damaged mail. The Hospital will not arbitrarily or purposely damage, lose or willfully take part in any other action that abuses the Residents’ mail.

i. General Supervision: In addition to direct supervision, all Residents receive two (2) hours weekly of additional General Supervision from clinical faculty. General supervisors will meet with the resident in their offices and provide patient-focused teaching and guidance, using patient interviews, process notes, resident reports, videotaped interviews, progress notes and the psychiatric interview as resources.

j. Inpatient Rotations:

i. Residents will be able to identify an available supervising attending at all times during patient care.

ii. Attending physicians must be available to Residents and must be able to provide direct consultation patient care when necessary.

iii. Admissions will be discussed with an attending supervisor on the day of admission.

iv. Transfers and discharges will be discussed with an attending prospectively.

v. As often as medically appropriate, attending faculty (or his/her attending faculty back-up), or a licensed Resident will personally supervise the care of all hospitalized patients assigned to his/her service, will document as appropriate and will see patients daily.

vi. An attending faculty will personally see and supervise inpatient consultations referred to his/her service and insure appropriate documentation.

vii. The attending faculty member will be responsible for compliance with ACGME policies in the inpatient setting.

k. Outpatient Rotations:

i. Residents will be able to identify an available supervising attending physician at all times during patient care.

ii. Attending faculty will be available to Residents during the entire outpatient clinic session.

iii. Attending faculty or licensed Resident physician will personally supervise and appropriately document the care of all patients under the care of unlicensed Residents.

iv. A faculty attending member will be responsible for service in each specific outpatient site. This individual will be responsible for insuring compliance with ACGME policies.

l. Comprehensive Psychiatric Emergency Program:

i. Residents will be able to identify an available supervising attending at all times during patient care.

ii. Attending faculty will be available to Residents.

iii. Compliance with requirements regarding the supervision of Residents and the care of patients.

iv. A specific attending faculty member will be assigned to be responsible for compliance with ACGME policies.

m. General Supervision for Call at St. Elizabeths Hospital (SEH):

i. Patients Admitted To SEH: The Resident will call the on-call attending for questions about admission orders and medications overnight.

ii. Patients Transferred To Another Facility: All transfers to another facility should be approved by the attending psychiatrist or general medical officer on call. The Director of Medical Affairs should be consulted in cases where questions cannot be resolved by the attending psychiatrist or general medical officer.

iii. Patients Being Discharged From SEH: Any unscheduled discharge from the unit needs to be cleared by the attending psychiatrist on-call or the Director of Medical Affairs.

iv. When to Call the Attending: Anytime the Resident believes it is necessary.

v. When restraints are needed, the attending psychiatrist needs to assess the patient.

n. Supervisory Procedures:

i. All Residents will be assigned three general supervisors. Two will be clinical supervisors and one will be administrative from the full-time attending faculty.

ii. Resident and supervisor meeting times are to be arranged during the first week in July.

iii. Supervisory assignments are not elective. It is expected that the Resident will meet once weekly with each of his/ her clinical supervisors.

iv. If some problems arise in the Resident’s supervisory experience, every attempt should be made to work it out with the Resident’s supervisor since this can be a very meaningful part of the supervisory experience. If the problem cannot be resolved between the Resident and his/ her supervisor, the administrative supervisor (if problems are with clinical supervision) or the Program Director should be called for an appointment to discuss the matter.

v. The Graduate Education Committee will expect each supervisor to make a written report at the end of the rotation period describing the supervisory experience and an evaluation of the Resident's work, to be described in terms of the six core competencies described in Section 8 a. This report should be shared with the Resident, discussed and signed. In the same way, a report by the Resident regarding his/her views of the supervision and the supervisor is expected. Both Resident and supervisor reports are to be sent to the Residency Program Coordinator.

vi. All supervisory assignments are made centrally in the Residency Program office. Occasionally a Resident may contact a supervisor about future supervision on his own initiative. This should be immediately reported to the Residency Program office for review and coordination since it is the responsibility of the Residency Program office to make all the assignments.

o. Faculty Expectations and Supervisory Lines of Responsibility: The Faculty plays a fundamental role in the Residency Program. Faculty members are responsible for the comprehensive professional development of the Residents. Faculty member are responsible for Resident training in areas of education, clinical service and supervision, research and scholarship and evaluation.

i. Education: As educators faculty members are expected to:

1. Teach the six core competencies through supervision, didactic seminars, and role modeling on clinical services.

2. Teach the art and science of clinical psychiatry including the biological, psychological, and socio-cultural aspects of the field, according to his or her areas of expertise.

3. Serve as an academic mentor for Residents who express clinical or academic interests in his or her area of expertise.

4. Help teach the Residents how to become educators and supervisors of lay and professional populations.

6. Represent the Residency Program in local, regional and national meetings.

10. RESIDENT DUTY HOURS AND WORK ENVIRONMENT:

Providing Residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and Resident well being. The Hospital will ensure that the learning objectives of the Residency 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.

a. Duty Hours:

i. 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. Duty Hours do not include reading and preparation time spent away from the duty site. These standards apply to all Residency Program training sites, including, but not limited to, the current Participating Institutions.

ii. Duty Hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

iii. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

iv. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.

b. On-Call Activities:

i. The objective of on-call activities is to provide Residents with continuity of patient care experiences throughout a 24-hour period.

ii. 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.

1. In-house call must occur no more frequently than every third night, averaged over a four-week period.

2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical care.

3. No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity clinics. A new patient is defined as any patient for whom the Resident has not previously provided care.

iii. At-home call (pager call) is defined as call taken from outside the assigned institution.

1. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each Resident.

2. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. When Residents are called into The Hospital (or Participating Institution) from home, the hours Residents spend in-house are counted toward the 80-hour limit.

3. The Program Director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.

c. Moonlighting and Duty Hours:

Moonlighting that occurs within the Residency Program or DMH, i.e., internal moonlighting, must be counted toward the 80-hour weekly limit on Duty Hours.

d. Work Environment:

The Hospital and Participating Institutions will provide services and develop systems to minimize the work of Residents that is extraneous to their educational programs, ensuring that the following conditions are met:

i. Residents on overnight duty in The Hospital will be provided adequate and appropriate food services and sleeping quarters.

ii. The Hospital will provide adequate lounge, toilet, shower and on-call facilities for both sexes. All facilities will be cleaned as necessary and specifically, the on-call facilities will be provided with clean bed linen. In the event the level of cleanliness needs review, the Residents may request such review with the Director of Medical Affairs. The Hospital shall give the Residents sufficient notice of any planned renovation or movement of on-call rooms, lounges, locker rooms, and toilet facilities.

iii. Patient support services, such as intravenous services, phlebotomy services, and laboratory services, as well as messenger and transporter services will be provided in a manner appropriate to and consistent with educational objectives and patient care.

iv. An effective laboratory and radiological information retrieval system will be in place to provide for appropriate conduct of the educational programs and quality and timely patient care.

v. A medical records system that documents the course of each patient's illness and care will be available at all times and will be adequate to support the education of Residents, quality-assurance activities, and provide a resource for scholarly activity.

vi. Appropriate security and personal safety measures will be provided to Residents in all locations including but not limited to parking facilities, on-call quarters, hospital and institutional grounds, and related clinical facilities (e.g., medical office building).

e. Oversight:

i. The Resident Duty Hours and Work Environment Policy must be distributed to the Residents and the faculty.

ii. Monitoring of Duty Hours is required with frequency sufficient to ensure an appropriate balance between education and service. Duty Hours will be monitored with frequency sufficient to ensure an appropriate balance between education and service. In the first year of implementation of this policy, compliance will be monitored quarterly; if in compliance, monitoring will be performed annually.

iii. The Program Director will be responsible for obtaining date on compliance with the Resident Duty Hours and Work Environment Policy for the program. Each Resident will be responsible for providing accurate and timely data on compliance with the Resident Duty Hours and Work Environment Policy to her/his Program Director, Graduate Medical Education Committee (GMEC) and ACGME when this information is required.

iv. If the program is out of compliance with the Resident Duty Hours and Work Environment Policy, the Program Director will determine a plan and timeline to come into compliance and submit this plan and timeline to GMEC.

v. Back-up support systems will be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create Resident fatigue sufficient to jeopardize patient care.

f. Duty Hours Exception:

Prior permission of the GMEC should be obtained before applying to the Residency Review Committee (RRC) for granting exceptions for up to 10 % of the 80-hour limit based on sound educational rationale.

11. PROFESSIONAL LIABILITY:

Residents, while providing medical services at The Hospital or at Participating Institutions and while acting within the scope of their employment, will remain covered by the provisions of the Medical Employees Protection Act of 1975, D.C. Code, Section 2-415(b) (2001 ed). Participating Institution is defined an institution with which The Hospital has executed an Affiliation Agreement for the purpose of furthering Residents’ clinical education and training, and to which Residents rotate for a specific learning experience. The District of Columbia is self-insured, and responsible for money damages assessed against medical employees who are sued for actions taken within the scope of their employment is set forth in D.C. Official Code §2-415(b).

12. PERFORMANCE EVALUATIONS, ADVANCEMENT, AND GRADUATION:

In order to enhance the educational process and keep Residents apprised of their progress, there will be periodic performance evaluations during the term of appointment at least on a mid-year and end of year basis during each year of training. In addition there is an annual written exam to test cognitive knowledge and an annual oral exam to test clinical and interviewing skills. The Program Director will be responsible for establishing the mechanism and frequency of performance evaluations in compliance with the essentials for his specific program. The Program Director will inform the Residents annually of the departmental procedure and schedule for performance evaluations. Documentation of periodic performance evaluations shall be maintained in the Resident File.

a. Evaluation of the Residents:

The program will use the following methods for evaluating individual Residents:

i. Clinical Skills Examinations: Every resident takes the “mini-board” exam annually. This exam is fashioned after the Part II exam of the American Board of Psychiatry and Neurology. A faculty member watches the resident conduct a 30-minute board-style interview on a live patient, followed by 30-minute session during which the resident presents and discusses the case and is asked questions about the case. The resident is then given verbal feedback about his/her performance. Written feedback is made part of the Resident Portfolio, which is discussed during the twice-yearly evaluation discussions at the Educational Policy Committee, and is made part of the Resident File. Residents are graded from excellent to fail. Failure is not satisfactory in any year of training, but those who fail in their PGY-III or IV year, must undergo immediate individualized remedial work, with reevaluation until they perform at least acceptably. The program provides continuous close evaluation of clinical skills through its heavy use of supervision

ii. Written Examinations: The Residency Program will use the nationally given multiple choice Psychiatry Resident in Training Examination (PRITE) as its formal examination of cognitive knowledge that each psychiatric Resident should learn. Given every fall, this test examines both psychiatric and relevant neurological knowledge. Passing will be achieved either by a score on the PRITE of the 10^thpercentile or above within a Resident’s own PG year or a standard score (200-800) range of 300 or above. Residents must achieve a passing score on both the psychiatry and neurology sections of the examination. Although we understand that PGY-I Residents will have had little formal training in psychiatry at the time of the examination, all Residents will take the PRITE exam. A PGY-I Resident who does not pass the exam will not be required to participate in remedial activities.

iii. Supervisor and Teacher Evaluations: The most important of the Resident evaluation is done on a daily, continuous basis by various levels of supervisors and teachers. The core of the faculty meets weekly and all more peripheral faculty are encouraged to come. Noteworthy Resident performance reports are brought up in these meetings, whether salutary or troublesome and provide a system of constant monitoring. There are formal mid year and near end of year evaluations on each Resident in the weekly faculty meetings, in which each Resident in the program is discussed by means of the reading of required written evaluations by all clinical supervisors, and teacher, and by verbal report and discussion by all knowledgeable faculty. These evaluations are based on the core competencies developed for each rotation or programmatic experience. The PGY Supervising Coordinator summarizes everything into a written report that goes to the Resident and into their personnel record.

b. The Education Policy Committee:

The Education Policy Committee will review all evaluations for the Resident along with all the messages received semi-annually. The written summary of the semi-annual committee evaluation will be forwarded to and discussed with the Resident. After discussion, it will be signed by the Resident and placed in the Resident File.

c. Semi-Annual Meeting with Program Director:

The Program Director meets semi-annually with each Resident in scheduled sessions to discuss their caseloads, didactic attendance, evaluations by supervisors and service directors, and their progress in the program.

d. Advancement and Graduation:

i. In order to be promoted to the next year of training, the Resident must:

1. Complete the curriculum outlined for each year of training in a satisfactory fashion (a maximum of one failed rotation may be allowed with the understanding that it will be completed during the next academic year).

2. Have passed USMLE Step 3 exam (in case of failure to pass Step 3, a plan of action must be submitted by the Resident).

3. Achieve 70% attendance in didactic courses and conferences.

4. Demonstrate professional behavior.

5. Demonstrate good moral and ethical behavior.

6. Be judged capable of performing in a satisfactory fashion at the next level of training.

If any of the above criteria are not met then the Educational Policy Committee will review the circumstances on an individual case basis and make a decision regarding promotion. Any disciplinary actions in a Resident’s file during the academic year will be reviewed and discussed. Effective July 2009, if the Resident has not passed USMLE Step 3 by the middle of PGY-II, the contract will not be renewed for PGY-III. A written notice of the intent not to renew a Resident’s contract will be issued no later than four (4) months prior to the end of the Resident’s current contract period. However, if the primary reason(s) for non-renewal occur(s) within the four months prior to the end of the contract period, the Resident will be given as much written notice of the intent not to renew as the circumstances will reasonably allow, prior to the end of the current contract period.

ii. Graduation from the 4-year residency program entails the successful completion of the following academic requirements:

1. Satisfactory completion of clinical rotations.

2. Demonstration of clinical competency.

3. Demonstration of ethical conduct.

4. Achievement of 70% attendance in didactic courses and conferences.

5. Satisfactory performance in the Oral examination.

6. Competence in Psychotherapy.

7. Competence in Psychopharmacology.

8. Satisfactory scores on the (PRITE).

9. Completion of a Senior Scholarly Project

e. Remediation:

Residents who do not pass either the PRITE examination in their PGY-II, III and IV years or the “miniboard” examination in their PGY-III and IV years must participate in a program of remediation. Residents who require remediation will meet with their administrative supervisors to develop a plan that addresses their particular needs. Residents must complete the program of remediation in order to be promoted to the next year of residency.

f. Effect of Leave on Completion of the Residency Program:

Make-up time may be required to meet the educational objectives and certification requirements of the training program and/or the American Board of Psychiatry and Neurology when a Resident utilizes excessive leave time. Residents must not take so much leave at a given time as to compromise their ability to accomplish the training goals of a given rotation, or satisfy the ACGME requirements of time and effort dedicated to a specific rotation. If the period of leave during a rotation is over the 10% of the rotation duration, the Resident may be required to make this time up, and graduation date may be extended. This 10% will include all kinds of leave e.g., annual leave, sick and family leave, education leave, and unpaid leave of absence, conference days away. In such cases, a decision will be made by the rotation supervisor, the Educational Policy Committee and the Program Director as to whether the Resident must make up a portion or the whole rotation in order to obtain credit for it.

13. LEAVE POLICY:

The Program Director shall be responsible for establishing policy on scheduling of holiday, vacation, sick, and leave of absence. All leave should be approved well in advance by the Program Director and recorded by the timekeeper. Any planned absence should be discussed and endorsed by all supervisors and class instructors well in advance of the leave. Annual or Educational Leave greater than 4 days or leave that causes absences over a two week period of a particular class or rotation must be approved by the PGY Coordinating Supervisor and the Program Director and recorded by the time keeper in July of each year.

a. Holidays:

Residents shall be entitled to paid government holidays, which usually include New Year’s Day, Dr. Martin Luther King Day, Washington’s Birthday, D.C. Emancipation Day, Memorial Day, Fourth of July, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving and Christmas Day. The list of paid government holidays may be obtained from the website of the District of Columbia Department of Human Resources: http://dchr.dc.gov.

b. Annual Leave:

Annual Leave is accrued in accordance with applicable personnel rules and regulations. In general, Annual Leave is accrued at the rate of 4 hours for every 2-week pay period worked during the first three years of employment and 6 hours thereafter. Each Resident shall be entitled to the number of hours of Annual Leave that they have accrued, subject to the approval of the Program Director. Subject to patient care needs and educational requirements, every effort will be made to grant Residents leave for the time requested. If the operation of The Hospital would suffer by scheduling all requests during a given period of time, a schedule will be worked out with all conflicts to be resolved according to the earliest date of application. Residents will be encouraged to schedule Annual Leave throughout the year. Requests by Residents to schedule leave in block of time or to divide vacations into shorter periods shall be determined according to the requirements in Section 12 f of this Manual (Effect of Leave on Completion of Training). After annual leaves are posted, no changes shall be made unless mutually agreed upon by the Resident and the Program Director or an emergency arises. Any Resident’s request for immediate leave due to family death or sickness shall be considered immediately, and granted or denied within a reasonable period of time.

c. Sick Leave:

Sick leave is accrued and granted in accordance with applicable personnel rules and regulations, and the Collective Bargaining Agreement between the Department of Mental Health and the Committee of Interns and Residents. In general, Sick Leave is accrued at the rate of 4 hours for every 2-week pay period worked. In general, supervisors shall approve sick leave of Residents incapacitated for the performance of their duties. Residents shall request sick leave as far in advance as possible prior to the start of their regular tour of duty on the first day of absence, and each subsequent day, unless extended sick leave has been approved. Residents requesting leave due to illness shall notify his/her rotation supervisor or the designated alternate no later than two hours prior to the start of the workday. Residents wishing to use sick leave for medical or dental appointments shall notify his/her rotation supervisor or the designated alternate 7 days in advance. Residents shall not be required to furnish a doctor's certificate to substantiate a request for approval of sick leave unless such leave exceeds three (3) consecutive workdays. However, if the Program Director has given written notice to a Resident that there is reasonable cause to believe that the Resident has abused sick leave privileges, then the Resident must furnish a doctor's certificate for each absence from work, which is claimed as sick leave regardless of its duration. Sick leave shall not be charged to Annual Leave unless all of a Resident's sick leave has been exhausted and the Program Director has given his/her express written permission. Residents may be allowed to use Annual Leave in lieu of sick leave but not vice versa, i.e., Residents will not be permitted to use Sick Leave for purposes other than illness/ family leave/ or medical appointments. Flexible scheduling (i.e. assignments to electives, rotations and duties appropriate to the Resident's physical condition) may be programmed within a reasonable period surrounding the Resident's disability and may be combined with the use of paid and/or unpaid leave. Residents have the responsibility to report to their supervisor any illness, which might have a negative impact on their ability to provide patient care in a safe manner. In such cases, the Residency Program may require a medical certificate of fitness for duty before the Resident is permitted to return to regular clinical duties.

d. Other Leave:

Education Leave, Disability and Family Leave, Leave of Absence, and other categories of leave are covered in the Collective Bargaining Agreement.

14. MOONLIGHTING POLICY:

Moonlighting refers to professional and patient care activities that are external to the educational program.

a. Residents must not be required to engage in Moonlighting.

b. Moonlighting activities, whether internal or external, must allow sufficient time for rest and restoration to promote the Residents’ educational experience and safe patient care. Therefore, all Moonlighting activities should be closely monitored by the institution and the Program Director.

c. A prospective, written statement of permission from the Program Director is required to start Moonlighting. A copy of this written approval must be placed in the official Resident File.

d. Any Resident who Moonlights in the absence of prior written approval from his/her Program

Director is subject to disciplinary action.

e. Only PGY-III and PGY-IV Residents are allowed to Moonlight. Effective July 2006, Residents are required to have passed USMLE Step 3 examination in order to start or continue Moonlighting.

f. Residents should make the request for permission to Moonlight using the approved “Moonlighting Application” form. All requests must be renewed in each of the following instances:

i. Annually

ii. When training schedule changes (e.g., promotion to next PG level).

iii. When the number of Moonlighting hours changes.

iv. When there is a change in supervisory arrangements for Moonlighting activity.

v. When the site of Moonlighting changes.

g. Because residency education is a full-time endeavor, the Program Director will ensure that Moonlighting does not interfere with the ability of the Resident to achieve the goals and objectives of the educational program.

h. PGY-III Residents are not allowed to Moonlight more than 16 hours per pay period (8 hours per week averaged over a 2-week period). PGY-IV Residents are not allowed to Moonlight more than 20 hours per pay period (10 hours per week averaged over a 2-week period).

i. When Residents are called into The Hospital from home while taking at-home call (or pager call), the hours Residents spend in-house at the Moonlighting institution are counted toward to 16-hour or 20-hour per pay period limit for PGY-III and PGY-IV Residents respectively.

j. Per Duty Hour requirements of ACGME, there should be a time period of at least 10 hours between all daily duty periods and after in-house call. Therefore, the Residents are not allowed to Moonlight after 10:00 P.M. on Sunday, Monday, Tuesday, Wednesday, and Thursday nights.

k. Residents must accurately report Moonlighting activities to the Program Director every pay period.

l. During Moonlighting, the Resident’s performance in the Residency Program will be monitored by the Program Director. Should the Resident’s performance be affected adversely by the Moonlighting activity, the Program Director reserves the right to withdraw the permission given to the Resident to Moonlight. Such a decision will be communicated to the Resident in writing and a copy of the notice will be placed in the official Resident File.

m. Following the decision to withdraw the permission to Moonlight, the Program Director and/or the Residency Program is not liable for any financial and/or other consequences that may result because of and/or following cessation of the Moonlight activities.

n. Not withstanding any other requirements of this or another policy, the total Duty Hours (including hours at the Residency Program and in Moonlighting) must be in accordance with the Duty Hours Policy for Residents.

o. Internal Moonlighting:

i. Moonlighting that occurs within DMH (including Saint Elizabeths Hospital, Comprehensive Psychiatric Emergency Program, DC Community Services Agency) is called Internal Moonlighting.

ii. Internal Moonlighting must be counted toward the 80-hour weekly limit on Duty Hours.

p. External Moonlighting:

i. External Moonlighting is defined as Moonlighting outside of the Department of Mental Health.

ii. While engaging in External Moonlighting activities, the Resident is not acting as an employee or agent of the Saint Elizabeths Hospital (SEH) or the DC Department of Mental Health (DMH) and should not be visibly identifiable as a DMH or SEH employee.

iii. Professional liability is not provided by The Hospital for External Moonlighting activities. All Residents engaged in External Moonlighting activities must obtain proper professional liability/ malpractice insurance with a minimum of $1M/3M and should provide the proof of coverage to the Program Director along with the request to Moonlight.

iv. Any Resident holding an H-1B or J-1 visa, by virtue of U.S. Citizenship and Immigration Service (USCIS) regulations and Educational Commission for Foreign Medical Graduates (ECFMG) sponsorship, is not permitted to accept work or receive income in any capacity other than that of a Resident as specified on the sponsorship document issued by the ECFMG or the Labor Condition Application approved by the USCIS.

v. All Residents engaged in Moonlighting must be licensed for unsupervised medical practice in District of Columbia or the jurisdiction of proposed Moonlighting activity.

vi. Residents have to obtain a federal Drug Enforcement Administration (DEA) number and a controlled substance number in the jurisdiction of Moonlighting.

vii. It is the responsibility of the Resident and the institution hiring the Resident to Moonlight to determine whether licensure, DEA number, controlled substance number, professional liability etc. are in place and all laws and regulations in the jurisdiction of Moonlighting have been followed.

15. RESIDENT FILES:

For each Resident the Residency Program will maintain a file (“Resident File”) that shall contain application materials and credentials, copies of contracts, personnel actions, including promotion, salary increases, initial appointments, etc., copies of visa applications/documentation, requests for/response to verifications, references, a record of all rotations and clinical assignments, a record of all evaluations including outside and in-house electives, and a record of all due process actions. Resident Files may not be removed from the designated area. The Resident may examine his/her Resident File upon request. Such review can occur only in the Residency Program where the specific file is located, under the supervision of the employees of that Residency Program.

In addition, the Collective Bargaining Agreement governs the policy regarding Resident Files.

16. DISCIPLINARY/ADMINISTRATIVE ACTION:

This is covered in the Collective Bargaining Agreement between the Department of Mental Health and the Committee of Interns of Residents.

17. GRIEVANCE PROCEDURE:

This is covered in the Collective Bargaining Agreement between the Department of Mental Health and the Committee of Interns of Residents.

18. PHYSICIAN (RESIDENT) IMPAIRMENT POLICY:

The definition of an impaired physician (Resident) is that of the American Medical Association, which defines the impaired physician as one, whose ability to practice medicine with reasonable skill and safety is impaired because of mental illness, substance abuse, or physical disability. GMEC shall be responsible for implementation of a process to identify and manage matters dealing with the health of an individual Resident. The education of the Residents about illness and impairment recognition issues specific to physicians shall be done through various continuing medical education activities, Resident Committees and Resident meetings. The purpose of this education is assistance and rehabilitation, rather than discipline, and to aid a physician in retaining or regaining optimal professional functioning consistent with protection of the patient and continuation of the Residency training.

a. When a Resident’s inability to practice medicine with reasonable skill and safety by reason of mental or physical illness including but not limited to deterioration through the aging process, or loss of motor skills or excessive use of drugs including alcohol is detrimental to delivery patient care in accordance with applicable standards or professional practice or disruptive to the operation of The Hospital and/or participating institutions, complaints or self referral may be made by any member of the faculty and/or by any Resident to the GMEC.

b. All complaints/self referrals shall be made in writing, to the GMEC, and shall be supported by references to the specific activities/conduct that constitutes ground for the complaint/self referral.

c. The GMEC will appoint and ad hoc committee of peers and faculty to evaluate the credibility of the complaint, and monitor the affected Resident and safety of the patients entrusted to his/her care until rehabilitation is completed.

• The ad hoc committee will provide the Resident with information about the availability of counseling and treatment that is confidential, voluntary and non-punitive. This treatment referral is confidential except when limited by law, ethical obligation, or safety of the patient is threatened.

d. If the impaired Resident does not comply and endangers patients, the ad hoc committee will report their findings to the GMEC for appropriate corrective action that includes strict adherence to District and federally mandated laws.

19. RESIDENCY CLOSURE/REDUCTION:

If the Hospital intends to reduce the size of the Residency Program or close the Residency Program, the Hospital will inform the Residents as early as possible.

In the even of such a reduction or closure, the Hospital will either allow Residents already in the program to complete their education or assist the Residents in enrolling in a program in which they can continue their education.

The Hospital will give the earliest possible notice to Residents upon receipt from ACGME of any notification regarding non-accreditation or probation or similar change in the professional status of the Residency Program.

20. EMPLOYEE ASSITANCE PROGRAMS:

a. COPE Incorporated:

The District government provides an Employee Assistance Program (EAP) designed to address personal issues that employees may encounter. The EAP provides counseling and related services to employees who are experiencing problems, including, but not limited to the following problems which may adversely affect their overall work performance or conduct on the job:

i. Family and marital problems

ii. Financial difficulties

iii. Emotional or mental illness

iv. Substance abuse problems.

Residents can arrange counseling for themselves and/or family members by contacting the District of Columbia Government Work and Family Employee Assistance Program (COPE) at (202) 628-5240 or 1-800-841-7406. All counseling is strictly confidential. Records of counseling will not be made available to the Program Director or faculty if the counseling was initiated by the Resident. If the Program Director feels that a Resident requires professional counseling because emotional problems of the Resident have compromised his/her ability to work effectively, the Program Director may refer the Resident to COPE for an evaluation. In such situation, the Program Director reserves the right to request a report from the mental health professional regarding the Resident’s ability to resume duties. The Resident must give consent to the mental health professional to release such a report.

b. Support Our Staff:

St. Elizabeths Hospital has a voluntary response team composed of employees in case of incidents. Support Our Staff (S.O.S) is a program responsible for providing support for any staff member who has been traumatized due to an unusual event or incident involving staff and/or patients at the hospital. Residents in need of help under those circumstances can reach S.O.S team members on call pager 24-hours a day, seven days a week at 301-206-4536 or 301-206-4846. All information will be held confidential.

21. RESIDENCY COMPLETION CERTIFICATE:

Upon satisfactory completion of residency tr