1. science
2. medicine

Approved 5/7/14
University of Alabama Family Medicine Residency-Tuscaloosa
Policy and Procedure Manual 2014-2015
CONTENTS
I.
II.
OVERVIEW
A. History of the University of Alabama Family Medicine Residency-Tuscaloosa
College of Community Health Sciences
p. 5-6
1. Mission Statement
p. 6
2. Strategic Plan
p. 6-8
B. Overview of Residency’s Goals
p. 8-9
C. Lines of Authority/Hierarchy
p. 9-10
1. Faculty
p. 10
CLINICAL POLICIES
A. Duty Hours, Call, Moonlighting
1. Duty Hours
p. 11
a. Maximum hours per week
p. 11
b. Mandatory time free of duty
p. 11
c. Maximum duty period length
p. 12
d. Minimum time off between scheduled duty periods
p. 12-13
e. Maximum frequency of in-house night float
p. 13
2. Call (see also Inpatient Clinical Duties Section)
p. 13
a. Monthly Call schedule
p. 13-14
b. Back-up Call
p. 14
c. Maximum in-house on-call frequency
p. 14
3. Moonlighting
p. 14-15
a. Moonlighting Policy-Appendix A
B. Resident Supervision Policy
p. 15
1. General Supervision
p. 15-16
2. Outpatient Supervision
p. 16-17
3. Inpatient Supervision
p. 17
C. Communications
p. 17
1. Pagers and email
p. 17-18
2. Hand-offs
p. 18
3. Faculty-resident communications, feedback
p. 18
D. Outpatient Clinical Duties
p. 18
1. Overview
p. 18
2. University Medical Center
p. 18
a. General Policies
p. 18-19
b. Preceptors
p. 19
c. Charting
p. 19-20
i.
General expectations and the Electronic Medical Record p. 19
ii.
Charting expectations of preceptors in the FM Clinic
p. 20
1. Primary Care exception
p. 20
2. Level 4 and 5 visits, procedures
p. 20
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iii.
Incomplete charts
d. Charges
i.
Identification of all services at UMC
ii.
Fee adjustments
iii.
ComCare (charity) policy
e. Other clinical policies
i.
Medical transportation
ii.
Transfer of patients
iii.
Termination of patients
iv.
Referrals
f. Home visits
g. Nursing home visits
E. Inpatient Clinical Duties
1. Overview
2. Family Medicine service
a. Duties
i.
Interns
ii.
Upper levels
b. Morning Report
c. Admissions and ED visits
i.
Procedures to follow
ii.
Unattached medicine call
d. Night Float
i.
Interns
ii.
Upper levels
iii.
Hand-off communications
e. Documentation
i.
Hospital orders
ii.
Notes and dictation
1. H&Ps and discharge summaries
2. Progress notes
3. ICU notes
iii.
401 calls
iv.
Delinquent hospital charts
f. Miscellaneous inpatient policies
i.
Consultations
ii.
Continuity inpatients
1. Of attendings
2. Of residents
iii.
Death certificates
iv.
Code Blue, trauma calls
3. Other inpatient services
III.
EDUCATIONAL POLICIES
A. Professionalism
1. Dress code
p. 20
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2. Impaired physicians
3. Mental health
a. Intern retreat
4. Workplace relationships
5. Drug testing
6. Drug rep policy
B. Curriculum
1. Overview of the curriculum
2. Rotations
a. Scheduling rotations
b. Elective/subspecialty rotations
c. Starting dates
d. Incomplete rotations
e. Away rotations
i.
Supervised Practice Experience (SPE)
ii.
Rural rotation
iii.
Elective Remote Site Experience (ERSE)
3. Conferences and scholarly activities
a. Academic Afternoon and other academic conferences
b. Behavior Medicine – PGY-3 presentations
c. Scholarly activities and research
4. Other requirements
a. Quality improvement
b. See also sections on Home Visits and Nursing Home
p. 33-35
p. 35
p. 35
p. 35
p. 35-36
p. 36
C. Advanced OB Focus
D. Library and Learning Resources
E. Assessment
1. Overview
a. Evaluation of the Resident
i.
Formative, summative and final
ii.
Faculty advisor
b. Evaluation by the Resident of Rotations
c. Evaluation by the Resident of Teachers
2. Documenting procedures
3. In-training exam
F. Advancement and Graduation
1. PGY-1 to PGY-2
2. PGY-2 to PGY-3
3. Graduation and board eligibility
G. Probation and Disciplinary Procedures
1. Academic or administrative probation
2. Informal adjudication
3. Summary suspension
4. Termination, non-reappointment and other adverse actions
H. Due Process
p. 40
p. 40
p. 36
p. 36
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p. 37
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p. 37-38
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p. 47
p. 47-50
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1. Grievance proceedings
2. Ombudsman
I. Restrictive Covenants
J. Working with Medical Students
1. General
IV.
ADMINISTRATIVE POLICIES
A. Resident Agreements
B. Compliance Training
1. HIPAA, privacy
2. Harassment
3. Working with minors
C. Benefits
1. Health insurance
2. Paychecks
D. Malpractice Coverage
1. For residency duties - policy on Professional Liability Claims
2. For moonlighting
3. Communications with attorneys
E. Leave
1. Vacation
2. Family and medical leave
3. Administrative leave
4. Holidays
5. Practice site visits
6. Educational leave
7. Sick leave
F. Immunizations
G. Miscellaneous
1. Mailing addresses
2. Phone calls for residents
3. Chief resident selection
4. Committees
5. USMLE
6. Licensure
p. 550-51
p. 51
p. 51
p. 51-52
p. 52
p. 52-53
p. 53
p. 53
p. 53
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p. 53-55
p. 55
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p. 55-56
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p. 58-59
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p. 60
p. 60
p. 60-61
p. 61
p. 61
p. 61-62
V. APPENDICIES
VI. SIGNATURES
p. 63
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I.
OVERVIEW
This Policy Manual contains information, policies, and/or policy overviews which are
current as of the listed revision date. Since some policies and practices change periodically,
the University and College of Community Health Sciences (CCHS) reserves the right to
change eliminate, and supplement employment policies deemed necessary to meet the
business needs of the University and CCHS, provided such changes do not conflict with
ACGME Institutional Requirements, as last amended. Moreover, this Policy Manual should
not be construed as, and does not constitute, an offer of employment by the University for
any specific duration, nor is it intended to state any terms of employment not otherwise
adopted and incorporated as part of any Residency Agreement.
I A. History of the University of Alabama Family Medicine Residency-Tuscaloosa
In the late 1960s, a public outcry arose in response to the country’s acute need for more physicians.
In response to that demand, the College of Community Health Sciences was established at The
University of Alabama. Many areas of Alabama, particularly small towns and rural communities,
suffered from a serious lack of health care. The distribution of doctors was not the only reason for
the physician shortage. Many of the new doctors being trained were choosing the more prestigious
specialties and subspecialties of medicine, and were choosing to practice them in the more urban
areas of the state.
With a mandate from the state Legislature to improve health care in Alabama, the College, founded
in 1972, looked to family medicine to achieve its goals. What was needed were doctors trained in
family medicine – general practitioners who would practice in Alabama, including the state’s small
towns and rural communities, and who were equipped to treat the myriad of medical problems
found there.
The College’s University of Alabama Family Medicine Residency-Tuscaloosa was started in 1974,
and the first class of residents graduated in 1977. Today, one in eight family medicine physicians
practicing in Alabama graduated from the College’s residency.
The Family Medicine Residency prepares physicians to provide exceptional care in family medicine.
The curriculum emphasizes community-based continuity of care and leads to board certification in
family medicine. It is an unopposed residency and the only one at the 658-bed DCH Regional
Medical Center in Tuscaloosa, which is the referral hospital for West Alabama. The residency is a
university-based program with a large full-time faculty assisted by local physician volunteers, and
students typically test in the top 20 percent of the country.
In recent years, the College has developed fellowships through its Family Medicine Residency to
enhance the education of family medicine physicians. The College offers fellowships in sports
medicine, hospital medicine, emergency medicine, obstetrics, behavioral health, rural public
psychiatry, and academic medicine.
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In 2012, the residency increased the number of residents it accepts each year from 12 to 15, and
plans call for further expansion in the future.
To date, the Family Medicine Residency has placed 423 physicians into practice in 29 states,
including Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Tennessee, North Carolina,
South Carolina, Oklahoma, Texas, and Virginia.
More than half of residency graduates are practicing in Alabama and the majority of those are
practicing in rural and underserved communities and Health Professional Shortage Areas.
I B. College of Community Health Sciences at The University of Alabama
1. Mission Statement
We are dedicated to improving and promoting the health of individuals and communities
in Alabama and the region through leadership in medical education and primary care; the
provision of high quality, accessible health care services; and scholarship.
We accomplish this mission by:
•
•
•
•
•
Shaping globally capable, locally relevant, and culturally competent physicians
through learner-centered, community-based medical education and mentoring.
Addressing the physician workforce needs of Alabama and the region with a
focus on comprehensive Family Medicine training.
Engaging communities as partners, particularly in rural and undeserved areas, in
efforts that improve the health of Alabama’s citizens.
Providing high quality, patient-centered, efficient clinical services.
Fostering scholarship in relevant and innovative community-oriented research to
influence population health and support community providers.
Our core values are:
• Integrity
• Social accountability
• Learning
• Innovation
• Patient-centeredness
• Transparency
• Interprofessional collaboration
2. Strategic Plan
The College of Community Health Sciences began a strategic planning process in the fall of 2012.
The goal was to develop a five-year plan that builds on the College’s deep roots in primary care and
family medicine education while responding to the changing needs of the communities of Alabama.
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There are four overarching Strategic Priorities:
• Build on the strong foundation of the University of Alabama Family Medicine ResidencyTuscaloosa
• Provide an innovative and community-oriented undergraduate medical education experience
• Transform the clinical enterprise to deliver exceptional patient-centered clinical care enabled
by a culture of continuous learning at all levels
• Foster an interest in and passion for scholarly pursuit in line with the College’s mission
For each Strategic Priority, the plan outlines a number of initiatives that will guide the College’s dayto-day tactics to achieving the Priority. These Initiatives are presented in three phases. Phase One
initiatives will be started as soon as possible. Phase Two initiatives will be started as soon as Phase
One initiatives are operationally stable. Phase Three initiatives will be started as soon as Phase Two
initiatives are operationally stable.
Strategic Priority A: Build on the strong foundation of the University of Alabama Family
Medicine Residency-Tuscaloosa
Goal: Enhance the quality of the Tuscaloosa Family Medicine Residence through expanded
community-based practice and experience, with continued emphasis on rural communities,
to prepare primary care physicians that will be equipped to meet the challenges of a new
world of health care.
Initiatives
Phase One:
A1: Conduct a thorough needs assessment and environmental scan to
determine the current state, educational priorities, and community-based
opportunities for the residency; and then, transform the curricular structure
of the residency to address the growth of the program and the evolution of
family medicine training standards.
A2: Expand the family medicine faculty to meet the needs of a growing and
high-quality residency by recruitment of additional full-time faculty, with
specialty interest in obstetrics, procedures, emergency medicine, and
population health, among others, as well as selecting and integrating
community-based faculty.
Phase Two:
A3: Diversity clinical experiences by opening new continuity clinic sites to
further serve rural, University, and other populations.
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A4: Provide more comprehensive training, including in population health
management skills, and faculty development for all preceptors.
Phase Three:
A5: Transform family medicine clinics to be exceptional learning labs, which
are regarded as the cornerstone of training; develop and integrate practice
management, team-oriented practice, and clinical quality throughout
residency experience; incorporate technology, e.g. social media and
telemedicine.
A6: Create a marketing plan to improve residency recruiting.
I C. Overview of Residency’s Goals
The residency requires its residents to obtain competencies before graduation in the six ACGME
competencies at the level expected of a new practitioner. Toward this end, the residency will define
the specific knowledge, skills, and attitudes required and provide educational experiences as needed in
order for residents to demonstrate:
Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health.
Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g.
epidemiological and social-behavioral) sciences and the application of this knowledge to
patient care.
Practice-Based Learning and Improvement that involves investigation and evaluation of
patient care, appraisal and assimilation of scientific evidence, and improvements in patient
care. Residents are expected to develop skills and habits to meet the following goals:
•
•
•
•
•
•
•
•
Identify strengths, deficiencies, and limits in one’s knowledge and expertise.
Set learning and improvement goals.
Identify and perform appropriate learning activities.
Systematically analyze practice using quality improvement methods, and implement
changes with the goal of practice improvement.
Incorporate formative evaluation feedback into daily practice.
Locate, appraise, and assimilate evidence from scientific studies related to patients’
health problems.
Use information technology to optimize learning.
Participate in the education of patients, families, students, residents, and other health
professionals.
Interpersonal and Communication Skills that result in effective information exchange
and teaming with patients, their families, and other health professionals. Residents are
expected to:
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•
•
•
•
•
Communicate effectively with patients, families, and the public, as appropriate,
across a broad range of socioeconomic and cultural backgrounds.
Communicate effectively with physicians, other health professionals, and healthrelated agencies.
Work effectively as a member or leader of a health care team or other professional
group.
Act in a consultative role to other physicians and health professionals.
Maintain comprehensive, timely, and legible medical records, if applicable.
Professionalism, as manifested through a commitment to carrying out professional
responsibilities and an adherence to ethical principles, with expected demonstration of:
• Compassion, integrity, and respect for others.
• Responsiveness to patient needs that supersedes self-interest.
• Respect for patient privacy and autonomy.
• Accountability to patients, society, and the profession.
• Sensitivity and responsiveness to a diverse patient population, including, but not
limited to, diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation.
System-Based Practice, as manifested by actions that demonstrate an awareness of and
responsiveness to the larger context and system of health care and the ability to effectively
call on system resources to provide care that is of optimal value. Residents are expected to:
• Work effectively in various health care delivery settings and systems relevant to their
clinical specialty.
• Coordinate patient care within the healthcare system relevant to their clinical
specialty.
• Incorporate considerations of cost awareness and risk-benefit analysis in patient
and/or population-based care as appropriate.
• Advocate for quality patient care and optimal patient care systems.
• Work in interprofessional teams to enhance patient safety and improve patient care
quality.
• Participate in identifying system errors and implementing potential systems solutions.
I D. Lines of Authority/Hierarchy
RESIDENCY LEADERSHIP: The University of Alabama Family Medicine Residency-Tuscaloosa
Program (TFMRP) has a Residency Director (Richard Friend, MD), an Associate Residency
Director (Jared Ellis, MD), an Assistant residency Director (Cathy Scarborough, MD), a Residency
Program Coordinator (Alison Adams) and a Residency Program Assistant (Stephanie Beers).
SPONSORING INSTITUTION: The Residency’s sponsoring institution is The University of
Alabama’s College of Community Health Sciences, whose Dean is Richard Streiffer, MD.
Additionally, the Residency reports to the Associate Dean of Academic Affairs, and to Chelley
Alexander, MD, the Designated Institutional Official (DIO), Assistant Dean for Graduate Medical
Education, and Chair of the Department of Family Medicine.
ADMINSTRATION STRUCTURE: The Graduate Medical Educational Review Committee,
referred to as GMEC by the ACGME, is the Residency oversight committee. It is chaired by the
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Designated Institutional Official (DIO) with voting members including the Residency Director,
Faculty, and Chief Resident(s). This committee deals with institutional and accreditation issues that
affect all graduate medical education programs of the College.
The Curriculum Oversight committee is responsible for educational changes that may affect
the Residency. It is chaired by the Residency Director, with voting members including a
Faculty member from each discipline contained within the curriculum.
DCH Regional Medical Center is the major participating hospital that receives Graduate
Medical Education funding from CMS (i.e., Medicare). These funds are partially passed on to
the College for resident salary and benefits.
ACCREDITATION: The Accreditation Council for Graduate Medical Education (ACGME) is the
accrediting institution for Allopathic residency programs in the United States. The TFMRP is fully
accredited by the ACGME and complies with the rules and regulations required at an institutional
level by the ACGME, as well as those specialty-specific requirements of its Review Committee for
Family Medicine residencies. The Institutional Requirements, Common Program Requirements, and
Program Requirements can be found on the ACGME website (www.acgme.org). Our last Residency
Review Committee (RRC) visit was in September 2010. We received a four-year accreditation. The
maximum accreditation awarded is five years.
The American Board of Family Medicine (ABFM) maintains its own set of requirements that
must be followed in order for a resident to be eligible for obtaining board certification,
including policies relating to continuity of care and leave of absence from Residency. Our
internal requirements are also written to comply with the ABFM requirements, which can be
found on the ABFM website (www.theabfm.org). In addition, the ABFM administers the intraining exam (ITE) every fall; previous in-training exams can be accessed on its website.
The in-training exam is an excellent predictor of initial certification exam passage.
The Alabama State Board of Medical Examiners (ALBME) and the Medical Licensure
Commission of Alabama are the state agencies that regulate the issuance of all licenses to
practice medicine or osteopathy in the state of Alabama. More information about their rules
and regulations can be found on the ALBME website (www.albme.org).
1. Faculty: CCHS has approximately 60 faculty members.
Community and Rural Medicine-15
Family Medicine-15
Internal Medicine and Hospitalist-17
OB-5
Pediatrics-4
Psychiatry-7
Surgery-2
II.
CLINICAL POLICIES
II A. Duty Hours, Call, Moonlighting
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1. Duty Hours
In accordance with ACGME requirements, duty hours will be monitored by the program.
The schedule of the University of Alabama Family Medicine Residency-Tuscaloosa Program
has been designed to comply with ACGME duty hour rules. It is the resident’s responsibility
to log his/her duty hours in New Innovations at the conclusion of each shift. Failure to log
duty hours or falsification of duty hours may result in disciplinary action. If you have any
concerns about duty hour violations on your own part, or by another resident, please notify
the Residency Director. If the Residency Director is not immediately available, please
contact the Residency Office in writing and your concern will be sent to the appropriate
faculty or administrative designee. All duty hour violations detected by the New Innovations
system will be sent automatically to the Residency Office and program director and will
generate an inquiry from the program. We ask that you respond to the inquiries via email
within 24 hours. Refer to Appendix E for the Adequate Rest Policy and Appendix F for the
24+4 Policy
Key aspects of ACGME duty hour related rules, effective July 1, 2011, are reproduced
below:
General Rules:
• Duty hours are defined as all clinical and academic activities related to the residency.
This includes clinical care, in-house call, short call, night float and day float, transfer
of patient care, and administrative activities related to patient care.
• For call from home, only the hours spent in the hospital after being called in to
provide care count toward the 80-hour weekly limit.
• Hours spent on activities that are required by the accreditation standards, such as
membership on a hospital committee, or that are accepted practice in residency
programs, such as residents’ participation in interviewing residency candidates, must
be included in the count of duty hours. It is not acceptable to expect residents to
participate in these activities on their hours; nor should residents be prohibited from
taking part in them.
• Duty hours do not include reading, studying, and academic preparation time, such as
time spent away from the patient care unit preparing for presentations or journal
club.
a. Maximum Hours per Week
VI.G.1. Duty hours must be limited to 80 hours per week, averaged over a fourweek period, inclusive of all in-house call activities and ALL moonlighting. Any tasks
related to the performance of duties, such as completion of medical records and
office tasks, even if performed at home, count toward the 80 hours.
b. Mandatory Time Free of Duty
VI.G.3. Residents must be scheduled for a minimum of one day free of duty every
week (when averaged over four weeks). At-home call cannot be assigned on these
free days.
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c. Maximum Duty Period Length
VI.G.4.a) Duty periods of PGY-1 residents must not exceed 16 hours in duration.
VI.G.4.b) Duty periods of PGY-2 residents and above may be scheduled to a maximum
of 24 hours of continuous duty in the hospital. Programs must encourage residents to use
alertness management strategies in the context of patient care responsibilities.
Strategic napping, especially after 16 hours of continuous duty and between the
hours of 10:00 p.m. and 8:00 a.m., is strongly suggested.
VI.G.4.b) (1) It is essential for patient safety and resident education that
effective transitions in care occur. Residents may be allowed to remain onsite in order to accomplish these tasks; however, this period of time must be
no longer than an additional four hours.
VI.G.4.b) (2) Residents must not be assigned additional clinical
responsibilities after 24 hours of continuous in-house duty.
VI.G.4.b) (3) In unusual circumstances, residents, on their own initiative,
may remain beyond their scheduled period of duty to continue to provide
care to a single patient. Justifications for such extensions of duty are limited
to reasons of required continuity for a severely ill or unstable patient,
academic importance of the events transpiring, or humanistic attention to the
needs of a patient or family.
VI.G.4.b) (3a) Under these circumstances, the resident must:
VI.G.4.b) (3ai) Appropriately hand over the care of all other
patients to the team responsible for continuing.
VI.G.4.b) (3aii) Document the reasons for remaining to care
for the patient in question and submit that documentation in
every circumstance to the program director.
VI.G.4.b) (3b) The program director must review each submission
of additional service and track both individual resident and programwide episodes of additional duty.
d. Minimum Time Off between Scheduled Duty Periods
VI.G.5.a) PGY-1 residents should have 10 hours, and must have eight hours, free of
duty between scheduled duty periods.
VI.G.5.b) Intermediate-level residents [as defined by the Review Committee] should
have 10 hours free of duty, and must have eight hours between scheduled duty
periods. They must have at least 14 hours free of duty after 24 hours of in-house
duty.
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VI.G.5.c) 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.
VI.G.5.c) (1) Preparation must occur within the context of the 80-hour,
maximum duty period length, and one-day-off-in-seven standards. While it is
desirable that residents in their final years of education have eight hours free
of duty between scheduled duty periods, there may be circumstances [as
defined by the Review Committee] when these residents must stay on duty to
care for their patients or return to the hospital with fewer than eight hours
free of duty.
VI.G.5.c) (1a) Circumstances of return-to-hospital activities with fewer than
eight hours away from the hospital by residents in their final years of
education must be monitored by the program director.
Residents are to familiarize themselves with the University of Alabama Family
Medicine Residency-Tuscaloosa Program policy (24+4) policy that addresses staying
later than 24 hours of continuous duty. See appendix A.
e. Maximum Frequency of In-House Night Float
VI.G.6 Residents must not be scheduled more than six consecutive nights of night
float.
2. Call (see also Inpatient Clinical Duties, pp 24-25)
a. Monthly Call Schedule
All inpatient teaching services of the TFMRP and CCHS teaching faculty at DCH
Regional Medical Center are covered 24/7 by Residents. They are:
1. The Adult Medicine Services consisting of:
A. Two Internal Medicine Services
i. Internal Medicine Teaching Service (UAIM1)
ii. Internal Medicine Private Service (UAIM2, aka Burnum
Service)
B. The Family Medicine Inpatient Services (CAPFM and CPFM2)
2. The Pediatrics Service
3. The OB/GYN Service
The Internal Medicine Teaching Service (UAIM1) has no Upper Level on service.
Similarly, the Internal Medicine Private Service (UAIM2, aka Burnum Service) has no
Intern on that rotation. However, for the purposes of admission and call, we still
have both an intern and an upper level.
The monthly call schedule is approximately as follows:
The on-call/night float group will consist of four members: Intern/Upper Level on
Adult Medicine and Intern/Upper Level on Peds/OB. “Call” occurs on weekends,
holidays, and Tuesday afternoons. Residents on call are expected to remain in the
hospital for their entire shift.
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Continuity of coverage for the various services should be maintained.
NO RESIDENT MAY MOONLIGHT WHEN SCHEDULED TO BE ON
CALL OR ON BACK-UP.
b. Back-Up Call
A resident with assigned back-up call may be called in if someone on call is unable to
work that day. Calling in back-up is at the discretion of the upper level residents on
call that night. The resident on back-up call must be available by pager and be able to
make it to DCH within an hour of being paged. The back-up resident may also be
asked to take 401 calls from home if the on call residents get too busy and cannot
return the calls in a timely fashion.
Residents on the Adult Medicine, Pediatrics, and OB/GYN services are assigned to
weekday/night back-up call according to their team call color (Blue, Green, Red, and
Gold).
c. Maximum In-House On-Call Frequency
VI.G.7 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).
3. Moonlighting
VI.G.2.a) Moonlighting must not interfere with the ability of the resident to achieve
the goals and objectives of the educational program.
VI.G.2.b) Time spent by residents in Internal and External Moonlighting must be
counted toward the 80-hour Maximum Weekly Hour Limit.
VI.G.2.c) PGY-1 residents are not permitted to moonlight.
Residents are not required to moonlight either externally or internally within the
program. In compliance with ACGME guidelines, the Residency Director must
approve moonlighting privileges and all experiences in writing. If moonlighting
occurs without this approval, the resident may be subject to disciplinary action, up to
and including termination.
1. No PGY-1 resident may moonlight.
2. Second- and third-year residents who are fully licensed in Alabama may request to
moonlight and be allowed to moonlight as long as it does not interfere with their
responsibilities to the residency program, their academic performance in the
program, they are in compliance with Work Hour limitations.
3. No moonlighting activities will be allowed until a resident has successfully passed
USMLE Step 3.
4. The Residency Director will monitor the resident’s program performance to
determine if moonlighting is adversely affecting his/her performance and to
monitor compliance with duty hour requirements and limitations.
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5. Residents are required to log all moonlighting, duty hours, and other hours in New
Innovations Software Program.
(or any subsequent replacement program). Those who fail to log duty hours or log
erroneous duty hours are subject to disciplinary action.
A. The program will monitor and document compliance with these
requirements for all trainees. This policy applies to every site where
trainees rotate.
6. No moonlighting activities will be allowed if a resident is participating in a
remediation plan of any kind. Any exception to this must be approved by the
Residency Director.
7. Residents who moonlight must obtain their own malpractice insurance, DEA and
ACSC number. These must be presented to the Residency Office for verification
PRIOR to the moonlighting activity. Residents must also fill out a moonlighting
request form PRIOR to each activity.
8. Residents will be required to fill out a declaration of outside employment form
every six months.
9. Moonlighting is not allowed during a normal workday (8:00 am to 5:00 pm) or for
residents who are on call or back-up.
10. Residents may use their annual leave to moonlight. No resident may use sick or
any other form of leave to moonlight.
11. Moonlighting in weight loss and pain management clinics is STRONGLY
discouraged.
12. Residents must familiarize themselves with the TFMR Moonlighting Policy, all
Alabama State Board of Medical Examiners and Ethics regulations prior to any
outside employment activity. It is the responsibility of the resident to adhere to all
relevant and the afore-mentioned policies.
Residents are advised that the Alabama State Board of Medical Licensure and the DEA have
the authority to independently investigate and prosecute individual resident physicians with
regard to compliance with the following:
• That moonlighting residents are fully licensed and have their own malpractice and
DEA number.
• Pre-signing prescriptions.
• Using University Medical Center (UMC) prescriptions outside UMC. This is
prohibited – your UMC number is site specific.
• Narcotics prescriptions must be properly completed, with the patient’s name and
address plus the date.
• Following accepted practice guidelines for everything, especially weight loss and pain
patients.
• All moonlighting residents should be cognizant of Medicare fraud and abuse
guidelines, be aware of state ethics requirements, and remain clear about their
individual accountability for contracts, attestations, or statements that they sign in
their roles as independent moonlighting physicians.
a. Moonlighting Policy-Appendix A
II B. Resident Supervision Policy
a. General Supervision
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Resident Supervision Policy
The attending physician (including faculty and preceptors) has the responsibility to enhance the
knowledge of the resident and ensure the quality of care delivered to each patient by any resident.
Attending physicians are responsible for the care provided to each patient, and they must be familiar
with each patient for whom they are responsible. Residents are to familiarize themselves with the
Supervision of Resident/ Responsibility of Attending and Resident Policy.
1. General Supervision:
The attending physician oversees the care of the patient and provides the appropriate level
of supervision based on the nature of the patient’s condition, the likelihood of major
changes in the management plan, the complexity of care, and the experience and judgment
of the resident being supervised. Medical services must be rendered under the supervision of
the attending physician or be personally furnished by the attending physician.
Documentation of this supervision is entered into the record by the attending physician or
reflected within the resident’s progress note at a frequency appropriate to the patient’s
condition. The resident note shall include the name of the attending physician with whom
the case was discussed as well as a summary of that discussion. The attending countersigns
and adds an addendum to the resident note detailing his/her involvement and supervision.
The attending physician shall review the progress notes and provide constructive
commentary on content. These progress notes shall be countersigned in a timely fashion.
The attending physician shall provide an addendum to both inpatient and outpatient
progress notes detailing his/her involvement and supervision as needed. Residents are to
familiarize themselves with the Supervision of Resident/Responsibility of Attending and
Resident Policy.
b. Outpatient Supervision
Outpatient Supervision
For outpatients, all evaluation and management (E/M) services, such as office visits and
procedures, provided by residents in the Family Medicine Center (FMC) must be staffed
with an attending physician (faculty or community-based staff). For each encounter, the
attending physician must: 1) ensure that services provided are appropriate; 2) review with the
resident the patient’s history, physical examination, and diagnosis, and; 3) document the
extent of his/her participation in the review and direction of services provided to the
patient. This review must occur before or shortly after the conclusion of each visit.
During a resident’s first six months of residency, the attending physician must be physically
present for the key portion of every encounter between the patient and that resident. The
Attending must also see and review each patient with the intern. After completion of six
months of residency, the Attending does not have to be present during encounters that are
low- or mid-level E/M codes for either new or established patients. The Attending shall
review progress notes and provide constructive feedback regarding history, physical exam,
assessment/plan and billing. The Attending must see all Medicare patients.
All residents will function under the supervision of attending physicians. A responsible
attending physician must be immediately available to the resident in person or by telephone
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and able to be present within a reasonable period of time (generally considered to be within
30 minutes of contact), if needed.
Residents should be given progressive responsibility for the care of their patients. The
determination of a resident’s ability to provide care to patients without a supervisor present
or to act in a teaching capacity will be based on documented evaluation of the resident’s
clinical experience, judgment, knowledge, and technical skill. Ultimately it is the decision of
the attending physician as to which activities the resident will be allowed to perform within
the context of the assigned levels of responsibility. The overriding consideration must be the
safe and effective care of the patient that is the personal responsibility of the attending
physician.
During the performance of such diagnostic and therapeutic procedures, an attending
physician will provide an appropriate level of supervision. Determination of this level of
supervision is generally left to the discretion of the attending within the context of the
previously described levels of responsibility assigned to the individual resident involved. This
determination is a function of the experience and competence of the resident and the
complexity of the specific case.
An “emergency” is defined as a situation where immediate care is necessary to preserve the
life of, or prevent serious impairment of the health, of a patient. In such situations, any
resident, assisted by other clinical personnel as available, shall be permitted to do everything
possible to save the life of a patient or to save a patient from serious harm. The appropriate
attending physician will be contacted and apprised of the situation as soon as possible. The
resident will document the nature of that discussion in the patient’s record.
c. Inpatient Supervision
Inpatient Supervision
For patients admitted to the inpatient team, the attending physician must meet the patient
early in the course of care (within 24 hours of admission, including weekends and holidays).
This supervision must be personally documented in a progress note within 24 hours of
admission. The attending physician’s progress note will include findings and concurrence
with the resident’s initial diagnosis and treatment plan as well as any modifications or
additions. The progress note must be properly signed (including physician identification
number), dated, timed, and reflect ongoing supervision of the residents. Attending
physicians are involved in the ongoing care of the patients assigned to them in a manner
consistent with the clinical needs of the patient and the graduated level of responsibility of
the trainee. The attending physician shall review and cosign all progress notes and provide
comments on content of the note including history, physical exam and assessment/plan in a
timely manner. Residents are to notify the attending physician immediately if a patient’s
acuity has changed while in the hospital.
II C. Communications
1. Pagers and Email:
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Professional behavior and responsibility is expected of all residents. The Residency Office,
the clinic, and your rotation need to be able to reach you at any time, unless you are on
approved leave. Our primary means of contact will be through your pager and/or email.
POLICY:
1. Residents are expected to have their pager on at all times (except while on approved leave)
and to respond to pages in a reasonable amount of time – no longer than 15 minutes.
2. If tied up in an emergency, a procedure, or other situation that will not allow a prompt
reply, another health professional should be asked to respond on the paged resident’s
behalf until free of the limiting activity.
3. If paged in error, it is the resident’s responsibility to help that person contact the correct
resident.
4. If the resident forgets his/her pager, the appropriate personnel (attendings, upper levels,
Residency Office, etc.) must be notified and given alternate contact information. Should
the Residency Office be unable to reach a resident by pager, the resident will be contacted
by cell phone, if necessary. Should reasonable response time to pages become a problem
(e.g., 30 minutes), the program director will respond and request a personal meeting with
the resident. Any ongoing or repeated instances will be considered unprofessional
behavior and disciplinary action may follow.
5. For non-urgent communication, the Residency Office will contact residents via their
@cchs.ua.edu email account, which residents are responsible for checking at least daily .
6. The University/CCHS will communicate weather and or emergency events via MyBama
(http://mybama.ua.edu) and CCHS email. Please forward MyBama emails to your CCHS
email account and maintain current contact and emergency information in MyBama at all
times.
2. Hand-Offs: Refer to Appendix C-Effective Transitions
3. Faculty-Resident Communications, Feedback: Feedback is provided during
rotations along with an evaluation completed at the end of the rotation by the
attending physician. Each resident is also assigned an advisor to assist them with
their educational goals.
II D. Outpatient Clinical Duties
1. Overview:
The resident’s patient panel in his/her continuity clinic is assigned for the duration of
residency. The panel will increase over the three years in keeping with the increased time
spent in the University Medical Center (UMC). The initial panel is composed of patients
from graduating residents’ panels, patients new to UMC, and patients on follow-up from
DCH (Emergency Department). A resident may add family members of his/her currently
assigned patients to his/her panel at any time by notifying the residency office. Refer to
Appendix B for the General Responsibilities Policy.
2. University Medical Center:
a. General Policies Regarding Resident Continuity Practice at UMC:
1. Residents will not care for or write prescriptions for their own family.
2. Nursing and administrative staff may not be treated by a resident.
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3. A resident’s clinic schedule is determined by the rotation to which he/she is
assigned. Clinic schedules are prepared by the Residency Office and are typically
available six months in advance.
4. Residents are expected to be at UMC 15 minutes before their first patient. If the
resident must be late for a scheduled clinic, he/she must notify, via email and
telephone, the Residency Office and the suite charge nurse so that patients can be
informed and arrangements can be made for rescheduling or for care by another
physician, if necessary.
5. If the resident must cancel a scheduled clinic, he/she must request the cancellation
from the Residency Office via email or in writing at least two weeks in advance.
Same-day cancellations may only occur due to emergency situations, and must be
done with a personal call to the charge nurse as well as the Residency Office.
b. Precepting Patients in Clinic:
1. First-year residents must consult with the attendings about each patient. Attendings
must examine EVERY Medicare patient during the first six months of the resident’s
first year.
2. Licensed second- and third-year residents will have an attending available to address
any questions.
3. All residents are required to consult with an attending when seeing Medicare
patients. Caring for clinic patient independently is a progressive process.
4. If a resident finishes clinic early, he/she may leave if the volume and patient care
needs for the day allow, and if the attending approves. If approved, the resident must
notify the nurses of his/her departure. Common courtesy dictates that the resident
also asks a colleague to see walk-in patients who arrive after the resident departs.
c. Charting
i. General Expectations and the Electronic Medical Record:
There is a 24-hour availability of University Medical Center records by
computer. Residents are expected to comply with all UMC policies and
procedures regarding the Electronic Medical Records System.
Faxing/Receiving Confidential Patient Medical Records:
Facsimile transmission of health information should occur only when the original
record or mail-delivered copies will not meet the needs of immediate patient
care. Health records should be transmitted via facsimile only when: (1) needed for
patient care; or (2) required by a third party payer for ongoing certification of
payment for a hospitalized patient. The information transmitted should be limited to
that necessary to meet the requestor’s needs. The Medical Records Department
should make routine disclosure of information to insurance companies, attorneys, or
other legitimate users through regular mail or messenger service. Except as required
or permitted by law, a properly completed and signed authorization should be
obtained prior to the release of patient information. An authorization transmitted
via facsimile is acceptable.
Each fax machine should have someone monitoring incoming documents. This
individual should remove incoming documents immediately, examine them to assure
receipt of all pages in a legible format, and send them in accordance with their
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instructions. Faxed documents will be scanned into the EMR by the staff of medical
records. All actions will be in accordance with HIPAA regulation:
• Faxes should be sent/received using fax machines in a secure, limited area.
• Fax requests from unfamiliar sources should always be verified.
• Highly sensitive health information will not be faxes.
• Psychotherapy notes will never be faxed.
A printed confirmation record should be used to confirm that the fax was delivered
to the correct number.
ii. Charting Expectations of Preceptors in the Family Medicine Clinic:
1. Primary Care Expectation-The Primary Care Exception Rule allows
residents to bill up to a level 3 charge without an attending
faculty member personally seeing the patient. This is only in effect for 1st
year residents after the first 6 months of their training.
2. Level 4 and 5 Visits, Procedures-An attending faculty member must be
personally see the patient to bill a Level 4 or 5 on all Medicare,
Tricare, and Federal BCBS patients. An attending must also be
present for all key portions of procedures in order to bill appropriately.
iii. Incomplete Charts
Within the residency program, incomplete is defined as any clinic visit note or
procedure note not completed within 48-hours of the encounter. The Residency
Office receives a daily incomplete chart list. This list is emailed to the residents, who
are given 72 hours to complete their incomplete charts. If the resident has not
completed his/her charts within the 72 hours, he/she has until 8:00 am the following
business day to complete them. At that time, if the charts are still not complete, the
resident will be pulled off his/her rotation and docked a vacation day. The resident
will also be required to meet with the program director. Any resident found to have a
significant number of incomplete charts and/or a repetitive pattern of incomplete
charts is subject to disciplinary action.
Timely completion of patient records is good patient care. Additionally, resident
chart documentation is necessary before the attending can complete their
documentation. Attendings are required to complete chart documentation within 33
days of the encounter otherwise, they are subject to a financial penalty.
d. Charges
Patient Charges and Discounts:
At UMC, professional physician charges are competitive with those of local
physicians. Residents, using the fee schedule available in each clinical suite, are
expected to assign charges to the patient’s bill that would be similar to charges given
by a private physician. Residents shall be responsible for coordinating any questions
or concerns on charges to patients. Specific policies are outlined below.
i. Identification of all Services at University Medical Center:
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Each patient who receives medical care at UMC should be billed in the computer at
the time of the visit by the resident identifying the services provided and the charges
incurred. In the event a special circumstance warrants a modification of this policy,
the Chief Operating Officer (COO), the Chief Financial Officer (CFO), and the
Director of Billing and Compliance should be consulted.
ii. Fee Adjustments:
Residents may offer professional courtesy adjustments only after consultation with
the attending.
iii. ComCare (charity) Policy:
Indigent patients should be referred to the Social Worker at 348-7195
e. Other Clinical Policies
i. Medical Transportation:
Patients who require transfer to DCH for emergency care or admission will be
presented to an attending, and will not be transported to or from DCH without
authorization from the attending.
ii. Transfer of Patients:
All patients who request a change in their assigned physician should be referred to an
attending in that suite, who will arrange the transfer. Changes should be made
according to a random list of physicians in each suite. The old physician and new
physician should be informed of the change and the circumstances surrounding it.
iii. Termination of Patients:
A physician may request that a physician-patient relationship be ended. Residents
must initially get approval from an attending to terminate a patient. The attending
must review the patient’s chart carefully, ensuring there are no omissions in the
standard of care and that no indiscreet remarks have been made in the chart. The
attending will then ask the clinic director and department chair to end the
relationship. If the patient is being seen by a physician in another department, the
attending must get termination approval from the other physician. The clinical
director will request a form letter to be signed by the resident and attending. A copy
of the signed letter will be placed in the patient’s chart. Terminations do not affect
the patient’s immediate family members, except in the case of outstanding bills.
If administration initiates a request for patient termination due to an outstanding bill,
an attending will be asked to review the patient’s chart, as above. The clinical
director will then request a form letter to be signed by the resident and attending.
A patient has 30 days from the date on the termination letter to find a new physician.
If medical care is needed during this time frame, the resident on referred call must
see the patient, if the patient so desires.
iv. Referrals:
When a patient is referred to another physician in or out of UMC, the resident must
complete a Referral Request Form and fax it to the consultant. The “Plan” section
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of the chart note should reflect why the patient is being referred. It is customary to
refer primarily to physicians who are involved in the teaching of residents.
f. Home Visits
Home visits are required for all residents. These visits are appropriate for all debilitated or
home-bound patients or any patient being followed by a home health or hospice agency.
Residents will not graduate without an appropriate number of home visits.
g. Nursing Home Visits
Each resident will be assigned two nursing home patients. Following your assigned nursing
home patients for the duration of your residency is a required part of your training. The
resident will provide primary care to patients with faculty backup. The resident is expected
to visit his/her nursing home patients monthly. Residents will not graduate without an
appropriate number of nursing home visits,
II E. Inpatient Clinical Duties
1. Overview:
Admissions:
All patients admitted will have an H&P written in Meditech by the admitting resident. The
H&P must be completed by the end of the shift. If the admitting resident is unable to
complete due to committing a duty hour violation, he/she will appoint another resident to
complete.
2. H&Ps should incorporate not only what you learn from your interview at the time, but also
notable information from previous visits/notes in Meditech and in NextGen, pertinent past
diagnostic studies, lab values and historical trends, consultant notes, and more.Utilize all
resources available to you (PCI, ChartMaxx, and scanned documents in the Categories tab of
NextGen) to obtain the whole clinical picture.
3. Before moving onto the next patient admission, the Primary Care Physician (PCP) should be
sent a task within NextGen as notification that their patient has been admitted.
1.
Discharges: (REPEATED UNDER H&Ps AND DISCHARGE SUMMARIES)
When discharging a patient, a discharge summary must be typed or dictated within 48 hours.
Every patient needs a progress note on the day of discharge in addition to a discharge
summary.
2. If a patient is seen and sent home from the ED or OB Triage, a Short Stay Summary must
be documented (i.e., an abbreviated H&P with History of Present Illness, Physical Exam,
Assessment and Plan, and follow-up instructions) within 24 hours from the discharge.
1.
1.
Progress Notes:
Progress notes should be typed daily in Meditech. These should be signed and submitted
to that day’s Attending before rounds. Draft forms are not acceptable. It is okay if the
plan for that patient changes during rounds from what you wrote in your note.
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Notes should be clear, readable, and accurate. No extraneous material should be carried
forward in daily notes.
3. If you are called to the floor to evaluate a patient, the encounter must be documented in the
patient’s chart as an addendum to that day’s progress note.
2.
2. Family Medicine Service:
a. Duties-Refer to Appendix H for Mandatory Notification of Faculty
i. Interns:
• Admission H&Ps – Written in Meditech after discussion with the
senior resident and Attending
• Discharge summaries – Dictated or written in Meditech within 48
hours of D/C
• Progress notes and addendums to Night Float’s ICU note
• See up to eight (8) patients on your team, ALL ICU patients MUST
be included in your cap of eight patients
• Writing orders
• Checking out to the Attendings – Residents will discuss with their
Attending all Emergency Department (ED) patients and all inpatients who undergo significant clinical changes during the shift
• Managing floor calls
• Involve medical students in all aspects of patient care
• Attend Morning Report at 8 am
• Read/review inpatient & ICU reading list (while on service during
intern year)
ii. Upper Levels:
• Supervise interns
• Review all orders
• Know all patients
• Pre-round and write notes on ALL patients above eight (8) on your
team
• For the first week of each rotation, see ALL patients on the service.
Review H&Ps and progress notes with the intern and provide
constructive feedback daily. As you feel that the intern progresses,
you may provide more autonomy at your discretion. However, ICU
patients should be seen EVERY morning, even after the first week
and addendums written.
• Write addendums to all intern H&Ps after seeing the patient and
reviewing the documentation and orders
• Write addendums to daily progress notes after seeing the patient and
reviewing the documentation and orders
• Teach interns and medical students
• Prepare and present Morning Report Case and materials at 8 am
• Review core topics with the interns
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Day Team intern will be capped at eight (8) patients (please recognize that
the absence of putting a note in Meditech on ICU patients only increases the
level of care and understanding for those critical patients). Day Team Upper
Level will be responsible for pre-rounding, writing notes including adequate
assessments/plans, and managing the care on all patients on the team above
eight (8).
b. Morning Report
Upper Levels and Interns from Day Team will meet with the day's Attending
(as well as pharmacy students, clinical pharmacist faculty, and medical
students if available) at 8:00 am for Morning Report. Morning Report will
consist of checkout and brief discussion of the previous night's admissions. This will
include pertinent admission details, interventions, prognosis, special needs, and
potential barriers to discharge.
Morning Report will continue with a discussion of all remaining patients on service
as usual. After the remaining patients have been reviewed, an Upper Level resident
from one of the two teams will be responsible for assigning a core topic relevant to
the current patient census that will also be high yield for Step 3, Family Medicine InTraining Exam, and Family Medicine Board Exam. If there are no patients with
relevant core topics, a topic from the Family Medicine Inpatient Reading List will be
presented instead. The topic discussion does not require a Powerpoint, but does
require familiarity with the patient and the topic. Day Team Upper Level who is not
presenting the core topic that morning will be available to assist the Day Team
Intern with new admissions from 7:30 am until walking rounds are completed.
The discussion will take place on Monday, Wednesday, and Thursday
mornings and will be led by alternating residents from each team
(Monday- Upper Level "A", Wednesday- Upper Level "B", Thursday- Upper Level
"A", Monday- Upper Level "B", etc).
After the topic is discussed, the Day Team (with Attending and Pharmacy) will
commence with walking rounds. Afterwards, interns will carry out any new orders
and write addendums on all patient progress notes previously written by Night Float.
c. Admissions and ED Visits
When the ER sees a patient, the Attending is called first and then the resident is
asked to evaluate the patient for admission. The Attending may alternatively
choose to allow the ER physician to Adult Medicine patients will be admitted to one
of four services:
1.
2.
3.
4.
Family Medicine Team 1 = CAPFM
Family Medicine Team 2 = CPFM2
UMC Internal Medicine = UAIM1
Internal Medicine (Burnum Service) = UAIM2 (upper level service)
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Note: Please do not write the name of the Supervising Attending on the orders of an
adult medicine patient. Admit them only to the codes above. The appropriate place
for the Supervising Attending’s name is in the H&P or progress note.
Patients admitted to OBGYN service should be written as “Admit to UMC
OBGYN; Attending: X”. Patients admitted to Pediatrics should be written as
“Admit to UMC Pediatrics; Attending: X”.
When a resident and/or attending admits a patient from UMC Clinic, the Family
Medicine residents and Attending should be notified. The admitting resident should
write orders and an admit note.
Inter-hospital transfers will be accepted only by Attending physicians and, on rare
occasions, senior residents.
i. Procedure to Follow:
The following hospital procedures must always be supervised by an attending
physician with credentials to perform that procedure until the requirements
listed below are met:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Chest tube placement
Peritoneal lavage
Endotracheal Intubation and complex airway management issues
Central line placement
Circumcision
Defibrillation and synchronous cardio version
Management of a pneumothorax
Acute management of shock
Administration of thrombolytic
Management of a major joint dislocation (shoulder, hip, knee, ankle)
Initial and ongoing ventilator management
Lumbar Puncture
Obstetrical hemorrhage
Fetal demise
Abruption
Eclampsia
In a life threatening situation, all physicians have a responsibility to perform
any lifesaving procedure that is deemed necessary. However, residents are
obligated to notify Attending physicians as soon as they are aware that a life
threating situation exists. Residents should also notify an Attending if a
patient experiences a sudden change in status. These situations (i.e.: the
need for transfer of a patient to a more acute setting, impending cardiacrespiratory failure) should always be anticipated and predicted if possible.
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For residents to perform the following procedures unsupervised, they must
have completed the indicated numbers of a particular procedure under the
supervision of an Attending with privileges for that procedure:
• Central venous line placement – 10
• Intubation – 10
• Thoracentesis – 5
• Newborn circumcision – 10
• Lumbar Puncture – 3
Residents certified to do these procedures may teach these procedures to
other residents as outlined by DCH. Before performing an unsupervised
CVL or thoracentesis, a resident should know how to do a chest tube
placement.
It is the preference of the OB/GYN faculty that before a resident performs
any neonatal circumcision, he/she must notify an OB/GYN faculty member.
A medical staff credentialing process must be followed at DCH Regional
Medical Center. This is initiated by the resident and must be approved the
Residency Director.
The Attending, a member of the DCH Regional Medical Center staff, has
been granted privileges for the procedures he/she teaches and supervises.
The Attending is responsible for any procedure performed by a resident
under the supervision of an Attending.
DCH Medical Center bylaws permit any physician in an emergency to
perform any procedure necessary to save a patient’s life.
ii. Unattached Medicine Call:
Unattached call (aka, unassigned, unreferred, etc.) only applies to the Internal
Medicine Services. The Internal Medicine services have a “cap” of patients,
beyond which they no longer accept unattached call patients. The cap for
UAIM1 is six (6) patients (ICU patients count as two patients) and for
UAIM2 is eight (8) patients. Please note that the cap does not apply to the
UMC Internal Medicine Attending’s private patients that are seen at UMC.
The UAIM1 and UAIM2 services alternate days when they take unattached
call. At the beginning of the Internal Medicine rotation, you will be oriented
by one of the UAIM1 Attendings, who will explain the procedure for
admitting unreferred patients. The Internal Medicine services take unattached
call for all Internal Medicine and Family Medicine Attendings when their
name comes up on the list. The Internal Medicine services only take
unattached call from 8:00 am until 5:00 pm daily. During that time, the
Internal Medicine services admit from the unattached list whenever Internal
Medicine faculty, Family Medicine faculty or the Hospitalists group come up
on the list until the cap is reached. Once the cap has been reached, the
Hospitalist group takes all our unattached admissions. From 5:00 pm to 8:00
am the Hospitalists group admits all unattached call for themselves, Internal
Medicine faculty and Family Medicine faculty. Unattached patients who have
been on the Internal Medicine service and who are readmitted within 30 days
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of discharge are readmitted to the Internal Medicine services regardless of
the time of day.
If an unattached patient presents to the Emergency Department and requires
admission to the hospital:
1. The patient will be asked if he/she has a private physician. If
none, the physician who is next on the list for medicine unattached
call will be responsible for either caring for that patient or seeing that
care is assumed by another physician.
2. If the patient does have a private physician, that physician will be
called to assume care. If the private physician provides
documentation that he/she has severed the physician-patient
relationship with this patient, then care will revert back to the
physician on call.
3. If the patient does not know his/her physician’s name, but states
he/she was an inpatient during the last year, a search of old records
will be conducted. The previous physician on record will assume
care for the patient in an effort to maintain continuity of patient
care. If the previous physician provides documentation that he/she
has severed the physician-patient relationship with this patient, then
care will revert back to the physician on call.
d. Night Float
Night Team coverage will begin at 5:00 pm (arrive by 4:15 pm for formal transition
of care meeting between Day and Night Teams) to 7:00 am (Day Team arrives by
6:15 am for formal transition of care meeting). Furthermore, these mandatory
meetings allow for the respective residents finishing their shifts to leave on time.
Per ACGME Family Medicine Guidelines (VI.B.1-4), transitions of care are critical
elements in patient safety and must be organized such that complete and accurate
clinical information on all involved patients is transmitted between the outgoing and
incoming individuals and/or teams responsible for that specific patient or group of
patients. Programs and institutions are expected to have a documented process in
place for ensuring the effectiveness of transitions. Pertinent elements evaluated
should include exam findings, laboratory data, any clinical changes, family contacts,
and any change in responsible attending physician.
At a time after midnight until no later than 4:00 am, the Night Float intern will
pre-round and write progress notes on ALL intensive care unit patients
(including Medical, Surgical, Stroke, and Cardiac critical care units). If there
are no intensive care unit patients on service, the Night Float team will prepare
discharge (including Orders, Rx, and f/u) on patients who will be eligible for
discharge in AM. All progress notes for critical care patients should include adequate
assessments and plans. Night Team Upper Levels are a crucial part of the Night
Team and must be available to assist the Intern with new admissions, floor calls, or
further duties while ICU patients are being seen. Additionally, Night Float upper
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level sh ould be involved in the care of ALL ICU patients including acute care,
discussion of assessment/plan, and documentation.
i. Interns:
Night Float Intern Duties:
• Admission H&Ps – written in Meditech after discussion with the
senior resident and Attending.
• If there are no intensive care unit patients on service, the Night Float
team will prepare discharge (including Orders, Rx and f/u) on
patients who will be eligible for discharge in the AM.
• Writing orders
• Checking out to the Attendings – residents will discussion with their
Attending all Emergency Department patients and all inpatients who
undergo significant clinical changes during the shift.
• Managing floor calls.
• If available, involve medical students in all aspects of patient care.
ii. Upper Levels:
Night Float Upper Level Duties:
• Supervise interns
• Discuss acute care, assessment/plan on ALL ICU patients (including
Medical, Surgical, Stroke and Cardiac critical care units) that intern
pre-rounds on; add addendum to ICU notes written by intern.
• Write addendums to the H&P after seeing the patient and reviewing
the documentation and orders.
• Teach interns and medical students.
iii. Hand Off Communications:
A formal check-out must happen between the Night Float Team and the Day
Float Team. The interns must communicate with the senior residents
regarding patient status and plans prior to AM attending rounds. Any
resident seeing a continuity patient must communicate about that patient to
the senior resident. Finally, the in-coming Night Float Team must receive a
formal check-out from the Day Float Team. It is expected that each hand-off
be face-to-face and substantive, no exceptions. Residents are to familiarize
themselves with the TFMR Transitions of Care Policy. This policy is to be
followed at all times. See Appendix “C.”
e. Documentation
i. Hospital Orders:
Attendings generally leave the writing of orders to the residents. If additional
orders are needed from the Attending, the resident should communicate this
during rounds or in the progress note. Verbal orders must be signed within
24 hours. Orders written by medical students are invalid until countersigned
by a physician.
ii. Notes and Dictations:
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Charting Progress Notes:
Please see Dr. Scarbrough’s inpatient coding lectures. When inserting lab
results, insert only the most pertinent results. When inserting radiology
results, do not insert the interpreting physician’s name as this may cause
signature errors in PCM. Rethink the Assessment and Plan section daily,
rearranging diagnoses in order of acuity and importance. Do not chart simply
with the goal to “create a discharge summary” by having the entire hospital
course in your daily progress notes. Finally, be sure to discuss the quality of
your progress notes with your upper level and Attending by requesting
regular feedback on your documentation content and accuracy.
1. H&Ps and Discharge Summaries:
Discharges:
When discharging a patient, a discharge summary must be
typed or dictated within 48 hours. Every patient needs a
progress note on the day of discharge in addition to a
discharge summary. If a patient is seen and sent home from
the ED or OB Triage, a Short Stay Summary must be
documented (i.e. abbreviated H&P with History of Present
Illness, Physical Exam, Assessment and Plan, and follow-up
instructions) within 24 hours from the discharge.
Discharge Summaries:
Per hospital policy, discharge summaries must be dictated at
the time of the patient’s release or within 24 hours. The
discharge summary must be copied (via transcription) to the
primary care physician and to all consultants involved in the
case. All residents should be aware of referring physicians and
state at the beginning of dictation that a copy should be sent
to Dr. (name) at (address). If a resident dictates a discharge
summary on a patient of a private physician, that physician
will get a copy of the discharge summary only if his/her name
is stated at the beginning of the dictation.
Discharge summaries should be concise yet
thorough. Abbreviations and initials for diseases, procedures,
and so forth are common sources of error in
transcription. Dictation of whole words rather than
abbreviations is preferable. Residents are to familiarize
themselves with the “Do not use abbreviations” at DCH
Regional Health System.
2. Progress Notes:
Progress notes will be written according to the SOAP method. There
MUST be a note prior to rounds for all active problems. All patient
encounters must be documented in the chart. Attendings will sign the
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notes and write comments at appropriate intervals. For non-ICU
patients, the assessment and plan should be organized by problems,
with the most pertinent problems listed first. As diagnoses are made,
they should replace the initial problem (e.g. acute CVA should
replace altered mental status). The A/P section of the progress note
should account for all active and/or significant inactive problems.
3. ICU Notes:
ICU notes will be written according to the system method. Residents
are to follow the UMC ICU Note Template in Meditech discussed
during orientation. Pre-rounds patient visits should start in the
ICU. Keep in mind that it is standard of care in the medical
community to see an ICU patient and document that visit at least
twice a day. Night Float residents must write daily progress notes on
all ICU patients (including ASU, ACCU, MICU, and TSICU [please
see Section on Night Float]). Oncoming Day Team intern must write
an on-service addendum to the ICU notes written by Night Float.
iii. 401 Calls:
The senior resident on call for Peds/OB from 5:00 pm to 7:00 am on
weekdays, weekends, and holidays, is assigned to receive UMC answering
service telephone calls – “401” calls. The senior resident on Peds is assigned
to receive these calls from 7:00 am to 8:30 am on weekdays. Please note that
encounters must be documented with a “Telephone Call” template in
NextGen and may be tasked to the appropriate PCP. Attendings are available
for questions and discussions about the proper advice and recommendation
for care.
iv. Delinquent Hospital Charts:
Delinquency is defined as any hospital H&P or discharge summary not
dictated within 48 hours of admission or discharge. Any resident found to
have a significant number of delinquent charts and/or a repetitive pattern of
delinquency is subject to disciplinary action. All charts are to be completed
prior to taking annual leave.
f. Miscellaneous Inpatient Policies
i. Consultations:
All consultations need to be approved by the Attending and communicated
personally. Writing an order asking the nurses to do this leads to poor patient
care: the consultant does not know why he/she was called, the urgency of
the consultation, or whether you are asking for advice or for the consultant
to manage the problem. It is customary for the intern to contact the
consulting physician. The senior resident should ensure that the intern has a
clear understanding of: 1) the patient’s clinical diagnostic situation and
prognostic status; 2) what the consultant is being asked to help with; and 3)
how to efficiently communicate this to a specialist attending.
ii. Continuity Inpatients:
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1. Of Attendings:
Every effort should be made to ascertain the patient’s primary care
physician and notify him/her that the patient has been admitted to
the hospital. If a difficult situation occurs after-hours requiring a call
to the primary care physician for patient information, such a call
should be made after consultation with the senior resident and/or
Attending on call.
Most of our patients expect and anticipate a visit from their principle
physician, so please do not neglect to call the Attending as soon as
possible. It is the responsibility of the admitting intern to notify the
principle physician of the admission. The senior resident should
verify that the principle physician was contacted.
2. Of Residents:
Every effort should be made to ascertain the patient’s primary care
physician and notify him/her that the patient has been admitted to
the hospital. If a difficult situation occurs after hours requiring a call
to the primary care physician for patient information, such a call
should be made after consultation with the senior resident and/or
Attending on call.
iii. Death Certificates:
The death certificate is the permanent legal record of the patient’s death and
is important in court, epidemiological studies, and to the family. Death
certificates are important legal documents, which may not be spindled,
folded, mutilated, erased, stapled, or have lines struck through. They must be
completed and mailed to the Health Department (or completed online)
within five days. They are never given to the family. Interns must consult
with a faculty member, who will check for accuracy before mailing.
The Health Department will list the name of the physician it assumes should
complete the certificate. It should be completed by the physician who has the
most knowledge about the patient’s death. For a University Medical Center
(UMC) patient, this will typically be the patient’s physician at UMC. If the
patient died in the hospital and was cared for by others, the patient’s UMC
physician should complete the death certificate using the hospital discharge
(death) summary. Should that physician be unavailable, the physician who
cared for the patient in the hospital should complete the death certificate.
iv. Code Blue, Trauma Calls:
The in-house medicine team is expected to attend and manage all code-blue
situations, under the supervision of the DCH Regional Health System ER
physician or qualified College of Community Health Sciences faculty
member. The team should also attend and assist in all trauma alerts, unless
patient care issues prevent this. The code link phone must be carried at all
times and should never be left unattended. The only exception to this rule is
when the medicine team attends Academic Afternoon. During this time, the
ER must be notified of the call team’s absence.
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3. Other Inpatient Services:
Transfers from another Institution
Residents MAY NOT accept a patient in transfer. All transfer calls from the ER or the DCH
Health System operator should be immediately referred to the Attending of the relevant
service. The resident should assist the ER staff in finding the appropriate attending.
Signatures
All handwritten signatures should be followed with your legible printed first and last name or
your DCH dictation number.
III.
EDUCATIONAL POLICIES
III A. Professionalism
Professionalism is one of the core competencies that the Accreditation Council of Graduate Medical
Education (ACGME) has identified as being vital to the clinical practice of medicine and to resident
development. Appendix G must be signed and turned into the residency office.
Attaining a professional degree and performing a job repeatedly, however, does not instill the quality
of professionalism. There are other components that help define this quality. According to the
National Board of Medical Examiners, elements of professionalism include:
• Altruism
• Integrity
• Honesty
• Respect
• Courtesy
• Excellence
• Scholarship
• Responsibility
• Accountability
• Leadership
• Compassion
• Communication skills
The Residency Review Committee (RRC) also specifies that professionalism entails:
• A commitment to ethical behavior
• Confidentiality
• The consideration of religious, ethnic, gender, educational, and other differences in
interacting with patients and other members of the health care team
A medical professional has an awareness of the impact of his/her actions on others, has an
appropriate attitude, is caring, and exhibits attention to detail. Professional behavior as a resident
involves being on time, attending required meetings and assignments, being aware of one’s schedule,
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accepting feedback constructively, and following up on test results and patient progress.
Professionalism also entails a self-awareness of one’s physical and mental health; if problems arise
that interfere with performance it is expected that a resident seek help. If such problems occur,
residents are expected to report them to their Advisor or the Program Director so that the
University of Alabama Family Medicine Residency-Tuscaloosa can help the resident succeed.
Examples of unprofessional behavior include:
• Rude or discriminatory language
• Disrespectful or arrogant attitude
• Refusal to admit mistakes or ask for appropriate help
• Repeated resistance to feedback
• Failure to comply with required paperwork and documentation
• Failure to respond in a timely manner to pages, text messages, email, or telephone calls
• Unexcused absences
• Inappropriately casual appearance
• Repeated inappropriate patient care
• Deliberate breach of confidentiality
• Abuse of physician power
• Manipulating schedules for personal gain
• Misrepresentation of patient data or other information
• Failure to seek help for an impairment
Lack of professionalism and disruptive behavior is grounds for administrative and/or academic
probation and dismissal from the program. I have read this policy and commit to maintain these
standards of professionalism during my residency training.
Windfall” and Professionalism:
Occasionally you will be on a rotation where your preceptor takes a day off or releases you to go
home early. Your preceptor being off does not free you from responsibility to your patients. You are
expected to be reachable by pager during the workday, unless you notify the residency office that
you will be taking leave.
1. Dress Code:
Residents are expected to be neat and professional. Residents will wear a white coat and
clothes appropriate to the setting with a visible name tag. Scrubs should not be worn outside
the surgical, obstetric, or high-risk nursery areas without a white coat. Scrubs should not be
worn elsewhere in the hospital during the day unless there are extenuating circumstances
(e.g., working in clinic while taking OB call). Scrubs are not to be work outside the hospital.
On hospital services and in private offices, residents are expected to conform to these
physician standards when seeing patients. While at University Medical Center (UMC),
professional attire should be worn with the exception of OB/Gyn and Surgery Clinic.
Scrubs may be worn by the Night Float residents in clinic. Weekend and Night Call residents
may wear scrubs in-house. Appropriate dress is an important part of our professionalism
policy. Repeated violations of the dress code will be considered unprofessional behavior and
be grounds for further action as deemed appropriate by the Residency Director or designee.
2. Impaired Physicians:
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Impairment is defined as the inability of a resident to physically, mentally, or morally meet
his/her responsibilities as caused by dependency on alcohol and/or controlled
pharmaceuticals, psychiatric disease, physical injury/illness, or dementia as a consequence of
age or other conditions.
The University of Alabama Family Medicine Residency-Tuscaloosa (TFMR) and the College
of Community Health Sciences (CCHS) recognize their responsibilities to patients, medical
staff, residents, and the community-at-large to ensure that residents enrolled in graduate
medical education programs are physically, mentally, and morally competent to meet their
designated responsibilities. TFMR does not assume a punitive role in cases of impairment,
but recognizes the importance of identifying and facilitating the treatment of any resident
who is incapable of meeting his/her responsibilities due to impairment. Any resident who
feels they may have a condition that may affect his/her abilities should seek immediate
assistance and the counsel of the Residency Director.
Other avenues of assistance include, but are not limited to, use of private counseling,
Alcoholics Anonymous, the University’s Employee Assistance Program (EAP), the Alabama
Physicians Health Program of the Medical Association of the State of Alabama, and
physician rehabilitation programs.
In cases of suspected impairment, the Residency Director, or designated member of the
program’s faculty, shall follow the procedures indicated below:
• A discreet investigation shall be conducted of any complaint, allegation, or concern
expressed by other residents, program faculty, medical staff, patients, hospital employees,
or resident’s family members.
• If there is sufficient evidence of impairment, the Residency Director will intervene with
the resident, present the concerns and evidence reported, and determine if additional
diagnostic testing is indicated. See reasonable suspicion drug /alcohol screening policy,
Appendix D.
• If the resident accepts the results of the investigation, the Residency Director will work
with the resident to develop a plan of action for appropriate counseling, treatment,
and/or rehabilitation.
• The Residency Director shall facilitate referral of the resident in accordance with the
plan of action developed. The Residency Director should work with the resident to
monitor the rehabilitation process and act as an advocate for the resident with medical
and teaching staff, other residents, and state review boards.
• If a resident does not accept the demonstration of impairment and accept the plan of
action, the Residency Director shall have authority for immediate suspension or
revocation of the resident’s appointment.
• All paid and unpaid leave taken by the resident will be in accordance with Annual Leave
policies. During any period of unpaid leave, the resident must make arrangements for
the payment of premiums for continuance of benefits, including health insurance. The
resident is responsible for the cost of counseling, treatment, and rehabilitation exceeding
the limits of coverage provided under his/her health insurance.
• The Designated Institutional Official (DIO) must be notified of all cases of resident
impairment and receive reports on the results of the intervention, the plan for and
results of diagnosis, treatment, and/or rehabilitation, the inclusive dates of the leave of
absence, the dates of the leave of absence, the dates of any leave planned as unpaid leave,
and arrangements for continuance of benefits during unpaid leave.
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•
All records concerning impairment of a resident will be treated with strict confidentiality
in accordance with existing state and federal laws.
3. Mental Health:
Medicine has its rewards and considerable stresses. Resident physicians are confronted for
the first time with the loneliness of having responsibility for the lives and health of their
patients. The effort to develop an attitude of detached concern for patients may be
complicated by cynicism. Crises may occur when residents are nearing the end of their
training and face major adjustments in choosing and establishing a practice.
Physicians have a higher frequency of drug abuse, affective disorders, and marital
disharmony than other people of similar social standing. Suicide is more frequent among
physicians, possibly because doctors are reluctant to acknowledge illness or difficulties. The
faculty of the College of Community Health Sciences (CCHS) recognizes the potential for
emotional difficulties among residents and the need for assistance. Physicians in training
who are suffering may bring this to the attention of the Residency Director or their advisor
without fear or disapproval. Confidentiality is important. Residents are encouraged to
consult with the psychiatry faculty in CCHS. If there is interest in obtaining assistance
outside the College, several good resources are available. A brief directory of community
resources include:
University of Alabama Employee Assistance Program (EAP) = (205) 759 -7890
Indian Rivers Community Mental Health Center = (205) 345 - 1600
Psychology Clinic/Parents Anonymous = (205) 348 - 5000
UMC Psychiatry Department = (205) 348 - 1265
Alcoholics Anonymous = (205) 759 – 2497
a. Intern Retreat:
It has been the tradition at the University of Alabama Family Medicine ResidencyTuscaloosa for the upper level residents to provide the interns with a few shifts off
near the conclusion of their internship. The Intern Retreat will occur during the last
weekend of April. The location and other details for the retreat will be coordinated
by the interns. The retreat starts at noon on Friday and ends at 7:00 pm on Sunday.
The Chief Residents will coordinate call coverage.
Interns not participating in the official Intern Retreat activities will be expected to
cover their own call shifts and clinics. Additionally, such interns may be assigned for
daytime call coverage of primary services in lieu of their regular rotation.
4. Workplace Relationships:
Those who are romantically involved cannot be in the same reporting structure, and one
party cannot have undue influence over the other’s career and/or advancement. The
University of Alabama has a Consensual Relationship Policy that residents are required to
abide by: http://facultysenate.ua.edu/handbook/append-j.html
5. Drug Testing:
As per the University of Alabama Family Medicine Residency-Tuscaloosa’s (TFMR) preemployment drug screening policy, house officers of TFMR will be required to undergo drug
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testing as a condition of employment. Drug testing may also be required during employment
for reasonable suspicion or post-accident for cause and for individuals who have signed
Fitness For Duty and/or Drug Testing Continuation of Employment contracts.
A prospective resident undergoing post-job offer drug testing who declines to consent to
testing or who receives a confirmed positive drug test result shall have the conditional offer
of employment withdrawn and shall be subject to disqualification from employment
consideration for a period of one year from the date of the drug test.
In order for incoming house officers to be paid through the Payroll system they must
undergo drug testing prior to their start date.
6. Drug Rep Policy: Samples are not permitted in clinic and drug vouchers are only to be
distributed to our patients. See appendix for our complete policy. Refer to Appendix D.
III B. Curriculum
1. Overview of the Curriculum: 13 blocks
FM Inpatient-4 blocks total (2 blocks intern year, 1 for PGY-2, and 1 for PGY-3)
Internal Medicine-2 blocks
OB/GYN-3 blocks
Peds-3 blocks
Surgery-1 block (intern year only)
Geriatrics-1 block
EKG/VENT-1 block (intern year only)
CM/PM-1 block (intern year only)
GYN Clinic-1 block (PGY 2 or 3)
Night Float-Adult Medicine-2 blocks
Night Float-Pediatrics/OB-2 blocks
Emergency Medicine-2 blocks (1 in 2nd year and 1 in 3rd year)
Ambulatory Pediatrics-2 blocks
Orthopaedics-1 block
Psychiatry-1 block
Rural Medcine-1 block
Neurology-1block
Cardiology-1 block
ENT/Urology/Opthamology-1 block
Sports Medicine-1 block
Radiology/Practice Management-1 block
Electives-6 blocks
2. Rotations:
a. Scheduling Rotations:
Rotation schedules are prepared in one-year blocks from July to June by the
Chief Residents. This schedule is subject to oversight and/or reassignment
by the Residency Director, Associate Director, Assistant Director, and/or
Coordinator. Any resident wishing to make a change in his/her rotation
schedule should apply 90 days in advance to the Residency Director.
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b. Elective/Subspecialty Rotations:
Before starting an elective or subspecialty rotation, the resident is required to
contact the preceptor one month prior to the start date to notify him/her of
clinic schedule and inquire about any requirements or preparations that
should be completed for the rotation.
c. Starting Dates:
Monthly rotations, with the exception of Night Float, begin on the first day
of the block. Night Float begins at 5:00 pm the night before the first day of
the month. For primary services, if the new month begins on a weekend, the
previous month’s call teams will be required to cover call until 7:00 pm on
Sunday (when the new month’s night float team starts).
Dates for rotations: All rotations begin July 1st
Rotation 1: July 1st-28th
Rotation 2: July 29th-August 25th
Rotation 3: August 26th-September 22nd
Rotation 4: September 23rd-October 20th
Rotation 5: October 21st-November 17th
Rotation 6: November 18th-December 15th
Rotation 7: December 16th-January 12th (this will be a shortened month due
to the holiday schedule)
Rotation 8: January 13th-February 9th
Rotation 9: February 10th-March 9th
Rotation 10: March 10th-April 6th
Rotation 11: April 7th-May 4th
Rotation 12: May 5th-June 2nd
Rotation 13: June 3rd-June 30th
d. Incomplete Rotations:
The curriculum for this program is 36 months, including allotted vacation
time. It is expected that each rotation, including electives, will be completed
in a satisfactory manner, meaning adequate attendance (present no less than
15 working days) and performance.
e. Away Rotations:
The American Board of Family Medicine (ABFM) requirements allow a total
of four months during the R2 and R3 years to be spent on away rotations.
These cannot exceed two months in any single year, be scheduled
consecutively, or taken the last month of residency.
i. Supervised Practice Experience (SPE):
A Supervised Practice Experience (SPE) may be spent in a physician
Practice of the resident’s choice at the discretion of the Residency
Director. The following criteria will be used to judge the acceptability
of the proposed rotation.
• The resident will apply for the SPE a minimum of three
months prior to the anticipated rotation.
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•
•
•
•
•
•
•
•
The resident will obtain agreement for the rotation from the
preceptor.
There must be a justifiable educational value to the
experience
The preceptor should have some experience in medical
education.
The preceptor must agree to evaluate the resident’s activity
and performance.
The resident must be supervised.
The College will not provide money for travel or meals.
There can be no conflict with the resident’s duties or
responsibilities. The resident must not have delinquent
dictations or charts at DCH Regional Medical Center or
University Medical Center. The resident must have seen an
adequate number of patients per the ACGME requirements
to be granted leave from clinic.
Unless previously discussed with the Residency Director, the
preceptor should be Board Certified in Family Medicine.
ii. Rural Rotation:
All residents are required to have a rural rotation. The resident will
select the site from one of the available teaching sites. The Residency
Office can be contacted for the list of approved teaching sites. The
resident will be required to return to University Medical Center for
one day of clinic a week to maintain their continuity of patient care.
Occasionally, a stipend is provided by the Alabama Family Practice
Rural Health Board to help defray the costs associated with travel to
the rural site. This stipend is dependent upon the favor of the state
legislature and is not guaranteed.
ii. Elective Remote Site Experience (SPE):
Domestic and international humanitarian or mission experiences are
encouraged during the R2 and/or R3 years of residency. It is possible
to receive academic (residency) credit for these experiences provided
AAFP and RRC guidelines are met. An ERSE typically involves
having a board-certified preceptor from a U.S. training program. A
resident must apply for an ERSE a minimum of three months prior
to the anticipated rotation.
Humanitarian trips/rotations are considered for reimbursement up to
$1,500. This benefit is available once during residency. To qualify for
this benefit, the following must be done:
A two to three page proposal for the experience must be written and
submitted to the Residency Director prior to the ERSE.
A summary of the experience must be written and submitted to the
Residency Director after the ERSE.
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If granted permission for reimbursement, UA travel guidelines must
be followed. All expenditures must have receipts and supporting
documentation. Typically the maximum reimbursement allowed is
$200 per night for hotel accommodations and $45 per day for meals.
Please refer to UA’s website for the most up-to-date rules for
reimbursement: http://financialaccounting.ua.edu/acctspayable/traveltravelpayable/travelpol5.htm#inttravel.
3. Conferences and Scholarly Activities:
a. Academic Afternoon and other Academic Conferences:
Academic Afternoon is every Tuesday afternoon and is a required part of the
program. Attendance is required of all residents, unless: 1.) the resident is on
approved leave; 2.) duty hours prohibit such involvement; 3.) urgent patient
care precludes this; or 4.) the resident is on an “away” rotation that does not
have University Medical Center continuity clinic. Academic Afternoon
should not be used for personal activities without having approved leave. If
urgent care does preclude attendance, please notify the Residency Office as
soon as possible.
Other conferences, such as Academic Conferences, Emergency Medicine
Series, and Special Emphasis Week, may be scheduled at various times
throughout the year. The attendance policy for these lectures is the same as
above.
In cases of ANY unapproved absences, the resident will be forced to use a
day of annual leave. If no annual leave is available, the resident will be forced
to take leave without pay and will be required to give a lecture from a list of
topics within the next month.
Academic Afternoon is designed to further your professional development.
Lecturers have been asked to take time from their schedules and deserve a
respectful and attentive audience. Please put your cell phones and pagers on
vibrate during this time.
It is understood that on occasion complex patient notes from Tuesday
AM clinic cannot wait. In this instance, please position yourself away from
the speaker to complete only the most urgent notes. Do not use Academic
Afternoon to catch up on delinquent charts. Any other use of laptops and/or
iPhones is strongly discouraged and may cause forfeiture of this privilege for
the group.
b. Behavioral Medicine – PGY-3 Presentations:
The conference is a required part of the Residency Program. It involves each
senior resident presenting a case/topic in Behavioral Medicine/Family
Medicine for discussion and dialogue. Preparation of the topic and the case is
done under the direct guidance of the faculty coordinator for the R3
conferences (Dr. Thad Ulzen) and/or the Residency Director. These
conferences will have their own orientation at the end of the R2 year.
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c. Scholarly Activities and Research:
As of July 1, 2006, all University of Alabama Family Medicine ResidencyTuscaloosa residents are required to participate in a scholarly
activity/research project. This is done as part of the R2 year and is presented
during Academic Afternoon before a panel of judges. It is a graduation
requirement. Information regarding this requirement will be formally given
during an orientation session at the beginning of the R2 year. If you would
like to get started earlier, you may schedule time to discuss this project at any
time during internship.
4. Other Requirements:
a. Quality Improvement:
Quality Improvement (QI) is increasingly becoming a part of private practice
in the form of insurance-initiated pay-for-performance programs and annual
American Board of Family Medicine Maintenance of Certification QI Chart
Reviews. As of July 1, 2006, all Family Medicine Residents are required to
participate in a QI project (AAFPs METRIC). This is a graduation
requirement and is typically completed during the R2 year.
b. See also Sections on Nursing Home and Home Visits pp 22-23
III C. Advanced OB Focus
Residents desiring to offer maternity services following graduation should take the advanced
OB curriculum to comply with the AAFP/ACOG guidelines. Residents choosing these
additional OB training months should consult with the Residency Director
III D. Library and Learning Resources
The Health Sciences Library is located on the ground floor of the College of Community Health
Sciences and is available to residents 24 hours a day.
III E. Assessment
1. Overview:
a. Evaluation of the Resident:
Residents evaluate the faculty and rotations. To preserve anonymity, these
evaluations are compiled every four to six months and a composite average of the
evaluations and comments are presented to the faculty. The evaluations remain
completely anonymous.
Preceptors from each rotation evaluate residents in New Innovations monthly.
These evaluations are released for the resident to review at his/her request.
Each quarter, residents will meet with their advisor to review these evaluations.
Quarterly Summative Evaluations are conducted by the Family Medicine faculty and
are kept on file in the Residency Office.
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i. Formative, Summative, and Final: Residents will be evaluated securely and
electronically by the faculty at the conclusion of each rotation. Access to
these formative evaluations will be available securely and electronically online
once the residents have completed their own evaluations of the faculty and
rotation.
During the academic year, the Family Medicine faculty shall meet quarterly to
consider the academic progress and promotion of all residents. The
residents will be required to meet with their advisors to discuss their
evaluations for that quarter. Any weakness or deficiency should be discussed
during this time. The advisor will complete a Summative Evaluation on the
resident and turn it in to the Residency Office.
Prior to the end of June, the Residency Director will transmit resident
evaluation reports to the Chair of the Department of Family Medicine, the
Designated Institutional Official, the Associate Dean for Academic Affairs,
and/or the Dean for review and approval. After approval, the Residency
Director shall forward to each resident the decision reached, pending
successful completion of the remainder of the academic year. If the resident
wishes to appeal the decision reached, the resident shall have five working
days to file a request for a formal hearing as detailed in the Probation and
Termination Section .
ii. Faculty Advisor: Residents are assigned a faculty advisor to assist
them in obtaining their educational goals.
b. Evaluation by the Resident of Rotations: Residents are required to complete an evaluation of
each rotation in New Innovations.
c. Evaluation by the Resident of Teachers: Residents are required to complete an evaluation
on each of their attendings at the end of a rotation in New Innovations.
2. Documenting Procedures:
All procedures done should be documented in New Innovations. This list is used to write an
official letter documenting your competency in procedural areas to all future employers,
hospitals, and/or insurance companies. Occasionally, some rotations require a certain
number of procedures to graduate.
Each resident must perform a minimum of 40 deliveries over the thee-year program, of
which a minimum of 10 must be continuity deliveries. At least 30 of the total deliveries must
be vaginal deliveries. Two residents may be given credit for the same delivery if one of those
residents is supervising. The experience of each resident must be documented as to the role
played in the delivery. For the minimum of 10 continuity patient deliveries, each resident
must assume responsibility for provision of antenatal, natal, and postnatal care during their
three years of training.
3. In-training Exam:
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The American Board of Family Medicine (www.theabfm.org) administers the In-Training
Exam (ITE) annually in the fall. The purpose of the examination is to provide an assessment
of each resident's progress, while also providing programs with comparative data about the
program as a whole. The examination consists of 240 multiple-choice questions and uses a
content outline that is identical to the blueprint for the ABFM Certification Examination.
It is the goal of the University of Alabama Family Medicine Residency-Tuscaloosa (TRMR)
to create an environment that fosters scholarship and lifelong learning. Thus, preparation for the
ITE and for Boards is highly emphasized.
The following criteria are considered internal benchmarks for the TFMR:
• PGY-1: 390 mean scaled score
• PGY-2: 410 mean scaled score
• PGY-3: 440 mean scaled score
Scores will be discussed with the resident’s Academic Advisor and the Residency Director. If
scores are lower than the internal benchmark listed above, formal assistance with
examination preparation will be provided. (NOTE: This is NOT academic probation. It is
expected that several residents will not be at this benchmark this early in the year. The goal
of this process is to identify those struggling with standardized tests and provide assistance
and training.)
A typical remediation plan will follow the procedures outlined below:
• Meeting with resident’s advisor outlining the 12-week plan.
• Weekly meetings with advisor (at advisor’s discretion).
• Advised to use CME fund on board-review course. (NOTE: R2s who remediate on
the ITE will not be allowed to use their R3 CME funds until successfully passing the
R3 ITE. If the R3 ITE is not passed, the CME funds must be spent on an approved
board-review course.
• Completion of the Board Review Simulator Course on either Challenger of Exam
Master. At the conclusion of the 12-week period, the resident will retake an exam on
Exam Master with the goal of a score at least 10 percent higher.
No academic probation will be prescribed SOLELY on the results of the ITE or follow-up
test. The Residency Director will review the results of the ITE with confidentiality,
professionalism, and a view of the big picture of the resident as a physician in training.
Failure to work with academic advisor on the ITE will result in academic probation.
III F. Advancement and Graduation
Each resident is expected to achieve standards of knowledge, skills, and attitudes in patient care,
medical knowledge, practice-based learning and improvement, interpersonal and communication
skills, systems-based practice, and professionalism. In order to progress successfully through the
residency, the resident must meet the requirements and professional obligations of each PGY level
before proceeding to the next level and finally graduating from the program. These requirements are
clearly delineated below.
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It is the intent of the residency that every first-year resident complete all three years successfully.
Standards are set by the various departments in accordance with the goals and objectives of the
residency. Failure to achieve these standards will be the basis for an academic probationary review.
Resident advancement is discussed and decided by the faculty group at the semi-annual review of
residents. The Residency Director ultimately has final decision-making in resident advancements, but
seeks input from multiple sources, including residency faculty, chief residents, and other parties
when arriving at promotion decisions.
1. PGY-1 to PGY-2:
In order to successfully advance from PGY-1 to PGY-2 year, the resident must meet the
following criteria:
• Demonstrate appropriate competence in the following areas:
o Patient Care
o Medical Knowledge
o Practice Based Learning and Improvement
o Professionalism
o Interpersonal Communication Skills
o System-Based Practice
• Complete all required rotations.
• Receive passing evaluations on all rotations; if resident fails any rotation, he/she must
repeat the rotation with passing evaluations prior to advancement.
Passing is defined as the department of that rotation awarding a passing grade to the
resident. Each attending on a rotation will submit an evaluation of the resident. At the
end of the rotation, the department of that rotation will meet to review the evaluations
and then determine a pass or fail grade for the resident from the department as a whole.
The failure of 2 or more rotations during the resident’s 36 months could constitute in
disciplinary action.
• Be assessed by the core faculty as ready to perform as an upper level by the second
summative evaluation of intern year.
• Be assessed as competent to progress to the less supervised upper level status in the
ambulatory clinic by the behavioral and communications video assessments.
• Perform and document 10 vaginal deliveries, and be deemed “competent” by two
separate faculty members on two subsequent deliveries in order to advance to upper
level call.
• Abide by all medical records policies of University Medical Center and DCH Regional
Health System.
• Complete 150 office visits in the Family Medicine Clinic.
• Fulfill all obligations and duties specified in the Resident Agreement.
2. PGY-2 to PGY-3:
In order to successfully advance from PGY-2 to PGY-3 year, the PGY-2 must meet the
following criteria:
• Demonstrate appropriate competence in the following areas:
o Patient Care
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•
•
•
•
•
•
•
•
o Medical Knowledge
o Practice Based Learning and Improvement
o Professionalism
o Interpersonal Communication Skills
o System-Based Practice
Complete all required rotations.
Receive passing evaluations on all rotations; if resident fails any rotations, he/she must
repeat the rotation with passing evaluations prior to advancement.
Passing is defined as the department of that rotation awarding a passing grade to the
resident. Each attending on a rotation will submit an evaluation of the resident. At the
end of the rotation, the department of that rotation will meet to review the evaluations
and then determine a pass or fail grade for the resident from the department as a whole.
The failure of 2 or more rotations during the resident’s 36 months could constitute in
disciplinary action.
Be assessed by the core faculty as ready to perform as a PGY-3 (including the ability to
act as chief of service on FMIS) by the second summative evaluation of PGY-2 year.
Abide by all medical records policies of University Medical Center and DCH Regional
Health System.
Have followed at least two continuity patients in the Nursing Home (monthly visits).
Substantial progress on the R2 Quality Improvement Project.
Substantial progress on the R2 Research Project / Scholarly Activity.
Fulfill all obligations and duties specified in the Resident Agreement.
Successfully completed USMLE Step 3 by January 1 of the PGY -2 year.
3. Graduation and Board Eligibility:
In order to successfully graduate from the program, the PGY-3 must meet the following
criteria:
• Demonstrate appropriate competence in the following areas:
o Patient Care
o Medical Knowledge
o Practice Based Learning and Improvement
o Professionalism
o Interpersonal Communication Skills
o System-Based Practice
• Complete all required rotations.
• Complete a total of at least 1,650 office visits in the Family Medical Center over the prior
three years.
• Complete 40 deliveries, of which at least 30 must be vaginal deliveries and at least 10
must be continuity deliveries.
• Document at least 15 unique ICU patient management encounters.
• Follow at least two continuity patients in the Nursing Home (every 30-60 days).
• Completion of the R2 Quality Improvement Project.
• Completion of the R2 Research Project / Scholarly Activity.
• Perform and document at least two home visits (at least one must be an elderly patient).
• Receive passing evaluations on all rotations; if resident fails any rotations, he/she must
repeat the rotation with passing evaluations prior to graduation.
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•
•
•
•
•
Be assessed by the core faculty as ready to perform as an independently practicing family
physician by the second summative evaluation of PGY-3 year.
Abide by all medical records policies of University Medical Center and DCH Regional
Health System.
Hold a permanent medical license in order to apply and sit for the ABFM boards.
Completion of all ABFM requirements for graduation.
Fulfill all obligations and duties specified in the Resident Agreement.
Each resident must satisfactorily complete 36 months in order to graduate and be eligible to sit for
the Board Certification Exam. Board expenses are the responsibility of the resident, who may be
reimbursed from his/her CME funds, if available. A resident will not be allowed to graduate without
having the required number of patient continuity visits, OB delivery totals and continuities, nursing
home visits, home visits, and ICU visits. All residents must sit ABFM Board Exam in April.
Exceptions to this may be made by the Residency Director under extenuating circumstances.
Promotion with Recommendations or Reservations
As noted in the section above, it is the intention of the program to progress its resident physicians
from internship to graduation to independent medical practice.
In addition to the full promotion described above, the following academic statuses exist at the
University of Alabama Family Medicine Residency-Tuscaloosa:
1. Promotion with Recommendations will be made when deficiencies in one or more of the
six ACGME core competencies exist, but are felt to be correctable in a timeframe conducive
with continued training. Review will occur at the next summative meeting with expectation
of resolution of the deficiency. Failure to resolve the deficiency shall potentially result in
Academic Probation.
2. Promotion with Reservations will be made when deficiencies in one or more of the six
ACGME core competencies exist, are felt to be correctable, but not conducive to
progression to further responsibility (e.g., upper level status) without remediation. Formal
review will occur following the next summative meeting with expectation of resolution of
the deficiency. Failure to resolve the deficiency shall result in either Academic Probation
and/or Dismissal from the Program.
III G. Probation and Disciplinary Procedures
1. Academic or Administrative Probation:
The Residency Director shall be authorized to place a resident on academic probation. This
may include a recommendation from the residency or College Faculty. Grounds for
academic probation include performance judged to be unsatisfactory for the resident's level
of training, unprofessional attitudes or conduct, or failure to comply with institutional
and/or departmental policies and procedures.
The Residency Director shall be authorized to place a resident on administrative probation
for violations of the eligibility standards for becoming and remaining a resident in the
training programs, as outlined in this Policy and Procedure manual. This may include a
recommendation from the residency or College Faculty. Grounds for administrative
probation include, but are not limited to, failure to complete the employment physical (if
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applicable), failure to obtain certification in ACLS, failure to meet deadlines for obtaining
passing scores for USMLE Steps 2 and 3, and/or failure to meet the deadline for obtaining
the appropriate Alabama medical license.
Additionally, in all such cases of academic or administrative probation, residents may be
placed on probation for, among other things, issuance of a warning or reprimand; or
imposition of a remedial program. Remediation refers to an attempt to correct deficiencies
which, if left uncorrected, may lead to a non-reappointment or disciplinary action. In the
event a resident’s performance, at any time, is determined by the Residency Director to
require remediation, the Residency Director shall notify the resident in writing of the need
for remediation. A remediation plan will be developed that outlines the terms of remediation
and the length of the remediation process. Failure of the resident to comply with the
remediation plan may result in termination or non-renewal of the resident’s appointment.
A resident who is dissatisfied with a Residency Director decision to issue a warning or
reprimand, impose a remedial program, or impose probation may appeal that decision to the
Family Medicine Department Chair informally by meeting with the Family Medicine
Department Chair and discussing the basis of the resident’s dissatisfaction within 10 working
days of receiving notice of the departmental action. If resident fails to prescribe to the above
time line, resident will automatically waive their right to further appeal. The decision of the
Family Medicine Department Chair shall be final.
2. Informal Adjudication:
A resident may request Informal Adjudication if the Residency Director initiates an action
(other than the actions that are subject to Academic or Administrative Probation described
above or to review pursuant to the Hearing Process below) that could significantly threaten a
resident’s intended career development, as determined solely by the University of Alabama
Family Medicine Residency-Tuscaloosa Program (TFMRP). These actions do not include
performance evaluations, which are in the sole discretion of the faculty completing the
evaluations. To request Informal Adjudication, the resident must submit a written request to
the Dean of Graduate Medical Education no later than five days after imposition of the
action. Failure to submit a written request within this time-period shall constitute a waiver of
the resident's right to request an Informal Adjudication.
The Informal Adjudication will be conducted by the Dean for Graduate Medical Education
and will consist of a record review of the file and any materials submitted by the Residency
Director and resident. The Dean may, in her/his sole discretion, choose to interview the
resident and Residency Director and to consult with any other individual deemed
appropriate. The Dean will issue a written decision that will constitute the College of
Community Health Sciences’ final decision and is not subject to appeal.
3. Summary Suspension:
The Residency Director, or designee, or the Family Medicine Department Chair or designee
shall have the authority to summarily suspend, without prior notice, all or any portion of the
resident’s appointment and/or privileges granted by The University of Alabama or any other
resident training facility, whenever it is in good faith determined that the continued
appointment of the resident places the safety of University or other training facility patients
or personnel in jeopardy or to prevent imminent or further disruption of University or other
resident training facility operations.
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Except in those cases where suspension occurs as part of other appealable disciplinary
actions, within two working days of the imposition of the summary suspension, written
reason(s) for the resident’s summary suspension shall be delivered to the resident and the
Dean for Academic Affairs. In those other appealable cases the due process is described in
the above section of this manual labeled Termination, Non-Reappointment, and Other
Adverse Action. The resident will have five working days upon receipt of the written reasons
to present written evidence to the Dean for Academic Affairs in support of the resident’s
challenge to the summary suspension. A resident who fails to submit a written response to
the Dean for Academic Affairs within the five-day deadline waives his/her right to appeal
the suspension. The Dean for Academic Affairs shall accept or reject the summary
suspension or impose other adverse action. Should the Dean for Academic Affairs impose
adverse action that could significantly threaten a resident’s intended career, the resident may
utilize the due process delineated above.
The Family Medicine Department may retain the services of the resident or suspend the
resident with pay during the appeal process. Suspension with or without pay cannot exceed
90 days, except under unusual circumstances.
4. Termination, Non-Reappointment and Other Adverse Action:
A resident may be dismissed or other adverse action may be taken for cause, including but
not limited to:
i. Unsatisfactory academic or clinical performance
ii. Failure to comply with the policies, rules, and regulations of the residency
program, University of Alabama, or other facilities where the resident is trained
iii. Revocation, expiration, or suspension of license
iv. Violation of federal and/or state laws, regulations, or ordinances
v. Acts of moral turpitude
vi. Insubordination
vii. Conduct that is detrimental to patient care
viii. Unprofessional conduct
ix. Patient abandonment
The residency may take any of the following adverse actions:
i. Issue a warning or reprimand
ii. Impose terms of remediation or a requirement for additional training,
consultation, or treatment
iii. Institute, continue, or modify an existing summary suspension of a resident’s
appointment
iv. Terminate, limit, or suspend a House Officer’s appointment or privileges
v. Non-renewal of a resident’s appointment
vi. Dismiss a resident from the residency
vii. Any other action that the residency deems is appropriate under the circumstances
III H. Due Process
All communication regarding due process will occur by official campus email, certified letter, or
hand delivery. Dismissals, non-reappointments, non-promotion, or other adverse actions excluding
probation that could significantly jeopardize a resident’s intended career development are subject to
appeal and the process shall proceed as follows:
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Recommendation for dismissal, non-reappointment, or other adverse action that could
significantly threaten a resident’s intended career development shall be made by the
Residency Director in the form of a Request for Adverse Action. The Request for Adverse
Action shall be in writing and shall include proposed disciplinary action, a written statement
of deficiencies and/or charges registered against the resident, a list of all known
documentary evidence, a list of all known witnesses, and a brief statement of the nature of
testimony expected to be given by each witness. The Request for Adverse Action shall be
delivered in person to the Family Medicine Department Chair. If the Department Chair
finds that the charges registered against the resident appear to be supportable on their face,
the Department Chair shall give Notice to the resident in writing of the intent to initiate
proceedings that might result in dismissal, non-reappointment, summary suspension, or
other adverse action. The Notice shall include the Request for Adverse Action and shall be
sent by campus email, certified mail to the address appearing in the records of the Human
Resource Management, or may be hand delivered to the resident.
Upon receipt of Notice, the resident shall have five working days to meet with the
Department Chair and present evidence in support of the resident’s challenge to the Request
for Adverse Action. Following the meeting, the Department Chair shall determine whether
the proposed adverse action is warranted. The Department Chair shall render a decision
within five working days of the conclusion of the meeting. The decision shall be sent by
campus email, certified mail to the address appearing in the records of the Human Resource
Management, or hand delivered to the resident and copied to the Residency Director and
Dean of Graduate Medical Education.
If the resident is dissatisfied with the decision reached by the Department Chair, the resident
shall have an opportunity to prepare and present a defense to the deficiencies and/or
charges set forth in the Request for Adverse Action at a hearing before an impartial
subcommittee of the Graduate Medical Education Committee, which shall be advisory to the
Dean. of Graduate Medical Education. The resident shall have five working days after
receipt of the Department Chair’s decision to notify the Dean of Graduate Medical
Education in writing or by email whether the resident would challenge the Request for
Adverse Action and desires that a Subcommittee be formed. If the resident contends that
the proposed adverse action is based, in whole or in part, on race, sex (including sexual
harassment), religion, national origin, age, Veteran status, and/or disability discrimination,
the resident shall inform the Dean of Graduate Medical Education of that contention. The
Dean of Graduate Medical Education shall then invoke the proceedings set out in the
Section entitled “Sexual Harassment Policy” of this Manual. The hearing for adverse action
shall not proceed until an investigation has been conducted pursuant to the Section entitled
“Sexual Harassment Policy.”
The Subcommittee shall consist of three full-time (75 percent or greater effort) clinical
faculty members from the Graduate Educational Committee, who shall be selected in the
following manner:
The resident shall notify the Dean of Graduate Education of the resident’s
recommended appointee to the subcommittee within five working days after the
receipt of the decision reached by the Department Chair. The Dean of Graduate
Medical Education shall then notify the Department Chair of the resident’s choice of
subcommittee Member. The Department Chair shall then have five working days
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after notification by the Dean of Graduate Medical Education to notify the Dean of
Graduate Medical Education his/her recommended appointee to the Subcommittee.
The two Committee Members selected by the resident and the Department Chair
shall be notified by the Dean of Graduate Medical Education to select the third
Committee Member within five working days of receipt of such notice; thereby the
Committee is formed. Normally, members of the committee should not be from the
same program or department. In the case of potential conflicts of interest or in the
case or a challenge by either party, the Dean of Graduate Medical Education shall
make the final decision regarding appropriateness of membership to the
subcommittee.
Once the Subcommittee is formed, the Dean of Graduate Medical Education shall forward
to the Subcommittee the Notice and shall notify the Subcommittee members that they must
select a Subcommittee Chairman and set a hearing date to be held within 10 working days of
formation of the Subcommittee. A member of the Subcommittee shall not discuss the
pending adverse action with the resident or Department Chair prior to the hearing. The
Dean of Graduate Medical Education shall advise each Subcommittee Member that he/she
does not represent any party to the hearing and that each Subcommittee Member shall
perform the duties of a Committee Member without partiality or favoritism.
The Chairman of the Committee shall establish a hearing date. The resident and
Department Chair shall be given at least five working days’ notice of the date, time, and
place of the hearing. The Notice may be sent by campus email, certified mail to the address
appearing in the records of the Human Resource Management, or may be hand delivered to
the resident, Department Chair, and Dean of Graduate Medical Education, Each party shall
provide the Dean of Graduate Medical Education five copies of the witness list, a brief
summary of the testimony expected to be given by each witness, and a copy of all
documents to be introduced at the hearing at least three working days prior to the hearing.
The Dean of Graduate Medical Education will assure that all parties will receive the other
parties’ documents.
The hearing shall be conducted as follows:
The Chairman of the Subcommittee shall conduct the hearing. The hearing shall
include the following persons: the resident appealing the action; the members of the
Subcommittee; the Residency Director with or without the Department Head;
counsel, if present; and any other persons deemed by the Chairman of the
Subcommittee to carry out the hearing. Each party shall have the right to appear, to
present a reasonable number of witnesses, to present documentary evidence, and to
cross- examine witnesses. The parties may be excluded when the Subcommittee
meets in executive session. The resident may be accompanied by an attorney as a
nonparticipating advisor. Should the resident elect to have an attorney present, the
program may also be accompanied by an attorney. The attorneys for the parties may
confer and advise their clients upon adjournment of the proceedings at reasonable
intervals to be determined by the Chairman, but may not question witnesses,
introduce evidence, make objections, or present argument during the hearing.
However, the right to have an attorney present can be denied, discontinued, altered,
or modified if the Committee finds that such is necessary to insure its ability to
properly conduct the hearing. Rules of evidence and procedure are not applied
strictly, but the Chairman shall exclude irrelevant or unduly repetitious testimony. The
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Chairman shall rule on all matters related to the conduct of the hearing and may be
assisted by University counsel.
There shall be a single verbatim record, such as a tape recording, of the hearing (not
including deliberations). Deliberations shall not be recorded. The record shall be the
property of The University of Alabama.
Following the hearing, the Committee shall meet in executive session. During its
executive session, the Committee shall determine whether or not the resident shall
be terminated or otherwise have adverse actions imposed, along with reasons for its
findings, summary of the testimony presented, and any dissenting opinions. The
Dean of Graduate Medical Education shall review the Committee’s report and may
accept, reject, or modify the Committee’s finding. The Dean of Graduate Medical
Education shall render a decision within five working days from receipt of the
Committee’s report. The decision shall be in writing and sent by campus email or
certified mail to the resident, and a copy shall be sent to the Family Medicine
Department Chair and Dean of the College.
If the Dean of Graduate Medical Education’s final decision is to terminate or impose
adverse measures and the resident is dissatisfied with the decision reached by the
Dean of Graduate Medical Education, the resident may appeal to the Dean of the
College with such appeal limited to alleged violations of procedural due process only.
The resident shall deliver Notice of Appeal to the Dean of the College within five
working days after receipt of the Dean of Graduate Medical Education’s decision.
The Notice of Appeal shall specify the alleged procedural defects on which the
appeal is based. The Dean of The College’s review shall be limited to whether the
resident received procedural due process. The Dean of The College shall then accept,
reject, or modify the Dean of Graduate Medical Education’s decision. The decision
of the Dean of The College shall be final.
A resident who at any stage of the process fails to file a request for action by the
deadline indicates acceptance of the determination at the previous stage.
Any time limit set forth in this procedure may be extended by mutual written
agreement of the parties and, when applicable, the consent of the Chairperson of the
SubCommittee.
1. Grievance Proceedings:
Residents are encouraged to work within the Residency to address and resolve any
issues of concern to the residents, including concerns related to the work
environment, faculty, or the resident’s performance in the program. The residents
should present all such concerns to the Chief Residents Associate, Assistant
Director, or the Residency Director for Resolution. Claims of harassment or hostile
work environment based on one’s race, color, religion, ethnicity, national origin, sex,
sexual orientation, age, disability, veteran status, or other legally protected status
should be directed to the College of Community Health Sciences’ Designated
Harassment Officer.
There are additional procedures for residents to request review of certain academic
or other disciplinary actions taken against residents that could result in dismissal
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(revocation of the resident’s appointment), non-renewal of a resident’s agreement, or
other actions that could significantly threaten a resident’s intended career
development.
Other Grievance Procedures
Grievances other than those departmental actions described above, or
discrimination, should be directed to the Residency Director for review,
investigation, and/or possible resolution. Complaints alleging violations of The
University of Alabama or Capstone Medical Foundation policy or sexual harassment
policy should be directed to the appropriate supervisor, Program Director, Director
of Human Resource Management, and EEO/ AA Programs.
Resident complaints and grievances related to the work environment or issues related
to the program or faculty that are not addressed satisfactorily at the program or
departmental level should be directed to the Associate Dean for Academic Affairs.
For cases that the resident believes cannot be addressed directly to the program or
institution he/she should contact the University of Alabama Family Medicine
Residency-Tuscaloosa Ombudsman.
2. Ombudsman:
Dr. Heather Taylor, Director of Medical Student Affairs, is available to serve as an
impartial third party for residents who believe their concerns cannot be addressed
directly to their program or institution. Dr. Taylor will work to resolve issues while
protecting resident confidentiality. She can be reached at 205-1384 or 1304.
III I. Restrictive Covenants
The ACGME does not allow restrictive covenants.
III J. Working with Medical Students
The College of Community Health Sciences serves as an academic and clinical home for the
Tuscaloosa Regional Campus of the University Of Alabama School Of Medicine. Third- and fourthyear medical students are assigned to the various specialty services at University Medical Center.
While the ultimate responsibility for students’ education remains with the faculty, residents are
expected to be involved in the teaching of medical students.
Residents are to allow and expect medical students to perform histories and physicals, formulate
ideas concerning impressions and diagnoses, and suggest treatments. Residents are to see the
patients either with or following the students to make sure findings and assessments are accurate and
to provide opportunity for necessary instruction. Residents and students also present patients to
faculty in OB/GYN and Pediatrics. Residents are expected to assist students with these
presentations whenever time permits. Students will be allowed to perform procedures under direct
supervision of residents. Orders are to be countersigned immediately in all instances by the resident
responsible for the patient.
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Residents should familiarize themselves with the rotation goals and objectives for each medical
student rotation for which they are assigned. Residents will also attend a lecture/seminar on
providing appropriate feedback and teaching skills directed towards medical students.
The residents may require the student to do reasonable reading and research on a patient. The
student should be familiar with all pertinent laboratory and clinical facts. Ideally, the student should
present the patient to the attending for comments and guidance, with the help of the resident on
rounds. Both residents and medical students are to present patients during morning report on the
Internal Medicine rotation and/or Family Medicine rotation. Interns must perform and dictate a
separate H&P from that of the medical student. The senior resident is to write a RAN note.
At University Medical Center, a senior resident or attending must review all patients seen by a
medical student. All orders and prescriptions must be signed by a licensed resident or attending.
Under no circumstances is a patient to be allowed to leave University Medical Center until the
student’s findings and plans are confirmed and approved by a senior resident or Attending.
Evaluations of students’ performance may be requested from residents for each student under
his/her instruction. These are to be filled out online and returned to the clerkship directors.
IV. ADMINISTRATIVE POLICIES
IV A. Resident Agreements
The Residency Agreements (contracts) are valid for the entire training period effective 2013-2014
and are signed by the resident prior to commencement of the initial year. Each resident will receive a
copy of the agreement. Originals are available in the Residency Office for reference. Any resident
who does not wish to renew his/her contract must notify the Residency Office 120 days prior to the
renewal date.
In addition to the Residency Agreement and the Policy and Procedure Manual, residents are
required to comply with:
•
•
UA HR Policy Manual – http://hr.ua.edu/benefits/HRpolicymanual.html
UA Staff Handbook – http://hr.ua.edu/employment/Staff_Handbook.pdf
The University of Alabama allows residents to be given a graduated salary. The current salary is
specified in the Residency Agreement. Residents will be paid in 12 equal monthly installments on the
last day of each month and will be subject to such withholdings as are required by law or authorized
by the resident. Any questions concerning monthly paychecks should be directed to the University
of Alabama Payroll Office at 348-7732. Residents are considered staff of The University of Alabama
with regard to participation in fringe benefit programs, athletic/social/cultural events, use of
University facilities, participation in University governance, parking privileges, and University
services. Residents are neither employees nor agents of the University, and the University assumes
no liability for negligence or other wrongful acts of the resident.
Salaries are determined each year based on the budget of the Residency Program from the College
of Community Health Sciences and DCH Regional Health System. The resident shall be paid the
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salary approved for the appointed postgraduate year, as specified in the resident agreement:
Such salaries are not intended as compensation for services rendered by the resident. Although it is
believed that it is an essential part of residency that the resident will be assigned responsibility for
care of patients under the supervision of faculty physicians and consistent with his/her skills and
experience, receipt of the agreed upon salary shall in no way be conditioned upon, measured by, or
related to any patient care service rendered by the resident incidental to the training program.
Furthermore, the resident understands that receiving direct patient care compensation is considered
“moonlighting,” which is subject not only to the rules of the University of Alabama Family Medicine
Residency-Tuscaloosa and the ACGME, but also to various federal laws stipulated by the Centers
for Medicare and Medicaid Services (CMS). See Moonlighting policy, Appendix “C.”
IV B. Compliance Training
1. HIPAA, Privacy: HIPAA training is required at the beginning of employment and must be
renewed each year along with completing the acknowledgement form. The HIPAA
training powerpoint and acknowledgement form can be found at:
http://cchs.ua.edu/faculty-staff/hippaa-information/hipaa-powerpoint/
2. Harassment:
The University of Alabama is committed to providing an environment for employees,
students, and campus visitors that is free from illegal harassment based on race, color,
religion, ethnicity, national origin, sex, sexual orientation, age, disability, or veteran status.
Such illegal harassment violates federal civil rights laws and University nondiscrimination
policy and may lead to personal liability of the results of such behavior. Residents should
become familiar with the University’s Harassment Policy, located at
http://eop.ua.edu/harassment/html. Residents are encouraged to review the University’s
online training tutorial on harassment (http://training.newmedialearning.com/psh/ua/) so
that they understand what inappropriate behavior is and what should be reported. The
Designated Harassment Person in the College of Community Health Sciences is Allison
Arendale, and complaints about harassment may be directed to her.
Pornographic material of any kind (videos, screen savers, posters, etc.) is prohibited in the
lounge or other place.
3. Working with Minors: Minors are a part of your patient panel as well as the possibility of
shadow students; therefore training is required to protect yourself as well as the minor
child. Child protection training must be completed yearly and is found
at http://hr.ua.edu/train_develop/index.html
3. Other courses can be deemed mandatory and required to be completed by the resident as
determined by the College and/or University.
IV C. Benefits
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The College of Community Health Sciences (CCHS) and the Capstone Health Services Foundation
(CHSF) will provide the residents with the following:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
American Academy of Family Physicians membership
Alabama Academy of Family Physicians membership (optional)
American Medical Association membership fees (optional)
Alabama State Board of Medical Examiners fees
Alabama Medical Licensure Commission fees
Alabama Controlled Substance fees
Federal Drug Enforcement Agency (DEA) license – one time only
Examination and Board History Report
Occurrence Malpractice Insurance
DCH Regional Medical Center Medical Staff privileges
Disability Insurance (with buy-up plans available at extra cost to the resident)
American Board of Family Practice In-Training Assessment Exam fees
USMLE 3 / COMLEX Level 3 Application Fees
Advanced Cardiac Life Support Certification (ACLS)
Pediatric Advanced Life Support Certification (PALS)
Neonatal Resuscitation Program Certification (NRP)
Advanced Life Support in Obstetrics Certification (ALSO)
Advanced Trauma Life Support Certification (ATLS) – up to $400
Board Exam Fees
Educational Reimbursement (CME funds) – up to $1,000 for each of the three years
Relocation Reimbursement – up to $1,500
DCH Regional Medical Center Meals – provided during months with inpatient call; on call
residents receive $196 per month, night float residents receive $252. A maximum of $20 per
day may be deducted for food (approximate; subject to change)
Copays are waived for services provided at UMC for you and your dependents who are on
UA’s Blue Cross/Blue Shield Health Insurance plan
Lab Coats (2)
Pager – to be returned at completion of residency
Parking permit codes to DCH parking lot
University of Alabama Staff ACT card
University of Alabama Parking Pass
University of Alabama Business Cards
AMA Introduction to the Practice of Medicine web-based program
If a resident receives a bill/statement from any of the above, he/she should promptly submit it to
the Residency Office for payment.
The University of Alabama offers insurance plans for the residents, which can be found on its
website at http://hr.ua.edu/benefits/.
Residents are responsible for paying:
Alabama Academy of Family Physicians Resident Chapter Dues – $20 annually (optional)
American Board of Family Practice Certification Examination fee – may be reimbursed from
resident’s CME funds
3. Moonlighting Malpractice Insurance – PGY-2 and PGY-3; also involves membership in the
Medical Association of the State of Alabama
1.
2.
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4.
5.
DEA Renewal – PGY-3
TFPRA Dues – $125
1. Health Insurance: The University of Alabama is self-insured with BCBS of Alabama
administering the plan. Information about the health insurance can be found at:
http://hr.ua.edu/benefits/HRhealthbenefits.html
2. Paychecks: You are considered an exempt employee and are paid on the last day of
each month. An email notification of your direct deposit will be sent a few days
before the deposit is made. The first paycheck must be picked up at Rose Administration.
The email notification will go to your MyBama email.
IV D. Malpractice Coverage
1. For Residency Duties – Policy on Professional Liability Claims:
The University provides an occurrence-based malpractice policy through the University of
Alabama at Birmingham Professional Liability Trust Fund. This policy covers the resident
during his/her official duties. Moonlighting is not covered by this policy.
If a resident receives communication from a lawyer, patient, or insurance company about
possible litigation, the resident should report this immediately to the Director of Risk
Management, the Chief of the service directly related to the case, and the Residency
Director. It is the responsibility of the Chief of the service to collect and review all related
records, notify our insurance carrier, and forward appropriate records as necessary. No
resident should give any information personally or over the phone to an insurance carrier or
lawyer other than our own without the permission of our own insurance carrier.
If a resident is involved in a PATIENT CARE INCIDENT THAT MAY RESULT IN A
LAWSUIT, the Residency Director and the Chief of the appropriate service should be
notified. This will allow us to notify the insurance carrier and start collection and review of
records early, if appropriate.
Early recognition and full documentation of potential claims will often lead to clarification
and resolution of patient dissatisfaction and prevention of litigation. When this process
reveals a legitimate error, early resolution of the issue often prevents long, drawn out, costly,
and emotionally wearing litigation.
Sensitivity to dissatisfaction on the part of the patient, his or her family, or “significant
others” is an essential skill for successful practice. Clear communication with patients and
families, coupled with that sensitivity, is the best protection against professional liability
claims.
The intent of incident reporting is to document those instances where patients or families
even hint that they are dissatisfied or that they are considering seeking legal advice. Suspicion
of such incident reports will not be construed as evidence of poor performance on the part
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of the resident, but rather that the resident is sensitive and aware of patient and family
attitudes that are not favorable to the doctor-patient relationship.
2. For Moonlighting: Refer to Appendix A.
3. Communications with Attorneys:
All requests for medical records should be given to the University Medical Center Director
of Medical Records, who will review the chart with the Residency Director.
Do not return an attorney’s telephone calls without first speaking to the Residency Director
and the Chief of the relevant service.
IV E. Leave
If there is no properly prepared leave request with the approval signature of the Residency Director
or his/her designee, THERE IS NO LEAVE.
Summary:
1. Resident must be present for a minimum of 15 days to pass a one month rotation (which
normally has 20-22 working days).
2. Leave requests must be submitted at least 60 days in advance. No leave requests will be
considered if they are less than 30 days in advance unless extraordinary circumstances can be
demonstrated.
3. Leave is not permitted on primary services except in extraordinary circumstances. In such
situations, resident must provide written justification as to why the leave should be
approved.
4. No one may take annual leave during the first two weeks of July OR the last two weeks of
June. No exceptions.
5. Administrative or Educational leave requires a copy of the brochure/related email before
request can be considered. No more than five days of educational or administrative leave will
be granted per academic year and does not roll over if unused.
6. Coverage must be arranged for Family Medicine clinics if request is made less than 60 days
and the clinic schedule is published (at Residency Director’s discretion).
7. Cancellations and changes to approved leave must be made in writing.
8. Once a resident has exhausted leave (annual/sick), additional time off will be taken as leave
without pay.
9. Sick leave may only be used for illness of resident or other family member as outlined below.
Sick leave may not be used as annual time. Once sick leave is exhausted a resident may use
annual leave as sick leave.
NOTE: At any given time between 8:00 am and 5:00 pm Monday through Friday, residents should
either be on rotation, in clinic, in academics, or have a properly prepared and approved leave
request.
Total Absence from the Residency
In accordance with guidelines from the American Board of Family Medicine (ABFM), total time
away from residency should not exceed 30 calendar days (20 work days) a year. This includes
vacation time, sick leave, etc. Time in excess of 30 days must be made up prior to graduation. In
addition, residents may not be away from their continuity clinic for more than one month in the first
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year and two months in each of the second and third years. This total time away includes Supervised
Practice Experiences and rural rotations in which residents do not continue their continuity clinic.
1. Vacation:
Each resident is permitted two weeks (10 working days) of paid vacation per year, plus one
week at Christmas/New Year. Unused vacation time does not accrue from year to year.
During the PGY-1 year, these weeks may be taken during following rotations: Geriatrics,
Surgery, CM/PM, EKG/Vent. Any on-call weekend days requested as part of a vacation will
not be considered unless coverage is arranged and listed on the request form.
When anticipating leave while on a rotation associated with University Medical Center
specialty clinics (Pediatrics, Psychology, Neurology, Sports Medicine), coverage
arrangements must be made and listed on the request form.
Other suggested vacation rotations include: Rural Medicine, Supervised Practice Experience,
ED, Orthopedics, Cardiology, Procedures, Dermatology or other electives.
Requests for vacation must be submitted to the Residency Office 60 days prior to the
requested dates. The Residency Director must approve any exceptions. Vacation will not
normally be approved at a time when it will reduce the call team to fewer than four.
Cancellations of vacations must be made in writing.
Leave may not exceed one week during any rotation. Requests for two consecutive weeks of
leave spanning two different rotations in two different months will be considered on a caseby-case basis. No leave will be allowed on split rotations or two week rotations.
It is the responsibility of the resident to notify via email the rotation preceptor, Family
Medicine suite, the Residency Office, the service, and clinic to which he/she is assigned of
his/her forthcoming absence.
2. Family and Medical Leave Act:
In accordance with the Family and Medical Leave (FML) Act of 1993, eligible residents may
take FML as provided in the University Policy #701. More information may be found at
http://hr.ua.edu/empl_rel/policy-manual/fmla-2-1-06.htm.
FML provides up to 12 weeks of leave for the following reasons:
• Birth and care of the resident’s child or the placement of a child with the resident for
adoption or foster care.
• The serious health condition of the resident OR the serious health condition of the
resident’s spouse, dependent child, or parent.
• A military qualifying exigency OR military caregiver leave to care for the resident’s
spouse, child, parent, or next of kin.
Residents should be aware that protracted FML absences may affect time toward board
eligibility. Interns should be aware that they will not qualify for FML and should seek
guidance and assistance from the Office of Disability Services. More information may be
found at the following link: http://ods.ua.edu/.
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3. Administrative Leave:
Residents may be granted administrative leave for activities whereby they directly represent
the College of Community Health Sciences and the University of Alabama Family Medicine
Residency-Tuscaloosa (e.g., national and regional residency meetings, presentation of
papers, residency fairs, etc.). Applications for administrative leave will be submitted and
processed in the same manner as all leave requests. No administrative leave will be granted
for more than five working days per academic year.
4. Holidays:
The seven stated holidays of The University of Alabama are New Year’s Day, Martin Luther
King Jr. Day, Fourth of July, Labor Day, Thanksgiving Day, the Friday after Thanksgiving,
and Christmas Day. University Medical Center is closed on these days and hospital services
operate on weekend schedules.
Thanksgiving, Christmas, and New Year’s Day have their own holiday schedules generated
by the chiefs and Residency Office.
Martin Luther King Jr. Day, Fourth of July, and Labor Day observe the following rules (see
call schedule for details):
• Primary service interns and residents round, even if they are not on holiday call. If
they are not on call, they go home after rounds and floor work.
• Call teams remain in-house (weekend-like staffing).
• Night Float Teams are off the night before the holiday, but come in at 5:00 on the
night of the holiday. Thus, the day before the holiday, the call team does a 24-hour
shift.
5. Practice Site Visits:
A total of five days may be allowed in the PGY-2 and/or PGY-3 year for investigating
available practice sites. Residents must apply for these days on the appropriate form, listing
the name and location of the practice as well as the names and contact numbers of the
personnel involved in the meeting. The Residency Office must approve the actual site visit
day(s). Site visit days may not be approved if charts are not current, academic status is in
questions, or if rotation attendance has been an issue. Cancellations of site visit days must be
made in writing.
6. Educational Leave:
Educational leave will not normally be approved at a time when it will reduce the call team
to fewer than four. A total of five days are available for both the PGY-2 and PGY-3 years,
but cannot be carried over. Leave must be requested 60 days prior to the requested dates. A
request form should be submitted with written documentation (e.g., brochure) of the
conference. Residents may use CME funds for educational leave (e.g., ATLS, etc.).
Coordination and scheduling of USMLE Step 3 and the ABFM Boards is the responsibility
of the resident, but leave for these exams must be approved before scheduling. Avoid
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scheduling during call or primary services. Time off a primary service will only be approved
in extenuating circumstances.
7. Sick Leave:
Residents accrue sick days at one per month for a total of 12 a year. Sick leave is cumulative.
On the morning of an absence, the resident must notify via phone or email his/her service
and preceptor, his/her suite, and the Residency Office as soon as possible. Resident should
arrange coverage for responsibilities as able.
Sick days may be requested in advance for physician appointments or scheduled medical
procedures. Unexpected illness occasionally occurs. All days taken for sick must be claimed
upon return to work. Any sick leave in excess of 72 hours must be accompanied a
physician’s statement and release to return to work.
Additional Guidelines for Use of Sick Leave:
Sick leave is not an earned right, but a privilege, and should be taken only for reasons
provided in this policy. Residents may be required to provide documentation for absences.
Eligible residents may be granted sick leave when they:
• Are unable to perform their duties because of personal illness or injury.
• Must attend to the serious illness of relatives who reside in the immediate household.
• Must attend to the serious illness of their parents (including current step-parents or
legal guardians).
• Must obtain health-related professional services that cannot be obtained after regular
working hours.
When conditions within the work unit dictate the necessity, the supervisor may require a
resident to reschedule an appointment.
IV F. Immunizations
Hepatitis Immunization – Since residents are among the high-risk group for hepatitis B, they will be
screened for susceptibility if they have not been screened previously. All individuals found to be
susceptible will be notified and required to obtain hepatitis immunization. Capstone Health Services
Foundation will pay for the immunization.
TB Testing – Residents will receive free yearly PPD tests.
Varicella Testing – All residents who have not had chickenpox will receive two doses of varicella
vaccine (VARIVAX).
MMR – All residents are required to have two doses of measles/mumps/rubella (MMR) vaccine
since their first birthday. Residents who are unsure of their immunization will receive MMR.
N95 Mask Fitting – All residents will be required to be fitted for an N95 mask annually.
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Flu Shot – Residents will receive free yearly flu shots. Those who choose not to have a flu shot will
be required to wear a mask in the clinic areas throughout flu season in keeping with University
Medical Center.
IV G. Miscellaneous
1. Mailing Address:
Business Address
850 5th Avenue East, D209
Tuscaloosa, AL 35401
or
Box 870377
Tuscaloosa, AL 35487
Business mail arrives at UMC and is sorted. The Residency Office opens insurance and patient
related mail. To avoid personal mail being opened by mistake, please use your home address. ALL
LICENSES SHOULD BE SENT TO THE RESIDENCY OFFICE RATHER THAN YOUR
HOME ADDRESS. All magazines must be sent to your home address and not University Medical
Center to avoid cluttering of mailboxes. The residency will pay for residents’ American Academy of
Family Physician membership dues. All residents will thus receive a bi-monthly copy of the American
Family Physician journal. This is REQUIRED reading and bi-monthly quizzes are a part of our
required curriculum. An average quiz score of 80 percent is required for promotion from one postgraduate year to the next.
Personal Mail
Again, to avoid personal mail being opened by mistake, please use your home address. All magazines
(except as noted above) must be sent to your home address and not University Medical Center to
avoid cluttering of mailboxes.
2. Phone Calls for Residents:
Friends or family members needing to reach a resident should first call the Residency Office
Assistant (Stephanie Beers) or the Residency Program Coordinator (Alison Adams) at 205-348-1370.
The staff of these offices will either page the resident (if it is an emergency) or email the resident a
message.
The DCH Regional Medical Center operators are not asked to page a resident unless it is an
emergency and the resident cannot be reached through the number above. At night, the resident can
be reached by calling the Resident’s Lounge at 205-750-5860 and asking that the resident be paged.
Please do not give these numbers to physician recruiters. Make arrangements to take recruiting calls
at home.
3. Chief Resident Selection:
As well as being a representative and leader among his/her peers, the Chief Resident position has
many junior faculty level administrative responsibilities, often occurring after-hours. The Chief
Residents will typically be chosen in January to facilitate work on the residency master schedule. The
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Chief Residents will be expected to attend quarterly Department meetings at DCH. The full transfer
of responsibility will occur in April (after the match). The selection of the Chief Residents begins
with resident nomination and ranking. The faculty then reviews the resident ranking and they
provide a ranking. The Residency Director makes the final selection, taking the final rankings into
account. No resident will be considered for Chief Resident unless they are in good academic
standing, as determined by the residency faculty.
The IT Chief will see that the resident computers and printers at the hospital are maintained,
troubleshoot resident issues with remote desktop and NextGen, and work with DCH and UMC IT
departments to continue to improve on our operating systems.
Committees:
Residents may be assigned to committees of the College and DCH. Assignments may be made by
the Chief Residents or by election with the approval of the Dean. Residents will receive notification
of their assignment to a committee by the Dean.
USMLE Step 3:
USMLE Step 3 should be taken and passed by January 1 of the PGY-2 year for those who are
eligible. If not, the resident is subject to “Academic Probation” resulting in extension of the PGY-2
year or non-renewal of the house officer contract. Residents will not be promoted to PGY-3 without
passing Step 3. Failure of Step 3 twice is automatic consideration for dismissal from the program.
Coordination and scheduling of USMLE Step 3 is the responsibility of the resident, but leave for
this exam must be approved before scheduling. DO NOT schedule your exam during call, night
float or primary services. Time off a primary service will only be approved in extenuating
circumstances and you will be responsible for finding your own call coverage (which must be
submitted with your leave request). Due to the scheduling process for Step 3, we realize the 60 day
notice may not be feasible. However, residents should submit their leave request to take Step 3 no
fewer than 30 days before their intended test date.
Licensure
Medical
First-year residents are issued a limited license that is paid for by the University. This license limits
the residents to activity within the supervision of the Program only. After one year of training and
passing USMLE Step 3, the resident may apply for a full license paid for by the University.
Thereafter, the license must be renewed annually by the resident. Resident CME funds may be used
for this purpose.
NOTE: International medical graduates are not allowed to obtain a full license in the state
of Alabama until they have completed residency.
Controlled Substance
Each resident is required to have an Alabama Controlled Substance Certificate. The University pays
this fee. The resident is also required to have a Federal DEA Certificate in order to prescribe
controlled drugs. The Residency Office makes arrangements for Federal DEA numbers when
residents enter the program. The DEA certificates are good for three years. Approximately six
months before completing the program, the DEA will send renewal information directly to PGY-3
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residents who will then be responsible for the renewal fee. No resident will be allowed to work
without an active and fully-unrestricted DEA permit,
The University of Alabama, the College of Community Health Sciences and the University of
Alabama Family Medicine Residency-Tuscaloosa annually reaffirms their commitment to equal
opportunity, acknowledging publicly its obligation to operate in a constitutional and nondiscriminatory fashion, both as an Equal Opportunity Employer and as an Equal Opportunity
Educational Institution. Applicable laws that are followed include, but are not limited to, Titles VI
and VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act, Executive
Order 11246, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the
Rehabilitation Act of 1973, the Vietnam Era Veterans Adjustment Assistance Act, the Age
Discrimination Act of 1975, the Americans with Disabilities Act of 1990, the ADA Amendments
Act of 2008, and the Genetic Information Nondiscrimination Act of 2008 and does not discriminate
on the basis of genetic information, race, color, religion, national origin, sex, sexual orientation, age,
disability or veteran status in admission or access to, or treatment of employment in, its programs
and services.
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VI.
SIGNATURES
I hereby certify that I have received the mandatory 2014-15 Policy and Procedure Manual. I
understand that I will be accountable for conducting duties in the workplace in accordance
with the information contained in this manual.
________________________________________________
Printed Name/Signature
__________
Date
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