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Program Policies

A.  Resident recruitment and selection

Qualifications required for resident appointment:

The University of Wisconsin Hospital and Clinics (UWHC) and its affiliates are committed to provide a training program for Residents that meets all requirements for programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

 

The University of Wisconsin Department of Neurology seeks well rounded candidates with a track record of academic success and great potential for the future.  Desirable attributes include: strong intellectual abilities as documented by success in past academic performance, sincere interest in a career in child neurology, and excellent interpersonal and communication skills.

 

To enter the child neurology training program candidates must complete either (a) two years of training in pediatrics, in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the United States or the Royal College of Physicians and Surgeons in Canada; (b) one PGY1 year in Neurology (as described in the Program Requirements for Graduate Medical Education in Neurology, Section I.A.1, and one year of residency training in pediatrics or (c) one year of pediatrics plus one year of basic neuroscience training, whereby the program director must review and determine the acceptability of these initial two years of training.
 
Procedures for evaluation and selection of applicants to the program:

Applications to our program are only accepted via ERAS.  All applications are reviewed in their entirety by the Admissions Committee, who will objectively rate each application with regard to: academic performance in college and medical school, performance on USMLE (COMLEX scores will not be accepted), interpersonal communication (personal statement, etc.), extracurricular activities, research accomplishments, and letters of recommendation.  This serves as a screening process; the most highly rated applicants are invited for in-person interviews. Applicants accepted for interview will be presented to the Department of Pediatrics for consideration for PGY1 and PGY2 years.  The program director for Pediatrics will communicate to the program director of Child Neurology which candidates are acceptable to Pediatrics.
 
The candidates are invited for a dinner on the night before the interview, so as to meet the residents and learn about the program from them.  The residents attending the dinner will evaluate each candidate.  On the following day, candidates have a structured interview day which includes a breakfast meeting with the Program Director for an overview of the program.  Subsequently each candidate will be interviewed by no less than 3 selected faculty members.  If indicated, candidates will then meet with a representative of the Department of Pediatrics to get an overview of the PGY1 and PGY2 years.  A final wrap-up session with the Program Director will be the last function.
 
The final rank list is created in a multi-step process.  First, candidates are divided into 2 lists depending on whether or not they fulfill the requirements to enter the PGY3 year of training in a child neurology training program.  A preliminary ranking is completed by the program director after review of the resident and interview evaluations.  The Residency Committee will then have a closed-door discussion to create the final rank list by consensus.
 
All candidates must meet the UWHC “Qualifications for Appointment,” and attest to this by signing an agreement form provided by GME office.

B. Duty hours

It has been recognized that sleep deprivation leads to impaired performance on cognitive tasks.  Thus, when physicians are sleep deprived, they are at higher risk for medical errors and place their patients at risk.  Furthermore, sleep deprivation may put the resident at personal risk, since fatigue is associated with increased rates of motor vehicle accidents.
 
The ACGME has created a mandatory set of duty hour regulations designed to reduce sleep deprivation and fatigue among physicians in training.  Full (100%) compliance with these regulations is expected of our Child Neurology residents.  A resident must take personal responsibility for tracking their duty hours, and must notify their current attending or program administrators immediately when any violation is imminent.
 
Residents will undergo yearly education about the importance of sleep issues by reviewing the SAFER program.   
 
Finally, Child Neurology residents must know that there are ways of notifying the UW GME Office and/or the ACGME about potential work hour violations.  Within our own department, it is expected that the Child Neurology Program Director be notified so that appropriate back-up systems can be implemented to prevent work hour violations—the Program Director will guarantee that there are no ramifications for notification.
The backup system for Child Neurology residents includes during the PGY-3 year the adult neurology residents and during the PGY-4 and 5 years the Pediatric Neurology attending, the rotating Neurology resident and the rotating Pediatric resident. These individuals will be timely asked to take over the Child Neurology resident’s duties to avoid that duty hour violations occur.

Duty Hours:

The estimated hours per week is 60 hours. Child Neurology residents are required to document duty hours and notify the attending physician and program director if he or she is in danger of exceeding the ACGME duty hour limits.
 
ACGME duty hour regulations are designed to reduce sleep deprivation and fatigue among physicians in training and thus ensure safe patient care. Full compliance with these regulations is expected of our pediatric neurology residents, and our departmental policy mirrors those of the ACGME and UWHC (see the UWHC policy, Resident Duty Hours):

  • Pediatric Neurology resident duty hours will not exceed 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.
     
  • Residents will be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call will not be assigned on these free days.
     
  • Duty periods of PGY2-5 residents will not exceed 24 hours.
     
    • Residents are encouraged 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 suggested.
       
    • It is essential for patient safety and resident education that effective transitions in care occur. Residents are allowed to remain on-site in order to accomplish these tasks, but this period of time must be no longer than an additional four hours and no new clinical responsibilities will be assigned during then.
       
    • In rare 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.
       
  • Residents will have at least eight hours free of duty between scheduled duty periods, and at least 14 hours free of duty after 24 hours of in-house duty.
     
  • Residents will not be scheduled on night float for more than six consecutive nights or two consecutive weeks.

Residents must take personal responsibility for tracking their duty hours, managing their workloads so as to avoid violations (see next section on Handoffs), and notifying their senior resident, attending, or program director immediately when any violation is imminent. The Program Director will guarantee that there are no reprisals for such notification.
 
Residents are expected to enter duty hours into the Med Hub program continuously, at a minimum each week. Failure to do so may result in freezing of educational allowance or suspension.

C. Curriculum

  1. Curricular components may be offered in blocks or longitudinally. An example of the latter is a regularly scheduled clinic attended over a period of time while assigned to other rotations. Those components offered in block assignments each year should be recorded in the block template. Those offered longitudinally should be recorded separately in the longitudinal templates by year.
  2. Both block and longitudinal components can be applied toward FTE minimums described in the Program Requirements. For example, one half-day per week for ten months of a longitudinal clinic would count for one month. Three months of the six-month outpatient rotation requirement are met by two and one-half years (30 weeks) of weekly continuity clinic attendance during hospital or other non-outpatient services (30 months x 4 weeks per month = 120 half day of clinics days per week = 12 full weeks of clinic-FTE). Three months of outpatient clinic (that include a weekly continuity clinic) would meet another three months of the six-month requirement.
  3. Block and Longitudinal Diagrams 

BLOCK ROTATIONS - PGY-3 (Sites 1+2; UWHC and VA)

Block 1
 
Site #1+2
Block 2
 
#1+2
Block 3
#1+2
Block 4
 
#1+2
Block 5
 
#1+2
Block 6
#1+2
Block 7
#1+2
Block 8
 
#1+2
Block 9
 
#1+2
Block 10
#1+2
Block 11
#1+2
Block 12
#1+2
Block 13
#1+2
Neurology Specialty
Clinics
Neuro
pathology
Epilepsy Inpatient
General Svc
Inpatient Stroke Svc NF/
ELE
Epilepsy Neurology Specialty Clinics Inpatient Stroke Svc Neuro
Surgery
 
Neuromuscular NF/
ELE
Move-
ment
Disorders

 
LONGITUDINAL EXPERIENCES

Type of Experience* Weekly Structured Number of Weeks Amount of Time (FTE)
Pediatric Neurology Continuity Clinic ½ day every week 40 20 days
Epilepsy Clinic UW 3 – ½ days per week 8 12 days
Epilepsy Clinic VA 1 – ½ day per week 8 4 days
Neuromuscular Clinic 3- ½ days per week 4 6 days
Movement disorders 5 – ½ days per week 4 10 Days

 
BLOCK ROTATIONS - PGY-4 (Site 1, UWHC)

Block 1
 
Site #1
Block 2
#1
Block 3
 
#1
Block 4
#1
Block 5
 
#1
Block 6
 
#1
Block 7
 
#1
Block 8
 
#1+2
Block 9
 
#1+2
Block 10
 
#1
Block 11
#1
Block 12
#1
Peds Neuro inpatient Peds Neuro Clinics Peds Neuro Inpatient Peds Neuro Clinics Peds Neuro Inpatient Peds Neuro Clinics Peds Neuro Inpatient Elective Elective Peds Neuro Clinics Peds Neuro Inpatient Peds Neuro Clinics

 
 
LONGITUDINAL EXPERIENCES

Type of Experience* Weekly Structured Number of Weeks Amount of Time (FTE)
Continuity Clinic UW ½ day every week 40 20 days
Neurooncology clinic ½ day once a month 12 6 days
Metabolic Genetics Clinic ½ day once a month 12 6 days
Cerebral palsy Clinic ½ day once a month 12 6 days
Epilepsy Clinics ½ day twice a month 24 12
Neuromuscular Clinic ½ day once a month 12 6 days

 
BLOCK ROTATIONS - PG-5 (Site 1, UWHC)

Block 1
 
Site #1
Block 2
 
 
#1
Block 3
 
#1
Block 4
 
 
#1
Block 5
 
#1+2
Block 6
 
#1+2
Block 7
 
 
#1
Block 8
 
 
#1
Block 9
 
 
#1+2
Block 10
 
 
#1
Block 11
 
#1
Block 12
 
#1+2
Dev Pedi
atrics
Metab Genetics Peds Neuro Clinics Child Psychiatry Elective Neuro
Muscu
lar
Peds Neurology Inpatient Peds Neurology Inpatient Epilepsy Rehabilitation Peds Neuro Clinics Elective

 
LONGITUDINAL EXPERIENCES

Type of Experience* Weekly Structured Number of Weeks Amount of Time (FTE)
Continuity Clinic UW ½ day every week 40 20 days

 

D.  Moonlighting

The Department of Neurology neither encourages nor discourages moonlighting. If a Child Neurology resident chooses to engage in moonlighting, the University of Wisconsin GME institutional policy must be followed.  For full details, please refer to this policy as well as the ACGME’s statement about moonlighting.  Notably:

  1. Residents wishing to participate in moonlighting activities must submit a request in writing to the Child Neurology program director.  The program director or designee will evaluate all requests on an individual basis.  Approval of any request shall be for no longer than one program year and may be revoked during the course of the year if it is determined by the program director that the moonlighting activity is interfering with the Child Neurology resident’s training program in any way.  All requests for moonlighting must be submitted on the appropriate form as approved by the Graduate Medical Education Committee.
  2. It is the Child Neurology resident’s responsibility to obtain a state medical license as necessary.
  3. The professional liability insurance (malpractice) coverage provided for Child Neurology residents by UWHC does not extend to moonlighting activities.
  4. The moonlighting workload must not interfere with the ability of the resident to achieve the goals and objectives of the training program. The Child Neurology program director will monitor Child Neurology resident performance to assure that factors such as resident fatigue are not contributing to diminished learning or performance, or detracting from patient safety. The Child Neurology resident is asked to regularly report the number of hours and the nature of the work in moonlighting experiences to the Program Director. 

E. Lines of Supervision

Roles
Child Neurology Residents are physicians in training.  They learn the skills necessary for their chosen profession through didactic sessions, reading and providing patient care under the supervision of Attending Staff physicians.  As part of their training program, residents are given progressively greater responsibility according to their level of education, experience and ability.
 
Responsibilities
Child Neurology Residents are part of a team of professionals who care for patients.  The professional team includes an attending physician, resident, other licensed practitioners such as NPs and PAs, and other trainees such as residents from other specialties and medical students.  Residents may provide care in both the inpatient and outpatient settings.  They may serve on a team that provides direct patient care, or may be part of a team that provides consultative service.  Each member of the team is dedicated to providing excellent patient care.

All residents evaluate patients by obtaining medical histories and perform physical exams with special emphasis on the neurological exam. They will establish diagnoses and create problem lists.  They will develop a plan of care in conjunction with other team members.  They will document the history and exam and medical decision making as required by hospital policy.  Residents will write orders for diagnostic studies, consultations, treatment interventions, and any other service required for the care of a patient.  They will interpret the results of laboratory and other diagnostic testing.  Residents will initiate and coordinate admissions and discharges of patients. They will participate in in various procedures under appropriate supervision.  Residents will discuss the patient’s status and plan of care with the attending physician and team on a regular basis.   Senior level residents (PG4 or 5) will supervise junior-level residents and medical students.
 
Supervision
In any physician training program, it is incumbent on the physician to be aware of his or her own limitations in managing a given patient, and to consult a more experienced physician when necessary.  When a resident requires supervision, this may be provided by a qualified member of the medial staff, or by a trainee who is authorized to supervise the patient’s management or procedure independently. In the clinical learning environment, each patient must have and will have an identifiable attending physician who is ultimately responsible for the patient’s care, including care provided by trainees. This information will be available to residents, patients and other hospital staff.  Residents and attending staff will inform all patients of their respective roles in each patient’s care.  In all resident care cases, the ultimate responsibility for the patient rests with the attending physician who supervises resident activities.PGY5 Child neurology residents may supervise PGY3 and PGY4 residents, PGY5 residents may only be supervised by attending Child neurologists.
 
Levels of Supervision
The following levels of supervision are mandated by the ACGME Common Program Requirements, effective 1 July 2011: 

Direct Supervision

  • The supervising physician is physically present with the resident and patient

Indirect Supervision

  • With direct supervision immediately available (The supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide direct supervision)
  • Without direct supervision available (The supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by telephone or other electronic means and is available to provide direct supervision)

Oversight

  • The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered 

Child Neurology Residents are supervised for patient care and performance of procedures as follows:
 
Clinical Supervision:

PG3 Training year
Child Neurology residents entering the neurology-specific portion of the training program will initially be supervised for all patient encounters at a minimum level of indirect supervision with direct supervision immediately available.  PG4 and PG5 child neurology residents, PG3 or PG4 adult neurology residents or attending staff may supervise in this setting.  As PG3 residents gain experience, minimum supervision level will change to indirect supervision with direct supervision available.  The timing of this will vary for each resident.  On a monthly basis, senior level residents and supervising staff will meet and decide whether a PG3 level resident has gained enough experience for this level of supervision, typically expected after the 4th month of neurology training.

PG4 Training year
Child neurology residents at the PG4 year are supervised for all patient encounters at a level of at least indirect supervision with direct supervision available.  In specific instances defined by the attending physician, supervision for patient encounters may occur at the oversight level.

PG5 Training year
Child neurology residents at the PG5 year may be supervised for patient clinical encounters at any supervisory level.  However, it is expected that most patient encounters will be supervised at the oversight level.
 
Residents providing patient care in the ICU setting, or where ‘end-of-life’ and brain death determinations are being made, supervision must be at a minimum of indirect with direct supervision available.  In particular, attending staff must immediately be made aware of sudden neurological deterioration of a patient under the care of a child neurology resident.
 
Procedures Supervision
*All procedures will be documented in MedHub with supervisor signature.* 

Lumbar Puncture
A PG3-PG5 child neurology resident will be directly supervised in the performance of 3 lumbar punctures.  Once a resident successfully completes the required 3 procedures, he or she may supervise other trainees in performance of lumbar puncture or perform the procedure with oversight level of supervision.  This also applies to PG1 and PG2 residents while they rotate on the neurology services.
Required documented number of procedures during training: 25

TPA administration for stroke
Initially, a child neurology resident will be directly supervised by an attending physician for TPA administration.  Child Neurology residents must participate in the decision to administer TPA to stroke patients (whether or not TPA was actually administered) for a minimum of 20 patients before he/she can administer TPA with indirect supervision with direct supervision available.
Required documented number of procedures during training: 10

EEG interpretation
All EEGs are reviewed and interpreted with an attending physician or neurophysiology fellow.  Prior to finishing the program, a child neurology resident will have reviewed and interpreted a minimum of 300 EEGs and created a minimum of 30 EEG reports in order to be recommended for credentialing for this privilege.

Required documented number of procedures during training: 30

Deep brain stimulator (DBS)adjustment prior to surgery or MRI
Child Neurology residents may need to turn on and turn off DBS for patient undergoing surgical procedures or MRI studies.  A child neurology resident will be directly supervised in this procedure by a resident/staff attending/nurse practitioner qualified under these same guidelines to perform a DBS adjustment for a single patient care episode before being permitted to perform the procedure with oversight level of supervision.

Required documented number of procedures during training: 2

Vagus nerve stimulator (VNS) adjustment
Similar to DBS above, a resident will be directly supervised by a qualified practitioner for a single patient care episode before being permitted to perform the procedure with oversight supervision.

Required documented number of procedures during training: 2

Nerve conduction studies (NCS)
Child neurology residents are directly supervised by Neurodiagnostic Technician, neurophysiology fellow or attending staff for a minimum of 25 patient studies.  The resident then may perform the study with oversight supervision.

Required documented number of procedures during training: 20

Electromyogram studies (EMG)
Child neurology residents are directly supervised by attending staff for a minimum of 200 patient studies.  The resident may then perform studies with oversight supervision if approved by supervising attending physician.

Required documented number of procedures during training: 10

Needle muscle biopsies
Child neurology residents may assist in this procedure with direct supervision of the attending physician.

Required documented number of procedures during training: 1

Skin punch biopsies
Child neurology residents may assist in this procedure with direct supervision of the attending physician.

Required documented number of procedures during training: 1

Botox administration
Child neurology residents may assist in this procedure with direct supervision of the attending physician.

Required documented number of procedures during training: 1
 
Procedures will be documented in a procedure log in MedHub.

F. Grievance

Resident grievances may be filed in writing with the Child Neurology Program Director or the Chair of the Department.  The Program Director will meet with the resident regarding the grievance within 5 working days to review the grievance.  The Program Director will then reply in writing to the resident within 3 working days of the meeting.

If the resident is not satisfied with the written response to the grievance, the resident may petition to have the grievance reviewed by other faculty members.  The Program Director will then appoint an ad-hoc Grievance Committee to review the grievance.  This committee will meet and issue a written reply within 10 working days to the resident.

If the resident is dissatisfied with the response to the grievance, he/she may appeal the response to the Department Chair.  Within 10 business days, the Chair will issue the final written response to the grievance.  If the resident is not satisfied with the response, he or she may file an appeal at the institutional level. Appeal can be initiated by calling the Resident Confidential Complaint Hotline and request that the grievance be evaluated by the GME Appeals Committee.
 
Evaluation of the grievance at institutional level will occur in accordance with the following policies.
 
The UWHC offers a Resident Confidential Complaint Hotline.  Residents who have exhausted intra-departmental complaint resolution mechanisms may call the hotline at 263-8013 for additional assistance. 
 
Appeals of Resident Evaluation, Discipline, Non-renewal or Dismissal Decisions. The UWHC GME policy on Appeals of Resident Evaluation, Discipline, Non-renewal or Dismissal Decisions details the process that provides residents with fair, reasonable, and readily available procedures for appeals and due process. The intent of the policy is to minimize conflict of interest by adjudicating parties in addressing academic or other disciplinary actions taken against residents that could result in dismissal, non-renewal of a resident’s agreement, non-promotion of a resident to the next level of training, or other actions that could significantly threaten a resident’s intended career development.

Resident Grievances related to Employment Concerns.  The UWHC GME policy on Resident Grievances related to Employment Concerns details the process that:

  1. Provides residents with fair, reasonable, and readily available procedures for grievance and due process. It is recognized that misunderstandings, disputes or disagreements may occur related to the:
    1. Work environment
    2. Issues related to the program or faculty
    3. Interpretation of the terms of UWHC Graduate Trainee Appointment Information Document
    4. Application of the program’s and/or hospital’s policies and procedures affecting residents.
  2. The policy does not apply to academic or other disciplinary actions taken against residents that could result in dismissal, non-renewal of a resident’s agreement, non-promotion of a resident to the next level of training, or other actions that could significantly threaten a resident’s intended career development.
  3. This procedure does not apply to allegations of discrimination based on sex, age, race, national origin or disability.  Such allegations shall be submitted to the UWHC Human Resources Department.

GME Appeals Committee. The GME Appeals Committee, a standing committee of the Medical Staff, is appointed to deal with grievances and appeals of non-renewal decisions filed by Residents.  Members are appointed by the President of the Medical Staff.  The committee consists of two members of the Medical Staff plus one alternate and three Residents plus one alternate.  The Committee Chairperson is appointed by the President of the Medical Staff from among the committee members. The alternate(s) serve in case of a conflict of interest of any member.

G.  Leave

When scheduling leave time, Residents must adhere to the requirements of UWHC, their RRC and specialty board, and get approval from their Program Director. In some cases, the GME Office and the Designated Institutional Official (DIO) must also give approval. Residents should be aware that any leave time taken may extend the length of time required to complete their training. In some cases, space for such additional training time may not be available at this hospital or at the time desired. All leave time must be requested and recorded through the residency management system, MedHub. In addition, the GME Leave Request form must be filled out and forwarded to the GME office where indicated below.

A. Family/medical leave. State and federal FMLA/WFMLA laws mandate minimum family and medical leave benefits.

  1. Family leave. UWHC will grant one week of paid family leave for the father/partner following the birth of a child or for either parent following adoption of a child. (See medical leave section regarding paid medical leave after childbirth). In addition, UWHC will grant unpaid family leave (leave due to birth of a child, adoption or a serious health condition of a spouse, parent or child, which necessitates the Resident’s care) in compliance with state and federal laws. In order to meet notice requirements, the Resident must contact the GME Office as soon as possible after deciding that he/she intends to take family leave. (Leave Request form required)
  2. Sick leave. The Program Director may approve up to one week of paid sick leave per year if needed. For any sick leave exceeding one week, the Resident and program must notify the GME Office.
  3. Return to work. Any sick or medical leave of more than 5 days requires being cleared to return to work through UWHC Employee Health. (UWHC Fitness for Duty: Health Service Clearance to Return to Work/Continue Work Policy# 9.22)
  4. Medical leave. The hospital will grant unpaid medical leave in compliance with applicable state and federal laws. In the event of a short-term disability (i.e. a temporary inability to work as a result of illness, injury, childbirth, etc), the hospital may grant paid leave for a “usual and customary” recovery period. Paid leave after childbirth shall be four weeks, unless the Resident has continuing medical complications certified by her treating physician. All cases will be individually evaluated by the UWHC Director of Employee Health or designee to determine disability, reasonable recovery period, follow-up requirements, and will consult with theProgram Director re: any necessary work-related accommodations. (Leave Request form required)
  5. The Designated Institutional Official (DIO) will determine whether some portion of the leave will be paid. Any approved paid leave longer than 6 weeks will be paid at 75% of stipend, mirroring the long-term disability policy. Paid medical leave will never exceed six months (at which time the hospital-provided long term disability insurance may begin), and in some instances may not cover the entire length of absence.

B. Personal leave. A Resident may be granted a leave of absence without pay at the discretion of the Program Director. All unpaid leaves must be reported to the GME Office by the Resident and program. (Leave Request form required)
C. Bereavement leave. In the event of the death of a Resident’s spouse/partner, or the child, parent, grandparent, brother, sister, grandchild, (or spouse of any of them), of either the Resident or his/her spouse/partner, or any other person living in the Resident’s household, the Resident is granted time off with pay to attend the funeral and/or make arrangements necessitated by the death. However, time off with pay cannot exceed three (3) workdays. Reasonable additional time off without pay may be granted in accordance with religious or personal requirements and must be reported to the GME Office by the Resident and program.
(Leave Request form required if more than 3 days)
D. Military leave. Residents may take time off for military service as required by federal and state statutes. The Resident is required to provide advance documentation verifying the assignment and pay to the GME Office. (Leave Request form required)

  1. UWHC will pay the excess of a Resident's standard wages over military base pay for military leaves of three (3) to thirty (30) days to attend military schools and training.
  2. For Residents who are recalled to active duty, UWHC will pay the difference between the Resident’s wages and the active duty military pay for up to one year (average hospital pay over the past year minus military pay). For the first month of recall, UWHC will pay the difference between the Resident’s base pay and hospital pay. For the next eleven months, UWHC will pay the difference between the Resident’s total monthly military pay (limited to base pay, Basic Allowance for Housing and Basic allowance for Subsistence) and the Resident’s hospital pay. If the Resident’s active duty pay is more than his/her hospital pay, UWHC will not compensate any wages

E. Military Family Member Qualifying Exigency Leave (if eligible under the FMLA). Eligible Residents with a covered military family member serving the National Guard or Reserves may take up to 12 weeks of unpaid leave for a qualifying exigency arising out of the fact that the covered military member is on active duty or is called to active duty status.
F. Vacation. UWHC Residents are entitled to three (3) weeks paid vacation per year. Three weeks of vacation equals 15 weekdays and 6 weekend days. Vacation may only be taken in full-day increments. This vacation time is to be used during the fiscal year in which it is allotted. In exceptional circumstances, if the Resident is unable to use all allotted vacation during the training year due to service requirements; he/she may carry over unused vacation with prior approval of the Program Director (not to exceed one and a half weeks) to the following year. When the Resident is leaving UWHC permanently, accrued vacation entitlement must be used prior to termination.
G. Professional meetings. Each Resident is entitled to a maximum of one (1) week to attend professional meetings each year with pay. The meeting is to be approved in advance by the Program Director and attendance documented. This meeting is in addition to vacation leave.
H. Holiday leave. When program patient care responsibilities allow, with Program Director approval, UWHC legal holidays will be observed, and paid leave given. Residents don’t earn or use floating holidays, extra VA holidays or state furlough days. Holidays taken should never exceed the number of UWHC legal holidays as indicated in MedHub. If Residents request time off for religious holiday, in lieu of state holidays, they should be allowed comparable leave where scheduling permits.
I. Career development leave. Each Resident is entitled to a maximum of one (1) paid week for fellowship and other employment searches per residency program. Unpaid leave may be granted for additional time. All time used must be approved by the Program Director. The GME Office must be notified of any unpaid time granted. (Leave Request form required for any unpaid leave)
J. Witness leave. Residents may take time off without loss of pay during regularly scheduled hours of work when subpoenaed as a witness in a matter directly related to their work duties. However, when not called for actual testimony, but instead on call, the Resident shall report back to work unless authorized otherwise by his/her Program Director. Residents needing time off for witness leave must provide advance notice to their Program Director and provide a copy of the subpoena. If a Resident is subpoenaed as a witness in a matter not directly related to their work duties, the Resident must use vacation or, if none is available, take time off without pay. The Resident and program must report unpaid leave to the GME Office. (Leave Request form required for any unpaid leave)
K. Jury duty leave. Residents may take time off without loss of pay during regularly scheduled hours of work for jury duty. However, when not impaneled for actual service, but instead on call, the Resident shall report back to work unless authorized otherwise by his/her Program Director. Residents needing time off for jury duty must provide advance notice to their Program Director and provide a copy of the jury summons.
L. Time off to vote. An Resident eligible to vote in an election who finds it impossible to vote during non-working hours may be absent from work for up to three (3) hours without loss of pay during regularly scheduled work hours to vote, including travel time. The supervisor can designate the time of day for the absence. The Resident must notify his/her Program Director before Election Day of the intended absence and must submit a written statement in advance to their Program Director explaining why they cannot vote during non-working hours.
NOTE: All Residents are strongly urged to vote during non-working hours or by absentee ballot. Contact the clerk of your municipality for more information.
M. Exam leave. Residents may take time off without loss of pay for up to 2 days per year to take required licensure or certifying Board exams. Time must be scheduled ahead of time with approval of the Program Director.
N. Accrual of leave time. No leave time described in Section IV is accrued for Residents except as described in Section IV. F. Vacation above.

H. Stress & Fatigue

Residents and faculty receive an annual educational experience in stress and fatigue, especially the recognition of fatigue in residents that may impact resident welfare and patient care.  All faculty and residents are to report to the program director any instances where a resident appears to have a situation that may be impairing resident performance and learning ability.  The program director immediately counsels the resident of concern, and offers help as needed. This may include immediate removal from clinical duties, and referral to counseling and medical services as needed.
 
On a monthly basis, or more often if needed, the program director holds a monthly group meeting with the residents where resident concerns about the program can be raised and discussed openly.  The program director maintains an open door policy to review any resident concerns.  Residents have the cell phone number of the program director so that they can reach the director at any time. Residents are encouraged to also work with their mentor if the program director is unavailable.
 
The institution maintains lists of resident help services through the Employee Assistance Program, which is an anonymous and confidential service. Examples include legal help, psychological counseling and financial counseling. These services are typically at no cost to the resident.

I. Resident evaluations

The Residency Committee, in conjunction with the program director, is responsible for  developing the evaluation process of assessing resident competence. The program director brings to the committee examples of various evaluation forms. The Residency Committee then creates evaluation forms which will be utilized by the training program.
 
Assessment criteria for each of the evaluations are reviewed and agreed upon by the committee. Changes to the forms based on changes in instruction or curriculum are made with agreement by all parties, which includes the chief resident of Neurology, the program director, the program coordinator, and the committee members. Each assessment form is reviewed annually.
 
Evaluations will include five first-patient encounter clinical examinations by each resident under direct observation during the three-year program. Clinical examination evaluations will be performed in the areas of neuromuscular, neurocritical care, neurodegenerative, outpatient (headache, seizure) and adult neurologic disorders to ensure these skills are observed and documented
The evaluation forms are then presented to the faculty at the first faculty meeting of the year. Criteria for the various evaluation forms and the process of the electronic evaluation are reviewed with all faculty. In addition, the goals and objectives for each rotation are made available to the faculty in paper form, or they are available online at all times in an electronic format.
 
The standardized clinical skills evaluation (NEX) required by the American Board of Psychiatry and Neurology is reviewed with the faculty evaluator. The criteria for this evaluation are provided in advance of each exercise to both the resident and evaluator.
 
Resident evaluation for each rotation
Goals and objectives that are core-competency based are provided for each rotation. At the beginning of the year and prior to the rotation, each resident reviews the goals and objectives, and discusses performance criteria with the attending physician.The end-of-rotation evaluation form lists the criteria for evaluation of each of the core competencies, and they are readily accessible to each resident.

Evaluation criteria for the clinical skills exams are provided to each of the residents at the beginning of the year and prior to the exercise.

All end-of rotation evaluations are submitted electronically. Each faculty member receives a notice via email on the last day of the rotation that an evaluation is scheduled to be completed. An email link takes him or her to the website of Med Hub, our electronic evaluation system. If an evaluation is not completed in two weeks, a reminder email is automatically sent to the faculty member.
Incomplete evaluations after 1 month result in a reminder sent by the residency coordinator or the program director. Compliance is monitored, and deficiencies will be included in the faculty member's annual evaluation of teaching effectiveness.
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Summative resident evaluations
Each resident meets with the program director for a mid-year summative evaluation in January, and a year-end summative evaluation in June. At that evaluation, results of the most recent rotational evaluations, clinical skills exams, in-service exams, etc., are reviewed together. Also, a semi-annual self assessment is required of each resident, and that assessment is reviewed at the time of the meeting. After the meeting, the program director creates a written summary of the meeting, which is placed in the resident's record. A copy of the summary is provided to the resident for review.
 
Evaluation of teaching faculty by residents
The system used by residents to evaluate the teaching faculty has two components. First, at the end of each rotation, each resident completes an evaluation of the faculty attending physician. This evaluation is completed electronically and confidentially. At the end of the year, each faculty member receives a compiled de-identified summary report of all evaluations that were submitted throughout the year. This combined report ensures that individual resident evaluations are anonymous and confidential.
Secondly, at the end of the academic year, the residents have a closed door meeting to evaluate the effectiveness of the faculty and the program. Each faculty member is reviewed by the resident cohort. A summary evaluation for each faculty member is created by the chief Neurology resident. That summary evaluation is attached to the summary report from the electronic evaluation system, and forwarded to each faculty member. Again, this process ensures resident confidentiality.
In the method described above, after confidential evaluations of the faculty are generated by the resident staff, a summary report for each faculty member is created and given to each faculty member for review. These reports are also forwarded to the department chair for review, and they may be used by the departmental chair for the departmental evaluation of each faculty member.
To assure confidentiality of faculty evaluation by the Child Neurology residents, these will be pooled with the evaluations by Adult Neurology residents.
 
Evaluation of training program
At the end of each academic year, residents hold a closed-door meeting to evaluate all aspects of the training program. This includes individual rotations, faculty, program director and coordinator. In preparation for this meeting, each resident submits a confidential individual evaluation that covers all aspects of the residency program. A summary report is created by the chief Neurology resident and submitted to the residency committee for review.
 
The residency committee reviews this report, as well as evaluations of each of the rotations that are accumulated throughout the year. Opportunities for improvement are reviewed, and a plan for improvement is created. The plan for improvement is reviewed periodically at the residency committee meetings, and strategies are developed to create ways of improving the program.

To assure confidentiality of faculty evaluation by the Child Neurology residents, these will be pooled with the evaluations by Adult Neurology residents.
 
Evaluations can be accessed by residents and faculty at any time via MedHub. 

Clinical Competency Committee

Purposes:

  • The committee reviews resident performance with respect to the six core competencies defined by the ACGME:
    • patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, and professionalism
  • In the ACGME’s Next Accreditation System, residents will be expected to achieve specific milestones developed by each specialty’s professional societies. The Competence Development Committee’s mission includes the assessment of each resident’s progress toward these milestones.
  • The committee advises the program director regarding resident promotion and, if necessary, remediation.
  • The committee will also consider issues that affect resident performance, such as fatigue, stress, affective disturbance, and substance abuse.
  • The committee seeks that each of our graduates achieves certification by the American Board of Psychiatry and Neurology.
  • The committee will monitor requirements set forth by the ACGME regarding conference attendance, case logs, duty hours, medical records and scholarly work.  

Functions:

  • The committee will review materials regarding resident performance and will determine if the resident will be promoted to next level, graduate, promoted upon remediation, remediation without promotion or contract non-renewal.
  • The Program Director attests that the resident has ‘demonstrated sufficient competence to enter practice without direct supervision.’
  • The committee will discuss issues that affect resident performance, including, but not limited to:
    • Sleep deprivation, Stress, Anxiety, Depression, Substance abuse

Format:

  • Meetings occur twice per year.
  • Resident performance data will be reviewed in December and June of every year.
    • Items reviewed include NEX Exams, evaluations submitted by faculty and ancillary staff, patient feedback, mentor comments, conference attendance, RITE Exam scores, duty hour violations
  • All reports, evaluations and correspondence will be kept on file in the Department of Neurology.
  • Items discussed about a specific resident are shared with corresponding resident.  

Program evaluation committee
 
This committee is responsible for monitoring and addressing a variety of matters related to overall quality of the residency program. These include:

  • Curricular goals and objectives
  • Aggregate resident performance
  • Faculty development
  • Graduate performance (e.g. board pass rates)
  • Compliance with ACGME standards
  • Conducting an annual program evaluation
  • Developing an annual program improvement plan

The committee is chaired by the program director and other members include the chief resident and/or an additional PGY4 resident, the program coordinator, the department chair, and various faculty representing different divisions of the department.
 
Each year, both residents and faculty are electronically surveyed regarding their assessments of the residency program. These are confidential (i.e. the faculty will not know which resident provided which assessment). In addition, the residents as a group meet on an annual basis to review the program, leading to a report written by the chief resident. The Program Evaluation Committee then conducts its annual program evaluation, reviewing:

  • The prior year’s improvement plan
  • Internal resident and faculty surveys
  • Resident milestones and RITE scores
  • Performance of program graduates on the board certification examination
  • Minutes from the program’s most recent meeting with UW’s GME Office
  • ACGME resident and faculty surveys
  • Other communications from the ACGME  

The committee prepares an annual improvement plan of action, which is shared with the teaching faculty at the next faculty meeting. 

J. Quality improvement

All child neurology residents are expected to participate in a formal quality improvement project during their residency, ideally in the PGY4 or PGY5 year. The specific topics may be tailored to the resident’s interest. The goal is to improve the quality of care provided in the specific area they chose to review.
 
One such planned project is: Optimization of pre-hospital treatment of febrile seizures. Children with febrile seizures often receive large doses of anticonvulsants which may lead to intubation and ICU admission. To avoid that, the ER visits and hospital admission electronic charts of all pediatric patients who were given the diagnosis of febrile seizures within a period of two years are reviewed with focus on documented duration of seizures, doses of given medications at home, by EMS, in the outside emergency room prior to the child reaching the UWHC.  In each individual case it will be determined whether the pre-hospital treatment was appropriate and where mistakes can be identified. A plan for interventions to improve quality of pre-hospital care of children with febrile seizures will be implemented which may include education of the primary care physicians, the outside ER physicians, the UWHC ER physicians, EMS providers, patients’ parents. Follow up evaluation will hopefully reveal improved performance on this crucial process of care. One child neurology faculty will supervise this activity. There will be regular meeting between the supervising faculty and the resident once every three months.

K. Hand-offs, Transition of Care

Our program, like all residency training programs and all nursing and other staff at UW, uses the SBAR process for hand-offs.
 
PGY-3 Adult Neurology year

  • Weekend sign-out occurs on Monday mornings at 0730. All of the on-service residents gather each Monday morning to review the patient lists and make sure that all patients appear on the appropriate list (stroke, general, consult, epilepsy, peds) and have the proper attending. This helps ensure that no one, especially consults seen over the weekend, falls through the cracks.  
  • On Saturdays and Sundays, rounds are preceded by a brief gathering of both the post-call and on-call residents and both the stroke and general neurology / consult attendings. In this way, the attendings can hear first-hand about any new patients they’ll be rounding on with the other resident and can also monitor the quality of resident handoffs.  
  • Importantly, residents may hand off pending consults when these are received at the end of a call shift, putting the resident at risk for a duty hour violation (i.e., not getting out of the hospital at the required time because of the last-minute consult and associated chart work). As a general rule, short-call residents may hand off consults received after ~ 19:30 in order to ensure that they can leave the hospital by 21:00. Of course, a preliminary determination must still be made whether the matter is urgent or not. As always, patient care comes first and so other unfinished work may have to be handed off to the oncoming resident if a late consult is for an urgent matter.  

Interprofessional Communication

In our adult neurology program, interprofessional communications formally occur at the following times:

  • Morning interdisciplinary rounds—daily at 0900. The stroke and general neurology inpatient teams gather with the nursing staff, PT, OT, speech, swallow, social work, case management, etc. to discuss each patient on service with specific attention to their overall plan of care and anticipated discharge needs.
  • Afternoon interdisciplinary rounds—daily at 1600. The on-service residents and the short call resident meet with a small group of nurses and case managers to “run the list” with an eye toward anticipated discharges. The short call resident assumes care from the on-service residents at that time.  

PGY-4 and PGY-5 years
 
During these years the pediatric neurology resident will not take inhouse call. He/she will be on service for four weeks at a time and will sign off Monday morning at 8:00 am to the pediatric or adult neurology resident on service. If there is no resident on the pediatric neurology service the resident will sign off to the pediatric neurology attending on service.

When the pediatric neurology resident is assigned to have the weekend off, signout rounds will take place on Fridays at 1600 to the on-service pediatric neurology or adult neurology resident or pediatric neurology attending.

When the pediatric neurology resident is assigned to have the evening/night off during his/her on-service weeks, signout rounds will take place at 1600 to the on-service pediatric neurology or adult neurology resident or pediatric neurology attending. Sign-in rounds will take place the next morning at 8:00 am.