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ARTICLE FIVE:  CHIEF PGY 1 – TR’s/RESIDENT/FELLOW’

1. Appointment

   1. Appointment of Chief PGY 1 – TR’s/RESIDENT/FELLOWS will be made by the Associate Dean for Graduate Medical Education, Program Director, Director of Graduate Medical Education and Manager of Postdoctoral Training.

      1. The number of Chief PGY 1 – TR’s/RESIDENT/FELLOWS will be determined by the Office of Graduate Medical Education.

      2. Appointments will be made within the first 15 days of the beginning of the training program.

      3. Chief PGY 1 – TR/RESIDENT/FELLOWS will report directly to the Program Director / professional staff in the Office of Graduate Medical Education.

      4. Chief PGY 1 – TR/RESIDENT/FELLOW are members of the management team for the PGY 1  year.

      5. Chief PGY 1 – TR/RESIDENT/FELLOW will be paid for the services provided as outlined in the CIR contract with the University and Article 5.3-2 (c) of the Rules and Regulation.

2. Duties and Responsibilities of the Chief PGY 1 -TR / RESIDENT/FELLOW

   1. The Chief PGY 1 – TR/RESIDENT/FELLOW will

      1. Meet on a regular basis with the Associate Dean for Graduate Medical Education, Director of Graduate Medical Education, Manager of Postdoctoral Training, Program Development Specialist, staff of the Office of Graduate Medical Education, Chief Medical Officer, Track Coordinator, Director of Medical Education, Program Director and/or others as designated by the Associate Dean for Graduate Medical Education, Chief Medical Officer, or Track Coordinator.

      2. Meet with the Office of Graduate Medical Education staff regarding management of the program, information concerning trainees in the residency/Fellowship/PGY-1 TR program, to provide feedback about the trainees in the PGY 1  program, to discuss problems arising in the residency/fellowship and PGY 1-TR programs and to suggest changes that would benefit the training programs

      3. Chiefs will take attendance at Core lectures and meetings using the House staff Attendance Sheet. All Attendance Sheets should be returned to the Office of Graduate Medical Education/residency program administration on a monthly basis.

      4. Assisting in Educational Conferences including but not limited to scheduling conferences and leading educational discussion.

      5. Transmit to the appropriate Department Chief and Chairperson any matters relating to department policy or procedure as it pertains to patient care or education within the department and transmit the issues and decisions of the department to all house staff.

      6. Transmit to the Chief Medical Officer any matters relating to medical staff, corporate, or medical center policies or procedure as it pertains to patient care or education in the conduct of the training program, and transmit decisions, policy and procedures to the house staff.

      7. Oversee compliance on the part of the house staff with the procedural safeguards and Rules and Regulations of their program.

      8. Preside at all meetings of the house staff to discuss problems, inform house staff on various issues and to offer the  trainees the opportunity to express and or discuss concerns.

      9. Be responsible for and appoint members of the house staff to participate as assigned in quality assurance activities of the medical center and  medical staff, or the PGY 1-TR/residency/fellowship programs.
      10. Review and enforce compliance with standards of conduct and professional demeanor among members of the house staff. Including: acting as a role model and assist in maintaining professional atmosphere, conduct, and attitude of house staff and clinical clerks, be able to problem solve and provide conflict resolution as appropriate, maintain strict confidentiality at all times.
      11. Represent the house staff at all organizational levels of interface with students, medical staff and administration/medical center departments.
      12. Report problems at the medical center to the staff in the Office of Graduate Medical Education.
      13. Assign on-call coverage from those house staff at the division if assigned PGY 1-TR staff is ill, absent, etc.  The Chief house staff officer is not responsible for covering all such activities him/herself; the Chief should distribute assignments equitably and in regard to appropriate patient care.
      14. Assist house staff in obtaining service/phone coverage when other house staff are on vacation, on ambulatory service, etc.
      15. Provide technical assistance as needed for morning report and other educational functions that utilize the teleconferencing system.
      16. Perform other related duties as assigned by the staff in the Office of Graduate Medical Education.
   2. The Chief Scheduling house staff officer will develop the house staff on-call schedule (weekends and nights) at least six (6) weeks in advance of the beginning of each new rotation.
3. Coverage
   1. There will be one Chief PGY 1 -TR or RESIDENT/FELLOW assigned for each rotation at each division.
   2. Chief PGY 1 -TR or RESIDENT/FELLOW may be selected after individual schedules have been completed or by AOA Specialty College standards/ACGME Program Requirements.  Therefore, if for any reason due to scheduling conflicts, personal leaves, or if there is disproportionate coverage, the following will occur:
      1. An alternate Chief PGY 1 - TR / RESIDENT/FELLOW within the Division will be designated by the Program Director/ staff of the Office of Graduate Medical Education during the first month.
      2. The relieved Chief PGY 1 -TR / RESIDENT/FELLOW will be absolved of the Chief PGY 1 – TR / RESIDENT/FELLOW duties during that month.
   3. Chief PGY 1 – TR / RESIDENT/FELLOW (or their replacements) will be paid for service, pro-rated over the number of rotations.  The rate for a full service is determined by the CIR contract.
4. Resignation/Removal from Office
   1. A Chief PGY 1 – TR / RESIDENT/FELLOW may resign at any time by giving written notice to the Associate Dean for Graduate Medical Education.  Such resignation shall take effect on the date of receipt or at any later time by mutual agreement.
   2. Removal from office may be initiated and implemented by the Program Director, Associate Dean for Graduate Medical Education or the Director of Graduate Medical Education for the following reasons:
      1. Failure to perform duties of the position timely and appropriately
      2. Failure to continuously satisfy the qualifications for the position; or
      3. Failure to establish and lead by example of competency or citizenship

ARTICLE SIX:  FORMAL EDUCATIONAL PROGRAMS/MEETINGS

1. Academic Year
   1. The PGY 1 – 1 2017-18 academic year shall commence on Monday, June 19, 2017, at 7:00 a.m. and conclude on Monday, June 18, 2018 at 7:00 a.m.  The new residency year will commence on July 1 , 2017
2. Orientation Programs
   1. An PGY 1 Orientation Program will be conducted prior to the first day of PGY 1  year.
      1. The PGY 1 will be notified in writing at least 28 days in advance of the dates and times of the orientation program.
      2. PGY 1 attendance is mandatory.                           
      3. The PGY 1 shall be responsible for transportation, lodging and other expenses incurred for the orientation program.                           
      4. All incoming house staff will be paid a onetime fee, as described in the CIR contract, for attending the orientation program payable in July after all necessary University entrance requirements are fulfilled.
   2. Divisional Orientation - Each medical center will conduct an PGY 1  Orientation at a time near the beginning of the first rotation on days preceding the starting date of the program.
   3. Service Orientation- Upon entering a new service for assignment, the PGY 1  shall be oriented to the service.  The PGY 1 should review the Objectives, Responsibilities and Evaluation sheet provided for each service.  The Chief of the Department (or his/her designee) is responsible for such orientations.
      1. The PGY 1 shall be responsible to contact and make appointment for such orientation at least 24 hours before the start of the service.
      2. The Chief may delegate orientation responsibilities (Section Head, Chief RESIDENT/FELLOW, another attending, another RESIDENT/FELLOW, etc.), but shall be responsible for such arrangements.
      3. The Chief will review the PGY 1 Rotation Goals and Objectives with the PGY 1.
   4. RESIDENT/FELLOW Orientation– RESIDENT/FELLOW Orientation will be held on July 1, of each academic year.  RESIDENT/FELLOWs will receive notification of orientation schedule from their respective Program Director. 
3. Formal Lectures
   1. Core Lecture Series.  ALL PGY 1 trainees shall attend Core Lectures at the onset of the training program, as well as additional training as designated by the Chief Medical Officer, Program Director, Director of Medical Education or Divisional Medical Director.  Such lectures shall be deemed by the Department Chief to be of special importance regarding emergency care and other issues related to the care of patients of the medical center.  PGY 1 must sign the House staff Attendance Sheet, or if an excused absence is granted, must remediate the lecture material in a manner recommended by the Chief of the Department in a timely fashion.
   2. Departmental Lectures/Educational Programs.Each department shall conduct a variety of educational and patient care programs that shall include, but not be limited to, attending rounds, conferences, lectures, etc.  The PGY 1  – TR / RESIDENT/FELLOW is required to attend all such programs and sign the House staff Attendance Sheet, unless an approved excused absence is granted by the Chief of the Department, and approved by the Chief Medical Officer, Program Director, or Director of Medical Education
4. Meetings
   The PGY 1 – TR/ RESIDENT/FELLOW is responsible to attend all other meetings recommended by the University, Chief of Service, or medical center administration.  This includes the monthly PGY 1 meetings at the division where the rotation is being completed.  The PGY 1 must sign the House staff Attendance sheet as indication of participation at these meetings.
5. External Education Programs
   1. Official External Programs
      1. Formal conferences and other teaching programs, which are provided at another division of the medical center, and which are approved as part of the official PGY 1  – TR / RESIDENT/FELLOW training program, shall be attended by the PGY 1  – TR/RESIDENT/FELLOWSHIP with the same attendance requirements as internal programs.
      2. An approved portion of the training program that is conducted at another institution shall be attended by the PGY 1 / RESIDENT/FELLOW with the same attendance requirements as internal programs.
      3. All PGY 1 rotations across all residencies and the one year Traditional Rotating program shall occur within the Sponsoring Institutions facilities.
   2. Non-Official Programs
      1. Lectures, conferences, and other educational programs which are not an official part of the PGY 1  – TR / RESIDENT/FELLOW Training Programs may be attended provided that
         1. Attendance is approved by the sponsoring organization.
         2. Attendance is approved by the Program Director, Service in agreement/coordination with the service Attending Physician, Office of Graduate Medical Education, Chief Medical Officer.
         3. All expenses are incurred by the PGY 1  – TR / RESIDENT/FELLOW
         4. Acceptable peer-patient responsibilities are arranged and guaranteed by the PGY 1 – TR / RESIDENT/FELLOW to the satisfaction of the Department Chief, and Chief Medical Officer, and Office of Graduate Medical Education.

ARTICLE SEVEN:  RULES AND REGULATIONS GOVERNING SERVICE ASSIGNMENTS

1. Standard

1. Services 
   *The traditional rotating PGY 1 internship training program will comply with the standards established by the American Osteopathic Association (AOA) and shall include a minimum of the following:

1. At least six months of training rotations in any or all basic core disciplines.  These include general internal medicine, general surgery, family practice, pediatrics, obstetrics/gynecology (ambulatory gynecology) and emergency medicine.

   1. No less than two months of exposure in general internal medicine, and must be under the supervision of an internist.
   2. One month exposure in emergency medicine at the base institution or an affiliate training site is required.
   3. At least one month in family practice in a hospital or ambulatory site or one-half day per week for a minimum of 46 weeks of ambulatory exposure in a family practice continuity of care type practice site.
   4. No more than three months of elective exposure adequate to meet the individual needs of the PGY 1 – TR and approved by the internship program director.
   5. All remaining time may be scheduled at the discretion of the base institution.
   6. No more than one month may be spent in non-clinical experience (research, scholarly pursuits, administration, etc.).
   7. Exposure must occur to the support disciplines of pathology, radiology, and didactic anesthesiology.  This may occur directly by rotation or indirectly by formal conferences and/or exposure while on medical and surgical services.  This exposure must be verified on PGY 1 - 1 logs. 
      *The family medicine, internal medicine, emergency medicine, general surgery, ob/gyn, general urology, otolaryngology and psychiatry PGY 1 - TRs will also comply with the standards established by the AOA.
      *Upon pre accreditation and Initial accreditation the above programs will abide by the ACGME Common Program requirements and their respective training program RC requirements.

1. Elective

1. Services (When applicable and if available)
               1.           
   1. 1. The Track Coordinators, Office of Graduate Medical Education, and Chief Medical Officers will designate specific electives designed to provide appropriate educational experiences.
               2.           
   1. 1. The PGY 1 – TR/RESIDENT/FELLOW may request one or more services he/she desires in the designated time period.
               3.           
   1. 1. Electives are permitted only within the designated medical center.
               4.           
   1. 1. The Office of Graduate Medical Education must approve the elective service, which must be an AOA-recognized service.
               5.           
   1. 1. If an PGY 1 – TR/RESIDENT/FELLOW has not made a choice of an elective two months in advance, the Track Coordinator/Program Director or Office of Graduate Medical Education will designate a service and division to be covered.  This may be altered only by written permission of the Track Coordinator/Program Director or Office of Graduate Medical Education and approval by the service that will no longer be covered.
         The Office of Graduate Medical Education reserves the right to change or alter service rotations for educational or other purposes.
   7.3       
   1. Patient Care Obligations
                 
      1. 1. It is a clear premise of the RowanSOM/Jeff/OLOL Sponsoring Institution that both education and patient care obligations are of prime importance.
      7.4       
      1. On Call
         7.4-1          
         1. 1. In-House Call: Nights, Weekends and Holidays
            (a)       
            1. 1. 1. PGY 1 – TR/RESIDENT/FELLOW will not leave the hospital while on call.
                                      (b)       
            1. 1. 1. Call will be assigned from the full PGY 1 – TR/RESIDENT/FELLOW group not to exceed the number of calls allowed by the AOA Basic Standards and CIR contract with the University.
            (c)          
            1. 1. 1. The staff in the Office of Graduate Medical Education, Hospital Director of Medical Education, Program Coordinator/Program Director, and the Chief PGY 1  – TR/RESIDENT/FELLOW are empowered with the authority to assign PGY 1  – TR/RESIDENT/FELLOW to in-house or from home call to meet patient care standards (in accordance with the Agreement between ROWAN and the CIR).
                                                      (1)       
               1. 1. 1. 1. Coverage assignments may not exceed those established by the ACGME/AOA and outlined in the CIR contract.
                                                      (2)       
               1. 1. 1. 1. Regular assignments to in-house call shall not exceed in excess of an average of every third night in each and every 30-day period.
               (3)          
               1. 1. 1. 1. In cases of emergency, where it is deemed necessary for patient care standards to be met, the Chief PGY 1 – TR/RESIDENT/FELLOW, the Chief Medical Officer, Track Coordinator/Program Director, and staff in the Office of GME have the authority to request a house staff officer not in-house to be on-call and to respond if needed.
               (4)          
               1. 1. 1. 1. All University and hospital duties and regulations regarding call must be adhered to strictly.
               7.4-2          
               1. 1. If patient care demands so dictate, the staff in the Office of Graduate Medical Education, are authorized to give weekdays off in lieu of scheduling weekend duty so long as such scheduling does not significantly affect the educational aspects of the PGY 1  - TR's/RESIDENT/FELLOW’s experience.
                           7.4-3       
               1. 1. Emergency/Unusual Situation
                                             The
                  1. 1. 1. The Chief Medical Officer, Track Coordinator/Program Director, and Director of Medical Education have the responsibility of ensuring the educational experiences of the PGY 1  – TR/RESIDENT/FELLOW and the patient care obligation of the medical center.  As such, he/she is authorized to temporarily alter any schedule to ensure a better educational experience or to provide emergency patient care.
                  7.5       
                  1. General Medical Rules and Regulations
                                 7.5-1       
                     1. 1. Verbal Orders:  Protocol for voice orders is in accordance with individual hospital policy.
                                7.5-2       
                     1. 1. Time/Date: Orders and other chart documentation will be invalid unless also dated
                                               
                     1. 1. and timed
                                 7.5-3       
                     1. 1. .
                        2. Legibility:  Illegibly written orders are invalid.
                             7.5-4       
                     1. 1. Signature: All materials written in a patient chart by an PGY 1  – TR/ RESIDENT/FELLOW shall be signed by the PGY 1  – TR/RESIDENT/FELLOW including the phone number and written on behalf of a licensed physician responsible for the case (Example: Dr. Attending / Dr. PGY 1  - 1, Beeper #1234).
                     7.5-5       
                     1. 1. Sequence of Record:  All materials written on a chart will be written in appropriate sequence after the last entry.
                     7.5-6          
                     1. 1. Stop Order:  The PGY 1 - TR/RESIDENT/FELLOW shall be responsible to notify the attending of any pending stop-order of drugs and seek advice on further continuation of the drug.
                     7.5-7          
                     1. 1. Informed Consent:  The PGY 1 – TR/RESIDENT/FELLOW will abide by the intent of the Informed Consent Policy and Procedure of the medical center.
                     7.5-8          
                     1. 1. “No Code" or "DNR":  The PGY 1 – TR/RESIDENT/FELLOW will abide by the intent of the Policy and Procedure of the "No Code Policy" of the medical center.
                     7.5-9       
                     1. 1. Consultations:  A PGY 1 shall not perform a consultation.  The PGY 1 's activities may include obtaining a history and physical examination and reports of necessary evaluations, but shall not include rendering medical opinion or recommendations.  All activities of the PGY 1’s in this request shall be directly supervised by the consultant.
                     7.5-10       
                     1. 1. First Associate for Major Surgery:  In elective major surgery, a PGY 1 – TR/ RESIDENT/FELLOW shall serve as a first Associate only when under the direction of a licensed physician and in full compliance with State regulations.
                     7.5-11       
                     1. 1. Invasive Procedures:  A PGY 1 – TR / RESIDENT/FELLOW shall perform invasive procedures only under the direct supervision of a licensed physician on the Medical Staff of the medical center who is granted such privilege by the Governing Board.
                     7.5-12       
                     1. 1. Osteopathic Musculoskeletal Examination: Required as an integral part of the physical examination performed by osteopathic physicians on their admitted patients unless contraindicated.
                     7.5-13       
                     1. 1. At Our Lady of Lourdes, all PGY 1 – TR / RESIDENT/FELLOW (registered practitioners) must clearly write their “PGY 1 ” status in addition to their officially recognized signature and title after every entry on every medical chart.  (e.g. “John Doe”, PGY 1  - 1 Phone #-----) PGY 1 – TR’s / RESIDENT/FELLOW’s are encouraged to use the signature stamp that will be provided by Our Lady of Lourdes after every entry on medical charts.