RowanSOM Housestaff Rules and Regulations

Rowan University
School of Osteopathic Medicine
House Staff Rules and Regulations

2017-18

OVERVIEW

The Rowan University – School of Osteopathic Medicine Osteopathic Postdoctoral Training Institution member hospitals include:  Jefferson Health, Our Lady of Lourdes Health System, Children’s Regional Hospital – Cooper University Hospital, Christ Hospital, K. Hovnanian Children’s Hospital –JerseyShoreUniversityMedicalCenter, South Jersey Health System andAtlanticHealthHospitals.

The Osteopathic Graduate Medical Education Internship (RESIDENCY/OGME – TR) program of Kennedy University Hospital (JEFF) and Our Lady of Lourdes Health System Camden Division (OLLC) is the responsibility of the School and the joint efforts of the two health systems, JEFF and OLLC.  This RRESIDENT/FELLOW/OGME – TR Manual addresses all OGME programs at JEFF and OLLC.CooperUniversityHospital,ChristHospital, K. Hovnanian Children’s Hospital – Jersey Shore University Medical Center, South Jersey Health System and Atlantic Health Hospitals OGME policies are addressed in separate documents.

The Associate Dean for Graduate Medical Education, Director of Graduate Medical Education, Manager of Postdoctoral Training, Program Development Specialist, and staff in the Office of Graduate Medical Education at ROWAN-SOM have primary responsibility for all University functions of the OGME  Programs. These functions include: the educational program, administration, scheduling, contract management, paychecks, benefits, collection of evaluations, and verification functions.

The ROWAN-SOM OPTI is responsible for developing the educational program and policies for the OGME – 1 Internship.  The Chief Medical Officer at JEFF and the Chief-Department of Medicine at OLLMC, have primary responsibility for all medical and medical center functions related to the Residency and OGME – 1 Internship programs at the respective medical centers.  These functions include: medical policies and issues, responsibilities, service delivery orders, medical center policies, and evaluations of clinical rotations. 

RESIDENT/FELLOW AND OGME – TR’s will report directly to, and be responsible to, a Chief of Service (clinical faculty member) at the Division indicated on the schedule.  The Chief of Service (or his/her designee) will be directly responsible for the OGME - 1's assignments, responsibilities, and evaluation while on that service. 

RESIDENT/FELLOWS AND OGME - TRs are employees of ROWAN.  No directives by the hospital or its employees can countermand the RESIDENT/FELLOW AND OGME - 1 contract, affiliation agreement, or Committee of Interns and RESIDENT/FELLOWs (CIR) contract.  If administrative problems occur, they should be brought first to the Office of Graduate Medical Education.  Medical Center based problems should be addressed first with the Chief RESIDENT/FELLOW AND OGME - 1 who can mediate with the Chief of Service.  If not resolved, the Divisional Medical Director should be approached.  If not resolved at that level, the Chief Medical Officer, Program Director or Director of Medical Education will try to resolve the issue. 

The Associate Dean for Graduate Medical Education, staff in the Office of Graduate Medical Education, the Chief Medical Officer, and the Program Directors will meet regularly to review the program and resolve general issues.  Individual issues will be handled on a case-by-case basis.

DEFINITIONS

1. University:  The Rowan University (ROWAN) – The School of Osteopathic Medicine became a member of Rowan University as part of the Higher Education Restructuring act on July 1,  2013.
   
   
2. ROWAN-School of Osteopathic Medicine (ROWAN-SOM):  The School of Osteopathic Medicine (SOM) is based inStratfordNJ and awards the D.O. degree.  SOM also awards combined degrees which include D.O./Ph.D., D.O./J.D. and D.O./M.P.A. These degrees are granted in cooperation with other universities in the state.
   
   
3. Medical Center:  Jefferson Health (Jeff) [Cherry Hill, Stratford and Washington Township Divisions], Our Lady of Lourdes Medical Center - Camden and Burlington (OLLMC and OLOLB)
   
   
4. OPTI:   Osteopathic Postdoctoral Training Institution.  The method of accreditation by which the American Osteopathic Association (AOA) “approves” OGME – TR internship, residency and fellowship training programs.  “ROWANSOM OPTI of New Jersey” is the official name of our OPTI, which includes the University and all member medical centers/hospitals.
   
   Each OPTI is a community-based training consortium comprised of at least one college of osteopathic medicine and one hospital. Other hospitals and ambulatory care facilities may also partner within an OPTI. 
   
   OPTIs provide an enhanced quality assurance mechanism for AOA-approved postdoctoral training programs. Partnerships and collaborations between academic medicine, hospitals and other community based healthcare facilities are an integral part of OPTI.  This collaboration helps combine the partners’ resources to minimize duplication of support services for medical education
   
   An OPTI provides a seamless continuum of osteopathic medical education; it also requires continuous educational assessment.  AOA approved OGME – TR internships, residencies and fellowship continue to be reviewed regularly.  This review includes a systematic self-study, and annual reporting of data on accreditation procedures established by the Council on Postdoctoral Training and Bureau of Professional Education.

Part of the accreditation process includes encouraging clinical medical education research.  Research programs are available to osteopathic OGME – TR (interns) and RESIDENT/FELLOW throughout the year of training. These research programs are developed in conjunction with guidelines and requirements of osteopathic specialty colleges for residency training programs and the council on Postdoctoral Training for OGME - TR programs.

1. Board of Directors: The governing bodies of the affiliated medical centers
2. Chief Executive Officer (CEO): The President of the medical center; the individual appointed by the respective Hospital Board to act on its behalf in the overall administrative management of the medical center.
3. Dean:  The individual appointed by the President and Board of Trustees of the Rowan University as Chief Executive Officer of ROWAN-SOM.
4. Associate Dean for Graduate Medical Education: The individual appointed by the Dean of ROWAN-SOM, responsible for the clinical graduate medical educational programs.
5. Director of Medical Education:  Appointed by the Medical Center in agreement with the University who is responsible for all medical education programs within the affiliated hospital.
6. Assistant Dean of Graduate Medical Education: The individual in the Office of Graduate Medical Education responsible for the daily functions of the Graduate Medical Education office.
7. Manager of Postdoctoral Training: The individual in the Office of Graduate Medical Education responsible for the planning and daily functions of the OGME – 1 internship program.
8. Program Development Specialist:  The individual in the Office of Graduate Medical Education who assists with the administration of post-graduate education program activities and with the development of plans to improve programs. 
9. Chief Medical Officer: The individual appointed by the President of the Medical Center to oversee all medical programs at the medical center.  The Chief Medical Officer is also referred to as the Director of Medical Education (DME).
10. Chief of Service (Department Chief): The individual faculty member appointed by ROWAN-SOM and the medical center who is responsible at the Division for the academic and patient care standards of his/her department.
11. Attending Physician: The physician assigned by the Chief of Service to implement/conduct the formal teaching program for the section/department for a specific time period.
12. Chairperson:  The individual appointed by ROWAN-SOM responsible for the academic program of the Department.
13. Program Director: The individual appointed by ROWAN-SOM to implement and administer resident and fellowship training programs.  This individual may or may not be the same individual as the Track Coordinator.
14. Track Coordinator: The individual appointed by ROWAN-SOM to implement aspects of the OGME – 1 internship program.  The Track Coordinator performs reviews and evaluations of his or her OGME – TR as well as assures accreditation standards.
15. Committee of Interns and Resident (CIR): The Housestaff organization, representing OGME – TR’s and RESIDENT/FELLOWs at ROWAN, responsible for negotiating and implementing housestaff contractual services.
16. OGME: Osteopathic Graduate Medical Education.  OGME – 1’s are also referred to as “Interns”.

ARTICLE ONE: PURPOSES OF THE OGME PROGRAMS

The purposes of the OGME – TR and Residency/Fellowship Programs are as follows:

1.1        To further the graduate medical education of the OGME – TR and RESIDENT/FELLOW in preparation to be eligible for licensure in the State of New Jersey and to enter advanced residency training programs in primary care or specialty training.

            (a)        To advance competency in the management of medical diseases.

            (b)        To advance skills in the performance of clinical procedures.

            (c)        To increase the medical knowledge base.

            (d)        To learn responsibilities of medical staff citizenship.

            (e)        To appreciate quality assurance as a means of insuring optimal patient care.

            (f)         To be exposed to regulatory controls in the health care system.

1.2        To provide housestaff care to patients in the medical center under the direction of members of the Medical Staff, and in so doing, provide benefits for the patient as well as giving the OGME – TR and RESIDENT/FELLOW medical educational experience.

1.3        To teach peers and students assigned to educational programs of the medical center, and in so doing, gain personal education and clinical, professional expertise.

1.4        To conduct research under the direction of RESIDENT/FELLOW, medical staff members, and college faculty in order to gain additional medical education experiences.

1.5        To experience the responsibility of practice in a medical center and an office and, in so doing, prepare for the medical records, reporting, committee responsibilities, etc., of the health care delivery system.

1.6        To assume some administrative responsibilities within the OGME – TR AND RESIDENT/FELLOW training program or the medical staff organizational structure, and in so doing, prepare for responsibilities as a contributing member of a medical staff organization.

ARTICLE TWO:  APPLICATION PROCEDURE

2.1        Application

            Application for the OGME – TR Internship and Residency/Fellowship Programs must be submitted by the candidate to the Office of Graduate Medical Education of ROWAN-SOM using the Electronic Residency Application Service (ERAS).  The initiation of the application process shall be instituted by the applicant sending their application materials through ERAS.

            2.1-1        Deadline for Applications

                           Applications must be submitted through ERAS by September 15^th of the academic year preceding the OGME – 1 internship.

            2.1-2        Application Content

                           Every applicant for an OGME – 1 internship and residency programs must furnish complete information concerning the following:

                           (a)        Complete the ERAS Common Application Form

                           (b)        Undergraduate and graduate medical training, including the name of each institution, degrees granted and anticipated, program completed, and dates attended.

                           (c)        Minimum of three (3) Letters of Recommendation.

                           (d)        Official transcript reflecting all courses through Year 3 of Osteopathic Medical School.

                           (e)        Copy of Part I, Part II CE and PE of the COMLEX National Board scores

                                       (if applicable)

(f)            Dean’s letter

(g)           Other information requested in the application.

2.2        Effect of Application

            By sending an application through ERAS, the applicant:

                           (a)        Attests to the correctness and completeness of all information furnished.

                           (b)        Signifies his/her willingness to appear for an interview in connection with the application.

                           (c)        Agrees to abide by the terms of the OGME – TR and Residency/Fellowship Contract, the OGME – TR and Residency/Fellowship Training Program Rules and Regulations of the American Osteopathic Association, the Rules and Regulations OGME – TR and Residency/Fellowship Training Program, the medical center Bylaws, Rules and Regulations, Policies and Procedures of the medical staff as they pertain to OGME – TR’s and RESIDENT/FELLOWS and agrees to abide by the terms thereof.

                           (d)        Authorizes and consents to University representatives consulting with those institutions and persons who have information regarding competence and consents to the inspection of all records and documents that may be material to evaluation of said qualifications.

                           (e)        Releases from any liability all those who, in good faith and without malice, review, act on, or provide information regarding the applicant's competency, ethics, character, health status, and other qualifications for OGME – TR and Resident/Fellow appointment.

2.3        Processing the Application

            2.3-1        Applicant's Burden

(a)           The applicant is required to produce adequate and correct information for a proper evaluation of his/her training, ability (knowledge and skills), ethical, and attitudinal conduct about the qualification for selection and appointment to the OGME – TR and Residency/Fellowship Training Programs, and of satisfying any reasonable request for information or clarification made by appropriate request.

(b)           The applicant further understands that should an appointment be granted, the burden of providing a verifiable diploma from the osteopathic school of graduation prior to beginning the training program is the responsibility of the OGME – TR / RESIDENT/FELLOW.

(c)           The responsibility of attending all required orientation programs prior to the OGME – TR / Residency/Fellowship shall be his/hers.

                          (d)        The OGME – TR / RESIDENT/FELLOW must submit to and satisfactorily pass a physical examination conducted by an agent of the medical center and submit to all State Regulations regarding health standards including PPD, MMR, tetanus, polio virus, varicella, hepatitis B and influenza vaccinations.

                          (e)        The OGME – TR / RESIDENT/FELLOW applicant agrees to and must show verifications that he/she has certification in ACLS and PALS prior to starting the OGME program.  Failure to do so will lead to nullification of the contract.

(f)        An OGME – TR / RESIDENT/FELLOW employment is contingent upon the satisfactory completion of a background check. The background check will consist of verifying present and past employment, criminal history, social security verification and employment references. Additionally, educational and professional credentials and motor vehicle records will be checked as position requirements demand. All background checks will be conducted in accordance with the Fair Credit Reporting Act (FCRA) and require a signed release by the applicant after an offer of employment has been made. The signed release is a condition of University employment and shall not be waived for any reason. If a background check disqualifies an applicant for any reason, the applicant will be notified and given a reasonable opportunity to correct any inaccuracies contained in the background report.

            2.3-2        Verification of Information

(a)           The applicant is responsible for having signed letters of reference, a completed application, Board scores, Dean’s letter, and transcripts sent through ERAS by the application deadline.  The completed application is submitted to the ROWAN-SOM Office of Graduate Medical Education.  The Office of GME collects these references and documents sent in support of the application. 

(b)           The OGME – TR / RESIDENT/FELLOW designates to which program(s) the completed application should be sent.

(c)           When possible, the Office of GME will notify the applicant of any problems in receiving the information required. Upon notification, it is the applicant's obligation to obtain the required information. 

(d)           When collection and verification is completed, the Office of GME forwards a copy of the application to the Chairperson of the OGME program Selection Committee to determine individuals eligible for an interview.

(e)           The application file is confidential and may not be reviewed by unauthorized personnel of the University or the applicant.  Information submitted in support of an application for OGME – TR or Residency/Fellowship remains the property of the Office of GME and can not be forwarded/released to other parties, nor the applicant.

            2.3-3        OGME – TR / RESIDENT/FELLOW Selection Committee Action

                           The OGME – TR and Residency/fellowship Selection Committee’s are responsible for the following actions:

                           (a)        Review the application file and credentials.

                           (b)        Schedule and conduct an interview with appropriate applicants.

(c)           Conduct a selection process from among the candidates, indicating selections for admission to the OGME Training Program, and rank alternate candidates.  Make such recommendations to the Associate Dean for Graduate Medical Education.

            2.3-4        Associate Dean for Graduate Medical Education

                           (a)        Review recommendations of the OGME Selection Committee and make final selections.

                           (b)        The Office of Graduate Medical Education shall participate in the AOA Match Registration Program.

                           (c)        The Associate Dean for Graduate Medical Education will monitor the AOA Match process.

                           (d)        ROWAN-SOM contracts will be issued within 10 days after the AOA matching process is concluded. OGME – TR / RESIDENT/FELLOW must sign and return the contract within 30 days after receiving it. 

                           (e)        The Associate Dean for Graduate Medical Education will keep administrators apprised of the final results of the AOA Match.

ARTICLE THREE:  GENERAL QUALIFICATIONS

3.1        General Qualifications

            Every OGME – TR / RESIDENT/FELLOW who seeks or enjoys membership in the OGME Training Program, at the time of appointment and continuously thereafter, must demonstrate, to the satisfaction of the faculty, administration, and the Governing Body of ROWAN-SOM, the Medical Staff of the medical center, its administrative officials and Board of Directors, the following qualifications:

            3.1-1        Official Transcripts

                           Official, verifiable transcripts showing date of completion of D.O. degree requirements from an AOA accreditedSchoolofOsteopathic Medicine.

            3.1-1a      ACLS and PALS verification.

            3.1-1b      COMLEX results showing date and passing score on Part I and Part II CE and PE prior to matriculation from medical school.

            3.1-2        Performance

                           Continuing performance that documents medical competence and clinical skills to provide, under supervision, optimal achievable patient care.

            3.1-3        Attitude

                           A willingness and capacity, based upon current attitude and evidence of performance:

                           (a)        to work, relate to, and cooperate with other OGME – TR, RESIDENT/FELLOWs, students, medical staff members, members of other health disciplines, medical center management, and employees, visitors and the community, in a professional manner that is essential for maintaining a medical center environment appropriate to quality patient care; and

                           (b)        to adhere to generally recognized standards of professional ethics, including proper dress, demeanor, and conduct at all times.

            3.1-4        Restrictions

                           To be free of or have under adequate control any significant physical or behavioral impairment that might restrict or present a substantial probability of interfering with the qualifications required herein, such that patient care could directly or likely be adversely affected.

3.1-5           Obligations

                           Each OGME TR / RESIDENT/FELLOW shall:

                           (a)        Provide patients with care at the recognized professional level of quality and efficiency recognized as standard at the medical center.

                           (b)        Abide by these Rules and Regulations and by all other lawful standards, policies and rules as they now exist or as they may be amended.

                           (c)        Discharge such functions for which he/she is responsible.

(d)           Prepare and complete, in timely fashion, all required medical records for all assigned patients and all service logs and evaluations.

(e)           Log duty hours using the system identified by this training program.

                           (f)         Prepare and complete all forms required by this training program.

                           (g)        Be a member of the AOA and abide by the AOA Code of Ethics.

                                 (h)        Satisfy the educational requirements of the program.

      (i) Sit for Comlex Part III during the OGME – 1 training year.

(j)                     Follow the directions of the attending physician, Program Directors, Track

               Coordinators, Chairpersons, Directors of Medical Education, Chiefs of  Service

                                    Office of Graduate Medical Education and all administrative persons responsible

                                     for the conduct of this program.

            ARTICLE FOUR: RESPONSIBILITIES OF THE RESIDENT/FELLOWS AND OGME TR STAFF/REQUIREMENTS OF AOA

            4.1 Provide responsible patient care under the authority of members of the medical staff to patients assigned to their service. The number of patients assigned to the OGME 1 shall not exceed an average of fifteen at a time during a given week.

            (a) Be immediately available to provide emergency care during the hours on duty (7:00

            a.m. to 5:00 p.m.) and night/weekend call unless otherwise specified by the Chief of Service. In addition to hours on duty, Monday through Friday night call is typically a 14 hour shift, and Saturday and Sunday weekend call and holiday call is typically a 24 hour shift.

            (b) Provide care for only those patients within the State of New Jersey for whom the OGME TR / RESIDENT/FELLOW is directly responsible as directed by the attending physician. The OGME – TR / RESIDENT/FELLOW may not provide care out-of-state without proper permission from ROWAN-SOM, licensure in that state, and training requirements of that state where service is being completed.

            (c) Examine all patients admitted to the service as soon after admission as possible, to

            determine immediate needs of the patient, and to assess the patient's condition.

            (d) Perform a complete history and physical examination, which includes an

            osteopathic structural exam, and record such on the chart of all patients assigned to

            the service.

            (1) Surgical patients prior to surgery.

            (2) Critical patients as soon as possible.

            (3) All others within 24 hours of admission.

            (e) Write a problem oriented progress note on the patient's chart on admission; daily

            thereafter, and more often as conditions demand.

            (f) Complete an osteopathic musculoskeletal examination on admission.

            (g) Write and review admission and daily orders on assigned patients only after review of

            such orders with the patient's staff physician.

            (h) Complete all other medical chart responsibilities on patients seen within 24 hours.

            (i) Complete all charting responsibilities by 3 p.m. on the date of discharge.

            (j) Conduct rounds on all assigned patients at the beginning of and conclusion of duty.

            (k) Properly report to peers or supervisors at the time of leaving duty and returning to duty

            to ensure continuity of care or at any time that a patient's deteriorating condition may

            warrant.

            (l) Date and time all materials recorded on the patient's chart.

            (m) Beeper numbers are to be under the RESIDENT/FELLOW/OGME TR's name. (Also OGME level if at OLLMC)

            (n) Complete all medical record responsibilities prior to proceeding to the next rotation.

            (o) Complete all logs and evaluations prior to proceeding to the next rotation.

            4.2 Conduct oneself in a professional manner at all times.

            (a) Abide by the Bylaws, Rules and Regulations, Policies and Procedures of the OGME – TR and RESIDENT/FELLOW Training Program, ROWAN-SOM, the Department, the medical center, the medical staff, the New Jersey Department of Health, State Board of Medical Examiners, and the

            Code of Ethics of the American Osteopathic Association as they currently exist and as

            they from time to time may be amended.

            (b) Accept patient care responsibilities and additional call (not to exceed the CIR contract

            limit) as assigned by the Chief of Service, Associate Dean for Graduate Medical

            Education, Director of Graduate Medical Education, Manager of Postdoctoral Training,

            other staff in the Office of Graduate Medical Education, or Chief Scheduling RESIDENT/FELLOW.

            (c) Dress Code: RESIDENT/FELLOWS/OGME TR’s are expected to maintain high professional standards of dress and behavior. Appropriate male attire includes shirt with tie, trousers (not blue

            jeans), and a white lab coat with name tag and identification badge. Appropriate female

            attire includes dresses, skirts or slacks with tops, and a white lab coat with name tag

            and identification badge. No sandals or open toed shoes are allowed. Scrub suits are

            the property of the medical center and are to be worn only when required in the medical

            center. Scrub suits are not to be worn outside the medical center unless RESIDENT/FELLOW/OGME TR's are specifically instructed to do so by the hospital.

            4.3 Provide clinical teaching and direct supervision to all students assigned to the Service.

            (a) Review, correct and approve all materials entered by the student on the appropriate

            history and physical form and progress record.

            (b) Specifically review all student-performed history and physical exams, editing and

            commenting on the recorded observations.

            (c) Constructively teach from clinical resources available on the service.

            4.4 Participate in all assigned quality assurance activities of the hospital or medical staff, and as

            specifically assigned.

            4.5 Attend assigned formal teaching programs and monthly OGME – TR / RESIDENT/FELLOW meetings with administrators of the Program.

            (a) Attend 100% of Core Lecture Series (OGME 1's only).

            (b) Attend 100% of the department formal education programs while assigned to the service.

            (c) Sign the official Housestaff Attendance Sheet at every program/meeting.

            (d) Remediate (by assignment of the Chief) any Core Lecture Series (OGME 1 only) not attended before the conclusion of the Internship Training Program.

            (e) Obtain excused absence from Chief of Service for any Departmental Formal Education

            Programs.

            4.6 Provide written documentation and obtain written approval from the Office of Graduate Medical Education for the following: (a) legitimate illnesses, (b) personal days, (c) compensatory days, (d)float days (including your birthday), (e) requests to attend conferences, CME programs, etc., which will require your absence, (f) changes in your rotation schedule, (g) changes in the on-call schedule, (h) other leaves or absences other than scheduled vacation weeks. Approvals must be made in advance. In the case of illness or personal tragedy, notification as possible is required. RESIDENT/FELLOW/OGME TR's must notify the Office of Graduate Medical Education in writing and in advance for the need of verification of malpractice insurance; verification of enrollment for loan deferments or permit/licensing information; or other similar requests.

            4.7 The OGME – TR / RESIDENT/FELLOW is responsible for completing the evaluation forms that are outlined in RESIDENT/FELLOW /OGME TR's Manual Appendices within the required time. These forms are needed for conducting periodic appraisals as well as graduation from the training program.

            Submit all reports on the quality of the faculty, quality of the training program, and registry of

            educational experiences (performance evaluations, program service evaluations and OGME – TR / RESIDENT/FELLOW clinical logs) on a timely basis.

            (a) Service/Faculty Evaluation by RESIDENT/FELLOW/OGME TR: Constructive critique by the OGME – TR / RESIDENT/FELLOW of the service and of the faculty. (TO BE COMPLETED AND RETURNED WITHIN FIFTEEN (15) DAYS OF THE LAST DAY OF THE ROTATION/BLOCK).

            (b) OGME TR (only) Log: A listing of all clinical patients seen during the rotation. (TO BE

            COMPLETED AND RETURNED WITH A SAMPLE H&P FROM THE ROTATION BY

            THE LAST DAY OF THE ROTATION).

            4.8 Give OGME – TR / RESIDENT/FELLOW Performance Evaluation Form to the attending physician on the service for evaluation of clinical performance. (To be given to the attending physician by the second week on the service and completed by attending physician within fifteen (15) days following completion of the service.) RESIDENT/FELLOW/OGME TR's are expected to follow-up with the attending to be sure all performance evaluations are received by the Office of Graduate Medical Education or their appropriate program director in a timely manner.

            4.9 OGME TR's / RESIDENT/FELLOW’s who are dissatisfied with the performance evaluation of their service rotation may appeal the evaluation. The OGME – TR / RESIDENT/FELLOW should first notify the Office of Graduate Medical Education of his/her request to challenge the evaluation. The GME staff will then inform the service attending of the RESIDENT/FELLOW/OGME TR's wish to challenge the evaluation and will make an appointment to discuss the evaluation with the attending physician and the OGME TR / RESIDENT/FELLOW. AN OGME – TR / RESIDENT/FELLOW who disagrees with an evaluation shall be allowed to submit written comments which shall become part of the evaluation and placed in the OGME TR's / RESIDENT/FELLOW’s permanent file.

            4.10 Requirements of AOA:

            (a) OGME TR's / RESIDENT/FELLOW’s must remain members of the AOA.

            (b) Outside employment or moonlighting is prohibited by the AOA and by the Committee of

            Interns and Resident (CIR) contract for all Interns.

            4.11 OGME TR's are released from service to attend the graduation ceremony. RESIDENT/FELLOWs are expected to attend as a requirement of the program only if excused by program director. Any excused absence must be approved by the Office of Graduate Medical Education.

            Failure to complete any of the responsibilities noted above can be considered as a first offense for Corrective Action as outlined in Section 9 of these Rules and Regulations and may lead to

            Suspension from the program for a second offense.

ARTICLE FIVE:  CHIEF OGME – TR’s / RESIDENT/FELLOW’s AND CHIEF SCHEDULING OGME – TR’s

5.1        Appointment

            Appointment of Chief OGME – TR’s and 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.

            5.1-1        The number of Chief OGME – TR’s / RESIDENT/FELLOWS will be determined by the Office of Graduate Medical Education.

            5.1-2        Appointments will be made within the first 15 days of the beginning of the training program.

            5.1-3        Chief OGME – TR / RESIDENT/FELLOWS will report directly to the professional staff in the Office of Graduate Medical Education / Residency Program Director.

            5.1-4        Chief OGME – TR / RESIDENT/FELLOW are members of the management team for the OGME year.

5.1-5           Chief OGME – 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 Regulations.

5.1-6           Chief OGME – TR will sign and abide by the Chief OGME – TR Agreement form.

5.2        Duties and Responsibilities of the Chief OGME – TR / RESIDENT/FELLOW and the Chief Scheduling OGME – TR

            5.2-1        The Chief OGME – TR / RESIDENT/FELLOW will:

                           (a)        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.

                           (b)        Meet with the Office of Graduate Medical Education staff regarding management of the program, information concerning trainees in the OGME program, feedback about the trainees in the OGME program, to discuss problems arising in the OGME training programs and to suggest changes that would benefit the OGME training programs.

                           (c)        OGME – TR’s will take attendance at Core lectures and meetings using the Housestaff Attendance Sheet. All Attendance Sheets should be returned to the Office of Graduate Medical Education at the Monthly Chief OGME  Meeting.

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

                           (e)        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 OGME  staff.

                           (f)         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 OGME  staff.

                           (g)        Oversee compliance on the part of the OGME staff with the procedural safeguards and Rules and Regulations of this program.

      (h)        Preside at all meetings of the OGME staff to discuss problems, inform 

            OGME staff on various issues and to offer the OGME trainees the opportunity to express and or discuss concerns.

(i)           Be responsible for and appoint members of the OGME staff to participate

            as assigned in quality assurance activities of the medical center and  medical

            staff, or the OGME  programs.

                           (j)         Review and enforce compliance with standards of conduct and professional demeanor among members of the OGME staff. Including: acting as a role model and assist in maintaining professional atmosphere, conduct, and attitude of OGME staff and clinical clerks, be able to problem solve and provide conflict resolution as appropriate, maintain strict confidentiality at all times.

                           (k)        Represent the OGME  staff at all organizational levels of interface with students, RESIDENT/FELLOWs, medical staff and administration/medical center departments.

(l)         Report problems at the medical center to the staff in the Office of Graduate Medical Education.

(m)       Assign on-call coverage from those OGME staff at the division if assigned OGME staff is ill, absent, etc.  The Chief OGME staff is not responsible for covering all such activities him/herself; the Chief should distribute assignments equitably and in regard to appropriate patient care.

(n)         Assist OGME staff in obtaining service/beeper coverage when OGME staff are

            on vacation, on ambulatory service, etc.

(o)         Provide technical assistance as needed for morning report and other

            educational functions that utilize the teleconferencing system.

(p)         Perform other related duties as assigned by the staff in the Office of Graduate

            Medical Education.

            5.2-2        The Chief Scheduling OGME staff will develop the OGME staff on-call schedule (weekends and nights) at least six (6) weeks in advance of the beginning of each new rotation.

5.3        Coverage

            5.3-1        There will be one Chief OGME – 1 or RESIDENT/FELLOW assigned for each rotation

                           at each division.

         5.3-2        Chief OGME – 1 or RESIDENT/FELLOW may be selected after individual schedules have been completed or by AOA Specialty College standards.  Therefore, if for any reason due to scheduling conflicts, personal leaves, or if there is disproportionate coverage, the following will occur:

                           (a)        An alternate Chief OGME – 1 / RESIDENT/FELLOW within the Division will be designated by the staff of the Office of Graduate Medical Education during the first month.

                           (b)        The relieved Chief OGME – 1 / RESIDENT/FELLOW will be absolved of the Chief OGME – 1 / RESIDENT/FELLOW duties during that month.

(c)           Chief OGME – 1 / 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.

5.4        Resignation/Removal from Office

5.4-1           A Chief OGME – 1 / 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.

            5.4-2        Removal from office may be initiated and implemented by the Associate Dean for Graduate Medical Education or the Director of Graduate Medical Education for the following reasons:

                           (a)        Failure to perform duties of the position timely and appropriately;

                           (b)        Failure to continuously satisfy the qualifications for the position; or

(c)           Failure to establish and lead by example of competency or citizenship

ARTICLE SIX:  FORMAL EDUCATIONAL PROGRAMS/MEETINGS

6.1        Academic Year

            The OGME – 1 2014-2015 academic year shall commence on Monday, June 16, 2014, at 7:00 a.m. and conclude on Monday, June 15, 2015 at 7:00 a.m.  The new residency year will commence on July1 , 2014

6.2        Orientation Programs

            6.2-1     An OGME - 1 Orientation Program will be conducted prior to the first day of OGME – 1 Internship.

                           (a)        The OGME - 1 will be notified in writing at least 28 days in advance of the dates and times of the orientation program.

                           (b)        OGME - 1 attendance is mandatory.

                           (c)        The OGME - 1 shall be responsible for transportation, lodging and other expenses incurred for the orientation program.

                           (d)        All incoming housestaff will be paid a one time fee, as described in the CIR contract, for attending the orientation program payable in July after all necessary University entrance requirements are fulfilled.

            6.2-2        Divisional Orientation - Each medical center will conduct an OGME - 1 Orientation at a time near the beginning of the first rotation on days preceding the starting date of the program.

            6.2-3        Service Orientation - Upon entering a new service for assignment, the OGME - 1 shall be oriented to the service.  The OGME - 1 should review the Objectives, Responsibilities and Evaluation sheet provided for each service.  (See attachments in this OGME - 1 Manual.)  The Chief of the Department (or his/her designee) is responsible for such orientations.

                           (a)        The OGME - 1 shall be responsible to contact and make appointment for such orientation at least 24 hours before the start of the service.

                           (b)        The Chief may delegate orientation responsibilities (Section Head, Chief RESIDENT/FELLOW, another attending, another RESIDENT/FELLOW, etc.), but shall be responsible for such arrangements.

                           (c)        The Chief will review the OGME - 1 Rotation Objective form with the OGME - 1.

            6.2-4        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

6.3        Formal Lectures

            6.3-1        Core Lecture Series.  The OGME - 1 training program shall include 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.  The OGME - 1 must attend all Core Lectures and sign the Housestaff 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.

6.3-2           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 OGME – 1 / RESIDENT/FELLOW is required to attend all such programs and sign the Housestaff 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.

6.4        Meetings

            The OGME – 1 / RESIDENT/FELLOW is responsible to attend all other meetings recommended by the University, Chief of Service, or medical center administration.  This includes the monthly OGME - 1 meetings at the division where the rotation is being completed.  The OGME - 1 must sign the Housestaff Attendance sheet as indication of participation at these meetings.

6.5        External Education Programs

            6.5-1        Official External Programs

                           (a)        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 OGME – 1 / RESIDENT/FELLOW training program, shall be attended by the OGME – 1/RESIDENT/FELLOWSHIP with the same attendance requirements as internal programs.

                           (b)        An approved portion of the training program that is conducted at another institution shall be attended by the OGME – 1 / RESIDENT/FELLOW with the same attendance requirements as internal programs.

            6.5-2        Non-Official Programs

                           Lectures, conferences, and other educational programs which are not an official part of the OGME – 1 / RESIDENT/FELLOW Training Program may be attended provided that:

                           (a)        Attendance is approved by the sponsoring organization.

                           (b)        Attendance is approved by the Attending Physician, Office of Graduate Medical Education, Chief Medical Officer, and Track Coordinator/ Program Director.

                           (c)        All expenses are incurred by the OGME – 1 / RESIDENT/FELLOW.

                           (d)        Acceptable peer-patient responsibilities are arranged and guaranteed by the OGME – 1 / 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

7.1        Standard Services

            The traditional rotating OGME – 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.
2. No less than two months of exposure in general internal medicine, and must be under the supervision of an internist.
3. One month exposure in emergency medicine at the base institution or an affiliate training site is required.
4. 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.
5. No more than three months of elective exposure adequate to meet the individual needs of the OGME – TR and approved by the internship program director.
6. All remaining time may be scheduled at the discretion of the base institution.
7. No more than one month may be spent in non-clinical experience (research, scholarly pursuits, administration, etc.).
8. 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 OGME - 1 logs. 

The family medicine, internal medicine, emergency medicine, general surgery, ob/gyn, general urology, otolaryngology and psychiatry OGME 1s will also comply with the standards established by the AOA.

7.2        Elective Services  (When applicable and if available)

            1.            The Track Coordinators, Office of Graduate Medical Education, and Chief Medical Officers will designate specific electives designed to provide appropriate educational experiences.

            2.            The OGME – 1 / RESIDENT/FELLOW may request one or more services he/she desires in the designated time period.

            3.            Electives are permitted only within the designated medical center.

            4.            The Office of Graduate Medical Education must approve the elective service, which must be an AOA-recognized service.

            5.            If an OGME – 1 / 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        Patient Care Obligations

            It is a clear premise of the ROWAN-SOM OPTI that both education and patient care obligations are of prime importance.

7.4        On Call

7.4-1           In-House Call: Nights, Weekends and Holidays

(a)        OGME – TR / RESIDENT/FELLOW will not leave the hospital while on call.

                           (b)        Call will be assigned from the full OGME – 1 / RESIDENT/FELLOW group not to exceed the number of calls allowed by the AOA Basic Standards and CIR contract with the University.

(c)           The staff in the Office of Graduate Medical Education, Hospital Director of Medical Education, Track Coordinator/Program Director, and the Chief OGME – TR / RESIDENT/FELLOW are empowered with the authority to assign OGME – 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)        Coverage assignments may not exceed those established in the CIR contract.

                                       (2)        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)           In cases of emergency, where it is deemed necessary for patient care standards to be met, the Chief OGME - 1, RESIDENT/FELLOW, the Chief Medical Officer, Track Coordinator/Program Director, and staff in the Office of GME have the authority to request an OGME - 1 not in-house to be on-call and to respond if needed.

(4)           All University and hospital duties and regulations regarding call must be adhered to strictly.

7.4-2           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 effect the educational aspects of the OGME - 1's / RESIDENT/FELLOW’s experience.

            7.4-3        Emergency/Unusual Situation

                           The Chief Medical Officer, Track Coordinator/Program Director, and Director of Medical Education have the responsibility of ensuring the educational experiences of the OGME – 1 / 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        General Medical Rules and Regulations

            7.5-1        Verbal Orders:  Protocol for voice orders is in accordance with individual hospital policy.

           7.5-2        Time/Date: Orders and other chart documentation will be invalid unless also dated

                           and timed

            7.5-3        Legibility:  Illegibly written orders are invalid.

        7.5-4        Signature: All materials written in a patient chart by an OGME – 1 / RESIDENT/FELLOW shall be signed by the OGME – 1 / RESIDENT/FELLOW including the beeper number and written on behalf of a licensed physician responsible for the case (Example: Dr. Attending / Dr. OGME - 1, Beeper #1234).

7.5-5        Sequence of Record:  All materials written on a chart will be written in appropriate sequence after the last entry.

7.5-6           Stop Order:  The OGME - 1 / 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           Informed Consent:  The OGME – 1 / RESIDENT/FELLOW will abide by the intent of the Informed Consent Policy and Procedure of the medical center.

7.5-8           “No Code" or "DNR":  The OGME – 1 / RESIDENT/FELLOW will abide by the intent of the Policy and Procedure of the "No Code Policy" of the medical center.

            7.5-9        Consultations:  An OGME - 1 shall not perform a consultation.  The OGME - 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 OGME - 1 in this request shall be directly supervised by the consultant.

7.5-10        First Associate for Major Surgery:  In elective major surgery, an OGME – 1 / 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        Invasive Procedures:  An OGME – 1 / 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        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        At Our Lady of Lourdes, all OGME – 1 / RESIDENT/FELLOW (registered practitioners) must clearly write their “OGME” status in addition to their officially recognized signature and title after every entry on every medical chart.  (e.g. “John Doe”, OGME - 1 Beeper #-----) OGME – 1’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.

ARTICLE EIGHT:  CONFIDENTIALITY, IMMUNITY AND RELEASES

8.1        Definitions

            The following definitions shall apply.

            (a)           Information: record of proceedings, minutes, interviews, records, reports, forms, memoranda, statements, recommendations, findings, evaluations, opinions, conclusions, actions, dates and other disclosures or communications whether in written or oral form relating to any of the subject matter specified in the Rules and Regulations.

            (b)           Representative:   an official of a medical school, Board of any medical center and any director, administrator, or committee thereof; a medical center Chief Executive Officer or his designee, a College/University or medical school faculty member, an officer of any clinical or academic training program, or any individual authorized by any of the forgoing to perform any specific information gathering, analysis, use or disseminating function.

            (c)           Activities: all acts, communications, proceedings, memoranda, statements, recommendations, findings, evaluations, opinions, conclusions, or disclosures performed or made in connection with this or any health care facility's or organization's activities.

8.2        Authorizations

            By submitting an application for admission to the OGME – 1 / RESIDENT/FELLOW Training Program, the OGME – 1 / RESIDENT/FELLOW:

            (a)           Authorizes representatives of the ROWAN-SOM and the medical center to solicit, provide and act upon information bearing on his/her training and qualifications.

            (b)           Agrees to be bound by the provisions of these Rules and Regulations.

            (c)           Agrees to be bound by the provisions of this article in the release of information by the ROWAN-SOM and medical center, as recorded during the OGME training program, and described in this Article as Activities and Information covered, to any agency requesting such information in accordance with his/her written consent.

            (d)           Acknowledges that the provisions of this Article are conditions to any application for OGME training programs.

8.3        Confidentiality of Information

            Information with respect to any applicant for OGME training submitted, collected or prepared by any representative of this or any other health care facility or organization, or medical staff, or medical school for the purpose of evaluating the candidate for acceptance to the OGME  Training Programs or for concurrent evaluation of the OGME candidate with regard to progress to fulfill requirements of graduation from the OGME Training Program, and as such information regards evaluation toward advancement toward further training or the documentation of competency to treat conditions or perform medical procedures, shall be confidential and shall not be disseminated to anyone other than a representative.  This information shall not be used in any way except as provided herein or except as otherwise required by law.  Such confidentiality shall also extend to information of like kind that may be provided by third parties.  This information shall not become part of any patient's records.

8.4        Immunity from Liability

            No representative of the University, medical centers, or medical staff and no third party shall be liable to an OGME trainee for damages or other relief by reason of providing information, including otherwise privileged or confidential information, to a representative of the medical centers or medical staff or to any other health care facility or organization of health professionals concerning an OGME  who is or has been a member of the OGME  staff, provided that such representative or third party acts in good faith and without malice and provided further that such information is related to the performance of the individual as it relates to attitude, knowledge and skills of the OGME staff, and is reported in a factual manner.

8.5        Activities and Information Covered

            8.5-1        Activities

                           The confidentiality and immunity provided by this Article applies to but is not limited to:

                           (a)        Periodic reappraisals for progress in the OGME Training Program.

                           (b)        Verifications of completion of the OGME – training program.

                           (c)        Application for further training in residency or fellowship fields.

                           (d)        State licensure boards.

                           (e)        Applications for appointments, clinical privileges, or specified service to this or other health care facilities.

                           (f)         Profiles and profile analysis.

                           (g)        Quality assurance activities.

                           (h)        Other medical center and staff activities related to monitoring and maintaining quality and efficient patient care and professional conduct.

            8.5-2        Information

                           The information referred to in this Article may relate to the OGME - staff's professional qualifications, clinical ability, judgment, character, physical or mental health, emotional stability, professional ethics, or any other matters that might directly or indirectly affect patient care.

8.6        Releases

            Each applicant for OGME training shall execute general and specific releases in accordance with the tenor and import of this Article, subject to such requirements, including those of good faith, absence of malice and the exercise of a reasonable effort to ascertain truthfulness, as may be applicable under the laws of this State.

8.7        Program Director Letters/Verifications

            The Associate Dean for Graduate Medical Education is responsible for signing Program Director Letters and verifications for KMH/OLL OGME – 1’s.  The OGME – 1’s must complete the request for Program Director’s letter and release for immunity form and submit it with the appropriate fee.  Requests must be made at least four (4) weeks in advance of the date the letter(s) are needed. See instructions for “OGME - 1 Program Director’s Letters” and “Authorization for Release of Information for OGME – 1 Program Director’s Letters” in the Appendices section of the Internship Manual.