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Resident and Fellow Policy Manual

Appendix 1 - Disciplinary Procedures and Appeals Policy:

These procedures are applicable to all residents and are intended to protect the rights of residents, patients, the training program, and to ensure fair treatment for all parties. The primary responsibility for defining the standards of academic performance and personal professional development rests with individual departments and program directors. In each program, there must be clearly stated bases for evaluation and advancement. At least semi-annually, each resident’s performance must be evaluated against these standards, and a written summary assessment prepared. This summary will document in some manner that it has been reviewed with the resident, and a copy shall be made available to the training program.  The written assessment will then become part of the resident’s record in both the program and Office for Graduate Medical Education.

DISCIPLINARY MECHANISMS

1. Immediate Termination: Immediate termination can occur if a resident puts patients, other health care professionals, employees or third parties at risk, or compromises the integrity of the program.  The bases for immediate termination include but are not limited to suspension or revocation of the resident’s license or permit; incompetence; misconduct; any conduct that has the potential to jeopardize patient safety or the quality of patient care, is disruptive of hospital operations, is a serious violation of URMC policy, is a serious violation of law or regulation, or is conduct constituting criminal activity. If the resident is terminated, his/her appointment shall end immediately and no probationary period is required. Residents who are terminated will receive one month’s salary and benefits in lieu of notice. Credit for training may be given in the event of any satisfactory performance prior to termination, per the guidelines of the individual board.

Reporting obligations related to conduct constituting professional misconduct is covered separately in the policy on Professional Misconduct.

2. Termination After Probation: When a resident’s performance is not commensurate with his/her appointed level of training, notification of the deficiencies must be made, in writing, to the resident by the program director with copies to the Associate Dean for Graduate Medical Education (ADGME). A plan to correct deficiencies, which includes the manner and time frame in which the deficiencies will be corrected, and the consequences of not correcting the deficiencies within the time frame, should be a part of this notice. There should, however, be a probation period of at least three months, which may be extended to a maximum of six months, before a decision is made to terminate a resident. A letter to the resident, which specifies the period of probation, must indicate the possible outcomes (full reinstatement to the program, continued probation, termination). In the case of termination, the end of the appointment is immediate and one additional month of salary is paid to the resident in lieu of notice. The resident is to be notified in writing of this action with a copy of the letter to the ADGME.

The resident does not continue to work after the notice of termination. Credit for training may be given for periods of satisfactory performance, per the guidelines of the individual board. If deficiencies in professional competence that may endanger patients arise during the probationary period, the resident may be terminated or suspended immediately (as described above) after consultation with the ADGME.

3. Non-Renewal of Contract After Probation:  In the event of non-renewal of a resident’s contract, at least four months notice prior to contract expiration should be provided to the resident. There should be a probation period of at least three months prior to a decision not to renew a contract.  If the end of the resident’s probation period is within four months of the end of the contract year, the fact that the resident is on probation will serve as notice that the contract may not be renewed if the probation is not remediated successfully.  The notice of non-renewal of contract will be made in writing to the resident with a copy to the ADGME. If the primary reason for the non-renewal occurs within the four months prior to the end of the contract, the program must provide the resident with as much written notice of the intent not to renew as the circumstances will reasonably allow. The resident will continue to work at his/her appointed level of training through the end of the contract period. Full credit for the year may be given to the resident at the discretion of the Program Director and guidelines of the individual board. In cases of non-renewal of contract, the trainee will be terminated at the end of the contract period. If deficiencies in professional competence that may endanger patients arise during the probationary period, the resident may be terminated or suspended immediately after consultation with the ADGME.

4. Delayed Promotion of a Resident:  If a resident has not met the program standards sufficiently in his or her current training level, the program may make a decision not to promote a resident to the next level of training.  These rules will also apply to a resident whose performance has been acceptable but who has not completed the required number of weeks of training during the contract period.  An official period of probation may or may not be indicated.

The resident should be notified of this decision as soon as circumstances reasonably allow, and in most cases 4 months, prior to the end of the contract year.  Exceptions to this timeframe would include performance issues that primarily arise within the final 4 months of the academic year.  If a resident is on probation, and the end of the resident’s probation period is within 4 months of the end of the contract year, the fact that the resident is on probation will serve as notice that the resident may not be promoted if the probation is not remediated successfully.

The notice of non-promotion should outline the remediation steps to be accomplished prior to the resident’s advancement to the next level.  The resident will be paid at his or her present level until they are advanced to the next level.  If the resident does not successfully complete the remediation plan, the process listed above for termination will apply.

5. Independent Evaluations: In order to determine an appropriate plan to address a resident performance problem, a program director, in consultation with the ADGME, may require an independent evaluation of a resident when the program director has a reasonable basis to believe that a resident’s performance is affected by an impairment including, but not limited to a medical, mental health or substance abuse problem. The purpose of the evaluation is to determine the resident’s ability to perform his or her clinical duties and responsibilities.  See also the Resident Impairment Policy.

6. Suspension:  A resident may be suspended from clinical activities by his/her program director, department chair or the chief medical officer of Strong Health. This action may be taken in any situation in which continuation of clinical activities by the resident may compromise URMC operations, the program, or the safety of patients, employees, the resident, or third parties.  Bases for suspension include but are not limited to potential threat to the safety of patients or others, quality of care concerns, a suspension or loss of the resident’s licensure, potential impairment of the resident, debarment from Medicare or other federal program, potential misconduct by the resident, or potential incompetence. A resident may also be suspended pending an investigation of an allegation of any of the above concerns.  At the discretion of the Program Director, the resident may also be offered a voluntary leave of absence pending investigation.  Such voluntary leave shall be for no longer than one week, at which time the resident will be automatically suspended unless the investigation has been completed and a decision favorable to the resident has been made. Unless otherwise directed by the program chair, a resident suspended from clinical services may participate in other program activities. Suspension may be with or without pay at the discretion of the program director. The resident must be notified in writing, with a copy to the ADGME, of the reasons for the suspension. The notice of suspension must be reviewed with the resident, who must sign and date indicating the material has been reviewed with him/her.

The resident may appeal the suspension to the Dean of the School of Medicine and Dentistry.  The resident must appeal the decision within 5 working days of the suspension by written appeal to the Dean.  The Dean shall make the final decision with respect to the appropriateness of the suspension.

Within 10 working days of a decision to suspend the clinical privileges of a resident, the program director must determine if the resident may return to clinical activities and/or whether further action is warranted including but not limited to counseling, warning letter, probation, fitness for duty evaluation, medical leave of absence, or termination. Written notification of the program director’s decision should be given to the resident with a copy to the ADGME.  If further investigation is needed before a determination can be made, the program director shall so notify the resident, but must complete the investigation within an additional 10 working days from the date of the suspension.  The resident must cooperate fully with the investigation.

Suspensions Related to Medical Records Documentation: See policy on delinquent medical records

Suspensions Related to Impairment:  See policy on impairment