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Policies

For further details, please refer to the Graduate Medical Education Trainee Manual and Benefit Guide, which can be found at the GME website:   http://www.gme.duke.edu

Compensation

All Duke University Hospital graduate medical trainees will receive compensation according to the Graduate Medical Education training level. See current stipend amounts.

Drug Free Workplace

Additionally, fellows are required to comply with the Federal Drug Free Workplace Act – for more information please refer to this website at:

http://www.dol.gov/elaws/drugfree.htm

Medical Licensure

All trainees are required to have either a full North Carolina State Medical License or a Residence Training License and must be registered with the North Carolina Medical Board.

Harassment / Sexual Coercion

Also outlined in the benefit guide is the Duke University Policy for House Staff Grievance and the Duke University Harassment Policy.  Duke University is committed to maintaining a bias-free environment for all members of the University community including freedom from harassment. Harassment is defined as the creation of a hostile or intimidating environment in which verbal or physical conduct because of its severity and/or persistence is likely to interfere significantly with an individual's work.

Sexual coercion consists of unwelcome sexual advances, request for sexual favors, or other verbal or physical conduct of sexual nature when submission to such conduct is made explicitly or implicitly a term or condition of an individual's employment, or submission to or rejection of such conduct is used as a basis for employment decisions affecting an individual.

The conduct alleged to constitute harassment or coercion under this policy should be evaluated from the perspective of a reasonable person similarly situated to the complainant and considering all the circumstances.

Individuals with questions or concerns may contact the Office for Institutional Equity (OIE) at 919-684-8222.  The harassment policy prohibits retaliation for filing a complaint.

Grievance

The grievance policy is intended to provide an additional, nonexclusive system of communication, exchange of information, and confidential concerns of individual Graduate Medical Trainees regarding their educational programs. Graduate Medical Trainees may contact their resident or faculty representative on the Institutional Committee for Graduate Medical Education, who have full access to the committee and any ad hoc committees necessary to explore and address Trainee’s concerns, complaints, or grievances not covered under the Corrective Action and Hearing Procedures for Associate Medical Staff of Duke University Hospital. Failure to resolve these issues at this level can be referred, in writing, to the Director of Graduate Medical Education (Designated Institutional Official) for further consideration and final resolution.

The names of the Graduate Medical Trainee and Faculty representatives will be made available to all Graduate Medical Trainees on an annual basis. Any records regarding these issues will have protected status of peer review.

Impairment

Graduate Medical trainees are at risk for all the health problems seen in the general population and are expected to function at a superior level as

trainees in medicine and as health care providers.  The supervision of their care provision and evaluation of their learning is complicated by the fact that their supervisors and evaluators are health care providers.

Role confusion can occur which interferes with both clear evaluation of performance and appropriate health care intervention for the trainee.

The policy, procedure and training program below are designed to enhance the quality of the Duke Graduate Medical Education program by providing guidance for handling issues of impairment of performance.

The Duke Office of Graduate Medical Education will address all cases of impaired performance among trainees in order to assure the safety of trainees and the safety of patients and co-workers. Impairment may result from physical and mental/behavioral health problems. Services to support confidential and constructive intervention to resolve impairments will be made available.

Supervisors of trainees will utilize the impairment checklist to evaluate trainees as appropriate.  Concerns arising out of the evaluation will be brought to the Graduate Medical Education Program Directors. Performance and/or behavioral concerns will be addressed with the trainee. Trainees will be encouraged to utilize the Personal Assistance Service (PAS) for employee assistance or Dean of Medical Education Counseling on a voluntary basis.  PAS is a free and confidential resource available to GME Trainees and immediate family members. PAS provides assessment, short-term counseling and referral. Clear expectations for improvement will be established in writing and evaluation will occur periodically.  Impairment concerns will be reviewed with Duke Employee Occupational Health and Wellness (EOHW) and/or the NC Physicians Health Program (NCPHP). With the concurrence of EOHW and/or NCPHP the trainee will be referred by Program Director for mandatory evaluation and removed from patient care responsibilities.  EOHW and/or NCPHP will evaluate the trainee and make recommendations for return to work to the Program Director and the Office of Graduate Medical Education.  Any trainee removed from any aspect of their training program for any reason must be returned to work through EOHW and the Office of Graduate Medical Education must be notified.

Most trainees are eager, productive learners and colleagues; however, some experience difficulties in learning and/or performance and may demonstrate behaviors that are inappropriate.  How these issues are addressed can have a substantial effect on a trainee's career and Duke's mission as an educational institution. The following suggestions can enhance successful resolution:

  • Consult with PAS. PAS is also a consultative resource for supervisors of trainees regarding how concern might be addressed.
  • Do not ignore, "push under the rug", or dismiss as a "bad day" inappropriate behavior. Address issues promptly to improve the outcome.
  • Document behaviors and incidents that create concern. Request co-observation with a colleague when possible.
  • Do not try to diagnose. Do not argue. Rather, discuss concerns i.e. specific behavioral terms and expectations for improvement.
  • Offer and encourage trainee to use available resources.
  • Establish clear, written expectations for improvement and an evaluation plan.

Manifestations of Impairment

  • Dramatic decrease in performance
  • Persistent or repetitive absenteeism/lateness
  • Mood swings
  • Interactional difficulties
  • Patient/colleague complaints
  • Disruptive behaviors
  • Medications missing from work area
  • Disappearances from work
  • Disordered thought
  • Alcohol on breath, other stigmata of drug use
  • Diminished physical appearance

Resources

Personal Assistance Service

2200 West Main Street, Ste 700

Durham NC 27705

919-416-1PAS (416-1727)

Personal Assistance Service (PAS) is the faculty/staff assistance program of Duke University. The PAS staff of licensed professionals offers assessment, short-term counseling, and referrals to help resolve a

broad range of personal, work, and family problems.  There are no charges for any service provided by the PAS staff.

Employee Occupational Health and Wellness

2200 West Main Street, Ste 600A

Durham NC 27705

919-684-3136/286-6000

Employee Occupational Health and Wellness (EOHW) provides evaluation of health issues that involve the safety of the work force and the safety of

patients, visitors, and products of Duke University.  EOHW services faculty and staff.

The North Carolina Physicians Health Program

The North Carolina Physicians Health Program (NCPHP) was established in 1988 by a collaborative effort of the North Carolina Medical Society and the North Carolina Medical Board to help impaired physicians. The NCPHP is set up to identify troubled physicians, get them the appropriate treatment and return them to the productive practice of medicine.

Impairment can be caused by alcoholism/chemical dependency, psychiatric disorders, disruptive behavior, professional sexual misconduct and severe stress. Anyone who feels that they themselves or a colleague possibly has an impairment problem can seek assistance anonymously and confidentially by calling the NCPHP at 1- 800-783-6792.

Resident Fatigue and Stress

Recognizing that residents can suffer from fatigue and stress, the Vascular Surgery Residency Program does the following to minimize fatigue and stress:

  • Adheres to specialty specific duty hour requirements,
  • Minimize prolonged work (> 24 hours of clinical duties),
  • Protects periods designed to address sleep debt ( i.e. the minimum of at least 24 hours off each week free from all clinical responsibilities)
  • Reduces non–essential tasks and enhance learning during clinical time,
  • Reduces non–essential interruptions (i.e. added ancillary services, triage of phone calls by charge nurse etc)
  • Assists residents to identify co–existent medical issues which impair their sleep (i.e. undiagnosed sleep disorder, depression, stress),
  • Educates regarding awareness and management of fatigue
  • Critically appraises the best way to implement shift work.
  • Provide napping resources
  • Explore options with residents to return home safely

The program director directly asks about issues pertaining to getting adequate sleep, resident safety such as concerning post–call driving, and resident concerns about the balance between professionalism and work hour restrictions.

Duke's free and confidential Personal Assistance Service is available free of charge to the residents to assist them in dealing with the stressers in their life, http://hr.duke.edu/pas/

Leave of Absence, Vacation, Academic Conferences

At the time each Graduate Medical Trainee requests a Leave of Absence (LOA), a LOA form will be completed and signed by the Business Manager, Program Training Director and the Trainee. The GME

Trainee must provide 30 days advance notice of the need to take FMLA when the need is foreseeable. When 30 days notice is not possible, the Trainee must provide notice as soon as possible. The Trainee

will be informed of what effect the leave will have on the completion of training. The form will then be sent to the Office of Graduate Medical Education for the DIO’s signature. The following is a list of possible leaves for Graduate Medical Trainees:

  • First Year at Duke Leave (FMLA)
  • Family Medical Leave (FMLA)
  • Military

No FMLA can be longer than 12 weeks. If additional time is needed the trainee must resign from their training program and reapply. Upon acceptance to the program, the trainee must complete all incoming registration requirements

The Surgical Critical Care fellow is allowed up to 3 weeks of vacation over the course of the 12 month period.  This should be scheduled and coordinated with the Program Director.

The fellow is permitted to attend one academic meeting during the year.  All travel must occur in the U.S.  Fellows are encouraged to be academically productive and will be granted additional meeting time for approved meetings where they have an abstract accepted.  The Program Director will determine if the conference is an approved conference pertinent to surgical critical care.

Work Environment

The Duke University Fellowship in Surgical Critical Care is designed to provide consistent and outstanding didactic, clinical, and technical education to the Critical Care fellow. The guiding principle to achieve these goals is to establish and maintain a work culture ensuring the safety and well-being of our patients. The attending intensivist ultimately assumes responsibility for the care of the patients in the Intensive Care Unit, and direct supervision of the residents and fellows is ensured by scheduling the intensivist’s primary activity to cover the SICU. At no time are the residents or fellows left alone, without attending consultation or backup, to manage critically ill patients. Because of the 24/7 in-house attending intensivist coverage, which was instituted in 1998, supervising faculty are always available on-site to cover emergencies, consultations, and to address patient care issues.  

While patient safety and patient care issues take priority, the learning objectives of the fellowship training program are not compromised by excessive reliance on fellows to fulfill service obligations. There is adequate time allotted during the week to provide didactic and clinical education, as outlined above. The lack of an in-house call requirement for the SICU Fellow also provides the fellow with ample time for self-directed learning opportunities.

Evaluation

Periodic and formal evaluations are conducted to assess the performance of the Surgical Critical Care fellow, the Fellowship Training Program, and the Critical Care faculty.

 A.  Fellow

The Surgical Critical Care Fellowship Program at Duke University utilizes a 360-degree assessment tool. This includes self-assessment by the fellow, faculty evaluation of the fellow, nursing and ancillary staff evaluation of the fellow, and housestaff evaluation of the fellow. The self-assessment evaluations are self-confidence ratings in a number of areas relative to critical care that are conducted at the beginning and at the end of the academic year. Assessments by faculty, nursing, ancillary staff, and housestaff are conducted quarterly while the fellow is on the SICU rotation, and include a summary of the fellow’s performance, technical abilities, and achievement of the ACGME competencies in patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice. The fellow is evaluated by the supervising physician while on non-SICU or elective rotations.

In March, the fellow also takes the annual standardized examination in critical care (MCCKAP exam – Multidisciplinary Critical Care Knowledge and Assessment Program), which is paid for by the program and sponsored by the Society of Critical Care Medicine. The results of this exam are reviewed with the fellow and provide a framework to address deficiencies or weaknesses in specific areas of critical care.

Semiannual written evaluations of the fellow are performed by the Program Director and communicated with the fellow in real time. An evaluation occurs at the mid-cycle of the training program, and a final evaluation occurs during the final month of the training period. Both of these evaluations are part of the fellow’s permanent record maintained at Duke University. The final evaluation should verify that the fellow has demonstrated sufficient professional ability to practice competently and independently without direct supervision.

B.  Program

The educational effectiveness of the Surgical Critical Care Fellowship Program is evaluated on an annual basis. A formal meeting that includes the Critical Care faculty, Program Coordinator, and fellow is convened mid-cycle of the academic year. The goals and objectives of the program are reviewed, assessments as to the attainment of those goals are made, recommendations for curriculum changes are considered, performances of recent graduates of the training program on the Critical Care Board Exam are reviewed, and the performance of the current Critical Care fellow is assessed.

The Critical Care faculty, as well as the fellow, also provide confidential, yearly written evaluations of the training program to assess the educational effectiveness of the program, the curriculum, and the teaching abilities and quality of the faculty. These evaluations are used by the Program Director to make modifications to the training program to enhance its overall effectiveness.

C.  Faculty

The Critical Care fellow provides confidential written evaluations of the Critical Care faculty at least once a year. Evaluations of the faculty by rotating housestaff in the Departments of Surgery and Anesthesiology are also utilized. These evaluations include the teaching ability of the faculty member, medical knowledge, professionalism, scholarly activities, and commitment to the educational program. Feedback is provided to the individual faculty members at the annual Critical Care faculty meeting. The Program Director reserves the right to re-appoint Critical Care faculty on an annual basis.