ADVANCED Certifications
ACLS
All residents who are members of code teams at University Hospital, Central Arkansas Veterans Administration Health Care System, or Arkansas Children’s Hospital must maintain current certification in ACLS or its equivalent and supply a copy of the certification card to their Training Program Director. All residents who rotate through Baptist Medical Center or St. Vincent Infirmary must maintain current certification in ACLS. Certification in ACLS must be accomplished prior to beginning as a resident in the training program and maintained during residency training. Recertification costs for ACLS may be taken from the resident’s enhancement funds.
NRP
Family Medicine residents entering the program are also strongly encouraged to secure certification in Neonatal Resuscitation prior to the beginning of their training. A copy of the certification card should be submitted to the Program Director. If they are unable to obtain training prior to the Pediatric Nursery rotation, then they are required to complete this training during their nursery rotation.
Family Medicine residents are strongly encouraged to secure certification in Advanced Life Support in Obstetrics. A portion of the resident’s enhancement funds may be used for this training.
Chief Residents DUTIES
The following describe the duties expected of the Chief Residents of the Department of Family and Preventive Medicine. The Chief Residents’ performance will be evaluated by the Program Director who may also add other duties or responsibilities to the Chiefs’ activities as needed.
Advocacy and Resident Representation
1. Facilitates communication between the faculty and residents.
2. Provides input to the Program Director regarding any resident concerns.
3. Keeps the Program Director informed of resident/program/scheduling/rotation problems.
4. Assists junior-level residents with problems, as appropriate.
5. Fosters collegial relationships with other UAMS Residency Programs.
1. Participates in New Resident Orientation at the end of June and in December.
2. Serves as a role model and guide for other residents in their professional and ethical interactions with patients, families, staff and colleagues.
3. Runs, plans and organizes the weekly Board Review sessions.
1. One month prior to the beginning of the academic year, completes the resident call coverage schedule for the academic year ensuring that all residents are treated fairly, equitably and are in compliance with the ACGME 80-hour per week duty requirement.
2. Maintains the resident call schedule and ensures that there are no lapses in the schedule.
3. Develops the schedules for the monthly Journal Club and for the PPFP’s with the assistance of the Residency Coordinator.
4. Schedules noon conference “Chiefs’ Rounds”, as required.
5. Assists with scheduling the Theme Days.
1. Attends a chief resident leadership conference as assigned by the Program Director.
2. Develops the agenda and chairs the monthly Resident Meetings.
3. Attends department and residency meetings or chooses a PGY-3 designee after discussion with the Program Director. The meeting are as follows:
a. Monthly Update Meeting (1st Thursday)
b. Faculty meetings (2nd and 3rd Thursdays)
c. Residency Administration meetings (Wednesday AM)
d. Curriculum Committee (3rd Wednesday AM)
e. Designate resident for PMG meeting (Thursday PM)
4. Participates in UAMS GME functions/committees as required. In particular, the chief residents will:
a. Become voting member of the Residents’ Council
b. Attend Chief Residents’ meeting in May
5. Become involved in Arkansas Academy of Family Practice
a. Attend meetings
b. Attend Scientific Assembly during the summer, if possible
1. Participates in residency recruiting functions.
2. Attends recruiting parties and functions
3. Recruits fellow residents to attend recruiting functions
4. Takes resident applicants to lunch and interviews applicants
5. Participates in resident selection process
6. Calls resident applicants for screening/ recruiting
Department Activities
1. Takes part in interviews for faculty candidates as requested by the Program Director or Chairman.
1. Plans and promotes social and educational events for the residents.
1. The Chief Residents for the following year will be chosen in February of the preceding academic year.
2. The tenure of Chief Residents will be one year and will begin on May 1 of their PGY-2 year and continue until April 30 of the following year.
3. There will be two Chief Residents chosen for the year. Both will serve for the entire year. Allocation of duties will be determined by the Chief Residents or by the Program Director. The Chief Residents are responsible for all scheduling, attending all required department meetings and helping with resident problems. The complete list of duties is described in the policy entitled “Chief Resident: Duties”.
4. One of the Chief Residents selected will serve on GME Committees requiring a chief resident for the entire year. The other resident will be encouraged to run for the resident Board position of the AR AFP and/or the elected member of the Residents’ Council.
5. Selection to be made by the votes of the following:
The Program Director will also solicit input about the candidates from the following: Residency Coordinator, the FMC Clinic Management Team, and others, as appropriate. The Program Director has the final, deciding vote.
6. Those residents not eligible for election
7. All residents nominated and/or selected to serve must accept the responsibility of serving in the position and not be on any type of probation. The resident also must have scored in at least the 25th percentile, nationally, for their year on the In-Training exam that was given the preceding November.
CRITERIA FOR ADVANCEMENT OF RESIDENTS
I. Reappointment:
Educational appointments to the Little Rock Family Medicine residency program are for a term not exceeding one year. The resident agreement of appointment, which outlines the general responsibilities for the College of Medicine and the resident, is signed at the beginning of each term of appointment. Renewal of the resident agreement of appointment for an additional term of education is the decision of the Program Director and the Department Chair. Promotion to the next level of training is dependent upon the resident performing at an acceptable level and meeting the requirements for clinical competence for that post graduate year.
It is the intent of the Little Rock Family Medicine training program to develop physicians who are competent to the level expected of a new practitioner in the six areas below.
a. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
b. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
c. Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
d. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
e. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
f. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
Upon completion of training, residents will be eligible to sit for the American Board of Family Medicine certification examination with an ultimate goal of a 100% pass rate.
The criteria for advancement shall be based upon, but not limited to, the parameters listed below: Standards that apply to all residents:
1. Patient care: Participation in patient care and management on each rotation as documented by the faculty evaluation forms. Major performance deficits will be grounds for remediation, Academic Warning or Probation at the discretion of the Program Director. Attendance and behavior are also considered in evaluating performance.
2. Medical Knowledge: This competency will be evaluated via the following:
A. Annual testing by the American Board of Family Medicine. Based on the resident’s G-1, 2 or 3 percentile rank, the following standards have been set:
1. Performance at < 15 percentile
a. A study plan will be developed by the resident and be approved by both the resident’s advisor and the Program Director. The plan will be placed in the resident’s folder.
b. The resident would be required to provide written quarterly reports on his/her plan and review progress with his/her advisor. The advisor will notify the Program Director if there is evidence of noncompliance or inadequate progress with the plan.
c. Residents who do not comply with their study plan during two consecutive quarters will be placed on Academic Warning.
d. The residency staff will monitor resident compliance with completion of the reports and meetings with his/her advisor.
2. Performance at the 16 - 25th percentile
a. A plan of study will be submitted to the advisor by the resident.
b. At 6 months, a written, 1-page report will be submitted by the resident to his/her advisor outlining how the plan’s objectives are being attained.
c. The residency staff will monitor resident compliance with completion of this report.
B. Attendance at departmental academic conferences.
C. Contribution to the academic and scholarly mission of the department. Student and resident teaching, conference presentations and participation, as well as overall faculty assessment of resident performance, will be evaluated. Major performance deficits will be grounds for remediation, Academic Warning or Probation.
3. Practice-Based Learning and Improvement: Performance in chart audits and recommendations for improving patient care as evidenced by completion of the required quality improvement project.
4. Interpersonal and Communication Skills: Participation in videotape review of patient encounters with the behavioral scientist.
5. Professionalism:
A. Personal integrity, which includes strict avoidance of substance abuse, theft, lying, cheating, and unexplained absences. Unauthorized use of UAMS equipment and personnel for other than educational, professional, and patient care use is prohibited. Failure to follow this standard will be grounds for punitive action.
B. Compliance with all hospital and departmental record keeping and documentation requirements including response to pages, emails and flags. A pattern of lateness and noncompliance will be grounds for action at the discretion of the Program Director.
6. Systems-Based Practice: Practice cost-effective health care and resource allocation and partner with other health care providers to assess, coordinate and improve health care as evidenced by performance on the chart stimulated recall.
The following describes the roles and responsibilities of the Resident Review Committee, the Faculty Advisor, and the Attending Physician.
The Resident Review Committee is chaired by the Residency Program Director. It is composed of all Department faculty members and members of the FMC management team. It meets monthly and reviews the clinical and academic performance and progress of each resident at least biannually.
Faculty Advisor
The faculty advisor meets with the resident at least biannually to discuss performance evaluation. If serious deficits are identified in the resident’s performance, meetings with the faculty advisor will be more frequent.
Attending Physician
The resident will receive timely feedback and be advised of deficits in performance by each attending with whom he/she works. It is recommended that the attending physician apprise the resident(s) whom he/she is supervising of his/her performance at the midpoint of the rotation to allow an opportunity for improvement, if required.
The Residency Program Director with the advice of the Committee decides whether to promote a resident to the 2nd postgraduate year. Criteria include, but are not limited to:
1. Patient Care
a. Conduct the visit in a time-efficient and professional manner.
b. Identify the purpose(s) for the visit.
c. Develop appropriate biopsychosocial hypotheses that apply to the presenting problem.
d. Conduct a focused evaluation of the presenting problem (including history, physical examination, and laboratory/radiological procedures).
e. Appropriately prioritize the probable and potential diagnoses to ensure that attention is given to the most likely, most serious, and most readily treatable options.
f. Present a tentative management plan for the patient to the faculty preceptor.
g. Present a provisional and working diagnosis to the patient.
h. Arrange for follow-up of the current problem that fits the guidelines of current standard of care and/or attends to the special needs of the patient.
i. Completely document the patient care encounter in the medical record in a concise and legible manner following a problem-oriented format and using the SOAP notation.
j. Update the biopsychosocial problem list and medication list at each visit.
2. Medical Knowledge
a. Successful completion of 12 months of American Board of Family Medicine (ABFM)-approved family medicine residency training. The resident must receive a passing evaluation in all rotations and in the Family Medical Center.
3. Interpersonal and Communication Skills
a. Participation in videotaped patient encounters with review by the behavioral scientist.
b. Conduct an interview that fosters an adequate doctor-patient relationship within the context of the patient’s racial, socioeconomic and cultural status.
4. Professionalism
a. Develop a plan of action that attends to salient medical, psychosocial, family, cultural and socioeconomic issues.
b. Adhere to medical records completion policy for all institutions and clinics.
5. Systems-Based Practice
a. Bill patients fairly and appropriately for services rendered (in accordance with their insurance option), referring those who need financial assistance to appropriate business office personnel.
b. Make appropriate referrals to healthcare agencies or other organizations.
6. Practice-Based Learning and Improvement
a. Demonstrate knowledge of basic statistics and study design and its applicability to clinical practice.
b. Become familiar with the US Preventive Services Taskforce recommendations and how the rating scales are used to support the recommendations.
c. Be familiar with the health priorities in Healthy People 2010.
d. Show progressive improvement in quality improvement indicators as measured for the resident’s clinical practice.
The Residency Program Director with the advice of the Committee decides whether to promote a resident to the 3rd postgraduate year. Criteria include, but are not limited to:
1. Patient Care
a. Conduct the visit in a time-efficient and professional manner.
b. Implement a negotiated plan.
c. Inquire into and discuss sensitive issues that may impact on the execution of the negotiated management plan.
d. Incorporate the principles and practice of health maintenance into each patient care encounter, where appropriate.
e. Review the biopsychosocial problem list at each visit and attend to appropriate longitudinal issues.
2. Medical Knowledge
a. Successful completion of USMLE Step 3. Step 3 must be passed by the completion of PGY-2. Failure to do so will result in mandatory leave and placement on Academic Warning.
b. Successful completion of 24 months of ABFM-approved family medicine residency training. The resident must receive a passing evaluation in all rotations and in the Family Medical Center.
3. Interpersonal and Communication Skills
a. Conduct an encounter that recognizes the primacy of patient needs and treats the patient as an appropriately equal health care partner.
b. Demonstrate interviewing techniques and communication skills in videotaped patient encounters appropriate to level of training as judged by the behavioral scientist.
4. Professionalism
a. Conduct an interview in a manner consistent with the values of family medicine using appropriate verbal and nonverbal skills.
5. Systems-Based Practice
a. If indicated, assist the patient in arranging for appropriate medical and ancillary referrals that seek to resolve specific issues in the diagnostic or management arenas.
6. Practice-Based Learning and Improvement
a. Learn to carry out a scholarly review of the scientific literature on a clinical preventive medicine topic of importance to family physicians focusing on one clinical preventive topic.
b. Identify best clinical practices in one clinical preventive medicine area that the resident has selected as the focus of his/her study.
c. Carry out a chart audit on a preventive medicine topic making use of the Logician capabilities and applying “best clinical practices” guidelines to assess compliance with the area to be studied.
d. Review the scientific literature on strategies that have been attempted to improve clinical preventive care in the area being studied.
e. Report how the US Preventive Services Taskforce guidelines relate to the recommended preventive care being performed at the FMC for the topic being studied.
f. Compare the recommendations made for the topic being studied by the resident to actual practice patterns in the FMC.
g. Be able to make a scholarly presentation on a preventive medicine topic to a professional audience.
It is the sole responsibility of the Residency Program Director with the advice of the Committee to determine whether the resident has successfully completed the residency. Criteria include, but are not limited to:
1. Patient Care
a. Complete the tasks of the patient care session so that all necessary duties (including telephone messages, charting, administrative tasks, patient care) are accomplished in a timely, organized, and professional manner.
2. Medical Knowledge
a. Engage in activities that will foster personal and professional growth as a physician.
b. Successful completion of 36 months of ABFM-approved family medicine residency training. The resident must receive a passing evaluation in all rotations and in the Family Medical Center.
3. Practice-Based Learning and Improvement
a. Engage in continuing medical education activities that are influenced by interest, deficiency, and need.
b. Anticipate and recognize new curriculum necessary for future practice and advocate for needed reform in medical education.
4. Interpersonal and Communication Skills
a. Demonstrate the ability to conduct an interview and communicate effectively with patients in videotaped encounters as judged by the behavioral scientist.
5. Systems-Based Practice
a. Work together with clerical staff and nursing staff in a manner that fosters mutual respect and facilitates an effectively run practice.
b. Work together with partners, fellow family physicians, and subspecialists in a manner that fosters mutual respect and facilitates the effective handling of patient care issues.
c. Work together with other professionals on the health care team in a manner that fosters mutual respect and facilitates the effective handling of patient care issues.
d. At each patient care encounter, present yourself and the practice in a manner that will encourage the patient to select you, the practice, and family medicine in the future.
6. Practice-based Learning and Improvement
a. Demonstrate the ability to investigate, evaluate and make improvements in their patient care.
b. Appraise and assimilate scientific evidence and apply this evidence to their clinical practice.
II. Evaluation and Promotion:
During the training period, each of the above elements of competence will be assessed in writing on a monthly basis by faculty supervisors with subsequent review by the Program Director. Evaluation by patients, upper level FM ward residents, nursing staff and other paramedical personnel may be included at less frequent intervals. A resident will meet with the Program Director or faculty advisor twice a year to review his/her performance. Written evaluations of the resident will be reviewed and signed by the resident to indicate that he/she has seen the evaluations. The evaluations will be maintained in confidential files and only available to authorized personnel. Upon request, the resident may review his/her evaluation file at any time during the year.
Reappointment and promotion to a subsequent year of training require satisfactory ratings on these evaluations and other criteria indicated in the following chart:
|
PGY-1 to PGY-2 |
PGY-2 to PGY-3 |
PGY-3 to Graduation |
|
1. Acceptable progress in all required areas listed in I. above 2. Able to supervise PGY-1’s and students 3. Able to act with limited independence
|
1. Acceptable progress in all required areas listed in I. above 2. Able to supervise and teach lower level residents and students 3. Able to act with increased independence 4. Passage of USMLE Step 3 |
1. Competence in all areas listed in I. above 2. Able to act independently |
The resident may appeal an unsatisfactory evaluation from DFPM faculty by submitting a written request to appear before the FP Resident Review Committee meeting at the next appointed meeting time or as called by the Program Director. The Committee reviews a summary of the deficiencies of the resident, and the resident has the opportunity to explain or refute the unsatisfactory evaluation. After the review, the decision of the committee is final.
Unsatisfactory rotation evaluations will be reviewed by the Program Director and discussed with the evaluator by phone or in person. If the Program Director feels the evaluation is justified, the decision to fail the resident for the rotation is final. A failed rotation must be made up by repeating the rotation during elective months. Failure of more than one rotation or the repeated failure of the same rotation may be grounds for disciplinary action as discussed below.
Any action taken by the Program Director that may lead to resident non-reappointment or non-promotion will be in compliance with due process guidelines as per the policy of the Graduate Medical Education Committee (no. 1.300 Evaluation and Promotion).
At the completion of the training program, the Program Director prepares a final evaluation of the competence of the resident. This evaluation stipulates the degree to which the resident has mastered each component of competence. This evaluation verifies the resident has demonstrated sufficient professional ability to practice competently and independently. This evaluation remains in the program’s files to substantiate future judgments in hospital credentialing, board certification, agency licensing, and in the actions of other bodies.
III. Academic and other Disciplinary Actions (in compliance with UAMS COM GME policy on disciplinary actions):
A. Academic Warning Status: Will occur when a resident needs remediation not considered serious enough by the FP Resident Review Committee or Program Director to merit probation. If requirements are met satisfactorily, this status will be removed from the resident’s file.
B. Probation: Probation is defined as the trial period in which a resident is permitted to redeem academic performance or behavioral conduct that does not meet the standard of the training program. A resident may be placed on probation for any one or more of the following:
1. Failure to satisfactorily perform at conferences, rounds, clinic and ward rotations as assessed by the Department Faculty
2. Failure to score above the 15th percentile on the annual Family Medicine In-Training exam
3. Inability to pass Step 3 by the end of the PGY-2 year. Exceptions may be made by the Program Director on a case-by-case basis.
4. Receiving more than one unsatisfactory performance on the resident evaluation form as determined by the Program Director
5. Failure to comply with the policies and procedures of the training program, the GME committee, UAMS Medical Center or the participating institutions
6. Misconduct that infringes on the principles and guidelines set forth by this training program
7. Documented and recurrent failure to complete medical records in a timely and appropriate manner as defined in the DFPM medical records policy and medical records policies of all affiliated hospitals and clinics
8. When reasonably documented professional misconduct or ethical charges are brought against the resident, which bear on his/her fitness to participate in the training program.
When a resident is placed on probation, the Program Director shall provide specific remedial steps to the resident in a written statement within one week of the notification of probation. The statement will specify the period of time in which the resident must correct a deficiency or problem, the specific remedial steps and the consequences of non-compliance with the remediation. Based upon the resident’s compliance with remedial steps, the resident may be:
1. Continued on probation
2. Removed from probation
3. Suspended, or
4. Dismissed from the residency program
IV. Suspension:
Suspension is defined as a period of time in which a resident is not allowed to take part in all or some of the activities of the training program. A resident may be suspended from clinical or other activities of the training program for reasons including, but not limited to, any of the following:
1. failure to meet the requirements of probation.
2. failure to meet the performance standards of the training program listed above.
3. failure to comply with the policies and procedures of the training program, the GME Committee, the UAMS Medical Center, or the participating institutions.
4. misconduct that infringes on the principles and guidelines set forth by this training program.
5. documented and recurrent failure to complete medical records in a timely and appropriate manner defined as above.
6. misconduct or failure to meet ethical standards, which bear on his/her fitness to participate in the training program.
7. when reasonably documented legal charges have been brought against a resident which bear on his/her fitness to participate in the training program.
8. if a resident is deemed an immediate danger to patients, himself or herself or to others.
9. if a resident fails to comply with the medical licensure laws of the State of Arkansas.
If suspension is deemed necessary, the Program Director notifies the resident through a written statement, with a copy to the Associate Dean for GME, to include:
1. reasons for the action
2. specific and appropriate measures to assure satisfactory resolution of the problem(s)
3. activities of the program in which the resident may and may not participate
4. the date the suspension becomes effective
5. determination of leave with or without pay
6. consequences of non-compliance with the terms of suspension
7. whether the resident is required to spend additional time in training to compensate for the period of suspension and be eligible for certification for a full training year.
During the suspension, the resident will be placed on leave, with or without pay, as appropriate depending on the circumstances. At any time during or after the suspension, the resident may be reinstated with no qualifications, reinstated on probation, continued on suspension or dismissed from the program.
V. Dismissal
Dismissal is the condition in which a resident is directed to leave the training program, with no award of credit for the current training year.
1. Dismissal from the training program may occur for reasons including, but not limited to, any of the following:
a. failure to meet the performance standards of the training program.
b. failure to comply with the policies and procedures of the training program, the GME Committee, the UAMS Medical Center, or the participating institutions.
c. illegal conduct.
d. unethical conduct.
e. performance and behavior which compromise the welfare of patients, self, or others.
f. failure to comply with the medical licensure laws of the State of Arkansas.
g. inability of the resident to pass the requisite examinations for licensure to practice medicine in the United States.
2. If dismissal is planned, the Program Director shall contact the Associate Dean for Graduate Medical Education and provide written documentation of the situation, which led to the proposed action.
3. Immediate dismissal can occur at any time without prior notification in instances of gross misconduct (e.g., theft of money or property; physical violence directed at an employee, visitor or patient; use of alcohol/drugs while on duty; other illegal conduct).
4. When dismissal is being considered because of performance or conduct, the Training Program Director shall notify the resident in writing of the basis of the action, the proposed action, the requirements for the resident and timeframe for satisfactory resolution of the problem(s).
5. In the event the situation is not improved within the timeframe, the resident will be dismissed.
A resident involved in the disciplinary actions of probation, suspension and dismissal has the right to appeal according to the GME Committee policy Adjudication of Resident Grievances (no. 1.410).
Dictation: Following a patient visit to the FMC or College Station Clinic, all DFPM residents must complete their dictation within 24 hours of that visit. If the patient is seen on the last day of the week, the dictation must be completed by the first working day of the following week (e.g., Friday visit, dictation completed on Monday).
Completed dictation is defined as: 1) all notes dictated, OR 2) entering and signing a text note or completing and signing an encounter form in Logician within 24 hours of the visit.
Signing dictation and other reports: Once dictation, lab results or other reports have been entered into Logician, the resident will sign it within one (1) week of its placement in Logician. This electronic signature will attest that the provider has completed all chart documents and used standard clinic workflows. If a resident is on leave or on an out-of-town rotation, he/she has one (1) week to sign the dictation after he/she returns to active duty.
Consequences for Non-Compliance
UAMS, Arkansas Children’s Hospital, VA Hospital and other affiliated hospitals:
1. Resident will be notified in writing (e-mail) of chart deficiencies at any of the above stated hospitals. Resident will have two weeks to correct the deficiencies. If deficiencies are not corrected by that time, the following will occur:
a. The resident will be notified in writing of non-compliance of medical records policies. The resident will have two weeks from the second notification to complete all deficiencies and delinquencies at the hospital where medical records are incomplete.
b. If the resident does not complete medical records by that time, the resident will be placed on leave. The resident will remain on leave until all deficiencies are taken care of. A notation will be made in the resident’s file. The resident will be required to take vacation time or extend the residency by the amount of time that he/she was absent from the residency for completion of medical records. This policy will be in compliance with all American Board of Family Medicine and Residency Review Committee for Family Medicine requirements regarding time away from the residency.
2. All fines assessed to the department for any delinquent records in a resident’s name will be passed on to the resident. The money to pay the fines will be taken out of resident’s enhancement account. If the enhancement account for that year has been used, the fines will carry over to the next year. If the PGY-3 enhancement has been used, the resident will reimburse the department for the amount of the fines levied on the department. If the department is not reimbursed, the resident will not be allowed to sign-out and will not be given the letter of completion of the residency.
DFPM Medical Records:
1. Resident charts in Logician will be audited monthly at the same time every month. Res