Policy of the Graduate Medical Education Committee
Section: Educational Administration
Subject: Extramural Experience (Rotation)
Date Developed: 7/2011
Last Review/Revision: new
ACGME Requirements: Institutional I.A., I.C, I.D., II.B, II.D; Common I.B., II.A, II.B., II.D., IV.A.; V.A. , V.B, VI.A. through VI.G.; Centers for Medicare/Medicaid Services Hospital Non-Hospital DGME and IME July 1, 2009
The purpose of this policy is to outline the procedure for extramural experiences (rotations).
Extramural Experience (Rotation) – an experience at a site that does not operate as a stipend source for rotations in that program.
Extramural Required Experience (Rotation): an experience that is necessary when temporary or permanent issues cause a failure of available educational resources to meet program requirements.
Extramural Elective Experience (Rotation): must be a rare occurrence due to the lack of a stipend source, the necessity of a medical license, and travel and housing expenses. The resident must purchase personal malpractice insurance.
All extramural experiences must be approved by the finance subcommittee before they occur.
The receiving Program Director will forward the Extramural Rotation Fact Sheet and the rotation goal and objective to the GME Office by the second Monday of the month.
At the time the Extramural Rotation Fact Sheet is sent to the GME Director, the program directors signature and the signature of the person who has agreed to provide the funding should be present on the sheet.
The Extramural Rotation Fact Sheet is found at the end of this policy.
Any time spent at an extramural location for an experience which is not required under the Program Requirements, or which can be obtained through regularly available paid rotations/sources will be counted as resident’s vacation time.
The program director must administer and maintain an educational environment conducive to educating the residents. (Common Requirements II.A.)
The curriculum for the experience must be competency based, level specific, and delineate resident responsibilities for patient care. (C.R. IV.A.2, 4)
The clinical responsibilities for each resident must be based on PGY-level, patient safety, resident education, severity and complexity of patient illness/condition and available support services. (C.R. VI.E.)
There must be a sufficient number of faculty who are currently board certified in the specialty, and who devote sufficient time to instruct, supervise and evaluate residents at that location. (C.R. II.B., V.A.1.a); VI.D.2.)
The rotation must have written evaluations: faculty evaluate residents and residents evaluate faculty performance as it relates to the educational program. (C.R. V.B)
The program director must ensure the experience provides a culture of professionalism that supports patient safety and personal responsibility. (C.R. VI.A.5)
The Sponsoring Institution maintains responsibility for the quality of GME at all sites. (Institutional Requirement I.C.1.)
The institution and the program must jointly ensure adequate academic and financial resources to enable residents to fulfill the responsibilities of their educational programs. (I.R. II.B. and II.F.1.)
An extramural rotation may not occur at a hospital that receives CMS funding for residents if the resident on that rotation is using UAMS Medical Center as a stipend source.
If the experience is at a hospital, it should be Joint Commission accredited (I.R. I.D.1)
There must be a process to inform residents of and monitor compliance of educational and clinical practices, policies, and procedures in all sites to which residents are assigned. (I.R. II.D.3.)
Program directors should ensure that during the experience, residents demonstrate an understanding and acceptance of their personal role in the following:
assurance of their fitness for duty;
management of their time before, during, and after clinical assignments;
recognition of impairment, including illness and fatigue, in themselves and in their peers; under certain circumstances, the best interests of the patient may be served by transitioning that patient’s care to another qualified and rested provider.