UCSF Department of Family and Community Medicine
UCSF/SFGH Family and Community Medicine Residency Program
POLICIES & PROCEDURES
EVALUATION
Decisions regarding advancement and promotion of residents are made with input from various sources: evaluations, faculty advisors and faculty members. Residents’ performance will be assessed twice yearly by the program’s “Clinical Competence Committee,” a committee of residency program faculty members. Each resident is expected to review the committee’s evaluation with his or her faculty advisor twice yearly.
Evaluation will comprise information gathered from direct observation, videotape review, rotation evaluations, feedback to the director, and written examinations (National Boards, Flex, In-service exams, e.g.).
Residents will be expected to participate in all aspects of the curriculum, as well as in the periodic evaluation of the faculty and program components.
The following competencies (demonstrated, specific knowledge, skills, and attitudes) will be used as advancement criteria. Illustrative examples are included:
Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
· Maintaining continuity of care for your panel of patients.
§ Visiting them when they are in the hospital, documenting your visits in the medical record, and communicating with the appropriate inpatient physicians about their care so that you are actively involved in their management
§ Answering voice mail and other messages in a timely manner
§ Reviewing clinical data in a timely manner
· Maintaining current medical records—chart notes, problem lists, and medication lists, dictations, discharge summaries
· Reviewing patient care with supervisors, including chart reviews and reviews of videotaped sessions
· Procedural competence and experience; documentation of procedures through E-Value
· Integrating family, social, and cultural systems into patient assessments
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.
· Demonstrated critical thinking in clinical situations
· Application of basic clinical sciences in the evaluation of diagnostic and treatment options
Practice-based Learning and Improvement that involves investigation and evaluation of a resident’s own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.
· Review of clinical feedback from the medical directors regarding your practice (e.g. Patient profile database, Diabetes Care, preventive services)
· Through Patient Conferences, Journal Club presentations
· Participation in Team Meetings, Medical Staff meetings
Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals.
· Clear, systematic presentations
· Appropriate use of consultation
· Review of videotaped patient visits
Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
· Performing evaluation of curriculum and rotations in a timely manner.
· Incorporation of feedback from evaluations and Advisor-Advisee meetings into development of individual learning objectives
· Behavior that demonstrates respect, compassion, dependability, and integrity
· Maintenance of confidentiality in the care of patients
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.
ADVANCEMENT
At each level of promotion, acceptable competence and progress will need to be documented.
At the PGY1 level, residents will be expected to demonstrate skills in data gathering and organization, basic medical knowledge, clinical insight, and critical thinking. At the conclusion of this year, residents will be expected to have acquired enough skills to prioritize clinical problems and assume a team leadership role.
At the PGY2 and PGY3 levels, residents will be expected to make independent decisions based on previous clinical experiences. Residents will be expected to develop the ability to recognize and manage clinical scenarios not previously encountered.
At the PGY3 level, residents will further demonstrate mastery of a large set of special skills and will demonstrate the ability to practice independently.
Residents are eligible to sit for the American Board of Family Medicine Certification Examination only after successfully completing the training requirements of the American Council on Graduate Medical Education and the requirements of the UCSF/SFGH Family and Community Medicine Residency Program.
Our program follows guidelines for Academic Due Process as set out by the University’s Graduate Medical Education (GME) Committee’s Policy, which can be referenced at their website: http://medsch.ucsf.edu/gme. It addresses issues related to promotion, each department’s determination of clinical competence, and an overall approach to unacceptable conduct in a variety of categories including:
· Incompetence, dishonesty, inadequate knowledge or ability to perform professional activities, complete assigned duties, and deliver proper medical care
· Failure to improve performance in an identified area
· Conduct that violates professional and/or ethical standards and/or the law, including intellectual dishonesty or cheating in scientific or scholarly activities
· Failure to fulfill any term of the employment contract or comply with rules or policies of the training program, university, or training site
· Disruptive behavior; forcible detention, threats of physical harm to, or harassment of another member of the UCSF community
· Unauthorized use of UCSF resources or facilities on a significant scale for personal, commercial, political, or religious purposes
VACATION LEAVE
You are allotted four weeks of vacation per year, i.e., 20 days away from your regular Monday through Friday responsibilities. There is no time allotted in the residency for educational leave. Other programs schedule three weeks of vacation leave and one week of educational leave, and you have the option of using your time this way.
Personal days (days taken for weddings, unscheduled holidays, graduations, reunions, leaving for vacation on a Friday to get a better fare) may be arranged with two important stipulations:
X You must give at least TWO MONTHS notice
X Your vacation leave will be shortened by the number of personal days taken
Exceptions to this policy include family leave, parental leave, and sick leave. In these situations, we will follow published University policies. UCSF House Staff Policies are available on line via http://www.som.uscf.edu/gme/education/hsbooklet/index.htm.
JURY DUTY
The University and the Residency Program understand that jury duty is an important civic responsibility, and it is our intention to support you in your service. University policy mandates that you continue to be paid while on jury duty.
That said, we have found it possible to postpone your jury service until after you complete residency training by sending an explanatory letter to the court clerk. If you get a jury summons, please take it to Jill as soon as possible and she’ll work on getting your postponement.
REFERENCE
UCSF Graduate Medical Education Moonlighting Policy (09/20/2004) (http://medschool.ucsf.edu/gme/).
POLICY AND RATIONALE
Moonlighting is not allowed by the Residency Program and Department.
Residency education is a full-time endeavor, and residents must not engage in activities that interfere with their ability to achieve the goals and objectives of the residency program, may result in fatigue that adversely affects learning or patient care, or are not consistent with GME Duty Hours Policies
In keeping with the UCSF GME policy, our Department’s policy applies to all residents. The department does not have any ACGME fellows.
PROCESS
Residents will obtain a copy of this policy during the initial orientation to the residency program, and it will be available on-line on our Program’s web page.
Any resident who does not comply with this policy will be subject to disciplinary action, consistent with established UCSF GME Academic Due Process Policies http://medschool.ucsf.edu/gme/coordinators/policies/AcademicDueProcess/index.asp
REVIEW
This policy was reviewed at a Family Medicine Residency Program Advisory Committee (RPAC) meeting on January 19, 2005. Copies were distributed electronically to all residents and faculty members. It was approved by the Department on February 4th, 2005. It was approved by UCSF GMEC February 14, 2005.
The policy will be reviewed by RPAC periodically. Any changes in policy will be submitted to UCSF GMEC for approval.
REFERENCE
UCSF Graduate Medical Education Housestaff Information Booklet
POLICY AND RATIONALE
Residency education, because of its intensity, can be physically, emotionally, and professionally demanding. Residents benefit from having ready access to information and resources that will support their well-being and help them cope with difficult situations related to the work/educational environment or to other life stressors.
While the development of a generally supportive culture is the overarching goal, specific attention will be devoted to monitoring and support for:
· Fatigue
· Depression
· Professional tensions, both internal and interpersonal
· Family distress
· Professional development and fulfillment
· Career planning
PROCESS
Each resident will be assigned an advisor/mentor at the beginning of training. The resident and his/her advisor will meet a minimum of twice yearly and document these meetings. Meetings will emphasize different areas as the resident’s training progresses and will serve as the main point for educational planning.
Each resident will work with a group of clinical faculty members (linkage faculty) during the first year of training. These faculty members are primarily responsible for supervision of the resident’s clinical development and for facilitating his/her integration into the Family Health Center and clinical practice.
First-year residents will participate in a confidential support group led by the chief residents.
During annual orientation sessions, the program director will review with residents:
· The role of faculty members and chief residents in monitoring for fatigue, depression, and professional tensions
· The role of the advisors in supporting residents through stressful professional and personal stressors and in guiding professional development
· The role of the program director and associate directors in helping to provide resources and referrals when needed
· The department and university policies regarding duty hours, fatigue, leaves of absence, grievance policy, and goals for facilitating a work environment free of violence and harassment
The program director will review responsibilities and expectations for faculty advisors/mentors and this policy at faculty meeting annually.
REVIEW
This policy was reviewed at a Residency Program Advisory Committee (RPAC) Meeting on February 10, 2006. Copies were distributed electronically to all residents and faculty members. It was approved by the department on February 16, 2006.
REFERENCE
UCSF Family and Community Medicine Residency Program Well-Being Policy
POLICY AND RATIONALE
General: Resident back-up is a system by which residents provide coverage for one another in order to ensure that we fulfill the program’s responsibility for patient care, resident well-being, and patient safety; it applies to our service (Family Health Center, Inpatient Service, Labor and Delivery), other services through which residents rotate, and all years in training.
Description: Back up is meant to cover resident duties in the event of illness, family emergencies, or fatigue; to guarantee patient safety; and to ensure that residents can fulfill educational requirements (e.g. attending continuity deliveries, sitting for the In-Service exam, participating in the ALSO course, and complying with duty hour policies).
The back-up process can be initiated (by paging the Chief Resident) by any family medicine resident or by one of the program directors.
· One R2 and one R3 (a.k.a. R2 and R3 back–up) alternate any nighttime back-up duties. The R2 is called in first. Both the R2 and R3 must be readily accessible by pager and able to begin their duties within 45 minutes.
· A second R3 (a.k.a. reserve back–up) also has back-up responsibilities and is reserved for instances where the above residents’ coverage exceed any of the duty hour policies. In the event that the R3 Reserve will be needed (e.g., R2 and R3 have been called in within 24 hours of each other), the Chief Residents will notify him or her (by pager) as soon as possible. The R3 Reserve resident may also call the Chief Resident to inquire about current backup status at any time.
· R2s and R3s on block are scheduled for half-days of back-up during daytime administrative hours (a.k.a. back–up admin). They will be notified in the event back-up is needed during daytime hours.
All back-up coverage duty is scheduled by the Chief Residents in consultation with the program directors. In general, they are guided by the following principles: complying with duty hour policies, maintaining continuity of patient care, and respecting educational activities. As an example, when a resident’s coverage responsibilities go beyond 11:30pm, his/her afternoon responsibilities the following day will be cancelled or covered by another resident (duty hours); he/she will be expected to fulfill any morning responsibilities (continuity, educational). As a second example, no resident will be asked to be on call more than every third night.
Because in a program of our size, we cannot anticipate every contingency, situations that fall outside these guidelines will be reviewed by the Chief Residents, who will, with input from the program directors, have discretion over any decisions.
In the event of a prolonged absence, the Chief Residents and program directors will plan for extended coverage in collaboration with the residents involved.
In the rare event that back-up is needed beyond those residents specifically scheduled for back-up coverage, residents on non-call, elective rotations, and regular administrative time will be required to provide coverage at the discretion of the Chief Residents and program directors.
PROCESS
Residents will obtain a copy of this policy during the initial orientation to the residency program, and it will be available on-line on our Program’s web page.
REVIEW
This policy was reviewed at a Family Medicine Residency Program Advisory Committee (RPAC) meeting on December 8, 2006. Copies were distributed electronically to all residents and faculty members. It was approved by the Department on December 14, 2006.
The policy will be reviewed by RPAC periodically.
REQUIREMENTS
· To apply for your license, you must have already passed USMLE Step 3.
· You must have a license by the end of your R2 year.
· UCSF sponsors a “licensing fair” usually twice during the fall. If you’re applying for your license then, and are on block, you can take care of a lot of it there with one-stop shopping (eg photos, fingerprinting, notarizing). If not, follow suggestions below for where/how to get it done.
USMLE STEP 3
Signing Up
This is a two-day exam, and you get can details about when/where/how much they take you for at: www.usmle.org
Preparing Your Application
On the website listed above, there’s an online application you will download. After you fill it out, you’ll then need to make a copy of your medical school diploma. You’ll also need to get a couple passport-sized photos taken. You might as well get two extra because you’ll need them for your license application as well. Two places near SFGH to do this are:
· Sapphire 1Hr Photo: 2761 Mission Street, between 23rd & 24th Streets, Ph: 285-8678
· Foto Video, Mail & More: 2417 Mission Street, between 20th & 21st Streets, Ph: 695-9999
Once you have all that taken care of, bring the application, photos, and diploma (original and copy) to Jill Thomas, who can notarize the application for you.
Scheduling Your Test Date
About six weeks after sending in your application, you’ll get a permit to schedule your test. If you take it as an intern, it must be during MSM, Geriatrics, EBM, or vacation. In truth, it’s easier if you look into a date during second year, during your first set of block (outpatient) months. After you’ve gotten your ticket in the mail, pause…and before officially scheduling your test dates, do these next steps:
· Look at AMION. Are you on L&D or back-up on the dates that you’d like to schedule your test? If yes, then those dates will not work. Keep looking. Don’t forget to look at the day before also! For example, if you’re test is Tues and Wed, make sure you’re not on back-up Mon night. If you are on back-up and would still like to schedule your test for those dates, it is your responsibility to arrange trades to ensure adequate coverage.
· Once you’ve found two days during block where you’re not on call and that USMLE also has available (challenging sometimes, I know), please submit a goldenrod +/- email the chiefs and Ebony with your proposed dates so that your clinics can be held ASAP. Please cc the chief’s email on all emails to Ebony about scheduling requests (even those unrelated to USMLE). It’s fine to schedule those dates with USMLE to hold them while everything is confirmed, but please be aware that you are not guaranteed to be excused until it’s been cleared by the chiefs and Ebony. You can make changes up to five days prior to the test without penalty.
· Once the goldenrod is submitted, feel free to check in with us if you haven’t heard back, but we will be as timely as possible in responding. At least eight weeks notice is required to avoid having to alter block and clinic schedules and reschedule patients.
Preparing for the Test
When your dates are confirmed, sit back, and relax. You’re going to do great! You’re already a step ahead of the majority of other residents since you see it all on a daily basis. The only preparation you need is to review the practice materials they send you when you sign up. This will get you accustomed to the format of the exam, which is different from Steps 1 and 2.
CA MEDICAL LICENSE
Fingerprints
You first need to obtain a “Live Scan” application form from the CA medical board. Go to: http://www.medbd.ca.gov/applicant/Index.html for more information. Once you’ve filled that out, you can figure out the location to get the fingerprinting done that’s most convenient for you. There’s a list on the CA medical board website, listed by county (we’re in SF county): http://www.medbd.ca.gov/applicant/Index.html. Once you’ve identified the place, call to set up an appointment and be sure to bring payment and the application with you. They’ll send in the results to the medical board and give you copies of the Live Scan form to send in with the rest of your license application materials. You can do this while you’re waiting for your Step 3 scores, if you want. You can also do this at one of the UCSF GME Medical Licensing Fairs.
Online Application
Go to the CA Medical Board website, http://www.medbd.ca.gov
Under the Applicants section, first click on Online Payment Application. This will allow you to create an account and pay the “reduced” application fee with a credit card online—be prepared, it’s a staggering amount. (See details at end of document for how to get a 50% reimbursement from the City and County of SF). Next, under the Applicants section, click on US/Canadian Medical Graduates section for the download-able application, accompanied by detailed instructions. A few notes about the multiple forms involved, adapted from the UCSF Internal Medicine resident website:
Form L1A-L1D: Since you already filled out the online application, the most important part of this form is Form L1D. You'll need to get passport photos again and get your form notarized by Jill Thomas.
Form L2: This form goes to your medical school. Fill it out completely and then send it to your medical school registrar along with a photocopy of your medical school diploma. Also attach a letter to your registrar letting them know that they need to do the following:
1. Fill out the form
2. Put their official seal on the form
3. Put their official seal on the copy of your diploma
4. Attach your transcript
5. Send it back to you (in a sealed envelope) or directly to the Medical Board
of California.
I would suggest doing this as early as possible because it takes a while for your medical school to get all of this together. You should not send in your actual diploma to the medical board, a copy with your school’s official seal is sufficient. You might want to include a pre-addressed envelope as well.
Form L3A: This form goes to your Residency Program Director. Fill it out completely and then put it in Teresa or Jill’s box. They will fill out and sign the appropriate parts and then send it to the GME office and then send it back to your Program Director's office who should then notify you that it is ready. Anticipate at least 1 week for this process.
Form L4: This form gets you the reduced fee. Yes, $815.00 is actually the reduced fee. Fill it out completely and give it to your Program Director's office. Once it is filled out and signed, get it back so that you can send it with the rest of your application.
**Important: We recommend using the FHC as your address in the application process. The address that you submit will be made public (eg to your patients and anyone else interested) once you are licensed on the website of the CA medical board. If you use the FHC address, all communications, including your license, will come to work instead.
Completing the Application
Once all of the above is complete, make a copy of everything for your records and then mail the original to the medical board with a letter that includes your full name, all your contact information (including email and phone), and your social security number. Send it by some form of certified mail to be certain it arrives. Once you have received your Step 3 scores, you’ll need to request them to be sent to the CA Medical Board. You can do this online (only after having received your official scores) via this website: http://www.fsmb.org/ebahronline.html
Getting Medical Licensure Fee Reimbursement
By your CIR union contract, you are eligible for 50% reimbursement of your medical license fees.
You need to submit to Jill as proof of payment either:
· the receipt from your online application (payment must total at least $506.21) OR
· a copy of the face page of your license application AND a copy of your cancelled check or credit card statement.
**You do not have to wait until your license is received to submit for reimbursement. As soon as you have the above documentation, bring it to me and we'll get started. The reimbursement will be deposited directly into your checking accounts three to four weeks after submission.
WEBSITE https://www.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp
INSTRUCTIONS
DEA certification is issued via the U.S. Department of Justice’s Office of Diversion Control. Go to website above and select Form 224 and PRACTITIONER as your Business Category. From there, enter your info, select authorization to prescribe Schedule II-IV drugs, and be sure to take the fee waiver offered for working in a Federally Qualified Health Center (FQHC). When asked for name and contact info of someone who can verify your employment, give Hali Hammer, MD, 415-206-5789.
Once the application is complete, mail it to the local DEA office:
DEA-San
Francisco Field Division
Attn: Registration Application
450 Golden Gate Avenue, 14th Floor
P.O. Box 36035
San Francisco, CA 94102
OBTAINING A NATIONAL PROVIDER IDENTIFIER (NPI)
WEBSITE https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
INSTRUCTIONS
NPIs are mandated by HIPAAto serve as standard unique identifiers for all health care providers and health plans. This ID, once assigned, will follow you throughout your career.
Go to website above and select Apply Online for an NPI.