Each year, the Program Director with the concurrence of the Residency Education Committee, will select an Administrative Chief Resident(s). The Administrative Chief Resident(s) will work closely with the Program Director on such issues as the Resident Call Schedule, conferences, resident leave, and orientation of new residents. Also, to ensure accurate presentation in the Morbidity and Mortality Conferences, to plan the end of the year resident graduation banquet, and to communicate frequently with other residents and the faculty to ensure an atmosphere of cooperation, open mindedness, and mutual respect in the overall conduct of the program. The Chief Resident will receive a supplement to their salary for their efforts.

Revised 2009

At times, residents may fail to achieve adequate progress in mastery of their discipline, may fail to provide patient care in a manner consistent with expectations or may fail to work in a collegial manner with other providers. In such circumstances, programs may take one of several adverse actions. Residents at risk for such actions should be notified as soon as is practical, but such an action may be taken without notice if the program director deems it urgently necessary. Adverse actions include:

• Probation: Residents who are considered to have academic deficiencies or other concerns so serious as to place them at risk for non-renewal of contract or dismissal from the residency program should be placed on probation. Programs must have established mechanisms for determining whether a resident should be formally placed on probation. The mechanism must be documented and residents provided a copy of the document that defines the mechanism. Probation is a serious decision that should involve multiple individuals at the departmental/program level. Prior to placing a resident on probation, the program shall inform the Associate Dean and/or the Director of GME who will be available, both to the program and to the resident, for administrative assistance as needed.
  
  Written notification of probation is required and shall include at a minimum: reason for probation, remediation requirements, what the resident must accomplish in order to come off of probation, the anticipated length of probation, method of ongoing evaluation, and a faculty advisor/supervisor for the probationary period. Probationary periods must be time-limited, but may be extended when appropriate. In such instances, written notification is required. The program shall maintain documentation that the resident has received written notification and a copy of the notification must be sent to the GME Office. (See appended draft of a letter of probation).
  
  Residents may appeal being placed on probation using the resident grievance procedure (AR II-7.0-5; Grievance Procedure for House Officers).

• Suspension: In urgent circumstances, a resident may be administratively suspended from all or part of assigned responsibilities by his/her department chairperson, program director, or the Chief of Staff of the University Hospital or of the affiliated institution or facility for cause, including failure to meet general or specific academic standards, failure to provide patient care in a manner consistent with expectations or failure to work in a collegial manner with other providers. Programs must have established mechanisms for determining whether a resident should be suspended. The mechanism must be documented and residents provided a copy of the document that defines the mechanism.
  
  A resident must be notified verbally and in writing as to the reason for suspension. When a resident is suspended, the Associate Dean and/or the Director of GME should be notified prior to suspension or as soon as possible thereafter. The program shall maintain documentation that the resident has received written notification and a copy of the notification must be sent to the GME Office. Suspensions must be time-limited but can be renewed if appropriate. A suspension may conclude in the resident being reinstated, placed on probation or dismissed.
  
  Residents may appeal being placed on suspension using the resident grievance procedure (AR II-7.0-5; Grievance Procedure for House Officers).
  
  
• Dismissal from the Residency Program:  A resident may be dismissed from a program because of failure to make academic progress, gross and serious violation of expected standards of patient care or gross and serious failure to work in a collegial manner with other providers. Programs must have established mechanisms for determining under what circumstances a resident can be dismissed. The mechanism must be documented and residents provided a copy of the document that defines the mechanism. This decision should involve multiple individuals at the departmental/program level. The program must consult with the Associate Dean and/or the Director of GME in dismissal decisions. Dismissal may, depending upon the situation, follow a period of suspension and/or probation. Insofar as is possible, a resident should be notified in person and in writing about the dismissal decision. This notification must include the reason for the dismissal decision, the date of the dismissal, and method for appeal.
  
  Residents may appeal being dismissed using the resident grievance procedure (AR II-7.0-5; Grievance Procedure for House Officers).
  
  
• Non-renewal of contract:  While residents are generally granted a renewal of contract annually until they have achieved board eligibility, program directors may determine that continuation in the program is not warranted because of deficiencies in academic progress or for other reasons. A decision regarding re-appointment must be reached by the RTD no later than March 1 (unless the resident is on suspension or probation) of the year of the current appointment (for residents on a July 1-June 30 contract year; no later than 4 months prior to end of the current appointment if on an off-cycle contract). Such a decision may be appealed through Stage III using the resident grievance procedure (AR II-7.0-5; Grievance Procedure for House Officers).
  
  
• Grievance Procedure: The Grievance Procedure for House Officers is outlined in UK AR II-7.0-5 and is available in the GME Office or via the UK web page. Should a grievance be filed, the Associate Dean and/or the Director of GME will be available, both to the program and to the resident, for administrative assistance as needed.

The decision to invoke one of the “adverse actions” outlined above is not taken lightly by the Faculty of the Department of Obstetrics and Gynecology. The overall mechanism applied by the Faculty is as follows: Each circumstance and situation will be considered individually. The Program Director will typically consult with the Associate Dean for GME as well as the Residency Education Committee. Further consultation with University Legal Counsel may be requested. The above individuals and groups will evaluate past and current performance in the context of the deficiency/problem under consideration. Before any decision is made the Program Director will also speak with the resident for whom an adverse action is being considered.

The departmental policy on probation is guided by the policy on probation from the institutional policy and procedures manual as noted above. A portion of each resident education meeting and each faculty meeting is devoted to a confidential (resident members excluded) discussion of resident performance. The committee may recommend probation when in their judgment previous evaluations or current observation indicate that a resident’s knowledge base and/or clinical skills have not developed consistent with that expected for their level of training or when there are deficiencies in other competencies and these have not improved despite previous discussion/coaching with the resident. Further, probation may be considered for a single deficiency if it is considered significant. When the majority of committee members recommend probation, terms of probation including mandated remediation strategies will be defined and submitted to the director of residency education and the departmental chairman for approval. Notice of probation will then be extended to the resident.

Dismissal or non-renewal of a resident from the training program may occur in several circumstances, and others that may be defined in the future, and will occur in accordance with institutional guidelines:

• Failure of the resident to fulfill obligations as outlined in the residents training agreement.
  
• Failure of the resident to satisfactorily complete the required educational curriculum despite remedial attempts, including probation.
  
• Failure of the resident to comply with the employment requirements of the sponsoring institutional.
  
• Professional or personal behavior, which in the judgement of the faculty and Program Director is inconsistent with completion of the training program and recommendation for licensure and support of credentialing.
  

Typically academic deficiencies are responded to with attempts at remediation and additional instruction before an “adverse action” is considered. At the other extreme, violations of Professional Conduct may be dealt with in a vigorous manner. The mechanism used for and causes associated with a resident being placed on suspension are similarly individualized. The Program Director (in consultation with the Associate Dean for GME) may place a resident on suspension for reasons “A” through “D” in the preceding paragraph or for less severe causes/issues/infractions than those associated with probation, non renewal or dismissal.

Revised 2009

The Department of Obstetrics and Gynecology and the Institution are committed to the provision of support and appropriate referral for residents whose performance is impaired due to psychological stress, psychiatric illness or abuse of drugs and/or alcohol. Accordingly, all residents are aware of these services and informed at the time of orientation to the Institution of the mechanisms through which they may confidentially access them, either to address problems they are experiencing personally, or to intervene when problems are suspected or observed in a peer. Services and mechanisms are as follows:

• The Impaired Physicians Program (IPP) of the Kentucky Physicians Health Foundation (or equivalent for other specialties): The IPP assists in the recovery of physicians who have substance abuse problems. It provides evaluation, referral for treatment, and ongoing aftercare including regular meetings and compliance monitoring. It also serves as an advocate for the recovering physician with the Kentucky Board of Medical Licensure and other appropriate agencies. Help for one self or a peer can be obtained confidentially by calling 502-425-7761.
• Resident Crisis Referral Program: Under the auspices of the Department of Psychiatry, access to confidential consultation regarding the need for emergency psychiatric services is available to residents 24 hours per day, seven days a week through the admissions office at The Ridge Behavioral System. The telephone number to call is: 859-260-6400. The resident is to ask for the Assessment Office and identify him/herself as a UK resident needing immediate evaluation. If admission is required, the caller will be asked to go directly to The Ridge, bypassing evaluation at the UK ER.
• Non-emergent Psychiatric Help: Under the auspices of the Department of Psychiatry, access to confidential consultation regarding the need for psychiatric services is available through the UK Outpatient Clinic during business hours, five days per week. The telephone number is 859-323-6021. Press 1 for the Outpatient Clinic.
• Residents and faculty are requested to contact the Program Director immediately if there are any concerns of impairment.
  
  Revised 2009

Resident call responsibilities will be assigned by the Administrative Chief Resident(s) with the concurrence of the Program Director. It is anticipated that the “call schedule” will be constructed at least six weeks in advance. Residents may change call responsibilities with the approval of the Administrative Chief Resident(s) and Program Director. Call assignments will be made to ensure the Residency Program is in 100% compliance with the resident duty hour policies. The frequency of resident call responsibilities is enumerated in the table below:

LEVEL OBG -1	10 weeks	5 weeks	10 weeks	10 weeks	5 weeks	4 weeks
Specific Assignment	OB	OB	GYN	GYN ONC	Night Float OB	ED
Institution 1,2,3**	1	2	1	1	1	1
Night/Weekend Call	4 (12-hour)  weekend calls/month	4 (12-hour)  weekend calls/month	4 (12-hour)  weekend calls/month	4 (12-hour)  weekend calls/month	none	none

LEVEL OBG -2	10 weeks	10 weeks	10 weeks	10 weeks	10 weeks
Specific Assignment	MFM	OB	Community Gyn and Ambulatory	GYN	Night Float GYN
Institution 1,2,3**	1	1	1 and 3	2	1
Night/Weekend Call	5 (12-hour)  weekend calls per month	5 (12-hour)  weekend calls per month	4 (12-hour)  weekend calls per month	q2 home call and every other weekend	none

LEVEL OBG -3	10 weeks	10 weeks	10 weeks	10 weeks	5 weeks	5 weeks
Specific Assignment	OB Night Float	GYN ONC	GYN	GYN	Elective	Community GYN
Institution 1,2,3**	1	1	2	1	1/away	3
Night/Weekend Call	none	4 (12-hour)  weekend calls per month	q2 home call and every other weekend	5 (12-hour)  weekend calls per month	none	4 (12-hour)  week-end calls per month

LEVEL OBG -4	10 weeks	10 weeks	10 weeks	10 weeks	10 weeks
Specific Assignment	OB	Night Float	REI	GYN ONC	GYN
Institution 1,2,3**	1	1	1	1	1
Night/Weekend Call	4 (12-hour)  weekend calls per month	none	4 (12-hour)  weekend calls per month	4 (12-hour)  weekend calls per month	4 (12-hour)  weekend calls per month

**Institution Codes: 1=Univeristy of Kentucky, 2=Central Baptist Hospital, 3=Frankfort Regional Medical Center

Revised 2009

As noted in the section entitled, “Formal Teaching Activities” Obstetrics and Gynecology residents on all rotations at the University of Kentucky (with the exception of the Emergency Department) as well as all rotations at Central Baptist Hospital and Frankfort Regional Medical Center, are expected to attend the formal teaching activities on Tuesday mornings unless the residents are involved with critical, unscheduled, clinical care activities. Attendance will be monitored during the Tuesday AM didactic conferences.

Residents are also expected to attend the “Rotation Specific” educational activities unless involved in unscheduled, urgent clinical care.

Revised 2009
 

Providing residents with a sound didactic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being.

Duty hour assignments recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.

Duty Hours for Obstetrics and Gynecology Residents will be monitored every month. At the beginning of the month to be monitored, the Program Coordinator will distribute to all residents the appended “duty hours record”. Residents are expected to complete this record during the month that is being monitored, and return it to the Program Coordinator.

The Program Coordinator is responsible to summarize the data and provide it to the Program Director within one week after its completion.

Residents will be educated and reminded frequently about the duty hour policies. Residents have the primary and important responsibility of monitoring their duty hours throughout each day, week, and month. If it appears that they are at risk to violate the duty hours, residents should immediately notify the Administrative Chief Resident(s) and/or Program Director.

Duty hour policies for residents in the Department of Obstetrics and Gynecology are as reflected in the common and specialty residency requirements per ACGME guidelines as outlined below.

Duty Hours:

Duty hours are defined as all clinical and academic activities related to the residency program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as 1 continuous 24-hour period free from all clinical, educational, and administrative duties.

Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.

On-call Activities

The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day, when residents are required to be immediately available in the assigned institution.

• In-house call must occur no more frequently than every third night, averaged over a 4-week period.
• Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.
• No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity clinics.
• At-home call (or pager call) is defined as a call taken from outside the assigned institution.
• The frequency of at-home call is not subject to the every-third-night limitation. At-home call, however, must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.
• When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.
• The program director and the faculty must monitor the demands of at-home call in their programs, and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.

Revised 2009

Application to Residency

The Obstetrics and Gynecology Residency Training Program at the University of Kentucky will accept applications only through the ERAS System. The Program will abide by its ethical and procedural rules. The ACGME’s “Institutional Requirements” for residency eligibility and selection will also be carefully followed.

• Resident Eligibility: Graduates of LCME and AOA accredited schools are eligible. Additionally, graduates of medical schools outside the United States and Canada who meet one of the following requirements: (1) have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates prior to appointment, or (2) have a full and unrestricted license to practice medicine in a US licensing jurisdiction in which they are training. Graduates of medical schools outside the United States who have completed a fifth pathway provided by an LCME-accredited medical school.
• Resident Recruitment: Completed applications from ERAS will be reviewed by the Program Director and/or members of the Residency Education Committee. Applications will be reviewed based on a candidate’s preparedness, eligibility, ability, aptitude, academic credentials and potential, communications skills, letters of recommendation and personal qualities such as motivation and integrity. The Program will not discriminate with regard to sex, race, age, religion, color, national origin, disability, or veteran status. After screening, specific applicants will be invited to interview.
• After invitations to interview have been extended, and applicants have responded, a series of resident interview days will be established. Typically, there will be five to six half days devoted to this activity. Efforts are made to accommodate applicant convenience among the scheduled days..
• On the evening before the interview day, invitees will be encouraged to attend a gathering which is sponsored by current resident physicians in the program. Faculty may also be present. The goal is to provide an opportunity outside of the medical center in which current residents, faculty and applicants can converse.
• The interview day will include an overview of the various divisions and components of the program. Applicants for residency positions typically meet with two teams of interviewers which are composed of a faculty member and a resident. Additionally, all interviewees will interview with the Program Director and Chairman. Applicants will be discussed during a brief “post-interview” meeting of all resident and faculty interviewers for each specific day of interviews.
• At the conclusion of their day of interviewing, the program coordinator will give applicants information about stipends and benefits at the University of Kentucky, a copy of the current University of Kentucky contract, a copy of the Graduate Medical Education Resident and Fellow Handbook, as well as the “University of Kentucky Interviewee Information Items” which contains information about which they need to be aware. After being provided the required items, interviewees will be asked to confirm that they have received the information and sign a certifying statement to that effect. Additionally, they will be given a supplemental information form, and an authorization for release of information form
• The training program encourages “second visits” so that a candidate and a program can learn more about one another.
• Resident physicians as well as faculty physicians review all of the applicants who interviewed and develop separate “rank order” lists. The criteria outlined above (Resident Recruitment) as well as information learned during the interviews and ensuing discussions is used to construct the lists. The Program Director and/or the Residency Education Committee will carefully evaluate both lists and determine the final overall “ranking” for the program.
• The Departmental ranking will be entered in the NRMP in accordance with their timeframes.
• After Match results are known, the Department will communicate with and welcome the new residents.
• In the event that the Residency Program does not fill of its positions through the Match, the program will, through personal communication and/or through the “scramble” attempt to identify suitable candidates. Positions unfilled in the Match may be offered to qualified applicants by our Program, but this offer will be made with a clear communication to the applicant, both verbally and in writing, that the appointment is contingent on the applicant meeting requirements, and passing a credential review.
• Appointment is effected through execution of a contract between the applicant and the University of Kentucky.

Revised 2009

Supervision of residents in obstetrics and gynecology is required to ensure proper (1) quality of care, (2) education, (3) patient safety, and (4) fulfillment of responsibility of the attending physicians to their patients.

In compliance with ACGME Guidelines in UK Hospital Policy (HP09-33) all patient care must be supervised by qualified faculty physicians.

Residents must be provided with rapid and reliable systems of communication with supervising faculty.

Faculty schedules must be structured to provide residents with continuous supervision and consultation. The supervising physicians will be listed and distributed on call schedules and made known in the “beep” system.

Supervisory lines of responsibility for patient care, in general, follow the “chain of command/communication”. While faculty physicians have the ultimate authority and responsibility for a patient’s care, this authority may be delegated through a service chief resident (e.g. PGY4 OB, REI, GYN, GYN ONC) to residents who are earlier and earlier in their residency training program, including PGY1 residents. When residents are notified of a patient, they should perform an evaluation and determine a proposed management plan. This plan should be communicated through successive levels of resident physicians to the attending who has the responsibility to evaluate and modify or approve the plan. In certain situations it may be appropriate and indicated for the resident who initially evaluates a patient to notify all successive members of the team concurrently. This usually occurs in the setting when a delay in communication before instituting a treatment plan would not be in the patient’s best interest. Examples might include patients presenting with massive vaginal bleeding, fetal distress, respiratory or cardiac compromise, hemodynamic instability and the like.

Documentation of faculty supervision will be accomplished by the review of patients’ medical records in relation to compliance guidelines, through direct observation and through review with faculty and residents.

The program curriculum must be structured to provide residents with direct, graduated and increasing levels of independent resident action in patient management. (Complete management under supervision).

Complete management of a patient’s care under adequate supervision is the norm for the program; however there are certain circumstances under which the resident may not assume complete management:

• When the program director or his/her designee does not believe the resident’s expertise or understanding is adequate to ensure the best care of the patient.
• When the attending physician is unable to delegate the necessary degree of responsibility.
• When the resident, for religious or moral reasons, does not wish to participate in proposed procedure.
• Increasing responsibility must progress in an orderly fashion, culminating in the chief resident year. This philosophy is expanded on below:

Throughout their medical career physicians have the responsibility to continually increase their professional knowledge. Residency is a period in that career during which physicians make considerable personal sacrifices to obtain the clinical knowledge, surgical and patient management skills that will allow them to practice their specialty in not only an appropriate but outstanding manner and to serve as a consultant in their specialty to other members of the medical community. The latter is the criteria for successful completion of the oral examination of the American Board of Obstetrics and Gynecology.

There is a vast amount of didactic knowledge which a resident must learn during residency. This is a shared responsibility between resident physicians and faculty. Residents must be active learners and faculty active teachers/mentors. Residents must build on their introduction to the basic science and mechanisms of disease obtained in medical school. Specifically genetics, physiology, embryology and developmental biology, anatomy, pharmacology, pathology and neoplasia and microbiology and immunology will be stressed as they relate to clinical conditions in obstetrics. Additionally there is a wide variety of obstetric, gynecologic and primary/preventive care clinical material which must be mastered during the residency (Educational Objectives, Core Curriculum in Obstetrics and Gynecology, Ninth Edition, Council on Resident Education in Obstetrics and Gynecology).

The four years of residency offer an opportunity for individuals at each level of training to progressively develop their clinical skills and judgments and to assume increasingly greater responsibility for the final management of the patient. However, the saying “I would rather learn from my own mistakes” has no place in modern medicine. During a residency program other individuals with greater experience, be they fellow residents or attending staff, are available and should be utilized to their fullest.

Since medicine is not an exact science, there may be several approaches to a given clinical problem with equal anticipated outcomes. One of the requirements of medicine is for the physician to evaluate the various approaches available, to make decisions and to select the method of management that will best serve the needs of the individual patient. In a pyramid system of clinical responsibility, each resident has an opportunity to make a decision on patient management for each patient seen, and to have decisions approved and/or modified by the responsible individual at the next level of training or experience. In presenting these decisions, the resident is expected to justify the particular course of planned action, as well as be able to discuss the other alternatives and the reasons they were not chosen.

Attendings, residents, students and nurses jointly care for obstetric patients. The authority and responsibility of the attending physician is often delegated through the “chain of command”. As such, considerations related to patient care, prior to their implementation, need to be discussed at successive levels in the chain of command, including the attending. As Attendings are responsible for teaching and supervising the care provided by residents, attending physicians must be called and consulted in a timely fashion to supervise residents as they evaluate and manage patients.

Faculty involved with the residency program and all residents must be educated to recognize the signs of resident fatigue and excess stress, and to adopt policies to prevent and counteract its potential negative effects. Recognition of resident stress likewise requires immediate implementation of management interventions. A backup system will be provided when patient case responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.

Revised 2009

It is well recognized that long hours and sleep loss have a negative effect on resident performance, learning, and well-being. It is equally well-known that resident stress can have significant and important adverse effects on a resident’s personal and professional life.

All faculty involved with the Resident Training Program as well as all residents in the Department of Obstetrics and Gynecology, will be educated to recognize the signs of fatigue, and to apply preventive and operational counter measures.

Additionally, faculty have the responsibility to evaluate for signs of resident stress, and to likewise apply preventive and operational counter-measures, and inform the Program Director immediately.

The Program Director and faculty in the Department of Obstetrics and Gynecology will monitor residents for the effects of sleep loss and fatigue, and respond in instances when fatigue may be detrimental to resident performance and well-being. The Department of Obstetrics and Gynecology will provide residents appropriate backup support when patient care responsibilities are especially difficult and prolonged, and if unexpected needs create resident fatigue sufficient to jeopardize patient care during or following on-call periods.

Fatigue identification is of the utmost importance. Aside from faculty monitoring of residents, it is expected that residents will assess and evaluate one another as well as the faculty. Management alternatives to deal with fatigue include: schedule change, encouraging an immediate rest period, addressing causal factors for acute or chronic fatigue and discussion of Circadian Management, among others.

Revised 2009

The department’s policy regarding the various types of vacation and leave time is guided by the Bulletin of the American Board of Obstetrics and Gynecology (ABOG), which, in conjunction with the Residency Review Committee (RRC) for Obstetrics and Gynecology, is responsible for the accreditation of training programs and the certification of individual competence in obstetrics and gynecology.

“Leaves of absence and vacation may be granted to the resident at the discretion of the program director in accordance with local policy. If, within the four years of graduate medical education, the total of such leaves and vacation, for any reason (e.g., vacation, sick leave, maternity or paternity leave, or personal leave) exceeds eight (8) weeks in any of the first three years of graduate training, or six (6) weeks during the fourth graduate year, or a total of twenty (20) weeks over the four years of residency, the required four years of graduate medical education must be extended for the duration of the time the individual was absent in excess of either eight (8) weeks in years one – three (1-3), or six (6) weeks in the fourth year, or a total of twenty (20) weeks for the four years of graduate medical education.”

In keeping with the above, the department’s policies with respect to this matter are:

1) Total Leave Time
The total of vacation, educational meeting, personal leave and maternity/parental days off cannot exceed 20 weeks during the four year program. Per the ABOG statement, more time per year is allowed off during the first three years to accommodate possible maternity/family leaves, which are discouraged during the fourth year. If such additional time is used during the first three years, the total leave still cannot exceed 20 weeks total. If the 20 weeks total is exceeded for whatever reason(s), one’s training must be extended accordingly into a fifth year. Such training extensions must be approved by the RRC and are not guaranteed.

2) Vacation Time
Arrangements for vacation time are to be made according to specific established guidelines. The hospital allows two weeks of vacation for PGY 1s and three weeks for PGY 2s, 3s, and 4s. According to the prevailing custom at the time, residents may be expected to make up call nights for vacation time. All requests require the approval of the Administrative Chief House Officer and Department Chairman.

3) Educational Meeting Timeme
Educational leave policies are defined in the department memo entitled “Resident Educational/Travel Expense and Leave Benefits/Rules” (to follow). Arrangements for educational leaves are to be made according to established guidelines and call make-up may be expected. Up to one week (five work days) per year is allowed for educational leave. For PGY 1s, 2s and 3s, days not used cannot be used for vacation or other purposes. For PGY 4s, unused days may be used for practice searching or fellowship interviewing.

4) Maternity Leavee
If desired, a resident will be granted up to eight weeks for maternity leave during the first, second and third program years, and up to six weeks during the fourth year. It should be remembered, however, that maternity leave must be factored into the 20 week total, which obviously means that vacation, educational meeting, or personal discretionary leave may be lost in current or subsequent training years. It is expected that all call nights/days will be made up either before or after the maternity leave such that the total per year over four years will be equal in numbers to her classmates.

5) Parental Leave
After his wife’s delivery, a resident may have a maximum of five days off during the postpartum period. Such leave must be approved by the program director and will be counted against that year’s vacation or personal/discretionary leave time. Call nights or days will be expected to be kept, unless exchange coverage is arranged. In addition, the program director may require the resident’s daytime presence if service needs warrant such. The five days allowed are inclusive of weekend days/holidays and may begin either on the day of delivery or the day his wife is discharged from the hospital.

6) Personal/Discretionary Leave
This category includes leaves for the following possible reasons:
a. job/practice interviews for PGY 3s and 4s
b. fellowship interviews for PGY 3s and 4s
c. December/January holidayss
d. religious holidays
e. weddings (as bride, groom, or otherwise!!)

A total maximum of five work days will be allowed per year for any combination of the above and must be approved by the program director. It is expected that PGY 1s, 2s and 3s will likely use this discretionary week for the December/January holidays or a combination of December/January holidays and other religious holidays. PGY 4s, will be expected to factor in their job or fellowship interview time away with December/January holidays, religious holidays, vacation days, and possible left-over educational meeting days such that a total of five weeks only will be taken off the PGY 4 year (exclusive of terminal leave). PGY 4s terminal leave in June (one week) may also be given up for additional interview time. PGY 3s interviewing for fellowships will be expected to use third-year discretionary time for such activities or count it against fourth-year vacation/discretionary/terminal leave time.

Only residents assigned to OB/GYN rotations are eligible for December/January holiday time off. In addition, eligibility for this time off must be earned as a total resident group by meeting certain performance expectations as defined by the program director.

Time away for examinations, e.g., Step 3 USMLE, or present papers/posters at sanctioned scientific meetings will be considered work days and not count against leave time. Attendance at funerals will also not be considered leave time. It is obviously hoped that personal or family illness will not occur. Recognizing that such may occur, however, it is the department’s intention to be as reasonable as possible in considering personal leave for illness. If needed for legitimate reasons, up to two days per year may be taken without loss of vacation or personal/discretionary leave time. In the event of a major illness, loss of subsequent vacation or personal/discretionary leave or program extension may have to be considered.

The Department Chairman/Program Director, will serve as the final arbiter in all questions arising from this policy. Working within the guidelines of ABOG/RRC, it is the department’s desire to be both liberal and fair to all concerned when considering the above issues. Residents must also accept the responsibility they have to the ABOG/RRC to their training, to the program, and to their peers. With such a spirit of cooperation and responsibility, major problems are unlikely to develop with this policy.

Revised 2009

1. Residents in the Department of Obstetrics and Gynecology must adhere to the Medical Records Policy of the University of Kentucky Hospital (policy #: MR05-30) and fulfill all of the requirements in the University of Kentucky Medical Records policy.

2. All entries in the medical records should be dated, timed, signed with credentials and legible.

3. Operative/procedure reports must be dictated immediately following surgery. In addition, a written postoperative progress note must be recorded in the medical record immediately following surgery.

4. Discharge summaries should be dictated on all inpatients and observation stay patients on the date of discharge. This requirement is unique to the Department of Obstetrics and Gynecology and failure to comply may result in suspension without pay. These discharge summaries should be dictated with the referring physician or clinic site identified and with a request that they be “expedited” so that they may be faxed to the facility or physician associated with the patient’s pre-hospital care.

5. Verbal orders are discouraged, but if given, must be signed as soon as possible.

6. History and physical examinations must be documented within twenty-four hours of admission. If a history and physical examination has been performed within 8 - 30 days prior to admission, readmission, or elective procedure, the note may be used with a statement to update any components of the current medical status that may have changed since the H&P was performed. If there are no changes, a statement to that effect must be documented. An H&P performed within seven days does not require an update.

7. All involved physicians must complete all records within thirty days of the patients discharge or suspension will be initiated. The suspension will last until deficiencies are corrected.

Revised 2009

1. Moonlighting: Professional and patient care activities that are external to the educational program are called moonlighting. Moonlighting activities, whether external or internal, may be inconsistent with sufficient time for rest and restoration to promote the resident’s educational experience and safe patient care.

2. Internal moonlighting involves that work which is above and beyond program requirements performed at either the University of Kentucky Hospital or a Medical Center facility affiliated with the Program. That would currently include Central Baptist Hospital and Frankfort Regional Medical Center.

3. External moonlighting involves that work which is above and beyond program requirements done at a non-affiliated hospital or with a private physician or clinic not affiliated with the OBGYN Residency Program at the University of Kentucky.

4. Internal moonlighting is not permitted.

5. External moonlighting, in deference to duty hour requirements, is strongly discouraged.

6. Request for external moonlighting must be approved by the Program Director and Department Chairman at least 2 weeks prior to the proposed moonlighting activity. See “Request to Moonlight” form, appended.

7. Approval/disapproval will be based on the resident’s performance in the Residency Program, proposed hours of moonlighting, and current rotational responsibilities of the resident.

8. Requests to approve external moonlighting that is performed during periods of vacation will be viewed more favorably than recurring episodes that occur within scheduled rotations.

9. It is expressly noted that University of Kentucky benefits do not apply to any moonlighting activities. Specifically the resident must clearly understand that it is his/her obligation to arrange for malpractice coverage with the physician and/or hospital entity for which he/she is providing the moonlighting services.

10. A separate request must be submitted for each episode of moonlighting.

11. The Program Director and Chairman reserve the right to rescind at any time permission for any episode of moonlighting activity and the opportunity for residents to moonlight at all.

Revised 2009

Exemplary ethical conduit is expected by all University of Kentucky faculty and staff, as outlined in the attached two documents “University of Kentucky Ethical Principles and Code of Conduit” and “University of Kentucky Hospital Policy”

University of Kentucky Ethical Principles and Code of Conduct

Ethical Principles The University of Kentucky Ethical Principles and Code of Conduct are intended to document expectations of responsibility and integrity. Exemplary ethical conduct is critically important in our relationships with colleagues, trustees, students, volunteers, contractors, and the public. This statement reflects the values of the University approved by the Board of Trustees on April 1, 2003. The following core values guide our decisions and behavior.

• Integrity
• Academic excellence and freedom
• Mutual respect and human dignity
• Diversity of thought, culture, gender, and ethnicity
• Personal and institutional responsibility and accountability
• Shared governance
• A sense of community
• Sensitivity to work-life concerns
• Civic responsibility

Each member of the University must endeavor to:

1. Promote the best interests of the University of Kentucky

2. Foster the Vision, Mission, and Values of the University

3. Preserve the public's respect and confidence in the University of Kentucky

4. Exhibit personal integrity, honesty, and responsibility in all actions

5. Provide an environment of mutual respect, impartiality, and collaboration

6. Maintain confidentiality in all matters deemed confidential

7. Assure independence of judgment free from conflicting interests

8. Ensure that relationships that constitute or could be perceived as conflicts of interest are fully and properly disclosed and University guidelines are followed

9. Comply with the policies and procedures of the University of Kentucky and applicable state and federal laws and regulations

10. Demonstrate stewardship of University property and resources

Code of Conduct

Those acting on behalf of the University of Kentucky have a duty to conduct themselves in a manner that will maintain the public's trust in the integrity of the University and to act compatibly with their obligation to the University. The Code of Conduct establishes guidelines for professional conduct for University members, including trustees, executive officers, faculty, staff, and other individuals employed by the University, those using University resources or facilities, and volunteers and representatives acting as agents of the University (collectively "University members").

The conduct of students is addressed in the Student Rights and Responsibilities.

The Code of Conduct is intended as a general guide to determine what conduct is expected and to help individuals to determine behaviors that should be avoided. Employees are strongly urged to consult with their supervisor to review and evaluate specific situations. In addition to the Code, University members are generally subject to all University codes, regulations, and policies and state and federal law. Violations of this code will be subject to appropriate penalties.

While this Code of Conduct provides overall guidance and in some instances interpretation, additional guidance is found in other official University policy documents, such as the Governing Regulations, Administrative Regulations, Human Resources Policies, and Business Procedures Manual.

Nondiscrimination Policy

Equal opportunities shall be provided for all persons throughout the University in recruitment, appointment, promotion, payment, training, and other employment practices without regard to sex, sexual orientation, race, ethnic origin, national origin, color, creed, religion, age, uniform service or veteran status, physical or mental disability, or political belief. All University members are expected to comply with the institution's nondiscrimination policy (Governing Regulation XII).

Confidentiality of Information

University members are entrusted with personal and institutional information that should be treated with confidentiality and used only for conducting University business. Respect for individual and institutional privacy requires the exercise of care and judgment. Unless required or permitted by law or University regulations, personal and official information provided by and about faculty, staff and students must not be given to third parties without the consent of the individuals concerned. When doubt exists regarding the confidentiality of information, University members should presume information is confidential until determined otherwise.

Use of the University's Name

University members have a public association with the University, but are also private citizens, thus care must be taken to appropriately differentiate between the two roles. University members may not use or allow the use of the name of the University or identify themselves as employees of the University of Kentucky in the public promotion or advertising of commercial products without prior written approval. Individuals writing or speaking publicly in a professional or expert capacity may identify themselves by their relationship with the University, but if so identified then in all instances where the individual might give even the appearance of speaking on behalf of the University, care must be taken to emphasize that any views expressed are their own and are not representative of the University of Kentucky.

University members are encouraged to contribute to public debate as citizens. In instances where University members comment publicly as part of their official University duties, they should do so using University stationery and e-mail accounts; when commenting as citizens, University members must use personal stationery and personal e-mail accounts.

University Resources

University members should be responsible stewards of University resources. University members are entrusted with protecting the property, equipment, and other assets of the University and exercising responsible, ethical behavior when using the University's resources. University assets are intended for University activities. Limited personal use of fixed University resources, such as computers and telephones, which does not result in a charge to the University is permitted as long as the use does not interfere with assigned job duties. In some instances, a University member may use University equipment outside of the realm of his or her professional duties when the goals of the individual and the University coincide. Any such use must have the prior, written approval from the dean or appropriate administrator where the resources are located, and must provide that the University will be reimbursed for the full cost of the use of the equipment. Such use must not interfere with the University of Kentucky's uses, and must occur outside of the University member's regular employment assignment. The Office of the University Legal Counsel can provide an appropriate form of agreement.

Sexual Harassment

To foster an environment of respect for the dignity and worth of all members of the University community, the University is committed to maintain a work-learning environment free of sexual harassment. The policy of the University of Kentucky, approved by the Board of Trustees, prohibits sexual harassment of students, faculty and staff and assures that complaints of sexual harassment will be treated and investigated with full regard for the University's due process requirements. The University policy and procedures on sexual harassment can be found in Governing Regulation XII and Administrative Regulation II-1.1-9.

Personal Relationships

The quality of decisions may be affected when those making decisions have personal relationships with those who are the subjects and possible beneficiaries of these decisions. The critical concern is that personal relationships, whether positive or negative, should not inappropriately or unfairly affect decisions. Conflicts of interest may arise when people are involved in making decisions affecting any members of their families, relatives, or those with whom they have or have had intimate relationships. Decisions affecting present or former business partners should also be avoided. Individuals with personal relationships should excuse themselves from such decision-making. In many cases, potential conflicts can be managed by candid but discreet disclosure of those relationships.

The University strongly urges those individuals in positions of authority not to engage in conduct of an amorous or sexual nature with a person they are, or are likely in the future to be, in a position of evaluating. The existence of a power differential may restrict the less powerful individual's freedom to participate willingly in the relationship. If one of the parties in an apparently welcomed amorous or sexual relationship has the responsibility for evaluating the performance of the other person, the relationship must be reported to the dean, department chair or supervisor so that suitable arrangements can be made for an objective evaluation of the student or employee (Administrative Regulation II-1.1-9).

Employment of Relatives

In order to assure independence of judgment that is free from conflicting interest and to avoid relationships that could be perceived as conflicts of interest, no relative of the President shall be employed in a position at the University. Similarly, no relative of the Provost, or any executive vice president, vice president, or any associate provost or associate vice president shall be employed in a position in that officer's administrative area. The Board of Trustees on a stated temporary basis may permit waiver of the above regulation, not to exceed two years, when it is otherwise impractical to fill a position with another fully qualified person. The same individual shall not be eligible for reappointment under the terms of this exception unless approval is given by the Board of Trustees. No relative of any employee of the University may be appointed to any position in the University over which the related employee exercises supervisory or line authority. Employment of relatives within the same department or division shall be approved specifically by the Provost or executive vice president, as appropriate (Governing Regulation X-1). The University shall employ no relative of a member of the Board of Trustees. Members of the Board of Trustees, except those elected to the Board as faculty, staff, or student representatives, and relatives of any member of the Board of Trustees are ineligible for employment at the University.

Intellectual Property

University members should be responsible stewards of University resources. All intellectual property conceived, first reduced to practice, written, or otherwise produced by faculty, staff, or students of the University of Kentucky using University funds, facilities, or other resources shall be owned and controlled by the University. Any member of the faculty or staff of the University who produces such intellectual property using University funds, facilities, or other resources shall assign personal rights to the property to the University, or its designate. The traditional products of scholarly activity which have customarily been considered the unrestricted property of the originator, such as journal articles, textbooks, reviews and monographs, and which have been created without involving a material use of University resources, shall be the unrestricted property of the author (Administrative Regulation II-1.1-3).

Conflict of Commitment

Decisions and the judgment upon which the decisions are based must be independent from conflicting interests and must hold the best interest of the University of Kentucky foremost. Conflicts of commitment relate to an individual's distribution of effort between University appointment and outside activities. The University of Kentucky permits external employment or self-employment in an employee's profession or specialty (with the exception of employees participating in a practice plan) where there is not a conflict of interest or commitment. Faculty and professional administrative employees are expected to devote their primary professional loyalty, time, and energy to University of Kentucky teaching, research and service endeavors; activities outside the University must be conducted without detracting from these primary commitments. A conflict of commitment generally occurs when the pursuit of outside activities interferes with obligations to students, to colleagues and to the missions of the University. These conflicts may become apparent in regular performance reviews, in connection with annual salary decisions and scheduled reviews incident to promotion, reappointment or tenure decisions and should be addressed by the appropriate department head. The University policy and procedures on outside consulting can be found in Administrative Regulation II-1.1-1.

A staff employee may be employed outside the University when the employment does not constitute a conflict with University interests and when the hours of outside employment do not coincide or conflict with hours of scheduled work or affect the employee's ability to perform satisfactorily. A staff employee may also perform outside employment while on vacation, holiday, or special leave as long as the outside employment does not constitute a conflict of interest. Adherence with this policy is the responsibility of the staff employee who seeks outside employment; however, it is recommended the employee advise his or her department head of the outside employment.

Conflict of Interest

The public's respect and confidence in the University of Kentucky must be preserved. Confidence in the University of Kentucky is put at risk when the conduct of University members does, or may reasonably appear to, involve a conflict between private interests and obligations to the University. All University members shall avoid conduct that might in any way lead members of the general public to conclude that he or she is using an official position to further professional or private interests or the interests of any members of his or her family. In conducting or participating in any transaction, full disclosure of any real or perceived conflict with personal interests and removal from further participation in such matters is required.

Administrative Regulation II-4.0-4 Conflict of Interest and Financial Disclosure Policy - Research sets forth specific relationships and activities that pose a potential conflict of interest for faculty, staff, and students involved in research and related activities. The University recognizes that actual or potential conflicts of interest may occur in the normal conduct of research and other activities. A conflict of interest can also arise if an employee's professional judgment is or may appear to be influenced by personal interests. It is essential that potential conflicts be disclosed and reviewed by the University. After disclosure, the University can make an informed judgment about a particular activity and require appropriate oversight, limitations, or prohibitions in accord with this policy. It is important to remember that each relationship is different, and many factors often will need to be considered to determine whether a conflict of interest exists.

Financial Advantage

Members of the University community must exhibit personal integrity, honesty and responsibility in all actions. Official position or office shall not be used to obtain financial gain or benefits for oneself or members of one's family or business associates. Any action that creates the appearance of impropriety should be avoided. Purchases and contracts shall not be made with an employee of the University of Kentucky for any item of supply, equipment, or service, nor may an employee have any interest, directly or indirectly, in any purchase made by the University of Kentucky (Business Procedures Manual B.2.C). An indirect interest may be defined as a real or perceived use of a university position or office with respect to a purchase or contract, leading to financial or other benefits to the individual or a member of his or her family. An indirect interest includes situations where a business owned or controlled by a family member does business with the University area where the employee is assigned.

Acceptance of Gifts or Benefits

University members' decisions and actions should be based on the best interest of the University. No member should accept any type of reward, monetary or non-monetary, if there is an explicit or implicit assumption that influence has been exchanged for the favor. When no favor is asked for or gained, gifts of nominal value or moderate acts of hospitality, such as meals, in relation to one's position with the University may be accepted. The following guidelines should be observed:

• Gifts or acts of hospitality valued up to $50 annually from any one source need not be reported
• Gifts or acts of hospitality valued between $50 to $200 should be reported to the supervisor prior to acceptance
• Acts of professionally related hospitality above $200 must be specifically justified and reported through the chain of command. Written approval for acceptance must be provided by the Provost or executive vice president, in advance.
• Individuals may not accept gifts valued above $200. These gifts or benefits acknowledged and accepted on behalf of the University should be directed to the Executive Vice President for Finance and Administration, where they can be acknowledged and accepted on behalf of the University.

Clarifications and Reporting Violations

Like all policies, this policy could not possibly cover all possible situations. When any doubt about the propriety of an action exists, the University's policy requires a full and frank disclosure to an appropriate individual with sufficient authority to address the matter. For interpretation, counsel or advice regarding this policy, contact the Office of the University Legal Counsel.

University members are expected to report violations of this policy to an appropriate individual. The University will not tolerate any retaliation against a University member who makes a good faith report of a violation.

Revised 2009

Each year, faculty in the Department of Obstetrics and Gynecology contribute monies that residents may spend for professional development. Allowances are as follows:

• PGY-1 - $500
• PGY-2 - $750 (plus District V Meeting)
• PGY-3 - $750
• PGY-4 - $2000

These professional development funds may be used for membership dues, medical journal subscriptions, books, and for the PGY-4 residents, one meeting pre-approved by the Program Director.

Should this allotment become depleted, the resident will be responsible for any expenditure. It is strongly suggested that each resident inquire with the Program Coordinator (who will in turn inquire with the Business Office) to determine the status of residual monies and the appropriateness of any potential purchase before making the purchase. The Department of Obstetrics and Gynecology will not pay for charges over the allotment. All receipts and paperwork should be turned into the Business Office of the Department of Obstetrics and Gynecology.

Laboratory coats are furnished by the House staff Office. The Department of Obstetrics and Gynecology provides funds to have them monogrammed. Residents are responsible for their own laundry expenses.

Beepers and Palm Pilots are the property of the Department of Obstetrics and Gynecology. Batteries are furnished by the Department, and may be picked up from the Program Coordinator in Room C-368. Any problems with beepers or Palm Pilots should be directed to the Program Coordinator.

Revised 2009

Advancement form one academic year to the next is dependent upon satisfactory performance of the established didactic and clinical educational curriculum for that academic year. The decision to promote a resident is based on the Residency Education Committee’s evaluation of the resident’s performance in the 6 areas of competencies as determined using various assessment tools.

If the evaluations warrant, a resident may not be promoted but instead receive an “adverse action” (see section).

Residents receive feedback on a regular basis both formally and informally. At the end of each clinical rotation, each resident requests an evaluation in the ACGME Learning Portfolio. These competency-based evaluations are specific to each rotation, with each successive year representing more advanced goals, objectives, patient responsibilities, and teaching responsibilities. The request is e-mailed to faculty and, once complete, is e-mailed to the resident for review.

If a resident disagrees with a “Clinical performance” evaluation by a faculty member, the resident may address the evaluation further with the evaluating faculty member. If unresolved, the Program Director, Residency Education Committee and Chair may be appealed to. If still unresolved the resident physician may follow the option of grievance.

Although each resident receives an evaluation at the end of each rotation, if a resident’s performance at the midpoint of any rotation is judged to be unsatisfactory, it is the responsibility of the attending physician(s) to meet with the resident, discuss and document the deficiencies and to devise a plan to address the deficiencies.

Documentation in memo/letter format must be sent to the Program Director.

The Program Director is available to discuss resident performance issues with them anytime for a timely appointment, as needed.

A decision regarding reappointment must be reached no later than March 1, (unless the resident is on suspension or probation) of the year of the current appointment.

Reappointment is the usual expectation if the resident is making normal progress toward board eligibility and/or attainment of the learning objectives of the program. It is affected through execution of and contract between the applicant and the University of Kentucky.

Revised 2009

Upon entering the Residency Program, each PGY1 resident will be specifically instructed in the ACGME approved case log recording system. Each PGY1 resident will be given a PDA to be used to collect their case log entries. In addition, there are several computer terminals which are accessible for entering statistics. Many residents have found that entering their stats directly into the computer is the easiest way to maintain these statistics. It is the responsibility of each resident to assure that these statistics are correct and maintained on a regular basis. Each resident should enter all cases of a weekly basis but it is mandatory that it be completed at least once a month. All surgical cases will be recorded separately for the primary surgeon and the assistant. Common problems encountered while performing ambulatory care also need to be documented.

The Program Coordinator will prepare an updated list each Monday morning to indicate the status of each resident’s compliance with this directive. If there is a resident who is not up-to-date with documentation of their case experience, this will be discussed with them and further action taken. This may include the resident being prevented from participating in further clinical activity until the statistics are completed.

Correct and accurate reporting of statistics is imperative for both self assessment of the Program curriculum and for documentation for the Residency Review Committee, whose role it is to assure that we are providing an adequate clinical experience for all of the residents in the Program.

Any questions should be directed to the Program Director or the Program Coordinator.

Revised 2009