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 2011

It is an ACGME requirement that all residency training programs “ensure the implementation of fair policies, grievance procedures, and due process as established by the sponsoring institution (UK) and in compliance with the (ACGME’s) Institutional Requirements. More importantly it is “the right thing to do”.  The following material has been excerpted from the GME Manual for you.

Adverse Actions-Definitions

• Probation: As used in this document, probation refers to a condition in which a resident has 1) had problems identified which, if not corrected, may lead to failure to renew a contract or dismissal from the program and, 2) been formally notified of this fact through an established process. A resident on probation may continue to provide patient care and to engage in the training program, but only within clearly defined limits that are stated in writing.



• Suspension: As used in this document, suspension refers to a circumstance in which a resident is administratively removed from some or all assigned duties for a specific period of time. Suspension may be with or without pay.



• Dismissal: As used in this document, dismissal refers to the separation of a resident from a training program for cause. In general, this occurs because a resident has failed to meet the conditions of probation. In instances, however, of a gross violation of academic or professional standards, a resident not on probation may be dismissed.



• Non-renewal of contract: As used in this document, non-renewal of contract refers to a decision by a program not to renew the annual contract of a resident before that resident has completed training. Such a decision may be appealed through Stage III as described in the Grievance Procedure for House Staff (AR 5.5)

Adverse Actions

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 5.5)

• 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 5.5).
  
  
• 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 5.5).
  
  
• 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 5.5)
  
  
• Grievance Procedure: The Grievance Procedure for House Officers is outlined in UK AR 5.5 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 2011

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 months 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 below in the Call Guidelines Policy:

We must ensure compliance for all residents in the 80 hour work week, including 24 hours off each week.  to accomplish this, the following guidelines are in place.


1. Labor and Delivery

1. Service turnover:
1. Saturday morning: All residents will report for work at 6 AM, person to person check out will be from 6:00-6:30 AM. Friday night person must be out the door at 6:30 AM.
2. Sunday morning: All resident will report for work at 6:30 AM, person to person check out will be from 6:30-7:00 AM. Saturday night person must be out the door at 7:00 AM.
3. Interns: Will arrive at 6:00am or 7:00pm depending on their weekend call shift.
4. Monday morning: This is more confusing, but I will try to be straightforward.
   1. Mid-Level OB: MFM & L&D resident come in at 7:00 AM regardless of call.
   2. GYN: Saturday person will come in at 7:00 AM.
   3. Chief: Saturday Chief will come in at 7:00 AM, arrangements should be made with your respective teams.
2. Resident responsibility:
   1. Intern: On-coming resident is responsible for notes on MBU. These notes will hopefully be completed prior to board rounds at 9 AM, or at earliest convenience. Off-going resident is responsible for all discharge paperwork. If any reasonable discharge paperwork is not complete, notify the chief. While it is not appropriate to keep residents over their allotted work time, deliveries/procedures may be restricted in those residents that are not compliant with paperwork.
   2. Mid-level: On-coming resident is responsible for notes on antepartum service and labor & delivery patients. Off-going resident is responsible for having up-to-date and concise checkout on all patients. Not having to write a note is not an excuse for not knowing the patients. Concise checkout can only occur if the off-going resident has a clear grasp of the board/patients.
   3. Chief: On-coming resident is responsible for MBU rounds, ensuring labor and delivery coverage while interns and mid levels round. Must verify that gynecology service has been taken care of prior to NOON. Off-going resident is responsible for overseeing paperwork being completed at MBU and overall OB/GYN service updates. GYN patients on the benign service need to be checked out to on-coming chief. THIS INCLUDES GSH PATIENTS.
3. Board Checkout:
   1. Attending coverage will remain unchanged. On-coming attendings will arrive at 8AM.
   2. Formal checkout rounds will be held in work room at 10:00am with an attending.

2. Gynecology

1. Service Turnover:
   1. Saturday morning: On-coming resident will report for work at 6 AM, person to person check out will be from 6:00-6:30 AM. Off-going resident must be out the door at 6:30 AM.
   2. Sunday morning: On-coming resident will report for work at 6:30 AM, person to person check out will be from 6:30-7:00 AM. Off-going resident must be out the door at 7:00 AM.
   3. Monday morning: Saturday person only will report for work at 7:00 AM. This should still allow time for rounding before OR for both GYN and GYN-ONC service. If there are conflicts about rounding on GYN patients at UK vs. GSH, these should be ascertained prior to Monday morning so that the GYN-ONC chief/third year may assist in rounding.
2. Resident Responsibility:
   1. Off-going resident: Will prepare all notes for GYN-ONC rounds & UK benign GYN patients. They should also keep a tally of things to be completed (i.e.-if notes have not been completed). This resident will no longer round at GSH after leaving UK. This does not excuse them from having up-to-date check out on the GSH patients… vitals; uop and labs (if available) need to be available at time of check out.
   2. On-coming resident: Will do all discharges. Will round at GSH prior to 12 PM. If there seems to be a conflict, the chief and/or fellow needs to be notified. GSH patients are NOT to be treated as second class patients because it is inconvenient to round on them. Tidying up GYN-ONC service does NOT take priority over GSH/Benign GYN patients.
3. Rounds:
   1. The Fellow determines rounding time, typically 6:30. We will ask that rounds on Sunday be at 7:00.

3. Monday:

1. Mid-Level: Both L&D and MFM resident will report at 7:00 AM on all Mondays regardless of call. (based on call pool, at least one of them will have been on call each weekend). They will divvy up the MFM service and attempt to complete rounds by 7:30 AM. If service is particularly large, they may ask Sunday night that the night float help them on rounds.
2. GYN: Saturday call residents will report to work at 7:00 AM. If there is a true conflict… GYN chief and either intern/3rd year took call on Saturday, then the ONC chief/3rd year may be asked to round on any benign GYN patients at UK. I would ask that GYN residents be particularly vigilant of their schedules.
3. Chief: Weekend Saturday Chief is not to report prior to 7:00 AM. Arrangements need to be made with your respective teams.

Revised 2011

Residents on all rotations at the University of Kentucky 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  by entering int he conference roster into New Innovations' conference attendance module.

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

Revised 2011
 

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 daily. Each resident is responsible to enter in their daily duty hours via the New Innovations duty hours module.   The system will then generate a notice to the program coordinator and director if/when a violation occurs.

The Residency Coordinator is responsible to summarize the data and provide it to the Program Director when requested.

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.

Duty hours for PGY-1 residents must not exceed 16 hours in duration.

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.

PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.

PGY-2 residents should have 10 hours, and must have eight hours, free of duty between scdeduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty.

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 4 additional hours to participate in didactic activities, and transfer care of patients.
• No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity clinics.
• Night float must not be scheduled for more than six consecutive nights.
• 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 2011

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 beginning 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 2011

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.

Revised 2011

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 2011

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. However, the total of such vacation and leaves for any reason – including, but not limited to, vacation, sick leave, maternity or paternity leave, job interviews or personal leave – may not exceed 8 weeks in any of the first three years of residency training, or 6 weeks during the fourth year of residency. If any of these maximum per year weeks of leave are exceeded, the residency must be extended for the duration of time the individual was absent in excess of either 8 weeks in year one, two or three, or 6 weeks in the fourth year.”

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. If a resident works one of the designated yearly holidays, they are able to utilize that time at a later date. Bonus days should be taken during the two weeks surrounding the Christmas/New Year’s holiday. If a resident is unable to take any of these days during this time, the days are to be used at a later date. All requests require the approval of the Administrative Chief House Officer and Department Chairman. Upon taking any unused holidays, it is forbidden to exhaust all days on one service and should be spread out during the academic year.

3) Official Travel
This category includes leaves for the following possible reasons:

1. job/practice interviews for PGY 3s and 4s
2. fellowship interviews for PGY 3s and 4s
3. educational travel

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 and administrative chief.

Time away for examinations, e.g., Step 3 USMLE, or present papers/posters at sanctioned scientific meetings will be considered as official travel.

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  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.  The resident should contact the GME office prior to contacting the education office.

5) Parental Leave
After his spouse'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, holiday, or sick 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.  The residents should contact the GME office prior to contacting the education office.

6) Sick/Funeral Leave
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 sick leave for illness. If sick leave is to be taken, the administrative chief and/or program director should be notified. Residents earn 1 sick day per month and are taken in accordance to Human Resources Policy 82.0. For Funeral Leave, per Human Resources Policy 84.0, you are allowed five days for immediate family or other relatives for whom you are directly responsible for. In case of death of grandparent, grandchild, aunt, uncle, niece, nephew, or in-law, you are granted two-days. For other relatives or close friends, you will be given one half day.

7. Absence Record For each leave listed above an absence record is required to have on file with the OBGYN Education Office and the institutional GME Office. When requesting time off, a resident must first seek approval from the administrative chief and/or program director. Upon receiving approval, the resident should then fill out an absence record in the education office or request one to be sent electronically. Then the resident should obtain a signature of their service chief (if applicable) and administrative chief prior to handing it in to the residency coordinator. Leave time is not approved until the proper paperwork is submitted two weeks prior to leave date. The only exception is sick/funeral leave. Failure to do so will result in the cancellation of requested time.

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 2011

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 2011

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 must be completed.

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 2011

House staff is expected to conduct themselves in a professional manner regarding achievement of educational objectives, provision of patient care and relations with their colleagues. The appointment contract makes explicit these expectations and makes reference to other relevant documents that govern resident behavior. They are the University Administrative Regulations (AR), the Chandler Medical Center Behavioral Standards in Patient Care, the Behavioral Code and other Medical Cente r documents, all of which are available via the GME Office.

House staff is bound to and must abide by the Behavioral Standards, and agree to abide by the policies, regulations and procedures of any hospital or institution to which they are assigned for any part of training and other responsibilities as assigned by the program. 

Revised 2011

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 (additional $1,500 to be used towards a course)
• PGY-3 - $750
• PGY-4 - $2000 (given at the beginning of the year through payroll)

These professional development funds may be used for membership dues, medical journal subscriptions, books, and educational courses.

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 Residency Coordinator of the Department of Obstetrics and Gynecology.

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

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

Revised 2011

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 receives an evaluation filled out by faculty through New Innovations. These competency-based evaluations are specific to each rotation, with each successive year representing more advanced goals, objectives, patient responsibilities, and teaching responsibilities. Residents are notified through New Innovations when an evaluation has been completed on them.

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 2011

Upon entering the Residency Program, each PGY1 resident will be specifically instructed in the ACGME approved case log recording system.  In addition, there are several computer terminals which are accessible for entering 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 Residency Coordinator.

Revised 2011