Section VI. General Policies and Procedures

Please refer to the Institution Policy Manual located on the GME website at http://z.umn.edu/gmeim for University of Minnesota Graduate Medical Education specific policies. Should policies in the Program Manual or Fellowship Addenda conflict with the Institution Manual, the Institution Manual takes precedence.)

ACLS/BLS CERTIFICATION REQUIREMENT, ENT RESIDENTS ( PALS AND ATLS ARE NOT A REQUIREMENT )

Required: Report life support certification in RMS

Programs are required to upload life support certification information and documentation about each of their trainees to RMS. Programs must upload this information regardless of where the resident/fellow received certification.

Life support certification at Fairview

Fairview Contact:

Terry Nelson Fairview HR BLS/ACLS Coordinator

612-273-6195

tnelson1@fairview.org

Basic Life Support (BLS)

New to UMN residents/fellows who attend a MHealth Fairview American Heart Association BLS course are issued a BLS Provider card. The BLS training is valid for two years.

BLS Renewal: BLS recertification is required every two years by M Health Fairview. There are two options for re-certification:

• Complete the M Health Fairview BLS review course. Those who complete the M Health Fairview review are issued a statement of attendance (minimum requirement at M Health Fairview).

• Complete the M Health Fairview BLS review course plus the online AHA didactic training, which carries a fee of $22, plus an additional $5 to receive an AHA BLS card (vs. a statement of attendance). This is currently a charge that must be incurred by resident/fellow.

Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), & Neonatal Resuscitation (NRP)

UMN residents/fellows required by their programs or M Health Fairview to maintain these advanced skills can complete a certification class. They are issued an AHA or AAP card. This training is valid for two years from the date of issue.

Renewal:

• UMN residents/fellows required by their programs or M Health Fairview to maintain these skills can schedule a renewal depending on class availability. AHA or AAP cards are issued for all ACLS/PALS/NRP renewal classes and valid for two years from the date of issue.

• If advanced life support courses are not required residents/fellows may register if room is available. There would be a fee upon registration.

Life Support Certification at VAMC

VAMC Contact:

Wendy Dahl

Director, Advanced Life Support Training

Wendy.Dahl@va.gov

The VA is offering ACLS and/or BLS training for the residents during the COVID pandemic. Residents/fellows that are rotating at the VA through December 31, 2020 (this date may be extended but it's unknown at this time if it will and for how long it will be extended through) can obtain their ACLS and/or BLS certification online followed by the VAM (Voice activated manikin) station for skills testing. Availability of this option in 2021 is unknown at this time.

Process is as follows:

1. A VA liaison staff member (site coordinator) verifies which course (ACLS or BLS or both) is required for the VA rotation and verifies that the resident/fellow is rotating at the VA prior to the expiration of this offer.

2. Once that information is verified, the liaison person sends Wendy Dahl a name with certifications needed and expiration dates of certification status currently. Wendy will assign the course/s in TMS where residents/fellows can complete the course/s. Staff should not try to self-enroll, as this process does not work. The VA does not provide key codes to anyone anymore.

3. Each resident/fellow must have an active PIV Card to access the VA CPR (VAM skills test stations in our library 4U-100) in order to complete the course.

4. Certification completion cards are located within the completion course itself for the residents/fellows to print as the VA no longer prints cards.

Acceptable proof of certification at VAMC

If your UMN resident/fellow is rotating to the VAMC and has already completed Life Support Certification, VAMC accepts proof of certification via completion certificate, BLS card, etc. (In the past, only AHA cards were accepted at VAMC.) VAMC considers the American Heart Association training the gold standard and recommends it; however, VAMC will accept the M Health Fairview hands-on training.

Life support certification at other affiliated hospital sites

Review the UMN GME Affiliated Sites Life Support Certification Resource for information, costs, and contacts for scheduling life support certification training at other affiliated hospital sites.

American Heart Association life support certification courses

Go to the AHA’s courses site to view life support certification course options, locate training centers, and review course content.

NOTE; CHILDRENS AND HCMC ARE BOTH HAVE MANY COURSES ALL YEAR SEE THE UMN GME Affiliated Sites Life Support Certification Resource FOR MORE INFORMATION

AUDIOVISUAL EQUIPMENT AT THE UNIVERSITY

The Department maintains audiovisual equipment in the Otolaryngology Conference Room, 8- 335 Phillips-Wangensteen Building, for your conference presentations. Please notify Teri Wolner, 612-625-9996, when any of this equipment needs repair.

AUTHORSHIP GUIDELINES, DEPARTMENT OF OTOLARYNGOLOGY

Needs review- Revised 4/12/08

Research and the publication of its results is the lifeblood of a major University. However, as research studies become more multidisciplinary, and the number of authors contributing to a publication has increased, credit and responsibility issues for authors have become controversial. Authorship disputes and misconduct in scientific research have damaged the reputation of individuals and institutions, and have fostered distrust by the public. In an attempt to address authorship issues before they arise, the department of Otolaryngology has prepared this guide for authorship credit based upon policies set forth by the University of Minnesota and the International Committee of Medical Journal Editors (ICMJE).

What are the criteria for authorship on a scientific publication?

Authorship credit should be based on (from ICMJE):

1) Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data.

2) Drafting the article or revising it critically for important intellectual content.

3) Final approval of the version to be published.

All authors should meet all 3 conditions. Acquisition of funding, collection of data, or general supervision of the research group, alone, does not justify authorship.

Investigators should discuss these criteria with potential co-authors at the initiation of a study so that all individuals can discuss their role in the project and whether they will be able to meet the criteria for authorship. If they cannot meet the 3 conditions, then it should be made clear that their name will appear in the Acknowledgements section of the paper.

If an individual does not make a significant intellectual contribution to the work, and they are not involved in the writing and critique of the work, then he/she should not be an author. The acceptance of “honorary” authorship by an individual is not ethical and could be detrimental if the work turns out to be fraudulent, as each author must take public responsibility for his/her work.

Author order is another important aspect of authorship, and the first or primary author is the major contributor and that person who has written the manuscript and met the three conditions of authorship. Students must be primary authors on their theses or dissertations. The last or senior author may be reserved for the principal investigator of the grant or laboratory and who has met the three conditions of authorship. The corresponding author, who may also be the primary or senior author, guides the manuscript through the editorial and publication process, and is the person who readers correspond with regarding questions or concerns. In addition, it is suggested that each author’s contribution to the research be described in the publication in order to clarify the credit and role of each author on the final publication.

AWARDS

Each year, residents and medical students are eligible to receive awards that include a financial gift. These awards honor academic activities and achievements, i.e., a professional presentation, a journal article or other achievement. Professional activities are recorded to become the basis for selecting recipients. The teaching award is based on written feedback from medical students.

The awards are:

Albert Hohmann Award - to encourage excellence in resident research

Paparella Clinical Otological Research Award - to the resident who has done the best research in otology

Melvin Sigel Outstanding Resident Teaching Award - for excellence in teaching medical students

Joseph Carter Award for Clinical Excellence - Given to a chief resident for outstanding clinical and surgical care

Residents also have the opportunity to select outstanding faculty, peers, and support staff to receive these awards:

Frank M. Lassman Teacher of the Year – awarded to a faculty for excellence in teaching residents

Joseph Carter Award for Humanism - awarded to the senior resident who best exemplifies high moral character and concern for patients and colleagues, and best promotes working relationships in the residency and with other services

Staff/Support Person of the Year – awarded to an ancillary staff member for excellence in supporting residents

Charts/Dictation/Patient Paperwork/Photographic Documentation

Charts must be kept current and it is important to remember that the Utilization and Review Committee may review them at any time. Residents/fellows are responsible for providing the following for all patients:

Work-ups

Progress notes

Orders

Summaries

Check with the staff person to be sure you have ordered appropriate studies.

Whether considering the medical, patient care, or legal perspectives, photographic documentation of all pre- and post-operative plastic, reconstructive, traumatic, and other unusual cases is advised. Photographic assistance, cameras, and film are available at all hospitals to record this information as part of the chart work.

As the result of referrals, we see many interesting cases. A prompt, courteous letter together with a follow-up to the referring doctor is important in establishing a good working relationship. This helps us to continue to receive significant and challenging cases. Usually the resident/fellow is responsible for this, but a few of the staff prefer to do their own. Check with the Chief Resident or staff physician to learn what is preferred.

CHIEF RESIDENT RESPONSIBILITIES

The PGY5 (chief) resident has many responsibilities. Some guidelines for these duties are listed below. In addition to the basic duties each year the Residency Program Director will also assign specific areas of responsibility( see Chief Descriptions and General Overview for roles and descriptions) If you are interested in a particular role talk to your residency program director and let them know.

• Oversee residents' participation in the entire otolaryngology service. Be aware of all patients on- and off-service, to assure they are being closely and responsibly followed;

• Make proper distribution of the workload to assure all residents are free to attend the Monday evening and other required conferences;

• Review all relevant lab tests, audiograms, and X-rays in addition to being informed on pertinent medical problems of all patients on the service. Supervise also the post-operative care of those patients under the direction of the attending surgeon;

• Remember the patients are primarily those of the attending surgeon. They should be treated with dignity and respect at all times, and not just as "teaching opportunities;”

• Conduct in the operating room should reflect concern for the total welfare of the patient.

• Conservation and good judgment always determine the limits of operative involvement for each patient.

Chief Descriptions and General Overview

Annual activities and events that are part of the chief resent role

Professional Development Chief:

Develop and coordinate programs to address topics of:

Practice management: billing, cpt, icds, setting up a practice, interviewing, contract negotiation

Leadership

Well-being and Burn out

Professional skills: giving talks etc

Specific areas of responsibility

Create, plan, and organize four professional series dates 1-2 hour in length in the third week in Sept. Dec. March and June send information to education coordinator a minimum of 1 month prior to event annual didactic schedule

Add any best practices for practice management to the shared drive in the professional development folder

Be a member of the PEC committee as a representative for resident well being initiatives

Evaluate student rotations in med hub

Be a liaison for program coordinator regarding outside vendor request to residents

Utilize the otol-resident email group for communication distribution

Give update at Quartley debrief meeting

Education Chief:

General oversight of didactic and educational programs

Help to develop efficiency and standardization in educational endeavors: minimize redundancy, optimize scheduling and communication to residents

Oversight of resident lecture series

Identify areas of possible educational growth and resources

Oversee course implementation and operations

Specific areas of responsibility

Assigning and distribute the weekly tuesday core topics schedule to residents (annually) add education coordinator into the communications( can use otol-residents group) this information is for accreditation recording and didactic scheduling

Assign/manage a junior residents to collect and add the case pretions to the resident shared drive folder “Didiatics”

Manage, plan and oversee the M&M cases in Redcap send two week reminders for entering cases. Partner with education coordinator who is scheduling the mediaoter.host and meeting links and reminders for faculty,

Partner with the education coordinator on the annual didactic schedule who is setting the education lectures 3-4 mo in advance. M&M moderators are on a rotation

Evaluate student rotations in med hub

Oversee Flex and chapter review

Advocate for new education materials for the group

Utilize the otol-resident email group for communication distribution

Give update at Quartley debrief meeting

Recruitment Chief:

Chief liaison and contact for medical students

General oversight of medical student experiences and rotations, working with David Hamlar, Brianne Roby Jenn Hsia, and education coordinator to optimize

Overseeing resident recruitment experience on interview days, resident involvement

Serves as one consistent interviewer on recruitment days

Specific areas of responsibility

Serve as interviewer and member of the resident selection committee

Provide resident feedback on medical students to Program Director

Minimum once/ 6 mos host a student interest event Fall MS2 with internet and Spring MS3 interred in applying

Respondent to interest emails

Set resident recruitment event dates by the 1st week in october each year, Partner with the education coordinator for detail planning

Fundamental to planning recruitment efforts

Evaluate student rotations in med hub

Utilize the otol-resident email group for communication distribution

Give update at Quartley debrief meetings

Administrative Chief :

Oversight of residency logistics: rotations, schedules, minimizing conflicts, intern orientation

Outreach chief for resident issues and concerns about the training program, structure, staff

Partner in fostering the success of junior residents: help identify and foster needed support etc

Be available to junior residents for problem solving and conflict resolution issues appropriately include the education coordinator , PD, or department leadership in decision making and policy verification

Liaison for program director and chairman for resident concerns and feedback

Specific areas of responsibility

Hold a debrief quarterly ( after each quarter)with resident group to overview each rotation -document areas that ended to be addressed to a PD debrief to be held semiannually and possibly escalate to PEC meeting

Attend the annual PEC meeting as a resident representative

Copy education coordinator in correspondence related to scheduling and policy.

Utilize the otol-resident email group for communication distribution

Host annual chief resident meeting with residents the 1st tuesday in July during conference/ orientation

Assign or be a part of the onboarding orientation for new residents

Partner with the education coordinator for administrative support.,zoom meetings, add calendar dates, send correspondence to the group ect.

CONFERENCES, COURSES, SCHOLARLY OPPORTUNITIES

Department conference schedules are available in the shared Google Calendar UMN ENT CONFERENCE RESIDENT the weekly curriculum can be found in the Shared Google drive OTOL -Residency Folder Didactics each week the residents topic presentation should be added to this folder as well by the presenter and managed by the education chief.

The Department and University offer many opportunities for scholarly activity as well as AAOHNS and professional development workshops. Please partner with you Program director, Mentor, PI, etc... if you have an interest in perusing additional scholarly activities while maintaining you resident training responsibilities.

Mandatory Course/Workshop List -

OTE Exam: Onsite - all resident normally the 1st Saturday in March exception can be requested in advance to the Program Director

ANAT 7999 1st six weeks summer UMN campus - first year PGY1 ( registered by the program)

Temporal Bone Lab - UMN Campus -1st or second weekend in October annually- Sponsored by the Otology /Neurotology Group- PGY2 required

Workshops Resident and Fellow planned -any food or sponsorship from the the dept. required requests to be made 60 days in advance to the Program director and copied to the program and if applicable site coordinator's

Emergency Simulation Workshop- Orientation week PGY1 's PGY2's ( leadership handed off to either Chief education or professional and PGY4 leadership) cost of simulation sponsored by residency funds dept.

BOTOX- Spring annually

Dissection Workshop- Winter annually

See curriculum manual for more details on professional conference attendance .

COMPUTER AND SOFTWARE AT THE UNIVERSITY

Personal computers with ethernet connections to the Internet, LaserJet printers, a scanner, and software have been purchased for the exclusive use of Department of Otolaryngology residents/fellows. These are located in the Residents' Room, eighth floor, Phillips-Wangensteen Building.

Student Computer Facilities are also available in a number of locations on the University campus. Check University’s Information Technology web site (https://it.umn.edu/computer-labs- learning-spaces-testing) for locations.

CLINICAL AND EDUCATIONAL WORK HOURS POLICY

Reason for Policy

The purpose of this policy is to define clinical and educational work hour requirements for Graduate Medical Education trainees, define oversight and monitoring for compliance with the regulations, and define the responsibilities of the trainees, the programs, and the sponsoring institution.

Definitions

Clinical and Educational Work Hours

Time spent at the worksite performing clinical and/or academic activities required by the trainee’s GME training program, including:

Patient care activities, both inpatient and ambulatory, whether scheduled or not.

Administrative activities that are related to patient care.

In-hospital “on call”, regardless of what the trainee activities are during such periods.

Scheduled academic activities.

Time spent on direct patient care activities and in-hospital during home call.

Time spent moonlighting, if allowed.

Clinical and Educational Work Hours

Time spent at the worksite performing clinical and/or academic activities required by the trainee’s GME training program, including:

Patient care activities, both inpatient and ambulatory, whether scheduled or not.

Administrative activities that are related to patient care.

In-hospital “on call”, regardless of what the trainee activities are during such periods.

Scheduled academic activities.

Time spent on direct patient care activities and in-hospital during home call.

Time spent moonlighting, if allowed.

Trainee Responsibilities

Trainees are responsible for adhering to the schedule created by their programs to provide both educational and clinical experience opportunities, as well as reasonable opportunities for rest and personal activities. Trainees have a personal role in accurately reporting their clinical and educational work hours. Trainees that are at risk of violating work hour rules have an obligation to inform program leadership so that coverage can be arranged to avoid violation.

Trainees are required to report the following work activities and all work hour violations to their program leadership for review and process improvement.

Patient care:

Inpatient and outpatient care occurring at the hospital or while at home.

Administrative duties related to patient care occurring at the hospital or while at home.

Electronic Medical Record (EMR) note writing, preparation of discharge summaries, phone calls related to patient care, while at home or at the training site.

The provision for transfer of patient care and sign-outs.

Time spent in-house during call activities.

Education/Academic:

Scheduled academic activities such as conferences or unique educational events.

Research.

Time spent at academic conferences and meetings when attendance is required by the program, or when the trainee is acting as a representative of the program. Only actual meeting time counts towards work hours.

Work hours spent on activities that are required by the accreditation standards or that are accepted practice in training programs.

The following activities are excluded from work hour reporting:

Academic preparation time.

Travel and non-conference time when at a conference or meeting.

Concerns about continuous work hour violations not adequately addressed by their program can be reported to the Designated Institutional Official at gme@umn.edu. Anonymous reporting of work hour violations can occur via a Qualtrics form. Trainees may also report violations directly to the ACGME.

ACGME Work Hours (Formerly Duty Hours)

It is imperative that residents comply with ACGME duty hour requirements.

To ensure that Otolaryngology Residents are able to comply with ACGME requirements, residents on University of Minnesota East Bank rotations or Regions/HealthPartners rotations who are post-call must go home by 2:00 p.m. This is mandatory.

ACGME Resident Work Hours Requirements

Maximum Hours of Work per Week-Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting.

In-House Call-Residents must have at least 14 hours free of clinical work and education after 24 hours of in- house call.

One Day In Seven Free-Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days.

24 Hour Maximum- Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments. Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. Additional patient care responsibilities must not be assigned to a resident during this time.

RECORDING WORK HOURS (FORMERLY DUTY HOURS)

Otolaryngology residents and fellows are required to record all duty hours using the online New Innovations Residency Management Suite (RMS). Hours entered into RMS will be used by the Program Director to monitor resident duty hours as required by ACGME; they will also be used by the affiliated hospitals to bill Medicare for the cost of resident training, and to reimburse the Department of Otolaryngology for the cost of resident salaries and benefits.

Web address for RMS is https://www.new-innov.com/login/. Institution login is “MMCGME” If you’ve forgotten your user name or password, contact your program coordinator.

It is imperative that residents/fellows keep duty hour logs up-to-date. On the fifth working day of each month, the affiliated hospitals will begin using data entered for the previous month to bill Medicare and to reimburse the residency/fellowship programs for residents’ and fellows’ salaries.

Please use this as the updated guidelines for entering your duty hours: You will need to change the assignment for call hours based off if you're called in or at home

change effective Spring 2020-WORK HOURS ASSIGNMENT DEFINITIONS

COVID 19 REDEPLOYMENT- Please use is you are off site for self quarantine or COVID positive. Assigned work during hours off site you would normally complete onsite pre COVID ( ex: virtual learning/ simulation training)Do not use if you are moved sites, that is being tracked differently.

DH- May see new patients- 6AM -6PM Use for patient care that is not after hours or weekend call. Can be used for -Grand Rounds / Virtual calls

DH-No New Patients - Use for hospital onsite time such as research and conference times onsite, meetings etc..

Home Call -Called in - ALL SITES 6PM -6AM Use for weekend call -called onto site, triage/ virtual call . When you are providing care onsite

Home Call-Not Called in -ALL SITES 6PM -6AM Use for weekend call and evenings that you are not called in.

Off Site - education activities - conferences off site/ training and development off site

Log Vacation time when taken excluding weekends: use for LOA- Leave of Absence and Vacation.

EVALUATION SYSTEM

New Innovations Residency Management Suite (RMS)

https://www.new-innov.com/login/ to evaluate faculty and rotations and to review evaluations submitted about the resident/fellow. Institution login is “MMCGME.” If you’ve forgotten your user name or password, contact your program coordinator

Chief Resident Med Hub

https://umn.medhub.com/index.mh to submit evaluations about medical students.

Institutional Trainee Evaluation of Faculty-

https://umn.qualtrics.com/jfe/form/SV_eFqK8dAZ6RxRY4R

GRADUATION BANQUET

The resident/fellow graduation banquet is held in June. Residents and fellows are guests of the department and are strongly encouraged to attend. Graduating residents and fellows may invite up to three immediate family members as guests of the department. All residents and fellows may invite family members at their own expense. Graduating residents and fellows are honored, awards are presented, and outstanding service to the department is recognized at this annual event.

GRAPHICS/PHOTOCOPIES/PHOTOGRAPHY

When costs are related to a joint resident/fellow-faculty project and the faculty member approves the expense, it is the responsibility of the faculty member to pay the cost of photocopies, graphics, and photographic work. Each time work is to be charged, residents are required to obtain a department budget number from Teri Wolner, 612-625-9996.

GUIDELINES FOR PROFESSIONAL INTERACTION

In the course of your duties, you will be asked to consult on a patient with another service. Keep in mind that otolaryngology is not a primary care specialty and it often functions as a consultant service. While you may disagree with certain issues regarding the patient's management, it is important to remember who is the patient's primary physician. If a major disagreement occurs, it should be referred to your staff.

In resolving a dispute, always present your opinions objectively as suggestions or recommendations. Avoid personal comments, derogatory remarks, or demands. Follow this same policy with any written remarks you make.

KEYS/ACCESS TO LOCKED SPACES AT THE UNIVERSITY

On weekends, if you need a key to the ENT Clinic at the University call Hospital Security, 612- 626-4005.

For security reasons, some areas of the eighth floor are kept locked. These include conference rooms, storage areas, and unoccupied faculty/staff offices. If you need access to these areas, the receptionist in 8-240 PWB (612-625-3200) will assist you.

LICENSURE/ RESIDENCY PERMIT

See also Institution Policy Manual, http://z.umn.edu/gmeim, Licensure/Residency Permit.

Residents and neurotology fellows are required to obtain and maintain a valid residency permit or medical license from the Minnesota Board of Medical Practice to participate in the training program. ( SAC Education Manager is the contact this is covered in you RMS onboarding checklist )

The Residency Permit is not a Medical License.

Pediatric Otolaryngology fellows are required to obtain a medical license from the Minnesota Board of Medical Practice.

Information on licensing can be obtained from:

Minnesota Board of Medical Practice

University Park Plaza

2829 University Avenue S.E., Suite 500 Minneapolis, MN 55414-3246

Phone: 612-617-2130

Fax: 612-617-2166

Web site: https://mn.gov/boards/medical-practice/

MEDICAL BLOGGING AND HIPAA

Please Read full policy : Social Media Policy for AHC Students, Residents and Fellows

Residents/fellows are strongly cautioned that blogging, posting information on the web, or broadcasting e-mail messages that include medical information which could allow a patient or family member to identify themselves could open the resident to the possibility of fines and jail time.

Beyond HIPAA regulations and privacy laws, please use common sense to keep in mind that specific mention of individuals and hospitals can be hurtful. Remember that all electronic communications can be easily transmitted beyond their target audience. Do not write critically of others; imagine what it would be like for others to write critically of you in public forums.

Information including name of the doctor, hospital, or characteristics of the patient (age, diagnosis, personal details) should be removed. A post stating that a certain patient event occurred “last night” or “last week” may be a violation of HIPAA, while the term “recently” may be vague enough. Non-anonymous bloggers may wish to avoid presenting cases at all unless they’re radically altered or very generalized.

At a minimum, the following information must be removed:

• Names

• All geographic subdivisions smaller than a State including street address, city, county, precinct, zip code, and their equivalent geocodes

• All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older

• Full face photographic images and any comparable images

• Any other unique identifying number, characteristic, or code

The section of HIPAA that appears to apply to medical bloggers is as follows:

Wrongful Disclosure of Individually Identifiable Health Information SEC. 1177.

(a) OFFENSE.--A person who knowingly and in violation of this part-- (1) uses or causes to be used a unique health identifier;

(2) obtains individually identifiable health information relating to an individual; or

(3) discloses individually identifiable health information to another person, shall be punished as provided in subsection (b).

(b) PENALTIES.--A person described in subsection (a) shall--

(1) be fined not more than $50,000, imprisoned not more than 1 year, or both;

(2) if the offense is committed under false pretenses, be fined not more than $100,000, imprisoned not more than 5 years, or both; and

(3) if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.

MEDICARE Regulations: SUPERVISING PHYSICIANS IN TEACHING SETTINGS

This department abides by the provisions of the Medicare Manual, Publication 100-04, Chapter 12, Teaching Physician Services. This means that a clinical faculty member must be present to supervise residents/fellows during the key part of any operating procedure.

MOONLIGHTING

PGY-1 residents are not permitted to moonlight.

Resident must obtain a medical license and private malpractice insurance in order to moonlight. Minnesota Board of Medical Practice prohibits use of the “Residency Permit” held by most of our residents/fellows for practice of medicine outside of the program for which it is issued.

Written permission from the Program Director is required to moonlight: policy and form are available in the Institution Policy Manual located on the GME website at http://z.umn.edu/gmeim

NIGHT FLOAT

Night float overview

- Sunday 6am – Monday 6am.

- Monday 6pm – Tuesday 6am

- Tuesday 6pm – Wednesday 6am

- Wednesday 6pm – Thursday 6am

- Thursday 6pm – Friday 6am

- Friday 6pm – Saturday 6am

Night Float Breakdown per resident (13 week rotation):

- HCMC (Non-trauma weeks)

o PGY4 (1)

o PGY2 (2)

- University (Trauma weeks)

o PGY4 (1)

o PGY3 (1)

o PGY2 (2)

- Children’s (1 Trauma, 1 Non-trauma)

o PGY2 (2)

- Research Residents (Trauma or Non-trauma weeks)

o PGY3 (2)

o PGY3 (2)

- **Research resident call weeks will depend on the rotation, whether there are 6 or 7 trauma weeks**

- No sites should have more than 1 person out at a time (ex: the U should not have a resident on night float and a resident on vacation)

• Regarding vacation time, the resident making the schedule should contact Dr. Roby to make sure that the fellow's vacation dates are taken into account when making the schedule

- Each site should always have a senior resident available (PGY4 or PGY5)

- The designated night float resident should be responsible for rounding at their respective site the weekend they start night float

o Ex: If they start on Sunday, they should round both Saturday and Sunday at the beginning of the week. They should not round the weekend at the ending of their float week (this is for residents with rounding responsibilities at HCMC/University/Masonic)

- The Masonic PGY4 is not apart of the weekly night float

o They still share weekend rounding responsibilities at Masonic with the University PGY4

o They will take weekend 24hr call, approximately 3-4 per quarter

- The Children’s PGY2 takes 2 weeks of night float

o They do not take 24hr weekend call

o The weeks that they are listed on night float, the Masonic PGY4 should take the respective Sunday 24hr call

RESIDENTS ON RESEARCH ROTATION -CURRENTLY UNDER REVISION 2/21

Residents on research time will be on call at least every two weeks. This call will occur Sunday through Friday.

Regions Hospital and the Veterans’ Affairs Medical Center

Residents at Regions Hospital and the Minneapolis VA Health Care System (VA) will take call from home. Regions and the VA will have a joint call schedule. The chiefs will alternate as permanent back up and the junior residents will cover both hospitals. If a Chief Resident is not available to provide back up, the Chief Resident must notify both Dr. Caiciedo and Dr. Schmidt.

Regions residents who are post-call must go home by 2:00 p.m. This is mandatory.

University of Minnesota Medical Center and Hennepin County Medical Center

Residents at University of Minnesota Medical Center (UMMC) and Hennepin County Medical Center (HCMC) will take call from home after 9:00 p.m. The resident on night call will remain in the hospital until at the earliest 9:00 p.m. or until all patient care issues are resolved. Should there be a seriously ill patient in the hospital, and it is felt that the resident needs to stay in the hospital, that decision will be made between the resident and the involved faculty. Hopefully this will not occur frequently. Residents not on call are encouraged to leave the hospital as soon as their tasks for that day are completed. They should not feel obligated to stay in the hospital once the work has been completed.

Residents on UMMC-East Bank rotations who are post-call must go home by 2:00 p.m. This is mandatory.

University of Minnesota Masonic Children’s Hospital

Expectations regarding new patient consults seen at Masonic when on call: First call your chief resident, discuss the case with them, and make sure you have not missed something in your workup of the patient. Second, call the pediatric ENT staff. This goes for every new consult whether an inpatient or in the emergency department.

In addition, during call coverage, the chief resident is expected at all Operating Room cases at Masonic.

Resident Responsibilities While on Home Call

1. It is expected that the resident will reach the hospital within 20 to 30 minutes from the time they are called.

2. It is expected that if the weather is extremely bad, as during a winter snowstorm, the resident will stay in the hospital.

3. Residents on call on the weekend (Saturday or Sunday) should be present in the hospital from 8:00 a.m. to 11:00 a.m. for completion of rounds. If there are no apparent issues or problems requiring their presence in the hospital, they may leave at 11:00 a.m.

and begin taking call from home.

4. It is expected that a resident on call who is called by the emergency room or any physician from the hospital and asked to come in to see a patient will come in. The decision about whether it is necessary to come in will be made jointly by the requesting physician and the resident. If there is doubt, the resident should come in rather than defer the case until morning. Junior residents who are called in should notify the Chief Resident of the reason for coming in if appropriate and if they have any specific questions. A thorough and complete consultation note should be placed on the chart.

5. If a patient is seen and will need to have operative intervention the responsible staff should be notified and must come in to see the patient. The only exception to this is in an extreme emergency such as a carotid blowout or airway obstruction, where carotid control or tracheostomy has to be performed on an emergency basis. Most tracheostomies and most bleeding problems can be temporarily controlled until arrangements have been made to take the patient to the operating room and the responsible faculty has arrived at the hospital.

6. Chief Residents at all hospitals will take back-up call. They should be aware, however, that if, for example, the resident on-call is called to the University, and a serious problem occurs at HCMC, the Chief Resident will be expected to go to HCMC to resolve the urgent problem, rather than wait for the case to be completed at the University.

On-Call Room Assignments, UMMC

They are located on floor 1, 1-365C PWB in the hallway that leads from the hospital into PWB. The new call room suite, includes a lounge, new exercise facility and locker/locker rooms. To access the call room suite area, the main entrance is accessed by your M Health Fairview badge. Your dept assigned call room is 18, which is access by an electronic key on your cell phone. You will be receiving an email from the door software instructing you to download the app for your phone. Once you have done this step to register, your key will appear. All that is needed is for you to open the app and hold your phone to the call room door to unlock it. There will always be onsite security starting at 7pm if you run into any issues or you may also email PWBOncall@fairview.org.

You need to register for your access to the call room: Directions https://drive.google.com/file/d/1rcCp3HJ5iTSchu7pLsZWikgy6yRUofsE/view?usp=sharing

Please follow the instructions and contact us at PWBOncall@fairview.org if you run into any issues adding the app to your phone.

Operating Room Rules and Precautions

See also Institution Policy Manual, http://z.umn.edu/gmeim, Blood Borne Diseases Policy

In the Operating Room and on the floor, residents/fellows are expected to observe the established rules concerning the universal precautions for dealing with body fluids. Please cooperate with nurses in observing these rules which are formulated for everyone's protection.

If disagreements occur, whether involving other residents/fellows, anesthesiologists, or the O.R. nurses, it is best to resolve these issues following surgery. Handle the discussion in a location outside the operating room.

Patient Examination - Opposite Gender

The following rules apply when conducting a patient examination:

1. If there is any question about what is appropriate, always have a nurse present in the room.

2. At no time should the door be closed when only a patient and physician are present.

3. Routine examination of the head and neck by male or female residents may be conducted without the presence of nursing staff in the room.

4. Examinations other than head and neck where the patient is the opposite gender (i.e., male resident/female patient or female resident/male patient) require a nurse in the room.

Personal Emergency

If an emergency (whether financial, medical, or personal) should arise, residents/fellows are encouraged to discuss the situation with the faculty Chief at their hospital, with their Program Director, or with Department Chair. They will determine whether special arrangements can be made to assist in these situations.

Additional support resources:

Physician wellness collaborative

Trainee support recourses

Personal Library

It is important to begin to establish a personal library of both ordinary and unusual cases. Photographs or slides should document these. Other information such as lecture materials, charts and graphs will accumulate. These will be useful to you throughout your career if you organize them in an orderly way.

Begin to develop a library of standard texts and atlases, as well. These are expensive purchases, so discussions with faculty and other students will help you decide on the best choices. Two sources of excellent and inexpensive monographs are the American Academy of Otolaryngology-Head and Neck Surgery and AFIP.

Knowledge of current literature is essential, and it is wise to establish now a lifelong habit of reading the relevant journals. If you have not already done so, subscribe to several good ENT journals. Examples include:

Archives of Otolaryngology-Head and Neck Surgery,

Laryngoscope,

Head and Neck Surgery, Annals of Otolaryngology.

Make good use of the library facilities and the internet to familiarize yourself with other source materials.

Rotation Schedule

The Resident Rotation Schedule is determined by the Program Director with the advice of faculty, residents, and staff. It is developed by Education Coordinator and the Chief Residents for the coming year, and is announced in May. Schedule changes require consent of the Program Director.

Although schedules may vary from one individual to another, the goal is a balanced schedule. Residents spend 48 months on clinical ENT rotations and 6 months on research rotation. First- year residents do one month each of Anesthesiology, Neurosurgery, General Surgery/Trauma, and Surgical Intensive Care, plus two months of Plastic Surgery. The resident's clinical needs and proficiencies, as measured by semi-annual meetings of the Resident Review Committee, determine the hospitals at which they spend their clinical rotations.

Rounds

While making rounds, residents/fellows are responsible to know all pertinent history concerning the patient, including past surgery and current indications for surgery. Faculty questions concerning a patient should be answered with referenced citations.

SECURITY/SAFETY

Appropriate security and personal safety measures must be provided to residents/fellows at all locations including but not limited to parking facilities, on-call quarters, hospital and institutional grounds, and related clinical facilities (e.g., medical office building).

The University of Minnesota Police Department provides a free Campus Escort Service. Available 24 hours a day, seven days a week, the Escort Service can be reached at 612-624-WALK (4-WALK from any campus phone). An escort will be dispatched to your location and will accompany you anywhere within the campus vicinity.

In addition, the University offers the Motorist Assistance Program, a FREE program designed to help Twin Cities Parking and Transportation Services customers who are legally parked in any University parking facility. This includes University meters, surface lots, ramps, garages, loading zones, and vendor stalls. This program does not include Fairview-University Hospital parking facilities. After calling 612-626-PARK (7275), individuals will receive assistance with unlocking vehicles when the keys are locked inside, changing flat tires, jumpstarting vehicles, and can be given referrals upon request to a service station when the problem is beyond the scope of our staff. Hours of Operation are Monday through Friday from 7 a.m. to 10 p.m. Service is not available on weekends or official University holidays.

SUPERVISION

Each patient must have an identifiable and appropriately-credentialed and privileged attending physician who is responsible and accountable for the patient’s care.

a) This information must be available to residents/fellows, faculty members, other members of the health care team, and patients.

b) Residents/fellows and faculty members must inform each patient of their respective roles in that patient’s care when providing direct patient care.

Supervision may be exercised through a variety of methods. For many aspects of patient care, the supervising physician may be a more advanced resident or fellow. Other portions of care provided by the resident can be adequately supervised by the immediate availability of the supervising faculty member, fellow, or senior resident physician, either on site or by means of telephonic and/or electronic modalities. Some activities require the physical presence of the supervising faculty member. In some circumstances, supervision may include post-hoc review of resident delivered care with feedback. The program uses trigger cards for assistance as to who and when to contact for supervisors.

The program must demonstrate that the appropriate level of supervision in place for all residents is based on each resident’s level of training and ability, as well as patient complexity and acuity. Supervision may be exercised through a variety of methods, as appropriate to the situation.

Levels of Supervision

To promote oversight of resident/fellow supervision while providing for graded authority and responsibility, the program must use the following classification of supervision:

a) Direct Supervision – the supervising physician is physically present with the resident and patient.

b) Indirect Supervision:

(1) With direct supervision immediately available – the supervising physician is physically within

the hospital or other site of patient care, and is immediately available to provide Direct Supervision.

(2) With direct supervision available – the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.

(3) Oversight – The supervising physician is available to provide review of procedures/ encounters with feedback provided after care is delivered.

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members.

a) The program director must evaluate each resident’s abilities based on specific criteria guided by the Milestones.

b) Faculty members functioning as supervising physicians must delegate portions of care to residents, based on the needs of the patient and the skills of the residents.

c) Senior residents or fellows should serve in a supervisory role of junior residents in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual resident or fellow.

Programs must set guidelines for circumstances and events in which residents must communicate with the supervising faculty member(s).

a) Each resident must know the limits of his/her scope of authority, and the circumstances under which he/she is permitted to act with conditional independence.

Initially, PGY-1 residents must be supervised either directly or indirectly with direct supervision immediately available. Each Review Committee may describe the conditions and the achieved competencies under which PGY-1 residents progress to be supervised indirectly with direct supervision available.

Faculty supervision assignments must be of sufficient duration to assess the knowledge and skills of each resident and delegate to the resident the appropriate level of patient care authority and responsibility.

Supervisory Lines of Responsibility for Care of Patients, Otolaryngology Residency

University of Minnesota Medical Center (UMMC)/Hennepin County Medical Center - At UMMC, Dr. Sofia Lyford Pike is the Director for Otolaryngology Residency Training. At HCMC, Dr. Odland is Local Program Director for Otolaryngology Residency Training.

Residents on UMMC, HCMC, and lab rotations have a combined resident call schedule. Junior residents (PGY-2, 3 and 4) rotate call, covering both hospitals. Chief residents (PGY5) provide back-up call. If activity at the two hospitals cannot be handled by the on-call resident the appropriate chief resident and staff will be called.

UMMC and HCMC each have a chief resident call schedule and a staff call schedule. The PGY2 resident calls the Chief Resident first. The junior resident may call the faculty directly. Faculty on call must be available at all times. Faculty must come in for all serious cases, or when the patient is taken to the operating room.

Minneapolis VA Health Care System (VA)/Regions Hospital (RH)

At the V.A., Dr. Caciedo is the Local Program Director for Otolaryngology Residency Training. At Regions Hospital, Dr. Schmidt is the Local Program Director for Otolaryngology Residency Training.

Residents on VA and RH rotations have a combined resident call schedule. Junior residents (PGY-2, 3, and 4) rotate call, covering both hospitals. Chief residents (PGY5) provide back-up call. If the on-call resident cannot handle activity at the two hospitals the appropriate chief resident and staff will be called. Faculty are available for back-up call and must come in when a seriously ill patient is seen or admitted, and whenever any patient is taken to the operating room.

SUPERVISION, NEUROTOLOGY FELLOWSHIP

In the clinic, most cases are first seen by residents or fellows who are supervising medical students. Residents and fellows present their history and physical, analysis of data, differential diagnosis and plan. Then all patients are seen by the faculty. Faculty assist in the process, duplicate critical portions and remain responsible for the patient’s care.

In the hospital the resident’s round on a daily basis and often see patients multiple times per day dependent upon the health of the patient. Fellows are expected to respond to problems that might arise in the hospital. If any concern exists, the faculty are available to discuss the case and see patients. Faculty are required to see their patients at least every other day while they are in the hospital. They are expected to round with the residents and approve their notes.

A great responsibility is expected in the operating room. At the beginning of the year, faculty are present and perform a large portion of the case. Faculty supervise every procedure. The degree of supervision is dependent upon the fellow and the faculty. In the operating room the faculty must be present prior to induction of anesthesia and the resident doctors are expected to prepare the case for surgery. Fellows are expected to guide the junior residents through early portions of the case and to perform later parts of the operation. Graded responsibility means that each individual fellow has the full attention of the faculty until they are certain that the fellow can perform the procedure without difficulty. As the year progresses and the faculty watch the fellow develop skills they may elect to give the fellow greater freedom and responsibility. This will occur over a period of time and during the second year it is expected that the fellows will be able to operate more independently.

The fellowship is a small program. Doctors Adams, Huang and Levine meet on a regular basis and discuss issues concerning the Fellowship. Faculty will always be available and Drs. Adams, Huang and Levine carry cellular telephones and pagers. University of Minnesota provides electronic messaging which is also available. Faculty readily distribute their home telephone numbers and cellular numbers to the fellows and residents. Residents and fellows are informed of call changes and Drs. Adams, Huang and Dr. Levine are always available. The fellows always know how to reach faculty because of clear communication before they leave the hospital. Residents and fellows are able to reach faculty 24-7-365. There is always a faculty neurotologist available.

Supervisory Lines of Responsibility for Care of Patients, Neurotology Fellowship

All patient care is supervised by qualified faculty. Fellows are provided with rapid, reliable systems for communicating with supervising faculty. On-call schedules for teaching staff are structured to ensure that supervision in readily available to fellows 24-7-365.

Dr. Tina Huang is the Program Director for the Neurotology Fellowship, which is based at the University of Minnesota Medical Center.

At Regions Hospital, Dr. Christopher Hilton is the Local Program Director for the Neurotology Fellowship.

The Neurotology fellow may travel to other clinical sites (the V.A. Medical Center, United Hospital) a few times per year to participate in interesting cases that present there. In these cases, the fellow will be under the supervision of the University of Minnesota neurotology faculty member who travels with the fellow to the site to participate in the case.

The faculty are ultimately responsible for every patient seen and every operation performed.

SUPERVISION, PEDIATRIC OTOLARYNGOLOGY FELLOWSHIP

Both operative sites (Children’s Hospital and the University) have strict procedures regarding presence of faculty at all procedures. All surgical cases will be under a full time faculty’s name and that faculty member will need to be present otherwise a case will not be allowed to start. Both hospitals’ governance require faculty to be present in the operating room area during the entire case.

Supervisory Lines of Responsibility for Care of Patients, Pediatric Otolaryngology Fellowship

Dr. Brianne Roby is the Program Director for the Pediatric Otolaryngology Fellowship, which is based at Childrens Hospitals and Clinics of Minnesota in Minneapolis.

TEACHING

Teaching Medical Students- see otol -curriculum manual for more information

Residents/Fellows are an essential part of the teaching of medical students. It is critical that any resident who supervises or teaches medical students must be familiar with the educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation. Therefore, we’ve included in this manual the URL to the objectives for the Medical School clerkships:

https://www.med.umn.edu/md-students/academics/course-directory