Resident Training Program Policies and Procedures 2012-2013 (PDF)

Duty Hour Policy | Moonlighting | Leave | Vacation | Professional Travel

Duty Hour Policy

SUBJECT: DUTY HOURS Updated July 1, 2011

The David Geffen School of Medicine at UCLA requires that the residency training programs foster both quality resident education and facilitate quality patient care. Overall, resident duty hours in all programs must be consistent with the Institutional and specific program Residency Review Committee (RRC) accreditation requirements established by the Accreditation Council for Graduate Medical Education (ACGME). The structuring of duty hours and on-call schedules focus on the needs of the patient, continuity of care and the educational needs of the residents.

Duty hours must be limited to 88 hours per week, averaged over a four-week period, inclusive of all in-house call activities. Duty hours do not include reading and preparation time spent away from the hospital.

Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. Residents must also be provided at least eight hours between duty assignment periods to obtain adequate rest.

PGY1 residents may not exceed 16 hours during their duty periods.

PGY2-7 residents: In-house call must not exceed 24 consecutive hours. Resident may remain on duty for up to four additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. No new patients may be accepted after 24 hours of continuous duty.

Residents are required to report and log all duty hours on Verinform. Resident must log in at least once every week. The Program Administrator runs reports on a weekly basis to review each resident's reported duty hours to ensure compliance and address potential violations.

UCLA Neurosurgery Duty Hour Policy and Procedures

Resident duty hours must comply with the overall ACGME RRC-Neurosurgery, the David Geffen School of Medicine at UCLA institutional requirements, and the Surgery Departmental requirements with the following exceptions:
1. Neurosurgery has an additional, eight-hour work week exception permitting a maximum work week allowance of eighty-eight (88) hours instead of the standard eighty.
2. Neurosurgery permits moonlighting within the confines of the workweek maximum for residents training on non-clinical rotations.

Duty hours are clinical and academic activities related to the residency program. Duty hours do not include reading and time spent away from the training program.

Duty hours must be limited to eighty-eight hours per week for clinical rotations. Duty hours must be limited to eighty hours per week for research and non-clinical electives. These limits include the PGY3 required pre-Harbor night call responsibility and Harbor moonlighting.

The residents must have one twenty-four hour period free from patient care every seven days averaged over a four-week period.

The residents should have sufficient rest between work periods. The ACGME recommended break minimum is ten hours free of duty.

In-house responsibilities have a twenty-four (24) hour maximum with up to four (4) additional hours permitted for transfer, debriefing, and didactic activities. No new patients may be accepted after the twenty-four hour maximum. When residents are called into the hospital from home, the hours spent in-house are counted towards the 88-hour limit.

The residents are required to report and log all duty hours into the Verinform system on a constant basis. Residents must log in at a minimum of every week.

The Associate Program Director and UCLA Chief Resident reviews the Verinform work hour report weekly to review for accuracy and to address compliance and fatigue concerns. The Chief Residents are responsible for determining which residents have maximized their work hours and are in jeopardy of fatigue. The Chief Residents must adjust the coverage schedules to compensate for residents required to be away from service.

The Vice-Chief and Site Directors provide an additional level of oversight. The work hour reports are sent to the designated faculty at the midpoint and end of each rotation period.
UCLA - Marvin Bergsneider, M.D.
Harbor-UCLA - Duncan McBride, M.D.
West Los Angeles V.A. - John Frazee, M.D.
UCLA-Santa Monica - Langston Holly, M.D.

The Program Director or his designee reviews the aggregate work hour reports quarterly and addresses any areas of non-compliance either during his monthly group meeting with the residents or individual meetings as needed.

The Program Director provides an annual written report to the UCLA GMEC.

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Moonlighting

SUBJECT: MOONLIGHTING POLICY Updated January 23, 2012

Moonlighting
Residents may moonlight during research and non-clinical elective rotations with required Program Director approval

All residents wishing to moonlight must obtain written permission from the Program Director. The Program Director will acknowledge his awareness of the resident's activities in writing by counter-signing this form. The number of hours spent moonlighting cannot exceed the 80-hour limit established by the ACGME. The request to moonlight must include a statement including why moonlighting is being requested as well as the location, duties, and schedule of the resident's proposed moonlighting. The resident must assure that moonlighting will not interfere with his/her training rotation.

Residents who demonstrate financial need may moonlight during their non-neurosurgical (non-clinical) rotations to meet their needs. The Program Director, Dr. Neil Martin, or his delegate will determine the merits of the special consideration request.

Non-clinical or "non-neurosurgical" rotations during which residents may be allowed to moonlight on a limited basis are as follows: laboratory research, neuropathology, neuroradiology, and neurology. All clinical rotations at UCLA, Harbor, the VA, and Santa Monica-UCLA are not allowed for obvious reasons.

Postgraduate training is demanding in time both at UCLA and for independent study. We do not encourage moonlighting but acknowledge the need as long as it does not interfere with your education, participation in the program, or patient care.

The potential for abuse of moonlighting privileges is well recognized. Guidelines for regulating moonlighting activity are as follows: 1) any resident found to be performing at an unsatisfactory level at the time of each six-month resident review may not moonlight; and 2) each resident will submit a signed statement each month tabulating the days spent moonlighting; and, 3) any resident found to be abusing the moonlighting privilege will be placed on probation and the privilege of ALL residents to moonlight will be revoked. Because the privilege to moonlight is needed by many of the resident staff, the residents will assume the primary responsibility in overseeing the activities of their colleagues to prevent abuses that would endanger future moonlighting.

Participation in outside employment may be allowed during assignment to the research hiatus. Formal approval for such activities must be obtained from the Program Director and the research mentor or principal investigator. Any residents not in good academic standing with the program will not be allowed to participate in moonlighting activities until being reinstated to good standing.

Moonlighting residents must continue to fulfill the one paper per year minimum training participation requirement and have performed satisfactorily* on the ABNS primary exam. *NS3-50th percentile, NS4-60th percentile, NS5-70th percentile, NS6-80th percentile.

Violation of this policy may result in immediate dismissal from the training program.

gmec/neurosurgery/moonlightingform.doc

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Leave

SUBJECT: LEAVE

PURPOSE: To comply with institutional policy regarding housestaff leave.

POLICY: The following program policy regarding leave from clinical duties during training is in effect.

Sick Leave: sick leave is accrued at the rate of eight (8) hours per month of appointment. In the event of illness, the resident must notify the chief resident of his/her service, and the Surgery Education Office immediately.

Family Illness or Death Leave: up to five days of sick leave may be used if the resident is required to be in attendance or provide care because of an illness in the family or attendance is required due to the death of a relative.

Paid Maternity Leave: two (2) weeks per academic year. Leave in excess of this time, with the exception of sick or vacation time will be leave without pay and may not be credited for training requirements.

Paid Paternity Leave: one (1) week if the following conditions are met:
Written notice given to the Program Director of the intention to take paternity leave at least 30- days prior to the expected birth or adoption.
The paternity leave cannot be taken later than thirty (30) days after the actual birth or adoption date, nor commenced prior to 30 days before the projected birth or adoption date.

Medical Leave: may be requested if a medical condition affects a trainee's ability to continue in the training program or to safely or adequately fulfill their patient care responsibilities. Please refer to UCLA Housestaff manual for the necessary procedure to follow.

Leave for Interviews or Meeting Travel: additional working days may be granted by the Program Director for interviewing or meeting attendance. Written approval from the Program Director and the Chief of Service is required prior to departure. Post facto approvals will not be given and in such instances, the time taken will be considered leave without pay. The traveling resident must provide their own coverage for their absence.

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Vacation

SUBJECT: VACATION TIME

All residents receive four weeks of vacation each year.
Residents receive four working weeks of vacation per year, seven days during clinical rotations, and five days during elective rotations. Residents will be allowed to schedule vacation in one-week blocks. Preferences for dates of vacation will be considered but not assured. If there are dual requests; priority by time submitted, resident level, conference participation.

1) No vacations are permitted after the second week of June or in the month of July.
2) All vacation requests for each rotation must be submitted within the first two weeks of the rotation. If requests are not received, the program administrator will assign vacation time.
3) No more than two residents on vacation during any one week.
2) No more than one resident at any level on vacation during one week (i.e. Junior, Senior, Chief) at all hospitals.
3) Clinical duty extends until next resident rotator is physically available. (i.e. until January 1 or July 1 just before rounds with the new team).
4) All vacations are scheduled in the first two weeks of the rotation. Seniority has preference, otherwise first come first serve.
5) There is no week off for the chief as he leaves. This week is counted as vacation. If the chief saves all of his vacation at UCLA, then he is eligible to leave two weeks early. If the UCLA Chief Resident uses vacation time prior to the end of the rotation, he is on duty until the morning of July 1, and the chief residents do not rotate one week ahead of time. If the UCLA chief saves one week of vacation until the last week of June, then the chiefs will rotate one week early.
6) Residents should not finalize travel arrangements until vacation request has been approved
7) Vacation requests are submitted in advance (beginning of each rotational period) for Program Director approval.
8) Resident secures appropriate coverage for vacations taken during clinical rotations.
9) UCLA Chief, Super Senior, Senior, and Operative P.A. may not take vacation at the same time.
10) Vacations must be taken within the academic year of appointment. No carry over to subsequent years will be made.
11) Non-approved days of leave in excess of the allowed (28) days will be considered absences without approval and no credit for training will be given for this time.

First year (NS1) Junior residents (UCLA juniors)
4 weeks of vacation a year covered by the NS2 residents on elective rotations

NS2 Senior residents (electives)
4 weeks of vacation, One week of vacation permitted during Neurology rotation.
Provide vacation coverage for the junior residents at UCLA.
Additionally, immediately prior to becoming the Harbor senior, the resident will provide vacation coverage for the Harbor senior.

NS3/4 Senior and Elective rotations residents
4 weeks of vacation.
Harbor - One week of vacation covered by the junior resident next in line as Harbor Senior.
UCLA Senior - one week covered internally by the UCLA Super Senior(NS4) and UCLA Chief Resident (NS5)
Santa Monica Spine Senior - One week covered by senior-level resident on elective rotation.
Elective - One/two week(s) vacation - no coverage required.

NSR Research residents
4 weeks of vacation. Includes academic travel. Additional time may be granted with Program Director approval.
No coverage required.

NS5 Chief Residents
4 weeks of vacation
One week as VA Chief Resident covered by senior-level resident on electives/research.
One week as Harbor Chief Resident covered by senior-level resident on electives/research.
Two weeks as UCLA Chief Resident covered internally by UCLA Super Senior and Senior.

UCLA Chief, Super Senior, Senior, and Surgical P.A. cross-cover vacations - one per time period.
All time away (including conferences and workshops) utilize vacation time

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Professional Travel

RESIDENT TRAVEL FOR PROFESSIONAL ACTIVITIES Updated July 17, 2012

POLICY: The involvement of residents in travel related to professional (educational) activities is necessary and encouraged. Because such travel can result in absences from clinical duties and also results in numerous expenses a number of conditions must be met before such travel will be supported.

Criteria for Approved Travel:
1) Departmental Support for Major National/Regional Conferences (i.e. AANS, CNS)
2) Maximum financial support $1500
3) The reason for traveling is to present the results of original investigative work conducted while at UCLA; or for participation in educational activities approved by the Chair/Program Director of Neurological Surgery.
4) The traveler will be personally making the presentation (paper or poster) of the investigative work.
5) Time away from clinical duties is minimized. Travel to the away location on the date prior to the day of presentation, and return immediately following completion of the presentation.
6) Board Review Courses require Program Director approval.

Courses - Departmental support to attend:

1) Research Update in Neuroscience for Neurosurgeons (RUNN)

2) INOVA Washington Neuroradiology and Dr. Kenneth M. Earle Memorial Neuropathology Review

3) Chicago Board Review Course

Authorization for Travel: Absences from clinical duties must be approved in writing by the:
1) Program Director
2) Chief of the Service involved
3) Sponsoring Faculty Member
4) Program Administrator
5) Covering Resident

This action is necessary so that adequate coverage can be arranged for the resident's absence from clinical duties. A travel request form must be completed and signed by the faculty member who will be the financial sponsor of the resident's travel. The completed travel request form will indicate that coverage has been arranged in anticipation of the resident's absence. The resident must provide a copy of the abstract to the Administrator of the residency program, followed by a draft for publication within the year.

Reimbursement of Travel Expenses: Expenses will not be reimbursed if the approval for travel was not obtained prior to the date of departure. Reimbursement of expenses incurred will be provided through the Department of Neurosurgery, but will be charged to the sponsoring faculty member. Only reasonable and customary expenses will be reimbursed up to a maximum of $1500. Allowable expenses include:
1) Domestic economy class airfare (includes the United States and Canada)
2) Single hotel room
3) Usual and customary meeting registration fees
4) Meal allowance of $50 per diem (receipts required for Accounts Payable documentation)

The following expenses will not be allowed:
1) Room service charges unless included with meal allowance
2) Mini-bar charges
3) Bar charges
4) Telephone call charges
5) Late registration fees
6) International air travel

SUBJECT: MEDICAL LICENSURE

POLICY: The State of California Business and Professions code Sections 2065 and 2066, states the following:
All graduates of foreign or domestic medical schools are allowed to train in an ACGME accredited training program for a maximum of two years without medical licensure. Graduates of American or Canadian medical schools may train in California for one year even if they have trained in another out-of-state ACGME accredited training program for two or more years. Graduates of foreign medical schools who have trained in an ACGME accredited program in another state; the period of time of that training reduces the amount of time allowed for unlicensed training in California.

Residents who continue to train after the two-year licensing exemption has expired may be fined by the Medical Board in amounts ranging from $100 to $2500 depending upon the severity of the violation.

The policy of the program will be as follows:
1) All resident physicians must obtain California medical licensure before the end of the second year of clinical training. Accomplishing this requires that USMLE Parts I, II, and III are successfully completed by May of the first year of training.
2) In the event that licensure is not obtained by the end of the second year of training, the trainee will be immediately suspended from the program. No credit for residency training will be given for the time under suspension.

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