UCSF Dermatology Residency Handbook - Dermatology - University ...

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20 RESIDENCY HANDBOOK 2010-2011 1) Because residency education is a full-time endeavor, Dermatology Residents must ensure that moonlighting does not interfere with their ability to achieve the goals and objectives of their educational program. 2) Residents are responsible for ensuring that moonlighting and other outside activities do not result in fatigue that might affect patient care or learning. 3) Dermatology Residents are responsible for complying with the Dermatology Training Program’s Duty Hours Policy, which has been approved by the Graduate Medical Education Committee and is consistent with the UCSF Policy on Duty Hours. 4) It is the responsibility of the Dermatology Residents to obtain written permission to moonlight from the Program Director prior to beginning the moonlighting activity, for both “internal” and “external” moonlighting (see below for definitions). Permission must be obtained using the appropriate, resident and faculty approved moonlighting form (i.e. eternal or internal) which requires both the Program Director and Resident signatures as well as information regarding the moonlighting activity. 5) Residents that are moonlighting, both internally and externally, will fill out monthly reporting forms regarding their moonlighting activities. C) Program Responsibility 1) The Program Director will also monitor resident performance in the program to ensure that moonlighting activities are not adversely affecting patient care, learning or resident fatigue. 2) If the Program Director determines that the resident’s performance does not meet expectations, permission to moonlight will be withdrawn. 3) Monitoring information will be reviewed periodically with the Dermatology Resident Education Committee. The GMEC will periodically review reports by the Program Director regarding moonlighting activity. D) Internal and External Moonlighting 1) Internal Moonlighting (a) Internal moonlighting is defined as extra work for extra pay performed at a site that participates in the resident’s training program. This activity must be supervised by faculty and is not to exceed the level of clinical activity currently approved for the resident. While performing internal moonlighting services, residents are not to perform as independent practitioners. Internal moonlighting hours must be documented and they must comply with the written policies regarding Duty Hours as per the Dermatology Training Program, UCSF and ACGME. 2) External Moonlighting (b) External moonlighting is defined as work for pay performed at a site that does not participate in the resident’s training program. External moonlighting hours must be documented (including days, hours, location, and brief description of type of service(s) provided) in order to comply with Medicare reimbursement requirements for GME. For external moonlighting, the resident is not covered under the University’s professional liability insurance program as the activity is outside the scope of University employment. The resident is responsible for his/her own professional liability coverage (either independently or through the entity for which the trainee is moonlighting), DEA licensure, Medicare, provider number and billing training, and licensure requirements by the California Medical Board and any other requirements for clinical privileging at the employment site. Residents performing external moonlighting will be required to file copies of all required professional liability insurance with the program coordinator before beginning such activities, as well as paid DEA licensure if prescribing any controlled substances.
RESIDENCY HANDBOOK 2010-2011 IX) Duty Hours and Resident Fatigue A) Duty Hours 1) 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 related to patient care, the provision for transfer of patient care, and scheduled academic activities such as conferences. Consistent with ACGME regulations, duty hours do not include reading and preparation time spent away from the duty site. These standards apply to all UCSF training sites including, but not limited to, the VA, SFGH, Mt. Zion, and Moffitt-Long hospitals. 2) Duty hours will be limited to 80 hours per week, averaged over a four-week period. 3) Residents will be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a four week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. 4) A 10-hour time period for rest and personal activities will be provided between all daily duty periods. Residents taking call from home who are paged for an urgent consult may return to the hospital during a 10-hour rest period without violating the policy. B) On-Call Activities 1) The residents in the Department of Dermatology DO NOT have in-house call. 2) The Department of Dermatology does not admit to its own inpatient service. Dermatology patients requiring admission are admitted to the Internal Medicine or Family Practice services. No Dermatology resident has primary responsibility for the care of any inpatient. 3) Dermatology residents do not work in shifts. All Dermatology residents have clinic responsibilities and consulting on-call coverage. 4) Continuous on-site duty in dermatology is scheduled so as never to exceed 24 consecutive hours. The inpatient consult rotation is also scheduled with mandatory hospital departure times during weekdays in order to comply with the 10-hour rest period requirement (see specific rotation goals/objectives/policies for details). Occasionally returning to the hospital during a 10-hour rest period for unanticipated urgent consults is not a violation of the 10-hour rules (as long as these returns do not occur routinely). 5) At-home call (pager call) is defined as call taken from outside the assigned institution. (b) The frequency of at-home call is not subject to the every third night limitation. However, at-home call will not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call will be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. (b) When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit. (b) Occasionally returning to the hospital during a 10-hour rest period for unanticipated urgent consults is not a violation of the 10-hour rules (as long as these returns do not occur routinely). (b) The Program Director and the faculty monitor the demands of at-home call and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. C) Methodology for Data Collection 1) Work hours are monitored and recorded twice yearly. 21
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