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4422 Third Avenue Bronx, New York 10457 718-960-6103 Daniel Lombardi, D.O., Program Director Michael Gindi, M.D., FACEP, Associate Program Director Daniel Cerbone, D.O., Assistant Program Director Dean Olsen, D.O., Research Director Maria Ferraro, Administrative Assistant/Residency Coordinator Juana Carmona, Administrative Assistant General Program Description: The St. Barnabas Hospital Emergency Medicine Residency Program is designed to provide the emergency medicine resident with the skills, knowledge, and experience required to become an outstanding and complete emergency physician. Accredited in 1990, and beginning with one resident, the emergency medicine residency program now trains over 65 residents in its various programs. The residency program, based at St. Barnabas Hospital, is now a 97,000 visit full service emergency department, accounting for some 70% of the admissions to the 460 hospital beds. Several expansions since 1990 have more than tripled the size of the emergency department, added faculty and resident office space and a resident classroom. A pediatric emergency department opened in 1999, and a level one trauma designation was acquired in July of 2000, with another expansion in 2004, which included a trauma bay, and expanded radiological services. St. Barnabas Hospital is also now a stroke center, the first in the Bronx, and a hypothermia center. In 1990, the faculty was composed of two residency trained, board prepared/certified emergency physicians; today, the faculty consists of 22 residency trained, board prepared/certified emergency physicians, all of whom are provided at least 20% “protected time” in order to better train the emergency medicine residents. Clinical Curriculum The clinical curriculum is designed to allow a progressive increase in case load and case complexities, as well as administrative and managerial aspects of emergency medicine. Other clinical, administrative, and research rotations are integrated into the emergency medicine experience as well. The emergency medicine internship (OGME-1) at St. Barnabas Hospital in fact begins residency training. During this year, residents spend 4 months in “E.D.-2,” caring for the “bread and butter” patients of emergency medicine. Additionally, they spend one month in “ED-1” caring for more acutely ill patients, an additional month is spent in the pediatric emergency medicine department at St. Barnabas Hospital. In the OGME-II year, residents move to “the back side” of “ED-I”; where they care for the moderately ill and injured patients. By the OGME-III year, residents progress to the “front side” of “ED-1”; caring for the most acutely ill and injured patients. In the OGME-IV year, residents act as “critical specialists,” participating in all resuscitations, as well as assisting in the management of the overall department, and the teaching of the junior residents. At all times, an attending faculty member directly supervises emergency medicine residents caring for emergency department patients. While rotating in the ICU, the emergency medicine residents are, at all times, supervised by an attending level intensivist. While rotating on the medical or surgical floors, the residents are supervised by either an attending level physician or a senior resident on service. Academic Curriculum Recognizing that a clinical experience, no matter how broad and varied, can not supply all the knowledge necessary to become complete emergency physicians, a strong complimenting academic curriculum has been developed. The academic curriculum is instructive and at the same time interactive, composed of daily teaching rounds, daily didactic sessions – including a full morning of didactics every Wednesday, required weekly readings (Rosen in the OGME-2 and 3 years, Tintinalli in the OGME-4 year) with concomitant required quizzes, as well as required monthly graded exercises in EKG and radiographic interpretation. In order to assure accountability, all residents are required to maintain a 70 average in all quizzes and exercises. Wednesday conference is required of all residents except those on specific rotations (including trauma, ICU, and out of town rotations), or when in conflict with Bell Commission rules. Plaques and prizes are awarded to those residents scoring the highest in Rosen, Radiology, and EKG quizzes. Resident Evaluation Process COMPETENCIES AND EVALUATIONS Residents will be evaluated after each rotation by individual departments they rotate with, and quarterly by the family practice department. The program stresses the concept of measurable outcomes to document competency over the three-year training period. What is meant by competent? While there are many definitions of competent, the executive director of the ACGME, Dr. David Leach, subscribes to the Dreyfus model, which defines "competent" as a stage along the path to “mastery".
Using measurable outcomes to document competency is referred to by many as "competency based education". This logical strategy is predicated on the concept that faculty will tell residents which competencies they need to master; then instruct the residents; then provide formative assessment/feedback ("educational Dx & Rx") to the resident as to how they are doing. And with a boost of encouragement, the resident should be able to demonstrate mastery (well at least competence) of the particular skill.
The Seven General Competencies It has been mandated that all residency training programs, teach and assess the following seven General Competencies: 1. Medical Knowledge (MK) 2. Patient Care (PC) 3. Interpersonal and Communication Skills (ICS) 4. Professionalism (P) 5. Practice-based Learning and Improvement (PBLI) 6. Systems-based Practice (SBP) 7. Osteopathic Philosophy and Osteopathic Manipulative Medicine (OMM) Out of Department Rotations
Rotation and Evaluation Process
Core Faculty Members must meet all the basic standards delineated by the AOA/ACOEP.
Moonlighting is permitted only with the express written consent of the Program Director. In order to moonlight, the resident must:
PROFESSIONAL BEHAVIOR Responsibilities of Residents By accepting a position in the St. Barnabas Emergency Medicine Department, the resident agrees to the following responsibilities: To demonstrate academic honestly, professional demeanor and ethical behavior with colleagues, staff, patients and the public. To strive for the highest ideals of professional conduct. To achieve the objectives of the residency training. To render patients the best possible care. To educate patients about health problems. To refrain from independent outside practice and consulting during the term of residency. To maintain satisfactory work records, including logs, evaluations and other required forms. To complete study and reading assignments. To assist in the clinical instruction of medical students. To attend all scheduled activities fully prepared and on time. To attend all Emergency Medicine didactic sessions and other meetings recommended by the Supervisor of Training. To abide by the rules and regulations of the College, Hospitals, and Clinics. Ethical Considerations Emergency Medicine residents of St. Barnabas Hospital are expected to conduct themselves in an ethical and professional manner at all times, especially when representing St. Barnabas in clinical and academic settings. In observing medical ethics, the physician will: Give primary concern to the patient's best interest. Be available to one's patients at all times or delegate that responsibility to another capable individual. Practice within the limits of one's capabilities. Maintain strict confidence about patients' situations and respect all confidentiality issues. Not indulge in rumored information.
The residents shall respect their patients' rights to privacy. Residents shall refrain from discussing any confidential information outside of the clinical settings or in any public areas. Any inquiries from the press, radio or television, regarding patient care, medical issues or related activities, shall be referred to the Supervisor of Training.
The AOA Code of Ethics is the primary guide for the osteopathic profession. Residents should seek growth in all aspects of medical ethics: Sensitivity to issues, conceptual analysis, evaluation of completing claims, and development of a personal philosophy. Resources for such growth include departmental faculty, trainers, hospital chaplains, books and journals, special grand rounds, and seminars.
No resident shall be coerced, held liable, or discriminated against in any manner, because of a refusal to perform, accommodate, or assist in a procedure, on any sincerely held religious or ethical grounds. This provision shall not be construed to permit abandoning the patient or withholding treatment urgently required for the preservation of the quality of life in any emergency situation
Legal Considerations
Like any other professional, the resident should be aware of legal issues that may affect his/her practice. Any potential or actual legal difficulty related directly to residency activities should be discussed, as soon as possible, with either the attending preceptor or the Residency Director. Special Points to note: Residents have liability coverage through the hospital for activities assigned as part of the residency. This coverage does not extend to independent outside practice and consulting. If questions, or malpractice problems ever arise, the resident will immediately notify the Attending Preceptor and/or Residency Director. Immediate knowledge and appropriate action has proven to be a very successful deterrent and problem-solving mechanism in early malpractice problems.
Grievances
On occasions, residents may have questions or problems regarding performance of work administration or policies and practices, which are not specifically covered in the Resident Manual, One or more of the following steps, in sequence, may be taken: Confidential discussion with:
Resignation
Residents shall give a minimum of 30 days notice of resignation from a training program. All resignations must be submitted to the Residency Director, in writing, and include the reason for leaving the residency. Leave Policy
Dismissal for Cause
The Residency Committee has the right to dismiss, without warning, in cases of unacceptable conduct. Anyone who is dismissed for cause may use the grievance procedure in this manual, for review and final dispensation. Grounds for immediate dismissal include, but are not limited to, the following infractions:
Resident Hours
Each rotation will establish resident hours and on call schedules. They must comply with a schedule that allows time for educational conferences, study periods and meals. All programs must comply with the New York State maximum residency workweek schedule. (See appendix A) Research Activities All residents are required to participate in research activities/projects throughout their training years. A written report must be submitted annually, with approval by the research director. Residents are strongly encouraged to submit completed research projects to the ACOEP research competition, as well as to other research formats and publications. All residents whose research is presented at a national venue will be reimbursed for travel and hotel expenses directly related to the presentation. In this context, the definition of “research” is extended to presentation of papers, posters, research abstracts, as well as participation in CPC competition.
Specific Rotation Descriptions, Goals and Objectives
First Year (OGME-1)
Second Year (OGME-2)
Third Year (OGME-3)
Fourth Year (OGME-4)
Under the guidance of Dr. Sulejman Celaj, interventional cardiologist, residents will be exposed to diagnosis and treatment of acute cardiologic emergencies including acute MI, pericarditis, aortic dissection, etc.
St. Barnabas Hospital Emergency Medicine Residency Program Benefits & Salary Scale for Emergency Medicine Residents 4 weeks vacation/year Additional Benefits Include Free meals Medical, Dental, Prescription Plan (Resident/Family plan) Malpractice Insurance
2006 – 2007 Salary Scale PGY-II……………………..$43,500.00 PGY-III…………………….$46,500.00 PGY-IV……………………..$49,000.00 PGY-V………………………$51,850.00
St. Barnabas Hospital Emergency Medicine Faculty Faculty Member Emergency Medicine Board Status
GME POLICIES AND PROCEDURES APPENDIX A- Working Hour Limitations APPENDIX B- Process of Supervision of Resident Physicians in Programs of Graduate Medical Education. APPENDIX C- Residents Professional Activities Outside the Educational Program (Moonlighting) APPENDIX D- St. Barnabas Hospital Position on Responsibilities to Residents APPENDIX E- Non Renewal of Contract APPENDIX F- Grievance Procedure – Residents and Interns (All Programs)
APPENDIX A
ST. BARNABAS HOSPITAL BRONX, NEW YORK
GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES
PURPOSE
POLICY:
There shall be an established Graduate Medical Education (GME) Committee to ensure that the Hospital meets Code Requirements set forth by NYSDOH regulations. The chair of this committee or a designee will report to the QA committee and the medical board. WORKING HOUR LIMITATIONS PAGE 2 OF 3
Requirements limit the working hours of residents in residency programs for surgery, anesthesiology, medicine, family practice, obstetrics, emergency medicine and pediatrics. St. Barnabas Hospital is committed to assure full compliance in all residency programs.
On-site supervision is required for residents in surgery, anesthesiology, medicine, family practice, obstetrics, pediatrics and psychiatry.
Supervision is required by physicians who are board certified or admissible in these specialties or by residents who are in the final year of training or at the PGY4 or above level in each of the specialty areas.
The Medical Director shall recommend appropriate action when a condition exists that could result in a potentially hazardous occurrence.
PROCEDURE
All residents, when joining a St. Barnabas Hospital residency, must sign the Resident Working Hours Regulations Form complying with the following:
WORKING HOUR LIMITATIONS PAGE 3 OF 3
The Medical Director or his designee, for ensuring compliance with this policy, will conduct random surveys twice a year. Any possible violations of these guidelines will be reviewed by the Medical Director and reported to the QA committee.
Adminpp.GME-4 APPENDIX B
ST. BARNABAS HOSPITAL BRONX, NEW YORK
GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES
PURPOSE:
To ensure quality patient care and patient safety when residents interact with patients.
ORGANIZATION:
The various residency training programs operate under the authority and control of St. Barnabas Hospital. The Graduate Medical Education Committee of St. Barnabas Hospital (GMEC) is a standing committee reporting to the QA committee, the medical board and via both to the Board of Trustees.
Process of Supervision of Resident Physicians. in Programs of Graduate Medical Education Page 2 of 3 POLICY:
Attendings
All care rendered by resident physicians is under the general supervision of the attending physicians for that patient. The supervising attending decides as to the degree ofindependence resident physicians are given about medical care decisions and rendering patient care.
The attending physician (or a covering attending) must be readily available to provide guidance for patient care decisions.
The attending physician must evaluate the patient in person, confirm the findings of the resident physician, and review all orders. The attending physician must communicate to the resident the findings, plan of patient care management, and the degree of independence the resident will be given for this patient's care.
As the level of skill and knowledge of individual residents’ increases, the supervising attending physicians will delegate increasing levels of responsibility and allow increasinglevel of participation in patient care.
At the time of discharge, the supervising attending may delegate some of the discharge planning to the resident. The attending physician will review any discharge documents produced by the resident and sign any required attestation statements.
While the principal documents of a hospital stay may be prepared by the residents, the completeness of the documents will be reviewed and countersigned by the supervising attending for completeness.
Resident Physicians
Resident physicians must promptly notify the supervising attending of all admissions, transfers to other services, transfers to other facilities, discharges, or any significant change in a patient's clinical status.
In urgent or emergency situations, if the supervising attending is not immediately available, the resident will discuss the patient care with an on-site Intensive Care Unit attending or senior resident.
Residents may perform a history and physical examination.
Residents may develop an assessment and plan.
Residents may perform rounds and record progress notes.
Residents may write orders under the general supervision of the attending.
Residents may perform procedures under direct, in person, supervision, if they have not yet been given written credentialing to perform the procedure on their own and they are being supervised by an individual who has been credentialed to supervise the procedure.
Process of Supervision of Resident Physicians. in Programs of Graduate Medical Education Page 3 of 3
Residents may perform procedures on their own, under the general supervision of the attending, if the procedure is indicated, appropriate consent has been obtained, and the resident has been granted written credentialing to perform the procedure on their own.
Residents may provide patient education.
Residents may assist at surgery.
Competencies:
The residency programs maintain files on each of their residents that include each resident's approved competencies.
Adminpp.GME-5
APPENDIX C
. BARNABAS HOSPITAL BRONX, NEW YORK
GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES
PURPOSE:
St. Barnabas Hospital policy on resident’s professional activities outside the educational program (Moonlighting).
Residents Professional Activities Outside the Educational Program (Moonlighting) Page 2 of 2 POLICY:
Working as a resident in a GME program is a full time commitment. Residents professional activities outside the educational program (Moonlighting) are, therefore, not encouraged by the GME Committee. If such activity occurs, it is governed by the following guidelines:
GME - 6 (Moonlighting)
APPENDIX D
ST. BARNABAS HOSPITAL BRONX, NEW YORK
GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES
POLICY:
St. Barnabas Hospital graduate medical education programs are designated to prepare the resident for the next phase of their professional careers, including advanced residencies, practice, or scholarship. In order to achieve this goal, St. Barnabas Hospital will fulfill the following responsibilities to residents through an organized system of education. St. Barnabas Hospital ensures that residents have the opportunity to:
St. Barnabas Hospital Position on Responsibilities to Residents Page 2 of 2
Adminpp GME-7
APPENDIX E
ST. BARNABAS HOSPITAL BRONX, NEW YORK
GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES
To notify the resident of non-renewal of his/her contract.
Policy:
In instances where a resident’s agreement is not going to be renewed, the Residency Program Director will:
Non Renewal of Contract Page 2
If a resident is informed of the non-renewal of their contract, the program director is required to advise the resident of the hospital’s grievance procedure, as well as the cause of the non-renewal
Gme-12
APPENDIX F
ST. BARNABAS HOSPITAL BRONX, NEW YORK
ADMINISTRATIVE POLICY AND PROCEDURE MANUAL
GRADUATE MEDICAL EDUCATION
POLICY STATEMENT
It is the policy of SBH to offer all Osteopathic and Allopathic Residents and Interns (hereinafter “Residents”) a process and opportunity to present any complaints or grievances before an appropriate representative of SBH where they can be settled in a fair and impartial manner. It is the intent of Administration to promote an atmosphere of cooperation and respect and to treat residents fairly.
SBH recognizes that certain complaints or grievances will relate to disciplinary matters arising out of violations of SBH policy or rules of conduct while others will relate to educational matters arising out of medical issues raised in the residency program. To that end, SBH has developed a two-tiered system for handling the different type of complaints or grievances. Those grievances that are considered to be disciplinary in nature (i.e. theft, insubordination, absenteeism, etc.) shall follow the “Disciplinary Due Process” outlined below. Those grievances that are considered Grievance Procedure – Residents and Interns (All Programs) Page 2
to be educational in nature (i.e. medical mistakes, failure to meet educational requirements, etc.) shall follow the “Educational Due Process” outlined below. In the event that there is a dispute as to which process a grievance shall follow, the Medical Director shall make that decision, and such decision is final.
Disciplinary Due Process
When a Program Director believes that a resident has violated SBH policy or rules of conduct, the Program Director shall take appropriate disciplinary action. The Program Director may consult with the Department of Human Resources in this regard. The Program Director or his/her designee shall meet with the resident to issue the appropriate disciplinary action. The disciplinary action should be documented, with a copy of such documentation to the resident, departmental file and Human Resources. If a resident requests that a co-worker be present at such disciplinary meeting, the Program Director should honor such request. If the resident intends to challenge the disciplinary action, he/she must take action at Step I below, within ten (10) working days of receiving the discipline. The resident has the right to be present at every Step and to present relevant testimony and evidence.
Step I (Grievance Meeting)
If a resident has a grievance, the first step is to present it, in writing, to his/her Program Director. A meeting shall be scheduled to occur within thirty (30) days. The resident shall receive notice of the date, time and location of such meeting at least five (5) days in advance of the meeting. After discussing the problem, the Program Director must provide the employee with an answer within five (5) working days.
Step II (Grievance Meeting)
If the answer is not satisfactory, a grievance meeting may be requested at Step II within ten (10) working days, in writing, with a copy of the Program Director’s answer from Step I, delivered to the Department Director. A meeting shall be scheduled to occur within thirty (30) days. The resident shall receive notice of the date, time and location of such meeting at least five (5) days in advance of the meeting. After discussing the problem, the Department Director must provide an answer within five (5) working days.
Step III (Hearing)
If the answer provided at Step II is not satisfactory, a hearing may be requested at Step III within ten (10) working days, in writing, with a copy of the Department Director’s answer from Step II, delivered to the Vice President for Human Resources. The Vice President for Human Resources must schedule a hearing to occur within thirty (30) days. The resident shall receive notice of the date, time and location of such hearing at lest five (5) days in advance of the hearing. Upon the close of the hearing, the Vice President for Human Resources must provide a written decision within five (5) working days served on the Resident by certified mail, return receipt requested.
Grievance Procedure – Residents and Interns (All Programs) Page 3
Step IV (Appeal)
If the problem is still not solved at Step III and appeal may be presented at Step IV within ten (10) working days, in writing, with a copy of the Vice President’s answer from Step III, delivered to SBH’s President or his designee. The President or his designee must schedule the appeal to occur within thirty (30) days. At least five (5) days in advance of the appeal, the resident shall receive notice of the date, time and location of such appeal and the right to submit a written statement at the appeal (to address any factual and/or procedural matters forming the basis of the appeal and the grounds therefore). Upon the close of the appeal, the President or his designee shall determine whether the Step III decision was justified and not arbitrary and capricious and provide a written decision within five (5) working days served on the Resident by certified mail, return receipt requested. The decision of the President shall be final and not subject to further hearing or appellate review.
Educational Due Process
When a Program Director believes that action is necessary to address educational concerns about a resident, the Program Director shall issue his/her adverse recommendation to the resident. The Program Director may consult with the Medical Director in this regard. The Program Director or his/her designee shall meet with the resident to issue the appropriate adverse recommendation. The adverse recommendation should be documented, with a copy of such documentation to the resident, departmental file and Medical Director. If a resident requests that a co-worker be present at such meeting, the Program Director should honor such request. If the resident intends to challenge the adverse recommendation, he/she must take action at Step I below, within ten (10) working days of receiving the adverse recommendation. The resident has the right to be present at every Step and to present relevant testimony and evidence.
Step I (Grievance Meeting)
If a resident has a grievance, the first step is to present it, in writing, to his/her Program Director. A meeting shall be scheduled to occur within thirty (30) days. The resident shall receive notice of the date, time and location of such meeting at least five (5) days in advance of the meeting. After discussing the problem, the Program Director must provide the employee with an answer within five (5) working days.
Step II (Grievance Meeting)
If the answer is not satisfactory, a grievance meeting may be presented at Step II within ten (10) working days, in writing with a copy of the Program Director’s answer from Step I, delivered to the Department Director. A meeting shall be scheduled to occur within thirty (30) days. The resident shall receive notice of the date, time and location of such meeting at least five (5) days in advance of the meeting. After discussing the problem, the Department Director must provide an answer within five (5) working days.
Grievance Procedure – Residents and Interns (All Programs) Page 4
Step III (Hearing)
If the answer provided at Step II is not satisfactory, a hearing may be requested at Step III within ten (10) working days, in writing, with a copy of the Department Director’s answer from Step II, delivered to the Osteopathic Education Committee (or Medical Education Committee if the grievant is an allopathic resident). The appropriate Educational Committee must schedule a hearing to occur within thirty (30) days. The resident shall receive notice of the date, time and location of such hearing at least five (5) days in advance of the hearing. Upon the close of the hearing, the appropriate Educational Committee must provide a written decision within five (5) working days served on the Resident by certified mail, return receipt requested.
Step IV (Appeal)
If the problem is still not solved at Step III an appeal may be presented at Step IV, within ten (10) working days, in writing, with a copy of the Education Committee’s answer from Step III, delivered to the Medical Director or his designee. The Medical Director or his designee must schedule an appeal, the resident shall receive notice of the date, time and location of such appeal and the right to submit a written statement at the appeal (to address any factual and/or procedural matters forming the basis of the appeal and the grounds therefore) The Medical Director shall determine whether the Step III decision was justified and not arbitrary and capricious and provide a written decision within five (5) working days served on the Resident by certified mail, return receipt requested. The decision of the Medical Director shall be final and not subject to further hearing or appellate review.
HEARING AND APPEAL PROCEDURE
Procedures during the Step III Hearing
The Vice President for Human Resources (in Disciplinary Hearings) or the Chairperson of the appropriate Educational Committee (in Educational Hearings) shall preside at the hearing and shall determine the order and amount of process to assure that all participants in the hearing have a reasonable opportunity to present evidence, written or oral.
The Hearing will not be conducted strictly according to the rules of law relating to the examination of witness or presentation of evidence. The Resident will not be permitted to an attorney present unless the Resident obtains prior consent from the Vice President of Human Resources (in Disciplinary Hearings) or the Chairperson of the appropriate Educational Committee (in Educational Hearings). If such permission is granted, the Hearing Officer will also be permitted to have an attorney present. In any event, however, such attorneys may not speak on behalf of the parties, but may be present and available only for consultation during the hearing. Further, there will not be a right Grievance Procedure – Residents and Interns (All Programs) Page 5
to cross-examine any witness providing testimony during the hearing, or a right to a written transcript of the hearing proceedings. The failure to request a meeting, hearing or appeal within the time limits provided herein shall operate as a waiver or either parties right to such meeting, hearing or appeal.
Procedures during the Step IV Appeal
The President or his designee (in Disciplinary Hearings) or the Medical Director (in Educational Hearings) shall preside at the appeal and shall determine the order and amount of process to assure that all participants in the appeal have a reasonable opportunity to be heard.
The Appeal will not be conducted strictly according to the rules of the law relating to appellate tribunals. The Resident shall have the opportunity to address the Appeal Officer concerning his or her disagreement with the Step III decision and shall answer questions put to him or her by the Appeal Officer. The Step III Hearing Officer shall have a similar opportunity. The Resident will not be permitted to have an attorney present unless the Resident obtains prior consent from the President or his designee (in Disciplinary Hearings) or the Medical Director (in Educational Hearings). If such permission is granted, the Step III Hearing Officer will also be permitted to have an attorney present. In any event, however, such attorneys may not speak on behalf of the parties, but may be present and available only for consultation during the appeal. Further, there will not be a right to a written transcript of the appellate proceedings. The failure to request a meeting, hearing or appeal within the time limits provided herein shall operate as a waiver of either parties right to such meeting, hearing or appeal.
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