Podiatry Manual

Tucson Medical Center And Midwestern University College of Health Sciences/ Arizona School of Podiatric Medicine
Podiatric Resident Training Manual 2013-2014
Table of Contents
Definitions CPME Documents Section I Training Program Section II Resident Requirements Section III Supervision and Evaluation of Podiatric Resident Resident Evaluation Probation, Corrective Action and Academic and Disciplinary Dismissals Tucson Medical Center/THMEP Disciplinary Policy 3 3 4 5 6 12 14 15 18 18 18 18 18 20 20 23 23 25 26 27 130
Section IV Policies and Procedures Planned and Unplanned Absence Leave of Absence Change in Federal Funding Status Work Hours Moonlighting HIPAA Health Information Services
Section V General Conduct Provider Benefits Training Schedule Curriculum and Assessments Didactic Schedule
Definitions 1. Graduate Medical Education. Postgraduate medical education is the process by which clinical and didactic experiences are provided to residents to enable them to acquire those skills, knowledge, and attitudes, which are important in the care of patients. The purpose of graduate medical education is to provide an organized and integrated educational program providing guidance and supervision of the resident, facilitate the resident's professional and personal development, and ensure safe and appropriate care for patients. Graduate medical education programs focus on the development of clinical skills, attitudes, professional competencies, and an acquisition of detailed factual knowledge in a clinical specialty. 2. Residency Program Director. The Residency Program Director is responsible for the quality of the overall affiliated education and training program in Podiatric Medicine and Surgery and for ensuring the program is in compliance with the policies of the Council on Podiatric Medical Education. 3. Residents. The term "residents" refers to individuals who are engaged in a postgraduate training program in podiatry. The term "resident" for the purposes of this policy includes individuals in their first year of training typically referred to as "interns" and individuals in advanced postgraduate education programs who are typically referred to as "fellows." 4. Attending Physician. Attending physician refers to licensed, independent physicians, who have been formally credentialed and privileged at the training site, in accordance with applicable requirements. The Attending physician may provide care and supervision only for those clinical activities for which (s)he is privileged. 5. Supervision. Supervision refers to the dual responsibility that an attending physician has to enhance the knowledge of the resident and to ensure the quality of care delivered to each patient by any resident. Such control is exercised by observation, consultation and direction. It includes communicating the practitioner's knowledge, skills, and attitudes to the resident and assuring that the care is delivered in an appropriate, timely, and effective manner. 6. Documentation. Documentation is the written or computer-generated medical record evidence of a patient encounter. In terms of resident supervision, documentation is the written or computergenerated medical record evidence of the interaction between a supervising practitioner and a resident concerning a patient encounter. 7. Supervising Practitioner. A Supervising Practitioner must provide an appropriate level of supervision. Determination of this level of supervision is a function of the experience and demonstrated competence of the resident and of the complexity of the patients' health care needs. CPME Documents CPME 320 Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies and CPME 330 Procedures for Approval of Podiatric Medicine and Surgery Residencies can be found at http://cpme.org under the Residencies tab.
Section I Training Program Purpose The Podiatric Residency Training Program is 36 months and designed to provide the following clinical and didactic experiences: 1. An appropriate opportunity to expand the residents competencies in the treatment of diseases, disorders, and injuries of the foot and ankle, by medical, biomechanical, and surgical means. 2. Participation in complete preoperative and postoperative patient care in order to enhance the residents competencies in the perioperative care of diseases, disorders, and injuries of the foot and ankle. 3. An opportunity to expand the residents competencies in the breadth of podiatric and non-podiatric medical and surgical evaluation and management. 4. To expand the residents knowledge in the breadth of podiatric and non-podiatric medical and surgical evaluation and management. Competencies The program will enhance the resident's ability to: 1. Prevent, diagnose, and manage diseases, disorders, and injuries of the pediatric and adult lower extremity by non-surgical (educational, medical, physical, biomechanical) and surgical means. 2. Assess and manage a patient's general medical status. 3. Practice with professionalism, compassion and concern, in a legal, ethical, and moral fashion. 4. Communicate effectively and function in a multidisciplinary setting. 5. Manage individual patients and populations in a variety of socioeconomic and health care settings. 6. Manage a podiatric practice in a multitude of health care delivery settings. 7. Be professionally inquisitive, lifelong learners and teachers utilizing research, scholarly activity and information technologies to enhance professional knowledge and clinical practice.
Section II Resident Requirements The resident entering a postdoctoral training program accepts the following duties and responsibilities: The resident is responsible to the training institution for executing certain duties and functions, such as delivering the best possible care to patients. The resident is responsible to the Residency Program Director to complete the training program as outlined. The resident must recognize that the professional staff has a collective responsibility to participate in the training of nurses, and other paramedical personnel. The resident has a responsibility to help educate patients in understanding their illnesses, grasping the reasons for procedures performed, and comprehending the prescribed medical programs to be followed upon discharge.
The resident is legally, morally, and ethically responsible to pursue exclusively the agreed upon program of training as follows: The resident shall spend his/her full time in their respective training program, except for assignments to other departments or programs approved by the Residency Program Director and designated institutional authorities. Such activities must not interfere with the resident's participation in the training program and the resident must have a signed Release of Liability on file with the University. The resident is obligated to abide by the laws, rules, and regulations of the professional staff, the terms of the hospital contract, and other guidelines established by the hospitals. The resident is responsible for participation in all professional staff activities involving evaluation of patient care. Residents at all times, when participating in patient care, must be directly or indirectly supervised by a readily identifiable attending physician, and must only practice the appropriate care within the residents scope of practice.
Academic requirements for residents: Resident logs Surgery log - Must be kept on Residency Resource and each Monday must be current through the previous Friday. Activity log - Must be kept on Residency Resource and each Monday must be current through the previous Friday Teaching conferences/Seminars An annual academic schedule will be provided. Residents are required to attend and participate in all teaching conferences, lectures, journal clubs, and rounds. The residents are encouraged to attend seminars with the permission of the Residency Program Director. The following will be required of all residents in order to complete this residency: 5
1. Deliver a case presentation monthly in power point format at weekly podiatry meetings. 2. Present a case at grand rounds annually. 3. Submit at least one poster presentation at a conference or seminar approved by the Residency Program Director. Section III Supervision and Evaluation of Podiatric Residents Monitoring Procedures The goal of monitoring resident supervision is to foster a systemwide environment of peer learning and collaboration among managers, attending physicians and residents. The monitoring process involves the use of existing information, the production of a series of evaluative reports, the accompanying process of public review of key findings, and discussion of policy implications. Monitoring of compliance with these procedures will be performed by the Residency Program Director and as part of the scheduled internal program reviews. Residency Program Director The Residency Program Director is responsible for the quality of the overall education and training program in Podiatry and for ensuring that the program is in compliance with the policies of CPME. The Residency Program Director defines the levels of responsibilities for each year of training by preparing a description of the types of clinical activities residents may perform and those for which residents may act in a teaching capacity. 1. Assess the attending physician's discharge of supervisory responsibilities. At a minimum, this includes written evaluations by the residents and interviews with residents, other practitioners and other members of the health care team. 2. Structure training programs consistent with the requirements of CPME and the affiliated sponsoring entity. 3. Arrange for all residents entering their first rotation to participate in an orientation to policies, procedures, and the role of residents within the affiliated training program. 4. Ensure that residents are provided the opportunity to contribute to discussions in committees where decisions being made may affect their activities. Attending Physician The attending physician is responsible for and must be personally involved in the care provided to individual patients in inpatient and outpatient settings as well as long-term care and community settings. When a resident is involved in the care of the patient, the responsible attending physician must continue to maintain a personal involvement in the care of the patient. The attending must provide an appropriate level of supervision. Determination of this level of supervision is a function of the experience and demonstrated competence of the resident and of the complexity of the patient's health care needs. The procedures through which the attending physician provides and documents appropriate supervision is outlined below. 6
Resident The residents must be aware of their limitations and not attempt to provide clinical services or do procedures for which they are not trained. Each training program will be structured to encourage and permit residents to assume increasing levels of responsibility commensurate with their individual progress in experience, skill, knowledge, and judgment. As part of their training program, residents should be given progressive responsibility for the care of the patient. The determination of a resident's ability to provide care to patients without a supervisor present or to act in a teaching capacity will be based on documented evaluation of the resident's clinical experience, judgment, knowledge, and technical skill. Ultimately, it is the decision of the attending physician as to which activities the resident will be allowed to perform within the context of the assigned levels of responsibility. In general, however, residents are allowed to order laboratory studies, radiology studies, pharmaceuticals, and therapeutic procedures as part of their assigned levels of responsibility. In addition, residents are allowed to certify and re-certify certain treatment plans (e.g., Physical Therapy, Speech Therapy) as part of their assigned levels of responsibility. These activities are considered part of the normal course of patient care and require no additional documentation on the part of the supervising practitioner over and above standard setting-specific documentation requirements. The overriding consideration must be the safe and effective care of the patient that is the personal responsibility of the attending physician. Each resident is responsible for discussing significant patient care issues with the attending physician. Such communication must be documented in the record. Failure to function within graduated levels of responsibility or to communicate significant patient care issues to the responsible attending physician may result in the removal of the resident from patient care activities. Policy for Delivery of Health Care by Resident 1. In a health care system where patient care and the training of health care professionals occur together, there must be clear delineation of responsibilities to ensure that qualified practitioners provide patient care, whether they are residents or staff. It is recognized that as residents acquire the knowledge and judgment that accrue with experience, they will be granted increased authority for patient care. 2. The hospital must comply with the institutional requirements and accreditation standards of the Joint Commission and other health care accreditation bodies. Qualified health care professionals with appropriate credentials and privileges provide patient care and provide supervision of residents. 3. The intent of this policy is to ensure that patients will be cared for by clinicians who are qualified to deliver that care and that this care will be documented appropriately and accurately in the patient record. This is fundamental, both for the provision of excellent patient care and for the provision of excellent education and training for future health care professionals 4. The quality of patient care, patient safety, and the success of the educational experience are inexorably linked and mutually enhancing. Incumbent on the clinician attending is the appropriate supervision of the residents as they acquire the skills to practice independently. 7
5. The principles of good training and educational supervision are not likely to change radically over time. Rules governing billing and documentation, however, will inevitably evolve. This policy focuses on resident supervision from the educational perspective. 6. CPME requirement 6.16 - The residency program shall ensure that the resident is afforded appropriate faculty supervision during all training experiences. This process is the underlying educational principal for all Podiatric Residents. Clinician educators involved in this process must understand the implications of this principle and its impact on the patient and the Resident. Procedures Assignment and Availability of Attending Physicians Within the scope of the training program, all residents, without exception, will function under the supervision of attending physicians. A responsible attending physician must be immediately available to the resident in person or by telephone and able to be present within a reasonable period of time (generally considered to be within 30 minutes of contact), if needed. Each discipline will publish, and make available "call schedules" indicating the responsible attending physician(s) to be contacted. Facilities must ensure that their training programs provide appropriate supervision for all residents as well as duty hour schedules and work environments that are consistent with proper patient care, the educational needs of residents, and all applicable program requirements. Resident Supervision by the Attending Physician Attending physicians are responsible for the care provided to each patient, and they must be familiar with each patient for whom they are responsible. Fulfillment of such responsibility requires personal involvement with each patient and each resident who is providing care as part of the training experience. Each patient will be assigned an attending physician whose name will be clearly identified in the patient's record. It is recognized that other attending physicians may, at times, be delegated responsibility for the care of a patient and provide supervision instead of, or in addition to, the assigned practitioner. It is the responsibility of the attending physician to be sure the residents involved in the care of the patient are informed of such delegation and can readily access an attending physician at all times. Such a delegation will be documented in the patient's record. The attending physician is expected to fulfill this responsibility, at a minimum, in the following manner: 1. The attending physician will direct the care of the patient and provide the appropriate level of supervision based on the nature of the patient's condition, the likelihood of major changes in the management plan, the complexity of care, and the experience and judgment of the resident being supervised. Medical, surgical or mental health services must be rendered under the supervision of the attending physician or be personally furnished by the attending physician. Documentation of this supervision will be by progress notes entered into the record by the attending physician or reflected within the resident's progress note at a frequency appropriate to the patient's condition. The resident note shall include the name of the attending physician with whom the case was discussed as well as a summary of that discussion. The attending may choose to countersign and add an addendum to the resident note detailing his/her involvement and supervision. The attending's co-signature of the resident's note is an acceptable method for the attending physician to document resident supervision. Pathology and radiology reports must be 8
verified by an attending physician. Attending physicians will be responsible for following the admitting procedures required by the institutions at which they are admitting patients in association with resident physicians. 2. In-Patient Admittance. For patients admitted to an inpatient team, the attending physician must meet the patient early in the course of care (within 24 hours of admission including weekends and holidays). This supervision must be personally documented in a progress note no later than the day after admission. The attending physician's progress note will include findings and concurrence with the resident's initial diagnosis and treatment plan as well as any modifications or additions. The progress note must be properly signed, dated, and timed. 3. Discharge from Inpatient Status. The attending physician, in consultation with the resident, ensures that the discharge of the patient from an inpatient service is appropriate and based on the specific circumstances of the patient's diagnoses and therapeutic regimen; this may include physical activity, medications, diet, functional status and follow-up plans. Evidence of this assurance must be documented by the attending physicians countersignature of the discharge summary. 4. Transfer from One Inpatient Service to Another, or Transfer to a Different Level of Care. The attending physician, in consultation with the resident, ensures that the transfer of the patient from one inpatient service to another or transfer to a different level of care is appropriate and based on the specific circumstances of the patient's diagnoses and condition. The attending physician from the transferring service must be involved in the decision to transfer the patient. The attending physician from the receiving service must treat the patient as a new admission and write an independent note or an addendum to the resident's transfer acceptance note. 5. Intensive Care Units (ICU), including Medical, Cardiac and Surgical ICUs. For patients admitted to, or transferred into an ICU the attending physician must physically meet, examine, and evaluate the patient as soon as possible, but no later than 24 hours after admission or transfer, including weekends and holidays. 6. Night Float Admissions. For patients admitted to an inpatient service of the medical center, a "night float" resident occasionally provides care before the patient is transferred to an inpatient ward team. In these cases, the attending physician must physically meet and examine the patient within 24 hours of admission by the night float to the inpatient service, irrespective of the time the ward team assumes responsibility for the patient. In addition, the supervising practitioner for the night float must be clearly designated by local policy. 7. Out Patient clinic. An attending physician must be physically present in the clinic area during clinic hours. All patients in the clinic for which the attending physician is responsible should be supervised by the attending physician. This supervision must be documented in the chart via a progress note by the attending physician or the resident's note and include the name of the attending physician and the nature of the discussion. New patients should be supervised as dictated by graduated level of responsibility outlined for each discipline. The supervision for new patients should be documented by either independent attending physician note or an addendum to the resident note. Unless otherwise specified in the graduated levels of responsibility, new patients must be seen by and evaluated by the attending physician at the time of the patient visit. Return 9
patients should be seen by or discussed with the attending physician at such a frequency as to ensure that the course of treatment is effective and appropriate. This supervision must be documented in the record via a note by the attending physician or the resident's note that indicates the nature of the discussion with the attending physician. The medical record should reflect the degree of involvement of the attending physician, either by staff physician progress note or the resident's description of attending involvement. The attending may choose to countersign and add an addendum to the resident note detailing his/her involvement. All notes must be signed, dated, and timed by the resident. 8. The attending physician is responsible for official consultations on each specialty team. When residents are involved in consultation services, the attending physician will be responsible for supervision of these residents. The supervision of residents performing consultation will be determined by the graduated levels of responsibility for the resident. Unless otherwise stated in the graduated levels of responsibility, the attending physician must meet with each patient who received consultation by a resident and perform this personal evaluation in a timely manner based on the patient's condition. The patients seen in consultation by residents must be discussed and/or reviewed with the attending physician supervising the consultation within 24 hours of initial consultation by the resident. The attending physician must document this official consultation supervision by writing a personal progress note or by writing his/her concurrence with the resident consultation note by the end of the next working day. The attending may choose to countersign and add an addendum to the resident note detailing his/her involvement. 9. Emergency Department. An emergency department attending physician must be physically present in the emergency department. Each new patient in the emergency department must be seen by or discussed with an attending physician. The attending physician, in consultation with the resident, ensures that the discharge of the patient from the emergency department is appropriate. 10. Emergency room consultations. Emergency room consultations by residents may be supervised by a specialty attending physician or the emergency room attending physician. All emergency room consultations by residents should involve the attending physician supervising the resident's discipline specific specialty consultation activities for which the consultation was requested. After discussion of the case with the discipline specific attending physician, the resident may receive direct supervision in the emergency room from the emergency room attending physician. In such cases where the emergency room attending physician is the principal provider of care for the patient's emergency room visit, the specialty specific attending physician does not need to meet directly with the patient. However, the specialty specific attending physician's supervision of the consultation should be documented in the medical record by co-signature of the consultation note or be reflected in the resident physician consultation note. 11. Do Not Resuscitate Orders. Assure all Do Not Resuscitate (DNR) orders are appropriate and assure the supportive documentation for DNR orders are in the patient's medical record. All DNR orders must be signed or countersigned by the attending physician.
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Supervision of Procedures 1. Diagnostic or therapeutic procedures require a high level of expertise in their performance and interpretation. Although gaining experience in performing such procedures is an integral part of the education of the resident, such procedures may be performed only by residents with the required knowledge, skill, and judgment and under an appropriate level of supervision by attending physicians. Examples include operative procedures performed in the operating suite, angiograms, endoscopy, bronchoscopy, and any other procedures where there is the need for informed consent. Attending physicians will be responsible for authorizing the performance of such procedures, and such procedures should only be performed with the explicit approval of the attending physician. NOTE: Excluded from the requirements of this section are procedures that, although invasive by nature, are considered elements of routine and standard patient care. Examples are the placing of intravenous and arterial lines, nail procedures, simple skin biopsies, injections, aspirations, wound debridement, and drainage of superficial abscesses. 2. Attending physicians will provide appropriate supervision for the patient's evaluation, management decisions and procedures. For elective or scheduled procedures, the attending physician must evaluate the patient and write a pre-procedural note or addendum to the resident's pre-procedure note describing the findings, diagnosis, plan for treatment, and/or choice of specific procedure to be performed. This pre-procedural evaluation and note may be done up to 30 days in advance of the surgical procedure. All applicable hospital accreditation standards concerning documentation must be done. A pre-procedure note may also serve as the admission note if it is written within 1 calendar day of admission by the attending physician with responsibility for continuing care of the inpatient, and if the notes meet criteria for both admission and pre-operative notes. Other services involved in the patient's operative care (e.g., Anesthesiology) must write their own pre-procedural notes (such as for the administration of anesthesia) as required by hospital accreditation, but such documentation does not replace the pre-operative documentation required by the surgery attending physician. 3. During the performance of such procedures, an attending physician will provide an appropriate level of supervision. Determination of this level of supervision is generally left to the discretion of the attending physician within the context of the previously described levels of responsibility assigned to the individual resident involved. This determination is a function of the experience and competence of the resident and of the complexity of the specific case. Emergency Situation An "emergency" is defined as a situation where immediate care is necessary to preserve the life of, or to prevent serious impairment of the health of a patient. In such situations, any resident, assisted by other clinical personnel as available, shall be permitted to do everything possible to save the life of a patient or to save a patient from serious harm. The appropriate attending physician will be contacted and apprised of the situation as soon as possible. The resident will document the nature of that discussion in the patient's record.
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Evaluation of Residents and Supervisors 1. Each resident will be evaluated by the supervising attending according to CPME requirements on the basis of clinical judgment, knowledge, technical skills, humanistic qualities, professional attitudes, behavior, and overall ability to manage the care of a patient. Evaluations will occur as indicated by the CPME at the end of the resident's rotation or monthly, whichever is more frequent. Written evaluations will be discussed with the resident. 2. If a resident's performance or conduct is judged to be detrimental to the care of a patient(s) at any time, action will be taken immediately to ensure the safety of the patient(s). 3. At least annually, each resident will be given the opportunity to complete a confidential written evaluation of attending physicians and of the quality of the resident's training. Such evaluations will include the adequacy of clinical supervision by the attending physician. The evaluations will be reviewed by the Residency Program Director. 4. All written evaluations of residents and attending physicians will be kept on file by the Residency Program Director in the Graduate Medical Education office and for the required time frame according to the guidelines established by CPME. Resident Evaluation Policy Purpose The Graduate Medical Education Committee (GMEC) has responsibility for the overall academic quality of each of the graduate medical training programs. The GMEC membership will include: the Residency Program Director and the Graduate Medical Education Director (or their designees). A part of that quality can be measured by the performance of the residents. The program expects a progression of knowledge in the specialty area from beginning to end of training, and such progress needs to be monitored and assessed. It is further expected that residents will be eligible for the specialty board examination upon completion of the training program, with an overall goal that all residents will pass the examination and become board certified. In addition to achieving board certification, the training of effective and competent physicians is the goal of each training program, and all evaluations will be directed at that ultimate objective. Policy Promotion and Graduation The resident is eligible for promotion or graduation upon the satisfactory completion of the training program. During the residency program the resident shall maintain satisfactory academic performance, demonstrate clinical competence, complete responsibilities as outlined by the Resident Training Manual, fulfill all the requirements set forth in CPME 320 for the appropriate category of residency training, and fulfill all financial obligations to all institutions affiliated with the program. 12
GMEC will review the resident's performance annually and at least three months prior to the completion of the resident's training year; the GMEC will review the resident's performance and research proposals/paper(s). The Committee will or will not recommend that the resident graduate or be promoted. Certification of completion of the residency will be made by an approval vote from the GMEC. Following approval the Residency Program Director will issue to the resident a certificate of residency completion. Remediation Any resident who fails to perform satisfactorily in a rotation will be given the opportunity to remediate the deficiencies identified in the evaluation of any rotation where the overall assessment is minimally acceptable or deficient. 1. If the grade of minimally acceptable is received one or more of the following remediation methods will be used: a. If the specific objectives which were graded as below expectations are part of another rotation in which the resident will participate before the end of the program, the director of the future rotation will be asked to emphasize those areas. If the resident performs satisfactorily in the areas in question the deficiency will be considered to have been satisfied. b. Extra clinical and/or didactic work in the area will be assigned. The clinical work, if needed, will be added to the resident's schedule. The resident must obtain a satisfactory rating on the work assigned. c. The resident will be assigned to repeat the rotation or an equivalent rotation (as defined by the Residency Program Director). This rotation may be added to the end of the training program and may be the same length as the original rotation (at the discretion of the GMEC). Training beyond the end of the standard 36 month training period will be without compensation. 2. If the grade of deficient is received the following remediation method will used: a. The resident will be assigned to repeat the rotation or an equivalent rotation (as defined by the Residency Program Director). The rotation time will be added to the end of the training program and may be the same length as the original rotation. b. Remediation will not extend beyond 3 months. Any resident still failing after that period will be dismissed without a certificate. A residents contract will not be renewed if failed or incomplete rotations constitute 25% or more of the years training except where his percentage is exceeded because of leave under the Family Medical Leave Act. A second failure of any rotation will constitute failure of remediation. Training beyond the end of the standard 36 month training period will be without compensation.
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Academic Evaluation 1. In addition to regular contact with supervisors, each resident will be evaluated in writing at least monthly or at the end of each rotation by the supervising physician. Rotations longer than one month will have an interim evaluation if resident progress is not satisfactory. 2. The written evaluations will be placed in the resident's file in the Graduate Medical Education Office and will be available for review by the resident upon request. 3. Residents new to a training program need special monitoring during the first six months of the program. Supervisors are responsible for early detection of problems, and remedial programs must be established by each program. 4. The resident will be allowed to refute in writing any evaluation, which will be placed in the resident's file along with the evaluation. 5. The GMEC, with resident representation, will be responsible for resident evaluation. That committee will meet at least quarterly to review performance of all residents not progressing satisfactorily. Residents having performance difficulty may need to be placed on a special program immediately, so the problem can be resolved before it is time to renew the agreement for the coming year. The evaluation committee may make recommendations on corrective action as described below. 6. The resident will meet with the Residency Program Director at quarterly intervals to review the accumulated written evaluations of the year's performance. 7. A final written evaluation will be done for each resident who completes a program, or changes to another program. That evaluation must include a review of the resident's performance during the final period of training and should verify that the resident has demonstrated sufficient professional ability to practice competently and independently. This final written evaluation will state whether a resident has successfully completed requirements for board eligibility, or list areas of deficiency for board eligibility. This final evaluation should be part of the resident's permanent record maintained by the GMEC. Probation, Corrective Action and Academic and Disciplinary Dismissals General Conduct 1. Residents shall strive for excellence in all aspects of patient care delivery and teaching. This implies professional demeanor and conduct both in direct patient care and in communication with family members, other health care staff members, students, and support staff members. 2. Residents shall not provide patient care under circumstances of possible physical, mental, or emotional lack of fitness that could interfere with the quality of that care. It is the responsibility of residents, upon identifying a situation in which themselves or another resident is impaired to the potential detriment of patient care, to notify the supervising physician to arrange for alternative patient care coverage. 14
Withdrawal of Residents Withdrawal of Residents: The Residency Director will make final decisions concerning any disputes resulting from this Agreement. All Residents are subject to Tucson Medical Center and THMEPs Bylaws and employee policies. All disciplinary action with regard to Residents shall be administered in accordance with the Bylaws and these policies. If the dispute involves the Residency Director, he/she will be excluded from all levels of the appeal process. TUCSON HOSPITALS MEDICAL EDUCATION PROGRAM/TMC DISCIPLINARY ACTION APPEAL AND GRIEVANCE PROCEDURES A. DISCIPLINARY ACTION Disciplinary action as a result of unsatisfactory performance or misconduct may be taken by the Program Director. Unsatisfactory performance includes, but is not limited to such activities as refusal to complete medical records, interpersonal relationships that interfere with patient care, persistent tardiness and violation of THMEP'S rules and regulations. Misconduct includes but is not limited to such activities as falsifying medical records, sexual harassment and activities that endanger patient welfare. The initial determination of unsatisfactory performance or misconduct by a resident shall be left to the sole discretion of the Program Director. Disciplinary action includes but is not limited to probation, suspension, or termination, written notice of which shall be provided to the resident, setting forth the specific grounds for the disciplinary action being taken. At the time such written notice is given to the resident, reference will also be made to the procedural rights of the resident as embodied in this document. 1. Probation a) Probation continues for a period of two months or until completion of the program, whichever period of time is shorter. b) At the expiration of the probationary period, performance is evaluated by the Program Director to determine: i) rescinding probation, ii) continuing probation, or iii) termination
2.
Suspension a) Suspension requires immediate discontinuance of duties. b) Upon suspension of a resident, the Program Director will initiate a complete investigation of the circumstances surrounding the suspension. The Program Director will then determine whether the resident should be: i) reinstated without probation
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ii) iii) 3.
placed on probation, or terminated
Termination Prior to termination the Program Director will provide the resident with written notice of intent to terminate and the opportunity to refute the allegations of unsatisfactory performance or misconduct. The notice shall include a specific date, time and place to meet personally with the Program Director and shall set forth the particular and specific claims alleged against the resident. Whenever possible, written notice of intent not to renew a residents agreement of employment will be provided within four months prior to the end of the current agreement of employment. If circumstances do not allow for notification of non-renewal within this period, written notice will be provided as soon as circumstances reasonable allow. Note: Disciplinary Actions become a part of the resident's permanent record, unless removed by the Program Director or by action under the "Informal Review" or the "Appeal Procedure".
B.
INFORMAL REVIEW AND HEARING 1. Any disciplinary action that is imposed may be informally reviewed by written request to the Program Director within seven (7) days of the date of notification of the action. 2. 3. The resident and the Program Director will attempt to resolve the matter to their mutual satisfaction within three (3) days of receipt of the appeal. If the matter cannot be resolved to their mutual satisfaction, the Program Director will call an informal hearing to make a recommendation to the Program Director. The hearing panel, to be selected by mutual agreement of the Program Director and the resident, will consist of two residents and three members of the THMEP teaching staff, one of whom will act as the Chairman of this panel. Both the Program Director and the disciplined resident will be in attendance at this hearing. The panel will make a recommendation in writing to the Program Director at the conclusion of the hearing. The Program Director will then render a decision to the resident.
4. C.
GRIEVANCE COMMITTEE 1. Within seven (7) days of the date of notification of the Program Director's Informal Review decision, the resident may request a review of the decision before a Grievance Committee by written notice. The notice must set forth the basis of this request. 2. The composition of the Grievance Committee will be as follows: a) b) The Chairman, who will be a member of the THMEP teaching staff, selected by mutual agreement between the resident and the Program Director. One resident and one THMEP teaching staff member selected by the resident and
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c) 3. 4.
One resident and one THMEP teaching staff member selected by the Program Director.
Both the Program Director and the resident may challenge members of this Grievance Committee based on demonstrable bias or prejudice. The Grievance Committee will meet within seven (7) days of receipt of the resident's written request, unless this time period is extended by mutual agreement between the resident and the Program Director. Both the resident and the Program Director may attend the Grievance Committee hearing with one representative or attorney each, to advise them only. Representatives and attorneys shall not participate in any proceedings before the committee. The resident and the Program Director may request the attendance of witnesses, ask questions of any witness, and present any reliable evidence for consideration by the committee. The Grievance Committee will render its decision in writing within three (3) days of completion of the hearing and communicate this decision to both the resident and the Program Director.
5.
6. D.
APPEAL PROCEDURE 1. Within three (3) days of receipt of this decision, the resident may appeal the Grievance Committee's decision to the Board of Directors of THMEP. 2. The Board of Directors will meet within seven (7) days of receipt of the resident's written appeal unless this time period is extended by mutual agreement between the resident and the President of the Board of Directors. Both the resident and the Program Director may attend the appeal hearing before the Board of Directors with one representative or attorney each, to advise them only. The resident and the Program Director may present any reliable evidence for consideration by the Board. The Board of Directors will render its decision in writing within three (3) days of completion of the appeal hearing and this decision shall be final.
3.
4. E.
GRIEVANCE PROCEDURE 1. If a resident has a grievance of whatever nature, this should be discussed informally with the Program Director. 2. If such informal discussion does not resolve the residents' grievance, the protocol described under C - 2 through 6 and D above may be followed.
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Section IV Policies and Procedures Planned and Unplanned Absence from Duties Planned absence An absence form must be completed with approval signatures and turned into the Residency Program Director. Unplanned absence (i.e. sickness, emergency) The following individuals and offices must be notified on a daily basis if conditions allow: Residency Program Director Clinic or hospital service of the current rotation Attending from the current rotation Communications (operators) Leave of Absence: If personal events impede the residents ability to function at the high level of a physician-in-training, it is the sole responsibility of the resident to request a leave of absence. If for any reason (medical or personal) a resident must go on a leave of absence, as outlined in the Human Resources Policy. Change in Federal Funding Status Federal funding to training institutions is based upon the number of years of the initial residency entered into to become board eligible. A situation may arise when a resident decides to change to another program that is longer than the first program chosen. Contract Violations Contract violations by a resident shall be reported to the appropriate Committee of the CPME immediately following the incident. Contract violations by a resident may result in the total loss, or partial loss, of credit for the time served in the training institution. In cases of early termination of a residents contract, the Residency Program Director will provide the resident with documentation regarding which rotations, if any, were completed satisfactorily. In the event of a dispute on the amount of credit to be given to the resident, an appeal may be made to the appropriate Committee of the CPME, whose decision on the dispute shall be final. Resident Work Hours It is recognized that excessive numbers of hours worked by physicians in training can lead to errors in judgment and clinical decision-making. The training institution and the Residency Program Director must maintain a high degree of sensitivity to the physical and mental well-being of residents and make every attempt to avoid scheduling excessive work hours leading to sleep deprivation, fatigue or inability to conduct personal activities.
18
The following work hour policy will apply to all residents in all specialties: The resident shall not be assigned to work in excess of eighty hours (80) per week averaged over a four (4) week period, inclusive of in-house night call. The resident shall not work in excess of twenty-four (24) consecutive hours exclusive of morning and noon educational programs. Allowance for transfer of care, educational debriefing and formal didactic activities may occur, but should not exceed six (6) hours for inpatient and outpatient continuity. Residents may not assume responsibility for a new patient after twenty-four (24) hours of duty. If moonlighting is permitted, it will be inclusive of the eighty (80) hour per week maximum work limit and must be reported. (See Moonlighting Policy.) The resident shall have alternate week forty-eight (48) hour periods off or at least one (1) twentyfour (24) hour period off each week. Upon conclusion of a twenty-four (24) hour duty shift, residents shall have a minimum of twelve (12) hours off before being required to be on duty again. Upon completing a lesser hour duty period, adequate time for rest and personal activity must be provided. All off-duty time must be totally free from assignment to clinical or educational activity. Those rotations requiring the resident to be assigned to Emergency Department duty shall not be assigned longer than twelve (12) hour shifts. Patient care responsibility is not precluded by this policy. In the case where a resident is engaged in patient responsibility which cannot be interrupted, additional coverage should be provided to relieve the resident involved as soon as possible.
On-Call Activities 1. In-house call is defined as work hours, beyond the normal work day, when residents are required to be immediately available in the assigned institution. a. In-house call will occur no more frequently than every third night, averaged over a four-week period. b. Continuous on-site work hours, including in-house call, will not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, maintain continuity of medical and surgical care, transfer care of patients, or conduct outpatient continuity clinics. c. No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity clinics. A new patient is defined as any patient for whom the resident has not previously provided care. 2. At-home call (pager call) is defined as call taken from outside the assigned institution. a. 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 four-week period. 19
b. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit. c. The Residency Program Director will monitor the demands of at-home call by reviewing resident work hours as recorded in Residency Resource. The total number of hours which a resident is called into the hospital from home will be recorded in a separate category. If in-house call is required, the training institution shall provide an on-call room for residents, which is clean, quiet, safe and comfortable, so as to permit rest during call. A telephone shall be present in the on-call room. Toilet and shower facilities should be present in or convenient to the room. Nourishment shall be available during the on-call hours of the night. Moonlighting Any professional clinical activity (moonlighting) performed outside of the official training program may only be conducted with the permission of the Residency Program Director. A written request by the resident must be completed and approved or disapproved by the Residency Program Director and must be filed in the institutions resident file. All approved hours are included in the total allowed work hours and are monitored by the institutions Graduate Medical Education Committee (GMEC). Failure to report and receive approval by the program may be grounds for terminating a residents contract. Health Insurance Portability and Accountability Act (HIPAA): Patients have a right to their privacy and protection of information about themselves and about their medical conditions. These rights are governed by Federal and State laws. The federal government has created a set of regulations to protect this basic patient right. The regulation is called the Health Insurance Portability and Accountability Act (HIPAA). Every member of the workforce must be knowledgeable about the requirements of HIPAA. This includes employees, physicians, nurses, students, volunteers, residents, temporary employees, contractors, and other business associates. HIPAA covers all patient information (i.e. clinical, demographic and financial) regardless of format. This includes oral, written or electronic information. All employees should follow these basic rules: Never access more information than is needed to perform job duties. Never share patient information with others unless it is required for treatment of the patient, payment, or authorized hospital operations. Secure all patient information. (Never leave records open where others can view them; never leave computer logged on so others can pull up information.)
20
Make sure that reasonable precautions are taken before discussing a patients personal information in public areas where others may hear it. Never fax patient information without making sure that it is being sent to someone needing the information for treatment, payment or operations, or with a patients written authorization. Validate all transmissions to reduce the risk of errors. If an inquiry is made about a specific patient, and the patient has not asked for restrictions on the release of this information, you may give the patients name, where they are located in the facility (except in behavioral medicine), the general condition (e.g., critical, serious, fair or good), and religious affiliation. Each patient must receive a written copy of the facilitys privacy notice policies on his/her first visit. All efforts must be made to obtain the patients signature verifying that he/she received it. All facilities must post a privacy notice. All disclosures of protected health information must be tracked unless the information is disclosed for treatment, payment, healthcare operations or a written authorization has been obtained from the patient. Information concerning appointments may be left on a patients answering machine or with a friend or family member who answers the phone. No more information than is absolutely necessary should be shared. Any, and all, suspected violations of the privacy and security regulations must be reported to the training facilitys Privacy Officer.
All members of the workforce, including volunteers and students, should be assigned security clearance to information systems based on the job duties performed. Violations of the Privacy and Security policies will result in discipline up to, and including termination. If the resident has a concern about a violation of HIPAA or a question about how to comply with this regulation, the resident should contact the supervisor or the training facilitys Privacy Officer. If the resident is faced with a privacy concern or becomes aware of a planned, suspected or actual violation of the privacy policies and standards, it is the residents responsibility to take action on the issue or refer it 21
to someone who can resolve it. When faced with such a situation, remember the three Rs: Recognize: Recognize the concern and the nature of the situation. Respond: Respond appropriately using the knowledge of the policies and good judgment. Report: Report the issue to someone who can assist in resolving the matter.
Computer Security
Never share computer log-on with anyone. Select a unique password that is not easily guessed. A unique password is six characters in length and contains letters, numbers, or special characters (example: 100th3, $hout3, Tru$t2, lokandlern). Do not write down a password or leave it out in the work area. When possible, position the computer screen to reduce the chance of others viewing information. PHI (Protected Health Information): Any patient information which could identify the person. Business Associate: A person or organization that performs a function or activity on behalf of the healthcare facility but is not part of the regular workforce. Workforce: Employees, volunteers, residents and other persons under the direct control of the hospital. Minimum Necessary: Controlling of protected health information by revealing only the information necessary to meet the need for treatment, payment, or healthcare operations.
Definitions
22
Health Information Services (Medical Records): Background The State Department of Public Health requires that all in-patient charts be completed within thirty (30) days of discharge. To be completed, all charts must have all required dictations and signatures on file, with the attending physician counter-signing all resident notes within this period. This rule is in addition to training institutions procedures that state the time required to complete history and physicals and consultations. Residents must complete their charts in a timeframe that allows attendings to remain in compliance with state regulations. Procedures Followed if Completion of Charts is Delinquent: Once the training site notifies the Residency Program Director of a delinquency, the following will occur: Any charts that are not completed within fourteen (14) days of patient discharge will be considered delinquent. Any resident who has any delinquent charts will be notified by letter and pager that they are delinquent. The resident will have five (5) days to complete all delinquent charts. If any delinquent charts remain after the deadline, the resident will be placed on immediate suspension without pay. o The Residency Program Director will review the chart list to confirm delinquency prior to suspension. o This suspension will continue until no delinquent charts remain, regardless of the location of the residents current rotation. o Time missed while on suspension will either be added to the end of their training or deducted from vacation. If a resident is repeatedly delinquent then the third and all subsequent notifications will only provide 24 hours to complete delinquent charts before a suspension is issued.
Section V General Conduct The dignity of the profession requires that the conduct of the resident be of the highest caliber and constitute an example of courtesy, cooperation, and respect. Quiet, good order and decorum must be maintained at all times. Loud conversations must be avoided, and no discussion concerning a patient is to be held within hearing distance of the patient or patient's relatives. All accepted policies of the hospitals must be adhered to by all members of the hospital staff whether medical or non-medical. The Residency Program Director will exert direct supervisory control over the residents. A resident may be suspended temporarily for suspicion of intoxication or substance abuse, insubordination, unprofessional conduct, or failure to comply with the Rules and Regulations as set forth by the medical staff of the hospitals or clinics involved in the training program. 23
Nursing and Other Professional Services The residents are expected to extend professional courtesy, assistance and cooperation to nursing and other service professionals. They are respected members of the health service team whose reason for being here is to provide the best service possible to all of the patients. Respond promptly to a call from a nurse, pharmacist, PT, or OT. Should any problem arise between a resident and any service professional, the resident should advise the Residency Program Director of the situation. The Residency Program Director will then handle the situation. Professional Care of Hospital Personnel The resident shall not render any professional service to hospital personnel or their dependents except under the provisions of the employee health service plan and under the direct supervision of the appropriate staff physician. Maintaining Discipline among Patients, Nurses and Employees The resident must not attempt to intervene in problems between patients and other health professionals. The hospital or clinic has policies and procedures for such problems. The resident should inform the Residency Program Director of the problem and allow the proper authorities to handle the situation.
24
STIPEND AND BENEFITS PLAN 2012-2013 G-1 Residents $49,000 G-2 Residents $51,000 G-3 Residents $54,000 THMEP Benefits Include: 1. 2. Health and Accident Insurance:. THMEP pays the premiums for the resident and his/her immediately family. Maternity benefits are also provided as part of the insurance. Dental Insurance: THMEP pays the premium for the resident and his/her immediate family: 100% coverage for routine work 80% coverage for basic work 50% coverage for major work Life Insurance: $100,000 term life insurance is provided. Disability Insurance: Full pay for three months; $1,500/month thereafter. Professional Liability Insurance, while performing duties that are normally included in the training program. (Includes"tail coverage") Workers' and Unemployment Compensation Insurance. Social Security employer contributions. Uniform Coats: Provided by THMEP. Vacation: Four weeks paid vacation each year. Optional Benefits: In addition to these benefits, residents may participate in tax-sheltered annuities, additional life insurance and disability coverage, by payroll deductions. Orientation Program including ACLS certification. Call Room Facilities during clinical rotations requiring overnight call.
3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
Living quarters (other than call rooms), and laundry are not provided. Lunch is provided daily and money for dinner and breakfast before and after call nights is provided on your ID badge.
25
TMC/THMEP PODIATRY ROTATION SCHEDULE # HealthSouth Tucson Medical Center * Tucson Surgery Center + University Medical Center ^ Private Office
@
JUL Year One Pod Surg@
AUG Pod Surg@
SEP Pod Surg*
OCT Pod Surg+
NOV Outpt Pod*
DEC IM@
JAN IM@
FEB 1-15 Behavior Health@ 16-28 Anes@ Derm^
MAR Wound Care@
APR Gen Surg@
MAY 1-15 Rad@ 16-31 Rehab# Peds Ortho^
JUN ED@
Year Two
Pod Surg@
Pod Surg*
Pod Surg+
OutPt Pod*
Vasc Surg@
Vasc Surg@
Trauma Surg+
1-15 Path@ 16-31 Rheum^ Vasc Surg+
Ortho@
IM@
Year Three
Pod Surg@
Pod Surg@
Pod Surg@
Pod Surg@
Pod Surg@
Pod Surg@
Outpt Pod*
Vasc Surg+
Plastic Surg^
ID@
1-15 Neuro@ 16-30 Rad@
Podiatry_schedule
Tucson Medical Center/MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Emergency Medicine
Subject: Evaluator: Site: Period: Dates of Activity: Activity: Evaluation Type:
Emergency Medicine Resident
Please rate Attainment of Competencies Competencies Specific for Rotation
Demonstrates ability to understand and appreciate the principles of general emergency medicine and emergency room protocol
Not Applicable 0 Poor Unlikely to reach minimal competency 1 Marginal Should reach expected competencies with remediation 2 Satisfactory Meet all expected competencies 3 Very Good Somewhat above expected ability 4 Outstanding Significantly exceeds expected level of ability 5
Demonstrates ability to recognize and is able to assist in the care of acute systemic emergencies (i.e., cardiac arrest, diabetic coma, insulin reactions, etc.)
Demonstrates ability to effectively handle common emergencies with emphasis on the lower extremity, (i.e., infected wounds, burns, lacerations, fractures, etc.)
Demonstrates ability to effectively handle orthopedic emergencies with emphasis on the lower extremity
Demonstrates ability to perform and interpret the findings of a comprehensive medical history and physical examination of the emergency room patient, including comprehensive medical history Including chief complaint, history of present illness, review of systems, medical history (including previous medical diagnosis, surgeries, medications, allergies), social and family history
Demonstrates ability to perform and interpret the findings of a comprehensive medical history and physical examination of the emergency room patient, including comprehensive physical examination Including vital signs and physical examination including, where indicated, HEENT, neck, chest/breast, heart, lungs, abdomen, genitourinary, rectal, extremities, neurologic examination
General Required Competencies
Demonstrates ability to prevent, diagnose, and manage diseases, disorders, and injuries of the pediatric and adult lower extremity
Demonstrates ability to assess and manage the patient's general medical status
Demonstrates he/she practices with professionalism, compassion and concern in a legal, ethical, and moral fashion
Demonstrates ability to communicate effectively and function in a multi-disciplinary setting

Not Applicable Poor Unlikely to reach minimal competency Marginal Should reach expected competencies with remediation Satisfactory Meet all expected competencies Very Good Somewhat above expected ability Outstanding Significantly exceeds expected level of ability
28
Demonstrates ability to manage individuals and populations in a variety of socioeconomic and healthcare settings
Demonstrates ability to understand podiatric practice management in a multitude of healthcare delivery settings
Demonstrates he/she is professionally inquisitive and a life-long learner utilizing research, scholarly activity, and information technologies to enhance professional knowledge and clinical practice
Competencies related to Attitudinal and Patient Management Assessment
Demonstrates ability to accept criticism constructively

29
Demonstrates continual self-study and literature review

Demonstrates punctuality, good attendance and appropriate appearance

Demonstrates ability to maintain charting, dictation and record keeping

Demonstrates he/she has good interpersonal relations with peers and other health providers
Demonstrates he/she has effective communication skills with patients, colleagues, payers, and the public
Demonstrates he/she abides by state and federal laws, including the Health Insurance Portability and Accountability Act (HIPAA), governing the practice of podiatric medicine and surgery
Demonstrates he/she practices and abides by the principles of informed consent

30
Demonstrates ability to understand and respect the ethical boundaries of interactions with patients, colleagues, and employees
Demonstrates professional humanistic qualities

Demonstrates ability to formulate a methodical and comprehensive treatment plan with appreciation of healthcare costs
Demonstrates an understanding of the psychosocial and healthcare needs for patients in all life stages: pediatric through geriatric
Demonstrates sensitivity and responsiveness to cultural values, behaviors, and preferences of one's patients when providing care to persons whose race, ethnicity, nation of origin, religion, gender, and/or sexual orientation is/are different from one's own.
Demonstrates an understanding of public health concepts, health promotion, and disease prevention
Demonstrates familiarity with utilization management and quality improvement

31
Overall Evaluation
Fails to meet expectations or demonstrate required competencies 1 Meets expectations; demonstrates required competencies 2 Exceeds expectations; demonstrate required competencies 3
Attendings Comments
______________________________________________________________________ Attending Signature Date
______________________________________________________________________ Resident Signature Date _______________________________________________________________________ Program Director Date
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program General Surgery
Subject: Evaluator: Site:
32
Period: Dates of Activity: Activity: Evaluation Type:
General Surgery Resident
Demonstrates ability to perform and interpret the findings of a comprehensive pre-operative medical history and physical examination, including comprehensive medical history Including chief complaint, history of present illness, review of systems, medical history ( including previous medical diagnosis, surgeries, medications, allergies) , social and family history
Demonstrates ability to perform and interpret the findings of a comprehensive pre-operative medical history and physical examination, including comprehensive physical examination Including vital signs and physical examination including: HEENT, neck, chest/breast, heart, lungs, abdomen, genitourinary, rectal, extremities, neurologic examination
Demonstrates ability to perform and interpret the findings of a thorough problem-focused history and physical exam on a surgical patient including problem focused history, and where appropriate, vascular, neurologic and musculoskeletal examination
Demonstrates effective pharmacologic management of surgical patients including the proper ordering of medications, being fully cognitive of indications, dosages, interactions, side effects and anticipated results
Demonstrates ability to recognize the need to appropriately order and interpret additional diagnostic studies, including EKGs, medical imaging, and laboratory studies
Not Applicable Poor Unlikely to reach Marginal Should reach expected Satisfactory Meet all expected Very Good Somewhat above Outstanding Significantly exceeds
33
minimal competency 0 1
competencies with remediation 2
competencies 3
expected ability 4
expected level of ability 5
Demonstrates proficiency in principles of surgery, including suturing techniques, atraumatic tissue handling, and instrumentation, especially as it pertains to general surgery and vascular surgery
Demonstrates ability to evaluate noninvasive and invasive vascular studies, with emphasis on the lower extremities
Demonstrates ability to diagnose and manage diseases, disorders, and injuries of the pediatric and adult lower extremity
Demonstrates that he/she practices with professionalism, compassion and concern in a legal, ethical, and moral fashion

34
Demonstrates understanding of podiatric practice management in a multitude of healthcare delivery settings

Demonstrates that he/she is professionally inquisitive and a life-long learner utilizing research, scholarly activity, and information technologies to enhance professional knowledge and clinical practice



Demonstrates ability to keep up with charting, dictation and record keeping

Not Applicable Poor Unlikely to reach minimal competency Marginal Should reach expected competencies with Satisfactory Meet all expected competencies Very Good Somewhat above expected ability Outstanding Significantly exceeds expected level of ability
35
remediation 0 1 2 3 4 5
Demonstrates good interpersonal relations with peers and other health providers
Demonstrates effective communication skills with patients, colleagues, payers, and the public
Demonstrates that he/she abides by state and federal laws, including the Health Insurance Portability and Accountability Act (HIPAA), governing the practice of podiatric medicine and surgery
Demonstrates that he/she practices and abides by the principles of informed consent
Demonstrates that he/she understands and respects the ethical boundaries of interactions with patients, colleagues, and employees

36
competencies 3
expected ability 4

Overall Evaluation
Attendings Comments
37
______________________________________________________________________ Attending Signature Date ______________________________________________________________________ Resident Signature Date _______________________________________________________________________ Program Director Date
Tucson Medical Center /MWU College of Health Sciences/ Arizona School of Podiatric Medicine Residency Program Anesthesia
Anesthesia Resident
Demonstrates knowledge of the pharmacology of common anesthetic agents, both regional and local, including indications, dosages, potential interactions, and side effects
Demonstrates ability to assess the patient's pre-anesthesia physical status

Demonstrates, via hands-on direct participation, knowledge of intubation techniques and maintenance of airway
38
Demonstrates knowledge of the basic management of patients during the perioperative period
Demonstrates knowledge, via hands-on direct participation, of the techniques and appropriate management of general, spinal, epidural, regional and conscious sedation anesthesia
Demonstrates proficiency in the performance of local anesthetic blocks of the lower extremity
Demonstrates knowledge of the current protocol for pain management, including where indicated, use of blocks and therapeutic medication(s)
Demonstrates ability to diagnose, and manage diseases, disorders, and injuries of the pediatric and adult lower extremity
39



40



41


42
Overall Evaluation
Attendings Comments
43
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Behavioral Science
Behavioral Science Resident
Demonstrates understanding of psychosocial aspects of health care delivery.

Marginal Should reach expected competencies with remediation 2 Outstanding Significantly exceeds expected level of ability 5
Not Applicable 0
Poor Unlikely to reach minimal competency 1
Satisfactory Meet all expected competencies 3
Very Good Somewhat above expected ability 4
Demonstrates knowledge of and experience in effective patient-physician communication skills.

Poor Unlikely to reach minimal competency 1 Marginal Should reach expected competencies with remediation 2 Satisfactory Meet all expected competencies 3 Very Good Somewhat above expected ability 4 Outstanding Significantly exceeds expected level of ability 5
Not Applicable 0
Demonstrates that he/she understands cultural, ethnic, and socioeconomic diversity of patients.
Not Applicable 0
Demonstrates that he/she is knowledgeable of the implications of prevention and wellness.

Poor Unlikely to reach minimal competency Marginal Should reach expected competencies with remediation Satisfactory Meet all expected competencies Very Good Somewhat above expected ability Outstanding Significantly exceeds expected level of ability
Not Applicable
44
Demonstrates ability to diagnose and manage diseases, disorders, and injuries of the pediatric and adult lower extremity
Not Applicable 0
Not Applicable 0
Not Applicable 0

Not Applicable 0
Not Applicable 0
45

Not Applicable 0
Not Applicable 0
Competencies Related to Attitudinal and Patient Management Assessment

Not Applicable 0

Not Applicable 0

Not Applicable 0

Not Applicable 0
46
Not Applicable 0
Not Applicable 0
Not Applicable 0

Not Applicable 0
Demonstrates he/she understands and respects the ethical boundaries of interactions with patients, colleagues, and employees
Not Applicable 0

Not Applicable 0
47
Not Applicable 0
Not Applicable 0
Not Applicable 0
Not Applicable 0

Not Applicable 0
Overall Evaluation
Attendings Comments 48
49
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Orthopedics
Orthopedic Surgery Resident
Demonstrates ability to perform and interpret the findings of a comprehensive pre-operative medical history and physical examination, including comprehensive medical history Including chief complaint, history of present illness, review of systems, medical history (including previous medical diagnosis, surgeries, medications, allergies) , social and family history
Demonstrates ability to perform and interpret the findings of a thorough problem-focused history and physical exam on orthopedic patients, and where appropriate, vascular, neurologic and musculoskeletal examination
Demonstrates effective pharmacologic management of orthopedic patients, including the proper ordering of medications, being fully cognitive of indications, dosages, interactions, side effects 50
and anticipated results

Demonstrates ability to recognize the need for, and the appropriate ordering and interpretation of additional diagnostic studies, including EKGs, medical imaging, and laboratory studies
Demonstrates knowledge of orthopedic techniques and instrumentation, i.e. AO/ASIF technique, fixation techniques, external fixation, total joint implant arthroplasty, bone grafting
Demonstrates understanding of the principles of care of trauma patients, with emphasis on the lower extremity
Demonstrates ability to apply the principles and techniques required in the management of fractures, with emphasis on the lower extremity
Demonstrates ability to diagnose and manage diseases, disorders, and injuries of the pediatric 51
and adult lower extremity



52
Demonstrate ability to accept criticism constructively




53

Not Applicable Poor Marginal Satisfactory Very Good Outstanding
54
Unlikely to reach minimal competency 0 1
Should reach expected competencies with remediation 2
Meet all expected competencies 3
Somewhat above expected ability 4
Significantly exceeds expected level of ability 5

Overall Evaluation
Attendings Comments
55
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Dermatology
Dermatology Resident
Demonstrates ability to prevent, diagnose, and manage diseases, disorders, and injuries of the pediatric and adult patient by non-surgical and surgical means. Performs and interprets the findings of a thorough problem-focused history and physical exam, including dermatologic examination
Not Applicable 0
Demonstrates ability to perform (and/or order) and interpret appropriate diagnostic studies, including: anatomic and cellular pathology.
Not Applicable 0
Demonstratesan understanding for metabolic disorders and its cutaneous manifestations

Not Applicable 0
Demonstrates ability to formulates an appropriate diagnosis and/or differential diagnosis regarding the dermatology patient
56
Unlikely to reach minimal competency
Meet all expected competencies
Somewhat above expected ability
Demonstrates appropriate management of the patient including pharmacologic management and usage of antibiotics, antifungals, corticosteroids both topical, oral or injectable
Not Applicable 0
Demonstrates ability to formulate and implement an appropriate plan of management including appropriate medical/surgical management when indicated, including: excision or destruction of skin lesion, skin biopsy and/or laser procedures.
Not Applicable 0
Not Applicable 0
Not Applicable 0
Not Applicable Poor Unlikely to reach minimal competency Marginal Should reach expected Satisfactory Meet all expected competencies Very Good Somewhat above expected ability Outstanding Significantly exceeds expected level of
57
competencies with remediation 0 1 2 3 4
ability 5

Not Applicable 0
Not Applicable 0

Not Applicable 0
Not Applicable 0

Not Applicable 0

58
ability 5

Not Applicable 0

Not Applicable 0
Not Applicable 0
Not Applicable 0
Not Applicable 0

Not Applicable
59
Not Applicable 0

Not Applicable 0
Not Applicable 0
Not Applicable 0
Not Applicable 0
Not Applicable
60

Not Applicable 0
Overall Evaluation
Attendings Comments
61
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program
Infectious Disease
Infectious Disease Resident
Demonstrates ability to perform and interpret the findings of a comprehensive pre-operative medical history and physical examination, including comprehensive medical history Including chief complaint, history of present illness, review of systems, medical history (including previous medical diagnosis, surgeries, medications, allergies) , social and family history
Demonstrates ability to perform and interpret the findings of a thorough problem-focused history and physical exam on a patient being evaluated for infectious disease, including problem focused history, and where appropriate, vascular, neurologic and musculoskeletal examination
62
Demonstrates he/she understands antibiotic therapy, both oral and parental, in both the normal and compromised patient, including drug pharmacology, potential interactions with other medications, side effects and cost factors.
Demonstrates he/she recognizes the need for, and the appropriate ordering and interpretation of additional diagnostic studies, including nuclear medicine imaging, MRI, CT and vascular imaging.
Demonstrates ability to order and interpret appropriate laboratory studies i.e. hematology, blood chemistries, cultures, urinalysis, serology/immunology
Demonstrates he/she can interpret culture and sensitivity results, as well as can properly collect culture specimens
Demonstrates he/she is knowledgeable in the performance and procedures of bacteriological testing, (i.e. gram stains, cultures) in the bacteriology laboratory.
63
Demonstrates ability to practice with professionalism, compassion and concern in a legal, ethical, and moral fashion

Demonstrates that he/she accepts criticism constructively

64




65

66

Overall Evaluation
Attendings Comments
67
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Internal Medicine
General Surgery Resident
Demonstrates ability to perform and interpret the findings of a comprehensive pre-operative medical history and physical examination, including comprehensive medical history Including chief complaint, history of present illness, review of systems, medical history (including previous medical diagnosis, surgeries, medications, allergies), social and family history
68
Demonstrates ability to recognize the need for, and the appropriate ordering and interpretation of additional diagnostic studies, including EKGs, medical imaging, and laboratory studies
Demonstrates he/she is able to evaluate noninvasive and invasive vascular studies, with emphasis on the lower extremities
Demonstrates ability to practice with professionalism, compassion and concern in a legal, ethical, 69
and moral fashion


Demonstrates he/she accept criticism constructively


70


71


72

Overall Evaluation
Attendings Comments
______________________________________________________________________ Attending Signature Date ______________________________________________________________________ Resident Signature Date _______________________________________________________________________
73
Program Director
Date
74
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Vascular Surgery
Vascular Surgery Resident
75
Demonstrates he/she practices with professionalism, compassion and concern in a legal, ethical, 76
and moral fashion





77



Demonstrates professional humanistic qualities 78
Not Applicable 0
Marginal Should reach expected competencies with remediation 2
Outstanding Significantly exceeds expected level of ability 5

Overall Evaluation
Attendings Comments 79
80
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Diagnostic Radiology/Interventional Cardiology
Diagnostic and Interventional Radiology Resident
Demonstrates effective pharmacologic management of surgical patients including the proper ordering of medications, being fully cognitive of indications, dosages, interactions, side effects and anticipated results 81
Not Applicable 0
Demonstrates he/she understands and appreciates the protocol of managing patients pre and post interventional revascularization.
Demonstrates he/she is knowledgeable in the performance and interpretation of noninvasive vascular testing techniques, i.e. doppler, duplex dopplerect.
Demonstrates he/she understands and appreciates the performance and interpretation of invasive vascular testing, i.e. angiography.
Demonstrates he/she understands and appreciates the various types of interventional revascularization techniques, i.e. angioplasty, stenting, thrombolysis, ect.
82



83

Demonstrates punctuality, good attendance and appropriate appearance.



84
competencies 3
expected ability 4


85
Overall Evaluation
Attendings Comments
86
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Pathology
Pathology Resident
Understands collection methods for specific tests in pathology

Not Applicable 0
Demonstrates ability to perform (and/or order) and interpret appropriate diagnostic studies, including: gross pathology and anatomic and cellular pathology
Demonstrates ability to assess and manage the patient's general medical status. Recognize the need for (and/or orders) additional diagnostic studies when indicated
Not Applicable 0
Demonstrates ability to read, interpret, critically examine, and present medical and scientific literature to enhance professional knowledge and clinical practice
Marginal Should reach expected competencies with remediation
Not Applicable
Poor Unlikely to reach minimal competency
Satisfactory Meet all expected competencies
Very Good Somewhat above expected ability
Outstanding Significantly exceeds expected level of ability
87


Demonstrates that he/she is professionally inquisitive and a life-long learner utilizing research, scholarly activity, and information technologies to enhance professional knowledge and clinical 88
practice




Demonstrates that he/she abides by state and federal laws, including the Health Insurance Portability and Accountability Act (HIPAA), governing the practice of podiatric medicine and 89
surgery

90

Overall Evaluation
Attendings Comments
91
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Podiatric Residency Program Plastic Surgery
Plastic Surgery Resident
Not Applicable 0
Not Applicable 0
Not Applicable 0
92
Not Applicable 0
Demonstrates ability to recognize the need to appropriately order and interpret additional diagnostic studies, including EKGs, medical imaging, and laboratory studies and vascular studies
Not Applicable 0
Demonstrates proficiency in various techniques of soft tissue coverage, i.e. skin grafts, vascular flaps, etc.
Not Applicable 0
Demonstrates he/she is knowledgeable in the more advanced surgical techniques and procedures involved in plastic surgery, including atraumatic tissue handling, suturing techniques, and instrumentation.
Not Applicable 0
Demonstrates appropriate management of basic and complex wounds and infections.

Not Applicable 0
Demonstrates appropriate management of preoperative and postoperative plastic surgical patients, including medical management of inpatients with complex medical problems, i.e. diabetes, renal, & cardiac disease, neuropathy, vascular disorders, etc.
Not Applicable 0
Demonstrates he/she is knowledgeable in the comprehensive team approach to medical and surgical management of diabetic foot ulcers.
Poor Unlikely to reach minimal competency Marginal Should reach expected competencies with Satisfactory Meet all expected competencies Very Good Somewhat above expected ability Outstanding Significantly exceeds expected level of ability
Not Applicable
93
Not Applicable 0
Not Applicable 0
Not Applicable 0
Demonstrates ability to communicate effectively and functions in a multi-disciplinary setting

Not Applicable 0
Not Applicable 0

Not Applicable 0
Demonstrates he/she is professionally inquisitive and a life-long learner utilizing research, scholarly activity,
94
and information technologies to enhance professional knowledge and clinical practice

Not Applicable 0
Competencies Related to Attitudinal & Patient Management Assessment

Not Applicable 0
Demonstrates continual self-study & literature review

Not Applicable 0
Demonstrates punctuality, good attendance & appropriate appearance

Not Applicable 0
Demonstrates ability to keep up with charting & dictation & record keeping
Not Applicable 0
Demonstrates good interpersonal relations with peers & other health providers
Not Applicable 0
Demonstrates effective communication in oral and written form with patients, colleagues, payers, and the public
Not Applicable 0
95
Not Applicable 0

Not Applicable 0
Not Applicable 0

Not Applicable 0
Not Applicable 0
Not Applicable 0
96
ability 5
Not Applicable 0

Not Applicable 0
Overall Evaluation
Attendings Comments
97
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program
Podiatric Residency Program
Wound Care
Wound Care Resident
Demonstrates ability to performs and interprets the findings of a thorough problem-focused history and physical exam on a patient including problem focused history, and where appropriate, vascular, dermatologic, neurologic and musculoskeletal examination
Not Applicable 0
Demonstrates that he/she understands principles of wound healing and management of wounds including the diabetic wound and trauma.
Not Applicable 0
Demonstrates ability to recognize the need to appropriately order and interpret additional diagnostic studies, including EKGs, medical imaging, and laboratory and pathology studies and vascular studies including Doppler, ABI, and TCO2.
Not Applicable 0
Demonstrates that he/she understands various treatment options available to the wound care patient, including surgical and non-surgical management.
98
Demonstrates that he/she understands and is able to utilize various wound care products in the appropriate clinical setting.
Not Applicable 0
Demonstrates appropriate management of basic and complex wounds and infections.

Not Applicable 0
Demonstrates that he/she is knowledgeable regarding hyperbaric oxygen therapy in the compromised wound.
Not Applicable 0
Demonstrates the ability to formulate an appropriate differential diagnosis regarding the wound care patient.
Not Applicable 0
Demonstrates ability to provide appropriate treatment including debridement of various ulcerations and wounds.
Not Applicable 0
Obtains knowledge and exposure to interpretation of cellular pathology, with emphasis on the lower extremity.
Marginal Poor Should reach expected Unlikely to reach minimal competencies with competency remediation 1 2 Satisfactory Meet all expected competencies 3 Very Good Somewhat above expected ability 4 Outstanding Significantly exceeds expected level of ability 5
Not Applicable 0
99
Obtains knowledge and exposure to interpretation of anatomic pathology with emphasis on the lower extremity.
Marginal Poor Should reach expected Unlikely to reach minimal competencies with competency remediation 1 2 Satisfactory Meet all expected competencies 3 Very Good Somewhat above expected ability 4 Outstanding Significantly exceeds expected level of ability 5
Not Applicable 0
Understands the principles and procedures involved in obtaining and preparing specimens for interpretation.
Not Applicable 0
If lower limb anatomic specimens are available, perform appropriate dissection and be able to differentiate between pathologic and normal tissue.
Not Applicable 0
Not Applicable 0
Not Applicable 0
Not Applicable 0
Demonstrates ability to communicate effectively and functions in a multi-disciplinary setting

Not Applicable
100
Not Applicable 0

Not Applicable 0
Not Applicable 0
Competencies Related to Attitudinal & Patient Management Assessment

Not Applicable 0
Demonstrates continual self-study & literature review

Not Applicable 0
Demonstrates punctuality, good attendance & appropriate

Not Applicable 0
Demonstrates ability to keep up with charting & dictation & record keeping
101
ability 5
Demonstrates good interpersonal relations with peers & other health providers
Not Applicable 0
Demonstrates effective communication in oral and written form with patients, colleagues, payers, and the public
Not Applicable 0
Not Applicable 0

Not Applicable 0
Not Applicable 0

Not Applicable 0
102
Not Applicable 0
Not Applicable 0
Not Applicable 0

Not Applicable 0
Overall Evaluation
Attendings Comments
103
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Podiatry
Subject: Evaluator: Site: Period: Dates of Activity:
104
Activity: Evaluation Type:
Podiatry Clinic / Office Resident
Demonstrates ability to perform and interpret the findings of a thorough problem-focused history and physical exam on podiatric patients, and where appropriate, vascular, dermatologic, neurologic and musculoskeletal examination
Demonstrates effective pharmacological management utilizing medications commonly prescribed in podiatric medicine Including proper ordering of, being fully cognitive of indications, dosages, interactions, side effects and anticipated results. (These medications include NSAIDS, antibiotics, antifungal, narcotic analgesics, muscle relaxants, medications for neuropathy, sedative/hypnotics, peripheral vascular agents, anticoagulants, antihyperuricemic, uricosuric agents, tetanus toxoid/immune globulin, laxatives/cathartics, fluid and electrolyte management, corticosteroids, and anti-rheumatic agents)
Demonstrates ability to recognize the need for, and to appropriately order and interpret additional diagnostic studies Including, but not limited to, electro diagnostic studies, noninvasive vascular studies, bone densitometry studies, compartment pressure studies
Demonstrates ability to order and interpret appropriate laboratory studies Including but not limited to: hematology, blood chemistries, drug screens, bacteriologic and fungal cultures, urinalysis, serology/immunology, toxicology, coagulation studies, blood gases, synovial fluid analysis
105
Demonstrates ability to utilize information obtained from the history and physical examination and ancillary studies. Demonstrates ability to arrive at an appropriate differential diagnosis and treatment plan utilizing appropriate consultations and/or referrals
Demonstrates ability to provide appropriate lower extremity health promotion and education
Demonstrates ability to perform manipulation/mobilization of the foot/ankle joint to increase/reduce associated pain and/or deformity
Demonstrates ability to effectively perform biomechanical evaluations and manage patients with lower extremity disorders utilizing appropriate prosthetics, orthotic devices and footwear
Demonstrates knowledge of the indications and contraindications of the use of orthotic devices, bracing, prosthetics, and custom shoe management, and able to fabricate appropriate casts for these devices, or write appropriate referrals to the prosthetist/orthotist
Demonstrates appropriate podiatric surgical management when indicated (See appendix in CPME 320 for list of procedures)
Demonstrates ability to recognize and manage post-operative complications i.e. infections, DVTs, 106
hematomas, cellulitis, dislocation, fracture, etc.

Not Applicable 0
Demonstrates appropriate use of local anesthetic agents, with knowledge of pharmacology, indications, dosages, potential interactions, and side effects
Demonstrates ability to appropriately order and interpret medical imaging, including plain radiography, radiographic contrast studies, stress radiography, fluoroscopy, nuclear medicine imaging, MRI, CT, diagnostic ultrasound, and vascular imaging
Demonstrates ability to effectively perform, where indicated, palliation of keratotic lesions and toenails
Demonstrates ability to effectively manage closed fractures and dislocations including pedal fractures/dislocations, and ankle fracture/dislocation, including the use of cast management and tape immobilization as indicated
Demonstrates ability to effectively perform appropriate injections and/or aspirations, with knowledge of pharmacology, indications, dosages, potential interactions, and side effects
107
Demonstrates ability to write appropriate referral for physical therapy for patients, and is able to monitor and modify the treatment plan as needed
Demonstrates understanding of the complexity of modern healthcare reimbursement, and common business practices
Demonstrates understanding of insurance issues including professional and general liability, disability, Workers Compensation, and the medical-legal considerations involving healthcare delivery

108




Demonstrates ability to maintain charting, dictation and record keeping 109
Not Applicable 0

Demonstrates ability to formulate a methodical and comprehensive treatment plan with appreciation of healthcare costs 110
Not Applicable 0

Overall Evaluation
Attendings Comments
111
112
Tucson Medical Center /MWU College of Health Sciences/Arizona School of Podiatric Medicine Residency Program Podiatric Surgery
Podiatric Surgery Resident
Demonstrates comprehensive knowledge in the basic principles of podiatric surgery, including suturing techniques, sterile techniques, fixation techniques, instrumentation, proper tissue handling, hemostasis, and operating room protocol
Demonstrates ability to understand and utilize appropriate hospital protocol, and appropriate medical records, and to adhere to hospital safety measures
Demonstrates ability to perform and interpret the findings of a thorough problem-focused history and physical exam on podiatric patients, including problem focused history, and where appropriate, vascular, dermatologic, neurologic and musculoskeletal examination
Demonstrates ability to evaluate a patient and determine an appropriate surgical procedure, utilizing the problem-focused history and physical, along with review of laboratory and radiologic studies, and to perform a biomechanical examination where indicated
113
Demonstrates ability to effectively assess appropriateness of a surgical procedure, including assessment of efficacy and potential complications relating to the procedure
Demonstrates progressive development of knowledge, attitude and skills in performance of podiatric procedures
Demonstrates progressive competency in preoperative, intraoperative, and postoperative assessment and management of podiatric surgical cases
Demonstrates ability to perform appropriate volume and diversity of cases and procedures in the categories of digital, first ray surgery, other soft tissue foot surgery, other osseous foot surgery, reconstructive rearfoot and ankle surgery, and other procedures
114




115


116

117

Overall Evaluation
Attendings Comments
118
119
D Diid da ac cttiic cS Sc ch he ed du ulle e Tucson Medical CenterPodiatric Residency Program will host 5 specific Conferences / Workshops designed to assist in the development of the Resident as a clinician, surgeon, researcher, scientist, and leader. The Programs will aid in the development of clinical and surgical skillsn through both discussionbased learning and manual labs. These didactic activities will also provide an opportunity for the resident to learn to research and prepare a professional presentation for their peers, and to develop the skills of public speaking. The Monthly calendar of didactic activities and their specific objectives is detailed below. M Mo on ntth hlly yC Ca alle en nd da arr Week I II III IV Day MON TUE MON TUE MON THUR MON THUR PRESENT Conference Radiology conference PRESENT Conference Cadaver / Saw Bone Workshop PRESENT Conference Journal Club PRESENT Conference Grand Rounds Program
1.)
PRESENT Conference
Tucson Medical CenterPodiatric Residency Program utilizes the PRESENT Podiatric Residency Courseware to assure didactic activities that complement and supplement the curriculum are available. PRESENTs professional teaching materials for residency directors provide a comprehensive curriculum of weekly instructional presentations for Residents. 2.) Radiology Conference
The purpose of the Radiology Conference is to provide an instructive environment for residents to observe and participate in the radiological assessment of patients, as well as in the development of diagnoses and treatment strategies. Residents will learn to enhance their skills of evaluation, interrogation, communication, and problem-solving. They will be encouraged to draw upon their clinical and surgical experience and the medical literature in defending their diagnoses and management plans. All Residents and Attendings at the conference will be required to participate in the Conference by presenting their most challenging, pertinent, or interest-worthy cases, complete with clinical and radiological data. Each will be responsible for researching, presenting, and defending his/her own clinical cases. 120
3.)
Cadaver / Saw Bone Workshop
The purpose of the Cadaveric Workshop is to provide a safe and controlled environment for residents to enhance their surgical skills. Residents will become more confident and efficient in their tactile skills as they learn proper dissection techniques, anatomical relationships, safe surgical approaches and exposures to critical target tissues, and primary closure techniques. The Saw Bone Workshop will provide residents an opportunity to become familiar with the variety of internal and external fixation products, and the manner of their proper application.
Month 1 2 3 4 5 6 7 8 9 10 11 12
Topic Internal Fixation I: AO technique; Small Fragment set Internal Fixation II: Contoured Plating: Forefoot / Midfoot Internal Fixation III: Contoured Plating: Rearfoot / Ankle Internal Fixation IV:Cannulated Screws: Forefoot / Midfoot Internal Fixation V:Cannulated Screws : Rearfoot / Ankle Intramedullary Fixation I: Steinmann Pin, Cann. Screw, Bolt Intramedullary Fixation II: Hindfoot Arthrodesis Nail External Fixation I: Smith and Nephew External Fixation II:Synthes Plastics techniques: Skin Graft + Flap, Skin Substitutes Bone Grafting techniques: Allograft, Autograft, BoneStim. Tendon Transfer techniques: PT, AT, FHL, FDL, Peroneal
121
4 4..))
Journal Club
The Journal Club will provide the Resident the opportunity to explore current research in lower extremity medicine, and other topics related to Podiatry. Relevant articles will illuminate ongoing clinical discussions, and inform residents and attendings of innovations in clinical and surgical care. The Club will encourage discussion and debate on current practices and best practices, and guide attendees in developing new ideas and methods in their treatment protocols. 5.) Research Methodology
The Resident will receive instruction in research methodology. Instruction will partially be self directed and facilitated by lectures provided by Midwestern University faculty. The resident will participate in research activities and present at Grand Rounds. 6.) Grand Rounds
Grand Rounds will be hosted in a semi-formal setting in which the Resident or Attending will present a professional PowerPoint presentation of sufficient length and research to provide the audience a thorough understanding of the topic at hand, and its relevance to their Podiatric practice. The Grand Rounds presentation will also serve as a quarterly update of the Residents research projects. The residents will be required to present at Grand Rounds at least once annually. The topics and their respective presenters are listed below. Month 1 2 3 4 5 6 7 8 9 Speaker Dr. Dahukey Dr.Dahukey RESIDENT Dr. Dahukey Dr. Dahukey RESIDENT Dr. Steck Dr. Huston RESIDENT Topic Limb Salvage: Concepts and Techniques Foot and Ankle Fractures: Surgical Treatment TO BE ASSIGNED RA: L.E. Manifestations and Treatment Lateral Ankle: Pathology & Reconstruction RESEARCH UPDATE Ankle Syndesmosis: Traumatology and Repair LisFranc Joint Pathology: Acute & Chronic Repair TO BE ASSIGNED
122
10 11 12
Dr. Dahukey Dr. Faul RESIDENT
Neurolgical Limb: Repair of Clubfoot, Polio, and CP Charcot Arthropathy: From TAL to ExFix RESEARCH UPDATE
123

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Tucson Medical Center And Midwestern University College of Health Sciences/ Arizona School of Podiatric Medicine

Podiatric Resident Training Manual 2013-2014

placed on probation, or terminated

3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

JUL Year One Pod Surg@

AUG Pod Surg@

SEP Pod Surg*

OCT Pod Surg+

NOV Outpt Pod*

FEB 1-15 Behavior Health@ 16-28 Anes@ Derm^

MAR Wound Care@

APR Gen Surg@

MAY 1-15 Rad@ 16-31 Rehab# Peds Ortho^

1-15 Path@ 16-31 Rheum^ Vasc Surg+

1-15 Neuro@ 16-30 Rad@

Emergency Medicine Resident

Please rate Attainment of Competencies Competencies Specific for Rotation

General Required Competencies

Demonstrates ability to communicate effectively and function in a multi-disciplinary setting

Competencies related to Attitudinal and Patient Management Assessment

Demonstrates ability to accept criticism constructively

Demonstrates continual self-study and literature review

Demonstrates punctuality, good attendance and appropriate appearance

Demonstrates ability to maintain charting, dictation and record keeping

Demonstrates he/she practices and abides by the principles of informed consent

Demonstrates professional humanistic qualities

Demonstrates familiarity with utilization management and quality improvement

______________________________________________________________________ Attending Signature Date

______________________________________________________________________ Resident Signature Date _______________________________________________________________________ Program Director Date

Period: Dates of Activity: Activity: Evaluation Type:

General Surgery Resident

Please rate Attainment of Competencies Competencies Specific for Rotation

competencies with remediation 2

expected level of ability 5

General Required Competencies

Demonstrates ability to communicate effectively and function in a multi-disciplinary setting

Demonstrates understanding of podiatric practice management in a multitude of healthcare delivery settings

Competencies related to Attitudinal and Patient Management Assessment

Demonstrates ability to accept criticism constructively

Demonstrates continual self-study and literature review

Demonstrates punctuality, good attendance and appropriate appearance

Demonstrates ability to keep up with charting, dictation and record keeping

Demonstrates professional humanistic qualities

competencies with remediation 2

expected level of ability 5

Demonstrates familiarity with utilization management and quality improvement

Please rate Attainment of Competencies Competencies Specific for Rotation

Demonstrates ability to assess the patient's pre-anesthesia physical status

General Required Competencies

Demonstrates ability to communicate effectively and function in a multi-disciplinary setting

Demonstrates understanding of podiatric practice management in a multitude of healthcare delivery settings

Competencies related to Attitudinal and Patient Management Assessment

Demonstrates ability to accept criticism constructively

Demonstrates continual self-study and literature review

Demonstrates punctuality, good attendance and appropriate appearance

Demonstrates ability to keep up with charting, dictation and record keeping

Demonstrates professional humanistic qualities

Demonstrates familiarity with utilization management and quality improvement

Behavioral Science Resident

Demonstrates understanding of psychosocial aspects of health care delivery.

Poor Unlikely to reach minimal competency 1

Satisfactory Meet all expected competencies 3

Very Good Somewhat above expected ability 4

Demonstrates knowledge of and experience in effective patient-physician communication skills.

Resident Signature Date _ Program Director Date