Residency Programs: Policies & Procedures

Residency Programs: Policies & Procedures

Performance & Leave Policy  

Resident performance is evaluated through direct and indirect observation by faculty and house staff as the residents perform their duties. The criteria used for these evaluations include cognitive and non-cognitive characteristics.

Criteria

Six competencies (which encompass the 18 ACGME milestones) are considered in the evaluation: 1) patient care, 2) medical knowledge, 3) systems-based practice, 4) practice-based learning and improvement, 5) professionalism, and 6) interpersonal and communication skills. An overall score is also included in faculty evaluation of residents.

Presentations and attendance at weekly conferences (Grand Rounds, Resident Conferences, Skills Lab, etc), research activities, and publications are also taken into account in evaluating overall performance, but the heaviest weight is given to performance on the clinical rotations.

1. Patient Care: includes subcompetencies in patient evaluation and decision making; intra-operative patient care - performance of procedures and technical skills; and post-operative patient care.
2. Medical Knowledge: includes subcompetencies in pathophysiology and treatment; and anatomy. 
3. Systems-Based Practice: includes subcompetencies in patient safety and quality improvement; system navigation for patient-centered care; and physician role in health care systems.
4. Practice-Based Learning and Improvement: includes subcompetencies in evidenced-based and informed practices; and reflective practice and commitment to personal growth.
5. Professionalism: includes subcompetencies in ethical principles; professional behavior and accountability; administrative tasks; and self-awareness and help-seeking. 
6. Interpersonal and Communication Skills: includes subcompetencies in patient and family-centered communication; interprofessional and team communication; and communication within health care systems.
7. Overall Performance: This is a compilation of all the performance elements listed above.

Process

The results of the evaluation process are recorded on the evaluation form. ABSITE results and conference attendance records are collated by the Resident Education Office. The material in these files is provided to the CCC and the CCC conducts a formal review of each resident a minimum of twice during each academic year. The results of the formal review and the summary evaluation will be provided to the resident as well as the resident's advisor. The advisor is responsible for discussing it with the resident. Digitally signed copies of the Summary Performance Review Sheet and the accompanying letter are included in resident personnel files in the Resident Education Office.

Feedback should also be provided directly by the service chief during a rotation via “exit interviews”. These discussions cover the areas where performance should be improved and advice on how to accomplish this. Areas of outstanding performance are also cited. If the level of a resident’s performance is judged by the CCC and program director to fall below minimum standards, this will be communicated to the resident and his/her advisor. Inadequate performance may result in remediation, probation, or dismissal from the program, depending on each individual circumstance.

Promotion

Residents are appointed on a yearly basis. Residents whose performance meets the expected standards will be promoted to the next level of training.

Probation

Probation is a conditional status that places specified requirements for improved performance on the resident, with dismissal from the residency as a possible result if the prescribed improvement does not occur. The requirements will be tailored to the individual situation, and they will prescribe the response expected of the resident and will include time limits for the probationary period. These requirements will be given to the resident in writing and discussed with the resident by his or her advisor, who must attend the CCC meeting when the resident is discussed. The resident is also required to speak directly with the Chair of the CCC. The performance of a resident on probation will be reviewed at least quarterly by the CCC, which may remove or extend probation and provide additional feedback to the resident and advisor. In general, residents will be expected to earn removal from probation within one or two quarters, but the maximum period of probation cannot exceed 8 consecutive quarters. At this point dismissal from the residency program would be likely unless there were compelling extenuating circumstances.

Any resident who scores below the 30th percentile on the in-training examination (ABSITE) is required to submit, in writing, their study plan to improve their scores for the next ABSITE to the CCC and program leadership. The in-training exam score the following year must exceed the 30th percentile or increase by 20 percentile points. If the resident fails to meet these performance standards on the in-training examination, the CCC may consider asking the resident to repeat a year. All residents are required to take the exam unless the resident is on vacation or has received permission to be absent from the Program Director or the Associate Program Director(s).

Dismissal

Although rare, dismissal from the residency program is a potential consequence of poor performance. Dismissal may follow a period of probation, or in exceptional circumstances, it may occur without a preliminary probationary period. Examples of events that may instigate dismissal without prior probation include criminal behavior and some types of substance abuse, dishonesty, or immoral behavior.

Substance Abuse: Although the Department of Surgery will not tolerate substance abuse among its residents, substance abuse will not necessarily result in dismissal. Each case will be considered on its own merits. Residents troubled by substance abuse will be referred to the University of California, Faculty and Staff Assistance Program. In some cases, the recommendation may be for suspension (with pay and benefits) until the outcome of therapy can be determined.

Appeal

The process for appeal of an adverse action such as remediation, probation or dismissal from the program is detailed in the House staff Handbook, and is available on the GME website. In general the resident will receive notice of a proposed adverse action and will have an opportunity to meet with the SEC, with his/her advisor present, to provide the resident’s perspective on the performance issues. Following that meeting, the CCC will decide on a course of action. Should the CCC determine that an adverse action is warranted, the resident will have the opportunity to appeal through the office of the Vice Dean for Education.

Vacation & Leave

• PGY1s: two weeks of vacation and two weeks of educational leave.

Rules for the one week vacation block for the interns:

• Each intern MUST notify the rotation from which they are taking their one week of uncovered vacation at least 30 days prior to the start of the rotation regarding which week they will take off. Failure to notify the service in advance as required may mean the resident will not be able to take the week off. (The only exception to this rule is the resident who has to take this week from his July rotation. )
• The week is from Monday to Monday and MAY NOT include two weekends.
• In those circumstances where there are two residents assigned to the same service, THE WEEKS OFF MAY NOT OCCUR AT THE SAME TIME.

*Please note: Some services may require a more advanced notice (i.e. 60 days prior to start of rotation). If this is the case, the service administrator will contact you directly. Please be sure to respond to them asap.

• PGY-2 ,3, 4, &5's: One month annual leave which must be taken as a one month block which is two weeks of vacation and 2 weeks of educational leave.

Parental Leave

Since the birth, adoption, or foster placement of a child is not usually an unexpected event, notification of the Department in writing of the resident’s intent to go on leave should be made at least five months in advance. Family leave is given in accordance with UCSF GME policy and includes eight weeks of paid leave per academic year, per event (effective January 1, 2023). Typical maternity leave begins two weeks paid leave prior to the anticipated due date and the remainder post delivery. Vacation can be scheduled as additional paid leave in conjunction with maternity leave. In addition, up to 60 days unpaid leave can be added to the paid leave mentioned above. If parental leave occurs during clinical training, residents should discuss any needed make up time with program leadership and administration. 

More details, guidelines, and resources can be found on the Parenting in Surgery page. 

Sick Leave & Disability Leave

Each resident is entitled to use up to twelve (12) days per academic year for personal illness or disability. In addition, any remaining educational or vacation leave may be used to cover illness or disabilities, which exceed twelve (12) days of sick leave. Should a resident exhaust all paid time leaves (sick, educational, and vacation), the resident may be placed on an unpaid leave until the end of the illness or disability. The total length of the leave (paid and unpaid together) may not exceed four (4) calendar months unless expressly extended in writing by the Chair or Program Director with the Chair’s approval. Any sick leave balance does not carry over from year to year.

Leave of Absence

Any resident who required a leave of absence that exceeds one month in a calendar year, MAY be required to make up the lost time. If the leave of absence occurs prior to the research component of the training program, this additional time would be taken from the research allotment. If the leave of absence occurs durng the clinical training component of the program, this additional time would be added on at the end of the chief resident year. The decision to require makeup time will be individualized and will reflect the resident’s overall performance, case volume, ABS requirements, etc.

Parenting in Surgery

Please refer to the Parenting in Surgery page` for a full list of policies, guidelines, and resources. 

Resident Research and Funding  

Please visit Resident Research Objectives & Policies on the resident research website.

Resident Book Reimbursement Program

All categorical general surgery and plastic surgery residents PGY1 and above are eligible to receive $200 in education fund reimbursement thanks to UCSF surgery alumni and faculty donations. The following items are applicable: educational books, software, journal subscriptions and D/Surgery laparoscopic training boxes. Items not clearly falling into one of those categories must be approved by the Education Office.

Turn original receipts and/or bank statements into the Education Office for reimbursement. Please allow 3-6 weeks for reimbursement processing.

Additionally, The City & County of San Francisco, in cooperation with CIR, administers Educational Expense Reimbursement requests of up to $600 per year from the Patient Care fund. Only residents scheduled for three or more months (12 weeks, not including vacation) in a fiscal year (e.g., July 1-June 30) are eligible to submit a reimbursement request.

More information and instructions to submit a reimbursement request can be found at https://sfdhr.org/online-tuition-reimbursement-process-zsfg-interns-residents

Please note that the education fund is a fixed amount every year. They process reimbursements in the order that they are received, and it’s possible that the fund will be depleted before every eligible person applies for reimbursement.

UCSF Resident & Clinical Fellow Meal Program

Residents on duty have access to food services 24 hours/day at all institutions.

Parnassus, Mission Bay, and Mount Zion

UCSF Medical Center supports eligible residents and clinical fellows by offering meals when working in the hospital at UC Moffitt/Long, Mission Bay and Mount Zion sites. Electronic meal cards (FastPay program) are distributed to each individual resident and funds allocated based on call schedules. Funds for the upcoming month are available for use on the first day of the eligible rotation. The FastPay cards can be used at select locations on Parnassus, Mission Bay, Mount Zion, Laurel Heights, and Mission Center campuses. To view the list of approved locations, please refer here. Lost or Stolen cards must be reported to the Surgery Education Office immediately by calling (415) 476-1239. Residents are responsible for paying the difference at the cashier, should purchases exceed the monthly card limit.  Funds do not roll over from month to month. All unused funds are revoked each month. All ACGME residents and fellows will be funded $350 a month when rotating at UC Medical Center (Parnassus, Mission Bay or Mt. Zion) on the GENERAL SURGERY rotations listed below:

• MB Breast
• MB HBOP
• MB Gold/Scope
• MB OHNS
• MB Peds
• MZ Endocrine
• UC Cardiac
• UC Complex General Surgery
• UC Critical Care
• UC KTU
• UC LTU
• UC On Call-LTU
• UC MBF (Dunphy)
• UC Plastic
• UC Red (ACS/Debas)
• UC Thoracic
• UC Vascular

Meal Card Program Guidelines:

1. Money will be available on the first day of each rotation.
2. Money is prorated if the rotation is split with another site or vacation
3. Unused meal money will not be carried over after your last day on the rotation.
4. Unused balances will be revoked after your last day on the rotation.

ZSFG

All ACGME residents and fellows performing clinical rotations at ZSFG are issued a meal card. Each card has a daily balance of $23.00 which breaks down to $5.00 for Breakfast and $9.00 each for Lunch and Dinner. Residents are responsible for monitoring their spending and are responsible for paying the difference if they exceed their maximum daily balance.

Residents and fellows are responsible for replacing lost, stolen, or misplaced meal cards. To obtain a replacement, residents should go to the Food & Nutrition Services Office (Bldg 5, 2nd Flr, Rm. 2D1A) with a Check or Money Order for $15.00 to get a replacement card. Checks should be payable to 'ZSFG.'

Veterans’ Administration Medical Center

The VA has a cafeteria that is open Monday thru Friday from 7 am-4 pm. For residents staying for overnight call, there is a meal program utilizing delivery from several participating outside restaurants. Vouchers are available from the service administrator. Tickets for breakfasts in the cafeteria are also provided to post call residents.

UCSF Physician Well Being Programs

Housestaff have access to a variety of systems for supportive intervention for dependency treatment and to obtain counseling services for a broad range of personal problems (e.g., workplace stress, anxiety management, personal or work relationships, depression, grief and loss, caregiver concerns, etc)

1. The UCSF GME has an extensive list of well-being and mental health resources for residents and fellows. The Map of GME Well-being Resources provides an easy to use guide to navigate all resource options.
2. The Faculty & Staff Assistance Program (FSAP) provides voluntary, free, and confidential services that include individual counseling and referral services at multiple locations. To set up an appointment, call 415-476-8279 or email [email protected].
3. The UCSF Physician Well-Being Committee is dedicated to recognizing and offering assistance to staff and physicians who have problems with substance abuse or physical and mental illness which impair their ability to practice safely and effectively. Confidentiality will be assured if possible, depending upon the severity of the situation and the immediate risk to patient safety. If you are anxious about making the first call, you may contact the committee initially, just to learn more about how the committee can offer help. To contact the Physician Well-Being Committee Chair, call the Medical Staff Office: (415) 885-7268 
4. Physicians' Confidential Assistance Line (California Medical Association)
5. UCSF GME ProtoCall Services provides 24/7 urgent (not emergent) psychiatric care: (885) 221-0598.
6. Resident and fellow HMO and PPO health insurance plans cover virtual and in-person mental healthcare with an insurance co-pay. See the Urgent and Important Mental Health Services section of the GME well-being page for details.
7. Ginger is an app that offers confidential, on-demand emotional and mental health support for life challenges through coaching via text-based chats, self-guided activities, and video-based therapy and psychiatry. 

These and other options are described on the GME website. In addition, the Dean's Office is currently exploring additional well-being programs. Housestaff are urged to provide input to the Director of Graduate Medical Education or the Associate Dean for Graduate Medical Education.

Workhour Policy / Fatigue Monitoring

Definitions

1. Work hours are defined as that time spent in all clinical and academic activities related to the training program. This includes all aspects of patient care in both the inpatient and outpatient settings, as well as all procedural activities in the operating room. It also includes time spent in the administrative aspects of patient care, the time spent transferring patient care (rounds), time spent in-house during assigned call and time spent in educational activities such as Grand Rounds, Resident Conferences and Surgical Skills Lab sessions. Time spent reading and studying off-site and practicing in the Skills Lab outside of scheduled training sessions is not included in work hours.
2. In-house call is defined as that interval when the resident is required to be immediately available in the assigned institution.
3. Call from home is defined as that interval when the resident is required to be available to return to the assigned institution within a reasonable period of time, but does not need to remain in the assigned institution.
4. A day is defined as a continuous 24-hour period.
5. A new patient is defined as one who has not previously received care from the surgery department.
6. These definitions apply to all of the integrated and affiliated sites participating in the UCSF General Surgery Residency Training Program.

Policy

The program will ensure compliance with ACGME work hours regulations, as outlined below:

1. Residents will work no more than 80 hours per week, averaged over a four-week interval.
2. Residents will have one day in seven free of all educational and clinical responsibilities, averaged over a four-week interval.
3. Residents will be assigned to in-house call no more often than every third night, averaged over a four-week interval.
4. Following a 24-hour work session, residents will work no more than four additional hours.  Activities during the additional four hours may include didactic activities, maintaining continuity of patient care, transferring patient care, operating on patients—including the first operation of the day or an operation on a patient admitted during the 24-hour tour of duty. The resident may not have primary responsibility for the care of any new patient during this additional 4- hour interval.
5. Call taken from home is NOT subject to the every third night limitation. However, when residents taking call from home return to the hospital for some indicated clinical activity, the hours spent in that clinical activity will count in the 80-hour limit. Additionally the frequency of call from home shall NOT prevent reasonable rest and personal time and shall NOT prevent one day in seven free from all educational and clinical responsibilities (see B.2. above).
6. Residents should have an 8-hour time period between assigned work sessions.
7. In unusual circumstances, residents may stay beyond these limits to care for a single patient. All such exceptions must be reported to the Program Director.
8. Residents in the clinical years of the UCSF General Surgery Residency Training Program MAY NOT moonlight, except during vacations with written permission from the Program Director. Residents in the laboratory years MAY moonlight.

Workhours Monitoring

1. All residents will enter their work hours weekly in MedHub. Residents must submit timesheets by 9:00am every Monday. 
2. Residents have the option to use ResQ to automatically log hours to MedHub; ResQ users must still review their MedHub timesheets on a weekly basis to ensure accuracy, correct errors, and submit by 9:00am every Monday.
3. Work hours monitoring includes the following : a. mid-month checks by the Education Office to identify residents at risk for violating work hours; b. schedule intervention/adjustment by the administrative chiefs (when applicable) or the service to ensure appropriate time off is given to avoid a violation. 
4. Residents should have eight hours free of duty between scheduled duty periods.
5. Residents must have at least 14 hours free of duty after 24 hours of in-house duty.
6. Failure to submit a timely report may result in the residents being relieved of duty from that service until the report is received.
7. Residents are expected to log hours accurately according to actual hours worked (not just scheduled shifts.)

Stress and Fatigue Monitoring

Faculty and residents will be instructed to recognize the signs of fatigue by annual review of the American Academy of Sleep Medicine “Sleep, Alertness and Fatigue Education in Residency (SAFER)" module. See Department of Surgery Workhours Policy/Fatigue Monitoring.

Residents are in close contact with faculty each day, which allows faculty to assess residents for signs of fatigue by direct observation.

If resident fatigue is present and action is needed, the resident will be sent home or sent to sleep and resume clinical duties when rested.

Fatigue Module Attestation ("Sleep, Alertness, and Fatigue Education In Residency" by American Academy of Sleep Medicine)

Impairment Module ("Doctors and Addiction: Helping Good People with a Bad Disease")

The EmergenTree outlines communication for any critical resident staffing issue (fatigue, illness, emergency, unexpected absence, etc.) 

Policy Deviations

1. Deviations from the workhours policy are to be reported to the Residency Office, any faculty member, the faculty mentor for any involved resident, any of the resident members of the Departmental Resident Council, any member (faculty or resident) of the Departmental Education Committee, the Program Director, or the Chair.
2. In addition deviations can be reported to any member of the institutional Graduate Medical Education Committee (resident member or faculty member), to the Graduate Medical Education office or to the UCSF Duty Hours Compliance Officer. Reporting to the GME Office can be totally anonymous if desired by calling 502-9400.
3. Department of Surgery Faculty ombudspeople are designated at each rotation/hospital site (as listed below) to discuss any issues of concern (confidentially if desired and possible). The goal is to provide residents with a convenient channel of communication where they are working and ensure they always have the ability to raise concerns/questions even if they do not have quick access to program leadership (or do not feel comfortable raising concerns directly with program leadership).
4. In addition, policy deviations or concerns can be reported to any member of the institutional Graduate Medical Education Committee (resident member or faculty member), to any member of the Graduate Medical Education office. Reporting to the GME Office can be done anonymously by calling the UCSF GME Confidential Hotline/Helpline at (415) 502-9400.
5. The UCSF GME well-being and mental health resources page contains a comprehensive list of avenues to report concerns, either confidentially or anonymously, depending on the situation.

Weekly Conferences - Attendance Policy

Surgery Grand Rounds & M&M Conferences

Policy:  In person or virtual attendance (minimum 75%) is required for all categorical and preliminary general surgery residents. Residents on vacation are excused from attending. Residents must sign in to claim credit.

Resident Conference Series

Policy:  PGY1 - PGY5 surgical residents are required to attend a minimum of 75% of the sessions. This includes ALL general surgery, categorical and preliminary. Attendance is closely monitored. Residents on vacation are excused from attending. Residents must sign in to claim credit. Categorical interns from other specialties are welcome to attend.

Skills Lab

Policy:  Attendance is required for all PGY1, PGY2 and PGY3 residents, approximately every other week, or as scheduled, by the Surgical Skills Center Director. Refer to the Surgical Skills Center website for the current schedule.  Residents on vacation are excused from attending.

Travel Reimbursement Policy

Request for Travel Reimbursement Form

Overview

The Department encourages residents to submit their clinical and basic science research efforts to significant scientific and surgical meetings for presentation. The Department will endeavor to help fund travel for categorical general, plastic, and vascular surgery residents who are presenting authors of abstracts accepted for oral/podium presentation, providing certain provisions and expectations are met.

Department Commitment

The Department will sponsor categorical general, plastic and vascular surgery residents to attend scientific and surgical meetings where the resident has submitted a first-author abstract that was accepted for an oral/podium presentation. This commitment will cover travel expenses of up to $1,500 per trip and $7,500/resident in total for their entire residency and will be limited to no more than two trips/year during the clinical years. The Department will not provide reimbursement for a resident to attend a meeting for a poster presentation.

The Department will consider requests for travel support for non-designated preliminary residents in the general surgery track for first-author oral/podium presentations on a case-by-case basis.

The Department strongly encourages residents to participate in at least one oral/podium presentation at the Academic Surgical Congress (of the Association for Academic Surgery and Society of University Surgeons), American College of Surgeons Clinical Congress, and/or the Pacific Coast Surgical Association per research year. In addition, the Department will sponsor up to two trips to attend professional development courses as part of the overall travel budget ($1,500/ trip and $7,500/ resident total). Trips during research years must be reviewed and approved by the research mentor, in addition to meeting budget requirements. If the resident has travel support/funding through their mentor, lab, or research award (e.g. T32, professional society award), then those monies should be used first rather than application to the Department.

Specific Guidelines & Limits: Travel assistance is a privilege, not a given. We need residents to be good stewards of the Department's resources, and to meet the Department at least halfway in using common sense and cost saving measures. All travelers are expected to exercise good judgment on behalf of the Department and follow UCSF policies and procedures. 

For reimbursement purposes, requests and notification for meetings and travel need to be approved in advance (via the Resident Travel Reimbursement Request form) by both the Residency Program Director and the Department’s Vice-Chair of Research. It is expected that each resident will work together with their mentor and the Vice-Chair to assure that there is appropriate stewardship and planning that goes into planning research-related travel.

Pre-travel approval is required prior to the booking of any travel expenses. Travel expenses made prior to approval are the financial responsibility of the traveler and may not be reimbursed.

Obtaining Pre-Travel Approval: To obtain approval for department-supported travel, residents must submit the Resident Travel Reimbursement Request form for each potential trip at least 90 days prior to the conference/meeting. Each submission will be reviewed; residents will be individually notified regarding travel approval and given instructions for submitting receipts for reimbursement.

Clinical residents must obtain approval for potential absences directly from their clinical service prior to submitting the Resident Travel Reimbursement Request form; clinical residents on general surgery rotations must obtain approval from the General Surgery Administrative Chief residents. Research residents are expected to obtain approval from their research mentor(s).

Please contact the Education Office if you have any questions regarding compliance with ACGME and ABS time in training policies and requirements.

Flight: Connexxus must be used to book flights. Only the cost of coach/economy class will be reimbursed; airline travel upgrades are considered a personal expense and are not reimbursable expenses. Flight changes must be approved before any change is made.

Hotel: The conference website or hotel block may be used to book a room, or by some other reasonable means. Reimbursement for hotel expenses will be subject to UCSF limits (currently $275/night before taxes). The hotel folio (bill) must reflect a $0 balance and include the last four digits of the credit card used to pay. If there are in-room meal/mini bar charges, itemized receipts must be provided. The proof of payment will be the hotel folio itself.

Registration: Registration fees for the conference should be paid by the traveler with a personal credit card after receiving pre-travel approval.

Rental Car: Most of the time, it is more economical to use shared rides, taxi cabs, and public transportation rather than a rental car for professional travel. Automobile rental will not be reimbursed without clear justification (before the trip) of the need for a rental instead of another mode of transportation. Keep in mind that fuel tax and insurance will not be reimbursed.

Meals: Meal reimbursement is based on actual expenses and should not exceed UCSF's daily per-diem of $79/day. Original, itemized receipts and proof of payment must accompany any request for reimbursement for meals.

Miscellaneous: Entertainment, health club expenses, video rentals, valet parking, and tips and not allowable and thus will not be reimbursed.

Reimbursement Process: All receipts (including Connexxus receipts for flights) must be submitted after pre-travel approval is obtained. Requests for reimbursement for travel should be submitted no later than 45 days of return from travel. Reimbursements for travel will be reported as taxable income if they are not finalized and approved within 60 days of return from travel.

EmergenTree

The EmergenTree - outlines communication for any critical resident staffing issue (fatigue, illness, emergency, unexpected absence, etc.) 

Jury Duty

If you are called for jury duty, the Education Office can provide a letter to the court requesting that you be excused from jury duty. Please request your jury duty letter from the education office as soon as possible after you receive your summons and include the court address listed on your summons. The Education Office will prepare and send the letter to you within 1-2 business days. It is then your responsibility to follow the instructions provided on your summons for submitting the letter to the court and requesting an excusal from jury duty.