general cardiology fellowship · 2017-04-10 · 6 goal and mission the rowan--som general...

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General Cardiology Fellowship Curriculum and Program Manual

Academic Year 2016 - 2017

Program # 126283

Troy L. Randle, D.O., FACC, FACOI

Program Director

Hafeza Shaikh, D.O., FACC

Assistant Program Director

Noelle Folkman

Program Coordinator

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Table of Contents Welcome Letter 3-4

Introduction 5

Goal and Mission 6

Teaching Objectives 7-8

Program Organization 9

Faculty Roster 10

Core Competencies of the Osteopathic Profession 11-13

Institutional Core Competency Plan

Program Core Competency Plan 13-17

I. Curriculum 18-23

II. Support 23-30

III. Policies and Procedures/ Remediation Policy 31-57

IV. Night/ Weekend / Holiday Call Duty 57-58

V. Rotations

Clinical Floor Rotation 59-61

Cardiac Catheterization 52-66

Non-Invasive Cardiology (Echocardiography / Electrocardiography) 66-72

Electrophysiology 73-74

Nuclear Cardiology 74-77

Congestive Heart Failure and Transplant 77-78

Research 78-79

Out-patient Ambulatory Clinic 79-83

VI. Procedure Logs 83-84

VII. Fellow Ambulatory Clinic Assignments / Schedule 84

VIII. Osborne Outpatient Clinic Coverage 84

IX. Fellow Case Presentation 84

X. Journal Club 85

XI. Nuclear and Echo QA 85

XII. Cardiology Fellowship Schedules for 2016-2017 85

XIII. Additional Information 85

XIV. Sample Forms/Evaluations 2016-2017 86

XV. Division of Cardiology Contact List / List of Attachments 86-87

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Welcome Letter

Dear Cardiology Fellow:

I would like to welcome you to the 2016-2017 Rowan University School of Osteopathic Medicine / South Jersey

Heart Group General Cardiology Fellowship Training Program. We look forward to an exciting clinical and

academic year. This comprehensive curriculum guide and program manual will be an essential reference for

your program. Please refer to it should you have any questions regarding any policies or procedures regarding

the fellowship.

Within this manual you will find your rotation schedule, lecture and ambulatory clinic assignments. I need to

make it perfectly clear that there are NO exceptions for missing weekly clinic hours. Your preceptor will

discuss with you particular requirements that need to be fulfilled during this clinical time.

Noelle Folkman is your fellowship program coordinator, and your first and best resource for program

information. I need to express that you maintain open communication with her. You’ll be expected to keep

your contact information up to date with her including home, cell and pager numbers, as most program

notifications come through the program coordinator. Please remember to check your Rowan-SOM e-mail on a

daily basis, as it is the preferred method for reminders and updates. Note – All Rowan-SOM housestaff are

required to use their assigned Rowan.edu email address as their primary source for University, GME and

Program related notices. Additionally, special alerts regarding school closings, required on-line compliance

modules and campus security alerts are sent through your Rowan dashboard. Also, through your dashboard

you have access to your E-IRB for research purposes. As such, our program will only send emails to a rowan.edu

email address. Our South Jersey Heart Group Website calendar is also a good source for updated information.

Please remember to check it on a regular basis. The fellow’s calendar on the website is password protected, the

password is Fellow2013.

Quarterly meetings and evaluations are held during the academic year. Evaluations include a thorough review

of your logs and monthly service evaluations, and duty hours. This is also your quarterly forum for program

feedback. Your research project will also be evaluated every quarter for appropriate progress. As you know,

your scientific research project is an absolute requirement in order to graduate the program and receive your

fellowship certificate. More information regarding the research project is available in this manual. The

quarterly meeting is two-part: First, we have a general meeting including the program director, coordinator,

chief fellow and all of the fellows; then, each fellow and chief fellow meets with the program director

individually to discuss their progress. Ashley and I are also available for you at any time.

Your procedure logs are one of the most important parts of your fellowship. Without them you cannot be

credentialed at any level. Not only does the AOA require log submission but hospitals frequently require more

than just a letter from the program director verifying your credentials. All procedures (as set forth by the

AOA/ACOI and COCATS) are to be logged utilizing our New Innovations RMS; which is the same software

used to log duty hours. Additional information regarding using procedure logger is available in your manual,

incoming fellows, if you have not had training in New Innovations, please make arrangements to spend time

with Ashley to become familiar with logging both procedures and duty hours.

You will note that in addition to your monthly schedule there are mandatory academic times to which you must

adhere. Other than clinic hours, Thursday afternoons from 1:00pm until 5:00pm are designated academic time

and must be attended. If you cannot attend for a valid reason, you must notify Ashley or me. As well, you will

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be expected to attend the cardiothoracic surgical morbidity and mortality meeting at Our Lady of Lourdes,

Camden, usually held the second Thursday of every month from 7:30am until 9:00am in the 3rd floor Main

conference room, and as well the cath lab peer review meetings held the first Friday of every month from

7:30am-8:30am in the 3rd floor cath lab film reading room. Both of these experiences are to help you understand

the process that takes place during surgeries and caths as well as outcomes and procedures. Please be aware

that dates and times of these conferences change often, please consult your monthly fellowship schedule for an

exact date and time.

Please note….. Being late for lecture is not an option. If, for any reason you experience any difficulty with

your service allowing you to leave in order to be on time for lecture, please bring it to our attention.

One other important point that must be mentioned is that in all of your consults, admission notes and history

and physicals you must address an OMT/ biomechanical examination and its relationship to cardiology. This

must be performed in both review of systems as well as the physical exam and will be scrutinized heavily.

Remember, we are an OSTEOPATHIC training program, and uphold the mission and goals of the AOA/ACOI

for training and treatment in the osteopathic medical office.

Lastly, there will be an ACC examination each October to help us to identify the strengths and weaknesses of

individual fellows as well as the program. The examination is designed to test your skills at your particular

fellowship year. Although this is not a formally graded examination, it will be discussed with each of you

individually and certainly your growth throughout the program will be monitored by these year-end exams.

Please refer to the In-service Examination addendum in your program manual.

We look forward to an exciting year. As always, Noelle and I are here to help you in any way possible and look

forward to starting the year!

Sincerely,

Troy L. Randle, DO FACC, FACOI

Program Director

Hafeza Shaikh, DO, FACC


Noelle Folkman

Program Coordinator

*please note: RowanSOM rules and regulations are at the end of this manual.

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Introduction

The administration, hospital staff and ancillary services would like to extend to you a warm welcome on the

beginning of this new academic year at the Rowan University – School of Osteopathic Medicine (Rowan-SOM)

and South Jersey Heart Group (SJHG)/ Lourdes Cardiology Services. We are proud of the fact that we are able

to provide the best in medical care while maintaining a warm and friendly atmosphere of a small hospital

environment. You will find our institution to be a comfortable learning environment while also being

academically challenging.

This manual is written with two intents in mind. First, we hope that it provides a means of orienting new

fellows to the operations of the various departments at Rowan and SJHG/LCS and to ease your transition from

your previous internal medicine residency training into cardiology fellowship training. Second, we hope that it

provides a reasonable complete and precise guideline for you to use in your day to day activities at Rowan and

SJHG/LCS. This manual is not meant to be a fixed and rigid document, but rather a flexible guide that can be

changed and updated in the ever changing field of cardiology and improved upon based upon your input and of

its various authors.

The cardiology fellowship training program of Rowan-SOM is an AOA approved three-year program designed

to provide excellence in training in the diseases of the cardiovascular system. This manual provides the specific

definitions, requirements and curriculum which govern the program. The manual will be updated on an annual

basis as new and important issues such as new diagnostic and treatment modalities and new training

requirements surface. Presently our program meets and exceeds the requirements of the basic standards for

training in cardiology as developed by the ACOI and approved by the AOA. Intrinsic to the standards of

training is an emphasis on the recommendations of the American College of Cardiology / American Heart

Association / American College of Osteopathic Physicians / American College of Physicians recommendations

as delineated in the COCATS documents.

The program director will be responsible for assigning your rotations, where they are and which service you are

assigned to. It is the sole discretion of the program director to maintain your schedule, which will meet the

COCATS/ACOI requirements, and provide for your education and supervision. The program director has the

final judgment regarding what rotations you will cover and which attending you will work with. This insures

that all AOGME guidelines and educational requirements are met.

**Please reference new COCATS 2015 for specific numbers.

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Goal and Mission

The Rowan--SOM General Cardiology Fellowship Training Program focuses on training leaders in

Cardiovascular Disease, who are committed to excellence in academic medicine. The training should not only

provide the fundamental skills necessary to enable the osteopathic physician to become an exemplary clinician,

scientist, and teacher, but it should instill the utmost respect for the patient, stressing the critical importance of

a compassionate and caring doctor-patient relationship. The training program emphasizes the development of

particular skills that will foster a lifelong enthusiasm for clinical and/or basic science research that will lead to

improved understanding of disease processes, and ultimately, toward advancements in the prevention,

diagnosis, and treatment of cardiovascular disease.

The mission of the Fellowship Training Program in Cardiovascular Diseases is to provide an academically and

clinically rigorous training program in general cardiology as well as advanced training in clinical cardiology

subspecialties and cardiovascular research. The aims of the program are to provide the trainee with the basic

and clinical knowledge, procedural skills, clinical judgment, professionalism and interpersonal skills, and

abilities necessary to continue to hone these skills through the course of a long career, as required of a leader in

cardiovascular medicine. The curriculum is designed to provide a broad clinical exposure in acute and chronic

cardiovascular care occurring in the inpatient and outpatient settings, as well as extensive experience in non-

invasive and invasive cardiac procedures. Fellowship training will prepare fellows to function not only as

outstanding cardiologists, but also as either sub specialists in a clinical area or investigators in the field of

cardiovascular research.

The Rowan-SOM program is deeply committed to providing the best training in cardiovascular disease. A

standard of excellence is achieved and maintained by strictly adhering to the complying with the AOA/ACOI

Basic Standards in Residency Training in cardiology which is based upon and incorporates the standards and

recommendations of the American College of Cardiology. The program is closely maintained by review, audit

and input from the program director, attending physicians and fellows.

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Teaching Objectives

The following guidelines have been established on the basis of standards as set forth in the Basic Standards for

Residency Training in Cardiology, which in turn is based upon recommendation of the American College of

Cardiology. These teaching objectives are to be used by fellows as specific, time-oriented goals and by the

attending physicians as teaching guidelines. Reaching these goals by completion of fellowship is expected. The

timetable for individual trainees may vary depending primarily on the scheduling of electives.

First Year Upon completion of the first year of training the fellow should be able to:

1. Be able to conduct a complete and comprehensive history; especially cardiovascular history and be able to confidently assess the patients’ needs for further testing and treatment.

2. Perform a complete and comprehensive physical examination especially of the cardiovascular system, which includes thorough palpation and auscultation of the heart and blood vessels and categorize the cardiac and vascular abnormalities based upon the examination.

3. Understand and recognize the osteopathic abnormalities associated with pathology of the cardiovascular system.

4. Understand the basic electrocardiogram and be adept at interpreting the vast majority of the electrocardiographic abnormalities that are clinically encountered.

5. Recognize the chest radiographic manifestations of diseases of the heart and great vessels and understand the normal structures of the heart and cardiac silhouette.

6. Know the indications and usefulness of the echocardiographic and doppler studies of the heart and be able to recognize the normal structures seen on two-dimensional and M-Mode echocardiography. A fundamental understanding of ultrasound imaging and doppler flow including color signal definitions should also be attained. The common abnormalities of the echocardiographic examination should also be attained.

7. Understand the indications, contra-indications and basic interpretations of exercise and ambulatory electrocardiography and arrhythmia monitoring.

8. Have a fundamental understanding of the radiopharmaceuticals used in nuclear cardiology and a basic ability to recognize normal and abnormal findings, along with the indications for the various studies.

9. Understand the basics of the electrophysiologic examination and its indications and contraindications. 10. Recognize the more common arrhythmias and their evaluation and treatments. 11. Understand the fundamentals of artificial pacing, its indications and usefulness. Additionally, a basic

recognition of pacemaker malfunction; and uses and operation of defibrillators should be attained. 12. Understand the indications and contra-indications of cardiac catheterization. And be able to interpret

the basic cardiac angiogram and hemodynamic tracings.

Second Year Upon successful completion of the second year of training the fellow should be able to:

1. Have adequately attained all of the requirements of the first year of training as noted above. 2. Perform a highly accurate cardiovascular history such that his diagnostic skills are approaching the

accuracy of the attending cardiologist. 3. Perform a highly accurate cardiovascular physical examination with the ability to comprehensively

determine the presence and nature of any cardiac structural abnormalities and vascular pathology. Recognition of essentially all the murmurs and heart sounds should be mastered

4. Interpret with high accuracy essentially all the electrocardiographic abnormalities encountered in clinical practice.

5. Perform an exercise stress study independently and be able to provide an accurate interpretation of the findings.

6. Accurately interpret any ambulatory arrhythmia study encountered in clinical practice.

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7. Perform a hands-on echocardiographic study with attainment of all the views used in the study to degree that it is interpretable.

8. Interpret essentially all of the abnormalities of the echo and doppler study. 9. Interpret most of the nuclear studies typically encountered in clinical practice. 10. Understand the basic findings of the electrophysiology study. 11. Accurately read most cardiac angiograms. 12. Thoroughly understand the hemodynamics of most of the cardiac abnormalities typically encountered

in clinical practice. 13. Understand the array of pacemaker parameters and settings used for the cardiac abnormalities

encountered. 14. Dictation of basic echocardiography and stress testing as well as cath will begin with supervision.

Third Year Upon successful completion of the third year the fellow should be able to:

1. Have adequately attained all of the requirements of the second year of training. 2. Have mastered all of the facts of invasive and non-invasive testing, and clinical findings, and be able to

understanding it to a depth that he/she can provide teaching of all of the material at a student and resident level.

3. Have completed an AOA approved fellow research paper. 4. Proficiently teach and mentor fellow physicians. 5. Mastered dictation of all cardiovascular studies.

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Program Organization Rowan University-School of Osteopathic Medicine

Department of Internal Medicine / Division of Cardiology

General Cardiology Fellowship Training Program

1 Brace Road

Cherry Hill, New Jersey 08034

Phone: 856-755-1173 Fax: 856-310-9821

Email: [email protected] Web: http://www.sjhg.org

Program Administration:

Program Director: Troy L. Randle, DO, FACOI, FACC

Assistant Program Director: Hafeza Shaikh, DO, FACC

Program Coordinator: Noelle Folkman

Chief Fellows 2016-2017 Baqir Lakhani & Kartik Mehta

Email address: [email protected]

OPTI Administration:

Thomas A. Cavalieri DO, FACOI, FACP, Dean, Chair Graduate Medical Education

Joanne Kaiser-Smith DO, FACOI, FACP, Associate Dean Graduate Medical Education

History of the program:

The Rowan University -- School of Osteopathic Medicine (formerly the University of Medicine and Dentistry of

New Jersey – School of Osteopathic Medicine) General Cardiology Fellowship Program was formed under the

direction of our program director, John N. Hamaty in 2001. To date, our program which boasts a 94% pass rate

for first time cardiovascular certification boards has graduated 28 graduates. We will have 9 general cardiology

fellows for the 2016-2017 academic year.

Duration:

The Rowan--SOM Cardiology fellowship is a 3 year program, with 13 AOA approved positions in the general

program emphasizing preparation in academic cardiology; we will have 9 general cardiology fellows for the

2016-2017 academic year. Comprehensive training in all major aspects of clinical cardiology is combined with

training in basic and clinical cardiovascular research.

Prerequisite Training / Selection Criteria:

All fellow trainees selected for the cardiovascular disease fellowship training program are required to have

graduated from an Osteopathic Medical school and must have completed an AOA accredited three year

residency program in internal medicine.

Program Certification:

The Cardiovascular Diseases Fellowship Training Program is certified by the AOGME. All fellows must be

licensed to practice medicine in the state of New Jersey.

mailto:[email protected]

mailto:[email protected]

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Faculty Roster

Thomas A. Cavalieri DO, FACOI, FACP, Dean, Chair Graduate Medical Education

Joanne Kaiser-Smith DO, FACOI, FACP, Associate Dean Graduate Medical Education

John N. Hamaty, DO, FACOI, FACC, FASE, FSNC

Troy L. Randle, DO, FACOI, Program Director

Mario L. Maiese, DO, FACC, FACOI

Jerome M. Horwitz, DO

Jay L. Rubenstone, DO, FACC

Surendra K. Bagaria, MD, FACC

Howard M. Weinberg, DO, FACC

Joshua M. Crasner, DO, FACOI, FACC

Anil G. Kothari, MD, FACC, FSCA&I

Timothy P. Morris, DO, FACOI, FACC

Sivaraman Yegya-Raman, MD, FACC

Thierry Momplaisir, MD

Geoffrey C. Zarrella, DO, FACC

Michael J. Horwitz, DO FACC

Hafeza Shaikh, DO FACC Assistant Program Director

Ramneet Wadehra, DO FACC

Adam Levine, DO FACC

Kristofer Hillegas, DO

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Core Competencies of the Osteopathic Profession

Seven Core Competencies of the Osteopathic Profession

Throughout your training, you have undoubtedly heard, and will, without question, continue to hear about the

core competencies of the osteopathic profession. Please familiarize yourself with these very basic tenets of

training, as they are the fundamental basis of all fellowship evaluations. All fellow case presentations must

reflect all core competencies; each monthly fellow evaluation of service addresses each competency, and the

fellow is evaluated on each competency during every rotation, etc. The following section fully explains each of

the core competencies. If you have any comments, questions or concerns on how these competencies will be

fulfilled during your training, please consult this section of the manual, or ask your program coordinator.

• Osteopathic Philosophy and Osteopathic Manipulative Medicine

• Medical Knowledge

• Patient Care

• Interpersonal and Communication Skills

• Professionalism

• Practice-Based Learning and Improvement

• Systems-Based Practice

COMPETENCY 1: OSTEOPATHIC PHILOSOPHY /OSTEOPATHIC MANIPULATIVE MEDICINE

DEFINITION:

Osteopathic Philosophy and Osteopathic Manipulative Medicine (This competency is not evaluated separately

but its teaching and evaluation in the training program shall occur through competencies 2-7 into which this

competency has been integrated.) Fellows are expected to demonstrate and apply knowledge of accepted

standards in Osteopathic Manipulative Treatment (OMT) appropriate to their specialty. The educational goal

is to train a skilled and competent osteopathic practitioner who remains dedicated to life-long learning and to

practice habits in osteopathic philosophy and manipulative medicine.

REQUIRED ELEMENTS:

1. Demonstrate competency in the understanding and application of OMT appropriate to the medical specialty.

2. Integrate Osteopathic Concepts and OMT into the medical care provided to patients as appropriate.

3. Understand and integrate Osteopathic Principles and Philosophy into all clinical and patient care activities.

COMPETENCY 2: MEDICAL KNOWLEDGE AND ITS APPLICATION INTO OSTEOPATHIC

MEDICAL PRACTICE

DEFINITION:

Fellows are expected to demonstrate and apply knowledge of accepted standards of clinical medicine in their

respective specialty area, remain current with new developments in medicine, and participate in life-long

learning activities, including research.

REQUIRED ELEMENTS:

1. Demonstrate competency in the understanding and application of clinical medicine to patient care.

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COMPETENCY 3: OSTEOPATHIC PATIENT CARE

DEFINITION:

Fellows must demonstrate the ability to effectively treat patients, provide medical care that incorporates the

osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive

medicine, and health promotion.

REQUIRED ELEMENTS:

1. Gather accurate, essential information for all sources, including medical interviews, physical examinations,

medical records, and diagnostic/therapeutic plans and treatments.

2. Validate competency in the performance of diagnosis, treatment and procedures appropriate to the medical

specialty.

3. Provide health care services consistent with osteopathic philosophy, including preventative medicine and

health promotion that are based on current scientific evidence.

COMPETENCY 4: INTERPERSONAL AND COMMUNICATION SKILLS IN OSTEOPATHIC

MEDICAL PRACTICE

DEFINITION:

Fellows are expected to demonstrate interpersonal and communication skills that enable them to establish and

maintain professional relationships with patients, families, and other members of health care teams.

REQUIRED ELEMENTS:

1. Demonstrate effectiveness in developing appropriate doctor-patient relationships.

2. Exhibit effective listening, written and oral communication skills in professional interactions with patients,

families and other health professionals.

COMPETENCY 5: PROFESSIONALISM IN OSTEOPATHIC MEDICAL PRACTICE

DEFINITION:

Fellows are expected to uphold the Osteopathic Oath in the conduct of their professional activities that

promote advocacy of patient welfare, adherence to ethical principles, and collaboration with health

professionals, life-long learning, and sensitivity to a diverse patient population. Fellows should be cognizant of

their own physical and mental health in order to effectively care for patients.

REQUIRED ELEMENTS:

1. Demonstrate respect for patients and families and advocate for the primacy of patient’s welfare and

autonomy.

2. Adhere to ethical principles in the practice of medicine.

3. Demonstrate awareness and proper attention to issues of culture, religion, age, gender, sexual orientation,

and mental and physical disabilities.

COMPETENCY 6: OSTEOPATHIC PRACTICE-BASED LEARNING AND IMPROVEMENT

DEFINITION:

Fellows must demonstrate the ability to critically evaluate their methods of clinical practice, integrate

evidence-based medicine into patient care, show an understanding of research methods, and improve patient

care practices.

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REQUIRED ELEMENTS:

1. Treat patients in a manner consistent with the most up-to-date information on diagnostic and therapeutic

effectiveness.

2. Perform self-evaluations of clinical practice patterns and practice-based improvement activities using a

systematic methodology.

COMPETENCY 7: SYSTEMS-BASED OSTEOPATHIC MEDICAL PRACTICE

DEFINITION:

Fellows are expected to demonstrate an understanding of health care delivery systems, provide effective and

qualitative patient care within the system, and practice cost-effective medicine.

REQUIRED ELEMENTS:

1. Understand national and local health care delivery systems and how they impact on patient care and

professional practice.

2. Advocate for quality health care on behalf of patients and assist them in their interactions with the

complexities of the medical system.

Rowan--SOM Cardiology Fellowship Core Competency Plan 2016-2017

1. Osteopathic Philosophy, Principles and Manipulative Treatment

Fellows are being trained in osteopathic philosophy and osteopathic manipulative medicine via a DVD-ROM

education series, in addition to monthly didactic lecture, mandatory lectures and presentations on OMM/OMT

provided by the OPTI. The objective is that each fellow demonstrate competency in his/her understanding and

application of OMM/OMT.

Cardiology Fellows are expected to:

1. Integrate osteopathic concepts and OMT into patient care as appropriate; and, that they and understand and

integrate osteopathic principles and philosophy into clinical and patient care activities as appropriate.

2. Medical Knowledge and its Application into Osteopathic Medical Practice

All fellows will receive comprehensive training in general cardiology, cardiac catheterization,

echocardiography, nuclear medicine and electrophysiology as part of the three-year program. Morbidity and

mortality conferences are held once a month to review missed information, inappropriate management,

technical errors, etc. Fellows present structured critical appraisals of articles verbally as part of their journal

club responsibilities. The fellows are encouraged to present research papers at a variety of scientific meetings.

Feedback from attending physicians and faculty, core and curriculum conferences. Information obtained from

literature search, Braunwald club, Journal club is then applied to their patient population and monitored by

their attending supervisor and program director. Fellows must demonstrate knowledge about established and

evolving biomedical, clinical and cognate (e.g. epidemiological and sociobehavioral) sciences and the

application of this knowledge to patient care.


1. Demonstrate an investigatory and analytic thinking approach to clinical situations

2. Know and apply the basic clinically supportive sciences which are appropriate to the cardiovascular

discipline.

3. Analyze practice experience and perform practice-based improvement activities using a systematic

methodology.

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4. Locate, appraise, and assimilate evidence from scientific studies related to their patient’s health

problems.

5. Obtain and use information about their population of patients and the larger population from which

their patients are drawn.

6. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other

information on diagnostic and therapeutic effectiveness.

7. Use information technology to manage information, access on-line medical information; and support

their education.

8. Facilitate the learning of students and other healthcare professionals.

3. Osteopathic Patient Care

Training includes daily opportunities to practice and improve interpersonal and communication skills

interacting with patients, patient’s families and health care staff. Training also includes daily opportunities to

communicate with patients about their diagnosis and treatment plans. Daily opportunities to develop a

professional approach while interacting with patients and healthcare staff in the OR, on the floor and in

ambulatory facilities. Morbidity and Mortality conferences are held monthly to review missed information,

inappropriate management, technical errors etc. Fellows have access to the internet which enables their

medical education and provides information relevant to patient care. Information obtained from literature

search, Braunwald club, Journal Club etc., is then applied to their patient population and monitored by

attending physicians and faculty. Fellows must be able to provide patient care that is compassionate,

appropriate, and effective for the treatment of health problems and the promotion of health.


1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with

patients and their families.

2. Gather essential and accurate information about their patients.

3. Make informed decisions about diagnostic and therapeutic intervention based on patient information

and preferences, up-to-date scientific evidence, and clinical judgment.

4. Develop and carry out patient management plans.

5. Counsel and educate patients and their families as appropriate.

6. Use information technology to support patient care decisions and patient education.

7. Perform competently all medical and invasive and non-invasive procedures considered to be essential

for the area of practice.

8. Provide health care services aimed health problems or at maintaining health.

9. Work with health care professionals, including those from other disciplines, to provide patient-focused

care.

4. Interpersonal and Communication Skills in Osteopathic Medical Practice

Fellows observe attending physicians and faculty interacting with patients on a daily basis. Training includes

daily opportunities to practice and improve interpersonal skills and interacting patients and healthcare staff;

daily opportunities to develop professional, ethical, and humanistic approach while interacting with patients

and health care staff; daily opportunities to communicate about patients by writing in patient charts. Fellows

must be able to demonstrate interpersonal and communication skills that result in effective information

exchange and teaming with patients, their families and professional associates.

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1. Create and sustain a therapeutic and ethically sound relationship with patients.

2. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory,

questioning and writing skills.

3. Work effectively with others as a member or leader of a health care team or other professional group.

5. Professionalism in Osteopathic Medical Practice

All fellows will receive training in the form of didactic lecture and seminar in medical ethics. Professionalism in

osteopathic medical practice is modeled by attending physicians, faculty, chief fellows, nurses, preceptors, etc.

Training includes daily opportunities to develop a professional and ethical approach while interacting with

patients and healthcare staff in the OR, on the floor and in ambulatory facilities. Faculty and attending

physicians discuss issues related to gender, culture, age and disability when in the clinical setting. Fellows

must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles,

and sensitivity to a diverse patient population


1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society

that supersedes self-interest; accountability to patients and society, and the profession; and a

commitment to excellence and on-going professional development.

2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of critical care,

confidentiality of patient information, informed consent, and business practices.

3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities.

6. Osteopathic Medical Practice Based Learning and Improvement

Morbidity and mortality conferences are held once a month to review missed information, inappropriate

management, technical errors, etc. Preparation for and participation in evidence based Journal Club. Fellows

present structured critical appraisals verbally as part of their journal club responsibilities. Preparation for

patient care. The fellows are encouraged to present research papers at a variety of scientific meetings. Monthly

journal clubs are used as an avenue to discuss research design and statistical analysis. Didactic lectures by

faculty and attending physicians and visiting professionals. Self-directed learning. Feedback from attending

physicians and faculty. Fellows must be able to investigate and evaluate their patient care practices, appraise

and assimilate scientific evidence, and improve their patient care practices.


1. Analyze practice experience and perform practice-based improvement activities using systematic

methodology.

2. Locate, appraise, and assimilate evidence from scientific studies related to their patient’s health

problems





5. Use information technology to manage information, access online medical information and support

their education.

6. Facilitate the learning of student and other healthcare professionals

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7. System Based Osteopathic Medical Practice

These issues are discussed in Fellow didactics to create awareness of cost without reducing quality of patient

care. Faculty and attending physicians serving as role models afford an opportunity for fellows to witness cost

effective healthcare in practice. Fellows regularly deal with a multi-system, multi-task health care arena that

provides them ample opportunities, if sought after, with understanding the component of well thought out

patient management and efficient health care delivery system with effective cost management and quality

medical care. Daily opportunities to be a patient advocate and provide information and coordination to the

patient for his and her own understanding and ability to deal with the multifaceted and sometimes problematic

dealings with health care managers and third party providers. Fellows must demonstrate knowledge about

established and evolving biomedical, clinical and cognate (e.g. epidemiological and sociobehavioral) sciences

and the application of this knowledge of patient care.


1. Demonstrate an investigatory and analytic thinking approach to clinical situations.

2. Know and apply the basic and clinically supportive sciences which are appropriate to the

cardiovascular discipline.

3. Analyze practice experience and perform practice based improvement activities using a systematic

methodology.

4. Locate, appraise and assimilate evidence from scientific studies related to their patient’s health

problems.





7. Use information technology to manage information, access online medical information; and support

their education.

8. Facilitate the learning of other students and fellows and other healthcare professionals

Fellow Performance Evaluation

Each fellow will be evaluated for his or her performance at the completion of each month of training by the

trainer of that service. Fellows are further evaluated quarterly, bi-annually and annually and at the completion

of an individual case presentation. Each of the core competencies is addressed in each evaluation. Evaluations

that fall out of the expected performance levels will be addressed on a case-by-case basis and may be prompt

specific remedies as determined by the program director. The evaluations are meant as a tool to be used for the

director and fellow to follow his or her progress of learning.

Forms Currently Used:

Appendix A – Monthly Evaluation of Fellow

Appendix C – Annual Program Directors Report / Evaluation

Appendix D – Quarterly Evaluation / Report

Appendix E – Preceptor Ambulatory Evaluation

Other -- 360° evaluation; case presentation evaluation

Fellow Evaluation of Rotation

Each fellow will provide feedback in the form of a formal evaluation form that critiques the teaching and

training he/she is receiving. Honest evaluation in this area is helpful in improving the quality of the training

that this program can offer. Evaluations should be completed in a timely fashion.

Form Currently Used:

New Innovations Residency Management Software – Monthly Review of Rotation Online Evaluation

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Presentation of Core Competencies

Core competencies are addressed in detail in our program manual and are updated annually and distributed to

all fellows at orientation.

Methods used to evaluate fellows on core competencies

Fellows quarterly, bi-annual, annual evaluations and 360 degree evaluations; Monthly service rotation

evaluations (Appendix A); Faculty supervisors evaluate the application of fellows knowledge daily as they

supervise them in both in and outpatient settings as well as ambulatory clinic settings; Competency will be

evidenced through journal club activities and research paper activity; Faculty and attending physicians monitor

fellows understanding of core competencies and how it directly affects the overall patient care system; Fellows

are evaluated bi-annually at the completion of a case-presentation at which all 7 core competencies must be

addressed.

Attachments:

Appendix A – Monthly Evaluation of Fellow

Appendix B – Monthly Evaluation of Service

Appendix C – Annual Program Directors Report / Evaluation

Appendix D – Quarterly Evaluation / Report

Appendix E – Preceptor Ambulatory Evaluation

Appendix F – Case Presentation Evaluation

Appendix G – List of tools for evaluation of the seven core competencies

Core Competency Plan Submitted

Troy L. Randle, DO, FACC, FACOI

Program Director, Rowan-SOM Cardiology Fellowship

Hafeza Shaikh, DO, FACC

Assistant Program Director, Rowan-SOM Cardiology Fellowship

Noelle Folkman

Program Coordinator, Rowan-SOM Cardiology Fellowship

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I. CURRICULUM

Core Curriculum Lecture Series

Acute Myocardial Infarction / Complications of Myocardial Infarction

Aortic Stenosis

Assessment of Left Ventricular Systolic Function

Bi-Directional Shunts

Cardiac Cellular EP

Cardiac Nutrition

Cardiac Rehab

Cardiac Catheterization Hemodynamics

Cardiac Catheterization Lab Complications

Chest X-Ray

Congenital Heart Disease I

Congenital Heart Disease II

Datascope / Intra-aortic Balloon Pump

Diastolic Dysfunction

End of Life Issues

Financial Planning

Groin Complications

Hemodynamics

Hemodynamics Exam

HIPAA / Red Flag

Implantable Cardioverter Defibrillator

Indications of Percutaneous Coronary Intervention

Intro to Cardiac Catheterization

Intro to Cardiac CT

Intro to Echocardiography

Intro to Electrophysiology

Intro to Stress I

Intro to Stress II

Iodinated Contrasts

Medical Billing

Medical Ethics

Medical Literature

M-Mode Echo

Nuclear diagnostics

Pacer Interrogation

Pericardial Disease

Physics of Echo

Practice Management

Pregnancy and CV Complications

Quantitative AI

Quantitative Mitral Regurgitation

Radiation Exposure

Supraventricular Tachycardia

Ventricular Tachycardia

TEE Case Review (monthly)

Nuclear QA Review (monthly)

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Echo QA Review (monthly)

Cardiac Catheterization Case Review (monthly)

CT Case Review (monthly)

Complete Case Review (monthly)

ECG Conference (monthly)

1st Quarter Administrative Evaluations

2nd Quarter Fellowship Meeting and One on One Evaluations

3rd Quarter Administrative Evaluations

4th Quarter Fellowship Meeting and One on One Evaluations

Cardiology In-service Examination (annual)

Cardiology Inservice Examination Review (annual)

Required Core Clinical Rotations

Year One (PGY: IV)

Cardiology Consultation / CCU 5 months

Cardiac Catheterization 2 months

Electrophysiology 1 month

Non-Invasive Cardiology 2 months

Nuclear Cardiology 2 months

Ambulatory Clinic ½ day per week, concurrent with rotation

Year Two (PGY: V)


Cardiac Catheterization 2 months (may vary due to training track)

Electrophysiology 1 month (may vary due to training track)

Non-Invasive Cardiology 2 months (may vary due to training track)

Nuclear Cardiology 2 months (may vary due to training track)


Year Three (PGY: VI)


Cardiac Catheterization 2 months (may vary due to training track)

Electrophysiology 1 month (may vary due to training track)

Non-Invasive Cardiology 2 months (may vary due to training track)

Nuclear Cardiology 2 months (may vary due to training track)


Training Tracks: ESTIMATED

Non-Invasive Track Invasive Track

9 Months clinical cardiology 8 Months clinical cardiology

5 Months cardiac/surgical/intensive care 5 Months cardiac/surgical/intensive care

8 Months nuclear cardiology/ECG/Stress testing 6 Months nuclear cardiology/ECG/Stress testing

6 Months echocardiography 6 Month echocardiography

4 Months cardiac catheterization lab 8 Months cardiac catheterization lab

2 Months electrophysiology 2 Months electrophysiology

2 Months electives 1 Month elective

(Includes vacation, echo and nuclear certification) (Includes vacation, echo and nuclear certification

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Satisfactory completion of the non-invasive track can lead to level two (independent operator status)

expertise in echocardiography and satisfy pre-requisites for licensing in nuclear medicine. Satisfactory

completion of the invasive track can lead to independent operator status in cardiac catheterization and

angiography, and level two expertise (independent operator status) in echocardiography.)

Learning Objectives

Fellows are exposed to the acute and chronic cardiovascular diseases, emphasizing accurate ambulatory

and bedside clinical diagnosis, appropriate use of diagnostic studies and integration of all data into a well-

communicated consultation, with sensitivity to the individual patient.

The order of clinical rotations is based primarily on availability and the interests of the Fellow. During this

time, under the direct supervision of the attending on each rotation, Fellows will begin to acquire and

develop skill in the diagnosis and treatment of cardiovascular disease, demonstrate their ability to gather,

synthesize and organize information relating to their patients, as well as demonstrate their understanding

of the pathophysiology of cardiovascular disease.

Beginning in the first year, and continuing throughout the training program, Fellows will develop their

ability to lead, teach and learn from other members of the healthcare team, as well as honing their

consultative skills in the performance and interpretation of diagnostic tests and procedures. How much

independence a fellow is given is dependent upon the attendings judgment of progress of skill level.

Training will include instruction the prevention, therapeutics and management of cardiovascular disease.

Fellows will demonstrate empathy for patients and their families by attention to pain control, patient

comfort, family counseling, informed consent as well as the ethical and legal principles involved with care

and end of life decisions.

Throughout years two and three, fellows are expected to continue to refine their clinical skills and assume

additional responsibilities in the management of patients with cardiovascular disease, obtain additional

training and experience in the performance and applications of diagnostic and therapeutic procedures

while under the direct supervisor of a faculty member.

Research Objectives

Scientific Research Requirement

The AOA and ACOI require that one scientific research project be submitted by each cardiology fellow

during his or her training. Please refer to the AOA/ACOI research requirements and guidelines as listed

below. In order to provide for a scientific research report that meets AOA/ACOI requirements and that is

submitted in a timely fashion, it will be required that each fellow provide a periodic progress report during

the fellowship. A timetable has been established as follows.

Citi Program for IRB approval (Due January 30th, first year of fellowship):

Completion of this online program is a first and necessary part of your fellowship research project. This

online program must be completed absolutely not later than January 30th of your first year of

fellowship. Please furnish your program coordinator with a copy of your completion certificate.

First report (due end of first year)

By midway through the first year of the fellowship program each fellow should have already established

a least the type of report (original research, case report) title, and co-investigators (authors) who will

be involved in his or her project. At the very least, a project outline should already be established, such

as hypothesis, methods, patient groups etc. This is due to the ACOI by the end of the first year.

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Second Report (due July 1st of the third fellowship year)

By the end of the second year of training, the fellow should have essentially completed their research

project and have it submitted in initial rough draft. This will allow enough additional time for any

needed changes, corrections etc. so that a final report, ready for submission can be completed on time.

Third Report (due December 30th of third year of training)

The final product, ready for submission to the ACOI, should be given to the program director by the

last day of December. The reports will then be copied and filed and subsequently submitted to the

ACOI prior to the required deadline, which is by December 30th of the third year.

Required Conferences / Teaching and Learning Activities

Conferences / Lectures / Didactic Functions

It is expected that the fellow attend as many of the offered didactic conferences that he/she can in order to

be exposed to the academic that our program has to offer. While not all fellows will be able to attend all

after hour dinners, lectures, conferences etc., it is expected that a concerted effort be made to attend as

many functions as possible within reason. There are, however, some didactic functions which require

mandatory attendance. For these functions, you will receive advance notice.

A monthly Journal club is held at the South Jersey Heart Group office in Cherry Hill. You can find the

monthly articles for Journal club on the SJHG website. Each fellow will present an article in detail

including statistical relevance, practice applications and an appropriate critique. Journal club articles must

be submitted in PDF format to the chief fellow not later than the 3rd or 4th of each month. Journal club is

held on the third Wednesday of every month.

Echo Board Review is fellow driven, for the second year fellows preparing for echocardiography board

certification. Echo board review is held weekly at 7am in the conference room in our Cherry Hill office and

is proctored by Dr. John Hamaty, during the weeks prior to the ASE certification examination.

A monthly ECG conference is held during our weekly Thursday lecture series. Strips are made available for

review in advance via email.

Academic Lecture Program

Every Thursday your academic time is from 1pm-5pm. During these times your formal academic lectures

will be given by the attending staff and visiting lecturers. You will also participate by giving several formal,

well-researched case presentations. Your case presentations will address all core competencies and be

evaluated on those same core competencies by an attending faculty member. Lecture topics include, but are

not limited to cath, echo, case review and a broad range of other topics geared toward making this a well-

rounded academic experience. Unless otherwise noted, lecture begins PROMPTLY at 1:00pm in the SJHG

Cherry Hill office and attendance is mandatory. If you are unable to attend lecture for any reason, please

notify the program director or program coordinator in advance.

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Fellow Case Presentation

The object of the case presentation is to pick a topic for you to learn and master. I strongly encourage basic

cardiovascular disease states such as valvular heart disease, coronary disease and congestive heart failure.

In conjunction with the case the fellow should also provide follow up care and management of that disease

state. The case must follow the guidelines in addressing all seven (7) core competencies. You will be

graded based on these core competencies and your outline of these during your case presentation. Lastly,

the last 15 minutes of the topic should refer to the standard of care guidelines provided for that disease

state. These are accessible on the acc.org website or any other standardized guideline reference. I want to

emphasize that the case should be appropriate for your level of training. An example for the first years

would be basics of ischemic heart disease, stress testing, heart failure and or valvular heart disease. A

second year case may involve complexities of the case involving aggressive hemodynamic monitoring or

cath lab interpretation. A third year course should be a master of its topic, its appropriate management and

follow-up of patient with complex and multiple disease states. I would be happy to discuss your case with

you prior to presentation. Again, the goal of this lecture is to help you to learn and understand a particular

topic with reference to the standard guidelines and treatment and management.

Morning Report

Nearly every morning at 8am morning report is help which provides a review of interesting cases presenting

in the hospital or lectures on pre-specified topics. South Jersey Heart Group supervises morning report at

Our Lady of Lourdes on Wednesday from 8-9am. The fellow on Cath rotation will be in charge of this

during most of the academic year a grand rounds conference will be held on Wednesday afternoons that

will usually be lectures from both full and part-time faculty and also visiting lecturers. These are

mandatory if you are on a rotation in the institution. Also, each fellow will present grand rounds two times

a year at Stratford and at Our Lady of Lourdes. Note: if no cath fellow on rotation that month, it is the

floor fellow’s responsibility to be in charge.

Evaluations

We feel strongly that frequent evaluation and constructive feedback are essential for Fellows to learn and

grow during their training. It is therefore imperative that the attendings discuss goals and learning

objectives at the start of each rotation. They must also provide feedback and discuss performance with the

fellow, particularly at the end of the rotation. Each fellow will be evaluated for his or her performance at

the completion of each month of training by the trainer of that service. Evaluations that fall out of the

expected performance levels will be addressed on a case by case basis and may prompt specific remedies as

determined by the program director. The evaluations are meant as a tool to be used for the program

director and fellow to follow his or her progress of learning through the program.

Fellows will also be evaluated annually via a 360 degree evaluation. This evaluation consists of evaluations

being done by the people you work with and for. Patients, peers, and support staff will complete these

evaluations in addition to attending physicians. They will be given unannounced and the results of which

will be discussed with the fellow at the following quarterly evaluation. Monthly evaluations of service are

due at the end of each month and are to be turned in to your program coordinator. Failure to comply may

result in a meeting with the program director. Further delays will result in corrective action at the

discretion of the program director.

Likewise, each fellow will provide feedback in the form of a formal evaluation form that critiques the

teaching and training he/she is receiving. Honest evaluations in this area are helpful in improving the

quality of training that this program can offer. Evaluations musts be completed promptly at the end of each

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rotation along with the attending rotation evaluation utilizing the New Innovations Residency

Management Software.

The program director will meet at least twice a year with each fellow to discuss each trainee’s performance

and overall review of his training progress. The program director also completes a year end evaluation for

each fellow, and additional evaluations for graduating fellows. The program director also monitors a

procedure report to make sure that each fellow has participated in the appropriate number of required

procedures.

Bi-annual meetings are held by the Program Director to air any issues or grievances that may need to be

addressed, although the program director and coordinator are always available to the fellows if they have

any concern about their program or training. Twice a year, fellows are asked to evaluate the program as a

whole, and are encouraged to offer suggestions for changes and improvements.

II. Support

BENEFIT PROGRAMS (As per your current CIR)

HEALTH BENEFITS

1. All bargaining unit members who are eligible for the State’s health insurance shall be provided with

those benefits on the same basis and to the same extent as provided to all State employees whose

collective bargaining agreements expired on June 30, 1999. Should negotiations or legislative action

change these benefits for State employees during the life of this contract, the benefits for eligible

bargaining unit members shall change accordingly. If the State should notify the University that it

will no longer provide benefit coverage of Part Time [less than thirty five (35) hours a week] staff

members, the University will not continue such benefit coverage.

2. Housestaff Officers "returning" from assignment at a Veterans Administration Hospital shall be

eligible for health and hospital benefits without the normal two (2) month waiting period (per

section 1). Eligibility shall be consistent with all other appropriate regulations. Housestaff Officers

whose initial assignment is at a Veterans Administration Hospital must complete the normal two

(2) month waiting period (per section 1) beginning with their commencement on the payroll of the

University. The University shall designate an individual who will be available, upon request, to

assist affected Housestaff Officers in maintaining continuity of health and hospital insurance.

It is understood and agreed between the parties that the cost of maintaining continuity of health

and hospital benefits coverage (securing a non-group or individual contract) shall be borne entirely

by the Housestaff Officer. The University agrees to provide affected employees with a timely

written reminder of the need to arrange for continuity of health and hospital benefits coverage.

PRESCRIPTION DRUG BENEFITS

It is agreed that the State shall continue the Prescription Drug Benefit Program during the period of

this Agreement. The Program shall be funded and administered by the State. It shall provide

benefits to all eligible unit employees and their eligible dependents. Each prescription required by

competent medical authority for Federal legend drugs shall be paid for by the State from funds

provided for the Program subject to a deductible provision which shall not exceed $5.00 per

prescription or renewal of such prescription unless otherwise provided by statute and shall be

subject to specific procedural and administrative rules and regulations which are part of the

Program.

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DENTAL CARE PROGRAM

It is agreed that the State shall establish and continue a Dental Care Program during the period of

this Agreement. The program shall be administered by the State and shall provide benefits to all

eligible full-time unit employees and their eligible dependents.

Participation in the Program shall be voluntary with a condition of participation being that each

participating employee authorize a bi-weekly salary deduction not to exceed fifty (50%) percent of

the cost of the type of coverage elected; e.g., individual employee only, husband and wife, parent

and child or family coverage.

There shall be only one opportunity for each eligible employee to enroll and elect the type of

coverage desired and once enrolled continued participation shall be mandatory.

Each employee shall be provided with a brochure describing the details of the Program and

enrollment information and the required forms.

Participating employees shall be provided with an identification card to be utilized when covered

dental care is required.

TEMPORARY DISABILITY

Employees shall be included in the State Temporary Disability Plan, which is a shared cost plan

providing payments to employees who are unable to work as the result of non-work connected

illness or injury.

LIFE INSURANCE

The University shall provide life insurance to all Housestaff Officers in the amount of three (3)

times the annual salary of the Housestaff Officer, at no cost to the employee.

PROFESSIONAL LIABILITY

The University shall continue to provide professional liability coverage to all Housestaff Officers for

services in the employ of the University. (Existing coverage is described in Deputy Attorney

General Lawrence G. Moncher's January 8, 1976 letter to Dr. Stanley S. Bergen, Jr., President of the

University). The University shall have at least one mandatory meeting each year with the House

staff, which informs House staff regarding risk and claims. Such meetings shall include the risk and

claims process, the University’s responsibility and liability.

UNIFORMS

The University shall provide uniforms and uniform laundering services to all Housestaff Officers at

no cost, which shall consist of three (3) lab-coats. Each Housestaff Officer shall be responsible for

damage beyond ordinary wear, or for loss or damage, except if such loss or damage should occur

after turning the uniform in for laundering.

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MEALS

Meals are not provided for fellows. Each fellow assumes the cost of his/her own meals during work

hours.

PAGERS

Cardiology fellow pagers are provided by South Jersey Heart Group/Lourdes Cardiology Services at

no cost to the fellow. Pagers are issued on the first day of fellowship and are to be returned to your

program coordinator prior to program completion.

PARKING

Cardiology fellows park in physician parking at all Kennedy and Lourdes Hospitals. Fellows who

attend ambulatory out-patient clinic at the University Doctor’s Pavilion in Stratford are required to

purchase at their expense a parking hang-tag. Please contact the security departments at Kennedy,

Lourdes and Rowan-SOM Stratford to receive your parking permits.

SALARY

Please refer to your individual contract for your salary rate for the 2016-2017 academic year. The

chief fellow receives an additional stipend based upon the number of fellows supervised.

LEAVES (As per your CIR)

VACATIONS

1. All Housestaff Officers shall be entitled to four (4) weeks of paid vacation to be scheduled in accordance

with departmental policy, which policy shall not preclude scheduling of vacation in two (2) week blocks.

Whenever a holiday falls within a vacation period, the individual Housestaff Officer shall be entitled to an

extra vacation day. Pro-rata earning of vacation is one and two-thirds (1 2/3) days for each full month of

employment.

2. It is agreed that Osteopathic Interns shall not be eligible for vacations. Where practical Osteopathic

Interns shall receive four (4) weeks flexible elective rotation, as scheduled by the Program Director,

during which time on-call and all reporting requirements shall be suspended.

Any Osteopathic Intern who receives less than four (4) weeks of such elective, shall receive a pro-rated

portion of their monthly salary for that portion of the rotation not received.

3. Quarterly, individual housestaff officers shall submit in writing to his/her Program Director all requests

for vacation leave. The Program Director, after review of the needs of the services and rotation schedules,

will make reasonable efforts to honor the individual request, granting Housestaff Officers not more than

two (2) consecutive weeks off. 3rd years, remember to save your days for end of the year interviews!

4. Should any Housestaff Officer fail to submit his/her vacation leave request on or before the required date,

the Program Director shall, after scheduling the vacation leaves of the other Housestaff Officers have the

right to schedule vacation leave for those failing to meet the September 1 submission date. Once the

vacation schedule is established, it will normally be available to the employee except where an emergency

mandates rescheduling.

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5. One week of scheduled vacation is defined as seven (7) consecutive twenty-four (24) hour days off during

which there is no assignment of work. If less than a week's vacation leave is requested, each day requested

shall be one-fifth (1/5) of a vacation week.

6. The parties acknowledge that Housestaff Officers are credited with vacation leave time in anticipation of

continued employment for the full year. In the event a Housestaff Officer leaves pay status during the

course of the year, his/her vacation leave accrual shall be adjusted on a pro-rata basis in order to determine

the proper amount of leave time to which the Housestaff Officer is entitled. In the event the Housestaff

Officer has no vacation leave balances, such Housestaff Officer shall reimburse the University for any

overdraft of leave time.

7. The University will make a reasonable effort not to assign Housestaff Officers on-call duty (including

beeper calls) or to make rounds on the weekend immediately preceding or following their scheduled

vacation.

8. When rotating in the non-invasive lab, please limit vacation time off as it becomes difficult to get

coverage. Only one (1) fellow will be allowed off at a time.

9. Vacation requests must be on the official ‘vacation request’ sheet and submitted to Ashley for approval in a

time fashion. No email or text message requests will be granted.

10. When rotating in the Unit, please limit your vacation to 1 week maximum and must be take consecutively.

You will not be allowed to take single days off during this rotation.

SICK LEAVE

All HSO’s will be credited with twelve (12) sick leave days at the beginning of each academic year. They can

accumulate up to forty-eight (48) sick leave days.

1. Sick leave shall be used when a HSO is unable to work due to illness or personal injury.

2. The HSO must notify his/her Program Coordinator or Program Director of his/her disability to work.

3. Approval for use of this time shall not be unreasonably denied by the Program Director.

4. Each department is responsible for maintaining a record of usage of sick leave for each year.

5. First year resident or residents in their initial year of appointment are not eligible to use sick time until six

full months have been completed.

6. Bargaining unit members are responsible for making up any unworked time after the end of the academic

year as determined by accreditation standards. Effective July 1, 2006, such additional work time after the

end of the academic year shall be paid up to four months if needed. Whether time is needed to complete

any requirements is up to the Dean of GME who has sole discretion to approve or deny such request. The

decision is not subject to the grievance procedure.

MEDICAL LEAVE

1. Each HSO is eligible for up to twelve (12) weeks of medical leave (they are eligible after six (6) months of

service). A resident can use any remaining allotment of his/her sick leave prior to being in an unpaid

status. Once sick leave days have expired and before the HSO chooses to be in “leave without pay” status

and apply for disability, the HSO shall have the option to use any remaining portion of his/her vacation

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days. Once paid leave days have expired, the HSO would be in “leave without pay” status and eligible to

apply for temporary disability.

2. The resident must provide appropriate medical documentation to his/her Program Chair. Upon

submission of the appropriate medical documentation such leave shall be approved.

3. Bargaining unit members are responsible for making up any unworked time after the end of the academic

year as determined by accreditation standards. Effective July 1, 2006, such additional work time after the

end of the academic year shall be paid up to four months if needed. Whether time is needed to complete

the requirements is up to the Dean of GME who has sole discretion to approve or deny such request. The

decision is not subject to the grievance procedure.

FAMILY LEAVE

1. For Birth or Adoption of a Child

All bargaining unit members are eligible for family leave (unpaid) upon the birth or adoption of a child

after one year of service. This leave, in accordance with FMLA and New Jersey State Law, can be up to

twelve (12) weeks. A HSO can use paid vacation leave to cover a portion of this twelve (12) week

period. Appropriate documentation must be provided to the Program Chair. Upon submission of

appropriate medical documentation, such leave shall be approved.

2. For Serious Illness in the Family

All bargaining unit members are eligible for family leave (unpaid) to take care of a seriously ill family

member after one (1) year of service in accordance with FMLA and New Jersey State Law. This leave can

be up to twelve (12) weeks. A HSO can use paid vacation leave to cover a portion of this twelve week

period. Appropriate documentation must be provided to the Program Chair. Upon submission of

appropriate medical documentation, such leave shall be approved.

Bargaining unit members are responsible for making up any unworked time after the end of the academic year

as determined by accreditation standards. Effective July 1, 2006, such additional work time after the end of the

academic year shall be paid up to four months if needed. Whether time is needed to complete the requirements

is up to the Dean of GME who has sole discretion to approve or deny such request. The decision is not subject

to the grievance procedure.

BEREAVEMENT LEAVE

If there is a death in the immediate family, a Housestaff Officer may utilize sick leave for up to three (3) days of

bereavement leave. Immediate family shall be defined as mother, father, sister, brother, spouse, child, or

unmarried domestic partner. For unmarried domestic partners to be included, prior notice of the relationship

shall have been provided to the University's Office of Labor Relations. The University may require reasonable

and appropriate documentation of the relationship or of cohabitation, such as leases, driver’s license, etc.

Additional leave may be granted as may be necessary without pay upon request to the Program Director.

LEAVE FOR AOBIM OR NATIONAL BOARDS

Housestaff Officers will be permitted to take up to two (2) days paid leave for the purpose of taking the AOBIM

or other licensing examination. This shall not be charged against vacation time and such paid leave shall be

permitted one time only.

HOLIDAYS

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1A. All Rowan-SOM Housestaff Officers, wherever assigned, shall be entitled to all Rowan-SOM holidays.

The University shall exercise its best efforts to ensure that Housestaff Officers on rotation to an affiliate

facility are granted all Rowan-SOM holidays on the day they occur.

1B. Effective July 1, 2016, Rowan-SOM holidays are: New Year’s Day, Martin Luther King's Birthday, Good

Friday, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Day after Thanksgiving,

Christmas and three (3) floating holidays, one of which shall be taken within thirty (30) calendar days of

the Housestaff Officer’s birthday, except as mutually agreed upon between the Program and the HSO.

As per the approved request form, a Housestaff Officer shall submit his/her written request for a float

holiday at least (7) seven calendar days in advance.

2. Housestaff Officers who work (including beeper calls) on a scheduled holiday shall be granted an

alternate day off or shall receive an additional day's pay in lieu of the holiday. (This provision does not

apply to the float holidays). When a Housestaff Officer is scheduled to work a holiday it is the Housestaff

Officer‘s responsibility to submit the request for an alternate day off (using the form previously agreed to)

within 10 business days of the holiday worked. If the form is not returned to the Housestaff Officer within

ten (10) business days, the Housestaff Officer shall be paid for the holiday worked. Scheduling of alternate

days off shall be with the approval of the Program Director or designee, as appropriate. In the event that

an alternate day off cannot be granted within 2 months of the holiday, holiday pay shall be granted. Pay in

lieu of a holiday shall be at the rate of one tenth (1/10) of bi-weekly pay.

3. Holidays falling on Saturday shall be observed the preceding Friday. Holidays falling on Sunday shall be

observed the following Monday.

4. Not later than July 1, 2000, a standard form and procedure shall be devised and implemented for a HSO to

obtain a compensation day or an additional day of pay for holidays and float holidays in cases where an

alternative day off is not granted.

FELLOWSHIP PROGRAM LEAVE POLICY

Vacation / Sick Leave

Each fellow will be granted 4 weeks of vacation time (20 work days) each academic year. Vacation scheduling

forms are available from the program coordinator. Requests for vacation/leave must be submitted 3 months

prior to requested time off. For example, the vacation is October, time off must be formally requested by July

1st. It is preferred and highly encouraged that fellows try to avoid taking vacation time while on some clinical

services. If you need vacation time during rotations requiring coverage, please discuss this need in advance

with your program director.

Fellows are required to arrange their own coverage for call, clinical responsibilities, case presentations,

regardless of the circumstance. Neither the Chief Fellow nor the program coordinator is responsible for

arranging coverage.

Your ambulatory clinic hours will only be cancelled if your absence is indicated on the request form with a

MINIMUM of 30 days’ notice. If you do not indicate on your time off request form that you will not be at clinic,

it is assumed that you will be there. All fellows on imaging rotations must provide coverage for the echo and

nuclear stress labs at both Brace Road and Sewell. This coverage is an absolute priority as patient services

cannot be rendered without the presence of a physician. The imaging fellow (NOT the personnel in the echo or

stress labs) is responsible for arranging coverage in the need of absence. Requests for time out on imaging

rotations must be made greater than 30 days in advance.

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Your program coordinator maintains a time-out calendar, before requesting any time off; please consult the

calendar to make sure that there is adequate fellow coverage. It is the policy of our program that no more than 3

(three) fellows can be off service on any given day. Special consideration and permission may be granted by the

program director in the event of a board review conference, or other occasion that requires more than 3 fellows

to be off service. After completion and submission of your time off request, both the program director and the

chairman of cardiology will review the request and all reasonable requests will be honored on a first-come, first-

served basis. It is expected that prior to leaving for vacation you complete all of your responsibilities such as

medical records; discharge summaries, catheterization reports, nuclear and echo QA, monthly service

evaluations, monthly timesheets, etc. If a fellows medical records etc. are significantly behind or other

requirements have not been brought up to date, this could possibly lead to a denial for requested vacation.

Staying up to date with your responsibilities should not be difficult. The 20 days of vacation time given each

year must be used during that academic year and cannot be carried out into the next academic year unless a

special circumstance exists and permission is granted by the program director and chairman of the department.

Any unapproved or un-notified absence from the hospital could possibly result in loss of vacation time as

judged by the program director. If you become ill and cannot report to your rotation, please follow the protocol

as listed in the manual. This is in conjunction to the agreement between the Rowan University-SOM and the

Committee of Interns and Residents. As you know in this agreement it states clearly what amount of time off

you have available to you. One area that needs clarification is the requirement for fellowship and coordination

in conjunction with your time off. If you were to utilize all of the time that is available to you, you would not

meet the attendance requirements to graduate from your fellowship. Therefore, you will have your 4 weeks off

per year. In addition you may take an additional 3 personal days and 5 sick days. Any additional time taken

beyond this must be made up in order to graduate from your fellowship. I would like to be clear that certainly

this time is available to you and you may utilize it in its appropriate fashion, but after vacation, personal and 5

sick days the time must be made up before you can graduate from the fellowship program. All time off,

regardless of the reason must be submitted in writing on the appropriate form.

FELLOWSHIP PROGRAM HOLIDAY POLICY

Each fellow will work one (1) major and two (2) minor holidays each academic year. If you work on a holiday,

you are entitled to a float holiday, which must be requested in advance and cannot be used before actually

working the holiday.

UNIVERSITY HOLIDAYS FOR 2016-2017

Monday July 4th, 2016 – Independence Day

Monday September 5st, 2016 – Labor Day

Thursday November 24th, 2016– Thanksgiving

Friday November 25th, 2016 – Day after Thanksgiving

Monday December 26th, 2016 – Christmas (Observed)

Monday January 2nd, 2017 – New Year’s Day (Observed)

Monday January 16th, 2017 – Martin Luther King Day

Friday April 14th, 2017 – Good Friday

Monday May 29th, 2017 – Memorial Day

CONFERENCES

Each Rowan-SOM General Cardiology Fellow is permitted to attend one reimbursable cardiovascular

conference per academic year. You are reimbursed up to $1,300.00 per conference, and allotted two (2) days off

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of regular service. Should your conference exceed the reimbursable amount, you are responsible for any

additional costs incurred. Likewise, if your attendance at the conference will be longer than two (2) days, you

must utilize your vacation and or personal days to cover the absence. Please note, often fellows take their

spouses or significant others with them on a conference, which remains perfectly acceptable, however, you will

only be reimbursed for costs associated with your attendance at the conference.

The following expenses are deemed acceptable for reimbursement:

• Conference Cost

• Hotel / Lodging Accommodations – Hotel and lodging accommodations are for standard room rates only.

If you take another person with you, and the hotel charges any additional fees, you are responsible for the extra

cost.

• Transportation to and from the conference only – If you choose to travel to sites other than the conference

site during your time at the conference, i.e., eating at restaurants other than those in the hotel or immediate

area, sight-seeing etc., you are responsible for the cost of such transportation.

• Parking /Taxi – The program will only reimburse you for short-term airport parking if you are flying to your

destination, and only for the time associated with the two day conference allowance. Should you choose to

extend your stay, you assume financial responsibility for additional parking. During the two days, should you

stay at a hotel away from the conference site, receipts will be accepted for transportation to and from the

conference site only.

•Meals – Only meals not provided at or during the course of the conference are acceptable for reimbursement,

and only for the fellow, not any additional guests. For example, if the conference offers a continental breakfast

and boxed lunch, only dinner receipts for the fellow would be reimbursed by the program.

The expenses listed below, but limited to, are NOT acceptable for reimbursement:

•Alcoholic beverages •Meals for guests •Transportation for guests •Room Service

•Guest Accommodations •Spa / Fitness Room Services

•Transportation to or from any location other than conference

•Learning materials (cd / DVD / books not specifically required for conference participation)

Please note –Receipts for alcoholic beverages, room service or spa services WILL NOT be reimbursed for

any reason. Additionally, any and all receipts submitted will be reimbursed at the discretion of the

Program Director

Conference Request Policy:

You must submit a conference request for to your program coordinator NOT LESS than 90 days prior to the

anticipated date of the conference. Any requests made less than 90 days will not be honored. All conference

requests must be approved by the Program Director in writing prior to conference registration. Once your

conference has been approved, your project costs are submitted to help streamline the reimbursement process.

No costs will be submitted for reimbursement until AFTER the fellow has completed the conference and has

turned in original receipts.

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III. POLICIES AND PROCEDURES

DUTY HOUR POLICY

11.1 TRAINEE DUTY HOURS POLICY

11.1-1 The base institution, DME, and program directors must make every attempt to avoid scheduling excessive

work hours leading to sleep deprivation, fatigue or inability to conduct personal activities.

(a) The institution policy must be reported in the house staff manual and available for review at all

program site reviews.

(b) Evidence of review of resident duty hours by the medical education committee (MEC) must occur

quarterly.

11.1-2 The trainee shall not be assigned to work physically on duty in excess of 80 hours per week averaged over

a 4-week period, inclusive of in-house night call and any allowed moonlighting. No exceptions to this policy

should be permitted.

11.1-3 The trainee shall not work in excess of 24 consecutive hours.

(a) Allowances for already initiated clinical care, transfer of care, education debriefing and formal didactic

activities may occur, but shall not exceed 4 additional hours and must be reported by the resident in writing

with rationale to the DME/Program Director and reviewed by the MEC for monitoring individual residents and

programs. These allowances are not permitted for OGME – 1 trainees.

(b) Residents shall not assume responsibility for a new patient or any new clinical activity after working

24 hours.

11.1-4 The trainee shall have 48-hour periods off on alternate weeks, or at least one 24-hour period off each

week and shall have no call responsibility during that time.

11.1-5 Upon conclusion of a 20-24 hour duty shift, trainees shall have a minimum of 12 hours off before

being required to be on duty or on call again.

(a) Upon completing a duty period of at least 12 but less than 20 hours, a minimum period of 10 hours off

must be provided.

11.1-6 All off-duty time must be totally free from clinical, on-call and education activity.

11.1-7 Rotations in which a trainee is assigned to Emergency Department duty shall ensure that trainees work no

longer than 12 hour shifts with no more than 2 additional hours for transfer of care and any educational

activities and must be reported by the resident in writing to the DME/program director and reviewed by the

MEC for monitoring individual residents and programs.

11.1-8 In cases where a trainee is engaged in patient responsibility which cannot be interrupted

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at the duty hour limits, additional coverage shall be assigned as soon as possible by the attending staff to relieve

the resident involved. Patient care responsibility is not precluded by the duty hours policy.

11.1-9 The trainee shall not be assigned to in-hospital call more often than every third night averaged over any

consecutive four-week period. Home call is not subject to this policy, however, must satisfy the requirement for

time off. Any time spent returning to the hospital must be included in the 80 hour maximum limit.

11.1-10 At the trainee’s request, the training institution must provide trainees with comfortable sleep

facilities to trainees who are too fatigued at shift conclusion to safely drive.

11.1-11 Any trainee OGME – 2 and above who works 24 consecutive hours may spend additional time of

no more than 30 minutes providing transfer of care / patient sign-out to receiving physicians and staff without

the need to report this time to the DME/Program Director. Any other activity or longer timeframe will require a

written report.

11.1-12 Residents are permitted to return to the hospital while on home-call to care for new or established

patients. Each episode of this type of care, while it must be included in 80-hour weekly maximum, will not

institute a new “off-duty” period. Faculty must be aware of the home-call responsibilities of their residents

recognizing fatigue and sleep deprivation. They must alter schedules and counsel residents as necessary.

11.1-13 The Rowan-SOM KUH/OLLMC work hour policy is subject to review and revision on an as needed

basis.

11.1-14 Residents on call from home who are still in the hospital (don’t go home after regular shift) until

12pm cannot start a new shift before 8am the following day.

11.1.-15 Residents on call from home and called into the hospital after 1am and spend a minimum two hours

and less than 4 hours cannot return to the hospital for 8 hours after they leave the hospital.

11.1-16 Residents on call from home and called into the hospital after 1am for more than 4 hours cannot

return to the hospital for 10 hours after they leave the hospital.

11.1-17 Residents on call from home and called into the hospital between 4am and 5am may only stay for a

shift of 14 hours.

11.1.-18 In all cases resident coming into the hospital during a call from home shift, a program director must

take into account fatigue and sleep deprivation when assigning patient responsibility.

11.2 MOONLIGHTING POLICY FOR TRAINEES

11.2-1 Any profession clinical activity (moonlighting) performed outside of an official residency program will

only be conducted with the permission of the program administration (DME/program director) and must not

interfere with the resident’s didactic or clinical performance.

(a) A written request by the resident must be approved or disapproved by the program director and DME and

be filed in the institution’s resident file.

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(b) This policy must be published in the institution’s house staff manual. Failure to report and receive approval

by the program may be grounds for terminating a resident’s contract.

11.2-2 If moonlighting is permitted, hours shall be inclusive of the 80 hour per week maximum work limit

and must be reported and monitored by the MEC.

11.2-3 OGME – 1 trainees shall be prohibited from moonlighting.

11.3 TEACHING FACULTY

Faculty must be educated in recognizing early fatigue and sleep deprivation and to alter schedules and counsel

residents as necessary, while maintaining continuity of patient care.

Adapted from the Accreditation Council for Graduate Medical Education May 2004,

REVISED May 2015

Duration of Appointment

All fellowship appointments should be for a period not to exceed one year, unless otherwise extended to

compensate for leave of absence.

Conditions for Reappointment

Fellow appointments are renewable annually on the recommendation of the Program Director. A decision to

reappoint will be based on the resident/fellow’s performance, evaluations and his/her ability to work and learn

effectively within the residency/fellowship program, as per the program’s curriculum.

Non-renewal of appointment or Non-Promotion

In instances where a resident/fellow’s agreement will not be renewed, or when a resident will not be promoted

to the next level of training, programs must provide the resident/fellow with a written notice of intent no later

than four months prior (if possible) to the end of the resident/fellow’s current agreement.

Policy on Supervision of Fellows:

It is the policy of the Section of Cardiology that all residents are given the required level of supervision in

all aspects of their training and that this supervision will be documented in the medical record. The Program

Director is responsible for the quality of the overall education and training program discipline and for ensuring

that the program is in compliance with the policies of the respective accrediting and/or certifying bodies.

Program supervision of residents is expected in all areas of all affiliated institutions to assure consistently high

standards of patient care. It is a cardinal principle that overall responsibility for the treatment of each patient

lies with the staff practitioner to whom the patient is assigned and who supervises the resident physician. All

inpatients and outpatients will have one staff practitioner listed as the physician in charge of the patient’s

medical treatment. The name of this staff practitioner will be clearly designated on each patient’s medical

record. A Medical Staff member will be involved in patient treatment to the degree necessary to assure

consistently high standards of patient care. This staff practitioner will be responsible for, and must be familiar

with, the care provided to the patient. The staff practitioner is expected to fulfill this responsibility, at a

minimum, in the following manner: 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, the experience and judgment of the resident being supervised and within the scope

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of the approved clinical privileges of the staff practitioner. Documentation of this supervision will be via

progress note, or countersignature of, or reflected within, the resident’s progress note at a frequency

appropriate to the patient’s condition, according to each affiliated institution’s requirements. Participate in

attending rounds. Participation in rounds provides the supervision to residents. A variety of face-to-face

interactions such as chart rounds, record review sessions, pre-op reviews, or informal patient discussions also

fulfill this requirement. As residents advance in their education and training, they may be given progressively

increasing levels of responsibility. The degree of responsibility will depend upon the individual’s general

aptitude, demonstrated competence, and prior experience with similar procedures, the complexity and degree

of the risks involved in the anticipated surgical/invasive procedure. An important aspect of a resident’s learning

experience is the opportunity of a senior resident to supervise more junior residents. This, however, does not

release the staff practitioner's responsibility for the oversight of the patient’s care.

Graduated Levels of Responsibility:

The program director will be responsible for developing a personal program with each fellow which assures

continued growth and guidance from teaching staff. As part of their training program, fellows will be given

progressive responsibility for the care of patients. A fellow may act as a teacher assistant to less experienced

fellows, and to internal medicine residents and medical students. Assignment of the level of responsibility must

be commensurate with their acquisition of knowledge and development of compassion, judgment and skill, and

consistent with safe and effective patient care and with the requirements of accrediting agencies. Based on a

fellow's knowledge, skill, experience and judgment, fellows will be assigned graduated levels of responsibility

to perform procedures or conduct activities without a supervisor directly present, and/or act as a teaching

assistant to less experienced fellows, and to internal medicine residents and medical students. The

determination of a fellow's ability to accept responsibility for performing procedures or activities without a

supervisor directly present and/or act as a teaching assistant will be based on documented evidence of the

fellow's clinical experience, judgment, knowledge and technical skill. As fellows advance in their education and

training, they may be given progressively increasing levels of responsibility. The degree of responsibility will

depend upon the individual's general aptitude, demonstrated competence, prior experience with similar

procedures, the complexity and degree of the risks involved in the anticipated surgical/invasive procedure. An

important aspect of a fellow’s learning experience is the opportunity of a senior fellow to supervise more junior

fellows, residents, and medical students. This, however, does not release the staff practitioner's responsibility

for the oversight of the patient's care. When a fellow is acting as a teaching assistant, the staff practitioner

remains responsible for the quality of care of the patient, providing supervision and meeting medical recorded

documentation requirements as defined within this policy.

EVALUATION AND ADVANCEMENT OF ROWAN SCHOOL OF OSTEOPATHIC MEDICINE -

CARDIOLOGY FELLOWS

All Fellows at the Rowan School of Osteopathic Medicine Cardiology Fellowship will be promoted upon the

satisfactory completion of the program year and evidence of satisfactory progressive scholarship and

demonstration of clinical competence and professional growth. Each Fellow will receive regular and timely

assessment of his/her overall performance and competencies through evaluations of the osteopathic core

competencies. The procedures and this policy are designed to insure that all house staff members are promoted

to a higher level of responsibility at the appropriate time. This is meant to be a guide for evaluation and

advancement, as well as remediation of Cardiology Fellows.

Fellows who have not satisfactorily completed the program year and fail to show evidence of satisfactory

progressive scholarship or demonstrate appropriate clinical competency and professional growth may be

offered a remediation plan of action prior to promotion as deemed appropriate by the Program Director and as

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described in this policy. If it is felt that a house staff member needs remediation or may even be considered

denied are provided due process that will be outlined in this document. The Program Director will consult

with the Graduate Medical Education Director at any time during this process.

DEVELOPMENT OF CRITERIA AND METHODS FOR EVALUATION

The Program Director in consultation with the faculty will develop criteria and methods for evaluating the

knowledge, skill and professional growth of each house officer. These evaluations will be reviewed by the

Program Director, Assistant Program Director and Coordinator. The written evaluations, as well as verbal

communication with faculty regarding the Fellow's performance will then be reviewed quarterly and discussed

semi-annually with each Fellow. This may happen more frequently if it is deemed at the quarterly review to be

appropriate. This process shall involve at least the following:

1. An annual written assessment of each house staff member by the Program Director using the

established criteria for the American College of Osteopathic Internist subspecialty rules and

regulations.

2. A review of the assessment of the house staff member and provision of a copy to the house staff member

if requested.

3. Completion of at least one assessment and review with the Fellow twice a year or more frequently if

deemed appropriate.

REMEDIATION PLAN OF ACTION

If the Program Director determines that the house staff member has not performed appropriately during that

rotation or satisfactorily completed the year, it is the responsibility of the Program Director to determine

whether or not remediation would benefit the house staff member. If remediation is deemed appropriate, the

Program Director will establish in writing a remediation plan of action for the Fellow including a mentoring

plan, monitoring of progress and identify date of reevaluation and the production of a report which summarizes

those results. This written plan of action will be signed and dated by both the Fellow and the Program Director

and reviewed by Graduate Medical Education and filed in the Fellow's file.

Other methods of evaluation include assessment of the Fellow's fund of knowledge through case presentations

both clinically and academically, the ACC end of year exam and frequent discussions with faculty regarding the

Fellow's growth and development.

Once the remediation plan of action is in place, the Program Director will meet on a regular basis with the

Fellow to monitor that progress. At the end of the designated remediation time period another evaluation will

take place to assess the Fellow's progress. If appropriate progress is made, the Fellow will then be advanced.

POLICIES

House officers are expected to meet and adhere to academic clinical and professional standards set forth in the

Institutional Department Program Requirements.

Inadequate performance should be clearly communicated in writing to the house officer as early as possible and

at a minimum at the six month formal evaluations.

If the Program Director deems necessary, the house officer may be placed in one of two levels of intervention:

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1. Academic remediation. Any house officer's performance assessed to be unsatisfactory by the Program

Director may be placed in academic remediation. The house officer will be notified in writing of the

deficiencies noted in academic, clinical or professional performance. Any improvement program we

develop will include duration of remediation program, the definition of successful completion and the

consequences of failure to successfully complete the remediation program. Improvement is the

responsibility of the house officer. This documentation will be maintained in the house officer's

departmental file. Academic remediation will be assigned for a specific period of time not to exceed 12

months in duration. Upon successful completion of academic remediation, the house officer will be

removed from this status. Documentation will remain as part of the house officer's file and will only be

disclosed upon written authorization of the house officer through legal processes. This will be an in-

house remediation. If it is not successfully completed, institutional probation, repeating or extending

the training year or termination/non-renewal could result. Academic remediation is not considered to

be disciplinary action. Assignment of academic remediation is not grounds for house officer to request

a fair hearing.

2. Institutional probation. If a house officer fails to meet the requirements as set forth in the academic

remediation or it has been determined that the house officer has committed a grievous act, institutional

probation with opportunity to be heard may be assigned. The Program Director shall inform the house

officer in writing of the decision to place him/her on institutional probation. This letter should contain

very specific program opportunities to cure, criteria, goals and objectives for successful completion of

the probation. Institutional probation must be assigned for a specific period of time not to exceed six

months in duration. Upon successful completion of institutional probation, the house officer will be

removed from the disciplinary status. Documentation will remain as part of the house officer's

permanent file. If institutional probation is not successfully completed, the probation may be extended

for a second six month period. The house officer's training may be extended or repeated as opposed to

termination or non-renewal, but this will be purely at the discretion of Graduate Medical Education

and the Program Director. Assignment of institutional probation is considered to be grounds for the

house officer to request a fair hearing.

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TITLE FAIR HEARING PROCESS

This policy is for all cardiology fellows at the Rowan School of Osteopathic Medicine to use in adjudication of

all actions resulting in probation, termination/non-renewal or otherwise threatening the career of the house

officer. The fair hearing process is established through the Rowan School of Osteopathic Medicine and should

be followed per their guidelines.

EXTENSION

If the Program Director determines that the house staff member would benefit from an extension before

promotion to the next level, the Program Director will produce another written plan, monitor progress and

track results. This written plan will be signed and dated by both the house staff member and the Program

Director and again reviewed by Graduate Medical Education and placed on file.

TITLE ADVANCEMENT PROCEDURES AND DEADLINES

After assessing each Fellow according to the Program's criteria and evaluation process, the Program Director

will decide to either include or not include the Fellow in the Graduate Medical Education Advancement

Report, according to it stated deadlines. This will be in full consultation with Graduate Medical Education and

the Fellow if the house staff member is not be included in the advancement report.

WRITTEN FINAL EVALUATION

A written final evaluation of each house staff member who completes the program will be completed by the

Program Director and submitted to the American College of Osteopathic Internists. This will be available for

review by the Fellow at the year end. This will also be made available to Graduate Medical Education and will

be performed within 30 days of the completion of the program.

FILE OF EVALUATION

Each Program Director will maintain a file of evaluations or assessments required by this policy and each house

staff member will not only have access, but is encouraged to review them on a regular basis.

RECOMMENDATION FOR CERTIFICATION

Recommendation for certification of a house staff member by the program will be made to the Program Director

when the last evaluation of the Fellow establishes that the house staff member's knowledge, clinical skills and

professional attitudes are consistent with the standards for that specialty.

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MOONLIGHTING POLICY STATEMENT OF POLICY

Fellowship training is a full-time educational experience. Extramural, paid activities (moonlighting) must not

interfere with the fellows’ educational performance, nor must those activities interfere with the fellow’s

opportunities for rest, relaxation and independent study. As a result, fellows are not required to engage in

moonlighting activities as a condition for appointment to the Rowan University Cardiology Fellowship. Please

note, this policy does not replace the program policy providing coverage in the CC2 at Our Lady of Lourdes

Medical Center. All fellows are required to provide coverage in the CC2 at Our Lady of Lourdes as part of their

program.

PROCEDURES

1. Definition of Moonlighting

Moonlighting is defined as any activity, outside the requirements of the fellowship program, in which an

individual performs duties as a fully-licensed physician and receives direct financial remuneration. This

includes, but is not limited to:

A. Providing direct patient care

B. Conducting wellness examinations

C. Reviewing medical charts, ecg’s, or other information for any company or agency

D. Clinical teaching in a medical school or other educational programs involving clinical skill

E. Providing medical opinions or testimony in a court of law, or to other agencies

F. Serving as a sports team physician or medical official for any event

What counts as “internal” moonlighting and needs to be reports as part of your 80-hour weekly duty hour

limits?

Any moonlighting by a fellow who is employed by any of the following organizations is considered “internal”

moonlighting.

A. Our Lady of Lourdes Medical Center, Camden

B. Lourdes Medical Center Burlington Campus

C. Kennedy Health System

D. South Heart Group

E. Any physician’s office, clinic, or medical facility which has an affiliation agreement with the fellows

OPTI.

If a fellow is employed by any other organization other than those listed above, it is considered external

moonlighting and is to be report as such. All moonlighting whether internal or external must have the

expressed and written consent from your program director, and the office of Graduate Medical Education.

2. Moonlighting privileges may be curtailed or prohibited by the program director or any of the following

conditions including but not limited to:

A. If it is determined that such activities interfere with the fellows patient care responsibilities and

education performance or if such activity adversely impacts the professional reputation of the

fellow and/or Rowan University School of Osteopathic Medicine and/or South Jersey Heart Group,

Lourdes cardiology services.

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Communication

Communication is done via email, text pages, verbally, and by mail. Please read emails and check your

mailbox daily. Fellows should provide their pager number or personal cell phone number as contact numbers

when filling out information of a personal nature. Third year Fellows should also provide their personal

numbers to recruiters. No messages of a personal nature will be taken or sent by the fellowship office

unless it is an emergency.

Discipline Policy

The cardiovascular division strongly believes in a collaborative, collegial multi-disciplinary care model, guided

by the leadership and professionalism standards of the cardiovascular staff and trainees. Fellows are expected

to manage the clinical services in which they participate, exemplifying the highest standards of professionalism

and modulating the professional, efficient and effective delivery of patient care by all members to the care

delivery team. In times of high stress or conflict it is expected that the fellow will model calm and thoughtful

care. In the event of conflicts which cannot be easily and professionally resolved or performance issues with

other members of the care delivery team, it is expected that the fellow will avail him or herself of discussion

with the program director or other members of the senior faculty.

Minor behavioral problems

Minor behavioral problems will be addressed in the following manner:

1. Meeting with program director or site director (OLOL-Dr. Blaber; Kennedy- Dr. Barone)

2. Meeting with program director and site director. Fellow may add comments to summary of meeting.

Documentation will be filed in the fellow’s permanent file.

3. (See major problems)

Major behavioral problems

Major problems are behaviors that threaten the safety of other people, including patients and staff; allegations

of chemical substance abuse, physical abuse or sexual harassment; or repeated minor behavioral problems.

If a major behavior problem is identified, the program director will call an immediate meeting with the fellow

and the department head. At this meeting, the allegations/concerns will be discussed and an initial plan of

action will be developed, including a decision regarding the suspension of patient care responsibilities pending

resolution of issue. Safety of patients and staff will be given highest priority in this decision. The program

director will provide a written summary of this meeting to the fellow and a copy will be placed in the fellow’s

permanent file.

A decision will be made as to whether a formal hearing is necessary. If a formal hearing is not necessary, the

program director will work with the fellow to develop a plan for counseling and identify criteria for resumption

of patient contact. The program director will provide a written summary of this meeting to the fellow and a

copy will be placed in the fellow’s file.

Federal, State, and University regulations may require the program director and/or Chief of Cardiology to take

specific actions as mandatory reporters. They will act in accordance with those requirements.

Academic problems: Initial concern

The program director will review below average evaluations and make a decision based on the comments in the

evaluation. If a fellow consistently receives below average evaluations, or if a single evaluation indicates a failing

performance in multiple areas, an “initial concern” will be raised.

The leadership committee (composed of representatives from each affiliate site) will meet annually to discuss

fellow progress. If the consensus of committee is that a fellow is not progressing at an acceptable pace,

irrespective of the fellow’s rotation evaluations, an “initial concern” will be raised.

If an initial concern is raised, the program director or advisor will meet with the fellow to review the academic

performance. A plan of supplementary experiences will be designated to enable the fellow to meet educational

goals. Specific goals and mechanisms for ensuring that the goals have been met will be identified. A timetable

will be set, and a review will be scheduled to determine if the fellow has met the educational goals in the plan.

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The review process will include the program director, fellow’s advisor, and chief of cardiology. A written

summary of the meeting will be distributed to all involved parties and a copy will also be placed in the fellow’s

permanent record. At the review, a determination will be made as to whether the fellow has achieved the

specific educational goals. If it is determined by the review committee that the fellow has not met the goals, and

is unlikely to meet the educations goals of the program, a formal hearing will be scheduled.

Disruptive Resident Policy

A guide to developing and promoting a culture of zero tolerance

I. POLICY

It is the policy of the medical staff of Kennedy Health System, Lourdes Health System and Rowan-SOM that all

practitioners who are members of, or affiliated with any physician training program at this facility shall

conduct themselves in a professional and cooperative manner, and shall not engage in disruptive behavior.

Disruptive behavior includes but is not limited to:

• Conduct that interferes with the provision of quality patient care

• Conduct that constitutes sexual harassment

• Making or threatening reprisals for reporting disruptive behavior

• Shouting or using vulgar or profane or abusive language

• Abusive behavior towards patients or staff

• Physical assault

• Intimidating behavior

• Refusal to cooperate with other staff members

II. PURPOSE

To ensure physicians-in-training conduct themselves in a professional, cooperative and appropriate manner

while providing services as a member of the medical staff

To encourage the prompt identification and resolution of alleged disruptive behavior by all involved or affected

persons through informal, collaborative efforts at counseling and rehabilitation.

To provide for the appropriate discipline of graduate trainees only after the informal efforts and formal

procedures described in this policy have been unsuccessful in causing the practitioner to appropriately modify

behavior in compliance with the policy.

III. PROCEDURE

1. Any written or oral report of alleged disruptive trainee behavior may be sent to the program director, who

shall initiate an informal investigation as he/she deems appropriate to identify or rule out the existence of

disruptive behavior.

2. During the investigation, the program director will meet with the practitioner to review the alleged

behavior and the requirements of this policy. Both the program director and the trainee may be accompanied at

this meeting by other practitioners that the program director or trainee feel are necessary to explain the

disruptive behavior. At the completion of the investigation, the program director will make determination as to

whether the trainee engaged in disruptive behavior.

a.) If the program director determines that the graduate trainee has not engaged in disruptive behavior,

he/she will advise the graduate trainee and the person to whom the allegedly disruptive behavior was directed

of such determination, and will prepare a written report to be filed in the program directors file, with a copy

given to the graduate trainee.

b.) If the program director determines that the graduate trainee has engaged in disruptive behavior, he/she

will meet with the trainee to counsel the trainee concerning compliance with this policy and assist the trainee

41

in identifying methods for structuring professional and working relationships and resolving problems without

disruptive behavior. It is the intent of this policy to allow the program director latitude to develop any plan for

resolution that is deemed appropriate with the goal to achieve a modification of the trainee’s behavior.

3. Following the meeting(s) with the trainee, the program director may, at his or her discretion, arrange for

and participate in a meeting between the trainee and the person(s) toward whom the disruptive behavior was

directed. In determining whether to arrange such a meeting, the program director is to consider the wishes of

the person(s) who reported the disruptive behavior. If no such meeting is arranged, the program director will

meet with the person(s) toward whom the disruptive behavior was directed, to advise of the resolution of this

matter.

4. Following the meeting(s) with the trainee and the person(s) toward whom the disruptive behavior was

directed, the program director will prepare a written summary of the reported behavior and document the

following:

a.) The date and time of the questionable behavior

b.) If the behavior affected or involved a patient, if so the patients name and medical record number

c.) The circumstances that precipitated the behavior

d.) A factual, objective description of the behavior

e.) The consequences of the behavior for patient care or hospital operations

f.) The dates, times and participants in any meetings with the graduate trainee, staff etc. about the behavior

The summary will be filed in the program directors file, the trainee residents file and a copy will be given to the

trainee

5. The program director will also develop a plan for monitoring future compliance with or violation of this

policy, and will document findings of these reviews in writing to the trainee’s resident file and the program

directors file, with copies given to the trainee.

6. If a second report of alleged disruptive behavior is made concerning the same trainee, the program director

will prepare a memo referring the matter to the well-being of physicians-in-training committee. The committee

will meet with the graduate trainee in identifying methods for structuring professional and working

relationships and resolving problems without disruptive behavior. Referrals for counseling with require

reports to the commit may also be part of this process. It is the intent of this policy to allow the committee

latitude to develop a plan for monitoring future compliance with or violation of this policy. At its discretion,

the committee may consult those person(s) who were the object(s) of the disruptive behavior. Finally, this

committee will send a written report to the program director.

7. The committee report shall remain in the program directors file of the trainee and the trainee’s resident

file.

8. Failure of the committee to satisfactorily resolve the behavior program will result in a referral of the

matter for further review and possible discipline.

Grievance Procedure as per the CIR:

ARTICLE XIII

GRIEVANCE PROCEDURE

A. Purpose

The purpose of this procedure is to assure prompt, fair and equitable resolution of disputes concerning terms

and conditions of employment arising from the administration of this Agreement by providing the sole and

exclusive vehicle set forth in this Article for adjusting and settling grievances. In no event shall matters

concerning academic or medical judgment be the subject of a grievance under the provisions of this Article.

Matters pertaining to non-reappointment shall be grievable under this Agreement only upon the basis of

42

claimed violations involving discriminatory treatment in violation of Article II, Discrimination, or Article VII,

Individual Contracts.

B. Definition

A grievance is an allegation by a Housestaff Officer or the CIR that there has been:

1. A breach, misinterpretation or improper application of the terms of this Agreement; or

2. An improper or discriminatory application of, or failure to act pursuant to, the written rules, policies or

regulations of the University or statutes to the extent that any of the above established terms and conditions of

employment which are matters which intimately and directly affect the work and welfare of Housestaff Officers

and which do not significantly interfere with inherent management prerogatives pertaining to the

determination of public policy.

C. Preliminary Informal Procedure

The parties agree that all problems should be resolved, whenever possible, before the filing of a grievance and

encourage open communication between the University and the Housestaff Officer so that resort to the formal

grievance procedure will not normally be necessary.

A Housestaff Officer may orally present and discuss a grievance with his or her Chief Resident, or with the

University's approval, an appropriate designee, who may, if the circumstances warrant, arrange an informal

conference between the appropriate administrator and the grievant. The grievant may, at his or her option,

request the presence of a CIR representative during attempts at informal resolution of the grievance. If the

Housestaff Officer exercises this option, the administrator may determine that such grievance be moved to the

first formal step.

Informal discussion shall not serve to extend the time within which a grievance must be filed, unless such is

agreed to in writing by the University official responsible for the administration of the first formal step of the

grievance procedure.

Any disposition of a grievance by a Chief Resident will be subject to confirmation by an appropriate

administrator.

D. Formal Steps

Step One

If the grievance is not informally resolved, the CIR may file a written request for review with the appropriate

Dean or designee within twenty-one (21) calendar days after the date on which the act(s), which is the subject

of the grievance, occurred, or twenty-one (21) calendar days from the date on which the individual Housestaff

Officer should reasonably have known of its occurrence.

The Dean or designee shall review the grievance and where he or she deems it appropriate, witnesses may be

heard and pertinent records received. The hearing shall be held within fourteen (14) calendar days of receipt of

the grievance, and the decision shall be rendered in writing to the Housestaff Officer within fourteen (14)

calendar days following the conclusion of the review.

Step Two

If the CIR is not satisfied with the disposition of the grievance at Step One, the CIR may appeal to the Vice

President of Human Resources or his/her designee within fourteen (14) calendar days of receipt of the Step One

43

decision. Hearings must be scheduled within fourteen (14) calendar days, excluding holidays, of receipt of the

appeal.

The decision shall be rendered in writing to the Housestaff Officer and the CIR representative within fourteen

(14) calendar days from the conclusion of the hearing.

If the grievance involves a non-contractual grievance as defined in B.2 above, the Vice President for Human

Resources may alternatively within fourteen (14) calendar days of receipt of the appeal, convene a Committee

described below which shall hear the merits of the grievance and shall deliver its findings to the Vice President

of Human Resources within fourteen (14) calendar days following the date of its hearing.

The Committee shall consist of two (2) members appointed by the Housestaff Officers who shall be officers

with at least two (2) years of service at the University and three (3) members appointed by the Vice President

for Human Resources, one of whom shall be the Associate Vice President for Academic Administration or

his/her designee, who shall serve as Chairperson. For the purposes of conducting the hearing, a quorum of the

Committee shall consist of one (1) member of the House staff and two (2) members appointed by the Vice

President for Human Resources.

The Vice President for Human Resources will review the Committee's recommendation as to the disposition of

the grievance and within fourteen (14) calendar days following receipt of the Committee's written report and

recommendation render a final and binding decision to the grievant.

No complaint informally resolved or grievance resolved at either Step One or Two shall constitute a precedent

for any purpose unless agreed to in writing by the Vice President for Human Resources and CIR acting through

its representative.

Step Three

If the grievance involves a contractual violation of the Agreement as defined in B.1 above, the CIR may, upon

written notification to the Vice President for Human Resources or his/her designee, appeal the Step Two

decision to arbitration. Said notice must be filed with the Public Employment Relations Commission within

twenty-one (21) calendar days following receipt of the Step Two decision. It must be signed by a CIR

representative or official.

The arbitrator shall conduct a hearing and investigation to determine the facts and render a decision for the

resolution of the grievance. The parties agree that the decision of the arbitrator shall be final and binding. The

arbitrator shall neither add to, subtract from, modify, or alter the terms and provisions of this Agreement or

determine any dispute involving the exercise of a management function which is within the authority of the

University as set forth in Article III (Management Rights). Arbitration shall be confined solely to the

application and/or interpretation of this Agreement and the precise issue(s) submitted.

The arbitrator shall not substitute his or her judgment for academic or medical judgments rendered by the

persons charged with making such judgments, nor shall the arbitrator review such decisions except for the

purpose of determining whether the decision has violated this Agreement.

E. Procedural Rules

1. A grievance must be filed at Step One within twenty-one (21) calendar days from the date on which the

act which is the subject of the grievance occurred or twenty-one (21) calendar days from the date on which the

individual Housestaff Officer should reasonably have known of its occurrence.

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2. Where the subject of a grievance suggests it and where the parties mutually agree, such grievance may be

initiated at, or moved to, Step Two of this process.

3. Time limits provided for in this Article may be extended by written mutual agreement of the parties at the

level involved.

4. No reprisal of any kind shall be taken against any Housestaff Officer who participates in this grievance

procedure.

5. Where a grievance directly concerns and is shared by more than one Housestaff Officer, such group

grievance may, upon mutual agreement, properly be initiated at the first level of supervision common to the

several grievants. The presentation of such group grievance will be by the appropriate HOROWAN/CIR

representative(s) and one of the grievants designated by the HOROWAN/CIR. A group grievance may be

initiated by the HOROWAN/CIR.

Where individual grievances concerning the same matter are filed by several grievants, it shall be the option of

the University to consolidate such grievances for hearing as a group grievance provided the time limitations

expressed elsewhere herein are understood to remain unaffected.

6. Should a grievance not be satisfactorily resolved, or should the employer not respond timely as prescribed

above either after initial receipt of the grievance or after movement of the grievance to Step Two, the grievant

may exercise the option within twenty-one (21) calendar days to proceed to the next step.

7. If, at any Step in the grievance procedure, the University's decision is not appealed within the appropriate

prescribed time, such grievance will be considered closed and there shall be no further appeal or review.

Corrective Action as per CIR

ARTICLE XIV

Corrective Action

A. Housestaff Officers may be disciplined or discharged for cause, Disciplinary actions shall be grievable, and

in the event the involved Housestaff Officer files a grievance, the burden of proving just cause shall be upon

the University.

B. The University shall give five (5) working days advance notice, in writing, of any intended disciplinary

action to the affected Housestaff Officer and the CIR. The notice shall state the nature and extent of discipline,

the specific charges against the Housestaff Officer and describe the circumstances upon which each charge is

based.

C. A Housestaff Officer whom the University has given notice of disciplinary action may be removed from

service without five (5) working days’ notice where his/her continued presence is deemed to imperil patient

safety, public safety or the safety of any fellow employee (staff, House staff or medical faculty). Notice of such

reassignment shall be contained in the University’s written notice of intended disciplinary action. Where a

Housestaff Officer has been removed from service, the University may concurrently remove the Housestaff

Officer from its payroll.

D. If it is later discovered that the Housestaff Officer was wrongfully removed from service, the Housestaff

Officer shall be reinstated with full back pay. In addition, if the Housestaff Officer, as a result of the wrongful

45

removal from service, is required to work beyond the end of the residency year to complete his or her residency,

the Housestaff Officer shall remain on the University payroll until such time as the residency has been

completed.

E. Appeals of disciplinary actions shall be presented at Step Two of the Grievance Procedure, Article XIII.

Such appeals shall be made within fourteen (14) calendar days of receipt of the charges and disciplinary penalty.

A hearing must be held within fourteen (14) calendar days, excluding holidays, or receipt of the appeal.

F. The Step Two decision by the Vice President of Human Resources or his/her designee may be appealed to

arbitration by filing with the Public employee Relations Commission. Such an appeal must be filed within

twenty-one (21) days of receipt of the written Step Two decision.

G. Arbitration decisions in disciplinary actions shall be made in accordance with Article XIII, Step Three.

The remedy in disciplinary actions will be limited to back pay and/or reinstatement to the Housestaff Officer’s

position. Housestaff Officers may not seek post-residency damages under this Agreement. However, this shall

not preempt or preclude a Housestaff Officer from seeking appropriate relief for any post-residency damages in

any judicial forum or administrative agency.

H. A Housestaff Officer shall not be reassigned from clinical duties until the completion of the review and

approval by the Dean of GME. However, it is understood that a clinical reassignment with pay may be imposed

prior to the review and approval of the Dean of GME only in cases where serious medical misconduct is alleged

and the employee’s continued presence in Hospital facilities is deemed to jeopardize patient care or the safety of

the Housestaff Officer or others. The Hospital shall provide written notice of, and the reasons for, such

reassignment from clinical duties.

In all cases, regardless of reason, where reassignment from clinical duties is imposed for disciplinary reasons,

the Housestaff Officer shall have the right to request a hearing before a panel of three physicians to review the

reasons for the reassignment. The three-physician panel shall be comprised of the Dean of GME, an attending

physician experienced in graduate medical education from another department and a Housestaff Officer from

another department. The Housestaff Officer shall request a hearing within seven (7) days of notification of the

reassignment. The hearing shall be held within seven (7) days from the date of the request for a hearing and the

Housestaff Officer shall have the right to have a CIR representative assist him or her at the hearing. The hearing

panel will decide whether reassignment is warranted or whether the Housestaff Officer shall be returned to full

or partial duties during due process proceedings. The hearing panel shall issue its decision no later than seven

(7) days from the completion of the hearing. The Hospital shall not report reassignments to any regulatory

agency until the hearing panel makes its determination, unless otherwise required by law or accreditation

standards. Reassignment shall end at any time during due process proceedings if the Dean of GME or

appropriate Department Chair determines that a viable alternative exists.

Within seven (7) days of the Hearing Panel’s decision, the decision may be appealed by either party to

arbitration pursuant to the following expedited procedures:

1. The PERC shall appoint a single neutral arbitrator from its Panel of Labor Arbitrators, who shall hear the

case within fourteen (14) days of his or her selection. The PERC is authorized to substitute another arbitrator

if an appointed arbitrator is unable to serve promptly.

2. The Arbitrator shall fix the date, time, and place of the hearing, notice of which must be given to the

parties at least 72 hours in advance. Such notice may be given orally or by facsimile. Normally, the hearing shall

be completed within one day. In unusual circumstances and for good cause shown, the arbitrator may schedule

an additional hearing to be held within seven (7) days.

46

3. It is understood that the representative for either party may have a conflict on the date scheduled for

arbitration and for good cause only may request an alternate hearing date. In such cases, the party claiming to

have a schedule conflict must use its best efforts to proceed on the first hearing date offered by the arbitrator,

including having another person act as a representative. A party’s inability to proceed on a scheduled

arbitration date for good cause shall not alone be grounds for the arbitrator to rule against such party.

4. The fees and expenses of the arbitrator shall be borne equally by the parties.

5. There shall be no transcript or stenographic record of the proceeding.

6. The parties shall provide to the arbitrator in advance of the hearing a copy of the collective bargaining

agreement, a copy of the written notice of the hospital’s intent to reassign from clinical duties, a copy of the

Hearing Panel’s decision, copies of any related grievance letters by the union, copies of all responses to

grievance letters by the employer and any other documents to which both parties agree. The parties may

stipulate in advance to facts that are undisputed.

7. The arbitrator shall be empowered to hold pre-hearing conferences between the parties. The arbitrator

may require either party to make available documents, in addition to those described in section E above, prior

to the arbitration and shall be empowered to rule on document requests prior to arbitration.

8. No briefs shall be submitted in cases unless agreed to by both parties or requested by both parties. In

cases for which briefs are submitted, briefs shall be postmarked within seven (7) days of the close of hearing.

9. The Arbitrator’s decisions are to be rendered within seven (7) days from the date of the close of hearing, or

the date on which briefs, if any, are due. The decision shall be in writing, contain a brief statement of the facts

and a summary of the reasoning for the decision. The decision shall be signed by the Arbitrator.

10. The Arbitrator shall decide whether reassignment during the Hospital’s internal procedures is warranted

or whether the Housestaff Officer shall be returned to full or partial duties during due process proceedings.

11. The procedures for arbitration do not apply where such clinical reassignment is imposed for academic

reasons. Such matters may not be appealed to arbitration and instead the decision of the three-physician panel

shall be final.

Additional Grievance Policies / Our Lady of Lourdes Medical Center

While on service at any of the Our Lady of Lourdes hospital institutions (Camden, Burlington) you will follow

all of the practice and procedures outlined in your manual as well as for the institution of Our Lady of Lourdes

Hospital. If a grievance arises at Our Lady of Lourdes Hospital, Camden Division, Dr. Reginald Blaber will be

the intermediary regarding this grievance between you and the parties involved. As program director, I

certainly will be involved in the process, but Dr. Blaber would have final discretion regarding final resolution

regarding any grievance. I encourage you to meet with Dr. Blaber immediately and to notify this office

immediately should a grievance arise.

Policy on Academic Remediation

1. House Staff or House Officer – refers to all interns, residents and fellows participating in a Rowan-SOM GME

training Program.

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2. Post-Graduate Training Program – refers to a residency or fellowship educational program.

3. Academic Remediation – the act or process of remedying or correcting. This is an educational tool

appropriate only when there is an educational deficit. Notice and opportunity to cure educational deficit(s)

is/are provided.

4. Institutional Probation – a formal level of academic or professional discipline. Notice and opportunity to

cure, or in the case of serious misconduct resulting in patient safety issues or alcohol/drug violations, notice to

be heard will be provided.

5. Termination – the act of severing employment prior to the expiration date of the house officer’s contract.

6. Non-Renewal – a decision to not renew a house officer’s participation in a postgraduate training program.

Such a decision is to be made prior to March 1 of each year. Termination for cause after this date is still a

departmental option.

Policies:

A. House Officers are expected to meet and adhere to academic, clinical and professional standards set forth in

the Institutional, Departmental Program Requirements.

B. Inadequate performance should be clearly communicated, in writing, to the house officer as early as possible,

and at minimum, at the six-month formal evaluation.

C. If the program director deems it necessary, the house officer may be placed on one of two levels of

intervention:

1. ACADEMIC REMEDIATION: Any house officer whose performance assessed to be unsatisfactory by the

program director may be placed on Academic Remediation. The Program director shall inform the house officer

in writing of the deficiencies noted in academic, clinical, or professional performance. An improvement program

will be developed to include: the duration of the remediation program, the definition of successful completion

of the program, and the consequences of failure to successfully complete the remediation program.

Improvement is the responsibility of the house officer. This documentation will be maintained in the house

officer’s departmental file. Academic Remediation must be assigned for a specific period of time, not to exceed

twelve (12) months in duration. Upon successful completion of Academic Remediation, the house officer will

be removed from this status. Documentation will remain part of the house officer’s departmental file, but will

only be disclosed upon written authorization of the house officer or through legal process. If the Academic

Remediation is not successfully completed, institutional probation, repeating or extending a year of training, or

termination/nonrenewal could result. Academic Remediation is not considered to be a disciplinary action.

Assignment of Academic Remediation is not grounds for a house officer to request a Fair Hearing.

2. INSTITUTIONAL PROBATION: If a house officer fails to meet the requirements as set forth in

Academic Remediation, or it has been determined that the house officer has committed an egregious act,

Institutional Probation with opportunity to be heard may be assigned. The program director shall inform the

house officer in writing of the decision to place him/her on Institutional Probation. This letter should contain a

very specific program opportunity to cure, criteria (goals and objectives) for successful completion of the

probation. Institutional Probation must be assigned for a specific period of time, not to exceed six (6) months

in duration. Upon successful completion of Institutional Probation, the house officer will be removed from this

disciplinary status. Documentation will remain part of the house officer’s permanent file, but will only be

disclosed upon written authorization of the house officer or through legal process. If the Institutional Probation

is not successfully completed, the Probation may be extended for a period not to exceed six (6) months.

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After Hours PT/INR Policy

After Hour PT/INR (Coumadin) Management Policy

Our guidelines state that if an INR is in excess of 7.0 you need to notify the patient of the abnormality with

regard to the blood work and instruct them to go to the emergency room for further testing irrespective of the

time. Also, if there is any sign of bleeding patients are to be instructed to go to the emergency room

regardless of the INR.

If the patient is not willing to do that, it should be documented for the medical record and the following

morning you should notify either Cindy Evans in the Cherry Hill office or the appropriate individual in the

Sewell office and notify them of the problem with the patients INR so that further measures can be taken for

the patients continued care.

Policy Modified: 5/27/2014

John N. Hamaty, DO, FACC, FACOI

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MAGGIE’S LAW COMPLIANCE

STATEMENT OF POLICY

I. PURPOSE

To establish guidelines for housestaff adherence to “Maggie’s Law,” which refers to N.J.S.2C:11-5

2C:11-5 “Death by auto or vessel

A. Criminal homicide constitutes vehicular homicide when it is caused by driving a vehicle or

vessel recklessly. (For the purposes of this section, driving a vehicle or vessel which knowingly

fatigues shall constitute recklessness. “Fatigued” as used in this section means having been

without sleep for a period of 24 consecutive hours.) Proof that the defendant fell asleep while

driving or was driving after having been without sleep for a period in excess of 24 hours (shall)

may give rise to an inference that the defendant was driving recklessly,

B. Vehicular homicide is a crime of the second degree”

II. SCOPE

This applies to all post graduate medical education programs and individual housestaff members.

III. DEFINITIONS

Housestaff – refers to all interns, residents and fellows enrolled in a Rowan University School of

Osteopathic Medicine postdoctoral training program. An individual member of housestaff may be

referred to as a house officer.

IV. RESPONSIBILITIES / REQUIREMENTS

A. Housestaff and residency program directors should be aware of the potential problems that

may result from driving a vehicle after having been without sleep for a period in excess of 24

consecutive hours.

B. Housestaff who have been without sleep for a period in excess of 24 consecutive hours must,

before driving, take one or more of the following actions:

1. Sleep for a period of time sufficient to feel rested before driving

2. Arrange to be driven to their home/place of residence or alternative site

3. Take public transportation to their home/place of residence or alternative site

C. The responsibility of the clinical site(s) is to ensure that a place conducive to sleep is available

to residents at the end of any shift of 24 or more consecutive hours.

D. The program director shall inform all residents of the potential impact of sleep deprivation and

fatigue on performance and the provisions of Maggie’s Law. The program director must also

ensure that any site at which residents work 24 hours has a space conducive to sleep.

E. Oversight

1. Each program must have written policies and procedures consistent with Maggie’s Law.

These policies must be distributed to the residents and faculty and kept on file in the GME

office. The program, the program director, program administrator and faculty must

monitor compliance with this policy.

2. The GME office will oversee that programs comply with this policy

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Universal Protocol – Wrong site, wrong person prevention

Universal Protocol for the prevention of wrong site, wrong procedure, wrong person surgery

KENNEDY MEMORIAL HOSPITALS – UNIVERSITY MEDICAL CENTER

Policy: Universal Protocol for the

Prevention of Wrong Site,

Wrong Procedure, Wrong

Person Surgery

Manual: Operating Room/Same

Day Surgery

Function: Patient Care

Policy Number: 3.22/324

Implementation Date: April 2000

Last Revision: October 2006

Page: 1 of 8

Author: Daniel Herriman

Perioperative Nurse Manager

Distribution: Medical Staff

Surgical Services

Universal Protocol for the Prevention of Wrong Site,

Wrong Procedure, Wrong Person Surgery

POLICY:

The purpose of this policy is to structure the responsibilities of members of the surgical team in preventing wrong-site, wrong procedure, and wrong person surgery. This process involves a pre-operative verification process, marking of the surgical site and a “Time Out” which is done immediately prior to the start of the surgical procedure. It is usually referred to a “Universal Protocol.” Every member of the team has specific responsibilities to prevent errors.

PURPOSE:

Patient Selection

This policy applies to patients undergoing procedures involving right/left distinction, multiple structures (such as fingers or toes), or multiple levels (such as spinal surgery).

It is not necessary to mark the surgical area where:

The surgical side or level is readily apparent to all operating room personnel because the site has been identifiably marked prior to arriving in the operating room (e.g., breast lumpectomy with pre-operative needle localization).

The surgical incision and planned procedure are midline, do not involve spinal segments and are not affected by laterality e.g., thyroidectomy, uvulectomy, mid line sternotomy, Cesarean section and laparotomy and laparoscopy. In endoscopic and laparoscopic procedures where the target site is for organs that are paired, site marking is required to indicate the intended side, even though the site of insertion of the instrument is midline. The patient should be marked near the proposed site or near the proposed incision/insertion site.

Cardiac catheterization and other interventional procedures for which the site of insertion is not predetermined.

The marking of teeth is also exempt from the site marking requirement BUT, indicate operative tooth name(s) on documentation OR mark the operative tooth (teeth) on the dental radiographs or dental diagram.

In spinal surgery where the approach is anterior. (It is encouraged that determination of spinal level be determined intraoperatively)

SCOPE:

Order requirement – none

Consent requirement - none

Responsibilities – Surgical Team

Approval - None

Definition of Terms – none

Equipment –none

Procedure

Key Points

A. The Operating Surgeon:

1. To identify the correct surgical/procedure site, the surgeon/physician performing the procedure checks medical records, films, and other indicators of proper surgery site. When appropriate and patient status permits participation (awake and aware), the surgeon/physician asks the patient to indicate the correct surgical site.

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Procedure

Key Points

2. After proper identification has taken place, the surgeon/physician performing the procedure marks the surgical site at or near the incision site. The site is to be marked with the physician’s initials. Do not mark any non-operative site(s) unless necessary for some other aspect of care.

3. Marking may take place in the preoperative area or in the operating room prior to the patient receiving any sedation.

4. Using a surgical marker to sign/initial the operative site of the patient.

An “X” is not used to identify the

correct or incorrect site.

Do not write over pressure sensitive areas (carotid artery) or in cosmetically sensitive areas. It is acceptable to sign in areas immediately adjacent to the surgery site.

If a diagnostic imaging study is used to determine the correct site and the patient or record (e.g., the X-ray lacks a right or left mark) does not substantiate the correct site, an X-ray or an image intensifier is used prior to making an incision to verify the site.

5. The surgeon is not to proceed with surgery unless the signature is visible after prepping/draping the area for surgery unless it is technically or anatomically impossible or impractical to do so.

6. It is not appropriate to mark the side of the patient that is not to be operated on.

B. Nursing Personnel

1. Blades will be removed from the scrub table and passed off to the circulator when the case is opened.

2. Blades are not to be returned to the table until the time out portion of the universal protocol is completed.

3. If the case does not require a blade no instrumentation is to leave the scrub table until the time out is completed.

C. Other Surgical Team Members

As part of the Universal Protocol, it is the responsibility of the

surgical team to conduct a “Time Out” prior to the initiation of the

procedure. The process takes place with every member of the

surgical team (Surgeon, Anesthesiologist/Anesthetist, Circulating

Nurse, Scrub Nurse, and Resident if present). Time out is to be

conducted immediately prior to incision or initiation of the

surgery or procedure.

All activity ceases in the OR/Procedure room while the time out

is being conducted.

1. The universal protocol is conducted utilizing the medical record and the patient identification band.

2. The surgical permit is reviewed and the patient is identified by name and medical record number against patient identification band.

3. The team will confirm laterality, multiple structures or levels and the signature/initials of the operating surgeon at the proper site.

52

Procedure

Key Points

4. The team will confirm procedure to be performed is the correct procedure.

5. The team will confirm that the patient’s position is correct.

6. Review of the chart will include review of the patient allergies. The statement of “no known allergies” will be used or the allergies that the patient has identified will be reviewed as part of this process.

7. The circulating nurse is responsible for confirming with the surgeon the availability of correct implants and any equipment or special requirements.

D. Anesthesia Department

1. 1. Anesthesiologist/ Anesthetist 2. administer anesthetic agents only 3. after the correct site has been 4. marked by the surgeon’s 5. signature/initials.

Special Considerations for Spinal Surgery

The Operating Surgeon

1. Reviews all necessary documents that indicate the level at which to operate.

2. For posterior approaches, marks the operative site with a radiographically visible marker and positions the patient on the operative table.

3. Obtains and interprets pre-incision radiographs to assure the proper operative level and exposure.

4. Uses reliable techniques to again identify the level intra-operatively:

Exposes the lamina at the operative site.

Marks the intended level using an instrument or clip at the level of the exposed lamina.

Performs an intra-operative spinal radiograph to determine the exact location and level. Personally interprets the X-ray with the marking in place

Indelibly marks the site using a cautery, stitch, or “bone bite” before moving the X-ray marker.

5. The orthopedic and radiology departments will collaborate in implementing using a consistent “level” terminology. The preferred terminology will define spinal interspaces by their upper and lower limits (e.g. “L3-4”, not “L3”) when reporting all spinal levels.

E. Discrepancies

A discrepancy at any point in time must stop the case from proceeding until resolved.

All team members and patient (if possible) must agree on the resolution to the identified discrepancy.

The discrepancy and resolution must be documented by the registered nurse.

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Procedure

Key Points

F. Special Considerations

For ophthalmology surgery a site mark will be made adjacent to the eye and must be visible after the patient is prepped and draped. Adhesive markers must only be used as an adjunct to the site marking.

Adhesive markers may be applied when team members need to perform a treatment (i.e. anesthesia block) or medication administration prior to site marking and should follow the patient identification process.

In the case of a surgical emergency, a site mark maybe omitted, but a surgical "time out" should be performed unless the risk outweighs the benefit.

If a patient refuses to have the site marked, the patient's physician will review with the patient the rationale for site marking. If the patient still refuses site marking, the physician will document this in the medical record. The patient's operative/procedure consent will be validated with the patient as to right procedure and right site in place of marking. This document will then be used during the surgical "time out" to validate correct site.

AGE SPECIFIC TECHNICAL CONSIDERATIONS: None

DOCUMENTATION: None

REFERENCES:

1. Administrative Decision

ORIGINAL APPROVAL DATE : April 2000

REVIEW DATES Annually through December 2005

REVISION DATES: January 2005, October 2006

APPROVAL OF REVISIONS:

Perioperative Management Committee

Service Line Committee, Perioperative Services

54

Clinical Indications Procedure:

KENNEDY UNIVERSITY HOSPITAL

Policy: Clinical Indications for House Staff to Notify Attending Physician or Critical Care Service

Manual: Medical Staff

Function: Patient Care Policy Number: 303 Effective: January 31, 2012 Revised:

Page: 1 of 2

Contact: Beth Reichman, M.A., M.S. AVP Medical Administration

Distribution: Medical staff / House Staff Nursing

POLICY

Communication between healthcare providers is essential to patient safety and quality outcomes. The most common contributory factor to sentinel events in root cause analyses conducted across the nation is failed communication. This policy is intended to provide guidelines for house staff, attending staff and nurses around when direct communication of a patient's change in clinical status is required. The attached list of guidelines is by no means intended to be all-inclusive, but rather a minimum set of expectations. It is clear through both the medical staff bylaws and state and federal regulatory requirements that the ultimate accountability for the patient rests with the attending physician. Timely communication of a change in clinical status more actively involves the attending physician or consultant in the management of their patient for whom they are responsible. It also facilitates our academic mission by fostering direct discussion between house staff and attending staff in the care management of their shared patient. House Staff are defined as physicians in training who are part of our AOA/CPME accredited residency and fellowship programs.

PROCEDURE House staff responsible for clinical management of inpatients are required to contact the appropriate physician (attending or consultant), depending on the clinical situation, each time a patient experiences a deterioration in clinical status in accord with the attached parameters. Communication should be direct and timely, generally less than an hour from the time of the clinical deterioration, rather than waiting for the next shift or rounding in the morning. Attending physicians or consultants are expected to return calls promptly in accord with the medical staff bylaws, rules and regulations and consistent with our code of conduct. In the event that a member of the house staff is unable to have a direct communication with the attending physician or consultant they are directed to the Chain of Command Policy that guides an escalated approach to contacting physicians to maintain patient safety Where there are failures in communication as intended it is important to bring these forward to the section head or clinical chief of the department to address as opportunities for improvement.

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MINIMUM CLINICAL INDICATIONS/STATUS CHANGE REQUIRING A CALL TO THE ATTENDING CARE SERVICE- ANY ER ADMISSION:

New hypotension requiring the use of vasopressor medication

Urine output of < 0.5 cc per kg/per hour three consecutive hours in a non-dialysis patient

An unexpected hemoglobin drop of ≥ 3 grams

Any requirement for an FiO2 of 100% regardless of effect on PaO2

pH ≤ 7.15

Mortality

CP requiring more than sub to resolve

Any sign of groin bleeding

Any transfer to a higher acuity floor

RRT

Code Blue

Development of significant ECG changes or life threatening arrhythmia

Sudden onset or change in LOC or mental status

Adverse event (e.g.: medication error, anaphylactic reaction, complication from an invasive procedure that required intervention)

Any ethical, family, staff concern

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Order Writing:

Documentation:

All entries in the medical record must be SIGNED-DATED and TIMES at the time the entry is made. Corrections can be

made with a SINGLE LINE through the area to be corrected, and the correct entry must be signed-dated-timed at the

time the correction is made. Print your name and pager number under your signature or use your name stamp.

Verbal orders are limited to urgent-emergent situations only and only if on-site response will be legitimately delayed.

ALL verbal orders must be signed by the end of the shift.

Medication orders must include medication; dose and ROUTE, in addition to frequency, if you are not sure, ask a

pharmacist. Review the list of abbreviations which are prohibited as well as the high risk and look alike /sound alike

medications.

Operative reports must be dictated ON THE DAY OF THE PROCEDURE.

Discharge summaries must be dictated within 48 hours, day of discharge is preferred. Attendings now have only 7

(seven) days to complete their medical record obligations.

All entries MUST BE LEGIBLE, if your writing is poor, print neatly.

When writing for a consult, it must be for a physician not a specialty (consult surgery NOT ACCEPTABLE.) Choice of

the consultant resides with the attending and patient, not you.

Acknowledge, in writing the input of other disciplines who have documented in the medical record.

Complete discharge instruction form COMPLETELY, including medication reconciliation.

Safe Practice

Bedside procedures require an informed consent and a TIME OUT, universal protocol. Ask the patient their name and

DOB as the means of proper identification, compare with ID band.

Wash hands before and after every patient encounter.

Follow ALL instructions on isolation signed if you will be entering the room, whether you “touch” the patient or not.

Fellow Dress Code

Fellows are expected to maintain the highest professional standards of dress and behavior. At all times the fellows

should have a legible name tag and / or hospital identification badge in plain view. You are issued three (3) new lab coats

at the beginning of the year. Your lab coats are expected to be clean, neat and pressed at all times.

Appropriate male attire includes shirt with tie*, dress pants (no denims), no open- toe shoes / sandals and a white

Rowan-SOM issued Lab coat with name tag and identification badge in view. Appropriate female attire includes

dresses, skirts or dress pants (not denim) with appropriate blouses; no open-toe shoes/ sandals and a white Rowan-SOM

issued lab coat with name tag and identification badge in plain view.

Scrubs are the property of the medical center and are to be worn only when in the respective medical center(s).

Scrub suits are not to be worn outside or removed from the medical centers.

• Neck ties are to be cleaned on a regular basis to prevent cross-contamination and the transmission of infection

Kennedy Memorial Hospital – University Medical Center / Lourdes Health System

Dress Code Guidelines – Students and House Staff

It is the policy of the Kennedy Healthy System and Lourdes Health System that all care givers present a professional

appearance. General dress should reflect good judgment and create a favorable, positive image as a representative of the

medical profession, SOM and Kennedy Health System.

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Medical students, interns, residents and fellows are expected to look and dress professionally when in any patient care

area. This includes the hospitals, family health center, surgical center, health care center and wound care center.

Personal Appearance Guidelines:

• Kennedy ID badges must be visible at all times

• White coats are to be worn at all times in the hospital, even if wearing scrubs

• Attire, including lab coats, must be clean, pressed and in good condition

• Clothing that is torn, even if the tear is part of the design, is not acceptable

Shoes must be clean and functional for work responsibilities. Closed toe shoes must be word in patient related

areas. Clean clogs are acceptable in the OR’s and L and D

• Hosiery / socks must be worn with all types of shoes in patient related areas

Hair, including facial hair, must be neatly trimmed. Specific areas / specialties may restrict the length of hair due

to infection control and personal / patient safety

• Hair longer than shoulder length should be tied back in patient care areas for infection control reasons

• Men are expected to wear shirts with collars unless wearing scrubs

Jewelry may be worn around the neck, wrists, ankles or ears provided it is safe and not excessive. In general,

body piercing is not acceptable, but it is recognized that some piercing may have religious / cultural significance

and may be tastefully worn

• Fingernails must be clean, neat and well-groomed at all times and kept and ¼ inch in length. Freshly applied,

non-chipped nail polish in a soft color is acceptable

• Artificial nails are not permitted due to their harboring more bacteria than natural nails

The following articles of clothing are not acceptable in patient care areas:

• Blue jeans

• Tee-Shirts

• Sweatshirts

• Halter tops

• Shorts / Capri pants

• Shirts with writing on them

• Sandals or flip-flops

• Skirts / dresses more than two inches above the knee

• NO SCRUBS!

Any medical student or house staff member who does not adhere to the dress code may be asked to leave the facility by a

member of the medical staff, manager or administrator. He/she may return to the facility when the attire meets

acceptable standards.

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IV. Night/ Weekend / Holiday Call Requirements

Guidelines for Fellows on Call

Primary Call Responsibilities

Consult / Referral Patterns

Call switches / changes

Night / Weekend / Holiday Call Coverage

The final fellow call schedule will be approved by the program director. Responsibilities include one to two weeknight

calls per week unless you are on the weekend. Weeknight call begins 5:00pm that night and ends 9:00am the next day.

Weekend call will involve approximately one weekend per month. Weekend call begins 5:00pm Friday and ends

Monday 9:00am. You will be first call for all hospitals and outpatient calls. There is a backup attending on call with you.

You are expected to address the calls and make decisions as a junior attending. Any issue may be discussed with the

attending. All ICU admissions MUST be discussed with the attending. You are responsible to go into the hospital if the

situation warrants it. Any procedures that are not an emergency require attending supervision. Again, each case should

be discussed with the attending if warranted. You are not required to stay in house for the calls.

Holiday coverage is one major and one minor holiday per calendar year. The holiday schedule is put out by Rowan-SOM

at the start of each year. The days that are covered will vary based on that schedule.

Rounding in the hospitals will be with an attending. You are responsible to decide how the weekend rounds will be

divided with the attending. Full notes and plan are to be done by the fellow. Notes are to be on the charts by the time

the attending rounds. You will then discuss the case with the attending and your plan will be evaluated. Preliminary

plans for admissions and consultations will be written in the chart and dictated after being seen by the attending.

*** Call Changes***

Any and all call changes must be requested and Ashley and the Chief Fellow be notified before 3pm, in order for the

website to be updated and accurate. Call changes after 3pm, unless absolutely emergent will not be accepted.

If emergency changes occur, fellows must notify attending on call to let them know that changes have occurred. It is the

fellow's responsibility to find a replacement for all call changes and notify the appropriate people.

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V. Rotations

Description of Facilities

Our Lady of Lourdes Medical Center is one of the region’s leading hospitals recognized nationally for quality patient

care. This 325 bed regional referral center is known for providing the most sophisticated levels of care. Our Lady of

Lourdes is the only hospital in the tristate area to have ever been awarded the American Hospital Association’s top honor

for excellence in community outreach services.

Our Lady of Lourdes Medical Center- Burlington is a community hospital in Willingboro, NJ. This 173 bed hospital

that provides technologically advanced diagnostic and treatment options close to home.

Kennedy Health System; three hospitals at Stratford, Washington Township, and Cherry Hill (215, 200 and 192-bed

facilities) draw primarily from suburban and rural communities. The Kennedy Health System is an integrated healthcare

delivery system providing a full continuum of healthcare services, ranging from acute-care hospitals to a broad spectrum

of outpatient and wellness programs. As a multi-site healthcare provider, Kennedy serves the residents of Camden,

Burlington and Gloucester Counties. Kennedy is a member of the Penn Cancer Network, Jefferson Neurosciences

Network (JNN), and is affiliated with the Rothman Institute of Orthopedics.

Clinical Floor Rotation / CCU/MICU/SICU

Inpatient service, Admissions, Discharges, Transfers

Rotation Sites: Our Lady of Lourdes Camden, Lourdes Medical Center Burlington Campus, Kennedy University

Hospital Cherry Hill Division, Kennedy University Hospital Washington Twp. Division

Time Required: 14 months (non-invasive track); 13 months (invasive track)

Learning Objectives and Expectations

Included in this section of your fellowship manual is information for specific services in our cardiology fellowship

training program. The outlines provide an introduction to the service and the fellow’s expectations; additional

information will be given once rotating through that service. These are general guidelines to orient you to the particular

service but some minor variations may exist, depending upon the specific trainer to which you are assigned. Naturally,

each trainer will have slightly different expectations and methods of conducting his or her service and it is expected that

the fellow comply with the wished of the individual trainer. Every attempt will be made on each service for the trainers

to achieve 100% compliance with the teaching objectives. It is expected that each trainer will be fair in his or her

evaluation of the fellow and it is also expected that the fellow be fair in his or her evaluation of the service and the trainer.

Clinical Cardiology

Responsibilities will include inpatient care and outpatient department evaluations. Each attending will have his or her

own approach to rounds, teaching etc. The general guidelines regarding fellow’s responsibilities are outlines below.

Inpatient Service:

During the fellow’s assignment to a clinical cardiology service you are expected to

1) Supervise any students, interns and residents presently assigned to that service

2) Provide comprehensive admissions, histories and physicals, daily management and discharge instructions of the

comprehensive care of the patients

3) Provide thorough and accurate progress notes to be presented to the attending cardiologist and

4) Provide any requested academic presentations to the attending physician and assigned house staff for mutual

learning purposes.

5) You will be responsible for all inpatient stress testing while on the clinical services at Kennedy and Lourdes.

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Admissions

Admissions to the hospital are your responsibility. The complete history and physical must be written to specifically

address all cardiovascular issues. An assessment and plan must be outlined. A complete review of systems and physical

are to be documented OMM evaluation with treatment options must be documented. You are responsible for discussion

and presentation to an attending physician. Also the house staff must be taught and their H&P must be reviewed.

A problem list should be included on every patient note. It includes room for listing all diagnosis and pertinent study

results and procedures. This should be completed on admission and updated during hospitalization as necessary.

Completeness and accuracy is important since this form becomes part of the patient’s permanent record. The usefulness

of this form cannot be overstated. It becomes very useful for evening and weekend and weekend on-call fellow when

he/she is asked to evaluate a patient he/she is unfamiliar with. Sign out to the person on call is essential for all critical

patients.

Daily care is also your responsibility. You are expected to act as an attending. You should see all patients and discuss the

cases with the house staff. It is expected that you begin to develop a differential diagnosis and institute a plan. As you

develop your skills during training, more responsibility should be taken. As always, an attending will be available to

round.

Discharges

Upon discharge a standard discharge summary needs to be completed at the time of discharge. Up to date problem lists

significantly facilitate completion. A standard set of discharge orders must also be written for each patient. These orders

must include a discharge diet, follow-up instructions, activity instructions, medications and other instructions such as

endocarditis prophylaxis, scheduling of outpatient visits and testing, etc. It is preferred that these orders are written on

the day before discharge. These orders are used by the nurses for patient teaching purposes and unit secretaries for

scheduling purposes, such as follow-up stress test, outpatient visits, etc. Prescriptions for the patient should also be

written for Saturday discharges; this prevents the Saturday on-call fellow from being inundated with unnecessary work.

Remember you will be on Saturday call too! Help each other out. All aspects of the discharge form must be filled out. If a

patient is intolerant to medicines that are normally used for that disease state, this must be addressed. You must dictate

that it is contraindicated or not medically necessary.

Transfers

When a patient requires transfer to another service, for example, the Medical Intensive Care Unit, the transfer orders and

a summary should be written. The attending whose service the patient is transferred to must be specified in the orders.

Verbal sign out to the transferring service is required.

When a patient is transferred from another service, likewise they should be accompanied by orders, transfer note and a

verbal sign-out (no verbal sign out is usually given from the Surgical Intensive Care Unit). The receiving fellow should

review the transfer orders to check for completeness and should see the patient on the same day of transfer.

Patients that get transferred from another hospital to OLOL must have the H&P done and orders written for transfer.

Inpatient / Critical Care Rotations

While assigned to any of the floor or critical care services (CCU/MICU/SICU) the fellow will be required to:

1) Supervise all assigned house staff

2) Provide comprehensive progress notes for presentation to the attending staff

3) Provide academic presentations as assigned to him/her

4) Rapidly assess and attend to any appropriate emergency department admissions or in house emergent or urgent

unstable patients already in one of the unites or in need of a transfer to the appropriate unit

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5) Timely and efficient treatment and ultimate transfer of a unit patient to a general medical or step down floor

6) Provide courteous interaction with the nursing staff and other ancillary staff involved in the critical care of the

patient and likewise is expected to involved these ancillary personnel in his/her academic presentations and

teaching so as to promote a sense of unity and learning progress as a cooperative critical care team.

7) While in the coronary care unit you are responsible for all intraoperative transesophageal echocardiograms

performed on the surgical patients. You are to get down to the operating room before patients are placed on

bypass and perform the pre-operative TEE. You then should return to the intensive care unit and begin your

rounding responsibilities. The post-operative TEE’s are usually performed mid-morning and you are to go back

and perform the post-op procedures. The remainder of the time in the CCU is dedicated to patient care,

rounding with housestaff and writing appropriate notes on patients. It must be emphasized that your

responsibilities are to all of the patients in the unit regardless of what group they are from. You will oversee the

resident in performing any procedures.

**The fellow MUST stay in the unit. If you leave for whatever reason, it is your responsibility to let the

ward clerk know where you are and when you will be back.

Please refer to the subspecialty basic standards for specific numbers for certification. All TEE’s must be

maintained on a log and supplied to your program coordinator.

Surgical Intensive Care Unit /Intensive Care Fellow Responsibilities

The fellow, when on duty in the SICU/MICU:

1) Is in the unit at all times, carries a beeper and notifies the charge nurse when leaving the MICU.

2) Is in charge of the care of all patients in the MICU and serves as a focal point of communication between surgeon,

cardiologist, anesthetist and family. He should be personally certain that all problems are brought to the

attention of the ICU staff. You are required to provide care to all cardiology group patients.

3) Discusses each postoperative patient immediately upon arrival in the MICU with the anesthetist, the surgeon

and the physician in charge of the MICU.

4) Discusses with the anesthetist and physician in charge of the patient the immediate postoperative orders. Fellow

coordinates patient care with the primary nurse.

5) The MICU fellow should fill out the doctor’s order form of each assigned patient as completely and clearly as

possibly, including medication, IV fluids, etc. These may be changed as necessary. SICU does not use verbal

orders! Accepts verbal orders from attending physicians.

6) Check pacemaker function and availability of standby equipment when the patient is being paced.

7) Writes a note in the chart of each assigned patient daily. The note should include pertinent procedures such as

subclavian and arterial line insertions, dialysis, catheter insertion, cardioversion, etc. The note should also detail

drug infusions, wound condition, foley catheter and chest tube drainage and pertinent physical findings.

8) Writes a full consultation note when consultation is requested. You may not dictate consults. Makes every

effort to speak directly to the consultant to minimize communication problems and delays. No consults are to be

ordered without direct approval of the MICU staff, primary surgeon or primary cardiologist.

9) You are responsible to coordinate care with the appropriate cardiothoracic surgeon. Please be advised that at

Our Lady of Lourdes Hospital the ultimate patient responsibility in the SICU is the surgeons and therefore you

must respect those decisions. Please commit to your recommendations on the chart, but all orders should be

discussed with the appropriate attending.

Learning Activities: Morning report; Grand rounds; Cardio-Thoracic M/M; Weekly didactic lecture; Fellow

case presentation

Supervision: Anil Kothari, MD; Thierry Momplaisir, MD; Timothy Morris, DO;

Jay L. Rubenstone, DO; Geoffrey Zarrella, DO; Michael Horwitz, DO; Jerome

Horwitz, DO; Troy Randle, DO; Hafeza Shaikh, DO; Howard Weinberg, DO; Joshua Crasner,

DO; Surendra Bagaria,MD; Ramneet Wadehra, DO; Adam Levine, DO;

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Evaluation Process: Monthly performance evaluations; 360° evaluations, annual in-service examination

Cardiac Catheterization

Rotation Sites: Our Lady of Lourdes Camden

Time Required: 4 months (non-invasive track); 8 months (invasive track)

Learning Activities: Cath Case Review; Morning Report; Grand Rounds; Cardio-Thoracic M/M

Supervision: Adam Levine, DO; Thierry Momplaisir, MD; Timothy Morris, DO

The fellow will be assigned to a specific attending physician. As always, the general responsibility of the cardiac

catheterization laboratory falls to the fellow; but your assigned attending will be responsible for daily didactics,

cardiac catheterization training and rounding. The assigned attending will be delineated by the first day of the

service. This may change on a weekly or bi-weekly basis to broaden your overall clinical and academic

experience.

**Obtaining lead for the cath lab is done through the nursing director of the cath lab.

Evaluation Process: Monthly performance evaluations; 360° evaluations; end of year in-service exam

Fellows will be evaluated by written critique on a monthly basis with input from all academic cath lab

attendings. This critique will include interpersonal skills, knowledge of cardiology, technical skills in the cath

lab and the quality of the cath conference presentations. Likewise, the fellow will evaluate the cath rotation and

attendings on a monthly basis. These written evaluations will be made available to and discussed with the fellow

during quarterly evaluations.

Suggested Reading List: Grossman’s Fifth Edition of Cardiac Catheterization

LEARNING GOALS AND OBJECTIVES:

Educational purpose and rationale or value as part of training of interventional cardiologist

Per COCAT requirements, exposure to percutaneous interventions will occur during your three years of cardiac

catheterization training. As a first year fellow, general observation regarding PTCA / stents will be performed.

Educational experience will include cath / PTCA case conference. You will be exposed to indications and

contraindications of these procedures, patient selection and techniques utilized to perform these procedures.

Second and third year fellows will build on the first year base with the addition of gaining understanding of the

catheters / devices and drugs used in the treatment of patients with coronary artery disease and acute myocardial

infarction, as well as improved patient selection as dictated by the literature and the attending physician staff. You

will become familiar with indications and contraindications of primary angioplasty as supported by medical

literature.

Per COCAT requirements you will gain exposure and hands on experience at the discretion of the attending

physicians. This is NOT a level 3 training program for interventional cardiology so your academic and hands on

training experience is limited to Level I certification which is defined as exposure to interventional cardiology.

The American College of Cardiology training guidelines states that programs that do not have an interventional

program should have exposure to cardiac intervention and this is provided in our program at Our Lady of Lourdes

Medical Center under the direction of the interventional cardiologists.

All trainees should learn the appropriate selection of patients for cardiac catheterization, both left and right heart,

and the specifics outlined below.

• Learn the risks and benefits of cardiac catheterization.

• Learn how to assess which patients are at risk for developing renal failure and to minimize that risk.

• Learn how to take a history for dye induced allergic reactions and to minimize that risk.

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• Learn the use of pre-medications and medications in the cath lab for conscious sedation.

• Learn indications for the use of ionic vs. nonionic contrast media.

• Become familiar with how to organize the schedule of a busy laboratory performing same day outpatient to

inpatient to emergency procedures.

• Learn how to acquire a pre-catheterization history and physical and document the same.

• Learn the technique of obtaining arterial and venous access.

• Learn the technique of left and right heart catheterization, and right heart biopsy.

• Learn how to interpret the results of a left and right heart catheterization.

• Learn how to convey the results of a catheterization in the patient chart.

• Learn how to remove arterial and venous sheaths and maintain hemostasis.

• For groins with larger arterial puncture sites, learn the use of mechanical device compression to gain hemostasis.

The above goals require invasive fellows to develop extraordinary set of communication and interpersonal skills.

These skills are honed daily with the teaching and guidance from attending physicians.

Methodology of Teaching Goals and Objectives

Principal Teaching Method

The principal method for teaching will be directly interacting with the patient, scrubbing in shoulder to shoulder

with the attending physician and interpreting the results of a catheterization with the attending physician.

The catheterization laboratory currently performs 2,000 procedures per year. These include coronary intervention,

diagnostic left heart catheterization for patients with valvular heart disease and chest pain disorders, right heart

catheterization for patients with congestive heart failure and diagnostic catheterization for patients being evaluated

for organ transplantation such as liver and kidney.

It is the responsibility of the attending physician to be an example for the invasive fellow particularly in terms of

interpersonal and communication skills to patients and patient’s families. Through personal example of the

attending physician will show the invasive fellows how to implement system-based practice as well as practice-based

learning. The invasive fellow will be a role model for the general cardiology fellow in the cath lab. The senior fellow

will take the lead role in the cath lab and introduce the first, second and third year fellows to the nuances of the cath

lab and will remain a teaching tool to the general cardiology fellows.

Educational Content / Mix of Disease

Formal conferences consist of a monthly cardiac catheterization conference. This conference will stress the relation

of history and physical findings to the hemodynamic and angiographic criteria for the selection of patients for

medical, surgical and interventional therapy. Interaction with the cardiac surgeons at this conference is very

important. The relation of non-invasive to invasive testing will be stressed. The presentation of original non-invasive

studies will be important.

There is a mix of social economic status among our patients providing an abundant supply of diverse patient

population. Through example the invasive fellow will learn responsiveness to the needs to patients in all social

economic groups. This will include a commitment to respect and compassion towards all patients. All fellows will

strive to excellence and ongoing professional development.

Patients for Cardiac Catheterization

Patients who will be going for cardiac catheterization will be worked up and pre-medicated by the catheterization

fellow and the cath film will be reviewed by the catheterization attending with the clinical attending and you, the

assigned fellow.

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The cath results are almost always discussed with the patient and their family on the same day. It is usually the

fellow’s responsibility to discuss these results, write a note and record the results on the face sheet; however, this is

left up to the discretion of the attending physician.

**YOU MUST SEE EVERY CATH PATIENT AND EXAMINE THEM

PRIOR TO PERFORMING ANY PROCEDURE ON A PATIENT

*You must identify yourself as a fellow in training prior to any patient contact.

Specific iodine prep is outlined as well as elevated creatinine. Please see the protocol sheet.

Adult Cardiac Catheterization Laboratory

General Instructions:

We are performing cases daily between 7:00am to 5:30pm. Our morbidity and mortality from cardiac catheterization

are better than the national average. Our prime concerns are the safety of the patient, patient care, then teaching.

You are responsible for a full and complete evaluation of the patient prior to the cath. The patient should be

presented to the attending and the case discussed.

To meet these requirements, we ask you to follow the instructions carefully and to read the enclosed article, which

may be helpful to you.

Everyone in our labs is willing to help you train as an invasive cardiologist and we ask for you full cooperation.

The list of patients for catheterization for the next day will be available in the late afternoon, and can be found in our

OLOL office.

EACH PATIENT SHOULD THEN BE SEEN BY THE FELLOW AND EXAMINED WITH PARTICULAR

ATTENTION PAID TO THE FOLLOWING:

Cardiac Catheterization and Angiography:

The fellow will be expected to provide the proper pre-catheterization work up and preparation of his/her assigned

patients and be knowledgeable enough to adequately explain the procedure to the patient and obtain informed

consent. He will work exclusively under the guidance of an attending cardiologist who will be scrubbed with the

fellow during the performance of the procedure. Under the attending cardiologists instruction the fellow will be

given various levels of hands on involvement in the lab. Ultimately, the fellow would be expected to be capable of

performing a complete study under the guidance of an attending if he/she is enrolled in the invasive track, while the

expectations of the non-invasive fellow would be less. He needs to learn the proper procedure for obtaining

homeostasis at the completion of arterial and venous puncture studies such as manual pressure and the use of clamps

and various other devices used in the closure of the puncture site. He/she will be responsible for providing the

appropriate pre and post cath orders for the patient and the supply of discharge instructions for the safe transition to

the outpatient for his or her return to home. He/she is expected to be capable of learning the accurate interpretation

of any obtained hemodynamics and angiograms, and may be expected to provide a written interpretation for the

patient’s records. During the course of this rotation the fellow will need to be able to learn the appropriate options of

care for the patient based upon the hemodynamic findings and angiograms (i.e., surgical, medical, catheter based

treatment options). You will have regularly scheduled cath conferences which are a mandatory didactic fellowship

function.

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PRE CARDIAC CATHETERIZATION POLICY / ORDERS

Pre-cath orders should be written the evening before the procedure. Routine orders are as follows:

1. NPO past midnight

2. Prep both groin and arm only as indicated

3. Pre-med with Benadryl 50mg p.o.

These medications should be administered at 6:30am for all first morning cases and “on=call” for all other cases.

Dosages of pre-medications may be adjusted in individual cases (elderly, COPD, thin patients, etc). Management of

diabetic patients should be discussed with the attending prior to the cath. Generally these patients should be

scheduled early in the morning if possible, especially insulin dependent diabetic patients, severe CHF, etc. Patients

with allergy to contrast, protocols are available and will be given to you during your rotation. Coumadin should be

discontinued before admission. If a patient is on Heparin, it should be discontinued at least 2 hours prior to cath

except for patients with unstable angina.

4. The catheterization procedure and risk should be discussed with the patient and their family. The family should

be asked in the next day (in the morning, if possible.) Contact the attending and discuss the cases and procedures

planned.

5. Informed consent must be obtained by the fellow after explaining the procedures to the patient. The cath lab

booklet must be given to the patient.

During Catheterization and Post-Catheterization Instructions:

1. During the cath lab procedure, please remember that the patient is awake. Unnecessary talk or discussion is not

allowed.

2. DO NOT GIVE ANY INFORMATION TO THE PATIENT, since the finding s on video or not as good as one the

cine film.

3. At the end of each case, the progress note must be written detailing the type of procedure done, any

complications, the attending that performed the procedure, the location of the catheter entry, and the post-cath

status of the pulses. Also a brief preliminary report should be written. The day following the catheterization, a short

follow-up note should be placed on the chart.

4. All calculations, ejection fractions, A-V differences, and oxygen consumption values should be calculated and

filled out on the data sheet. Please discuss with the appropriate attending regarding any questions.

5. All data sheets and pressure tracings must be delivered to the Cath Lab office by the end of the same day

6. Post-cath orders are to be completed by the fellow and reviewed by the attending.

7. The cath site should be examined for the presence of a hematoma and the peripheral pulses should be evaluated.

A note should then be recorded on the daily progress note sheet. The cath lab attending must be notified of all

complications resulting from catheterization. Also, all complication report forms should be sent to the Cath lab

office, since it has to be entered into the database of the cath lab.

Contrast Dye Allergy Prophylaxis:

Assess with individual attending.

Cath Lab Protocols

I. Iodine Allergy

Prednisone 40 mg. 10pm. Night before procedure & 6am morning of procedure

Zantac 150 mg. 6am Day of procedure

II. Creatinine 1.5 – 2.0 OR

GFR < 60 on CMP

I. 3 Amps. NaHCO3 +1000cc D5/W

0.9% cc/hour on admit

II. Creatinine > 1.2

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STOP nephrotoxic drugs especially NSAIDS pre-cath

Non-Invasive Cardiology / Cardiac Rehabilitation

Rotation Sites: Lourdes Care Center, Cherry Hill

Time Required: Six (6) Months / coverage is in conjunction with stress testing and echocardiography rotations

Learning Activities: Fellow case presentation; Braunwald Club; Journal Club

Supervision: Jay L. Rubenstone, DO; Geoffrey Zarrella, DO; Michael Horwitz, DO; Jerome Horwitz, DO; Troy

Randle, DO; Hafeza Shaikh, DO; Howard Weinberg, DO; Joshua Crasner, DO; Surendra Bagaria, MD; Mario

Maiese, DO, John Hamaty, DO

Evaluation Process: N/A

Suggested Reading List: N/A


We have cardiac rehab at our Brace Road facility. You are peripherally involved, to the extent that you are

responsible to respond to all patient emergencies or telemetry strips needing evaluation for the rehab clinic. There

may be some more formal involvement in this area in the future; but for now your responsibilities are to respond to

emergent situations only.

Non-Invasive Cardiology Echocardiography / Electrocardiography

Rotation Sites: Our Lady of Lourdes Camden, Lourdes Medical Center Burlington Campus, Kennedy University

Hospital Cherry Hill Division, Kennedy University Hospital Washington Twp. Division; South Jersey Heart

Group Brace Road Office; South Jersey Heart Group Washington Twp. Office

Time Required: Six (6) Months

Learning Activities: Fellow case presentation; Braunwald Club; Journal Club; Monthly Echo QA; Monthly ECG

conference

Supervision: Jay L. Rubenstone, DO; Geoffrey Zarrella, DO; Michael Horwitz, DO; Jerome Horwitz, DO; Troy

Randle, DO; Hafeza Shaikh, DO; Howard Weinberg, DO; Joshua Crasner, DO; Surendra Bagaria, MD; Mario

Maiese, DO, John Hamaty, DO

Evaluation Process: Monthly performance evaluations; 360° evaluations, Monthly Echo QA

Suggested Reading List: Otto, Braunwald, Feighenbaum


During the rotation in the echo laboratory the fellow will be responsible in working closely with the echo

technician in an effort to obtain hands on skills with the ultimate goal of becoming expert in obtaining a

complete echocardiographic and Doppler study. He/she will interpret the majority of the studies done within the

laboratory and review these studies with the attending cardiologist in order to learn proper interpretation skills.

He/she will be responsible for the careful handling of the esophageal probe and learn proper manipulation and

imaging with the probe under the supervision of the attending cardiologist. At times he/she may be required to

complete an interpretation report or dictate a comprehensive report. The fellow will also be responsible for

exercise and pharmacological stress testing during his rotation through the echo laboratory, including non-

echocardiographic stress testing as his/her time allows. At the beginning of the second year, the fellow will begin

to learn dictation of echos. M-mode studies will be evaluated and discussed. It is well recognized that the

technical staff have a great deal of expertise to offer the fellows in the acquisition of technically excellent images.

The technologists are also skilled in interpretation. The fellow should approach his/her experience in the echo

lab as a student recognizing that his/her teachers will be technical as well as the physician staff. The physician

staff will be more oriented towards the instruction in the interpretation of echocardiograms. Evaluations of

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fellow will reflect their acquisition of both technical and interpretive skills and will be based upon the judgments

of both the technical as well as the physician staff.

Please Note: Competency core curriculum is based on Journal the American Society of Echocardiography;

Volume 28 Number 6 June 2015.

Standards for Image Acquisition

In this section is a checklist of standard views required on all transthoracic echocardiograms as well as additional

reviews required for specific clinical problems. It is expected that on each study the fellow will acquire images in

the standard format. Even a specific view is technically suboptimal is should be acquired to demonstrate that an

attempt was made to acquire the image. It also will serve as an opportunity to instruct the fellow on how to

improve suboptimal image when they occur. The fellow should take the opportunity to do a brief cardiac

examination on the patient prior to performing an echo. The technician or attending should guide the fellow in

the use of color flow doppler during acquisition of each of these five views.

Specific techniques for identifying valvular lesions and other abnormalities will be taught in the laboratory. A

checklist will be used to assure that standard views are obtained and that in-depth investigation of specific

cardiac abnormalities occurs with all cases. For quality assurance, 2 echos per month will be read and logged.

2-D Study

Each study should have at least 10 beats of each of the following views:

1) Parasternal long axis (include off-axis tricuspid view)

2) Parasternal short axis (include off-axis tricuspid/ pulmonic views)

3) Apical Four chamber

4) Apical Two chamber

5) Subxiphoid

Doppler

When indicated, all valves should be interrogated by doppler.

The specific valves and lesions include:

Aortic Stenosis:

Flow velocities from

Apical Four Chamber

Suprasternal Notch – Pedoff transducer

Right Upper parasternal – Pedoff transducer

Aortic Insufficiency:

Color flow and PW when color flow signal poor

Parasternal Long axis

Parasternal Short axis

Apical Four chamber

Mitral Stenosis:

Pressure half-time measurements from

Apical four chamber

Apical Two chamber

Mitral Insufficiency:


Parasternal Long axis

Apical Four chamber

Apical two chamber

Tricuspid Insufficiency:


Parasternal Long axis (off-axis tricuspid view)

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Parasternal Short axis (off-axis tricuspid view)

Apical four chamber

Subxiphoid

Interpretation of Transthoracic Echocardiograms

Immediately following the completion of the study, the study should be reviewed by the attending cardiologist or

the senior noninvasive fellow (at the discretion of the attending cardiologist.) The fellow performing the

procedure should document the study with the following format:

Chamber measurements (from M-mode and 2D)

Doppler measurements

2-D Narrative

Chamber sizes

Left ventricular function

Right ventricular function (if abnormal)

Aortic valve morphology and function

Mitral valve morphology and function

Tricuspid valve morphology and function

Pulmonic valve morphology and function (if abnormal)

Other abnormalities:

LVH

Intracardiac masses

Pericardial abnormalities

Aortic abnormalities

Septal defects

Doppler Narrative (may immediately follow the related 2D findings)

Valve abnormalities (regurgitation or stenosis)

Shunts

Other flow abnormalities

Estimated systolic or mean PA pressure

LV dp/dt

Estimated systolic RV pressure (in VSD)

Pressure half-time of AR flow velocity

Reporting of transthoracic echocardiograms:

If the study was performed on a patient from the outpatient clinic, the attending cardiologist or referring

physician ordering the study should be called as soon as the study has been reviewed.

Transesophageal Echocardiography

Indication of Transesophageal Echocardiography (TEE)

Ambulatory Patients:

1. Difficult and inadequate TTE

2. Evaluation of prosthetic valve malfunction

3. Evaluation of bacterial endocarditis

4. Evaluation of intracardiac mass

5. Evaluation of aortic dissection

6. Evaluation of congenital heart disease, especially atrial septal defect and patent foramen ovale

7. Better assessment of severity of mitral regurgitation

8. Evaluation of the source of systemic emboli

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Operating Room and ICU or ER settings:

1. Cardiac evaluation in open chest trauma patients

2. Pre-operative evaluation of valvular or congenital lesions

3. Immediate postoperative assessment of the results of cardiac or aortic surgery

4. Monitoring of left ventricular function during surgery

5. Checking of intracardiac air immediately after surgery

6. Evaluation of the cause of heart failure or low output state after surgery

7. Evaluation of cardiac tamponade after surgery

Procedures for performing TEE:

1. Informed consent is obtained

2. Nothing by mouth for at least 4 hours prior to TEE

3. Sedation, if required, using Versed, Demerol or Valium, etc.

4. Xylocaine or Benzocaine local anesthetic gargle and orapharnageal spray to facilitate probe entry

5. Nasal oxygen and suction stand-by

6. Every 3 minute check of blood pressure, pulse and oxygen saturation, the latter if preceded by IV

sedation

7. Patient lies in left lateral position with head anteflexed

8. Introduction of TEE probe through mouth into esophagus and further advanced into stomach

9. Imaging at 3 standard position, namely: gastric, lower esophageal and high esophageal with proper

flexion and rotation of the probe

Interpretation of the TEE:

While manipulating the TEE probe to optimize the cardiac images, structural findings are noted and with the aid

of color flow imaging, flow patterns across the valves and the intracardiac defects are observed. Important

findings are communicated to the surgeons whenever the examiner see fit. Video recording of the displayed

images are made for permanent record.

Procedures for reporting results of TEE:

The TEE report includes not only the TEE findings but also the pre-medications given, the patients tolerance of

the procedure and the presence or absence of complications and proper remedial steps undertaken and the final

outcome.

Emergency TEE:

Emergency TEE at night or during the weekend is performed by attending on call.

Dobutamine Echocardiography

Indications:

1. Detection of viable hibernating myocardium

2. Diagnosis of significant CAD in patients unable to exercise

3. Cardiac risk stratification post-MI inpatients unable to exercise

4. Pre-operative cardiac risk evaluation

Contra-indications:

1. Significant uncontrolled ventricular arrhythmias

2. Atrial fibrillation with uncontrolled ventricular response

3. High grade AV block

4. Severe hypertension (Systolic >200 mmHg / Diastolic >120 mmHg)

5. Hemodynamic instability

6. Severe valvular disease

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7. Unstable angina

8. Acute myocardial infarction within the past 5 days

9. New York Heart Association Class III or IV

10. Hypertrophic cardiomyopathy

11. Technically poor echocardiographic windows

12. Allergy to dobutamine

13. Atropine is contra-indicated in patients with glaucoma and prostatism

Before Dobutamine Echocardiography:

1. Schedule the test with Echo personnel before entering the order into the computer system

2. Beta-blocker therapy should be discontinued 24-48 hours prior to study

3. Nothing by mouth (except for medications) for three hours prior to testing

Evening and Weekend Studies

There will be instances in which transthoracic echocardiograms are necessary during the evenings and on

weekends. In all such instances the attending on-call should be notified. If a fellow who is on call is experienced

in echocardiography, he or she may perform the study. The study should be discussed with the echocardiography

attending as well as with the physician ordering the study. When performing echo, all studies must be recorded

and documented, even if it is brief and or technically limited. Technicians are available 24 hours a day to guide

your study. An attending must be notified if a stat study is to be done.

Transesophageal echocardiograms requested as urgent or emergent procedures must be performed in

collaboration with the echocardiography attending on-call. Advanced fellows meeting case-load requirements

for credentials in echocardiography may be allowed to do emergent or emergent echocardiograms at the

discretion of the echocardiography attending on-call, but it is expected that this will occur infrequently and the

attending must be present.

STAT Echocardiography Policy:

Electrocardiography

Electrocardiograms performed on both inpatients and outpatients are reviewed by the fellows. EKG’s are delivered to the

reading room. Fellows should spend time between echocardiography cases reviewing ekg’s.

Basic EKG interpretation

Most ekg tracings come with computer-generated interpretation. They have to be reviewed and approved or properly

revised (on an interpretation sheet) first by the fellows and then by the attending cardiologist (on the ekg space allotted

for interpretation) before editing and rendering of final reports by the ekg technicians.

Some ekg tracings recorded by the floor nurses using ekg machines come without computer interpretation capability will

come with an interpretation sheet. This sheet must be completed and initialed by the fellow.

1. Complete the form with rate, intervals and axis.

2. Identify the rhythm

3. Comment on abnormalities of condition (arrhythmias, intraventricular conduction delays etc.)

4. Comments on abnormalities of the P waves, QRS complex, ST segment, T waves

5. Note any other abnormalities (infarction, hypertrophy, etc.)

6. Note any changes from previous tracings

7. When pacing is present, comment on evidence for sensing and capture, the appropriate chambers paced (when

possible based upon the tracing) and the abnormalities or pacing.

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Electrocardiography Covered Topics:

EKG TOPICS

GENERAL ATRIAL ARRHYTHMIAS

Measurements Premature atrial beats

Calibration Ectopic Atrial Rhythm

P waves Ectopic Atrial Tachycardia

Q waves Paroxysmal Atrial Tachycardia

QRS complex Multifocal Atrial Tachycardia

ST waves Atrial Flutter

T waves Atrial Fibrillation

General approach to EKGs JUNCTIONAL RHYTHMS

ATRIAL ABNORMALITIES Junctional rhythm

left atrial abnormality Junctional tachycardia

right atrial abnormality AV nodal reentrant tachycardia

VENTRICULAR ABNORMALITIES VENTRICULAR ARRHYTHMIAS

Left ventricular hypertrophy Premature ventricular complexes

right ventricular hypertrophy VT vs. Aberrancy

biventricular hypertrophy Idiopathic ventricular rhythm

Hypertrophic cardiomyopathy Accelerated idioventricular rhythm

Left bundle branch block Ventricular Tachycardia

Right bundle branch block Ventricular Flutter

Intraventricular conduction delay Ventricular Fibrillation

Left anterior fascicular block Polymorphic ventricular tachycardia

Left posterior fascicular block Torsades de Pointes

AXIS DEVIATION ATRIOVENTRICULAR BLOCKS

Left axis deviation First degree AVB

Right axis deviation Second degree Mobitz I

ISCHEMIA, INJURY, INFARCT Second degree Mobits II

Ischemia (T wave inversion) 2:1 AV block

Injury (subepicardial injury) Third degree (complete) ABB

Injury (subendocardial injury) PREEXCITATION

Q waves Wolff-Parkinson-White

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Inferior AV reentrant tachycardia

Posterior Lown-Ganong-Levine Syndrome

Anterior Mahaim type of Preexcitation

Lateral localization of bypass tract

Pseudoinfarction DRUGS

acute MI Digoxin

recent MI Antiarrhythmic Agents

age undetermined MI Psychotropic Agents

old MI ELECTROLYTE ABNORMALITIES

reciprocal ST and T changes Hyperkalemia

ST AND T WAVE CHANGES Hypokalemia

Primary changes Hypercalcemia

Secondary changes Hypocalcemia

PERICARDITIS Hypermagnesemia

Pericarditis Hypomagnesemia

PULMONARY DISEASE Sodium abnormalities

COPD pH abnormalities

Acute pulmonary embolus CENTRAL NERVOUS SYSTEM

CONGENITAL HEART DISEASE CNS effects

ASD HYPOTHERMIA

VSD Hypothermia

PDA MISCELLANEOUS

Coarctation Mitral valve prolapse syndrome

Pulmonary stenosis skeletal abnormalities

Tetology of Fallot Nonspecific ST and T changes

Ebstein's Anomaly Prolonged QT

Dextrocardia Abnormal U waves

Corrected Transposition Misplacement of Limb Leads

ARRHYTHMIAS Misplacement of precordial leads

SINUS RHYTHMS Poor R wave progression

Normal sinus rhythm Low voltage

Sinus Arrhythmia PACEMAKERS

Sinus Bradycardia Pacemaker codes

Sinus Tachycardia Single chamber

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Sinus Pause Duel Chamber

Sinus Arrest

Sinoatrial Block

Electrophysiology

Rotation Sites: Our Lady of Lourdes Camden, Kennedy University Hospital Cherry Hill Division, Kennedy

University Hospital Washington Twp. Division; South Jersey Heart Group Brace Road Office; South Jersey Heart

Group Washington Twp. Office

Time Required – Two (2) Months

Supervision: Sivaraman Yegya-Raman, MD

Evaluation Process: Monthly Fellow Performance Evaluation, 360° evaluation

Learning Activities: Weekly didactic lecture series; visiting speakers; Journal Club


During assignment to the EP services the fellow will be exposed to all of the aspects that this subspecialty entails. He/she

will be required to perform EP consultations that often will require the evaluation of ecg’s and rhythm strips.

He will be required to perform complete admissions, history and physicals and complete patient work-up.

Responsibilities in the lab will be under the direction of the attending. Exposure to all lab aspects of EPS including

pacemakers, ICD’s and biventricular pacers will be provided.

Curriculum Content and Methods

Complex cardiac arrhythmias are managed with expertise in cardiac electrophysiology, the use of implantable

pacemakers, ICD’s, antiarrhythmic agents and techniques utilizing electrophysiologic mapping and ablation.

Within the cardiology core training program, level 1 training will comprise of at least 2 months of clinical cardiac

electrophysiology rotation.

This will assist the trainee to:

Acquire knowledge in the diagnosis and management of brady and tachy arrhythmias

Learn the indications and limitations of invasive EP testing, ambulatory ECG monitoring, event recorders and stress

testing for arrhythmia assessment.

Gain experience in the arrhythmia consultation service.

Learn the fundamentals of cardiac pacing; recognize normal and abnormal pacemaker function and learn indications for

temporary and permanent pacing.

Learn indications for ICD’s and biventricular pacing.

Understand pacing modes, interrogation, programming and surveillance of pacers and ICD’s.

Learn/perform cardioversions.

Learn indications for tilt table testing for evaluation of syncope.

Gain exposure to interpretation of complex arrhythmias on the surface ECG.

Electrophysiology Lecture Series:

Introduction to EP I

Introduction to EP II

Cardiac Cellular Electrophysiology

Cardiac Channelopathies

Indications for EP Testing

Supraventricular tachycardia

Management of AFib/Flutter

Ventricular tachycardia

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Antiarrhythmic Drugs

Syncope – Diagnosis and Management

Pacemakers – Temporary / Permanent

Pacemakers – Trouble Shooting

Sudden Cardiac Death and ICD Trials

ECG Review

EP Tracing Review

Nuclear Cardiology

Rotation Sites: Our Lady of Lourdes Camden, Kennedy University Hospital Cherry Hill Division, Kennedy University

Hospital Washington Twp. Division; South Jersey Heart Group Brace Road Office; South Jersey Heart Group

Washington Twp. Office

Time Required: 8 months (non-invasive) 6 months (invasive track)

Learning Activities: Daily Nuclear QA; Monthly QA Review; Nuclear Physics Course (10 weeks per three year

program)

Supervision: Jay L. Rubenstone, DO; Geoffrey Zarrella, DO; Michael Horwitz, DO; Jerome Horwitz, DO; Troy Randle,

DO; Hafeza Shaikh, DO; Howard Weinberg, DO; Joshua Crasner, DO; Surendra Bagaria,MD; Mario Maiese, DO, John

Hamaty, DO

Evaluation Process: Monthly Performance Evaluation; 360° evaluation; end of year in-service examination

Suggested Reading List

Nuclear Cardiology. In Heart Disease, 6th Edition, Eugene Braunwald, editor. Pgs 273-323

Atlas of Nuclear Cardiology by Vasken Dilsizian.

Nuclear Cardiac Imaging: Principles and Applications by Ami E. Iskandrian.

Nuclear Cardiology Case Files


Each Fellow in Cardiovascular Disease will rotate through Nuclear Cardiology for at least 6 months as part of the

basic COCATS requirements, with the expectation of developing at least Level II competence in this subject. Fellows

who elect to pursue more advanced training may do so during elective months. Level II is designed to provide the

trainee with special expertise to practice nuclear cardiology. During the first year of fellowship, the fellow will rotate

through Nuclear Cardiology for two months. To have an adequate understanding of the clinical applications of

nuclear cardiology and to perform tests safely, the trainee must acquire knowledge and proficiency in the following

areas of general cardiology, and integrate them with nuclear medicine:

Coronary angiography and physiology

Cardiac physiology and pathophysiology

Rest and exercise electrocardiography

Exercise physiology

Pharmacology of standard cardiovascular drugs

Pharmacology and physiology of commonly used ‘stress agents’

Teaching Methods:

Fellows will learn about nuclear cardiology through a combination of:

Self-study

Hands-on experience

Study interpretation

Involvement in lectures within the laboratory including material on radiation safety.

75

Mixes of Disease:

Fellows will be exposed to patients and/or nuclear studies from patients with:

Coronary artery disease

Congestive heart failure

Congenital heart disease

Valvular heart disease

Types of Encounters:

Encounters will be both inpatient and outpatient. Fellows will be involved with a number of different procedures,

including:

Myocardial perfusion imaging

SPECT with technetium agents and thallium

Planar imaging

ECG gating of perfusion images

Imaging protocols

Stress protocols, both exercise and pharmacologic

Viability assessment

Equilibrium gated blood pool or “first pass” radionuclide angiography

Qualitative and quantitative methods of image display and analysis

Metabolic imaging using positron emitting radionuclides

Myocardial infarct studies

Cardiac shunt studies

During the nuclear cardiology rotation and at times during echo and clinical rotations the fellow will be responsible in

learning the proper and safe way to perform treadmill and pharmacologic stress testing. He/she will need to be able to

properly assess the patient and determine the appropriateness of the test being performed and adequately explain the

procedure to the patient and obtain a signed consent. He/she will supervise the test from beginning to end and act

accordingly to the needs of the patient should any complications or instability occur. He will provide the interpretation

of the study, review it with the attending cardiologist for accuracy, and provide a completed interpretation form for

dictation. It is important that he/she learn the proper dosing of any pharmacologic agents used in testing and know how

to accurately calculate and assess the proper intravenous concentration of the drug as prepared by the pharmacy.

Nuclear Regulatory Commission requirements for nuclear certification will be met over the course of three years for the

noninvasive track. You must perform a certain number of studies and dictate as well. Also you will have the appropriate

lectures and exposure to nuclear agents. You will perform the daily quality assurance testing in the nuclear lab with the

nuclear medicine technologist.

Every month you will complete two (2) nuclear quality assurance studies and complete the form and turn it in to the

program director for evaluation.

In addition to the responsibilities noted for exercise stress testing above, there are specific expectations of the fellow

during his assignment to nuclear cardiology. The nuclear regulatory commission has very specific requirements for any

personnel working in a laboratory that uses radioactive materials and these requirements must be referred to an adhered

to in a strict manner. The fellow will need to learn the proper handling of these materials and know their pharmacology

and uses in clinical cardiology. Proper and accurate description to the patient is needed and at times consents for their

use must be obtained by the fellow. The fellow will learn how to evaluate and interpret the nuclear studies under the

guidance of an attending physician, and learn the optimum agents and their limitation for each clinical situation.

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Lectures and Self-Study

This component consists of lectures on the basic aspects of nuclear cardiology and parallel self – study material

consisting of reading and viewing case files. Fellows will be involved in weekly conferences, which they are expected to

attend and play an active role in. Fellows will be expected to lead at least one of these conferences during the rotation.

Lectures and self-study will include material regarding radiation safety. Interpretation of Nuclear Cardiology Studies

Fellows will actively participate in daily study interpretation except when excused for their ½ day per week continuity

clinic. Fellows are expected to be able to relay clinically important information during the reading sessions regarding the

stress portion of the study, clinical history of the patient, angiographic data, etc. Fellows are expected to play an active

role in relaying the information from the nuclear study to the referring team or physician.

Hands-On Experience

Fellows are expected to be present in the nuclear cardiology laboratory no later than 7:00 AM, or earlier if needed to

accommodate the case load for the day. Fellows are expected to meet at the beginning of the day with the technical

director of the lab and/or with the cardiology nurses in the lab to plan management of the day’s case-load. Fellows will

perform 35 complete nuclear cardiology studies alongside a qualified technician and/or cardiac nurse. The fellow is

responsible for documenting the individual cases. Fellow is expected to spend one day of the rotation at the local

radiopharmaceutical dispensary.

Goals and Expectations:

1. Learn proper techniques and protocols of nuclear procedures, including pharmacologic stress testing.

2. Fellow appropriately triages and makes diagnostic and therapeutic decisions for patients undergoing stress testing

with LBBB, paced rhythm, atrial fibrillation, newly diagnosed cardiomyopathy, aortic stenosis and/or on going chest

pain.

3. Ability to risk stratify patients after being evaluated by cardiac stress test and nuclear cardiovascular procedures.

4. Ability to manage complications from stress test and nuclear studies, including nuclear decontamination

procedures.

5. Ability to correlate angiography and nuclear studies

6. Ability to generate accurate test reports.

7. Understands safety and application of different exercise and pharmacologic stress protocols.

8. Understands technical sources of error/artifact in Nuclear imaging.

9. Understands concepts of nuclear physics as they pertain to radioisotope choices, cardiovascular testing, and radiation

safety.

10. Interpretation of Nuclear Cardiology Studies

11. Able to accurately identify normal studies

12. Able to accurately interpret moderate sized (or larger) and moderate intensity (or greater) areas of ischemia,

infarction and/or viability on myocardial perfusion scans.

13. Able to accurately interpret moderately (or greater) abnormal wall motion and LV function on gated SPECT images

and radionuclide angiography.

14. Has a basic understanding of metabolic imaging using positron emitting radionuclides

15. Fellow effectively communicates and interacts with nurses and technologists.

16. Fellow effectively communicates with other fellows and staff physicians.

17. Fellow arrived in the stress/nuclear lab on time and was an active participant.

18. Fellow was available and accessible for patient care at all times.

19. Fellow fulfilled additional obligations of the rotation including didactic conferences, case presentations and site visits.

20. Fellow was responsive to constructive suggestions and demonstrated improvement in deficiencies.

21. Commitment to scholarship and the use of evidence based nuclear cardiology.

22. Fellow has a good understanding of the nuclear lab workflow and assists in improving efficiency

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Reporting Hours during Non-Invasive / Outpatient Rotations:

Reporting time for all non-invasive ambulatory rotations is 7:00am, unless otherwise notified.

Effective July 1st, 2015 all fellows on a stress rotation at SJHG/CH or WT will report to the office not later than 6:30am on

Tuesday and Wednesday in order to complete the morning nuclear QA. This time may change to 6:00am depending on

patient scheduling; please check with the nuclear technicians the day before for your exact reporting time. This daily QA

is part of your nuclear credentialing process. The fellow will do the morning QA on those days and give copies of the

daily report to Ashley for archiving; the technician will counter-sign the report. The technician will go over the QA form

with you, as there are tasks done on a weekly, monthly, bi-monthly and quarterly basis. You will be responsible to

complete the daily and weekly items; and ideally will be exposed at some point during your rotation to those procedures

performed on a quarterly basis. Some of these objectives will be discussed during your Nuclear Stress lectures. The goal

of this initiative is to give the fellow proficiency in the nuclear lab in order to prepare for credentialing at an independent

operator status. Beginning July 2015, Monday, Wednesday and Friday 7:00am-9:00am will be nuclear and echo case

review for fellows on this rotation in the Cherry Hill office.

Congestive Heart Failure and Transplant

Rotation Sites: University of Pennsylvania Health System; Our Lady of Lourdes Camden, Kennedy University

Hospital Cherry Hill Division, Kennedy University Hospital Washington Twp. Division; Lourdes Cardiology

Outpatient Heart Failure Clinic, Brace Road Office; Lourdes Cardiology Outpatient Heart Failure Clinic Washington

Twp. Office

Time Required: One (1) Month

Supervision: Joyce Wald, MD (UPHS); Anil Kothari, MD; Thierry Momplaisir, MD; Timothy Morris, DO; Jay L.

Rubenstone, DO; Geoffrey Zarrella, DO; Michael Horwitz, DO; Jerome Horwitz, DO; Troy Randle, DO; Hafeza

Shaikh, DO; Howard Weinberg, DO; Joshua Crasner, DO; Surendra Bagaria,MD; Mario Maiese, DO, John Hamaty,

DO

Evaluation Process: Monthly Performance Evaluation; 360° Evaluations; annual in-service examination


In the past decade, many advances have been made in the care of patients with coronary artery disease and primary

valvular disease. This has allowed patients with these diseases to live longer placing them at risk for the subsequent

development of congestive heart failure. The incidence and prevalence of congestive heart failure has been steadily

increasing over the past decade with heart failure now constituting the number one cardiovascular discharge

diagnosis. Whereas patients with mild to moderate congestive heart failure may be adequately cared for by family

practitioners and general internists, the patient with advanced congestive heart failure often presents with life-

threatening complications requiring a higher level of expertise.

Despite major advances in the treatment of congestive heart failure over the past five to ten years, the prognosis from

this disease remains poor. During this same period, cardiac transplantation has become an accepted alternative to the

conventional medical armamentarium. Most patients that undergo cardiac transplantation are referred to a

Transplant Center by cardiologists and although a Transplant Center generally assumes a primary care role for these

patients postoperatively, the community cardiologist continues to have a role in the initial evaluation of

postoperative problems after transplant patient’s return to their home community.

Goals

The goal of the Heart Failure/Transplant Service rotation is to educate the cardiology fellow in the diagnostic and

prognostic modalities available for the patient initially presenting with congestive heart failure and to allow the

cardiology fellow to develop expertise in the treatment of congestive heart failure including the use of conventional

78

medications and more aggressive modalities such as intravenous inotropes, intraaortic balloon counter pulsation and

left ventricular assist devices. A further goal is to educate the fellow, in a more general way, in the care of the

postoperative heart transplant patient specifically exposing the fellow to the management of postoperative

hemodynamics, routine clinical follow-up and the myriad of complications that can occur in the immunosuppressed

patient.

Objectives

1. The cardiology fellow will become knowledgeable in methods of diagnosis and evaluation of the patient with new

onset congestive heart failure.

2. The cardiology fellow will be become proficient in the management of congestive heart failure exacerbations in

hospitalized patients. (It is assumed that the cardiology fellow will follow patients with chronic stable congestive

heart failure in the outpatient clinic.)

3. The cardiology fellow will gain expertise in the more advanced methods of stabilizing patients in profound

congestive heart failure such as the use of intravenous inotropes and vasodilators, intra-aortic balloon counter

pulsation and left ventricular assist devices.

4. The cardiology fellow will become knowledgeable in the methods of appropriate referral and evaluation for cardiac

transplantation.

5. The cardiology fellow will gain knowledge and proficiency in the routine care of postoperative cardiac transplant

patients including:

A. The use of immunosuppressants

B. Routine surveillance methods for rejection and graft vasculopathy

C. Diversity and complexity of postoperative complications

Research

Rotation Sites: Our Lady of Lourdes Camden, Lourdes Medical Center Burlington Campus, Kenned University

Hospital Cherry Hill Division, Kennedy University Hospital Washington Twp. Division; South Jersey Heart Group

Kresson Road Office; South Jersey Heart Group Washington Twp. Office; South Jersey Heart Group Burlington

Office; Library, Rowan-SOM; Office of the IRB at Our Lady of Lourdes Medical Center and Rowan-SOM

Time Required: Continuous over three years

Learning Activities: CITI Program; Annual Fellow Research Presentation Meeting

Supervision: John N. Hamaty, DO, Sherry Pomerantz,PhD, H. Timothy Dombrowski, DO

Evaluation Process: Quarterly evaluations and review, annual progress reports

Expectations

The AOA and ACOI require that one scientific research project be submitted by each cardiology fellow during his or her

training. Please refer to the AOA/ACOI research requirements and guidelines as listed below. In order to provide for a

scientific research report that meets AOA/ACOI requirements and that is submitted in a timely fashion, it will be

required that each fellow provide a periodic progress report during the fellowship. A timetable has been established as

follows.

CITI Program for IRB approval (Due January 30th, first year of fellowship):

Completion of this online program is a first and necessary part of your fellowship research project. This online program

must be completed absolutely not later than January 30th of your first year of fellowship. Please furnish your program

coordinator with a copy of your completion certificate.

First report (due end of first year)

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By midway through the first year of the fellowship program each fellow should have already established a least the type of

report (original research, case report) title, and co-investigators (authors) who will be involved in his or her project. At

the very least, a project outline should already be established, such as hypothesis, methods, patient groups etc. This is

due to the ACOI by the end of the first year.

Second Report (due July 1st of the third fellowship year)

By the end of the second year of training, the fellow should have essentially completed their research project and have it

submitted in initial rough draft. This will allow enough additional time for any needed changes, corrections etc. so that a

final report, ready for submission can be completed on time.

Third Report (due December 30th of third year of training)

The final product, ready for submission to the ACOI, should be given to the program director by the last day of December.

The reports will then be copied and filed and subsequently submitted to the ACOI prior to the required deadline, which

is by December 30th of the third year of fellowship. Submitted research is then reviewed for approval by the ACOI. No

fellow can complete the fellowship program until the required research has been approved by the ACOI and this

requirement has been satisfied.

Out-patient Ambulatory Clinic

Rotation Sites: South Jersey Heart Group Burlington Office, South Jersey Heart Group Cherry Hill Office, South Jersey

Heart Group Sewell Office, South Jersey Heart Group Stratford Office

Time Required: ½ Day per week ( 4 hours), 48 weeks per year for three years

Supervision: Surendra Bagaria, MD; Jay L. Rubenstone, DO, Mario Maiese, DO; John N. Hamaty, DO

Evaluation Process: Bi-annual preceptor evaluation; 360˚ evaluations; quarterly program director evaluation; annual

program director evaluation; ACOI end of year evaluation; AOA end of year core competency evaluation


I. Educational Purpose: To provide the cardiology fellow during all three years of training with a broad based learning in

all aspects of managing of cardiovascular diseases in the outpatient setting.

III. Specific Goals: The rotation will be structured to apply the varied aspects of basic sciences and cardiac

physiology to the clinical management of complex cardiovascular issues, with a primary emphasis on defining

cost effective outcomes based management approaches.

IV. The fellow will be required to address clinical problems using an evidence based approach or in situations

where evidence is sparse, will be challenged to develop a consensus approach to confront the clinical

scenarios. Each trainee is required to evaluate and present cases independently and encouraged to pursue

scholarly activity during their service tenure. Thus, on leaving the clinical rotation, the trainee will possess a

familiarity with medical and surgical intervention for cardiovascular diseases, develop clinical judgment to

independently recognize, manage and treat complications and become proficient in interpretation of

diagnostic studies pertinent to cardiovascular diseases. In addition, the trainee will improve his knowledge in

the management of cardiology consultations.

Fellowship Year One:

It is assumed that the fellow can take a complete and cardiovascular-pertinent history at this point and perform an

adequate physical examination. A thorough differential diagnosis for each cardiovascular problem should be made and a

plan proposed for each problem. Awareness of the guidelines and other principles of management should be used to

structure such a plan. Following discussion with the supervising attending, this plan should be articulated with the

patient, the note completed, and procedures scheduled by the ancillary staff in a timely manner. Awareness of each of the

core competencies, discussed below, should come into play in the decision-making process.

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Fellowship Year Two:

In addition to honing those skill sets noted above, focal areas of growth should include expansion of physical

examination acumen, more complete development of differential diagnosis, and more complete knowledge of guidelines

and principles. As the second year fellow has now experienced different technological aspects of cardiovascular diagnosis

and treatment, inclusion of the benefits and risks of each should play an increasing role in discussion with the attending

and the patient. At this point, more attention to system-based practice competencies, as noted below, should become an

important part of each treatment plan.

Fellowship Year Three:

In addition to the above, mastery of physical examination and the core competencies is the goal. The fellow should

demonstrate increasing independence of thought and plan in the discussion with the attending and the patient. The goal

is to move toward mastery of all core competencies and demonstration of full ability to function independently and

successfully in the outpatient setting of completion of the fellowship.

III. Program Overview:

The ambulatory experience is provided within the outpatient offices of South Jersey Heart Group. Examination rooms are

provided for the cardiology fellows outpatients’ encounters, as well as an adjacent work area for confidential discussions

with the assigned attending physician as well as for computer access to clinical laboratory, radiology, nuclear medicine

and subspecialty cardiology testing.

IV. Specific Educational Opportunities:

At the conclusion of the rotation, the trainee will have been exposed to or primarily managed the following clinical cases:

A. Coronary Artery Diseases: recognize and treat chronic coronary syndromes. They will learn to discern unusual

presentations, distinguish the pathophysiological varieties of coronary artery disease, and evaluate the necessity for

noninvasive (stress test) or invasive testing and therapeutic options. In addition, emphasis will be given in the

electrocardiographic diagnosis of coronary artery diseases as well as on the interpretation of different testing modalities,

such as stress testing (echo, EKG, nuclear, CTA) and coronary angiograms. In addition, emphasis is place in cardiac

rehabilitation and prevention of coronary artery disease.

B. Valvular Heart Disease: participate in the long-term treatment of valvular heart disease with pre-op and post-

operatively, and with medical management.

C. Hypertension: learn how to manage patients with hypertension and learn how to design therapeutic strategies for the

outpatient management of these subjects. They will also learn the pathophysiologic mechanisms and the tools necessary

to differentiate essential and secondary forms of hypertension.

D. Heart Failure: recognize and treat heart failure and define therapeutic options that improve morbidity and patient

outcomes and, develop effective transitional strategies to avoid recrudescence.

E. Arrhythmias: learn the diagnosis and management of the different forms of supraventricular and ventricular

arrhythmias. Emphasis is placed on electrocardiographic diagnosis as well as other noninvasive and invasive

electrophysiological studies.

F. Pulmonary heart Disease: learn the pathophysiology of pulmonary heart disease and the management of these patients.

A variety of patients with pulmonary embolism, sleep apnea and chronic obstructive pulmonary disease will allow the

fellow to become proficient in these clinical entities.

G. Syncope: learn the pathophysiology, invasive and non-invasive methods of evaluation and therapeutic strategies for

patients with different types of syncopal syncope.

H. Surgical Clearance: evaluate patients that require surgical procedures, evaluate them for perioperative cardiovascular

risk, and offer management options.

I. Congenital Heart disease: evaluate adult patients with different congenital heart disease problems.

J. Peripheral vascular diseases: evaluate and manage patients with peripheral vascular disease including carotid disease.

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V. Structure and Supervision:

Typically a cardiology fellow has half a day of clinic weekly. Each fellow sees a minimum of six and a maximum of 10

patients every week on a regularly scheduled basis. The cardiology fellow has direct care and management responsibility

for each patient, but is supervised by the attending physician. This experience extends throughout the fellowship,

through all their services without exception, so that they provide a continuity of care for patients and have regular

ambulatory care responsibility.

VI. Scholarly Activity:

The fellows are mentored to develop skills in teaching and review of the literature in cardiovascular diseases. Similarly

the fellows are expected to use these skills under the direct supervision of a staff attending in the preparation of materials

for presentations. In addition, clinical research is encouraged.

VII.Technical Experience:

The trainees are encouraged to participate under direct supervision by the attending physicians of cardiovascular

diagnosis through history, physical examination and laboratory methods; the natural history of cardiovascular diseases,

the medical and surgical management as well as the primary and secondary prevention of and rehabilitation from the full

spectrum of cardiovascular disorders and conditions.

VIII. Suggested Reading:

At the beginning of the rotation and throughout, the trainees are continuously provided with structured reading lists that

are updated as the scientific body of evidence grows. Some of the reading material recommended is:

• The latest ATP guidelines

• Framingham risk score model

• The latest JNC guidelines

• Secondary prevention guidelines

• ACC/AHA CHF guidelines

• ACC/AHA Atrial-Fibrillation guidelines

• ACC/AHA Chronic Stable Angina Management

• ACC/AHA Perioperative Cardiovascular Evaluation

• Diabetes CV guidelines

Note: Some of the above listed information may be found on the ACC website (acc.org)

IX. Competencies for the Ambulatory Clinic Rotation

The attending staff physicians submit quarterly evaluations that are shared with the fellow and program director. In

addition, the fellows will be evaluated upon the basic six core competencies established by the ACGME as follows:

Patient Care:

Competency: Provides compassionate, appropriate, and effective health care for the treatment of cardiac problems and

the promotion of health.

1. Gathers essential and accurate information about the patient through interviews, examination, and complete history

and by appropriately accessing adjunctive sources of information to this obtained from the patient and/or family

members.

2. Makes informed diagnostic and therapeutic decisions based on patient information, current scientific evidence, clinical

judgment, and patient preference.

3. Fellows learn the practice of health promotion, disease prevention, diagnosis, care, and treatment of men and women in

all age ranges within the domain of adult cardiology, during health and all stages of illness. This includes, but is not

limited to, management of patients with ischemic heart disease, congestive heart failure, valvular heart disease, and

disorders of cardiac rhythm.

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Medical Knowledge:

Competency: Demonstrates knowledge of concepts involved in the outpatient diagnosis and management of

dyslipidemia, hypertension, coronary artery disease, arrhythmias, heart failure, and peri-operative risk assessment.

1. Understands and employs recommendations and pharmacotherapy for lipid management

2. Understands and employs recommendations and pharmacotherapy for hypertension.

3. Understands recommendations for dietary management of weight, lipids and hypertension and discusses such with

clinic patients.

4. Understands outpatient use of warfarin and anti-arrhythmic drugs and appropriately monitors such.

5. Understands indications for and limitations of outpatient diagnostic tests including stress testing, echocardiography

and ambulatory electrocardiographic monitoring.

6. Fellows demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral

sciences, as well as the application of this knowledge to patient care. Fellows learn the scientific method of problem

solving, evidence-based decision making, a commitment to lifelong learning, and an attitude of caring that is derived from

humanistic and professional values.

Practice-Based Learning and Improvement:

Competency: Evaluates each patient individually and addresses new problems/questions encountered through

assimilation of scientific evidence as part of improving care practices.

1. Identify strengths, deficiencies, and limits in one’s knowledge and expertise;

2. Set learning and improvement goals;

3. Identify and perform appropriate learning activities;

4. Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice

improvement;

5. Incorporate formative evaluation feedback into daily practice; locate, appraise, and assimilate evidence from scientific

studies related to their patients’ health problems;

6. Use information technology to optimize learning;

7. Participate in the education of patients, families, students, residents and other health professionals.

Interpersonal and Communication Skills:

Competency: Fellows demonstrate interpersonal and communication skills that result in the effective exchange of

information and collaboration with patients, their families, and health professionals.

1. Fellows communicate effectively with patients, families, and the public, as appropriate, across a broad range of

socioeconomic and cultural backgrounds;

2. Maintains comprehensive, timely and legible medical record demonstration and correspondence related to patient care

activities.

3. Communicate effectively with physicians, other health professionals, and health related agencies provide accurate and

timely feedback to referring physician.

4. Actively listens and elicits appropriate information from the patient and/or family members and colleagues.

5. Work effectively as a member or leader of a health care team or other professional group;

6. Act in a consultative role to other physicians and health professionals;

Professionalism:

Competency: Proficiency is primarily behavioral and attitudinal. The major components of professionalism are

commitment, adherence, and sensitivity. Commitment means respect, altruism, integrity, honesty, compassion, empathy,

and dependability; accountability to patients and society; and professional commitment to excellence (demonstrated by

engaging in activities that foster personal and professional growth as a physician). Adherence means accepting

responsibility for continuity of care; and practicing patient centered care that encompasses confidentiality, respect for

privacy and autonomy through appropriate informed consent and shared decision-making as relevant to the specialty.

Sensitivity means showing sensitivity to cultural, age, gender and disability issues of patients as well as of colleagues,

including appropriate recognition and response to physician impairment.

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Fellows are expected to demonstrate:

(1) Compassion, integrity, and respect for others;

(2) Responsiveness to patient needs that supersedes self-interest;

(3) respect for patient privacy and autonomy;

(4) Accountability to patients, society and the profession; and,

(5) Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age,

culture, race, religion, disabilities, and sexual orientation.

Systems Based Practice:

Competency: Focuses on the broader context of patient care within the multiple layers of a healthcare system including

purchasers (employers, government), insurers (commercial, Medicare, Medicaid), delivery systems (hospitals, physician

networks, drug and technology companies, community resources), work group (local entity providing care such as a

group practice, hospital service), providers (physicians, nurses, physicians extenders and others both as individuals and

teams that provide direct care), and the users (patients and families). Demonstrates teamwork skills to identify, analyze,

implement, evaluate and report improvement initiatives as well as identifying system errors.

1. Understands accesses, utilizes and evaluates effectiveness of resource providers, and systems to provide optimal cardiac

therapy.

2. Understands different medical practice models and delivery systems and how to best utilize them to care for the

individual patient.

3. Practices quality, cost-effective health care.

4. Advocates and facilitates patient advancement through the health care system.

V.Procedure Logs

It is critically important for satisfactory completion of cardiology fellowship training and for further considerations of

staff privileges in hospitals where fellows may practice that an accurate record of required procedures be maintained. It

is also and AOA/ACOI requirement that certain procedures (as listed in the Annual Resident Report) are logged and

submitted annually. All required clinical procedures that are part of training requirements are maintained by the

program coordinator for quantifying and record keeping purposes. Logs are collected and reviewed on a quarterly basis.

(Due two/three weeks prior to quarterly evaluations) Beginning July 1st, 2011 all procedure logs will be done utilizing

New Innovations RMS software, much like duty hours are logged. This year, we will begin using the procedure logger on

New Innovations as opposed to Log Books. If you have not already, you will have an in-service on using this new feature.

Your logs must be accurate, complete and on time. A record of all procedures will be part of your permanent record and

will be used for future inquiries from hospitals and professional societies to which you wish to apply.

The following procedures require logs:

• Nuclear / Exercise / Pharmacologic Stress Testing

• Echocardiography (TTE/TEE/Stress Echocardiography)

• Intubations and Conscious Sedation

• Diagnostic Cardiac Catheterization

• Outpatient Clinic Encounters

• Inpatient Encounters

• EP (interrogations, tvp/ permanent pacer placement, cardioversion)

• IABP placement/management/sheath removal

• Conscious / Moderate Sedation

• Ambulatory Blood Pressure Monitoring

• Ambulatory ECG monitoring

Cardiovascular disease training requires excellence in several laboratory skills and proper exposure and documentation is

critical to the eventual credentialing in order to perform these skills as an adult cardiologist. Careful, comprehensive

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maintenance of a procedure log is a necessity and represents the fellow’s record when applying for future privileges in

their hospitals of practice. Failure to properly document any procedures can result in a loss of credit for these procedures

and could significantly impact on the fellow’s future privileges and ability to complete the fellowship.

VII. Fellow Ambulatory Clinic Offices

Burlington Office:

1113 Hospital Drive Suite 201 Willingboro, NJ 08046

Cherry Hill Office:

1 Brace Road Suite C and F Cherry Hill, NJ 08034

Sewell Office:

#1 Medical Arts Building Suite 1 539 Egg Harbor Road Sewell, NJ 08080

Stratford Office:

University Doctors Pavilion 42 East Laurel Road Suite 3100 Stratford, NJ 08084

VIII. Osborne Outpatient Clinic Coverage

As most of you know, as a program we provide coverage to indigent patients at the Osborn Family Health Clinic at Our

Lady of Lourdes Hospital. This is a service that we agreed to provide to Lourdes, a program requirement, and a way of

giving back to the community that we collectively serve. It is the responsibility of the senior cath fellows to provide this

coverage on the 3rd Wednesday of every month, beginning PROMPTLY at 1pm. Your Lourdes attends are aware and

supportive of this obligation. Towards the end of the year, we will begin introducing second year fellows to this

coverage. Thank you in advance for your valued participation in this very important experience. The schedule for this

academic year is in your binder. Please note your dates, and do not schedule vacations or time off on those dates.

IX. Fellow Case Presentation

The object of the case presentation is to pick a topic for you to learn and master. I strongly encourage basic

cardiovascular disease states such as valvular heart disease, coronary disease and congestive heart failure. In conjunction

with the case the fellow should also provide follow up care and management of that disease state. The case must follow

the guidelines in addressing all seven (7) core competencies. You will be graded based on these core competencies and

your outline of these during your case presentation. Lastly, the last 15 minutes of the topic should refer to the standard of

care guidelines provided for that disease state. These are accessible on the acc.org website or any other standardized

guideline reference. I want to emphasize that the case should be appropriate for your level of training. An example for

the first years would be basics of ischemic heart disease, stress testing, heart failure and or valvular heart disease. A

second year case may involve complexities of the care involving aggressive hemodynamic monitoring or cath lab

interpretation. A third year course should be a master of its topic, its appropriate management and follow-up of patient

with complex and multiple disease states. I would be happy to discuss your case with you prior to presentation. Again,

the goal of this lecture is to help you to learn and understand a particular topic with reference to the standard guidelines

and treatment and management.

Standardized Checklist of Criteria:

□ Osteopathic Philosophy / Osteopathic Manipulative Medicine

1. Osteopathic concepts and/or OMT was integrated into presentation.

□ Medical Knowledge

1. Demonstrated Competency in the understanding and application of clinical medicine as applied to topic present

2. Knows and applies the foundations of clinical and behavioral medicine.

3. Demonstrates strong understanding of standard of care guidelines for presented disease state.

□ Patient Care:

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1. Gathered accurate, essential information from all sources including histories and physical exams, medical records,

diagnostic/ therapeutic plans and treatments.

2. Validated competency in the performance of diagnosis, treatment and management

3. Provided Insight into health care consistent with osteopathic philosophy, including preventative medicine and health

promotion based on current scientific evidence and guidelines.

□ Interpersonal and Communication Skills:

1. Exhibited effective written and oral skills, both with regard to doctor/patient/peer relationships; as well as in

preparation and presentation of this case.

□ Professionalism:

1. Adhered to ethical principals in the practice of medicine

2. Demonstrated awareness and proper attention to issues of culture, religion, age, gender, sexual orientation, and mental

and physical disabilities.

□ Practice-Based Learning and Improvement:

1. Addressed presentation in a manner consistent with the most current information on diagnostic and therapeutic

effectiveness

2. Understood and applied research methods, medical informatics and the application of technology as applied to

medicine

□ Systems-Based Practice:

1. Demonstrated awareness of local health care delivery system and how it affects patient care and professional practice.

X. Journal Club

A monthly Journal club is held at the South Jersey Heart Group office in Cherry Hill, on the third Wednesday of every

month. You can find the monthly articles for Journal club on the SJHG website. Each fellow will present an article in

detail including statistical relevance, practice applications and an appropriate critique. Journal club articles must be

submitted in PDF format to the chief fellow not later than the 3rd or 4th of each month. In the event that you are

scheduled to present an article and cannot be present for whatever reason, it is your responsibility to find a fellow to

switch with. This must be done prior to Journal Club, and your chief fellow and proctor should be made aware of the

change. Please consult your Journal Club schedule for your dates and proctors.

XI. Nuclear and Echo Monthly QA’s

Each month you are expected to complete a nuclear and echo QA. They are posted in the reading room bulletin board.

XII. Cardiology Fellowship Schedules for 2016-2017

(Printed Version: Attached hereto / Digital Version: Included Separated on USB)

Rotation Schedule

Thursday Lecture Series Schedule

Journal Club Schedule

XIII. Additional Information


AOA/ACOI Professional Documents

Common Basic Standards / Internal Medicine Subspecialties

Specific Basic Standards / Cardiology

COCATS Training Overview

Contract of Interns and Residents

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XIV. Sample Forms / Evaluations


Case Presentation Evaluation

Fellow Performance Evaluation

Quarterly Evaluation

Program Director Annual Evaluation

Preceptor Ambulatory Clinic Evaluation

Program Director Annual Evaluation

360° Evaluation Forms

Fellow Leave Request

Fellow Conference Request

XV. Division of Cardiology Contact List


LIST OF ATTACHMENTS

A1_ AACOM Glossary of Osteopathic Terminology

A2_ AOA Basic Standards for Residency Training in Internal Medicine

A3_ AOA Common Basic Standards for Osteopathic Fellowship Training in Subspecialties

A4_ AOA Specific Standards for Osteopathic Training in Cardiology

A5_ COCATS

A6_ State of New Jersey Uniform Ethics Code

A7_ ROWAN-SOM Moonlighting Policy

A8_ 2016-2017 Master Rotation Schedule

A9_ 2016-2017 Journal Club Schedule with Proctors

A10_ 2016-2017 1st Quarter Lecture Schedule

A11_ 2016-2017 Osborn Clinic Schedule

A12_ Maggie’s Law

A13_ Rowan University Moonlighting Policy

A14_ STAT Echo Policy

A15_ Pre Cardiac Catheterization Guidelines 2016-2017

A16_ Daily Nuclear QA Form 2016-2017

A17_ Nuclear QA Monthly 2016-2017

A18_ Echo QA Monthly 2016-2017

A19_ Fellow time off request 2016-2017

A20_ Conference request form 2016-2017

A21_ CIR

A22_ Duty Hours Justification Form 2016-2017

A23_ 360 Evaluation Forms 2016-20167

A24_ Appendix A Fellow Performance Evaluation 2016-2017

A25_ Appendix C Program Director Annual Evaluation Report 2016-2017

A26_ Appendix D Cardiology Fellowship Quarterly Review 2016-2017

A27_ Appendix E Preceptor Ambulatory Clinic Evaluation 2016-2017

A28_ Appendix F Case Presentation Evaluation 2016-2017

A29_ Appendix G Core Competency Table of evaluating tools 2016-2017

A30_ Rowan – SOM Department of Cardiology Core Competency Plan 2016-2017

A31_ Rowan – SOM Moonlighting request form

A32_ Fellow Orientation Sign-off 2016-2017

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A33_ South Jersey Heart Group/ Lourdes Cardiology – Contact List 2016-2017

2016-2017 Cardiology Fellowship Curriculum and Program Manual

Respectfully Submitted 06/2016

__________________________________________________________

Troy L. Randle, DO FACC FACOI

Program Director

__________________________________________________________

Hafeza Shaikh, DO FACC


__________________________________________________________

Ashley Radcliffe

Program Coordinator

*revised 6/1/2016

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OVERVIEW

The Rowan University – School of Osteopathic Medicine Osteopathic Postdoctoral Training Institution of New

Jersey member hospitals include: Kennedy University Hospitals, Our Lady of Lourdes Health System,

Children’s Regional Hospital – Cooper University Hospital, Christ Hospital, K. Hovnanian Children’s Hospital –

Jersey Shore University Medical Center, South Jersey Health System and Atlantic Health Hospitals.

The Osteopathic Graduate Medical Education Internship (RESIDENCY/OGME–TR) program of Kennedy

University Hospital (KUH) and Our Lady of Lourdes Health System Camden Division (OLLC) is the

responsibility of the School and the joint efforts of the two health systems, KUH and OLLC. This

RESIDENT/FELLOW/OGME–TR Manual addresses all OGME programs at KUH and OLLC. Cooper University

Hospital, Christ Hospital, K. Hovnanian Children’s Hospital – Jersey Shore University Medical Center, South

Jersey Health System and Atlantic Health Hospitals OGME policies are addressed in separate documents.

The Assistant Dean for Graduate Medical Education, Director of Graduate Medical Education, Manager of

Postdoctoral Training, Program Development Specialist, and staff in the Office of Graduate Medical Education

at ROWAN-SOM have primary responsibility for all University functions of the OGME Programs. These

functions include: the educational program, administration, scheduling, contract management, paychecks,

benefits, collection of evaluations, and verification functions.

The ROWAN-SOM OPTI of NJ is responsible for developing the educational program and policies for the OGME1 Internship. The Chief Medical Officer at KUH and the Chief-Department of Medicine at OLLMC, have primary responsibility for all medical and medical center functions related to the Residency and OGME1 Internship programs at the respective medical centers. These functions include: medical policies and issues, responsibilities, service delivery orders, medical center policies, and evaluations of clinical rotations.

RESIDENT/FELLOW AND OGME–TR’s will report directly to, and be responsible to, a Chief of Service (clinical

faculty member) at the Division indicated on the schedule. The Chief of Service (or his/her designee) will be

directly responsible for the OGME1's assignments, responsibilities, and evaluation while on that service.

RESIDENT/FELLOWS AND OGME-TRs are employees of ROWAN. No directives by the hospital or its

employees can countermand the RESIDENT/FELLOW AND OGME1 contract, affiliation agreement, or

Committee of Interns and RESIDENT/FELLOWs (CIR) contract. If administrative problems occur, they should

be brought first to the Office of Graduate Medical Education. Medical Center based problems should be

addressed first with the Chief RESIDENT/FELLOW AND OGME1 who can mediate with the Chief of Service.

If not resolved, the Divisional Medical Director should be approached. If not resolved at that level, the Chief

Medical Officer, Program Director or Director of Medical Education will try to resolve the issue.

The Assistant Dean for Graduate Medical Education, staff in the Office of Graduate Medical Education, the

Chief Medical Officer, and the Program Directors will meet regularly to review the program and resolve general

issues. Individual issues will be handled on a case-by-case basis.

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DEFINITIONS

1. University: Rowan University (ROWAN) – The School of Osteopathic Medicine became a member of Rowan University as part of the Higher Education Restructuring act on July 1, 2013.

2. ROWAN-School of Osteopathic Medicine (ROWAN-SOM): The School of Osteopathic Medicine (SOM) is based in Stratford NJ and awards the D.O. degree. SOM also awards combined degrees which include D.O./Ph.D., D.O./J.D. and D.O./M.P.A. These degrees are granted in cooperation with other universities in the state.

3. Medical Center: Kennedy University Hospitals (KUH) [Cherry Hill, Stratford and Washington Township Divisions], Our Lady of Lourdes Medical Center - Camden and Burlington (OLLMC and OLOLB), Children’s Regional Hospital at Cooper Hospital-University Medical Center and K. Hovnanian Children’s Hospital – Jersey Shore University Medical Center, Christ-Carepoint Medical Center.

4. OPTI: Osteopathic Postdoctoral Training Institution. The method of accreditation by which the American Osteopathic Association (AOA) “approves” OGME–TR internship, residency and fellowship training programs. “ROWANSOM OPTI of New Jersey” is the official name of our OPTI, which includes the University and all member medical centers/hospitals.

Each OPTI is a community-based training consortium comprised of at least one college of osteopathic

medicine and one hospital. Other hospitals and ambulatory care facilities may also partner within an

OPTI.

OPTIs provide an enhanced quality assurance mechanism for AOA-approved postdoctoral training

programs. Partnerships and collaborations between academic medicine, hospitals and other community

based healthcare facilities are an integral part of OPTI. This collaboration helps combine the partners’

resources to minimize duplication of support services for medical education.

An OPTI provides a seamless continuum of osteopathic medical education; it also requires continuous

educational assessment. AOA approved OGME–TR internships, residencies and fellowship continue

to be reviewed regularly. This review includes a systematic self-study, and annual reporting of data on

accreditation procedures established by the Council on Postdoctoral Training and Bureau of

Professional Education.

Part of the accreditation process includes encouraging clinical medical education research. Research

programs are available to osteopathic OGME–TR (interns) and RESIDENT/FELLOW throughout the

year of training. These research programs are developed in conjunction with guidelines and

requirements of osteopathic specialty colleges for residency training programs and the council on

Postdoctoral Training for OGME-TR programs.

5. Board of Directors: The governing bodies of the affiliated medical centers.

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6. Chief Executive Officer (CEO): The President of the medical center; the individual appointed by the respective Hospital Board to act on its behalf in the overall administrative management of the medical center.

7. Dean: The individual appointed by the President and Board of Trustees of the Rowan University as Chief Executive Officer of ROWAN-SOM.

8. Assistant Dean for Graduate Medical Education: The individual appointed by the Dean of ROWAN-SOM, responsible for the clinical graduate medical educational programs.

9. Director of Medical Education: Appointed by the Medical Center in agreement with the University who is responsible for all medical education programs within the affiliated hospital.

10. Director of Graduate Medical Education: The individual in the Office of Graduate Medical Education responsible for the daily functions of the Graduate Medical Education office.

11. Manager of Postdoctoral Training: The individual in the Office of Graduate Medical Education responsible for the planning and daily functions of the OGME1 internship program.

12. Program Development Specialist: The individual in the Office of Graduate Medical Education who assists with the administration of post-graduate education program activities and with the development of plans to improve programs.

13. Chief Medical Officer: The individual appointed by the President of the Medical Center to oversee all medical programs at the medical center. The Chief Medical Officer is also referred to as the Director of Medical Education (DME).

14. Chief of Service (Department Chief): The individual faculty member appointed by ROWAN-SOM and the medical center who is responsible at the Division for the academic and patient care standards of his/her department.

15. Attending Physician: The physician assigned by the Chief of Service to implement/conduct the formal teaching program for the section/department for a specific time period.

16. Chairperson: The individual appointed by ROWAN-SOM responsible for the academic program of the Department.

17. Program Director: The individual appointed by ROWAN-SOM to implement and administer resident and fellowship training programs. This individual may or may not be the same individual as the Track Coordinator.

18. Track Coordinator: The individual appointed by ROWAN-SOM to implement aspects of the OGME1 internship program. The Track Coordinator performs reviews and evaluations of his or her OGME–TR as well as assures accreditation standards.

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19. Committee of Interns and Resident (CIR): The Housestaff organization, representing OGME–TRs and RESIDENT/FELLOWs at ROWAN, responsible for negotiating and implementing housestaff contractual services.

20. OGME: Osteopathic Graduate Medical Education. OGME1s are also referred to as “Interns”.

ARTICLE ONE: PURPOSES OF THE OGME PROGRAMS

The purposes of the OGME–TR and Residency/Fellowship Programs are as follows:

1.1 To further the graduate medical education of the OGME–TR and RESIDENT/FELLOW in preparation to

be eligible for licensure in the State of New Jersey and to enter advanced residency training programs

in primary care or specialty training.

(a) To advance competency in the management of medical diseases.

(b) To advance skills in the performance of clinical procedures.

(c) To increase the medical knowledge base.

(d) To learn responsibilities of medical staff citizenship.

(e) To appreciate quality assurance as a means of insuring optimal patient care.

(f) To be exposed to regulatory controls in the health care system.

1.2 To provide housestaff care to patients in the medical center under the direction of members of the

Medical Staff, and in so doing, provide benefits for the patient as well as giving the OGME–TR and

RESIDENT/FELLOW medical educational experience.

1.3 To teach peers and students assigned to educational programs of the medical center, and in so doing,

gain personal education and clinical, professional expertise.

1.4 To conduct research under the direction of RESIDENT/FELLOW, medical staff members, and college

faculty in order to gain additional medical education experiences.

1.5 To experience the responsibility of practice in a medical center and an office and, in so doing, prepare

for the medical records, reporting, committee responsibilities, etc., of the health care delivery system.

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1.6 To assume some administrative responsibilities within the OGME–TR AND RESIDENT/FELLOW

training program or the medical staff organizational structure, and in so doing, prepare for

responsibilities as a contributing member of a medical staff organization.

ARTICLE TWO: APPLICATION PROCEDURE

2.1 Application

Application for the OGME–TR Internship and Residency/Fellowship Programs must be submitted by

the candidate to the Office of Graduate Medical Education of ROWAN-SOM using the Electronic

Residency Application Service (ERAS). The initiation of the application process shall be instituted by

the applicant sending their application materials through ERAS.

2.1-1 Deadline for Applications

Applications must be submitted through ERAS by September 15th of the academic year

preceding the OGME1 internship.

2.1-2 Application Content

Every applicant for an OGME1 internship, residency and fellowship program must furnish

complete information concerning the following:

(a) Complete the ERAS Common Application Form

(b) Undergraduate and graduate medical training, including the name of each institution,

degrees granted and anticipated, program completed, and dates attended.

(c) Minimum of three (3) Letters of Recommendation.

(d) Official transcript reflecting all courses through Year 3 of Osteopathic Medical School.

(e) Copy of Part I, Part II CE and PE of the COMLEX National Board scores

(if applicable)

(f) Dean’s letter (g) Other information requested in the application.

2.2 Effect of Application

By sending an application through ERAS, the applicant:

(a) Attests to the correctness and completeness of all information furnished.

(b) Signifies his/her willingness to appear for an interview in connection with the application.

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(c) Agrees to abide by the terms of the OGME–TR and Residency/Fellowship Contract,

the OGME–TR and Residency/Fellowship Training Program Rules and Regulations of

the American Osteopathic Association, the Rules and Regulations of the RowanSOM

OGME–TR and Residency/Fellowship Training Program, the medical center Bylaws,

Rules and Regulations, Policies and Procedures of the medical staff as they pertain to

OGME–TRs and RESIDENT/FELLOWS and agrees to abide by the terms thereof.

(d) Authorizes and consents to University representatives consulting with those institutions

and persons who have information regarding competence and consents to the

inspection of all records and documents that may be material to evaluation of said

qualifications.

(e) Releases from any liability all those who, in good faith and without malice, review, act

on, or provide information regarding the applicant's competency, ethics, character,

health status, and other qualifications for OGME–TR and Resident/Fellow appointment.

2.3 Processing the Application

2.3-1 Applicant's Burden

(a) The applicant is required to produce adequate and correct information for a proper evaluation of his/her training, ability (knowledge and skills), ethical, and attitudinal conduct about the qualification for selection and appointment to the OGME–TR and Residency/Fellowship Training Programs, and of satisfying any reasonable request for information or clarification made by appropriate request.

(b) The applicant further understands that should an appointment be granted, the burden of providing a verifiable diploma from the osteopathic school of graduation prior to beginning the training program is the responsibility of the OGME–TR/RESIDENT/FELLOW.

(c) The responsibility of attending all required orientation programs prior to the OGME–TR/Residency/Fellowship shall be his/hers.

(d) The OGME–TR/RESIDENT/FELLOW must submit to and satisfactorily pass a physical

examination conducted by an agent of the medical center and submit to all State

Regulations regarding health standards including PPD, MMR, tetanus, polio virus,

varicella, hepatitis B and influenza vaccinations.

(e) The OGME–TR/RESIDENT/FELLOW applicant agrees to and must show verifications

that he/she has certification in ACLS and PALS prior to starting the OGME program.

Failure to do so will lead to nullification of the contract.

(f) An OGME–TR/RESIDENT/FELLOW’s employment is contingent upon the satisfactory

completion of a background check. The background check will consist of verifying

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present and past employment, criminal history, social security verification and

employment references. Additionally, educational and professional credentials and

motor vehicle records will be checked as position requirements demand. All

background checks will be conducted in accordance with the Fair Credit Reporting Act

(FCRA) and require a signed release by the applicant after an offer of employment has

been made. The signed release is a condition of University employment and shall not

be waived for any reason. If a background check disqualifies an applicant for any

reason, the applicant will be notified and given a reasonable opportunity to correct any

inaccuracies contained in the background report.

2.3-2 Verification of Information

(a) The applicant is responsible for having signed letters of reference, a completed application, Board scores, Dean’s letter, and transcripts sent through ERAS by the application deadline. The completed application is submitted to the ROWAN-SOM Office of Graduate Medical Education. The Office of GME collects these references and documents sent in support of the application.

(b) The OGME–TR/RESIDENT/FELLOW designates to which program(s) the completed application should be sent.

(c) When possible, the Office of GME will notify the applicant of any problems in receiving the information required. Upon notification, it is the applicant's obligation to obtain the required information.

(d) When collection and verification is completed, the Office of GME forwards a copy of the application to the Chairperson of the OGME program Selection Committee to determine individuals eligible for an interview.

(e) The application file is confidential and may not be reviewed by unauthorized personnel of the University or the applicant. Information submitted in support of an application for OGME–TR or Residency/Fellowship remains the property of the Office of GME and can not be forwarded/released to other parties, nor the applicant.

2.3-3 OGME–TR/RESIDENT/FELLOW Selection Committee Action

The OGME–TR and Residency/Fellowship Selection Committees are responsible for

the following actions:

(a) Review the application file and credentials.

(b) Schedule and conduct an interview with appropriate applicants.

(c) Conduct a selection process from among the candidates, indicating selections for admission to the OGME Training Program, and rank alternate candidates. Make such recommendations to the Assistant Dean for Graduate Medical Education.

2.3-4 Assistant Dean for Graduate Medical Education

(a) Review recommendations of the OGME Selection Committee and make final

selections.

(b) The Office of Graduate Medical Education shall participate in the AOA Match

Registration Program.

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(c) The Assistant Dean for Graduate Medical Education will monitor the AOA Match

process.

(d) ROWAN-SOM contracts will be issued within 10 days after the AOA matching process

is concluded. OGME–TR/RESIDENT/FELLOW must sign and return the contract

within 30 days after receiving it.

(e) The Assistant Dean for Graduate Medical Education will keep administrators apprised

of the final results of the AOA Match.

ARTICLE THREE: GENERAL QUALIFICATIONS

3.1 General Qualifications

Every OGME–TR/RESIDENT/FELLOW who seeks or enjoys membership in the OGME Training

Program, at the time of appointment and continuously thereafter, must demonstrate, to the satisfaction

of the faculty, administration, and the Governing Body of ROWAN-SOM, the Medical Staff of the

medical center, its administrative officials and Board of Directors, the following qualifications:

3.1-1 Official Transcripts

Official, verifiable transcripts showing date of completion of D.O. degree requirements from an

AOA accredited School of Osteopathic Medicine.

(a) ACLS and PALS verification.

(b) COMLEX results showing date and passing score on Part I and Part II CE and PE

prior to matriculation from medical school.

3.1-2 Performance

Continuing performance that documents medical competence and clinical skills to provide,

under supervision, optimal achievable patient care.

3.1-3 Attitude

A willingness and capacity, based upon current attitude and evidence of performance:

(a) to work, relate to, and cooperate with other OGME–TR/RESIDENT/FELLOWs,

students, medical staff members, members of other health disciplines, medical center

management, and employees, visitors and the community, in a professional manner

that is essential for maintaining a medical center environment appropriate to quality

patient care; and

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(b) to adhere to generally recognized standards of professional ethics, including proper

dress, demeanor, and conduct at all times.

3.1-4 Restrictions

To be free of or have under adequate control any significant physical or behavioral impairment

that might restrict or present a substantial probability of interfering with the qualifications

required herein, such that patient care could directly or likely be adversely affected.

3.1-5 Obligations Each OGME-TR/RESIDENT/FELLOW shall:

(a) Provide patients with care at the recognized professional level of quality and efficiency

recognized as standard at the medical center.

(b) Abide by these Rules and Regulations and by all other lawful standards, policies and

rules as they now exist or as they may be amended.

(c) Discharge such functions for which he/she is responsible.

(d) Prepare and complete, in timely fashion, all required medical records for all assigned patients and all service logs and evaluations.

(e) Log duty hours using the system identified by this training program. (f) Prepare and complete all forms required by this training program.

(g) Be a member of the AOA and abide by the AOA Code of Ethics.

(h) Satisfy the educational requirements of the program. (i) Sit for Comlex Part III during the OGME1 training year. (j) Follow the directions of the attending physician, Program Directors, Track Coordinators, Chairpersons, Directors of Medical Education, Chiefs of Service, Office of Graduate Medical Education, and all administrative persons responsible for

the conduct of this program.

ARTICLE FOUR: RESPONSIBILITIES OF THE RESIDENT/FELLOW AND OGME-TR STAFF/

REQUIREMENTS OF AOA

4.1 Provide responsible patient care under the authority of members of the medical staff to patients

assigned to their service. The number of patients assigned to the OGME1 shall not exceed an

average of fifteen at a time during a given week.

(a) Be immediately available to provide emergency care during the hours on duty (7:00 a.m. to 5:00 p.m.) and during night/weekend call unless otherwise specified by the Chief of Service. In addition to hours on duty, Monday through Friday night call is typically a 14 hour shift, and Saturday and Sunday weekend call and holiday call is typically a 24 hour shift. (b) Provide care for only those patients within the State of New Jersey for whom the OGME-

TR/RESIDENT/FELLOW is directly responsible as directed by the attending physician. The OGME–TR/RESIDENT/FELLOW may not provide care out-of-state without proper

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permission from ROWAN-SOM, licensure in that state, and training requirements of that state where service is being completed.

(c) Examine all patients admitted to the service as soon after admission as possible, to determine immediate needs of the patient, and to assess the patient's condition.

(d) Perform a complete history and physical examination, which includes an osteopathic structural exam, and record such on the chart of all patients assigned to the service.

(1) Surgical patients prior to surgery. (2) Critical patients as soon as possible. (3) All others within 24 hours of admission. (e) Write a problem oriented progress note on the patient's chart on admission; daily

thereafter, and more often as conditions demand. (f) Complete an osteopathic musculoskeletal examination on admission. (g) Write and review admission and daily orders on assigned patients only after review of

such orders with the patient's staff physician. (h) Complete all other medical chart responsibilities on patients seen within 24 hours. (i) Complete all charting responsibilities by 3 p.m. on the date of discharge. (j) Conduct rounds on all assigned patients at the beginning of and conclusion of duty. (k) Properly report to peers or supervisors at the time of leaving duty and returning to duty to

ensure continuity of care or at any time that a patient's deteriorating condition may warrant.

(l) Date and time all materials recorded on the patient's chart. (m) Beeper numbers are to be under the RESIDENT/FELLOW/OGME-TR's name. (Also

OGME level if at OLLMC) (n) Complete all medical record responsibilities prior to proceeding to the next rotation. (o) Complete all logs and evaluations prior to proceeding to the next rotation.

4.2 Conduct oneself in a professional manner at all times.

(a) Abide by the Bylaws, Rules and Regulations, Policies and Procedures of the OGME–TR and RESIDENT/FELLOW Training Program, ROWAN-SOM, the Department, the medical center, the medical staff, the New Jersey Department of Health, State Board of Medical Examiners, and the Code of Ethics of the American Osteopathic Association as they currently exist and as they from time to time may be amended.

(b) Accept patient care responsibilities and additional call (not to exceed the CIR contract limit) as assigned by the Chief of Service, Asst. Dean for Graduate Medical Education, Director of Graduate Medical Education, Manager of Postdoctoral Training, other staff in the Office of Graduate Medical Education, or Chief Scheduling RESIDENT/FELLOW.

(c) Dress Code: RESIDENT/FELLOW/OGME-TRs are expected to maintain high professional standards of dress and behavior. Appropriate male attire includes shirt with tie, trousers (not blue jeans), and a white lab coat with name tag and identification badge. Appropriate female attire includes dresses, skirts or slacks with tops, and a white lab coat with name tag and identification badge. No sandals or open toed shoes are allowed. Scrub suits are the property of the medical center and are to be worn only when required in the medical center. Scrub suits are not to be worn outside the medical center unless RESIDENT/FELLOW/OGME-TR's are specifically instructed to do so by the hospital.

4.3 Provide clinical teaching and direct supervision to all students assigned to the Service.

(a) Review, correct and approve all materials entered by the student on the appropriate history and physical form and progress record.

(b) Specifically review all student-performed history and physical exams, editing and commenting on the recorded observations.

(c) Constructively teach from clinical resources available on the service.

4.4 Participate in all assigned quality assurance activities of the hospital or medical staff, and as

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specifically assigned.

4.5 Attend assigned formal teaching programs and monthly OGME–TR/RESIDENT/FELLOW

meetings with administrators of the Program.

(a) Attend 100% of Core Lecture Series (OGME1s only). (b) Attend 100% of the department formal education programs while assigned to the service. (c) Sign the official Housestaff Attendance Sheet at every program/meeting. (d) Remediate (by assignment of the Chief) any Core Lecture Series (OGME1 only) not

attended before the conclusion of the Internship Training Program. (e) Obtain excused absence from Chief of Service for any Dept. Formal Education Programs.

4.6 Provide written documentation and obtain written approval from the Office of Graduate Medical

Education for the following:

(a) legitimate illnesses,

(b) personal days,

(c) compensatory days,

(d) float days (including your birthday),

(e) requests to attend conferences, CME programs, etc., which will require your absence,

(f) changes in your rotation schedule,

(g) changes in the on-call schedule,

(h) other leaves or absences other than scheduled vacation weeks.

Approvals must be made in advance. In the case of illness or personal tragedy, notification as

possible is required. RESIDENT/FELLOW/OGME-TRs must notify the Office of Graduate Medical

Education in writing and in advance for the need of verification of malpractice insurance; verification of

enrollment for loan deferments or permit/licensing information; or other similar requests.

4.7 The OGME–TR/RESIDENT/FELLOW is responsible for completing the evaluation forms that are

outlined in RESIDENT/FELLOW /OGME-TR Manual Appendices within the required time. These forms

are needed for conducting periodic appraisals as well as graduation from the training program. Submit all

reports on the quality of the faculty, quality of the training program, and registry of educational experiences

(performance evaluations, program service evaluations and OGME–TR/RESIDENT/FELLOW clinical

logs) on a timely basis.

(a) Service/Faculty Evaluation by RESIDENT/FELLOW/OGME-TR: Constructive critique by the OGME–TR/RESIDENT/FELLOW of the service and of the faculty. (TO BE COMPLETED AND RETURNED WITHIN FIFTEEN (15) DAYS OF THE LAST DAY OF THE ROTATION/BLOCK).

(b) OGME-TR (only) Log: A listing of all clinical patients seen during the rotation. (TO BE COMPLETED AND RETURNED WITH A SAMPLE H&P FROM THE ROTATION BY THE LAST DAY OF THE ROTATION).

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4.8 Give OGME–TR/RESIDENT/FELLOW Performance Evaluation Form to the attending physician on the

service for evaluation of clinical performance. (To be given to the attending physician by the second week on

the service and completed by attending physician within fifteen (15) days following completion of the service.)

RESIDENT/FELLOW/OGME-TRs are expected to follow-up with the attending to be sure all

performance evaluations are received by the Office of Graduate Medical Education or their appropriate

program director in a timely manner.

4.9 OGME-TR/RESIDENT/FELLOWs who are dissatisfied with the performance evaluation of their service

rotation may appeal the evaluation. The OGME–TR/RESIDENT/FELLOW should first notify the Office of

Graduate Medical Education of his/her request to challenge the evaluation. The GME staff will then inform the

service attending of the RESIDENT/FELLOW/OGME-TR's wish to challenge the evaluation and will make an

appointment to discuss the evaluation with the attending physician and the OGME-

TR/RESIDENT/FELLOW. AN OGME–TR/RESIDENT/ FELLOW who disagrees with an evaluation shall be

allowed to submit written comments which shall become part of the evaluation and placed in the OGME-

TR/RESIDENT/FELLOW’s permanent file.

4.10 Requirements of AOA:

(a) OGME-TR/RESIDENT/FELLOWs must remain members of the AOA. (b) Outside employment or moonlighting is prohibited by the AOA and by the Committee of Interns and Resident (CIR) contract for all Interns.

4.11 OGME-TRs are released from service to attend the graduation ceremony. RESIDENT/FELLOWs

are expected to attend as a requirement of the program only if excused by program director. Any

excused absence must be approved by the Office of Graduate Medical Education.

Failure to complete any of the responsibilities noted above can be considered as a first offense for Corrective Action as outlined in Section 9 of these Rules and Regulations and may lead to

Suspension from the program for a second offense.

ARTICLE FIVE: CHIEF OGME–TR/RESIDENT/FELLOWs AND CHIEF SCHEDULING OGME–TRs

5.1 Appointment

Appointment of Chief OGME–TRs and RESIDENT/FELLOWs will be made by the Assistant Dean for

Graduate Medical Education, Program Director, Director of Graduate Medical Education and Manager

of Postdoctoral Training.

5.1-1 The number of Chief OGME–TR/RESIDENT/FELLOWs will be determined by the Office of

Graduate Medical Education.

5.1-2 Appointments will be made within the first 15 days of the beginning of the training program.

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5.1-3 Chief OGME–TR/RESIDENT/FELLOWs will report directly to the professional staff in the

Office of Graduate Medical Education / Residency Program Director.

5.1-4 Chief OGME–TR/RESIDENT/FELLOWs are members of the management team for the

OGME year.

5.1-5 Chief OGME–TR/RESIDENT/FELLOWs will be paid for the services provided as outlined in the CIR contract with the University and Article 5.3-2 (c) of the Rules and Regulations.

5.1-6 Chief OGME–TRs will sign and abide by the Chief OGME–TR Agreement form.

5.2 Duties and Responsibilities of the Chief OGME–TR/RESIDENT/FELLOW and the Chief

Scheduling OGME–TR

5.2-1 The Chief OGME–TR/RESIDENT/FELLOW will:

(a) Meet on a regular basis with the Assistant Dean for Graduate Medical Education,

Director of Graduate Medical Education, Manager of Postdoctoral Training, Program

Development Specialist, staff of the Office of Graduate Medical Education, Chief

Medical Officer, Track Coordinator, Director of Medical Education, Program Director

and/or others as designated by the Assistant Dean for Graduate Medical Education,

Chief Medical Officer, or Track Coordinator.

(b) Meet with the Office of Graduate Medical Education staff regarding management of the

program, information concerning trainees in the OGME program, feedback about the

trainees in the OGME program, to discuss problems arising in the OGME training

programs and to suggest changes that would benefit the OGME training programs.

(c) OGME–TRs will take attendance at Core lectures and meetings using the Housestaff

Attendance Sheet. All Attendance Sheets should be returned to the Office of Graduate

Medical Education at the Monthly Chief OGME Meeting.

(d) Assisting in Educational Conferences including but not limited to scheduling

conferences and leading educational discussion.

(e) Transmit to the appropriate Department Chief and Chairperson any matters relating to

department policy or procedure as it pertains to patient care or education within the

department and transmit the issues and decisions of the department to OGME staff.

(f) Transmit to the Chief Medical Officer any matters relating to medical staff, corporate,

or medical center policies or procedure as it pertains to patient care or education in the

conduct of the training program, and transmit decisions, policy and procedures to the

OGME staff.

(g) Oversee compliance on the part of the OGME staff with the procedural safeguards and

Rules and Regulations of this program.

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(h) Preside at all meetings of the OGME staff to discuss problems, inform OGME staff on various issues and to offer the OGME trainees the opportunity to express and

or discuss concerns. (i) Be responsible for and appoint members of the OGME staff to participate as assigned in quality assurance activities of the medical center and medical

staff, or the OGME programs.

(j) Review and enforce compliance with standards of conduct and professional demeanor

among members of the OGME staff. Including: acting as a role model and assist in maintaining

professional atmosphere, conduct, and attitude of OGME staff and clinical clerks, be able to problem solve

and provide conflict resolution as appropriate, maintain strict confidentiality at all times.

(k) Represent the OGME staff at all organizational levels of interface with students,

RESIDENT/FELLOWs, medical staff and administration/medical center departments.

(l) Report problems at the medical center to the staff in the Office of Graduate Medical

Education.

(m) Assign on-call coverage from those OGME staff at the division if assigned OGME staff

is ill, absent, etc. The Chief OGME staff is not responsible for covering all such

activities him/herself; the Chief should distribute assignments equitably and in regard

to appropriate patient care.

(n) Assist OGME staff in obtaining service/beeper coverage when OGME staff are on vacation, on ambulatory service, etc.

(o) Provide technical assistance as needed for morning report and other educational functions that utilize the teleconferencing system.

(p) Perform other related duties as assigned by the staff in the Office of Graduate Medical Education.

5.2-2 The Chief Scheduling OGME staff will develop the OGME staff on-call schedule (weekends

and nights) at least six (6) weeks in advance of the beginning of each new rotation.

5.3 Coverage

5.3-1 There will be one Chief OGME1 or RESIDENT/FELLOW assigned for each rotation

at each division.

5.3-2 Chief OGME1 or RESIDENT/FELLOW may be selected after individual schedules have been

completed or by AOA Specialty College standards. Therefore, if for any reason due to

scheduling conflicts, personal leaves, or if there is disproportionate coverage, the following will

occur:

(a) An alternate Chief OGME1/RESIDENT/FELLOW within the Division will be designated

by the staff of the Office of Graduate Medical Education during the first month.

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(b) The relieved Chief OGME1/RESIDENT/FELLOW will be absolved of the Chief

OGME1/RESIDENT/FELLOW duties during that month.

(c) Chief OGME1/RESIDENT/FELLOW (or their replacements) will be paid for service, pro-rated over the number of rotations. The rate for a full service is determined by the CIR contract.

5.4 Resignation/Removal from Office

5.4-1 A Chief OGME1/RESIDENT/FELLOW may resign at any time by giving written notice to the Assistant Dean for Graduate Medical Education. Such resignation shall take effect on the date of receipt or at any later time by mutual agreement.

5.4-2 Removal from office may be initiated and implemented by the Assistant Dean for Graduate

Medical Education or the Director of Graduate Medical Education for the following reasons:

(a) Failure to perform duties of the position timely and appropriately;

(b) Failure to continuously satisfy the qualifications for the position; or

(c) Failure to establish and lead by example of competency or citizenship ARTICLE SIX: FORMAL EDUCATIONAL PROGRAMS/MEETINGS

6.1 Academic Year

The OGME1 2015-2016 academic year shall commence on Monday, June 15, 2015, at 7:00 a.m. and

conclude on Monday, June 20, 2016 at 7:00 a.m. The new resident/fellow year will commence on July

1, 2015

6.2 Orientation Programs

6.2-1 An OGME1 Orientation Program will be conducted prior to the first day of OGME1 Internship.

(a) The OGME1 will be notified in writing at least 28 days in advance of the dates and

times of the orientation program.

(b) OGME1 attendance is mandatory.

(c) The OGME1 shall be responsible for transportation, lodging and other expenses

incurred for the orientation program.

(d) All incoming housestaff will be paid a one time fee, as described in the CIR contract,

for attending the orientation program payable in July after all necessary University

entrance requirements are fulfilled.

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6.2-2 Divisional Orientation - Each medical center will conduct an OGME1 Orientation at a time near

the beginning of the first rotation on days preceding the starting date of the program.

6.2-3 Service Orientation - Upon entering a new service for assignment, the OGME1 shall be

oriented to the service. The OGME1 should review the Objectives, Responsibilities and

Evaluation sheet provided for each service. (See attachments in this OGME1 Manual.) The

Chief of the Department (or his/her designee) is responsible for such orientations.

(a) The OGME1 shall be responsible to contact and make appointment for such

orientation at least 24 hours before the start of the service.

(b) The Chief may delegate orientation responsibilities (Section Head, Chief

RESIDENT/FELLOW, another attending, another RESIDENT/FELLOW, etc.), but shall

be responsible for such arrangements.

(c) The Chief will review the OGME1 Rotation Objective form with the OGME1.

6.2-4 RESIDENT/FELLOW Orientation – RESIDENT/FELLOW Orientation will be held on

July 1, of each academic year. RESIDENT/FELLOWs will receive notification of

orientation schedule from their respective Program Director

6.3 Formal Lectures

6.3-1 Core Lecture Series. The OGME1 training program shall include Core Lectures at the onset

of the training program, as well as additional training as designated by the Chief Medical

Officer, Program Director, Director of Medical Education or Divisional Medical Director. Such

lectures shall be deemed by the Department Chief to be of special importance regarding

emergency care and other issues related to the care of patients of the medical center. The

OGME1 must attend all Core Lectures and sign the Housestaff Attendance Sheet, or if an

excused absence is granted, must remediate the lecture material in a manner recommended

by the Chief of the Department in a timely fashion.

6.3-2 Departmental Lectures/Educational Programs. Each department shall conduct a variety of educational and patient care programs that shall

include, but not be limited to, attending rounds, conferences, lectures, etc. The

OGME1/RESIDENT/FELLOW is required to attend all such programs and sign the Housestaff

Attendance Sheet, unless an approved excused absence is granted by the Chief of the

Department, and approved by the Chief Medical Officer, Program Director, or Director of

Medical Education.

6.4 Meetings

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The OGME1/RESIDENT/FELLOW is responsible to attend all other meetings recommended by the

University, Chief of Service, or medical center administration. This includes the monthly OGME1

meetings at the division where the rotation is being completed. The OGME1 must sign the Housestaff

Attendance sheet as indication of participation at these meetings.

6.5 External Education Programs

6.5-1 Official External Programs

(a) Formal conferences and other teaching programs, which are provided at another

division of the medical center, and which are approved as part of the official

OGME1/RESIDENT/FELLOW training program, shall be attended by the

OGME1/RESIDENT/FELLOWs with the same attendance requirements as internal

programs.

(b) An approved portion of the training program that is conducted at another institution

shall be attended by the OGME1/RESIDENT/FELLOWs with the same attendance

requirements as internal programs.

6.5-2 Non-Official Programs

Lectures, conferences, and other educational programs which are not an official part of the

OGME1/RESIDENT/FELLOW Training Program may be attended provided that:

(a) Attendance is approved by the sponsoring organization.

(b) Attendance is approved by the Attending Physician, Office of Graduate Medical

Education, Chief Medical Officer, and Track Coordinator/ Program Director.

(c) All expenses are incurred by the OGME1/RESIDENT/FELLOW.

(d) Acceptable peer-patient responsibilities are arranged and guaranteed by the

OGME1/RESIDENT/FELLOW to the satisfaction of the Department Chief, and Chief

Medical Officer, and Office of Graduate Medical Education.

ARTICLE SEVEN: RULES AND REGULATIONS GOVERNING SERVICE ASSIGNMENTS

7.1 Standard Services

The traditional rotating OGME1 internship training program will comply with the standards established

by the American Osteopathic Association (AOA) and shall include a minimum of the following:

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(a) At least six months of training rotations in any or all basic core disciplines. These include

general internal medicine, general surgery, family practice, pediatrics, obstetrics/gynecology

(ambulatory gynecology) and emergency medicine.

(b) No less than two months of exposure in general internal medicine, and must be under the

supervision of an internist.

(c) One month exposure in emergency medicine at the base institution or an affiliate

training site is required.

(d) At least one month in family practice in a hospital or ambulatory site or one-half day per

week for a minimum of 46 weeks of ambulatory exposure in a family practice continuity

of care type practice site.

(e) No more than three months of elective exposure adequate to meet the individual needs

of the OGME–TR and approved by the internship program director.

(f) All remaining time may be scheduled at the discretion of the base institution.

(g) No more than one month may be spent in non-clinical experience (research, scholarly

pursuits, administration, etc.).

(h) Exposure must occur to the support disciplines of pathology, radiology, and didactic

anesthesiology. This may occur directly by rotation or indirectly by formal conferences

and/or exposure while on medical and surgical services. This exposure must be verified

on OGME1 logs.

The family medicine, internal medicine, emergency medicine, general surgery, ob/gyn, general urology,

otolaryngology and psychiatry OGME1s will also comply with the standards established by the AOA.

7.2 Elective Services (When applicable and if available)

1. The Track Coordinators, Office of Graduate Medical Education, and Chief Medical Officers will

designate specific electives designed to provide appropriate educational experiences.

2. The OGME1/RESIDENT/FELLOW may request one or more services he/she desires in the

designated time period.

3. Electives are permitted only within the designated medical center.

4. The Office of Graduate Medical Education must approve the elective service, which must be

an AOA-recognized service.

5. If an OGME1/RESIDENT/FELLOW has not made a choice of an elective two months in

advance, the Track Coordinator/Program Director or Office of Graduate Medical Education will

designate a service and division to be covered. This may be altered only by written

permission of the Track Coordinator/Program Director or Office of Graduate Medical

Education and approval by the service that will no longer be covered.

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The Office of Graduate Medical Education reserves the right to change or alter service rotations

for educational or other purposes.

7.3 Patient Care Obligations

It is a clear premise of the ROWAN-SOM OPTI of NJ that both education and patient care obligations are of prime importance.

7.4 On Call

7.4-1 In-House Call: Nights, Weekends and Holidays (a) OGME–TR/RESIDENT/FELLOWs will not leave the hospital while on call.

(b) Call will be assigned from the full OGME1/RESIDENT/FELLOW group not to exceed

the number of calls allowed by the AOA Basic Standards and CIR contract with the

University.

(c) The staff in the Office of Graduate Medical Education, Hospital Director of Medical Education, Track Coordinator/Program Director, and the Chief OGME–TR/RESIDENT/FELLOW are empowered with the authority to assign OGME–TR/RESIDENT/FELLOW to in-house or from home call to meet patient care standards (in accordance with the Agreement between ROWAN and the CIR).

(1) Coverage assignments may not exceed those established in the CIR contract.

(2) Regular assignments to in-house call shall not exceed in excess of an average

of every third night in each and every 30-day period.

(3) In cases of emergency, where it is deemed necessary for patient care standards to be met, the Chief OGME1, RESIDENT/FELLOW, the Chief Medical Officer, Track Coordinator/Program Director, and staff in the Office of GME have the authority to request an OGME1 not in-house to be on-call and to respond if needed.

(4) All University and hospital duties and regulations regarding call must be adhered to strictly.

7.4-2 If patient care demands so dictate, the staff in the Office of Graduate Medical Education, are authorized to give weekdays off in lieu of scheduling weekend duty so long as such scheduling does not significantly effect the educational aspects of the OGME1/RESIDENT/FELLOW’s experience.

7.4-3 Emergency/Unusual Situation

The Chief Medical Officer, Track Coordinator/Program Director, and Director of Medical

Education have the responsibility of ensuring the educational experiences of the

OGME1/RESIDENT/FELLOW and the patient care obligation of the medical center. As such,

he/she is authorized to temporarily alter any schedule to ensure a better educational

experience or to provide emergency patient care.

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7.5 General Medical Rules and Regulations

7.5-1 Verbal Orders: Protocol for voice orders is in accordance with individual hospital policy.

7.5-2 Time/Date: Orders and other chart documentation will be invalid unless dated and timed

7.5-3 Legibility: Illegibly written orders are invalid.

7.5-4 Signature: All materials written in a patient chart by an OGME1/RESIDENT/FELLOW shall be

signed by the OGME1/RESIDENT/FELLOW including the beeper number and written on

behalf of a licensed physician responsible for the case (Example: Dr. Attending/Dr. OGME1,

Beeper #1234).

7.5-5 Sequence of Record: All materials written on a chart will be written in appropriate sequence

after the last entry.

7.5-6 Stop Order: The OGME1/RESIDENT/FELLOW shall be responsible to notify the attending of any pending stop-order of drugs and seek advice on further continuation of the drug.

7.5-7 Informed Consent: The OGME1/RESIDENT/FELLOW will abide by the intent of the Informed Consent Policy and Procedure of the medical center.

7.5-8 “No Code" or "DNR": The OGME1/RESIDENT/FELLOW will abide by the intent of the Policy and Procedure of the "No Code Policy" of the medical center.

7.5-9 Consultations: An OGME1 shall not perform a consultation. The OGME1's activities may

include obtaining a history and physical examination and reports of necessary evaluations, but

shall not include rendering medical opinion or recommendations. All activities of the OGME1

in this request shall be directly supervised by the consultant.

7.5-10 First Associate for Major Surgery: In elective major surgery, an OGME1/RESIDENT/ FELLOW shall serve as a first Associate only when under the direction of a licensed physician

and in full compliance with State regulations.

7.5-11 Invasive Procedures: An OGME1/RESIDENT/FELLOW shall perform invasive procedures only under the direct supervision of a licensed physician on the Medical Staff of the medical center who is granted such privilege by the Governing Board.

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7.5-12 Osteopathic Musculoskeletal Examination: Required as an integral part of the physical examination performed by osteopathic physicians on their admitted patients unless contraindicated.

7.5-13 At Our Lady of Lourdes, all OGME1/RESIDENT/FELLOWs (registered practitioners) must clearly write their “OGME” status in addition to their officially recognized signature and title after every entry on every medical chart (e.g. “John Doe”, OGME1 Beeper #--). OGME1/RESIDENT/FELLOWs are encouraged to use the signature stamp that will be provided by Our Lady of Lourdes after every entry on medical charts.

ARTICLE EIGHT: CONFIDENTIALITY, IMMUNITY AND RELEASES

8.1 Definitions

The following definitions shall apply.

(a) Information: record of proceedings, minutes, interviews, records, reports, forms, memoranda,

statements, recommendations, findings, evaluations, opinions, conclusions, actions, dates

and other disclosures or communications whether in written or oral form relating to any of the

subject matter specified in the Rules and Regulations.

(b) Representative: an official of a medical school, Board of any medical center and any director,

administrator, or committee thereof; a medical center Chief Executive Officer or his designee,

a College/University or medical school faculty member, an officer of any clinical or academic

training program, or any individual authorized by any of the forgoing to perform any specific

information gathering, analysis, use or disseminating function.

(c) Activities: all acts, communications, proceedings, memoranda, statements, recommendations,

findings, evaluations, opinions, conclusions, or disclosures performed or made in connection

with this or any health care facility's or organization's activities.

8.2 Authorizations

By submitting an application for admission to the OGME1/RESIDENT/FELLOW Training Program, the

OGME1/RESIDENT/FELLOW:

(a) Authorizes representatives of the ROWAN-SOM and the medical center to solicit, provide and

act upon information bearing on his/her training and qualifications.

(b) Agrees to be bound by the provisions of these Rules and Regulations.

(c) Agrees to be bound by the provisions of this article in the release of information by the

ROWAN-SOM and medical center, as recorded during the OGME training program, and

described in this Article as Activities and Information covered, to any agency requesting such

information in accordance with his/her written consent.

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(d) Acknowledges that the provisions of this Article are conditions to any application for OGME

training programs.

8.3 Confidentiality of Information

Information with respect to any applicant for OGME training submitted, collected or prepared by any

representative of this or any other health care facility or organization, or medical staff, or medical school

for the purpose of evaluating the candidate for acceptance to the OGME Training Programs or for

concurrent evaluation of the OGME candidate with regard to progress to fulfill requirements of

graduation from the OGME Training Program, and as such information regards evaluation toward

advancement toward further training or the documentation of competency to treat conditions or perform

medical procedures, shall be confidential and shall not be disseminated to anyone other than a

representative. This information shall not be used in any way except as provided herein or except as

otherwise required by law. Such confidentiality shall also extend to information of like kind that may be

provided by third parties. This information shall not become part of any patient's records.

8.4 Immunity from Liability

No representative of the University, medical centers, or medical staff and no third party shall be liable to

an OGME trainee for damages or other relief by reason of providing information, including otherwise

privileged or confidential information, to a representative of the medical centers or medical staff or to

any other health care facility or organization of health professionals concerning an OGME who is or has

been a member of the OGME staff, provided that such representative or third party acts in good faith

and without malice and provided further that such information is related to the performance of the

individual as it relates to attitude, knowledge and skills of the OGME staff, and is reported in a factual

manner.

8.5 Activities and Information Covered

8.5-1 Activities

The confidentiality and immunity provided by this Article applies to but is not limited to:

(a) Periodic reappraisals for progress in the OGME Training Program.

(b) Verifications of completion of the OGME training program.

(c) Application for further training in residency or fellowship fields.

(d) State licensure boards.

(e) Applications for appointments, clinical privileges, or specified service to this or other

health care facilities.

(f) Profiles and profile analysis.

(g) Quality assurance activities.

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(h) Other medical center and staff activities related to monitoring and maintaining quality

and efficient patient care and professional conduct.

8.5-2 Information

The information referred to in this Article may relate to the OGME staff's professional

qualifications, clinical ability, judgment, character, physical or mental health, emotional

stability, professional ethics, or any other matters that might directly or indirectly affect patient

care.

8.6 Releases

Each applicant for OGME training shall execute general and specific releases in accordance with the

tenor and import of this Article, subject to such requirements, including those of good faith, absence of

malice and the exercise of a reasonable effort to ascertain truthfulness, as may be applicable under the

laws of this State.

8.7 Program Director Letters/Verifications

The Asst. Dean for Graduate Medical Education is responsible for signing Program Director Letters and

verifications for KMH/OLL OGME1s. The OGME1s must complete the request for Program Director’s

letter and release for immunity form and submit it with the appropriate fee. Requests must be made at

least four (4) weeks in advance of the date the letter(s) are needed. See instructions for “OGME1

Program Director’s Letters” and “Authorization for Release of Information for OGME1 Program

Director’s Letters” in the Appendices of the Internship Manual.

ARTICLE NINE: CORRECTIVE ACTIONS

9.1 Purpose

The corrective actions in this Article apply to academic and medical judgment issues. In compliance

with the Agreement between ROWAN and the Housestaff Organization of ROWAN/Committee of

Interns and Residents (CIR), actions regarding terms and conditions of employment will be subject to

provisions of the Agreement between ROWAN and the CIR.

9.2 Routine Corrective Action

Whenever an OGME–TR and RESIDENT/FELLOW engages in, makes or exhibits acts, statements,

demeanor or professional conduct, either within or outside of the medical center, and the same is or is

reasonably likely to be detrimental to patient safety or to the delivery of quality patient care, disruptive

to medical center operations or an impairment to the community's confidence in the medical center

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and/or its OGME–TR/RESIDENT/FELLOW training program, corrective action against the OGME–

TR/RESIDENT/FELLOW may be initiated by any University administrator, officer of the medical staff,

by the Chief or Program Director of any Department, by the Chief Executive Officer of the corporation,

Administrator of the Division, or corporate officer.

9.2-1 Requests and Notices

All requests for corrective action must be in writing, submitted to the Assistant Dean for

Graduate Medical Education, and supported by references to the specific activities or conduct

which constitutes the grounds for the request. The Assistant Dean for Graduate Medical

Education will promptly notify the Dean, ROWAN-SOM and the representative of the hospital

(Chief Medical Officer or Program Director).

9.2-2 Investigation

The Dean (or his/her designee) will conduct, or order to be conducted, an investigation

concerning the grounds for the corrective action request. The investigation is not a "hearing,"

but may include a discussion with the person(s) initiating the request, and with other

individuals who may have knowledge of the events involved. The OGME–

TR/RESIDENT/FELLOW is entitled to make a personal appearance before the investigative

person(s) at a time scheduled to discuss the matters pertaining to his/her standing. During

that appearance before the investigative person(s), the OGME–TR/RESIDENT/FELLOW may

be accompanied by one fellow OGME–TR/RESIDENT/

FELLOW and one or two other faculty members or personnel of the ROWAN-School of

Osteopathic Medicine. Upon completion of the investigation, a written report will be prepared

for the Dean. The Dean may then direct subordinates to proceed with action as provided

below.

(a) Recommend rejection of the request for corrective action.

(b) Recommend admonition in the form of a formal letter.

(c) Recommend a warning in the form of a formal letter.

(d) Recommend a probationary period.

(e) Recommend a period of suspension that must be remediated during or after the

conclusion of the residency.

(f) Recommend termination of the OGME training.

The OGME–TR/RESIDENT/FELLOW may appeal the decision of the investigation to the

Dean. During that appearance, the OGME-TR/RESIDENT/FELLOW may be accompanied by

one fellow OGME-TR/RESIDENT/FELLOW and one or two other faculty members or

personnel of the ROWAN-School of Osteopathic Medicine.

The decision of the Dean or his designee is final.

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9.2-3 Records

(a) Following investigation, any corrective measures listed under Article 9.2-2 (c-f) shall

become a part of the OGME–TR/RESIDENT/FELLOWS's permanent Credentials File

and are subject to disclosure as presented in Articles 8.1 to 8.6 of these Rules and

Regulations.

(b) A second or subsequent admonition (9.2-2 (b) will also become part of the OGME–

TR/RESIDENT/FELLOWS's permanent credentials file.

9.3 Summary Suspension

Whenever an OGME–TR/RESIDENT/FELLOWS's conduct requires that immediate action be taken to

protect the life of any patient or to reduce the substantial likelihood of injury or damage to the health or

safety of any patient, employee or other person present in the medical center, the Assistant Dean for

Graduate Medical Education, Director of Graduate Medical Education, Manager of Postdoctoral

Training, Chief of Service, Track Coordinator/Program Director, Chief Medical Officer, or their

respective designated representative has the authority to summarily suspend the OGME–

TR/RESIDENT/FELLOW. A summary suspension is effective immediately upon imposition, and the

person imposing the suspension is to give prompt notification of the suspension to the OGME-

TR/RESIDENT/FELLOW, Assistant Dean for Graduate Medical Education, Director of Graduate

Medical Education, Manager of Postdoctoral Training, Chief of Service, Track Coordinator/Program

Director, and the Chief Medical Officer. The procedure for further action on summary suspension is set

forth under sections 9.2-1 through 9.2-3 above.

9.3-1 As soon as possible, however no longer than within 72 non-weekend/non-holiday hours after

a summary suspension is imposed, the Dean (or his respective designee) will discuss and

recommend continuation, modification, or termination of the suspension.

9.3-2 Unless the recommendation is to terminate or modify the suspension to one of lesser

sanctions (i.e., 9.2-2 (a-d)), the OGME–TR/RESIDENT/FELLOW will remain suspended until

the investigation as described in Article 9.2-2 is completed.

9.3-3 Actions then follow in accordance with Article 9.2-2 and 9.2-3.

9.4 Automatic Suspension

Automatic suspensions occur: (1) after first offense (when warned of failure to comply with timely

preparation and completion of medical records, or logs, or evaluations; unexcused absences from

service or call schedule; improper conformity to dress code; conduct; attitude; or availability or

completion of OGME–TR/RESIDENT/FELLOW’s responsibilities as outlined in Article 4.1 to 4.10), or

(2) the second offense.

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Corrective Action:

(a) First offense: The OGME–TR/RESIDENT/FELLOW may not continue to the next rotation and

a warning will be given in writing to the OGME–TR/RESIDENT/FELLOW by the Chief Medical

Officer, Track Coordinator/Program Director, Chief of Service, Asst. Dean for Graduate

Medical Education, Director of Graduate Medical Education or Manager of Postdoctoral

Training and will become a part of the OGME–TR/RESIDENT/

FELLOW's Credentials File. The Asst. Dean for Graduate Medical Education will receive a

copy of the warning for placement in the OGME-TR's/RESIDENT/FELLOW’s file.

(b) Second offense: The OGME–TR/RESIDENT/FELLOW will be automatically suspended. The

OGME–TR/RESIDENT/FELLOW will be required to meet with the Asst. Dean for Graduate

Medical Education, Director of Graduate Medical Education, Manager of Postdoctoral

Training, and/or the Chief Medical Officer. After such interview, further corrective action may

be imposed and may include suspension, termination of the OGME–TR/RESIDENT/FELLOW,

or other measures as outlined in 9.2-2 (b - f). These actions shall become a part of the

OGME-TR/RESIDENT/

FELLOW's Credentials File.

(c) All corrective action obligations must be fulfilled before the OGME–TR/RESIDENT/

FELLOW will receive the official certificate of completion of their OGME–TR/

RESIDENCY/FELLOWSHIP training.

9.5 Specifics

9.5-1 Attendance Requirements

Failure to meet the attendance requirements of the formal training program including call schedule and lectures shall be remediated in a manner established by the Asst. Dean for Graduate Medical Education, Director of Graduate Medical Education, Manager of Postdoctoral Training, the Chief Medical Officer and Track Coordinator /Program Director. Unapproved absences from a service obligation or on-call will be considered as a first offense for possible dismissal from the program as noted in 9.4

(a-c). These obligations will be fulfilled before the OGME–TR/RESIDENT/FELLOW will receive the official certificate of completion of their OGME–TR/RESIDENCY/

FELLOWSHIP Training.

9.5-2 Medical Records

Medical Records for patients assigned to OGME–TR/RESIDENT/FELLOW must be completed in a timely fashion. Failure on the part of the OGME–TR/RESIDENT/

FELLOW to fulfill his/her medical record obligations within the time frame outlined in this document, shall result in the actions as outlined under Article 9.4 (a-c).

9.5-3 Logs and Evaluations

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Service logs and evaluations of service and faculty must be completed in a timely fashion.

Failure on the part of the OGME–TR/RESIDENT/FELLOW to fulfill his/her logs/evals

obligations within the time frame outlined in this document, shall result in the actions as

outlined under Article 9.4 (a–c).

9.5-4 Dress Code-Proper Conformity

Failure of the OGME–TR/RESIDENT/FELLOW to abide by the stated dress code policy (4.2

c) shall result in the same corrective action as outlined under Article 9.4 (a-c)

9.5-5 Conduct, Attitude, Availability

Failure of the OGME–TR/RESIDENT/FELLOW to abide by the standards of conduct, attitude

and availability as set forth, shall be subject to the same corrective action as outlined under

Article 9.4 (a-c)

9.6 OGME Evaluation (Remediation)

Evaluations of OGME–TR/RESIDENT/FELLOW performance will be completed by clinical faculty

within fifteen days (15) of completion of each month's service or block. The Track Coordinator/

Program Director shall have ultimate responsibility for review of the evaluation with the OGME–

TR/RESIDENT/FELLOW. Any remedial recommendations must be fulfilled in a timely fashion by

the OGME–TR/RESIDENT/FELLOW. All incomplete or remedial work must be completed to the

satisfaction of the Chief of Service, Track Coordinator/Program Director, Director of Medical

Education, and the Assistant Dean for GME before an official certificate of OGME–TR/

RESIDENT/FELLOW training is presented to the OGME–TR/RESIDENT/FELLOW.

ARTICLE TEN: GRANTING OF CERTIFICATE OF COMPLETION OF OGME–TR/RESIDENCY/

FELLOWSHIP PROGRAMS

On satisfactory completion of an OGME–TR/RESIDENCY/FELLOWSHIP training program, ROWAN-SOM

OPTI of NJ shall award the certificate of completion. All OGME1R trainees will be issued a letter of completion

for the AOA approved OGME1R year, in the appropriate specialty by ROWAN-SOM, for licensing purposes.

This letter will be provided at the end of the first year. The certificate/letter shall confirm the successful

fulfillment of the program requirements, the starting and completion dates of the program, the name(s) of the

training institution, and program director(s). Such certificate/letters will be granted to the OGME–

TR/RESIDENT/FELLOW only after the following requirements have been met.

10.1 OGME–TR/RESIDENCY/FELLOWSHIP Performance Evaluations are received and satisfactorily

document all fifty-two weeks of each year of OGME training in accordance with AOA regulations

and the OGME Training Program.

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10.2 Any remediation recommended on OGME–TR/RESIDENT/FELLOWS Performance Evaluations

has been satisfied, verified by the Track Coordinator/Program Director and reported to the Office

of Graduate Medical Education.

10.3 Any remediation required for attendance at Core Lecture or Departmental progress is satisfied

and reported to the Office of Graduate Medical Education.

10.4 Any corrective action measures taken have been satisfied and reported to the Office of Graduate

Medical Education.

10.5 Any fair hearing proceedings have been completed and corrective actions satisfied and reported

to the Office of Graduate Medical Education.

10.6 All service evaluations by the OGME1/RESIDENT/FELLOW, faculty evaluations by the OGME-TR

/RESIDENT/FELLOW, and all logs are completed and submitted to the Office of Graduate

Medical Education.

10.7 All University and medical center supplies, materials, equipment, books, beepers, passes, and

records have been satisfactorily returned and verified.

10.8 All medical records for patients assigned to the OGME1/RESIDENT/FELLOW have been

satisfactorily completed at each division of the medical center.

10.9 The OGME1 must sit for Part III of the COMLEX.

ARTICLE ELEVEN: OGME - 1 DUTY HOUR REQUIREMENTS

11.1 TRAINEE DUTY HOURS POLICY

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11.1-1 The base institution, DME, and program directors must make every attempt to avoid scheduling

excessive work hours leading to sleep deprivation, fatigue or inability to conduct personal

activities.

(a) The institution policy must be reported in the house staff manual and available for

review at all program site reviews.

(b) Evidence of review of OGME–TR/RESIDENT/FELLOW duty hours by the medical

education committee (MEC) must occur quarterly.

11.1-2 The trainee shall not be assigned to work physically on duty in excess of 80 hours per week

averaged over a 4-week period, inclusive of in-house night call and any allowed moonlighting.

No exceptions to this policy should be permitted.

11.1-3 The trainee shall not work in excess of 24 consecutive hours.

(a) Allowances for already initiated clinical care, transfer of care, education debriefing

and formal didactic activities may occur, but shall not exceed 4 additional hours and

must be reported by the RESIDENT/FELLOW in writing with rationale to the DME/Program

Director and reviewed by the MEC. These allowances are not permitted for OGME1

trainees.

(b) RESIDENT/FELLOWs shall not assume responsibility for a new patient or any new

clinical activity after working 24 hours.

11.1-4 The trainee shall have 48-hour periods off on alternate weeks, or at least one 24-hour period off

each week and shall have no call responsibility during that time.

11.1-5 Upon conclusion of a 20-24 hour duty shift, trainees shall have a minimum of 12 hours off

before being required to be on duty or on call again.

(a) Upon completing a duty period of at least 12 but less than 20 hours, a minimum period

of 10 hours off must be provided.

11.1-6 All off-duty time must be totally free from clinical, on-call and education activity.

11.1-7 Rotations in which a trainee is assigned to Emergency Department duty shall ensure that trainees work no longer than 12 hour shifts with no more than 30 additional minutes allowed for transfer of care and shall be required to report in writing to the DME/Program Director for review by the MEC, only any time exceeding the 30 additional minutes, for monitoring individual RESIDENT/FELLOWs and program.

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11.1-8 In cases where a trainee is engaged in patient responsibility which cannot be interrupted

at the duty hour limits, additional coverage shall be provided as soon as possible by the

attending staff to relieve the RESIDENT/FELLOW involved. Patient care responsibility is not

precluded by the duty hours policy.

11.1-9 The trainee shall not be assigned to in-hospital call more often than every third night averaged over any consecutive four-week period. Home call is not subject to this policy, however, must satisfy the requirement for time off. Any time spent returning to the hospital must be included in the 80 hour maximum limit.

11.1-10 At the trainee’s request, the training institution must provide trainees with comfortable sleep facilities to trainees who are too fatigued at shift conclusion to safely drive.

11.1-11 Any trainee OGME2 and above who works 24 consecutive hours may spend additional

time of no more than 30 minutes providing transfer of care / patient sign-out to receiving

physicians and staff without the need to report this time to the DME/Program Director. Any

other activity or longer timeframe will require a written report.

11.1-12 RESIDENT/FELLOWs are permitted to return to the hospital while on home-call to care for new or established patients. Each episode of this type of care, while it must be included in 80-hour weekly maximum, will not institute a new “off-duty” period. Faculty must be aware of the home-call responsibilities of their RESIDENT/FELLOWs recognizing fatigue and sleep deprivation. They must alter schedules and counsel RESIDENT/FELLOWs as necessary.

11.1-13 The ROWAN-SOM KUH/OLLMC work hour policy is subject to review and revision on an as needed basis.

11.2 MOONLIGHTING POLICY FOR TRAINEES

11.2-1 Any professional clinical activity (moonlighting) performed outside of an official residency

program will only be conducted with the permission of the program administration

(DME/program director) and must not interfere with the RESIDENT/FELLOW’s didactic or

clinical performance.

(a) A written request by the RESIDENT/FELLOW must be approved or disapproved by the

program director and DME and be filed in the institution’s RESIDENT/FELLOW file.

(b) This policy must be published in the institution’s house staff manual. Failure to report

and receive approval by the program may be grounds for terminating a

RESIDENT/FELLOW’s contract.

11.2-2 If moonlighting is permitted, hours shall be inclusive of the 80 hour per week maximum work

limit and must be reported and monitored by the MEC.

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11.2-3 OGME1 trainees shall be prohibited from moonlighting.

11.3 TEACHING FACULTY

Faculty must be educated in recognizing early fatigue and sleep deprivation and to alter schedules and

counsel RESIDENT/FELLOWs as necessary, while maintaining continuity of patient care.

Adapted from the Accreditation Council for Graduate Medical Education May 2004, REVISED JULY 2011

ARTICLE TWELVE: CORE COMPETENCY COMPLIANCE

The American Osteopathic Association requires DME’s and Program Directors to implement training, and

Program Evaluators to assess, the AOA Core Competencies in all AOA training programs.

12.1 Osteopathic Philosophy Principles and Manipulative Treatment

RESIDENT/FELLOWs are expected to demonstrate and apply knowledge of accepting standards

in OPP/OMT appropriate to their specialty. The educational goal is to train a skilled and

competent osteopathic practitioner who remains dedicated to life-long learning and to practice habits

in osteopathic philosophy and manipulative medicine.

12.2 Medical Knowledge and Its Application Into Osteopathic Medical Practice:

RESIDENT/FELLOWs must demonstrate and apply integrative knowledge of accepted standards

of clinical medicine and OPP in their respective osteopathic specialty area, remain current with new

developments in medicine, and participate in life-long learning activities, including research.

12.3 Osteopathic Patient-Care

Osteopathic RESIDENT/FELLOWs must demonstrate the ability to effectively treat patients,

provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of

behavioral issues, the incorporation of preventive medicine, and health promotion.

12.4 Interpersonal and Communication Skills in Osteopathic Medical Practice:

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RESIDENT/FELLOWs are expected to demonstrate interpersonal and communication skills that

enable them to establish and maintain professional relationships with patients, families, and other

members of health care teams.

12.5 Professionalism in Osteopathic Medical Practice:

RESIDENT/FELLOWs are expected to uphold the Osteopathic Oath in the conduct of their

professional activities that promote advocacy of patient welfare, adherence to ethical principles,

collaboration with health professionals, life-long learning, and sensitivity to a diverse patient

population. RESIDENT/FELLOWs should be cognizant of their own physical and mental health in

order to care effectively for patients.

12.6 Osteopathic Medical Practice-Based Learning and Improvement:

RESIDENT/FELLOWs must demonstrate the ability to critically evaluate their methods of clinical

practice, integrate evidence-based traditional and osteopathic medical practices into patient care,

show an understanding of research methods, and improve patient care practices.

12.7 System-Based Osteopathic Medical Practice:

RESIDENT/FELLOWs are expected to demonstrate an understanding of health care delivery

systems, provide effective and qualitative osteopathic patient care within the system, and practice

cost-effective medicine.

The core competencies shall be taught and assessed throughout the OGME1 internship year by a variety of

methods as indicated in the ROWAN-SOM OPTI Core Competency Plan.

Adapted from the American Osteopathic Association March 2, 2004 REVISED: JANUARY 2011

ARTICLE THIRTEEN: AOA PROGRAM CLOSURE OR REDUCTION REQUIREMENTS:

13.1 In the event of a discontinuation of a training program, the University agrees that it will make every effort to place displaced HSO in another appropriate University (ROWAN) program, or if

necessary, a program outside the University.

13.1-1 The training institution shall immediately notify the AOA, its OPTI and its trainees of a program closure or reduction in positions, which would impact trainees prior to program completion.

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13.1-2 If a training institution reduces in size or closes a program every attempt should be made to permit the current OGME-TR/RESIDENT/FELLOWs enrolled in the program to complete their training prior to such action.

13.1-3 In the event of a hospital or program closure or reduction in positions, which would impact trainees prior to program completion, the training institution shall immediately notify the OPTI to aid in placement of the enrolled OGME-TR/RESIDENT/FELLOWs in other AOA, approved programs within the OPTI structure.

13.1-4 Severance pay shall be provided for two months when institutional program closure or reduction decisions prevent the OGME-TR/RESIDENT/FELLOWs from program completion in that or another geographically proximate program arranged by the institution and/or the OPTI.

ARTICLE FOURTEEN: RESIDENT/FELLOW NON-RENEWAL HEARING PROCEDURE

14.1 Policy Each Graduate Medical Education (GME) program shall provide a grievance procedure for house

officers who wish to appeal a notice of non-renewal of the house officer’s contract. Each School shall

provide for the appointment of an Ad Hoc Non-Renewal Committee to conduct the grievance

procedure, and all such committees shall review non-renewal appeals in accordance with the standards

set forth in this policy.

14.2 Procedure

14.2-1 A house officer may appeal a Program Director’s decision not to renew the house officer’s

contract for the following academic year by submitting a written request to the Department

Chair within five (5) working days of receipt of notice of the decision.

14.2-2 If the house officer submits timely notice of appeal, the Department Chair shall convene a

Non-Renewal Committee to consider the appeal. The Non-Renewal Committee shall be

composed of either:

(a) the Department Chair, the Assistant Dean of Graduate Medical Education, or their designees, and one faculty member designated by the Chair of the GME Committee, or

(b) such other individuals as designated by the GME policies of the School.

14.2-3 The house officer will be invited to meet with and make a personal presentation to the

Non-Renewal Committee and may be accompanied by a faculty member or fellow house

officer who may act as an advisor. The house officer may also be accompanied by a

representative of the CIR, who shall not participate in the proceedings. The Non-Renewal

Committee may invite the Program Director and any other witnesses to make

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presentations. All parties may submit any relevant information to the Non-Renewal

Committee prior to or during the hearing.

14.2-4 The Non-Renewal Committee shall consider only whether the non-renewal conforms to

the following standards:

(a) the decision was communicated to the house officer in writing; (b) the decision was communicated in a timely manner, in accordance with ROWAN

procedure on non-renewal of house officer contracts; and (c) the non-renewal decision was not based on reasons prohibited by law or ROWAN

policy.

If the Non-Renewal Committee determines that the non-renewal decision

conforms to these standards, the decision shall be upheld.

14.2 Following the hearing, the Non-Renewal Committee shall deliberate and render a written decision, which shall be communicated to the house officer and Program Director. The decision of the

Non-Renewal Committee will be final and binding.