Resident Handbook 2008

8/4/2019 Resident Handbook 2008

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UCSF

DermatologyResidencyHandbook

2008-2009


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Table of Contents Page Nos.I) Introduction................................................................................................................. 4

A) Accreditation and Sponsoring Institution ................................................................ 4

B) Program Director .................................................................................................... 4

II) Resident Selection and Appointments...................................................................4-6

A) Resident Selection..................................................................................................4

B) Resident Appointments .......................................................................................4-6III) Program Curriculum.................................................................................................6-9A) Written Statement of Goals and Objectives............................................................6

B) Teaching Methods.................................................................................................. 6

C) Organization of Didactic and Clinical Curriculum ................................................6-9

IV) Responsibilities of the UCSF Dermatology Resident .........................................9-14

A) General Educational Goals and Objectives for Each Rotation ..........................9-10

B) Clinic Performance Additional Expectations......................................................... 10

C) Clinic Attendance.............................................................................................10-11

D) On-Call ................................................................................................................. 11

E) Evaluations of Faculty, Rotations, Self, Peers, and Program..........................11-12

F) Evaluations of Medical Students .......................................................................... 12

G) Chief Resident ...................................................................................................... 12

H) Managed Care and Prior Authorization for Services ............................................ 12

I) Skin Cancer Screening....................................................................................12-13

J) Audiovisual Support..............................................................................................13

K) Grand Rounds Photography.................................................................................13

L) Resident Teaching................................................................................................ 13

M) Resident Expert Talks .......................................................................................... 13

N) Research/Publications.......................................................................................... 13

O) American Board of Dermatology Annual In-Training Exam.................................. 14

P) ACGME Case Log................................................................................................ 14

Q) ACGME Case Log................................................................................................14

V) Mount Zion Dermatology Clinics/UCSF Wards..................................................14-15A) Locations and Access......................................................................................14-15

B) Parking and Transportation ..................................................................................15

C) Specialty Clinics ................................................................................................... 15

VI) San Francisco General Hospital Dermatology Clinics and Consultations ..........16

A) Location and Access ............................................................................................ 16


C) Clinics ................................................................................................................... 15

D) Admitting Patients.................................................................................................16

E) On-Call ................................................................................................................. 16

F) Quality Assurance ................................................................................................16

G) Chart Notes and Prescriptions.............................................................................. 16VII) San Francisco Veterans Affairs Medical Center Dermatology Clinics and

Consultations........................................................................................................17-18

A) Location and Access ............................................................................................ 17


C) Clinic..................................................................................................................... 17

D) Resident Responsibilities ................................................................................17-18

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RESIDENCY HANDBOOK 2008-2009

VIII) Resident Leave .....................................................................................................18-21

A) Annual Leave...................................................................................................18-21

1) Vacation

2) Education Leave and Travel Stipend

3) Other Leave

4) Leave Request Process

5) Senior Resident Electives

IX) Evaluation of Residents.......................................................................................21-22A) ACGME Six Competencies .............................................................................21-22

B) Formal Program Director Evaluations ..................................................................22

C) Filing of Evaluations .............................................................................................22

X) Moonlighting.........................................................................................................22-23

A) Introduction........................................................................................................... 22

B) Resident Responsibility ...................................................................................22-23

C) Program Responsibility......................................................................................... 23

D) Internal and External Moonlighting ....................................................................... 23

XI) Duty Hours and Resident Fatigue.......................................................................23-25A) Duty Hours.......................................................................................................23-24

B) On-Call Activities .................................................................................................. 24C) Methodology for Data Collection .......................................................................... 24

D) Stress and Fatigue ..........................................................................................24-25

1) Education

2) Monitoring Methodology

3) Back-Up Systems for Fatigue

XII) Resident Supervision................................................................................................ 25

A) Faculty Supervision of Residents in Clinics.......................................................... 25

B) Faculty Supervision of Residents During On-Call Activities ................................. 25

XIII) Academic Due Process........................................................................................25-26

XIV) Resident Well-Being.................................................................................................. 26

XV) Sexual Harassment and Non-Discrimination.......................................................... 26A) Policy .................................................................................................................... 26

B) Resources ............................................................................................................26

XVI) UCSF School of Medicine guidelines for Interactions Among UCSF Faculty,Students and Staff, and Industry ........................................................................27-30

A) Guidelines Regarding School of Medicine Relationships with Industry...........27-28

B) Industry Support for Educational Programs.....................................................28-29

C) Provision of Scholarships or Other Educational Funds for Studentsand Trainees......................................................................................................... 29

D) Disclosure of Relationships with Industry ........................................................29-30

E) Access by Sales and Marketing Representatives to Faculty,

Staff and Students................................................................................................30XVII) Additional Policies ...............................................................................................30-31

A) Parking ............................................................................................................30-31

1) Moffitt-Long

2) San Francisco General Hospital

3) Veterans Administration Medical Center

4) Mt. Zion Medical Center

B) Additional Information on GME Services and Policies .........................................31

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I) Introduction

A) Accreditation and Sponsoring Institution

1) The University of California, San Francisco, Dermatology Residency TrainingProgram is fully accredited by the Accreditation Council for Graduate MedicalEducation (ACGME). The University of California, San Francisco is thesponsoring institution, and other Participating Institutions include the VA MedicalCenter and San Francisco General Hospital. The program abides by the

guidelines and requirements issued by the Dermatology Residency ReviewCommittee, which can be accessed online at: www.acgme.org

B) Program Director

1) Program director Jack Resneck, Jr, MD is responsible for the DermatologyResidency Training Program at UCSF.

2) Executive Vice-Chair and Clinic Chief Tim Berger, MD works with Dr. Resneck inthe administration of the residency program.

II) Resident Selection and Appointments

A) Resident Selection

1) The Dermatology Resident Selection Committee selects from among eligible

applicants on the basis of preparedness and ability to benefit from theDermatology Residency Training Program.

(a) In the selection process, we consider aptitude, past academic performance,motivation, integrity, ability to work with others, interpersonal communicationskills, and other unique characteristics. We seek candidates with highpotential for leadership.

(b) The Department of Dermatology does not discriminate with regard to sex,race, age, religion, color, national origin, sexual orientation, disability, orveteran status.

(c) In selecting from among qualified applications, the Department ofDermatology participates in the Electronic Residency Application System(ERAS) and the National Resident Matching Program (NRMP).

B) Resident Appointments

1) The UCSF Dermatology Residency Training Program complies with the criteriafor resident eligibility as specified in the UCSF GME Eligibility Policy.

2) The Dermatology RRC of the ACGME approves the number of resident positionsbased upon established criteria that include the adequacy of resources forresident education, faculty-resident ratio, institutional funding, and the quality offaculty teaching.

3) UCSF Health Requirements

(a) All residents are required to provide proof of immunizations in order to beappointed as UCSF Housestaff. Details are available on the UCSF GMEwebsite and in the UCSF GME Handbook

(b) An annual tuberculin skin test is required (state law). This evaluation isprovided (free of charge) year round at locations convenient to serviceassignments. Reappointment and continued employment will be held inabeyance pending proof of TB testing. The following are designated to verifya negative PPD reaction: Administrative Nurses, Clinical Nurse Specialists,Nursing Supervisors, Respiratory Therapy Supervisors, and AttendingPhysicians. New residents and fellows with a history of negative PPDs arerequired to provide documentation of 2 PPDs within the last year. Forindividuals with positive PPD history, a copy of the written interpretation of achest x-ray taken within the preceding 12 months is required.

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4) Licensure Requirements

(a) First year residents will complete an L3 form that will be submitted on theirbehalf to the California State Medical Board stating their intent to train in anACGME-approved program for their PGY2 training year.

(b) All residents, in accordance with California law, must obtain theirCalifornia Medical License beforethe start of their second year ofdermatology residency. Specifically:

(i) Residents in their first year of training from U.S., Puerto Rico orCanadian medical schools must have graduated from an accreditedschool of medicine or osteopathy and be licensed to practice medicinein the State of California before the start of the 25th month ofpostdoctoral training. If, by the end of the PGY2-year (or the first year inCalifornia after the PGY1 year) a license is not obtained, all "privilegesand exemptions..shall automatically cease."

(ii) Residents and Clinical Fellows enrolled in an ACGME program with 2 ormore years of training from another state, Puerto Rico or Canada mustobtain a California medical license before the start of the 13th month oftraining.

(c) Trainees who have not obtained a California medical license within theabove mentioned time frames will not be allowed further patientcontact or access to patient information including medical records,laboratory values, radiographic studies, etc. A trainee not licensed by July1st (or other start date) of the required year may not do any clinicalwork until a medical license is secured. During the period of non-licensure, the appointment, including salary, may be suspended.Resumption of training, once a California Medical License has beenobtained, will be at the discretion of the Program Director and/or DepartmentChair. Thereafter and for the duration of training, the California medicallicense must be continually maintained as a prerequisite to appointment.

(d) Of major importance, application materials and fee payment must besent to the California Medical Board 6-9 months ahead of theappointment date (i.e., send by September/October for the June 30deadline). In some cases, FBI fingerprint clearance may not beavailable for several months after the data is submitted.

(e) California licensing regulations specify that the expiration date of an initiallicense is the last day of the second birth month of the licensee after the datethe license is issued. Therefore, in order to enjoy the full 24-month validity ofan initial license, the trainee must obtain licensure DURING the birth month.However, the primary responsibility is to obtain a valid license by July 1 ofthe required year of training. IT IS AGAINST THE LAW TO PRACTICEMEDICINE WITHOUT A LICENSE, when a trainee has reached a certainlevel of postgraduate training.

5) Attestations:(a) Residents are required to complete attestation statements regarding

malpractice claims, drug and alcohol abuse, disciplinary action and criminalactivity as a condition of appointment. Any yes response to thesestatements demands an answer. After review of a residents explanation ofyes statements, an offer of a contract for training may be revoked or theconditions of the offer revised.

6) Additional information on Duties and Operational Standards, HIPAA, GeneralEducational Responsibilities, Identifiers, IDs, Library Cards, Salary, Benefits,

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Resident Services, Financial Aid, and other items are available in the UCSFGME Housestaff Information Booklet.

III) Program Curriculum

A) Written Statement of Goals and Objectives for Clinical rotations

1) There are competency-based written goals and objectives for each rotation, withspecific goals and objectives for each year of residency.

2) These goals and objectives are reviewed and revised annually by the programdirectors and the appropriate faculty overseeing each rotation. The goals andobjectives for MZ rotations are in binders in the resident room and are availableon the Department website.

3) Residents should review the goals and objectives before starting every rotation,and are expected to read the assigned readings during that rotation. The facultysupervising each rotation teach to these goals and objectives as well as othertopics as the clinical experience dictates. Additional readings may be assignedfor any rotation.

B) Teaching Methods

1) Teaching methods include lectures, conferences, seminars, demonstrations,

individual and group study of histologic slides, clinical rounds, chart and recordreviews, faculty-trainee sessions in small groups and one-on-one settings, bookand journal reviews, and attendance at local, regional and national meetings.

C) Organization of Didactic and Clinical Curriculum

1) Didactic Curriculum

(a) Didactic training complements and precedes/parallels clinical activitieswhenever possible. This curriculum is organized to ensure residentexposure to the complete range of disorders encountered by thedermatologist.

(b) The didactic curriculum is covered every year in clinical dermatology,dermatopathology and procedural dermatology, and every 18 months inbasic science

(i) On average, the curriculum requires residents to read two hours everynight, or 150 to 300 pages of weekly reading.

(c) Didactic Teaching

(i) Daily Conferences/Journal Clubs

Attendance and punctuality are required (lectures begin at the timestated, not 10 minutes after the hour). Residents are required to signin for all lectures they attend. Residents who arrive more than 10minutes after the lecture start time may not sign in as present, butmay be allowed to attend the remainder of the session at thediscretion of the lecturer.

Please refer to the online curriculum at

http://www.dermatology.ucsf.edu/education/lectureschedules/index.aspx for the most updated schedule

Mondays: Dermatopathology Lectures

7:30 am-8:30 am, Mount Zion Campus (so that continuity clinicscan begin promptly at 9:00 am at VAMC and Mt. Zion)

Tuesdays, Thursdays: Lectures/Journal Clubs

Tuesday/Thursday Lectures begin at 7:30 am or 8:00 am at Mt.Zion check the monthly schedule for details

Wednesdays: Lectures/Journal Clubs/Clinical Unknowns

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8:00 am Grand Rounds at Mt. Zion

10:15 am at Mt. Zion

11:30am at Mt. Zion

Fridays: Derm Surgery Lectures

Friday lectures are primarily on topics in dermatologic surgery,and begin at different times depending on the topics covered.

Check the lecture schedule regularly to confirm start times. Prior to the lectures, residents are expected to have read the material

in the assigned readings.

For dermatopathology sessions at 7:30 am (Tuesdays and/orThursday morning), the residents should review slides ahead of time,and come prepared to describe the findings and differentialdiagnoses. As this is a short session, please do not attend thesession if you are not there by 7:40 am; it is disrespectful anddisruptive to the dermatopathologist and your colleagues to arrivelate.

(ii) Grand Rounds and Wednesday Staff Conferences

Attendance, punctuality and proper dress (no scrubs allowed; whitecoats for patient viewing) are required.

The Grand Rounds lecture begins at 8:00am on Wednesday morningsin Herbst Hall at Mount Zion Hospital, 2nd floor.

Residents provide the bulk of patients presented at the WednesdayStaff Conference (immediately following the Grand Rounds lecture).

The full-time attendings will help residents identify good cases forstaff conference.

Presenting a patient includes writing a concise, but complete,protocol and a review of the literature on the patients condition.Formal PowerPoint presentations on diseases during staffconference are discouraged.

If you are presenting a patient, please make sure to coordinate inadvance with dermatopathology to ensure that pertinent biopsyslides are photographed for presentation at Staff Conference.

It is good to have interesting patients come to Grand Rounds fortheir second clinic visit after initial biopsy but before the patientstreatment plan is outlined and the patients questions are allanswered.

Residents are expected to carefully examine all of the presentedpatients and be able to describe the physical findings and give aclinical differential diagnosis.

The Mt. Zion senior resident is assigned to be responsible for

assuring there are appropriate numbers of patients at each StaffConference. As a goal, every resident should try to present onepatient at Grand Rounds every other month..

(iii) San Francisco Dermatologic Society Meetings

Residents are members of SFDS free of charge, but must registerwith the society.

There are several meetings during the year, two of which are usuallyheld at UCSF/MZ.

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The fall meeting at UCSF is the Herschel Zackheim CutaneousOncology Lectureship.

The spring meeting at UCSF is the John Weiss ClinicalDermatology meeting.

The other two meetings are held at Stanford.

A Social/Dinner meeting is usually held during the winter.

UCSF Dermatology is responsible for providing half of the patients(up to four) for each of the meetings held at UCSF.

Resident attendance at all meetings but the winter dinner meeting isexpected from all residents not out of town.

Residents prepare any cases they present in the standard manner:write case protocol, review literature, and be prepared to give cursorydiscussion of interesting aspects of the case.

Cases which are diagnostically or therapeutically difficult areappropriate for presentation.

More common dermatoses with good morphology are alsoacceptable.

(d) Didactic General Topics(i) Basic Science

The basic science curriculum is overseen by Drs. Kari Connolly andKanade Shinkai. A basic science faculty member oversees each ofthe scheduled sessions

This curriculum component consists of text reviews.

Residents are expected to read the assigned reading prior to thesession.

(ii) Clinical Dermatology

Clinical Dermatology is taught daily in clinics and on the inpatientwards.

Lectures on clinical dermatology take place approximately three hoursa week.

There are monthly dermatology journal clubs reviewing the Journal ofthe American Academy of Dermatologyand the Archives ofDermatology. Although only selected articles may be discussed at

journal clubs, residents are required to read Archives of Dermatologyand The Journal of the American Academy of Dermatology in theirentirety. The CME articles are of great importance and should alwaysbe read carefully.

The residents are responsible for reading a complete textbook ofdermatology each year. For the first year residents this is BologniasDermatology. For the second year residents this is Andrews

Diseases of the Skin. The department provides these two textbooksto first year residents upon arrival in the program. Third years mayread the assigned chapters from either text and supplement from theliterature.

Clinical Unknown sessions held weekly emphasize morphology anddifferential diagnosis.

(iii) Dermatopathology

The dermatopathology core is taught by weekly didactic sessions in a12 month cycle.

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The residents also have weekly scope sessions

Each resident is assigned full-time to dermatopathology at Mount Zion(dermatopathology rotation) for one month each year.

At each of the other participating institutions (VAMC and SFGH), thereare weekly dermatopathology signout sessions to review biopsiesperformed by the residents during the previous weeks.

(iv) Dermatologic Surgery

The dermatologic surgery/procedural dermatology curriculum iscovered each year. This includes weekly lectures, demonstrationsand hands-on teaching sessions.

Dermatologic surgery journal clubs are held regularly, and attendancefor residents is required.

Early in each academic year, there is at least one session teachingbasic surgical techniques using pigs feet.

Each resident spends one month per academic year full-time on thedermatologic surgery service at Mount Zion.

There are resident surgery clinics at Mt. Zion on selected Fridays,which are cosmetic in focus (these clinics are staffed by fellowshiptrained dermatological surgeons). There are also weekly residentsurgery clinics at SFGH and the VAMC.

(v) Ethics

The Department offers an ethics course for all physicians in theDepartment each academic year.

The ethics course consists of one to two sessions on various topics,usually based on requests/suggestions from residents and faculty, aswell as a one to two hour workshop, in which small-group discussionsare utilized.

IV) Responsibilities of the UCSF Dermatology Resident

A) General Educational Goals and Objectives for Clinical Rotations

1) General Dermatology (Mt. Zion, San Francisco Veterans Affairs Medical Center,San Francisco General Hospital): The following are basic goals and objectivesthe experience at UCSF in general. Specific goals and objectives for eachrotation are found in the resident room and on the Department website.

(a) First Year Residents

(i) To be able to diagnose and treat the most common inflammatory andmalignant skin disorders.

(ii) To be able to classify skin diseases into diagnostic groups and provide adifferential diagnosis.

(iii) To learn basic diagnostic techniques: KOH, scabies preps, direct

fluorescent antibody, fungal culture.(iv) To write clear and concise notes within institutional and Medicare

guidelines.

(v) To see patients at a rate of four per hour.

(vi) To present at least one patient per month at weekly rounds.

(vii) To be able to describe the natural history and quality of life impact ofcommon skin disorders

(viii) To advance their understanding of the systems in which they practiceand their impacts on patient care

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(ix) To communicate effectively with colleagues, staff, referring physicians,and patients.

(b) Second Year Residents

(i) To improve on the goals outlined for first year residents.

(ii) To manage complex dermatology patients with multiple medicalproblems.

(iii) To recognize uncommon skin disorders.

(iv) To develop a logical diagnostic approach for difficult patients.

(v) To present at least one patient per month at weekly rounds.

(vi) To manage a cohort of continuity patients, coordinating their care andoverseeing the management of their skin disease over a prolongedperiod.

(vii) To begin to recognize gaps in their own knowledge and skills and directtheir own learning.

(c) Third Year Residents (MZ Senior/Res D)

(i) To be able to manage complex dermatology patients.

(ii) To provide advanced consultative services for patients referred fromprimary care physicians and other dermatologists, and to effectivelycommunicate at an advanced level with referring physicians.

(iii) To teach basic dermatology to medical students and primary careresidents.

(iv) To manage the schedule and curriculum of the residents and coordinatetheir educational activities.

(v) To present at least one patient per month at weekly rounds.

(vi) To exceed the goals of second year residents in diagnosis andmanagement of skin diseases.

(vii) To continue to recognize gaps in their own knowledge and skills andestablish self-directed lifelong learning skills

B) Clinic Performance Additional Expectations

1) Outstanding quality of care is expected for all patients. Clinical dermatology islearned by examining and treating patients, reading, and good follow-up.

2) Residents will present all cases to attendings.

3) Clear, concise notes are expected.

(a) The diagnosis must be exactly stated, the physical findings clearly explainedand diagramed if appropriate, and the exact nature of all treatments and labevaluations noted.

(b) The attending who oversaw the visit must be noted by the resident at thebottom of the note (e.g. seen with Dr. Berger)

(c) At Mt. Zion, residents must accurately document adequate information tocomply with Medicare and University requirements. If the resident has a

question, the attending should be consulted. This involves fully documentingall areas of the physical examination done and adequately detailing theproblem list, treatment plan, proposed diagnostic evaluations, and patienteducation.

4) Pathology forms must be filled out legibly with a concise but accurate descriptionof the clinical setting and the location of the lesion. The measured size of thelesion biopsied and its exact location (defined by adjacent anatomic landmarks)must be noted on the visit and the pathology form.

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5) All of the residents in a clinic share the responsibility of seeing all the patients,even though each resident may have his/her own patient schedule. Do not leavethe clinic until all patients are seen or you have checked out with the attending.

C) Clinic Attendance

1) Residents must strictly adhere to the Resident Leave Policy outlined in thishandbook. Be sure to verify your vacations with appropriate clinic staff asoutlined on the vacation request form both at the time of the request and again 4

weeks prior to any anticipated absences (educational leave or vacation).2) Residents must be available to see patients at the start of the scheduled clinic. If

you are going to be late, notify the attending.

D) On-Call

1) A resident at each training location will be assigned to take call for that institutionduring weekdays and weeknights (For UCSF/MZ, this is the resident on theinpatient consult rotation. For VAMC and SFGH, this is one of the residentsrotating at that site.).

2) A single resident will be assigned call covering all three institutions for weekendsor holidays. The chief resident(s) prepares the weekend/holiday schedule priorto the beginning of the academic year.

(a) Weekend and holiday call may be traded among residents with priornotification of the division chiefs affected, chief resident(s) and the programcoordinator. Trades that divide a weekend among multiple residents are notpermitted.

3) Any evening, weekend, or holiday on-call resident must be within pagerrange of their assigned on-call location, and must be available to come into the hospital within one hour to see patients. Do not make plans duringon-call periods that would preclude you from being available to come in tothe hospital within one hour.

(a) The UCSF/MZ on-call resident pager is 443-9296.

(b) The SFGH on-call resident pager is 443-9274.

(c) The VAMC on-call resident pager is 443-2722

4) Cell phones are available for the ward resident and the weekend/holiday callresident to return pages and to contact the on-call attending (not for personaluse). Phones may be obtained from the Academic Office.

E) Evaluations of Faculty, Rotations, Self, Peers, and Program

1) Teaching faculty are evaluated (monthly or every three months depending on thelength of the rotation) by confidential, mandatory online forms completed by theresidents using the E*Value system, and these evaluations are monitored by theprogram director. De-identified evaluations are made available to faculty only onan annual basis in order to optimize confidentiality. Low scores (i.e., less than orequal to 2) generate an immediate report to the Program Director.

2) Mid-rotation informal face-to-face feedback sessions are also required.

Residents are responsible to initiate a


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file confidential, mandatory evaluations of each rotationusing the E*Valuesystem. In addition, the residents are asked to meet without faculty present atleast twice annually to make a joint confidential report regarding program issueswhich is passed on to the Program Director. Residents have an annual full-dayretreat off-site each spring at which they work on program development. Onceannually, the residents meet with the Dean for Graduate Medical Educationwithout the Program Director, chair or other faculty members being present. In

this setting, the residents are queried regarding the effectiveness of the facultyand management of the residency program.

4) The Resident Education Committee meets monthly and works with the programdirector to regularly review the teaching faculty, curriculum, individual rotations,and other parts of the residency program. The entire faculty meets together onceyearly to review evaluations by the residents of the program and de-identifiedevaluations of program faculty, and at this meeting, the faculty also discuss theoverall effectiveness of the residency program. The faculty also reviews programeffectiveness on a regular basis.

5) Residents are required to complete all evaluations in a timely manner.

F) Evaluations of Medical Students

1) Selected residents are assigned a medical student partner during that students

rotation on the basic dermatology elective (140.01). This resident partner isassigned to the same clinic as that student and should work with them in everyclinic they both attend. They are a resident-student team. The assigned residentwill be asked to evaluate the student in the areas of professionalism.

2) These evaluations are used by the faculty preceptor to write each students finalevaluation, which is used for the students Deans Letter.

3) Residents are expected to be prompt, complete, honest and fair in completingthese evaluations, especially on those students who have expressed an interestin dermatology as a potential career.

G) Chief Resident

1) Resident(s) may be selected by the program director and the Resident Education

Committee to serve as chief resident.2) Other senior residents may be asked by the chief resident and program director

to assist in selected residency program management duties.

3) The chief resident and other senior residents are involved with various duties,including (but not limited to): didactic curriculum planning, rotation scheduleplanning, resident vacation planning, distribution of articles for all conference and

journal clubs, medical student teaching, obtaining follow-up on all UCSF patientspresented at Grand Rounds (within one month), planning of the resident retreat,service on the admissions committee and resident education committee,planning of resident orientation, and related other duties as required.

4) The chief residents schedule is created to meet his/her educational needs,career development goals, programmatic service needs, and also to protect time

for administrative duties.5) The chief resident is granted one extra meeting per year (up to three days with

travel time) to be paid for by the Department. This meeting must be pre-approved by the residents mentor and the Resident Education Committee.

6) The chief resident will receive an additional $150 stipend during each month thathe/she serves as chief resident.

H) Managed Care and Prior Authorization for Procedures

1) Because so many of our patients at UCSF/Mt. Zion are covered by managedcare plans, residents must check with staff before proceeding with any

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procedures to ensure that insurance will cover the procedure and to obtainpreapproval when required. In the event that staff cannot confirm coverage, thepatient should be notified before proceeding.

I) Skin Cancer Screening

1) The American Cancer Society has designated May as Melanoma Month and theAmerican Academy of Dermatology has designated the first Monday of May asMelanoma Monday. Skin cancer screening is a primary public outreach/civic

activity of dermatologists throughout the USA.2) Resident participation is mandatory if a skin cancer screening is planned.

(a) Each physician works for three hours performing basic (5 minute) skinscreenings.

3) If residents take vacation the week before of after the skin cancer screening day,they will be required to take a vacation day for the Saturday screening as well.

J) Audiovisual Support

1) First year residents will be assigned to make sure the audiovisual supportrequired for daily resident lectures and Wednesday conferences is present andoperational. Residents are expected to have the equipment set up no less than 5minutes before the lecture is scheduled to start.

2) The academic year will be divided up among the first year residents by the ChiefResidents.

3) This includes responsibility for all AV support that faculty may need (slidecarousels, slide projectors, LCD projector, and laptop).

K) Grand Rounds Photography

1) Second year residents will be assigned months to be responsible forphotographing patients who are presented at Grand Rounds. Pleasephotograph the patient protocols first, followed by the patients, using the clinicdigital camera. Chris Walker will download the images to our Grand Roundsdatabase.

2) On Grand Rounds morphology days, when there are no protocols, please take aphotograph of the words Grand Rounds so that Chris Walker will know that thephotos to follow are from Grand Rounds, and that they belong in the GrandRounds Database.

L) Resident Teaching

1) Senior residents will be asked to staff primary care residents. All residents maybe asked to help precept medical students.

2) Senior Residents also lecture medical students on the dermatology rotation onbasic dermatologic material on Wednesday mornings from 7:15 am 8:00 amprior to Grand Rounds.

M) Resident Expert Talks

1. Residents in their 2nd and 3rd years give a talk to the department about anacademic topic of their choice.

2. The goals of the Resident expert talks are three-fold

a. To gain expertise in one focused area of dermatology

b. To work closely with one or two mentors to chose the topic for the lecture,prepare, and execute a 45-minute Grand-Rounds level talk that is appropriatefor an audience of general dermatologists

c. To gain confidence is speaking and answering questions in the setting of anaudience of about 50 people. (For the dos and donts of preparing your talk,please see the Department website.)

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N) Research/Publications

1) Residents are strongly encouraged to write at least one paper for publicationduring their residency.

(a) This may be in any form (i.e. case report, review article, etc.) and shouldinvolve the residents area of interest for his/her Resident Expert Talk.

(b) Faculty can be asked to assist in finding an appropriate topic and/or co-authoring the paper.

O) American Board of Dermatology Annual In-Training Exam

1) All residents are required to take this on-line exam each April. While somecurricular time is set aside for review, residents are expected to devote significantoutside time to preparation and self-study.

2) This exam serves as one important measure of the fund of medical knowledgeeach resident has acquired. The comparison pool of dermatology residents inthe US is a highly selective group, so residents should not be surprised if theirpercentile rank scores are lower than they might have experienced during collegeor medical school. However, truly substandard performance on the exam isusually symptomatic of a more general failure to study and acquire the necessaryfund of knowledge, and often serves as a predictor that a trainee is at risk of poor

performance on actual Board certifying examinations.3) Scoring above the 20th percentile (compared with same-year dermatologyresidents nationwide) is expected. Performance below this level places traineesat high risk of failing their actual certifying board exam, and will result in arequirement for remedial work. Unsatisfactory performance may also lead to acounseling letter, notice of concern, academic probation, or other academicaction as outlined in the Academic Due Process Policy. The selection of adisciplinary action may be based in part on the severity of the low score andother measures of resident competency beyond the in-training examination,though a low score alone may be sufficient for action.

P) ACGME Case Log

1) Every resident is required to log all surgical procedures that he/she performs or

observes each academic year.(a) These procedures include those performed/observed during his/her surgery

rotation and also during surgery clinics at all training sites.

(b) Biopsies done on a routine basis in general dermatology clinics do not needto be logged.

2) Residents are required to use the ACGME on-line case log system.

(a) This log must be kept up to date with procedures logged in a timely manner.

3) Residents must submit a tally of all surgical procedures done during theirresidency to the program coordinator by May 1st each academic year to besubmitted to the American Board of Dermatology.

4) This log will be reviewed at the beginning and end of the surgery rotation by the

Dermatologic Surgery faculty to plan for optimal exposure to the breadth ofdermatologic surgery and ensure that residents are gaining sufficient exposure.

5) Residents should be aware that licensing and credentialing agencies may, in thefuture, ask trainees to provide these logs as evidence of proficiency.

V) Mount Zion Dermatology Clinics/UCSF Wards

A) Locations and Access

1) Dermatology Clinics Location

(a) The majority of Mount Zion dermatology clinics are located at the mainDepartment of Dermatology site, 1701 Divisadero Street, 3 rd Floor.

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(b) Residents will be given keys/codes to clinic doors during residencyorientation.

2) Cutaneous Oncology Clinics

(a) High-risk melanoma clinics and cutaneous lymphoma clinics are located atthe UCSF Cancer Center at the Mount Zion campus at 1600 DivisaderoStreet, 2nd Floor.

3) Wards

(a) The Department of Dermatology provides inpatient consults for both themain UCSF campus as well as the Mount Zion campus.

(b) UCSF inpatients are located at the main Parnassus campus in theMoffitt/Long building.

(c) Inpatients at Mount Zion are located at 1600 Divisadero Street.

B) Parking and Transportation

1) Free or metered parking is available near the clinic, but usually limited to twohours. There are pay lots located near the clinic. For details on parkingreimbursement beyond the base payment required for residents at the Parnassuscampus, see section on parking.

2) Free shuttles run approximately every 15-20 minutes to and from the main

Parnassus campus and all other sites except the VAMC.C) Specialty Clinics

1) Several specialty clinics occur at Mount Zion, either at the main clinic or at theUCSF Cancer Center.

(a) These include cutaneous lymphoma, hair and nail, pigmented lesion clinicautoimmune dermatology, melanoma, and others.

(b) The residents are the primary providers in many of these clinics.

2) Surgery Clinic

(a) Specific resident surgery cases (patients referred from resident clinicspecifically for the surgery resident) will be distributed throughout the month-long surgery rotation.

(i) Cases will be scheduled from the Resident General Derm clinics. Onmost days, there will be one slot per day set aside for these specificresident cases, but the number may vary depending on surgery clinicschedules.

(ii) The residents control the booking of these patients and are responsiblefor pre-operative screening and counseling. Specific care must betaken if you are scheduling a patient to have surgery performed by aresident other than yourself (make sure the patient is aware that you willnot be their surgeon, and make sure the resident who will perform thecase is informed).

(iii) A cosmetic clinic will be scheduled once per month on a Friday morning.This clinic will allow several residents based at Zion that month the

opportunity to develop basic experience with lasers and other cosmetictechniques. Residents must clear cosmetic cases with the attendingstaffing the clinic to ensure that the case is appropriate for the residentslevel of training.

(iv) Fellowship-trained dermatologic surgeons staff each clinic.

(b) Residents are responsible for inputting procedures/surgeries from theseclinics (as with other surgical clinics) into their ACGME surgical logs in atimely manner.

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VI) San Francisco General Hospital Dermatology Clinics and Consultations

A) Location and Access

1) SFGH general dermatology clinics are held at 1001 Potrero, Bldg 90, Ward 92.

2) Access to the clinic is available Monday through Friday, 9:00 am to 5:00 pm.

(a) The emergency room is accessible and staffed 24 hours a day. Residentson weekend call can access the hospital through the emergency room.

(b) Residents will be given keys to the outpatient clinic.

B) Parking and Transportation (See also parking section)

1) Parking is available on selected streets at no charge, but is restricted to shorttime periods. Residents and faculty can purchase parking permits that allowmonthly parking closer to the facility.

(a) The institutional police are available to escort residents to their cars 24 hoursa day.

2) Shuttles run approximately every 20 minutes to and from other UCSF locations.

C) Clinics

1) Residents are asked to see the patients in the order they are placed in theirrooms.

2) There are at least two faculty available for each session, who precept:

(a) Dermatology residents

(b) Rotating residents from multiple specialties

(c) Medical students in the clinic.

D) Admitting Patients

1) Dermatology patients are admitted to Family Practice or Internal Medicine

2) The head nurse will complete the paperwork and the resident calls the admittingresident on-call after checking with the emergency department.

E) On-Call

1) Residents assigned to SFGH share call (weekdays and M-Th evenings) and takecall at no more than two consecutive weeks at a time.

2) An attending is available at all times to assist the consult resident.3) The resident should always present consult patients to the attending.

(a) Residents write consult notes on forms provided, leaving adequate space forattending note and signature at the bottom.

(b) On-call residents can eat dinner at the hospital at no charge.

F) Quality Assurance

1) Residents are given pathology reports of all cancers biopsied in the dermatology clinics.

2) Dermatology residents are responsible for documenting adequate treatment forevery skin cancer identified.

3) When residents identify patients who cannot be contacted or have refuseddefinitive procedures, the resident should work with staff to send the patient a

registered letter. In addition, the nursing staff will enter a clinical alert into theSFGH computer system.

G) Chart Notes and Prescriptions

1) Notes are to be complete and neatly written in SOAP format.

2) The attending who staffs each case must always be listed at the end of the note.

3) Residents are responsible for prescribing only medications which will be available topatients under their medical coverage. If the medication isnt standardly available,residents must begin any authorization process required (i.e. TAR for MediCalpatients).

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VII) San Francisco Veterans Affairs Medical Center Dermatology Clinics and Consultations

A) Location and Access

1) SFVAMC dermatology clinics are held at 4150 Clement Street, 1st Floor, Module 3.

2) There is access to all facilities during business hours, but access otherwise is obtainedthrough the emergency room entrance.

(a) Supplies in dermatology are difficult to access on nights and weekends. Thesecurity service has keys, but access is not always available.

(b) Call residents are responsible for carrying the call bag with them as clinic accessmay not always be available.

B) Parking and Transportation (See also parking section)

1) A monthly parking permit, which allows for on-site parking, is available at the cashiersoffice.

2) Parking permits can be bought on a daily basis at various yellow ticket dispensersaround the VA Medical Center.

3) Parking is also available in the neighborhood, but caution is advised to pay attention tosigns regarding street cleaning.

4) There are free shuttles that go to/from Parnassus on an hourly basis, but no shuttlesthat go directly from the VA to Mount Zion. Pick-up at Parnassus is near the ER

entrance.C) Clinic

1) All medical records are electronic. Patients are roomed by the nurses and checked ona master schedule posted on the clinic bulletin board. Put your initials by the patient'sname when you go in to see the patient and put a check by the patient's name whenyou have finished seeing them.(a) All resident notes must be entered into the computer.

(b) Residents should see the next patient as indicated by the nurses, so that patientsare seen in their proper order of arrival.

2) After a resident sees a patient, he/she must present to the attending. Senior residentsmust present consults or new patients. Follow-up patients can be presented by senior

residents at the resident's discretion.3) When the resident has completed seeing a patient, the resident must complete both

the computer note and the computer billing.

4) Prescriptions are to be entered electronically.

D) Resident Responsibilities

Besides caring for patients, each resident will have specific responsibilities. If one residentis on vacation, another resident should cover his/her responsibilities.

1) On-Call Consult Resident: This resident is responsible for all inpatient and nursinghome consultations. This includes checking the dermatology consult view alertsonce each weekday and checking with the chief nurse to see if any verbal consultshave been called into the clinic. The resident is expected to see the patients before

presenting them to the attending. Please plan to see inpatients and nursing homepatients in house instead of bringing them to clinic, as the clinics generally are fullybooked. The resident is responsible for contacting the attending each day andreviewing new or continuing patients. This resident should sign out patients to theweekend call resident, as well as signing out patients to the new Call/Consult residenteach month.

2) Pathology Book Resident:This resident is responsible for these aspects of thepathology book: recognition and scheduling of skin cancer surgeries, coordinatingdermatopathology conferences, and quality assurance to ensure that skin cancershave been treated.

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a) Recognition and scheduling of skin cancer surgeries: Each week, the residentshould check that all biopsies done have a diagnosis, either by reviewing them atpathology conference each Wednesday or by checking the diagnosis in CPRS.Skin cancers should be marked with a star. The resident should discussappropriate surgical treatment with either Dr. Mauro or Dr. Neuhaus and note thistreatment in the Comments Column. The resident then should send a computergenerated letter to the patient (see website for detailed instructions). If the patient

has been diagnosed with a melanoma, the resident also should call the patient todiscuss the diagnosis and plan. Once the patient gets the letter, he/she will call thenursing station and the nurses will schedule the surgery, according to theinstructions the resident has placed in the Comments Column.

b) Coordinating dermatopathology conferences: This resident also is responsible forcoordinating the weekly dermatopathology conferences among the dermatologyresidents, the VA pathology resident, and the UC dermatopathologist. Each week,this resident should determine which slides should be reviewed by thedermatopathologist, give this list to the pathology resident on Monday, pick up theslides on Tuesday and bring them to conference on Wednesday. The slidesshould be returned on Wednesday or Thursday

c) Quality Assurance: Each month, the resident should check that all skin cancers

diagnosed 3-4 months earlier have been treated, and that their previously markedstars have been destarred. If a patient has not been treated, but has beenscheduled, no further treatment is needed, unless the resident feels that thetreatment should be furnished sooner than the patient is scheduled. If the patientis not scheduled, this patient should be contacted and scheduled. If the patientcannot be contacted, a registered letter must be sent. Contact JerelynMagnusson, the VA dermatology secretary, about patients who must be sentletters.

3) Message Board Resident: This resident is responsible for making sure that messagesthat have been called into the clinic are dealt with in a timely fashion. All messagesthat are addressed to residents who are not rotating through the VA, includingcontinuity clinic residents or residents on vacation, should be answered. If the

message is not urgent, the resolution can be left to the continuity or vacationingresident, but the message board resident should contact the patient to determine thenature and urgency of the request.

a) This resident is also responsible to work with the senior resident to review and

write the teledermatology consults each week.

4) Senior Resident: This resident is responsible for reviewing and writing teledermatologyconsults each week, and reviewing these consults with Dr. Oh each Friday, or soonerif these consults are urgent. The resident also is responsible for supervising the juniorresidents to help each resident perform their duties properly and ensure that the clinicis running smoothly.

VIII) Resident LeaveA) Annual Leave

1) Vacation

(a) Residents are granted 20 days of vacation per academic year.

(b) Vacation leave must be taken in 5 consecutive day blocks over a one-weekperiod.

(c) If vacation occurs during a week that contains a university holiday, then thefifth day of vacation must occur either the Friday before the week or theMonday after.

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(d) Residents must take 5 days of vacation per three-month quarter. Unuseddays will not carry over into the next quarter.

(e) Exceptions to the consecutive days rule and the 5 day per quarter rule aregranted only for extraordinary circumstances, with prior approval from theprogram director, site director, and chief resident.

(f) Senior residents are given one additional vacation day during their third yearto use for interview purposes. Additional days off for interviews are at the

discretion of the program director and site director and will be counted asvacation.

(g) Annual vacation leave may not be carried over from one academic year tothe next, nor may it be borrowed in advance from the following academicyear.

(h) Annual vacation may be used for educational purposes (at the discretion ofthe resident) if the resident has used all available educational leave or if theResident Education Committee does not approve a requested educationalactivity for use of educational leave.

(i) Approval of vacation leave dates is contingent upon there being no conflictwith other residents leave requests.

(i) Seniority is considered when prioritizing leave requests.(ii) No two residents on the same rotation will be permitted to be on leave atthe same time unless it is specifically pre-approved by the site directorand chief resident.

(j) No vacation is allowed while on the UCSF inpatient consult rotation. Allother rotations (including dermpath and dermsurg) permit vacations, and ifany resident feels that a particular rotation discourages taking of vacation,this should be reported to the program director.

(k) Institutional regulations at the VA limit the amount of vacation that may betaken by residents while rotating at the VA. Residents rotating at the VAshould coordinate with the chief resident, the site director, and each otherearly in the academic year to ensure that institutional regulations are

followed.(l) In order to comply with VA regulations and to distribute vacation among sites

in proportion to resident time spent at those sites, please work closely withfellow residents and the chief resident so that:

(i) No more than 16 weeks of vacation are taken by all residents whilerotating at the VA.

(ii) About 12 weeks of vacation are taken by all residents while rotating atSFGH.

2) Education Leave and Travel Stipend

(a) Residents are given 15 education leave days for their three-year residency(10 days over 2 years if in the 2+2 program).

(i) These days are loosely divided as follows: 3 days per year for the American Academy of Dermatology Annual

Meeting. Two first year residents do not attend the AAD meeting, butthose residents usually attend the SPD or SID instead.

One additional 2-day meeting per year.

(b) If substantial travel is required to attend a meeting (i.e. on the East coast orinternational), residents may request a travel day from the REC which willnot count against the educational leave limit.

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(c) All meetings must be discussed with and approved first by the residentsmentor and then the Resident Education Committee, with the exception ofthe AAD Annual Meeting, SID (for physician-scientists), and SPD (forPediatric Dermatology dedicated residents). Meetings should be approvedby the mentor and REC beforeresidents apply for outside travel support orother funding. The REC must also approve any additional travel daysbeyond the meeting dates. It is the residents responsibility to request being

placed on the REC agenda for consideration of a meeting request in time forapproval and adjustment of clinic schedules (at least 4 months in advance ofthe meeting).

(d) Residents are allotted a maximum travel stipend of $1,000 per academicyear, which may be used towards REC-approved educational meetings andto cover expenses for the AAD annual meeting over and above those paidfor by the AAD resident travel program. Extra approved meetings will notlead to an increase in the travel stipend, and expenses beyond the stipendare to be paid by the resident. The chief resident is funded for one additionalmeeting beyond the annual stipend.

(e) All expenses and reimbursement must be in accordance with the Universitystravel policy, which limits all meals to the per diem maximum rate of $64.

The revised University policy limits meal reimbursement to only those mealsthat are an integral part of a business meeting (e.g., working dinner). Moreinformation on the travel policy (including details of allowable expenses,receipts required, and other information) can be found athttp://www.ucop.edu/ucophome/policies/bfb/g28.html

(f) Airfare should be coach-class, advanced purchase. Hotel accommodationsshould be at the lowest rate available at the conference hotel.

(g) After completing your trip, fill out the travel reimbursement form, attach alloriginal receipts, and submit to Christina Walker within 21 days of yourreturn. She will obtain the signature of the program director, whose approvalis required before the request will be processed.

3) Other Leave

(a) The department complies with the Universitys policies regarding parentalleave, sick/disability leave, family & medical leave, personal leave, militaryleave, and jury duty, as outlined in the GME Housestaff Information Booklet.Vacation days may also be used to extend standard parental leave at thebirth or adoption of a child.

(b) While residents are entitled by departmental, university, and governmentpolicies and regulations to take certain leaves as outlined in the GMEHousestaff Information Booklet, residents should understand that theAmerican Board of Dermatology has its own policies for board eligibility.Residents who miss more than 14 weeks (not counting education leave)during their whole residency for any reason (including vacation and

approved leave), will not be eligible for board certification. To reiterate, evenapproved leaves may place a resident at risk of being board-ineligible ifthe resident misses more than 14 weeks of training. At the discretion ofthe department, residents may be given the opportunity to make upadditional weeks to complete the residency program and become boardeligible after the completion of their regularly scheduled months of residency.

4) Leave Request Process

(a) All residents will receive an email from the Program Coordinatorapproximately two months prior to the beginning of each quarter.

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(i) Residents are required to submit a completed and signed LeaveRequest Form to the Program Coordinator within two weeks of receivingthe first request email.

Completed forms must have signatures from the chief resident andsite director of the rotation the resident will be on during the vacation.

Vacation requests must list the entire 5-day leave in accordance withthe consecutive days policy.

Education leave requests in which travel days are needed mustdocument the requested travel day.

If the Program Coordinator does not receive completed requestswithin the two-week time period, he/she will assume that the residentis not requesting leave and leave may be lost.

(ii) The Program Coordinator will put copies of the approved request form inthe residents box.

(iii) Residents must then notify all appropriate faculty and clinic staff by e-mail as outlined on the leave request form.

(b) The Program Coordinator will log all of the leave dates on the master calendar.

(i) It is ultimately each residents responsibility to make sure the calendar

reflects the correct dates.(ii) If there are any issues with approved leave dates on the master

calendar, these issues must be immediately brought to the attention ofthe Program Coordinator. If the Program Coordinator is unavailable, thechief resident should be contacted.

5) Senior Resident Electives

(a) Senior residents in good standing may be granted one month of elective timeto study dermatology in other ACGME-approved training programs. Allelectives must be planned with the residents mentor and approved by theProgram Director and REC. The primary issue in considering approval ofelectives will be the likely contribution to a residents career development.

IX) Evaluation of Residents

A) ACGME Six Competencies

1) The training program is structured to assure that residents assume increasinglevels of responsibility commensurate with individual progress in experience,skill, knowledge, and judgment. This is outlined in the rotation-specific goals andobjectives. In accordance with ACGME guidelines, UCSF Dermatology residentsare required to attain competence appropriate for their level of training in the sixareas listed below:

(a) Patient Care that is compassionate, appropriate, and effective for thetreatment of health programs and the promotion of health.

(b) Medical Knowledge about established and evolving biomedical, clinical, and

cognate sciences as well as the application of this knowledge to patient care.(c) Practice-Based Learning and Improvement that involves the investigation

and evaluation of care for their patients, the appraisal and assimilation ofscientific evidence and improvements in patient care.

(d) Interpersonal and Communication Skills that result in the effectiveexchange of information and collaboration with patients, their families, andother health professionals.

(e) Professionalism as manifested through a commitment to carrying outprofessional responsibilities, adherence to ethical principles, and sensitivityto patients of diverse backgrounds.

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(f) Systems-Based Practice as manifested by actions that demonstrate andawareness of and responsiveness to the larger context and system of healthcare as well as the ability to call effectively on other resources in the systemto provide optimal health care.

2) The Department of Dermatology evaluates its residents using a variety of tools toassess performance in the six competency areas:

(a) Evaluation of Resident Live Performance, once yearly, performed in the

residents continuity clinic(b) Chart Stimulated Recall

(c) Record Review

(d) American Board of Dermatology In-Training Exam, once yearly

(e) Faculty Evaluations of Residents

(i) All full-time teaching faculty evaluate residents they work with during athree-month period using E-Value, an on-line evaluation system.

(ii) These evaluations are made available to residents by the on-lineE*value system.

B) Formal Program Director Evaluations

1) The program director meets with individual residents for formal evaluations twice

per academic year.2) First year residents will be evaluated after three months of residency.

3) The year-end evaluation for each resident is sent to the American Board ofDermatology.

(a) Third year residents must also submit the ABDs surgical log form to be sentin with their final evaluation.

C) Filing of Evaluations

1) All evaluations are kept in resident portfolios in the academic office. Residentsmay request an appointment with the program director to review their portfolio.

X) Moonlighting

A) Introduction1) Resident input was solicited in the creation of this policy. This policy and

necessary forms were approved by the UCSF Dermatology Residents, ProgramDirector and Faculty in December, 2004.

2) Dermatology Residents are not required to moonlight, but are permitted tomoonlight both internally and externally under certain circumstances.

B) Resident Responsibility

1) Because residency education is a full-time endeavor, Dermatology Residentsmust ensure that moonlighting does not interfere with their ability to achieve thegoals and objectives of their educational program.

2) Residents are responsible for ensuring that moonlighting and other outside

activities do not result in fatigue that might affect patient care or learning.3) Dermatology Residents are responsible for complying with the Dermatology

Training Programs Duty Hours Policy, which has been approved by theGraduate Medical Education Committee and is consistent with the UCSF Policyon Duty Hours.

4) It is the responsibility of the Dermatology Residents to obtain written permissionto moonlight from the Program Director prior to beginning the moonlightingactivity, for both internal and external moonlighting (see below for definitions).Permission must be obtained using the appropriate, resident and facultyapproved moonlighting form (i.e. eternal or internal) which requires both the

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Program Director and Resident signatures as well as information regarding themoonlighting activity.

5) Residents that are moonlighting, both internally and externally, will fill out monthlyreporting forms regarding their moonlighting activities.

C) Program Responsibility

1) The Program Director will also monitor resident performance in the program toensure that moonlighting activities are not adversely affecting patient care,

learning or resident fatigue.2) If the Program Director determines that the residents performance does not

meet expectations, permission to moonlight will be withdrawn.

3) Monitoring information will be reviewed periodically with the DermatologyResident Education Committee. The GMEC will periodically review reports bythe Program Director regarding moonlighting activity.

D) Internal and External Moonlighting

1) Internal Moonlighting

(a) Internal moonlighting is defined as extra work for extra pay performed at asite that participates in the residents training program. This activity must besupervised by faculty and is not to exceed the level of clinical activity

currently approved for the resident. While performing internal moonlightingservices, residents are not to perform as independent practitioners. Internalmoonlighting hours must be documented and they must comply with thewritten policies regarding Duty Hours as per the Dermatology TrainingProgram, UCSF and ACGME.

2) External Moonlighting

(a) External moonlighting is defined as work for pay performed at a site thatdoes not participate in the residents training program. External moonlightinghours must be documented (including days, hours, location, and briefdescription of type of service(s) provided) in order to comply with Medicarereimbursement requirements for GME. For external moonlighting, theresident is not covered under the Universitys professional liability insurance

program as the activity is outside the scope of University employment. Theresident is responsible for his/her own professional liability coverage (eitherindependently or through the entity for which the trainee is moonlighting),DEA licensure, Medicare, provider number and billing training, and licensurerequirements by the California Medical Board and any other requirements forclinical privileging at the employment site.

XI) Duty Hours and Resident Fatigue

A) Duty Hours

1) Duty hours are defined as all clinical and academic activities related to theresidency program, i.e., patient care (both inpatient and outpatient),administrative duties related to patient care, the provision for transfer of patient

care, and scheduled academic activities such as conferences. Consistent withACGME regulations, duty hours do not include reading and preparation timespent away from the duty site. These standards apply to all UCSF trainingsites including, but not limited to, the VA, SFGH, Mt. Zion, and Moffitt-Longhospitals.

2) Duty hours will be limited to 80 hours per week, averaged over four-week period.

3) Residents will be provided with 1 day in 7 free from all educational and clinicalresponsibilities, averaged over a four week period, inclusive of call. One day isdefined as one continuous 24-hour period free from all clinical, educational, andadministrative activities.

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4) A 10-hour time period for rest and personal activities will be provided between alldaily duty periods. Residents who are taking call from home who are paged foran emergency consult may come to the hospital during a 10-hour rest period.

B) On-Call Activities

1) The residents in the Department of Dermatology DO NOT have in-house call.

2) The Department of Dermatology does not admit to its own inpatient service.Dermatology patients requiring admission are admitted to the Internal Medicine

or Family Practice services. No Dermatology resident has primary responsibilityfor the care of any inpatient.

3) Dermatology residents DO NOT work in shifts. All Dermatology residents haveclinic responsibilities and consulting on-call coverage.

4) Continuous on-site duty will not exceed 24 consecutive hours. Residents mayremain on duty for up to 6 additional hours to participate in didactic activities,maintain continuity of medical and surgical care, transfer care of patients, orconduct outpatient continuity clinics.

5) At-home call (pager call) is defined as call taken from outside the assignedinstitution.

(a) The frequency of at-home call is not subject to the every third night limitation.

However, at-home call will not be so frequent as to preclude rest andreasonable personal time for each resident. Residents taking at-home callwill be provided with 1 day in 7 completely free from all educational andclinical responsibilities, averaged over a 4-week period.

(b) When residents are called into the hospital from home, the hours residentsspend in-house are counted toward the 80-hour limit.

(c) The Program Director and the faculty monitor the demands of at-home calland make scheduling adjustments as necessary to mitigate excessiveservice demands and/or fatigue.

C) Methodology for Data Collection

1) Work hours are monitored and recorded twice yearly.

(a) The Program Coordinator and Program Director compile work hours dataand report it yearly using the ACGME WebADS system. This occursbetween November and January.

(b) Once during the year residents may be asked to carry a card for a week onwhich each resident lists his/her time in and time out. At the conclusion ofthe reporting period, the cards are submitted to the Program Director forreview.

D) Stress and Fatigue

1) Education

(a) The residents are required to review the presentation entitled MonitoringFatigue and Performance: Implications for Resident Duty Hours by David F.Dinges, PhD, on the GME website at http://www.medschool.ucsf.edu/gme

and sign a form attesting they have done so.(b) Fatigue education will also take place during resident/fellow orientation for

new and continuing Dermatology Housestaff by the Residency ProgramDirector on July 1 of each academic year.

(c) Fatigue education for the faculty consists of annual review of thepresentation entitled Monitoring Fatigue and Performance: Implications forResident Duty Hours by David F. Dinges, PhD on the GME website athttp://www.medschool.ucsf.edu/gme and notify the Program Coordinator, inwriting, that they have done so.

2) Monitoring Methodology

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(a) Residents spend a minimum of 3 to 4 hours each day in face to faceinteractions with an attending. The faculty assesses by observationresidents fatigue and stress levels on a daily basis. Faculty and residentsare educated to recognize the signs of fatigue and adopt and apply policiesto prevent and counteract the potential negative effects.

3) Back-up Systems for Fatigue

(a) If a resident is found to be fatigued, he/she is sent home and the attending or

another resident will cover the responsibility.

XII) Resident Supervision

A) Faculty Supervision of Residents in Clinics

1) All patient care is supervised by qualified faculty.

2) At all three clinical sites, full-time faculty supervise residents on-site duringpatient care activities in the clinics. This continuous supervision and consultationis clearly documented on the faculty attending schedules at all three sites.

3) There must be a ratio of resident to faculty in patient care settings of 3 to 1 orless.

4) Faculty must not have other obligations during teaching time.

5) Such supervision will occur in structured, patient-oriented, small groupeducational activities, such as outpatient general dermatology clinics andoutpatient subspecialty dermatology clinics.

B) Faculty Supervision of Residents During On-Call Activities

1) On-call residents responsible for consults in the inpatient setting present allpatients to faculty members.

2) The ward attending schedule provides the residents with a rapid, reliable systemfor communicating with supervising faculty about inpatient consults.

3) The ward attending is available to the consult resident 24 hours per day, 7 daysper week, by pager and telephone.

(a) In the rare event that the resident is unable to reach the ward attending, theschedule clearly identifies a back-up attending, who is available 24 hours perday, 7 days a week.

(b) In the event that an on-call resident is unable to reach both the ward andback-up attendings, the residency program director and the department chairare both available by cell phone.

(c) At no time is a consult resident ever left without reliable, available facultyconsultation.

XIII) Academic Due Process and Dismissal Policies

A) The Dermatology Residency Program abides by the UCSF GME Academic DueProcess Policy, which sets forth administrative and academic actions (such ascounseling letter, notice of concern, probation, suspension, requirement to repeat an

academic year, non-renewal of contract, dismissal, etc.). Importantly, this policy alsoestablishes procedures that residents may use to resolve differences when suchactions occur, and lays out appeals processes for certain appealable actions. Thecomplete policy is available in the UCSF GME Resident Handbook and online at theUCSF GME Website.

B) In accordance with the University GME Dismissal policy and the Academic DueProcess Policy, a trainee may be dismissed from the Dermatology ResidencyProgram for academic deficiencies. This action is appealable to the Dean of theSchool of Medicine. Reasons for dismissal may include, but are not limited to thefollowing:

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1) A failure to achieve or maintain Dermatology Training Program standards in anycompetency area;

2) A serious or repeated act or omission compromising acceptable standards ofpatient care, including by not limited to an act which constitutes a medicaldisciplinary cause or reason;

3) Unprofessional, unethical or other behavior that is otherwise consideredunacceptable by the Dermatology Training Program;

4) A material omission or falsification of an application for the Dermatology TrainingProgram, medical record, or University or medical document, including billingrecords. Any allegation regarding failure to comply with UCSFs billing rules shallbe forwarded to UCSFs Corporate Compliance Officer and/or the Office ofGeneral Counsel for resolution in accordance with UCSFs CorporateCompliance Program.

XIV) Resident Well-Being

A) The Dermatology Residents have access to a variety of systems for supportiveintervention for dependency treatment and to obtain counseling services for a broadrange of personal problems (i.e. workplace stress, anxiety management, personal orwork relationships, depression, grief and loss, caregiver concerns, etc.).

B) The Dermatology Department recognizes a broad range of personal issues may ariseduring the course of a residency and encourages Residents to use any of thefollowing services when necessary:

1) UCSF Physician Well-Being Committee

2) Physicians Confidential Assistance line of the California Medical Association (650) 756-7787, http://www.cmanet.org/cpl/index.htm

3) Faculty and Staff Assistance Program (FSAP) (415) 476-8279,http://www.ucsfhr.ucsf.edu/assist/index.html

C) These and other options are described in the UCSF GME Resident Handbook andonline at the UCSF GME Website.

XV) Sexual Harassment and Non-DiscriminationA) Policy

1) It is the policy of UCSF School of Medicine that no residents be discriminatedagainst because of race, color, religion, marital status, national origin, ancestry,sex, sexual orientation, physical disability or medical condition as defined inSection 12926 of California Government Code, status as a Vietnam-era veteranor special disabled veteran, or within the limits imposed by law or universityregulations, because of age or citizenship.

B) Resources

1) The following offices have been designated as resources. Residents whobelieve they may have been subjected to discrimination and/or gender, sexual orother forms of sexual harassment in the workplace may seek guidance and

counseling.(a) Office of Sexual Harassment Prevention & Resolution, (415) 476-5186

(b) Office of Affirmative Action/Equal Employment Opportunities/Diversity (415)476-4752

(c) Faculty and Staff Assistance Program (FSAP), (415) 476-8279

2) A resident is entitled to follow the Universitys confidential sexual harassmentprocedure: http://www.ucsf.edu/oshpr/policies/policy.html.

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http://www.cmanet.org/cpl/index.htmhttp://www.ucsfhr.ucsf.edu/assist/index.htmlhttp://www.ucsf.edu/oshpr/policies/policy.htmlhttp://www.ucsf.edu/oshpr/policies/policy.htmlhttp://www.ucsfhr.ucsf.edu/assist/index.htmlhttp://www.cmanet.org/cpl/index.htm


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XVI) UCSF School of Medicine Guidelines for Interactions Among UCSF Faculty,Students and Staff, and Industry

Preamble: The following guidelines are being distributed to faculty, students and staff ofthe School of Medicine regarding the relationship with the health care industry. Theguidelines were developed to provide guidance to the School of Medicine and ensureindependence of clinical decisionmaking, educational curriculum and research programs.They are meant to be an interim step in the development of more broad-based policies for

all UCSF faculty, students and staff.

General Principles: The UCSF School of Medicine policy is developed to ensure that allinteractions with industry be conducted in ways that avoid actual or perceived conflicts ofinterest. Because of the importance of the relationship between industry and theUniversity community, when conflicts arise, they must be addressed appropriately and allattempts must be made to minimize conflicts that affect clinical care, education orresearch. All faculty, students and staff have a responsibility to ensure, to the best of theirabilities that all decisions about clinical care, research activities and educational contentare independent and unbiased. Decisions should made in the best interests of patients,students and the University and should not be based on any actual or perceived personalbenefit that might be derived to the individual. The University has a long history of

collaboration with industry, including pharmaceutical companies and medical technologycompanies. These collaborations have benefited patients, our educational programs andresearch activities. However, these interactions could have the potential for undue anddeleterious influence by industry on the activities of the School of Medicine, its faculty,students and staff. The following guidelines have been adopted to minimize the potentialfor real or perceived bias in clinical care, education or research. The goal of theseguidelines is to ensure, to the extent possible that clinical decisionmaking, educationalprogram content and research activities are as free from bias and outside influence aspossible and that all real or potential conflicts are disclosed and resolved. The guidelinescannot identify every potential conflict, but provide general principles upon which faculty,students and staff should act. It is incumbent upon each of us to comply with theguidelines and, when real or potential conflicts are identified to disclose and eliminate

them to the extent possible.

A) Guidelines Regarding School of Medicine Relationships with Industry

1) Compensation or Gifts

(a) Personal gifts from an industry representative may not be accepted byany faculty, student or staff at any School of Medicine site, as part ofany work- related activity or during any clinical or other educationalrotation.

(b) Individuals may not accept compensation, including reimbursement forexpenses, associated with attending a CME or other activity in which theattendee has no other role. Reasonable honoraria and payment ofexpenses may be provided for speakers at accredited educational meetings,

consistent with guidelines developed by the Accreditation Council forContinuing Medical Education (ACCME) and University policy. Residentsare permitted to receive travel support from the AADs resident travelprogram, which is funded by an unrestricted grant.

(c) No gifts or compensation may be accepted in exchange for listening to asales talk or similar presentation by a representative of a commercialinterest that produces or distributes health care goods and services.

(d) Faculty, students and staff are strongly discouraged from acceptinggifts of any kind from industry as part of non-professional activities.Individuals should be aware of and comply with applicable policies, such as

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the AMA Statement on Gifts to Physicians from Industry (http://www.ama-assn.org/ama/pub/category/8484.html) and the Accreditation Council forContinuing Medical Education Standards for Commercial Support(http://www.accme.org).

(e) Meals and other gifts or donations funded directly by industry may notbe provided at any UCSF School of Medicine location. Vendors andother industry representatives may provide unrestricted funds to

departments or divisions for educational programs. The funds will bemanaged according to the Standards for Commercial Support of theACCME.

(f) No gifts may be accepted in exchange for modifying patient care, such asprescribing a specific medication. Support for research and educationalprograms must be provided without influence on clinical decisionmaking.

(g) Free samples, supplies or equipment designated for an individual areconsidered a gift and are prohibited. Vendors may donate products forevaluation or educational purpose

Documents

Resident Handbook 2008