UCSF Dermatology Residency Handbook

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UCSF Dermatology Residency Handbook

2007-2008

Table of Contents Page Nos.

I) Introduction................................................................................................................. 4 A) Accreditation and Sponsoring Institution ................................................................ 4 B) Program Director .................................................................................................... 4

II) Resident Selection and Appointments...................................................................4-5 A) Resident Selection.................................................................................................. 4 B) Resident Appointments .......................................................................................4-5

III) Program Curriculum.................................................................................................5-8 A) Written Statement of Goals and Objectives............................................................ 5 B) Teaching Methods.................................................................................................. 5 C) Organization of Didactic and Clinical Curriculum ................................................5-8

IV) Responsibilities of the UCSF Dermatology Resident .........................................8-12 A) Educational Goals and Objectives for Each Rotation..........................................8-9 B) Clinic Performance ................................................................................................. 9 C) Clinic Attendance.................................................................................................. 10 D) On-Call ................................................................................................................. 10 E) Evaluations of Faculty, Rotations, Self, Peers, and Program............................... 11 F) Evaluations of Medical Students .......................................................................... 11 G) Chief Resident ...................................................................................................... 11 H) Managed Care...................................................................................................... 11 I) Skin Cancer Screening....................................................................................11-12 J) Audiovisual Support.............................................................................................. 12 K) Resident Teaching................................................................................................ 12 L) Resident Expert Talks .......................................................................................... 12 M) Research/Publications.......................................................................................... 12 N) American Board of Dermatology Annual In-Training Exam.................................. 12 O) ACGME Case Log................................................................................................ 12

V) Mount Zion Dermatology Clinics/UCSF Wards....................................................... 13 A) Locations and Access........................................................................................... 13 B) Parking and Transportation .................................................................................. 13 C) Specialty Clinics ................................................................................................... 13

VI) San Francisco General Hospital Dermatology Clinics and Consultations .......... 14 A) Location and Access ............................................................................................ 14 B) Parking and Transportation .................................................................................. 15 C) Clinics ................................................................................................................... 15 D) Admitting Patients................................................................................................. 15 E) On-Call ................................................................................................................. 15 F) Quality Assurance ................................................................................................ 15 G) Chart Notes and Prescriptions.............................................................................. 15

VII) San Francisco Veterans Affairs Medical Center Dermatology Clinics and Consultations........................................................................................................15-16 A) Location and Access ............................................................................................ 15

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RESIDENCY HANDBOOK 2007-2008

B) Parking and Transportation .................................................................................. 15 C) Clinic..................................................................................................................... 15 D) On-Call ................................................................................................................. 15 E) Dermatopathology ...........................................................................................15-16

VIII) Resident Leave .....................................................................................................16-18 A) Annual Leave...................................................................................................16-18

1) Vacation 2) Education Leave and Travel Stipend 3) Other Leave 4) Leave Request Process 5) Senior Resident Electives

IX) Evaluation of Residents.......................................................................................19-20 A) ACGME Six Competencies .................................................................................. 19 B) Formal Program Director Evaluations .................................................................. 19 C) Filing of Evaluations ............................................................................................. 19

X) Moonlighting .........................................................................................................20-21 A) Introduction........................................................................................................... 20 B) Resident Responsibility ........................................................................................ 20 C) Program Responsibility......................................................................................... 20 D) Internal and External Moonlighting ..................................................................20-21

XI) Duty Hours and Resident Fatigue.......................................................................21-22 A) Duty Hours............................................................................................................ 21 B) On-Call Activities .................................................................................................. 21 C) Methodology for Data Collection .....................................................................21-22 D) Stress and Fatigue ............................................................................................... 22

1) Education 2) Monitoring Methodology 3) Back-Up Systems for Fatigue

XII) Resident Supervision...........................................................................................22-23 A) Faculty Supervision of Residents in Clinics.......................................................... 22 B) Faculty Supervision of Residents During On-Call Activities ............................22-23

XIII) Academic Due Process............................................................................................. 23 XIV) Resident Well-Being.................................................................................................. 23 XV) Sexual Harassment and Non-Discrimination.......................................................... 24

A) Policy .................................................................................................................... 24 B) Resources ............................................................................................................ 24

XVI) Additional Policies ...............................................................................................24-25 A) Parking

1) Moffitt-Long 2) San Francisco General Hospital 3) Veteran’s Administration Medical Center 4) Mt. Zion Medical Center

B) Additional Information on GME Services and Policies

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I) Introduction A) Accreditation and Sponsoring Institution

1) The University of California, San Francisco, Dermatology Residency Training Program is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). The University of California, San Francisco is the sponsoring institution, and other Participating Institutions include the VA Medical Center and San Francisco General Hospital. The program abides by the guidelines and requirements issued by the Dermatology Residency Review Committee, which can be accessed online at: www.acgme.org

B) Program Director 1) Program director Jack Resneck, Jr, MD is responsible for the Dermatology

Residency Training Program at UCSF. 2) Executive Vice-Chair and Clinic Chief Tim Berger, MD works with Dr. Resneck in

the 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 the applicant’s preparedness and ability to benefit from the Dermatology Residency Training Program. (a) Aptitude, academic credentials, leadership potential, personal characteristics

such as motivation and integrity, and an ability to communicate are considered in the selection.

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

(c) In selecting from among qualified applications, the Department of Dermatology 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 criteria

for resident eligibility as specified in the UCSF GME Eligibility Policy. 2) The Dermatology RRC of the ACGME approves the number of resident positions

based upon established criteria that include the adequacy of resources for resident education, faculty-resident ratio, institutional funding, and the quality of faculty teaching.

3) UCSF Health Requirements (a) All residents are required to provide proof of immunizations in order to be

appointed as UCSF Housestaff. Details are available on the UCSF GME website and in the UCSF GME Handbook

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

4) Licensure Requirements 4

http://www.acgme.org/


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

(b) All residents, in accordance with California law, will obtain their California Medical License before the start of their second year of residency.

(c) Trainees who have not obtained a California medical license within the above mentioned time frames will not be allowed further patient contact or access to patient information including medical records, laboratory values, radiographic studies, etc. A trainee not licensed by July 1st (or other start date) of the required year may not do any clinical work until a medical license is secured. During the period of non-licensure, the appointment, including salary, may be suspended.

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

malpractice claims, drug and alcohol abuse, disciplinary action and criminal activity as a condition of appointment. Any “yes” response to these statements demands an answer. After review of a resident’s explanation of “yes” statements, an offer of a contract for training may be revoked or the conditions of the offer revised.

III) Program Curriculum

A) Written Statement of Goals and Objectives for Clinical rotations 1) There are written goals and objectives for each rotation, with specific goals and

objectives for each year of residency. These include educational goals with respect to the knowledge, skills, and other attributes of residents for that rotation.

2) These goals and objectives are reviewed and revised annually by the program directors and the appropriate faculty overseeing each rotation. The goals and objectives for MZ rotations are in binders in the resident room and are available on 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 faculty supervising each rotation teach to these goals and objectives as well as other topics as the clinical experience dictates. Additional readings may be assigned for any rotation.

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

individual and group study of histologic slides, clinical rounds, chart and record reviews, faculty-trainee sessions in small groups and one-on-one settings, book and 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 activities whenever possible. This education is organized to follow a curriculum that will ensure resident exposure to the complete range of disorders encountered by the dermatologist.

(b) The didactic curriculum is covered every year in clinical dermatology, dermatopathology and procedural dermatology, and every 18 months in basic science (i) On average, the curriculum requires residents to read two hours every

night, a total of 15 hours weekly, or 150 to 300 pages of weekly reading. (c) Didactic Teaching

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(i) Daily Conferences/Journal Clubs • Attendance and punctuality are required (lectures begin at the time

stated, not 10 minutes after the hour). Residents are to sign in for all lectures they attend. ♦ Mondays: Dermatopathology Lectures • 7:30am-8:30am, Mount Zion Campus (so that continuity clinics

can begin promptly at 9:00am at other sites). ♦ Tuesdays, Thursdays: Lectures/Journal Clubs • Thursday 7:30am – 8:00am, Clinical Unknowns • Tuesday/Thursday Lectures begin at 8:00am

♦ Wednesdays: Lectures • 10:15am, 1701 Divisadero, 1st or 3rd Floor Conference Rooms

♦ Fridays: Derm Surgery Lectures • Friday lectures are primarily derm surgery, and begin at different

times depending on the Friday morning schedule. Check the lecture schedule regularly to confirm start times.

• Prior to the lectures, residents should read and learn the material in the assigned readings.

• For dermatopathology sessions, the residents should read the assigned material, examine the slides, make diagnoses, and come prepared to discuss the differential diagnosis.

(ii) Grand Rounds and Wednesday Staff Conferences • Attendance, punctuality and proper dress (no scrubs) are required. • The Grand Rounds lecture begins at 8:00am on Wednesday mornings

in Herbst Hall at Mount Zion Hospital. • Residents provide the bulk of patients presented at the Wednesday

Staff Conferences immediately following the Grand Rounds lecture. ♦ The full-time attendings will help residents identify good cases for

staff conference. ♦ Presenting a patient includes writing a concise, but complete,

protocol and a review of the literature on the patient’s condition. ♦ It is good to have interesting patients come to Grand Rounds for

their second clinic visit after initial biopsy but before the patient’s treatment plan is outlined and the patient’s questions are all answered.

♦ Residents are expected to carefully examine all of the presented patients and be able to describe the physical findings and give a clinical differential diagnosis.

♦ Coordinate with dermatopathology to ensure that any biopsy slides are photographed for presentation at Staff Conference.

• The chief resident or another senior resident is assigned to be responsible for assuring there are adequate numbers of patients at each Staff Conference.

(iii) San Francisco Dermatologic Society Meetings • Residents are members of SFDS free of charge, but must register

with the society. • There are quarterly meetings.

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♦ The fall meeting at UCSF is the Herschel Zackheim Cutaneous Oncology Lectureship.

♦ The spring meeting at UCSF is the John Weiss Clinical Dermatology meeting.

♦ The other two meetings are held at Stanford. • 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 January dinner is

expected 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 cursory discussion of interesting aspects of the case. ♦ Cases which are diagnostically or therapeutically difficult are

appropriate for presentation. ♦ More common dermatoses with good morphology are also

acceptable. (d) Didactic General Topics

(i) Basic Science • The basic science curriculum is overseen by Drs. Kari Connolly and

Dr. Shinkai. • It consists of journal clubs and text reviews. • Residents are expected to read the assigned reading prior to the

session. (ii) Clinical Dermatology

• Clinical Dermatology is taught daily in clinics and on the inpatient wards.

• There are monthly dermatology journal clubs reviewing the Journal of the American Academy of Dermatology and the Archives of Dermatology. Although only selected articles may be discussed at journal clubs, residents are required to read Archives of Dermatology and The Journal of the American Academy of Dermatology in their entirety. The CME articles are of great importance and should always be read carefully.

• The residents are responsible for reading a complete textbook of dermatology each year. For the first year residents this is Andrews’ Diseases of the Skin. For the second year residents this is Bolognia Dermatology. Third years may read the assigned chapters from either text.

• “Unknowns” sessions held weekly emphasize differential diagnosis. (iii) Dermatopathology

• The dermatopathology core is taught by weekly didactic sessions in a 12 month cycle.

• 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 (San Francisco Veterans

Affairs Medical Center and San Francisco General Hospital), there are weekly dermatopathology signout sessions to review biopsies performed by the residents during the previous weeks.

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(iv) Dermatologic Surgery • The dermatologic surgery/procedural dermatology curriculum is

covered each year. These include lectures, demonstrations and hands-on teaching sessions.

• Dermatologic surgery journal clubs are held each month and attendance for residents is required.

• Early in each academic year, there is at least one session teaching basic surgical techniques using pigs’ feet.

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

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

(v) Ethics • The Department offers an ethics course for all physicians in the

Department each academic year. • The ethics course consists of one to two one-hour lectures on various

topics, usually based on requests/suggestions from residents and faculty, as well as a one to two hour workshop, in which small-group discussions are utilized.

IV) Responsibilities of the UCSF Dermatology Resident

A) Educational Goals and Objectives for Each Rotation 1) General Dermatology, UCSF (Mt. Zion, San Francisco Veterans Affairs Medical

Center, San Francisco General Hospital): The following are basic goals and objectives the experience at UCSF in general. Specific goals and objectives for each rotation 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 and malignant skin disorders.

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

(iii) To learn basic diagnostic techniques: KOH, scabies preps, direct fluorescent antibody, fungal culture.

(iv) To write clear and concise notes within HCFA 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 of

common skin disorders (b) Second Year Residents

(i) To improve on the goals outlined for first year residents. (ii) To manage complex dermatology patients with multiple medical

problems. (iii) To recognized 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.

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(vi) To manage a cohort of “continuity” patients, coordinating their care and overseeing the management of their skin disease over a prolonged period.

(c) Third Year Residents (MZ Senior/Res D) (i) To be able to manage complex dermatology patients. (ii) To provide consultative services for patients referred from primary care

physicians and other dermatologists. (iii) To teach basic dermatology to medical students and primary care

residents. (iv) To administer the schedule and curriculum of the residents and

coordinate their 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 and

management of skin diseases. B) Clinic Performance

1) Excellent quality of care is expected. Clinical dermatology is learned 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 explained and diagramed if appropriate, and the exact nature of all treatments and lab evaluations noted.

(b) At Mt. Zion, medical students may write notes for the residents, but if a medical student signs a note, it cannot be considered as documentation of the visit (and an MD must write a separate note). If the medical student drafts a note but does not sign it, the resident can review the note for accuracy, make any necessary corrections, and sign the note.

(c) The attending who oversaw the visit must be noted by the resident at the bottom of the note (seen with….)

(d) At Mt. Zion, residents must document adequate information to bill at the appropriate level for that visit. If the resident has a question, the attending should be consulted. This involves checking adequate numbers of boxes and adequately detailing the treatment plan, proposed diagnostic evaluations, and patient education.

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

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 leave the 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 this

handbook. Be sure to verify your vacations with appropriate clinic staff as outlined on the vacation request form 4 weeks prior to any anticipated absences (educational leave or vacation).

2) Residents must be available to see patients at the start of the clinic (9 or 930 AM for morning clinics and 1PM for afternoon clinics). If you are going to be late, notify the attending.

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D) On-Call 1) A resident at each training location (MZ/UCSF, VAMC, SFGH) will be assigned to

take call for that institution during weekdays and weeknights. 2) A single resident will be assigned call covering all three institutions for weekends

or holidays. The chief resident prepares the weekend/holiday schedule prior to the beginning of the academic year. (a) Weekend and holiday call may be traded among residents with prior

notification of the division chief affected, chief resident and the program coordinator. Trades that divide a weekend among multiple residents are not permitted.

3) Any evening, weekend, or holiday on-call resident must be within pager range of their assigned on-call location, and must be available to come in to the hospital within one hour to see patients. Do not make plans during on-call periods that would preclude you from being available to come in to the 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 call resident to return pages and to contact attendings. 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 the

length of the rotation) by confidential, mandatory online forms completed by the residents using the E*Value system, and these evaluations are monitored by the program director. De-identified evaluations are made available to faculty only on an annual basis in order to optimize confidentiality. Low scores generate an immediate report to the Program Director.

2) We believe that resident input on program effectiveness and program change are extremely important. In addition to reviewing individual faculty, the residents also file confidential, mandatory evaluations of each rotation using the E*Value system. In addition, the residents are asked to meet without faculty present at least twice annually to make a joint confidential report regarding program issues which is passed on to the Program Director. Residents have an annual full-day retreat off-site each spring at which they work on program development. Once annually, the residents meet with the Dean for Graduate Medical Education without the Program Director, chair or other faculty members being present. In this setting, the residents are queried regarding the effectiveness of the faculty and management of the residency program.

3) The Resident Education Committee meets monthly and works with the program director to regularly review the teaching faculty, curriculum, individual rotations, and other parts of the residency program. The entire faculty meets together once yearly to review evaluations by the residents of the program and de-identified evaluations of program faculty, and at this meeting, the faculty also discuss the overall effectiveness of the residency program. The faculty also reviews program effectiveness on a regular basis.

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

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F) Evaluations of Medical Students 1) Residents are required to evaluate each medical student that he/she works with

within one work week of the completion of the rotation. 2) These evaluations are used by the faculty preceptor to write each student’s final

evaluation, which is used for the student’s Dean’s Letter. 3) Residents are expected to be prompt, complete, honest and fair in completing

these evaluations, especially on those students who have expressed an interest in 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 administrative duties. 3) The chief resident and other senior residents are involved with various duties,

including (but not limited to): didactic curriculum planning, rotation schedule planning, resident vacation planning, distribution of articles for all conference and journal clubs, medical student teaching, obtaining follow-up on all UCSF patients presented at Grand Rounds (within one month), planning of the resident retreat, service on the admissions committee and resident education committee, and related other duties as required.

4) The chief resident’s 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 resident’s mentor and the Resident Education Committee.

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

H) Managed Care 1) Because so many of our patients at Mt. Zion are covered my managed care

plans, residents must check with staff before proceeding with any procedures to ensure that insurance will cover the procedure and to obtain preapproval when required. In the event that staff cannot confirm coverage, the patient should be notified before proceeding.

2) The authorizations staff, Will Cadondon and Tonya Jones, can assist with obtaining authorizations.

I) Skin Cancer Screening 1) The American Cancer Society has designated May as Melanoma Month and the

American Academy of Dermatology has designated the first Monday of May as Melanoma 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 screening patients at about one per

five minutes to look at moles, etc. 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 support required for daily resident lectures and Wednesday conferences is present and operational.

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2) The academic year will be divided up evenly among the first year residents. 3) This includes responsibility for slide carousels, slide projectors, LCD projector,

and laptop. K) Resident Teaching

1) Senior residents will be asked to staff primary care residents and medical students.

2) Residents may also be selected to lecture medical students on the dermatology rotation on basic dermatologic material.

L) Resident Expert Talks 1. 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 appropriate for an audience of general dermatologists

c. To gain confidence is speaking and answering questions in the setting an audience of about 50 people. (For the do’s and don’ts of preparing your talk, please see the Department website.)

M) Research/Publications 1) Residents are strongly encouraged to write at least one paper for publication

during their residency. (a) This may be in any form (i.e. case report, review article, etc.) and involve the

resident’s 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. N) American Board of Dermatology Annual In-Training Exam

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

2) Scoring above the 20th percentile is expected. Performance below this level may result in an academic action as outlined in the Academic Due Process Policy (such as academic probation).

3) This exam acts as one measure of the fund of medical knowledge the resident has acquired. Substandard performance on the exam may often be symptomatic of a more general failure to study and acquire the necessary fund of knowledge, and may be a predictor of poor performance on Board certifying examinations.

O) ACGME Case Log 1) Every resident is required to log all surgical procedure that he/she performs or

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

rotation, resident surgery clinics, surgery at the VA, and surgery at SFGH. (b) Biopsies done on a routine basis in general dermatology clinics do not need

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

(a) This log must be kept up to date and done in a timely manner. 3) Residents must submit a tally of all surgical procedures done during their

residency to the program coordinator by May 1st each academic year to be submitted 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 of dermatologic surgery and ensure that residents are gaining sufficient exposure.

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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 main

Department of Dermatology site, 1701 Divisadero Street, 3rd Floor. (b) Residents will be given keys/codes to clinic doors on the first day of their

residency training program. 2) Cutaneous Oncology Clinics

(a) High-risk melanoma clinics and mycosis fungoides clinics are located at the UCSF Cancer Center at the Mount Zion campus at 1600 Divisadero Street.

3) Wards (a) The Department of Dermatology provides inpatient consults for both the

main UCSF campus as well as the Mount Zion campus. (b) UCSF inpatients are located at the main Parnassus campus in the

Moffitt/Long building. (c) Inpatients at Mount Zion are located at 1600 Divisadero Street.

B) Parking and Transportation (See also Pages 24-25) 1) Free or metered parking is available near the clinic, but usually limited to two

hours. 2) There are pay lots located near the clinic. For appropriate parking

reimbursement beyond the base payment required for residents at the Parnassus campus, submit receipts to the business office. .

3) Shuttles run approximately every 15 minutes to and from the main Parnassus campus and all other sites except the VAMC.

C) Specialty Clinics 1) Clinics dedicated to a single disease occur at Mount Zion, either at the main

clinic or at the UCSF Cancer Center. (a) These include mycosis fungoides, hair and nail, and melanoma. (b) The residents are the primary providers in many of these clinics.

2) Surgery Clinic (a) There are three resident surgery clinics each month.

(i) Two are regular surgery clinics for the removal of benign and malignant lesions diagnosed in resident clinics.

(ii) One surgery clinic is for cosmetic surgery. (iii) The residents control the booking of patients for this clinic and are

responsible for pre-operative screening and counseling of the patients. Specific care must be taken if you are scheduling a patient to have surgery by another resident (clear that with the patient AND the resident whose schedule you are putting them on, if appropriate)

(iv) Fellowship-trained dermatologic surgeons staff each clinic (b) Residents are responsible for inputting these surgeries into their ACGME

surgical logs in a timely 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. Residents on 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 Pages 24-25)

1) Parking is available on selected streets at no charge, but is usually for very limited time periods. Residents and faculty can purchase parking closer to the facility. (a) The institutional police are available to escort residents to their cars 24 hours

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

C) Clinics 1) Residents will see the patients who are placed in their rooms. 2) There are two faculty available for each session.

(a) Residents present cases to the attendings. (b) In addition, there are rotating residents from multiple specialties and medical

students in the clinic. D) Admitting Patients

1) Dermatology patients are admitted to Family Practice/Internal Medicine 2) The head nurse will complete the paperwork and the resident calls the admitting

resident on-call. E) On-Call

1) Residents assigned to SFGH share call and take call at no more than two 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) Resident writes note, leaves space for attending note, attending signs note. (b) On-call residents can eat dinner at the hospital at no charge.

4) In-patient consults are written on specific forms. 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 for every skin cancer identified.

3) Patients who have not had definitive procedures will be sent registered letters. 4) A clinic alert will be put into the computer system by the head nurse to lost-to-

follow-up patients will be captured. G) Chart Notes and Prescriptions

1) Notes are to be neat and written in SOAP format. 2) The attending who staffed the case must always be listed at the end of the note. 3) Residents are responsible for prescribing only medications which will be

available to patients under their medical coverage. If the medication isn’t standardly available, residents must begin any authorization process required (i.e. TAR).

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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. 2) There is access to all facilities during business hours, but access otherwise is

obtained through the emergency room entrance. (a) Supplies in dermatology are difficult to access on nights and weekends. The

security service has keys, but access is not always available. (b) Call residents are responsible for bringing the call bag as clinic access may

not always be available. B) Parking and Transportation (See also Pages 24-25)

1) A monthly parking permit, which allows for on-site parking, is available at the cashier’s office.

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

3) Parking is also available in the neighborhood. 4) There are shuttles that leave from Parnassus regularly, but no shuttles that go

directly from the VA to Mount Zion. C) Clinic

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

2) After a resident sees a patient, he/she must present to the attending. Senior residents must present consults or new patients. Other patients can be presented 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 written on the computer. D) On-Call

1) The on-call resident is responsible for all inpatient consultations. This includes checking the dermatology consult “view alerts” once every weekday (these also go to the clinic nurse and site chief, so if the resident does not receive the alerts he/she can check with them).

2) The on-call resident is responsible for quality assurance follow-up on patients in the dermatopathology book for the month 2 months prior to when he/she is on-call. (a) This involves calling up charts on patients who have not been “destarred” to

see if they were actually treated. (i) If not, the patients must be sent a letter instructing them to contact the

VA to make the appropriate appointment. • All the resident has to do is give the names to the nurses and they will

print out form letters which the resident signs and the nurse mails. E) Dermatopathology

1) The residents are responsible for the Dermatopathology at the VA.

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(a) This includes maintaining the path book that must be brought to all path conferences in which the on-call resident must record all conference findings.

(b) Patients with conditions that need to be further treated must be starred (this involves placing a larger asterisk in the last column, opposite the patient’s name in the book).

(c) Destarring occurs at the time of treatment and involves scribbling out the asterisk and recording the treatment and date of the procedure; this is the responsibility of the performing physician.

VIII) Resident Leave A) Annual Leave

1) Vacation (a) A resident will take a maximum of 20 days of vacation per academic year. (b) Vacation leave must be taken in 5 consecutive day blocks over a one-week

period. (c) If vacation occurs during a week that contains a university holiday, then the

fifth day of vacation must occur either the Friday before the week or the Monday after.

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

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

(f) Senior residents are given one additional vacation day during their third year to use for interview purposes. Additional days off for interviews are at the discretion of the program director and site director and will be counted as vacation.

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

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

(i) Approval of vacation leave dates is contingent upon there being no conflict with 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 at

the same time unless it is specifically pre-approved by the site director and chief resident.

(j) No vacation is allowed while on the UCSF ward rotation. All other rotations (including dermpath and dermsurg) permit vacations, and if any 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 be taken by residents while rotating at the VA. Residents rotating at the VA should coordinate with the chief resident, the site director, and each other early in the academic year to ensure that institutional regulations are followed.

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(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 with fellow residents and the chief resident so that: (i) First year residents will have 1-2 weeks of vacation at the VA (each

resident to check with chief resident to find out how many they have been assigned) to total 9 weeks for the whole class. The remaining weeks of vacation should be distributed between SFGH (approximately 2 weeks for the whole class) and Zion (approximately 13 weeks for the whole class). Zion vacation may include Res A, Res B, Res C, Dermsurg, and Dermpath.

(ii) Second year residents will not have any vacation at the VA. Each resident will have 2 weeks of vacation while at SFGH and 2 weeks of vacation while at Zion. Zion vacation may include Res A, Res B, Res C, Dermsurg, and Dermpath.

(iii) Third year residents will not have any vacation at the VA or at SFGH. All vacation will be taken at Zion, and may include Res A, Res B, Res C, Zion senior, dermpath, and dermsurg.

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, but those residents usually attend the SPD or SID instead.

• One additional 2-day meeting per year. (b) Residents may be granted one additional travel day per education leave, but

only if substantial travel is required (i.e. travel to the east coast). (c) All meetings must be discussed with and approved first by the resident’s

mentor and then the Resident Education Committee with the exception of the AAD Annual Meeting, SID, and SPD (for Pediatric Dermatology dedicated residents). Meetings should be approved by the mentor and REC before residents apply for outside travel support or other funding. The REC must also approve any additional travel days beyond the meeting dates.

(d) Residents are allotted a maximum travel stipend of $1,000 per academic year, which may be used towards REC-approved educational meetings and to cover expenses for the AAD annual meeting over and above those paid for by the AAD resident travel program. Extra approved meetings will not lead to an increase in the travel stipend, and expenses beyond the stipend are to be paid by the resident. The chief resident is funded for one additional meeting beyond the annual stipend.

(e) All expenses and reimbursement must be in accordance with the University’s travel policy, which limits all meals to the per diem maximum rate of $64. The revised University policy limits meal reimbursement to only those meals that are an integral part of a business meeting (e.g., “working dinner”). More information on the travel policy (including details of allowable expenses, receipts required, and other information) can be found at http://www.ucop.edu/ucophome/policies/bfb/g28.html

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

(g) Once completing your trip, fill out the travel reimbursement form, attach all receipts, and submit to Christina Walker within 21 days of your return. She

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will obtain the signature of the program director, whose approval is required before the request will be processed.

3) Other Leave (a) In accordance with Board requirements and departmental policy, residents

cannot miss more than 14 weeks (not counting education leave) during their whole residency for any reason (four weeks per year plus an additional two weeks for unforeseen absences). Any absence exceeding the 14 week limit must be made up prior to the completing the program and qualifying for the Board Certifying Exam.

(b) Specific and detailed policies regarding sick/disability leave, maternity/paternity/adoption leave, family and medical leave, personal leave, military leave, and jury duty are outlined in the GME Housestaff Information Booklet. Vacation days may be used to extend beyond standard parental leave at the birth or adoption of a child. In accordance with these policies, a resident who is sick may take the necessary time to recover, but must notify the chief resident and program coordinator if he/she will not be coming to work.

4) Leave Request Process (a) All residents will receive an email from the Program Coordinator

approximately two months prior to the beginning of each quarter. (i) Residents are required to submit a completed Leave Request Form to

the Program Coordinator within two weeks of receiving the first request email. • Completed forms must have signatures from the chief resident and

site director of the rotation the resident will be on during the vacation. • Vacation requests must list the entire 5-day leave in accordance with

the consecutive days policy. • Education leave requests in which travel days are needed must

document the requested travel day. • If the Program Coordinator does not receive completed requests

within the two-week time period, he/she will assume that the resident is not requesting leave and leave may be lost.

(ii) The Program Coordinator will put copies of the approved request form in the resident’s 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 resident’s 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 of the Program Coordinator. If the Program Coordinator is unavailable, the chief resident should be contacted.

5) Senior Resident Electives (a) Senior residents in good standing may be granted one month of elective time

to study dermatology in other ACGME-approved training programs. All electives must be planned with the resident’s mentor and approved by the Program Director and REC. The primary issue in considering approval of electives will be the likely contribution to a resident’s career development.

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IX) Evaluation of Residents

A) ACGME Six Competencies 1) The training program is structured to assure that residents assume increasing

levels of responsibility commensurate with individual progress in experience, skill, knowledge, and judgment. This is outlined in the rotation-specific goals and objectives. In accordance with ACGME guidelines, UCSF Dermatology residents are required to attain competence appropriate for their level of training in the six areas listed below: (a) Patient Care that is compassionate, appropriate, and effective for the

treatment 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 of scientific evidence and improvements in patient care.

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

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

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

2) The Department of Dermatology evaluates its residents using a variety of tools to assess performance in the six competency areas: (a) Evaluation of Resident Live Performance, once yearly, performed in the

resident’s continuity clinic (b) Chart Stimulated Recall, every 6 months (c) Record Review, every 6 months (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 a three-month period using E-Value, an on-line evaluation system.

(ii) These evaluations are made available to residents by the on-line E*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 of

Dermatology. (a) Third year residents must also submit the ABD’s surgical log form to be sent

in with their final evaluation. C) Filing of Evaluations

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

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X) Moonlighting

A) Introduction 1) Resident input was solicited in the creation of this policy. This policy and

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

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

B) Resident Responsibility 1) Because residency education is a full-time endeavor, Dermatology Residents

must ensure that moonlighting does not interfere with their ability to achieve the goals 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 Program’s Duty Hours Policy, which has been approved by the Graduate Medical Education Committee and is consistent with the UCSF Policy on Duty Hours.

4) It is the responsibility of the Dermatology Residents to obtain written permission to moonlight from the Program Director prior to beginning the moonlighting activity, for both “internal” and “external” moonlighting (see below for definitions). Permission must be obtained using the appropriate, resident and faculty approved moonlighting form (i.e. eternal or internal) which requires both the Program Director and Resident signatures as well as information regarding the moonlighting activity.

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

C) Program Responsibility 1) The Program Director will also monitor resident performance in the program to

ensure that moonlighting activities are not adversely affecting patient care, learning or resident fatigue.

2) If the Program Director determines that the resident’s performance does not meet expectations, permission to moonlight will be withdrawn.

3) Monitoring information will be reviewed periodically with the Dermatology Resident Education Committee. The GMEC will periodically review reports by the 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 a site that participates in the resident’s training program. This activity must be supervised by faculty and is not to exceed the level of clinical activity currently approved for the resident. While performing internal moonlighting services, residents are not to perform as independent practitioners. Internal moonlighting hours must be documented and they must comply with the written policies regarding Duty Hours as per the Dermatology Training Program, UCSF and ACGME.

2) External Moonlighting (a) External moonlighting is defined as work for pay performed at a site that

does not participate in the resident’s training program. External moonlighting hours must be documented (including days, hours, location, and brief description of type of service(s) provided) in order to comply with Medicare

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reimbursement requirements for GME. For external moonlighting, the resident is not covered under the University’s professional liability insurance program as the activity is outside the scope of University employment. The resident is responsible for his/her own professional liability coverage (either independently or through the entity for which the trainee is moonlighting), DEA licensure, Medicare, provider number and billing training, and licensure requirements by the California Medical Board and any other requirements for clinical 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 the

residency 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 with ACGME regulations, duty hours do not include reading and preparation time spent away from the duty site. These standards apply to all UCSF training sites including, but not limited to, the VA, SFGH, Mt. Zion, and Moffitt-Long hospitals.

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 clinical

responsibilities, averaged over a four week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

4) A 10-hour time period for rest and personal activities will be provided between all daily duty periods.

B) On-Call Activities 1) The residents in the Department of Dermatology DO NOT have in-house call. 2) The Department of Dermatology is not an in-patient service. Dermatology

patients requiring admission are admitted to the Internal Medicine service. No Dermatology resident has primary responsibility for the care of any in-patient.

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

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

5) At-home call (pager call) is defined as call taken from outside the assigned institution. (a) The frequency of at-home call is not subject to the every third night limitation.

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

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

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

C) Methodology for Data Collection 1) Work hours are monitored and recorded twice yearly.

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

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

D) Stress and Fatigue 1) Education

(a) The residents are required to review the presentation entitled “Monitoring Fatigue 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 Program Director on July 1 of each academic year.

(c) Fatigue education for the faculty consists of annual review of the presentation entitled “Monitoring Fatigue and Performance: Implications for Resident Duty Hours” by David F. Dinges, PhD on the GME website at http://www.medschool.ucsf.edu/gme and notify the Program Coordinator, in writing, that they have done so.

2) Monitoring Methodology (a) Residents spend a minimum of 3 to 4 hours each day in face to face

interactions with an attending. The faculty assesses by observation residents fatigue and stress levels on a daily basis. Faculty and residents are educated to recognize the signs of fatigue and adopt and apply policies to 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

other 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 during

patient care activities in the clinics. This continuous supervision and consultation is 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 or less.

4) Faculty must not have other obligations during teaching time. 5) Such supervision will occur in structured, patient-oriented, small group

educational activities, such as outpatient general dermatology clinics and outpatient subspecialty dermatology clinics.

B) Faculty Supervision of Residents During On-Call Activities 1) On-call residents responsible for consults in the inpatient setting present all

patients to faculty members. 2) The ward attending schedule provides the residents with a rapid, reliable system

for communicating with supervising faculty about inpatient consults. 3) The ward attending is available to the consult resident 24 hours per day, 7 days

per week, by pager and telephone.

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

(b) In the event that an on-call resident is unable to reach both the ward and back-up attendings, the residency program director and the department chair are both available.

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

XIII) Academic Due Process and Dismissal Policies

A) The Dermatology Residency Program abides by the UCSF GME Academic Due Process Policy, which sets forth administrative and academic actions (such as counseling letter, notice of concern, probation, suspension, requirement to repeat an academic year, non-renewal of contract, dismissal, etc.). Importantly, this policy also establishes procedures that residents may use to resolve differences when such actions occur, and lays out appeals processes for certain appealable actions. The complete policy is available in the UCSF GME Resident Handbook and online at the UCSF GME Website.

B) In accordance with the University GME Dismissal policy and the Academic Due Process Policy, a trainee may be dismissed from the Dermatology Residency Program for academic deficiencies. This action is appealable to the Dean of the School of Medicine. Reasons for dismissal may include, but are not limited to the following: 1) A failure to achieve or maintain Dermatology Training Program standards; 2) A serious or repeated act or omission compromising acceptable standards of

patient care, including by not limited to an act which constitutes a medical disciplinary cause or reason;

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

4) A material omission or falsification of an application for the Dermatology Training Program, medical record, or University or medical document, including billing records. Any allegation regarding failure to comply with UCSF’s billing rules shall be forwarded to UCSF’s Corporate Compliance Officer and/or the Office of General Counsel for resolution in accordance with UCSF’s Corporate Compliance Program.

XIV) Resident Well-Being A) The Dermatology Residents have access to a variety of systems for supportive

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

B) The Dermatology Department recognizes a broad range of personal issues may arise during the course of a residency and encourages Residents to use any of the following 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 and

online at the UCSF GME Website.

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XV) Sexual Harassment and Non-Discrimination A) Policy

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

B) Resources 1) The following offices have been designated as resources. Residents who

believe they may have been subjected to discrimination and/or gender, sexual or other 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 University’s confidential sexual harassment procedure: http://www.ucsf.edu/oshpr/policies/policy.html.

XVI) Additional Policies

A) Parking 1) It is against statewide UC policy to cover parking expenses for faculty, residents,

and staff. However, the department obtained special approval from the Dean’s Office for covering excess parking expenses when monthly parking exceeds the baseline monthly rate for residents on Parnassus. All receipts for parking must be submitted within 21 days after the end of the month.

2) Moffitt-Long Housestaff may purchase a parking permit at the University Parking Office located on "G" level under the West wing of Millberry Union. Identification (a driver license) is required. The Parking Office must verify the applicant’s status as a trainee. A hangtag is displayed on the inside mirror and a cardtrol is issued to open the garage gate. The cost of a parking permit is high, so that many trainees elect to purchase privileges for only ward months. Each permit holder is liable for late charges if the cardtrol is not returned and citations are issued for an expired hangtag on the 5th working day (weekends and holidays excluded) of a new month. Parking fees are regulated by a University of California systemwide policy. During ward service months, residents may submit individual parking receipts for daily parking when attending Wednesday Grand Rounds at MZ (since that is over and above the Parnassus permit the resident will need).

3) San Francisco General Hospital Housestaff may purchase a parking permit at the SFGH Parking Garage. This parking permit is for use in the parking areas located on the hospital grounds. A hangtag is displayed on the inside mirror of the vehicle. A UCSF Identification Badge and certification by the Dean’s Office at SFGH are required when purchasing a parking permit. The San Francisco Department of Parking and Traffic (DPT) determines the parking fees. Neither SFGH nor the Dean’s Office at SFGH has any authority over parking fees at SFGH. The institutional police are available to escort residents to their cars 24 hours a day. For residents returning to SFGH at night to see consults, a limited number of dedicated parking spaces are available. The Department of Dermatology will reimburse residents for the

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difference between the cost of SFGH parking and the cost of a regular housestaff permit at Moffitt-Long. For example, as of July 1, 2007, the monthly parking at Parnassus was $101 and the parking at SFGH was $105. Therefore, the department would reimburse for the difference of $4 for any given month. During SFGH months, residents may submit individual parking receipts for daily parking when attending Wednesday Grand Rounds at MZ (since that is over and above the SFGH permit the resident will need).

4) Veterans’ Administration Medical Center Housestaff may park on campus but must register their car with the VA police, located on the ground floor at the entrance of building 203. Once registered, housestaff may buy a monthly pass at the cashier’s desk located in building 2, room 63 or housestaff may pay for parking on a daily basis. The machine to purchase the daily pass is located in the employee parking lot towards the northwest side. Both the VA sticker documenting the registration of the vehicle and either the current monthly pass or daily parking pass must be prominently displayed; if not there is a high likelihood of a ticket. Because the cost of parking permits at the VAMC is far below those at Parnassus, no reimbursement will be paid during VA months for Grand Rounds parking at Zion.

5) Mt. Zion Medical Center While rotating at Zion, residents may purchase monthly permits from a nearby private lot. The Department of Dermatology will reimburse residents for the difference between the cost of the lowest-priced nearby lot and the cost of a regular housestaff permit at Moffitt-Long. For example, as of July 1, 2007, the monthly parking at Parnassus was $101 and the parking at Mt. Zion was $145. Therefore, the department would reimburse for the difference of $44 for any given month.

B) Additional information on GME Services and Policies not discussed above (such as benefits, police & security, scientific misconduct, etc.) is available in the UCSF GME handbook.

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Documents

UCSF Dermatology Residency Handbook