# Resident Manual DESCRIPTION1. APPOINTMENT Resident’s appointment by Kaiser Foundation Hospital

(KFH) shall be for a period of one year or as stipulated in the “Resident Physician Training Agreement”. The appointment may be terminated in accordance with the established termination policy.

2. BENEFITS See the “Benefits for You – Summary Plan Description” or “Benefits in Brief” for information regarding the items listed below. Also, on the Kaiser Intranet, please visit http://insidekp.kp.org/california/insidekp/south/. At this web address, click on “Work at Kaiser” and then do a search for “Resident Benefits.”

1. KP Health Plan coverage2. Dental Plans3. Life and Short Term Disability Insurance4. Retirement Programs5. Domestic Partners Benefits6. Dependent Care Reimbursement Plan7. Employee Assistance Program8. Child Care Assistance Program9. Alternative Mental Health10. Supplemental Medical Plan11. Employee Assistance Program (EAP)12. Employee Life Insurance13. Health Care Spending Account14. Commuter Choice Program15. Parent Medical Coverage16. Kaiser Permanente 401-K Plan17. Kaiser Permanente Retirement Plan

3. BOARD APPLICATIONS--MAINTENANCE OF DOCUMENTATION

Residents who anticipate becoming board certified must keep their own copes of required documentation. It is the responsibility of each resident to know the respective board’s requirements for certification.

4. CERTIFICATIONS All residents must maintain valid Basic Life Support (BLS) Certification. Certification in Advanced Cardiac Life Support (ACLS) is required in the following programs: Cardiology, Interventional Cardiology, Diagnostic Imaging, Family Medicine, Gastroenterology, Internal Medicine, Nephrology, Neurology, Radiation Oncology, Sports Medicine, General Surgery, and Urology. Pediatrics, Family Medicine, and Obstetrics & Gynecology residents must have certification in Neonatal Advanced Cardiac Life Support (NALS). Pediatrics, Family Medicine, & Radiation Oncology residents must have certification in Pediatrics Advanced Life Support (PALS). Additional certifications

# Resident Manual DESCRIPTIONmay be required at the time of or before Orientation. Check with Program Director or residency administration regarding other required certifications such as DEA, fluoroscopy, procedural sedation, & TB mask respirator tests. Certification requirements will be included in the hiring packet mailed to incoming residents in the spring prior to beginning the academic year in June.

5. COMMITTEES - RESIDENT REPRESENTATION

The ACGME requires peer selected resident representation on the Institutional Graduate Medical Education Committee (IGMEC) and in its internal review process. Residents are encouraged to participate on many of the hospital committees. Contact the Center for Medical Education or the administrative offices of the training program at the medical center for the list of hospital committees, and program director for other opportunities.

Resident issues and concerns may be brought to the IGMEC through the resident representative. Residents may contact the Designated Institutional Official (DIO) or any member of the IGMEC to request that an issue or concern be addressed by the IGMEC. Contact the Center for Medical Education or the administrative offices of the training program for a list of IGMEC members.

6. DISCIPLINARY ACTIONS Any of the following disciplinary actions may be taken if a resident’s performance or professional conduct does not comply with KFH policies & procedures and practices or any other requirements of the “Resident Physician Training Agreement” or if the resident’s academic performance is unsatisfactory. Disciplinary action will be based on the severity of the violation and taken at the discretion of the Program Director, in consultation with the Designated Institutional Official (DIO).

These steps may include any or all of the following: Resident receives verbal warning. Resident receives written counseling outlining problems

and remedial expectations. Resident is placed on probation with conditions and

terms of probation period defined in writing. Resident is placed on leave of absence (suspended

from the training program). Termination.At the end of the probationary period, resident will be counseled and receive written notification of either full reinstatement, extended probationary term, immediate

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# Resident Manual DESCRIPTIONtermination, or non-renewal of resident’s appointment to the training program. Resident shall also receive written notification and verification of academic credit given by program director to that point in time and whether program director will recommend resident for medical board specialty certification.

Disciplinary action that results in residents being required to repeat training already completed, or involves any other reportable conditions under Medical Board of California statutes may be reported to the Medical Board of California by the program director.

7. DRESS CODE Residents will utilize good judgement in determining their dress and appearance and are expected to present a professional image. The program director and/or chief of service will address questions regarding appropriateness of attire.

8. DRUG AND SUBSTANCE ABUSE

No resident will provide patient care while under the influence of drugs or alcohol. The use of drugs or alcohol while on “beeper call” from home is prohibited.

A resident suspected of or found to have a substance abuse problem may be subject to one or more of the following: Discipline Suspension Referral to the Diversion Program of the Medical Board

of California Referral to the Kaiser Chemical Dependency Recovery Program

Residents concerned about their ability to deal with alcohol or drugs may self-refer to the Kaiser Chemical Dependency Recovery Program.

Residents concerned about the health and competence of a colleague or about a potential threat to patient care are strongly advised to report their concern confidentially to the program director and/or chief of service. “Well Being” committees exist at the medical centers, and residents are encouraged to join as committee members.

After treatment, rehabilitation, and demonstrated evidence of an acceptable ongoing recovery program, the resident may be allowed to rejoin the resident training program

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# Resident Manual DESCRIPTIONsubject to appropriate monitoring and other terms and conditions.

In addition to suspension and discipline, reports to legal authorities will be made as appropriate. Circumstances which will result in reporting to law enforcement and regulatory agencies include refusal of treatment or non-compliance with the treatment plan, unsatisfactory progress toward recovery, risk to patient safety, and criminal activities such as stealing or selling drugs.

9. DUE PROCESS AND GRIEVANCE PROCEDURE

Kaiser Permanente provides an internal grievance and problem solving procedure for residents to utilize in resolving individual resident complaints or problems fairly and promptly through a series of steps which are to be followed in sequence (See Attachment #1).

The Resident’s Professional and Academic Grievance Process (See Attachment #2) is a process to provide residents with an exclusive, final, binding, timely, and impartial method for resolving issues related to certain actions taken concerning professional and academic performance.

Issues related to Kaiser Foundation Health Plan, Inc. and the resident’s relevant Membership Agreement issued for resident’s medical care coverage are exempt from this grievance procedure.

10. DUTY HOURS ANDMOONLIGHTING

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, time spent in house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

Duty hours will be limited to 80 hours per week averaged over a four week period, inclusive of all in house call activities.

Residents will be provided with 1 day in 7 away from all educational and clinical responsibilities, averaged over a 4 week period, inclusive of call. One day is defined as one continuous 24 hour period free from all clinical, education, and administrative activities.

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# Resident Manual DESCRIPTIONAdequate time for rest and personal activities will be provided. This will consist of a 10 hour time period provided between all daily duty periods and after in house call.

In some departments, there may be an ACGME approved “Exception to Duty Hours.” Residents should check with the program director for clarification.

The structuring of duty hours and on-call time periods will focus on the educational needs of the resident, the needs of the patients, and continuity of care. The program director or designee will monitor resident duty hours.

Supplemental employment outside the residency must be discussed with the program director. The resident’s current performance will be considered. The hours involved can not be so excessive as to interfere with the educational purpose of the training program. See Moonlighting Policy on Attachment # 6.

11. EQUAL EMPLOYMENTOPPORTUNITY

Kaiser Permanente is committed to maintaining up-to-date polices regarding Equal Employment Opportunity (EEO). (See Attachment #3 for the EEO Policy).

12. EVALUATIONS Residents will receive feedback and formal evaluations twice per year. The program director or designee will regularly evaluate resident’s knowledge, skills, and overall performance, including the development of professional attitudes consistent with being a physician, and will communicate each evaluation to the resident in a timely manner.

13. FINANCIAL SUPPORT Residents will be paid the sum of money for the entire term described in their “Resident Physician Training Agreement”, payable every two weeks for services rendered during the prior two weeks. Payment will be made in the manner customarily utilized for payment of Kaiser employees. The sum will be prorated if the “Resident Physician Training Agreement” is terminated prior to the expiration of the specific term.

14. HEALTH CLEARANCE All residents are required to take and pass a health screening following acceptance into the program and prior to beginning work. Residents are required to have the physical and mental ability to perform the essential duties

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# Resident Manual DESCRIPTIONof the residency training program.

In the interest of protecting both patients and staff, southern California Permanente Medical Group (SCPMG) requires residents to have, or provide evidence of having had health screening and immunizations, including, but not limited to:1. Health screening for tuberculosis, which must

demonstrate freedom from active tuberculosis;2. Health screening for hepatitis B, rubella, and rubeola

immune status; 3. Immunization for hepatitis B, rubella, and rubeola if not

already immunized.

Failure to comply with the requirements of this section and/or obtain any other immunizations or screenings as may be required by SCPMG or any hospital may result in termination of employment.

15. HOLIDAYS Residents are eligible for the following 6 designated holidays provided resident is not scheduled to work on these days: New Year’s Day; Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. If the resident is scheduled to work on a designated holiday, an alternate day off may be negotiated with the program director.

16. ID BADGES A photo ID badge will be provided to each resident. The ID badge must be worn at all times.

17. LICENSURE Residents who graduated from medical school in the United States will take the United States Medical Licensing Exam (USMLE) Part III no later than the end of the 12 th month of residency training in an (ACGME) accredited program. Residents must start the licensing application process with the California Medical Board at least six to nine months before the license is required (the 25th month of residency).

International graduates are excluded from this policy and are not required to be licensed until the 36th month of residency training in the United States. Training beyond the 36th month cannot take place unless the international graduate is licensed by the Medical Board of California.

Residents will pay the Medical Board of California registration fee for California licensing.

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# Resident Manual DESCRIPTION

18. LAUNDRY White coats and surgical scrubs are provided to residents. Laundry service of white coats and scrubs is provided. Personal laundry service is not provided.

19. MEALS A meal allowance is provided which covers the cost of most meals.

20. MEDICAL LIBRARY Medical Library services are provided and access is available 24 hours per day. Computers are available in the library for resident’s use.

21. MEDICAL RECORDS The accurate and timely completion of medical records is a mandatory requirement and a professional standard for Residents. It is considered an integral part of training. Residents are required to comply with policies, procedures and practices instituted by the hospital and the training program regarding accurate and timely completion of medical records.

The JCAHO standards require that medical records be completed within 14 days of a patient’s discharge. Residents will be notified of delinquent records. Failure to complete medical records in a timely manner may subject the resident to suspension which may result in the resident’s inability to complete the program on time. Continued non-compliance may result in termination from the program.

Medical charts cannot be removed from patient care units or from the Medical Records Department (except for patient care). Written entries are to be legible. Only approved abbreviations and symbols may be used. Medical student entries must be co-signed by a resident. Resident’s operative reports, consultations, discharge summary, and history & physical examinations must be reviewed, corrected as required, and co-signed by the attending physician. Only residents and attending physicians may dictate to the medical record.

22. MEETING ATTENDANCE Presentations at Medical Meetings: Under special circumstances, if staffing permits, residents at any level of training who present papers at meetings of major professional medical organizations or institutions will be provided educational leave time, registration fees, travel, and other reasonable expenses in accordance with the regional policies and procedures on leave time for educational meetings (see Attachment #4). Approval will

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# Resident Manual DESCRIPTIONbe necessary from the program director, chief of service, DIO, and Medical Director of Clinical and Analytical Services.

Senior Resident Educational Meeting: Residents in an independent Kaiser Permanente training program who are in their final year of required training will be given the opportunity to apply for reimbursement of travel, lodging, meals, and registration expenses for attendance at one United States or Canadian educational meeting in that academic year (see Attachment #4). Permission to attend a meeting is at the discretion of the program director and the designated institutional official. Examples of activities NOT covered under Senior Educational Meetings are: board review courses, home study, books and educational materials. Total maximum reimbursement for all reasonable expenses up to $1,000 for up to five (5) days is at the discretion of the program director and designated institutional official. The completed application form (with all signatures), travel authorization and a copy of the meeting brochure must be received in the Center for Medical Education or the administrative offices of the training program four (4) weeks prior to the meeting. After the fact requests for reimbursement will not be honored. An expense report must be submitted to the Center for Medical Education or the administrative offices of the training program within one (1) week of the conclusion of the meeting. Delay in submitting expense report may result in no reimbursement. The educational meeting must be attended prior to graduating at the end of June.Local Meetings and Kaiser Permanente Symposia: Attendance at local meetings and Kaiser Permanente symposia is at the discretion of the program director and chief of service for all residents. (see Attachment #4).

23. PARKING Parking will be provided at all Kaiser Permanente facilities to which the resident is assigned.

24. PHARMACEUTICAL REPRESENTATIVES

Resident’s interaction with pharmaceutical companies and their representatives will be conducted in compliance with the Pharmacy and Therapeutics (P&T) Committee policy.

Program directors will provide guidance to residents regarding pharmaceutical company activities.

25. PROFESSIONAL DEVELOPMENT

Residents will develop a personal program of self-study and professional growth under the guidance of the program director and/or training program teaching faculty.

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# Resident Manual DESCRIPTION26. PROFESSIONAL

LIABILITY INSURANCEProfessional liability insurance coverage is provided on an occurrence basis by Kaiser Foundation Hospital (KFH) and will only apply and extend to clinical activities within the scope of the training program and under direct supervision of licensed physicians approved by the program director.Professional liability coverage is not provided for any professional work or activities performed outside the training program.

27. REAPPOINTMENT Resident reappointment to the next postgraduate training year will be by recommendation from the program director and will be contingent upon many factors including the resident’s successful completion of the current postgraduate year of education in the training program.

28. RESIDENT RESPONSIBILITIES

Refer to Supervision Grid for specialty.

29. SECURITY Residents are required to comply with program and hospital policies, procedures, and practices regarding staff and patient security including, but not limited to, wearing photo ID badge while on duty, participating in security measures training, and using hospital facilities for their designated purposes only.

30. SEXUAL HARASSMENT Kaiser Permanente is committed to maintaining up-to-date policies regarding Sexual Harassment. See Attachment #5 for the Kaiser sexual harassment policy.

31. SLEEP ROOMS Sleep rooms will be provided for residents when they are on-call.

32. SUPERVISION All residents are supervised by staff physicians and are given increasing levels of responsibility through their training. The staff physicians are ultimately responsible for patient care.

33. UNIVERSAL PRECAUTIONS

All body fluids and specimens are regarded as potentially infectious. Universal precautions are practiced in all areas of the medical centers. Each resident is required to learn and practice universal precaution procedures.

34. VACATION Residents are eligible for 3 weeks (15 days) of vacation each year. Residents at LAMC receive a vacation cash payout for any unused vacation at the end of each academic year, usually in August or September.

All time off is at the discretion of the program director. The

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# Resident Manual DESCRIPTIONresident will be notified if make-up time is necessary to meet the “Medical Specialty Board Certification Requirements” as adopted by the American Board of Medical Specialties.

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