WellStar Spalding Internal Medicine Residency Program

The mission of Graduate Medical Education at WellStar Spalding is to create an exceptional and personalized training environment to develop the next generation of physicians to provide the highest quality of care to our people and improve the physician workforce in our community.

Aims

• Train providers in the specialty of Internal Medicine so that they are able to practice independently, with a focus to provide care in keeping with the mission of the American Board of Internal Medicine (ABIM) to improve the quality of medical care available to the public through certification, training standards, research, leadership development and collaboration.
• Facilitate each resident's and faculty member's growth as an individual and as a physician by encouragement and the promotion of:
  • Excellence in clinical practice
  • A Commitment to life-long learning and self-improvement
  • Patient advocacy
  • Leadership
  • Teamwork
  • Respect for patients and colleagues with diverse race, cultural, and spiritual backgrounds
  • Balance in personal and professional lives
• Enhance the patient care experience for persons in the community served by our residents and faculty members as providers who are trained to deliver evidence-based, high-value, world-class quality patient care with compassion.
• Decrease population health disparities by equipping providers to proactively work to tackle both patient and societal needs.
• Increase the number of internal medicine physicians who train and ultimately practice medicine in the Griffin community and in the State of Georgia.

The curriculum of the 'Wellstar Spalding Internal Medicine Residency Program' is carefully crafted to support the holistic development of each resident as a well-rounded physician. This comprehensive training takes place at various locations, including Spalding Regional Hospital, the GME clinic, and other specialized clinics within the community.

Whether residents aspire to pursue a career in Hospital Medicine, Primary Care, or a specific subspecialty within Internal Medicine, our program is dedicated to helping them shape their training experience to foster their future success. We are equally committed to nurturing our residents' scholarly pursuits and offer guidance tailored to their individual career interests.

During the initial months of residency training, every resident is paired with a faculty advisor. This advisor's role is to regularly check in on residents and provide encouragement, with a particular emphasis on frequent meetings during the crucial first six months of training. As residents progress, they have the option to either continue with their faculty advisor as a mentor or choose a mentor more aligned with their unique career and educational objectives.

To ensure residents' progress and maintain high standards, scheduled meetings with the Program Director occur at least every six months. These meetings encompass performance assessments, milestone reviews, and summative evaluations. The content of these semi-annual reviews is shaped by input from the Clinical Competency Committee (CCC), which reviews all evaluations submitted since the last CCC gathering.

Residents must be able to provide patient care that is patient- and family-centered, compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Residents must demonstrate the ability to manage the care of patients:

• Using clinical skills of interviewing and physical examination
• In a variety of roles within a health system with progressive responsibility, including serving as the direct provider, a member, or leader of an interprofessional team of providers; as a consultant to other physicians; and as a teacher to the patient, the patient's family, and other health care workers
• Including the prevention, counseling, detection, diagnosis, and treatment of adult diseases
• In a variety of health care settings, including the inpatient ward, critical care units, and various ambulatory settings
• For whom they have limited or no physical contact, through the use of telemedicine
• In the subspecialties of internal medicine
• Using population-based data
• Using critical thinking and evidence-based tools

Residents must be able to perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.

Residents must demonstrate the ability to:

• Use and/or perform point-of-care laboratory, diagnostic, and/or imaging studies relevant to the care of the patient
• Perform diagnostic and therapeutic procedures relevant to their specific career paths
• Treat their patients' conditions with practices that are patient-centered, safe, scientifically based, effective, timely, and cost-effective

Program expects residents to develop individualized learning plans for studying the topics of the ABIM Blueprint. We provide MKSAP and PEAC modules to all residents.

All residents must sign up for MKSAP Tracker and PEAC modules.

All residents are expected to complete monthly assigned tasks which are monitored by program leadership in MKSAP Tracker and PEAC modules.

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social behavioral sciences, including scientific inquiry, as well as the application of this knowledge to patient care.

Residents must demonstrate a level of expertise in the knowledge of the broad spectrum of clinical disorders seen by an internist, including:

• the core content of general internal medicine, which includes the internal medicine subspecialties, the multidisciplinary subspecialties of geriatric medicine, hospice and palliative medicine and addiction medicine, and neurology.

Residents must demonstrate sufficient knowledge in the following areas:

• evaluation of patients with an undiagnosed and undifferentiated presentation
• pharmacotherapeutic and non-pharmacotherapeutic treatment of the broad spectrum of medical conditions and clinical disorders managed by internists
• provision of preventive care
• interpretation of clinical tests and images
• recognition and initial management of urgent medical problems
• application of technology appropriate for the clinical context, including evolving techniques

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, including the structural and social determinants of health, as well as the ability to call effectively on other resources to provide optimal health care.

Medical practice occurs in the context of an increasingly complex clinical care environment where optimal patient care requires attention to compliance with external and internal administrative and regulatory requirements.

Residents must demonstrate competence in:

• working effectively in various health care delivery settings and systems relevant to their clinical specialty
• coordinating patient care across the health care continuum and beyond as relevant to their clinical specialty. Every patient deserves to be treated as a whole person. Therefore, it is recognized that any one component of the health care system does not meet the totality of the patient's needs. An appropriate transition plan requires coordination and forethought by an interdisciplinary team. The patient benefits from proper care and the system benefits from proper use of resources.
• advocating for quality patient care and optimal patient care systems
• participating in identifying system errors and implementing potential systems solutions
• incorporating considerations of value, equity, cost awareness, delivery and payment, and risk-benefit analysis in patient and/or population-based care as appropriate
• understanding health care finances and its impact on individual patients' health decisions
• using tools and techniques that promote patient safety and disclosure of patient safety events (real or simulated).
• Residents must learn to advocate for patients within the health care system to achieve the patient's and patient's family's goals, including, when appropriate, end-of-life goals.

All residents will participate in a Quality Improvement and Patient Safety (Quips) Curriculum throughout the training, with additional time during Ambulatory Blocks.

Residents will analyze a near miss or adverse event case and perform a root cause analysis.

Each resident will also choose a longitudinal QI project to address an issue within the clinical practice areas where residents work at Wellstar Spalding or GME Clinic.

If any patient safety events or near misses are observed by residents or faculty, they are expected to report this through Wellstar Safer online reporting system.

During the training, bedside, ACP modules and during didactics residents receive education about cost awareness and the importance of high value patient care. All residents are also expected to complete the ACP Caring with Compassion online modules.

Residents are expected to participate in Root cause analysis in either simulation or part of Hospital RCA meetings.

Educational Content will be provided on Healthcare Disparities, Palliative Care, and Assessing Patient Goals and during Palliative Care Rotation at North Fulton.

Residents expected to participate in Goals of Care discussions on many inpatient rotations and ICU.

Residents expected to participate in Huddles in Hospital during wards and ICU rotation, and in GME clinic.

Residents use the Social Determinants of Health Screening with provision of patient resources in Continuity Clinic, participate in Biweekly care conference, and incorporate in their management plans.

Residents expected to participate Community volunteer event during the Ambulatory block.

Education in Addiction Medicine and Substance Use Disorders will continue to be emphasized in both GME clinic and inpatient settings. Trainees will regularly interact with patients experiencing substance use disorders during their inpatient and outpatient rotations and are expected to complete the ACP Pain Management Modules during the Ambulatory Block.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.

Residents must demonstrate competence in:

• identifying strengths, deficiencies, and limits in one's knowledge and expertise
• setting learning and improvement goals
• identifying and performing appropriate learning activities
• systematically analyzing practice using quality improvement methods, including activities aimed at reducing health care disparities, and implementing changes with the goal of practice improvement
• incorporating feedback and formative evaluation into daily practice
• locating, appraising, and assimilating evidence from scientific studies related to their patients' health problems.

Residents expected to ask for and respond to feedback from supervising residents and faculty. Direct observations are encouraged so that specific formative feedback can be given.

Residents are expected to complete self-evaluation in New Innovations prior to Semiannual and annual evaluations. Prepare for Semiannual meeting by going over check list Provided and meet with advisor prior to meeting.

Residents must be able to analyze their practice habits, by reviewing metrics and patient data, and develop strategies to address health care disparities. Program shares and provides access to individual resident patient panel and metrics, performance data in Epic.

Treat others with respect.

Honesty and ethical behavior are expected at all times.

Unprofessional or abusive behavior from residents or faculty will not be tolerated. Abuse is defined as public humiliation, physical harm, threat of harm, sexual or other forms of harassment, coercion, denial of opportunities or inappropriate low grades/evals, or offensive remarks due to gender, race/ethnicity, sexual orientation.

If unprofessional or abusive behavior is observed, residents or faculty should do the following, escalating as appropriate to the situation, in this order, but not always necessary. Program's aims for psychological safety, confidentiality, and resident/faculty wellness:

1. Report to PD or APD
2. Report to GME Director if not resolved/or PD or APD is subject of concern
3. Report to DIO any time if appropriate
4. File Wellstar Safer report
5. Call Wellstar Human Resources hotline (confidential reporting is also available)
6. Ombudsperson offices at Institution and/or ACGME ombudsperson (Check institutional policies and procedures)

Communications:

1. Check emails respond timely and Check Epic In Basket daily when at work; address messages daily
2. Perfect Serve messages must be addressed in a timely manner
3. Duty Hours: (Please see policy) Residents must log duty hours at least once a week in New Innovations
4. In Case of Resident fatigue or illness, bereavement, Jeopardy system can be utilized. (Please see policy)
5. Requesting a scheduled absence (Please see leave of absence policy)
6. Professional Dress Code policy is attached
7. Arrive to work at expected time, ready to do the assigned work
8. Resident and Faculty Well-Being — please see wellbeing policy, fatigue mitigation policy
9. Monitor self and others for signs of depression, substance abuse, self-harm behavior, and fatigue.
10. If concerned about the health or safety of a peer or a supervising attending, report it to APD or PD immediately.
11. Program honors every request received by residents for their doctors, and professional appointments all the time, with advanced notice so not to jeopardize patient care. If any such concerns involving lapse of support from program or faculty, must report to Institution.

ACGME Professionalism guidelines:

1. Compassion, integrity, and respect for others
2. Responsiveness to patient needs that supersedes self-interest
3. Cultural humility
4. Respect for patient privacy and autonomy
5. Accountability to patients, society, and the profession
6. Respect and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation
7. Ability to recognize and develop a plan for one's own personal and professional well-being
8. Appropriately disclosing and addressing conflict or duality of interest.

1. Closed loop communication is expected with any urgent or emergent patient care related issues.
2. Consultations should be ordered in Epic and called as specified by each specialty service.
3. Residents are expected to communicate clearly and respectfully with all hospital and clinic staff (including support staff, nurses, other residents, and attending physicians). Seek to understand when approaching difficult conversations. It is best to speak via telephone or in person if a contentious conversation arises via text, email, or Perfect Serve.
4. Handoffs: I-PASS format should be followed. It is extremely important for patient safety that no important patient care information is lost during handoffs. (Please see hand off policy)
5. Clinical documentation a. No copying and pasting b. Dictation software available (Fluency Direct) c. Medication reconciliation d. Utilize Smart Phrases, order sets, and preference lists to improve efficiency.

ACGME ICS Guidelines:

a. Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. i. Residents must demonstrate competence in communicating effectively with patients and patients' families, as appropriate, across a broad range of socioeconomic circumstances, cultural backgrounds, and language capabilities, learning to engage interpretive services as required to provide appropriate care to each patient ii. communicating effectively with physicians, other health professionals, and health-related agencies iii. working effectively as a member or leader of a health care team or other professional group iv. educating patients, patients' families, students, other residents, and other health professionals v. acting in a consultative role to other physicians and health professionals vi. maintaining comprehensive, timely, and legible health care records, if applicable. vii. Residents must learn to communicate with patients and patients' families to partner with them to assess their care goals, including, when appropriate, end-of-life goals.

Total 36 months of training under the supervision of the training program with satisfactory performance. While such training generally occurs in a continuous fashion, interruptions such as extended family/medical leave may occur which would extend the duration to complete the required training, but not the total months of such training.

Specific ABIM requirements include:

• Total 36 months of fulltime internal medicine training
• A minimum of 30 months in Internal Medicine
• A minimum of 24 months of meaningful patient responsibility
• A satisfactory overall rating throughout all years of training
• Satisfactory demonstration of professionalism related to the practice of medicine

Distribution of rotations and requirements (subject to some rotational revisions for the remainder of academic year to ensure adequacy of educational experience).

Program uses 4+1 schedule. 4 weeks of Inpatient rotation followed by 1 week of continuity clinic.

An overview of core rotations completed at each level of residency under the 4+1 scheduling model, which pairs blocks of inpatient and specialty training with a recurring week of continuity clinic.

Categorical Track

PGY-1

PGY-2

PGY-3

Primary Care Track

PGY-1

PGY-2

PGY-3

Vacation: 3 weeks per year, taken during any elective block.

Policy: Conference Attendance and Schedule

Revised: 01/13/2026

Noon conferences are scheduled from Monday to Friday, 12pm to 1 pm, which would allow for maximum participation in educational activities for all residents and faculty, and allowing residents the opportunity to eat lunch during conferences. While most of the conferences' virtual attendance will be made possible, residents scheduled to work in Spalding regional hospital and GME clinic are required to attend in person to allow for greater interaction.

Residents are expected to attend all educational conferences, simulations, unless on ICU, Night Float or Vacation.

• Protected time is provided for educational conferences (Ambulatory Morning Report, Noon Report, Noon Conference, Grand Rounds, MM&I, Board Review).
• Residents expected to get their Lunch at 11.45 am and attend conference at 12 noon.
• Resident will have access to Recordings of educational conferences in case they could not attend.
• Conference attendance of 70% is expected.
• Residents are encouraged to attend conferences in person when working at Spalding regional Hospital and GME clinic. If working outside of the hospital (e.g., off-site rotations (>2 miles from the hospital, etc), residents may attend the conferences via Microsoft Teams.
• Residents Exempted from noon conference are ICU seniors, night float, and vacation.

Noon report: Fridays

Traditional morning Report changed to noon report to ensure timely and efficient rounds in the morning to meet the operational requirements of inpatient workflow.

Noon report on Fridays provides the opportunity for the residents to present an interesting or challenging case which has been admitted during their call.

The patient is presented in detail by the intern/resident and the case is dissected with faculty involvement.

A key component of this conference is to allow residents to learn differential diagnosis, improve skills in EKG, labs and CXR interpretation, and review management of common disease states seen in patients admitted to the Internal Medicine Service.

The admitting team is expected to prepare a short summary of some aspect of their case to enhance learning opportunities for all present.

Hospitalist faculty must be notified in advance, so they will be able to attend.

Grand rounds: Thursdays. System level Grand rounds occur on Thursday-Residents expected to be present in Noon conference room.

Ethics Conferences: Institutional level conferences occur periodically.

Core curriculum and subspecialty lectures: Monday, Tuesday and Wednesday.

Resident Presentations: During clinic week

• Case of the month (PGY-1)
• Journal Club (PGY 1, 2 and 3)
• Journal Review (PGY-3)
• Mortality, Morbidity and Improvement (PGY-3)
• Critically Appraised Topics Conference (PGY-2)

Presentation guidelines are at the end of this document. PowerPoint templates are shared in OneDrive.

All residents must wear a Wellstar identification badge at all times while on duty. The badge must display the resident's name and photograph and remain clearly visible to patients, families, and staff.

A clean white coat must be worn in all patient care areas, regardless of whether professional attire or scrubs are being worn.

Residents are encouraged to utilize the Wellstar Concierge Service for convenient pickup and delivery of white coats for dry cleaning.

Business casual attire is required in all clinical areas unless assigned to a rotation where scrubs are permitted.

Scrubs are permitted only while assigned to Wards, ICU, Night Float, Admit, and the Emergency Department.

Scrubs must be clean, well-fitting, and wrinkle-free and should be changed if visibly soiled.

Purpose: To outline vacation, leave of absence, and scheduling policies for Internal Medicine Residents, ensuring compliance with Wellstar Health System Graduate Medical Education (GME) and ACGME requirements.

Vacation / Paid Time Off (PTO)

Residents are allotted 15 days of compensated vacation leave per academic year (July 1–June 30), in accordance with Wellstar GME policy. PTO cannot be carried forward or paid out at program completion, transfer, or termination.

Vacation will be scheduled as either divided (1 week and 2 weeks) or 3 weeks consecutively, preferably at the beginning or end of each rotation.

All 3 weeks of vacation cannot be taken in any one rotation.

Vacation may only be taken during sub-specialty rotations, electives, neurology, geriatrics, ambulatory block (non-sick call), or Emergency Department (ED).

Vacation requests must be made well in advance, ideally at the beginning of the academic year.

Once the vacation schedule is finalized, changes will only be considered in rare circumstances, such as emergencies or unforeseen events. Routine changes to vacation schedules are not permitted.

Residents are not permitted to use PTO (Vacation) for their last week of training in the program, except for residents who will be starting fellowship on July 1st, which requires program director and DIO approval.

Residents must first discuss their intended absence verbally with program leadership to ensure feasibility and address any concerns. After verbal discussion, the absence request must be submitted via email for official documentation and approval.

Absence requests must be submitted by email after verbal discussion with program leadership.

Residents must notify program leadership as soon as possible for emergent/urgent leave needs.

For personal or family emergencies, residents must verbally notify the attending physician and program leadership. Text or email without confirmation is not acceptable.

Failure to report for assigned clinical duties without prior communication constitutes a severe offense and may result in disciplinary action.

Sick Leave / Extended Illness Bank (EIB)

Residents may accrue up to 5 days of compensated sick leave per academic year, for personal illness or care of an immediate family member. Sick leave does not accrue year to year.

Internal Medicine Residents are not granted additional sick leave beyond the existing Paid Time Off (PTO).

Residents are allowed to use EIB (if accrued), then PTO for sick days by completing the Sick Day Reporting Form in New Innovations. PTO cannot be used if EIB is available. In case residents do not have EIB, no PTO is available and the leave is unpaid.

Sick day Reporting form can be found in New Innovations.

• If a resident becomes unable to perform their clinical duties due to illness, the program has an established Jeopardy System to provide emergency cross coverage. (Review continuity of care Policy)
• When using EIB, residents must provide Return to Work documentation (Doctor's note). Please use Wellstar Virtual Urgent care in case of illness, and provide the doctor's note to program coordinator (Please review institutional Policy).

Emergency Leave and Unplanned Absences

The program recognizes that personal or family emergencies and medical conditions may arise unexpectedly, requiring time away from assigned clinical duties.

In such situations, residents must immediately notify:

• Attending physician in charge of their service
• Chief Residents

Due to the urgency of emergency situations, notification should be made via direct verbal conversation whenever possible. Simply sending a message without confirmation is considered inadequate and unprofessional.

Once confirmation is received, then send email to:

• Program Director
• Program coordinator
• Attending of rotation
• Chief Residents

It is unacceptable to fail to report for duty without prior communication regarding an urgent need for absence. Failure to notify program leadership and the attending physician in advance constitutes a dereliction of duty, reflects a lack of professionalism, and violates the physician's fiduciary responsibility to patients.

Dereliction of duty is a serious offense and will result in disciplinary actions as determined by program leadership according to HR and institutional policies.

Professional Leave

Professional leave may be granted at the Program Director's discretion for:

• Up to 2 days for USMLE Step 3/COMLEX III exam
• Presenting at national, regional, or state meetings/conferences
• Reasonable number of interviews for fellowship or practice positions
• Every effort should be made Professional leave not to combined with scheduled vacation and is not preferred during Wards, ICU, Night Float, Admitting, Ambulatory Sick Call, or Continuity Clinic.
• Requests for professional leave must be submitted at least 2 weeks in advance, and providing supportive documentation.

Family and Medical Leave (FMLA) / Parental Leave — Up to 12 weeks — Review Institutional policy

Impact on Graduation and Board Eligibility

Residents must be informed of the impact of extended leave on program completion and board eligibility.

Extended leave may affect a resident's ability to graduate on schedule and eligibility to sit for the ABIM exam.

Monitoring and Tracking

• Program coordinators are responsible for monitoring and tracking resident leave in New Innovations systems, also maintain an Excel spreadsheet.
• Residents are prohibited from exiting training before the official end date. Requests to leave early must be reviewed and approved by the program director and DIO, as per institutional policy.

Purpose: To establish a policy to ensure appropriate and necessary patient care coverage and continuity of care in the event that a resident is not able to attend to their patient responsibilities for any reason, including but not limited to fatigue, illness, personal and/or family emergencies, medical and/or parental leaves of absence, and bereavement. Additionally, to ensure fairness among residents for the services provided on behalf of their colleagues.

Policy: During residency training, it is likely that each resident will experience circumstances that do not allow for the continued care of their patients for a limited period of time. Most commonly, these occur in the setting of short-lived personal illness or medical appointments, but can be related to many other circumstances, the most common of which are enumerated above.

If a resident becomes unable to perform their clinical duties, there is an established Jeopardy System to call in another resident for emergency cross-coverage. The Jeopardy System schedule will be planned and communicated to all residents at least three months in advance.

In general, the circumstances that require coverage by another resident when a fellow resident is unable to assume their duties are the following: Wards rotation, ICU rotation, Admitting, Night Float, Ambulatory Sick Call, or Continuity Clinic. (In the resident continuity clinic, when a resident calls in sick, if there are enough residents to redistribute the patients during both AM and PM slots, the Jeopardy resident may not be called in.)

Any calendar day taken as a sick day leave will have to be repaid to the covering resident later in the form of a repayment day, any time before the conclusion of the residency training period. This repayment day should be communicated with the program leadership and administration (Program Director, Associate Program Director, Chief Residents, and Program Coordinator) for appropriate approval and monitoring. The program will monitor this process.

The repayment day will be requested by the resident who provided Jeopardy System-based coverage on the original sick day. The repayment day can be done during any of the rotations mentioned above, not necessarily the same rotation.

Payback to the resident by not attending other designated rotations will not fulfill the deficit, will still count towards EIB/PTO (Review institutional, and program policy with details) unless payback happens during the resident's day off or weekend. However, residents must ensure that they have one day off every seven days, as per duty hour policy.

When absence from work is needed due to personal illness

We recognize that personal or family emergencies/medical conditions may arise that demand time away from assigned clinical duties. If, in any situation, the resident has a personal or family emergency that they feel precludes them from reporting for duty or carrying out any assigned medical/patient care responsibilities, it is their responsibility to contact the attending physician in charge of their service, Chief Resident and the residency program leadership. This must be done as soon as they become aware of the situation. Because of the urgency, it is strongly encouraged that this be communicated via a verbal conversation. Text or email communications without confirmation (i.e., no closed-loop communication) are not acceptable and will be considered a failure of communication and professionalism. It is unacceptable to simply not report for duty.

If a resident has any personal issues that preclude them from reporting for duty or carrying out any assigned medical/patient care responsibilities, and if the personal issue is to remain confidential even to the residency program leadership, residents can opt to reach out to the program coordinator GME director, who will maintain confidentiality from the program leadership while the absence from work is approved.

Failure to report for assigned clinical duties without prior communication of this urgent need constitutes a dereliction of duty, demonstrates a lack of professionalism regarding a physician's fiduciary responsibility to patients, and is a manifest failure of communication. Dereliction of duty is a severe offense and will result in appropriate disciplinary actions as determined by program leadership.

The sick day reporting form available in New Innovations must be completed on the same day of absence. Please review the Leave of Absence policy.

The program, and chief residents, keeps a log to track, in addition to the New Innovations duty hour log, to effectively implement this policy. The Program will review this record with each resident during semiannual evaluations to ensure no deficit in training.

Effective date: 07/01/2022 · Revision date: 10/22/2023

Purpose: To establish a policy to delineate expectation that resident writes all orders on patients for whom they bear responsibility as per ACGME program requirements.

"4.11.e.6. residents must write all orders for patients under their care, with appropriate supervision by the attending physician"

Policy: Residents are expected to write all orders on the patients for whom they bear responsibility. Order entry is considered to primarily a resident function and attendings must not routinely enter orders into EPIC or give verbal orders on resident's patients. On rare occasions if an order is entered by an attending/consultant, s/he is expected to communicate such order to the appropriate resident. To ensure the implementation of this policy and enhance resident autonomy and independence, attendings should encourage other care team members to discuss cases directly with the residents when seeking orders, except in emergencies or delay may cause harm to patient care.

Residents are expected to follow the Wellstar's order entry guidelines. Residents are strongly encouraged to limit their use of telephone orders, provide verbal orders ONLY in emergency situations and must be familiar and comply with hospital wide "Read-back" policies.

Revised: 11/05/2025 · Effective Date: July 1, 2022

Purpose: To establish clear guidelines ensuring that all ACGME-mandated duty hour requirements are met and fully compliant with both ACGME Common Program Requirements and institutional policies.

Policy: All residents and faculty are expected to:

• Review and adhere to the ACGME Common Program Requirements for Duty Hours.
• Follow the Wellstar Clinical Experience and Educational Work Hour Policy in conjunction with this document.

The following sections outline the standards as required by the ACGME and the processes used by the program to ensure compliance.

Clinical Experience and Education Work Hours are defined by the ACGME as follows:

All clinical and academic activities related to the program, i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, time spent at home doing clinical work (e.g., documentation using an electronic health record and taking calls from home) and scheduled activities, such as conferences.

Reading done in preparation for the following day's cases, studying, and research done from home and do not count toward the 80 hours rule.

Maximum hours of clinical and educational work per week — Clinical and educational Work Hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting.

Time spent in Internal and External Moonlighting must be counted toward the eighty hour maximum weekly hour limit.

Mandatory Time Free of Clinical Work and Education

The program must design an effective program structure that is configured to provide residents with educational and clinical experience opportunities, as well as reasonable opportunities for rest and personal well-being.

Residents should have eight hours off between scheduled clinical work and education periods.

There may be circumstances when residents choose to stay to care for their patients or return to the hospital with fewer than eight (8) hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements.

Residents must be scheduled for a minimum of one (1) day in seven (7) free of clinical work and required education (when averaged over four (4) weeks). At-home call cannot be assigned on these free days.

Maximum clinical work and education period length

Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.

Up to four (4) hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education.

Additional patient care responsibilities must not be assigned to a resident during this time.

This 24 hours and up to an additional four (4) hours must occur within the context of 80-hour weekly limit, averaged over four (4) weeks.

Clinical and Educational Work Hour Exceptions

In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances:

• To continue to provide care to a single severely ill or unstable patient;
• To give humanistic attention to the needs of a patient or patient's family; or
• To attend unique educational events.

These additional hours of care or education will be counted toward the 80-hour weekly limit.

Night float must occur within the context of the 80-hour and at least one-day-off-in-seven requirements.

Maximum In-House On-Call Frequency

Residents must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).

At-Home Call

Time spent on patient care activities by residents on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every-third night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four (4) weeks.

At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.

Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient patient care must be included in the 80-hour maximum weekly limit.

The Review Committee may further specify under any requirement of this section of the ACGME requirements.

Monitoring and Compliance

Duty Hour Logging: All residents must document duty hours in New Innovations at least weekly.

Program Oversight: The Program Coordinator monitors completion and compliance weekly.

Noncompliance Notification: If a resident fails to comply on more than two occasions, the Program Coordinator will notify the resident and copy the Program Director. Repeated instances will be considered a violation of this policy and will be documented in the resident's file.

Follow-up and Remediation: Recurrent or serious violations will prompt a meeting with the Program Director and/or Associate Program Director to determine contributing factors. Appropriate measures such as counseling, schedule adjustments, or programmatic changes may be implemented to prevent recurrence.

Revised: 11/14/2025 · Effective Date: July 1, 2023

Purpose: To establish a policy to ensure that the guidelines regarding supervision of residents in accredited training programs mandated by the ACGME are met.

Policy: Residents will be supervised by faculty physicians in a manner that is consistent with the ACGME common program requirements and Institutional requirements. Resident supervision is structured to provide residents with progressively increasing responsibility commensurate with their level of education, experience, and attainment of milestones. The advancement of residents to positions of greater responsibility will be based on assessments of the "Milestones" and other measurements of competency which are reviewed biannually by the Clinical Competence Committee.

For each teaching service or rotation, the Internal Medicine Residency handbook specifies explicit written descriptions regarding lines of responsibility for the care of patients. The written objectives for each rotation delineate the membership of the clinical team and the role of the individual team members.

Residents shall be given a clear means of identifying supervising physicians who share responsibility for patient care on each rotation. It is understood that supervision can be exercised through a variety of means. Some activities may require the presence of a supervising faculty member while others may occur with the immediate availability of the attending physician or senior resident by telephone or electronic means. In outlining the lines of responsibility, the following classifications of supervision are used:

Direct Supervision: the supervising physician is physically present with the resident and patient. If patient is not physically present, supervising physician must concurrently monitor through Telecommunication technology.

Indirect Supervision, with Direct Supervision immediately available: the supervising physician is physically within the hospital or other site of patient care and is immediately available to provide Direct Supervision.

Oversight: the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Faculty members functioning as supervising physicians should assign portions of care to residents based on the needs of the patient and the skills of the resident. Based on these same criteria and in recognition of their progress toward independence, senior residents should serve in a supervisory role of junior residents.

PGY-1 residents must have direct supervision at least first 6 months of training. Each resident must know the limits of his/her scope of authority and the circumstances under which he/she is permitted to act with conditional independence.

Guidelines regarding notification of supervising attending: The intern and/or resident involved in the care of a patient should notify the attending physician as soon as is feasible anytime there is clinical deterioration. Situations that merit attending notification include (but are not limited to):

• Any acute clinical change that the intern/resident feels may lead to a higher level of care (e.g., need to transfer the patient to the ICU from the floor)
• Transfer to another service (e.g., transfer from medicine to surgery, etc.) or transfer to another facility because of a new or evolving concern better cared for by another service.
• Any need for a Rapid Response intervention
• Any code situation
• The death of any patient
• Any time there is a diagnostic or management question that needs input from the attending physician.

The team is also to notify the attending of the results of any "code status" discussions so that the orders can be co-signed by the attending, as required by the hospital.

Residents will be assigned a faculty supervisor for each rotation or clinical experience. The faculty supervisor shall provide to the Program Director a written evaluation of each resident's performance during the period that the resident was under his or her supervision. The Program will structure faculty supervision assignments of sufficient duration to assess the knowledge and skills of each resident and delegate to him/her the appropriate level of patient care authority and responsibility.

Revised: 11/14/2025 · Effective Date: July 1, 2023

Purpose: Resident perform diagnostic and therapeutic procedures relevant to their specific career paths, and within the scope of Internal Medicine.

The American Board of Internal Medicine (ABIM) procedure requirements for eligibility for board certification focus on understanding and being able to explain a number of specific medical procedures, and having the ability to effectively obtain informed consent with patients when applicable. The ABIM also requires actual demonstration of competence and safe performance of a smaller subset of specific procedures through direct observation. Internal medicine graduates will likely perform some invasive procedures in the course of their future training or practice; however, the specific procedures will vary based on subsequent subspecialty, hospitalist or general career path taken. The performance of all invasive procedures requires the ability to facilitate an effective discussion with patients regarding risk and benefits of the procedure before obtaining consent, a critical task that all internists must effectively perform. Internists who perform any invasive procedures must be able to initiate a standardized preparation beforehand including hand washing, donning of sterile gloves, preparation of the procedural field, and application of some form of anesthetic.

Procedures for which internal medicine trainees should understand and explain include:

• Abdominal paracentesis
• Arthrocentesis
• Electrocardiography
• Incision and drainage of an abscess
• Lumbar puncture
• Nasogastric intubation
• Pulmonary artery catheter placement
• Thoracentesis

Procedures requiring demonstration of competent and safe performance include:

• Advanced cardiac life support
• Central venous line placement
• Arterial line placement
• Arterial and venous blood sampling
• Pap smear and endocervical culture
• Placement of a peripheral venous line

Although the ABIM does not specify the exact number of each of the required procedures that must be performed to demonstrate competency, the Spalding IM program requires teaching trainees through initial simulation followed by supervised active participation, with the expectation that trainees should actively perform these supervised procedures at least Six or more times to achieve conditional independence.

Residents are required to maintain an accurate detailed record of all procedures performed and supervised with appropriate and complete information to allow for sign-off on New Innovations. Completed procedures will be reviewed at residents' semi-annual evaluation meeting with the program director. This is a critically important requirement for residents who intend to perform procedures after graduation.

Effective: 07/01/2022 · Revised: 10/30/2025

Purpose: To provide a policy on discipline, non-renewal of contract and/or dismissal of residents in training.

Policy: Resident disciplinary action, non-renewal of contract or dismissal may occur as a direct result of failure in one or more of the required competencies which include Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Communication and Interpersonal Skills, Professionalism and Systems-Based Practice.

When academic or disciplinary issues arise, it is the expectation that the resident with work together with his/her program leadership to resolve the deficiency or undesirable behavioral issue. The typical step-wise process for such meetings is as follows:

Verbal coaching with or without warning Program Director or APD meets with resident and discusses issues face-to-face and provides a verbal coaching, and goal setting with expectations.

Written Warning If the concern persists despite an initial verbal warning, the situation is escalated with a second face-to-face meeting during which a written warning is provided to the resident and placed in his or her file. A plan of action to resolve the deficiency or undesirable concern is documented with delineation, as appropriate, of the allotted time of course for such improvement.

Additional Actions If this further action does not result in resolution, various actions including academic warning, remediation, or probation and possible non-renewal of contract or termination would be discussed and implemented according to Institutional and HR policies. (Please review the Institutional policies)

In general, when anticipated disciplinary action, non-renewal or dismissal is due to chronic recurring problems, the Program Director will convene an ad hoc Clinical Competency committee to discuss the situation and gather input from members of the Committee. The Committee will then provide recommendations to the Program Director regarding subsequent actions. In the setting of an acute serious action involving a resident, the Program Director (or Associate Program Director in the absence of the Program Director) retains the authority to make decisions prior to committee meeting, however will follow due process as per institutional polices.

Residents placed on probation and/or suspension will be provided with a clear statement as to the cause of the disciplinary action. Furthermore, a plan of remediation will be provided with a specified time-frame during which subsequent goals need to be met.

At the end of the time allotted for remediation, an outcome-decision must be made by the Program Director in conjunction with the Internal Medicine Clinical Competence Committee. An outcome-decision will be categorized as follows: Successful Resolution of problem, Unresponsive to Remediation, Remediation still in Progress, Needs More/Different Remediation, Non-renewal of Contract or Termination (Dismissal). Residents with unfavorable decision-outcomes resulting in Non-renewal of Contract or Termination retain the right of appeal. Please note that egregious actions resulted in violation of organizational policies may subject to termination from organization.

Residents are referred to GME Institutional Policy: Discipline and Adjudication of Resident Complaints and Grievances (Due Process), Non-Renewal of Contract or Dismissal for further information.

Effective: 07/01/2022 · Revised: 10/22/2025

Purpose: To provide a policy on the evaluation process of residents in training.

Policy: Residents will be evaluated periodically during their residency to ensure fulfillment of the essential components of their training in Internal Medicine.

Program uses Residency Management System called New Innovations.

All evaluations must be completed within three days after completion of rotation and must be available to residents.

Anonymous evaluations such as resident evaluating faculty and Peer to peer evaluations will be kept on hold released in bulk after 10 have been completed.

The Clinical Competence Committee, comprised of the Program Director, Associate Program Directors and core faculty will meet quarterly to systematically review the performance of all residents. Additionally, additional members of the Internal Medicine faculty may be invited to Clinical Competency Committee. The Clinical Competence Committee will review all available information including but not limited to attending evaluation forms, peer evaluation forms, nursing evaluation forms, patient experience, In-service Training exams scores, procedures, conference attendance, professionalism requirements, and any additional information added to the resident's file regarding clinically related issues. Recommendations will be made to the Program Director regarding advancement as well as performance improvement plans, remediations, probation, non-renewal of contract and dismissal.

Residents will specifically be evaluated their trajectory in the six (6) areas of clinical competencies to ensure compliance with the ACGME requirements which include Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Communication and Interpersonal Skills, Professionalism and Systems Based Practice.

The Program Director will meet with each resident personally to review his or her overall performance after a summary of the findings from the Clinical Competence Committee is prepared. Such meetings with occur semiannually/ and as needed basis and allow the resident the opportunity to address any concerns or deficiencies which the Committee has noted.

Effective date: 07/01/2022 · Revised date: 10/22/2023

Purpose: To establish a policy regarding resident promotion so as to provide clear and consistent guidelines for residents in training with the Department of Internal Medicine regarding the promotion process.

Policy: Resident promotion will be based on successful completion of the residency training requirements.

Additionally, residents will be required to demonstrate overall satisfactory evaluations in all areas of the clinical competence including Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Communication and Interpersonal Skills, Professionalism and Systems Based Practice. Residents' overall performance will be tracked using comprehensive Milestone Evaluations which will be completed on a semi-annual basis by the Clinical Competence Committee.

Decisions regarding promotion will be made by the Program Director in close conjunction with other members of the Clinical Competence Committee (CCC). The Program Director and CCC will review all available information including, but not limited to, attending evaluation forms, peer evaluation forms, nursing evaluation forms, patient evaluation forms, conference attendance and any additional information added to the resident's file regarding clinical and professional-related issues including complaints registered in Wellstar's SaFER system.

It is the expectation of the Internal Medicine Training Program that all residents will successfully complete the residency training program. In the event that a resident is denied promotion to the subsequent year of training, every effort will be made to notify the resident as soon as possible of such a decision and as per Institutional policy deadlines. Decisions to offer a resident the opportunity of remediation through an additional year of training are made on a case-by-case basis by the Program Director and Clinical competency Committee.

Effective: 07/01/2022 · Revised: 10/22/2023

Purpose: To provide understanding of the process within the Internal Medicine Residency training program for selection of residents from a large applicant pool.

Policy: Wellstar Spalding Regional Hospital Internal Medicine residency program requires applications submitted through Electronic Residency Application System (ERAS). All required documents must be submitted through ERAS only. All categorical internal medicine residency positions will be filled through National Resident Matching Program (NRMP).

• Applicants must be graduates from medical schools in the United States or Canada, accredited by The Liaison Committee on Medical Education (LCME).
• Graduates from a medical School outside of the United States or Canada must hold valid certification from the ECFMG prior to appointment.
• Medical school graduation within five years preferred.
• Must have passing score in USMLE Step 1 and we prefer applicants with minimum score of 240 in Step 2 CK (international medical graduates must hold valid ECFMG certificate prior to starting residency).
• U.S. clinical experience required for international medical graduates.

ERAS Application consists of:

• Personal Statement
• Curriculum Vitae
• MSPE or Deans Letter or Equivalent
• Medical School Transcript
• USMLE Transcript
• Three Letters of Recommendation

International Graduates:

• Must be certified by ECFMG.
• J-1 Visa (if applicable, program accept J-1 visa through ECFMG), which is subjected to change every year as per institutional guidance. Visa related issues, and changes in recruitment process, program defers to Institutional decisions.

Purpose:

• These technical standards define the essential abilities and professional behaviors required to provide safe, efficient, and effective medical care and to successfully complete training in Wellstar Internal Medicine and Transitional Year programs.
• They apply to all applicants, current residents, and residents undergoing evaluation for promotion or graduation.

Observation

• Observe patients accurately at both close range and a distance
• Obtain information through visual, auditory, and tactile methods
• Interpret clinical data including labs, imaging, ECGs, pathology, and electronic medical records
• Recognize changes in patient condition and escalate concerns appropriately

Communication

• Communicate clearly with patients, families, and healthcare teams
• Communicate in English verbally and in writing
• Obtain medical histories and provide counseling
• Explain diagnoses, results, and treatment plans
• Obtain informed consent and deliver difficult news with empathy
• Use interpreter services when needed
• Document clinical encounters accurately and timely
• Participate in handoffs, conferences, and urgent communications
• Collaborate with interdisciplinary team members

Motor Skills

• Perform physical examinations and procedures under supervision including venipuncture, ABG sampling, lumbar puncture, paracentesis, thoracentesis, central line placement, and airway management
• Use standard clinical equipment
• Provide life support and respond to emergencies
• Perform clinical duties including bedside care and documentation
• Function safely in clinical environments
• Maintain stamina for extended shifts and movement
• Possess sufficient sensory function for diagnostic evaluation

Intellectual Abilities

• Apply medical knowledge to patient care
• Integrate and analyze clinical information
• Develop differential diagnoses and management plans
• Prioritize tasks and manage multiple patients
• Exercise sound clinical judgment
• Recognize limitations and seek supervision
• Incorporate feedback and improve
• Maintain attention and memory for safe care
• Use digital tools
• Perform problem-solving and quantitative analysis

Behavioral and Social Attributes

• Demonstrate professionalism, integrity, and ethical behavior
• Work respectfully with patients and teams
• Show empathy, emotional stability, and maturity
• Maintain professional boundaries
• Adapt to stress and changing environments
• Accept feedback and demonstrate accountability
• Maintain reliability and punctuality
• Make sound judgments under stress
• Follow safety and confidentiality standards

Workload Requirements

• Comply with ACGME duty hour regulations
• Manage inpatient and outpatient responsibilities
• Complete overnight shifts and home call
• Sustain attention and clinical judgement during periods of fatigue while utilizing appropriate fatigue mitigation strategies. Balance competing clinical demands.
• Provide care to all assigned patients

Effective: 07/01/2024 · Revised: 06/22/2024

Purpose: The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements mandate that residents participate in scholarly activities during their training. To provide clarification on Scholarship requirements prior to graduation.

Policy: Residents must participate in scholarship throughout the training and will tracked in New Innovations and reviewed at each semiannual evaluation. Below are examples and requirements but not limited to.

Conferences

• Case of the Month (PGY-1)
• Critically Appraised Topics Conference (PGY-2)
• Journal Review (PGY-3)
• Mortality, Morbidity and Improvement (PGY-3)
• Journal Club (PGY-1, 2 and 3)

Publications — All residents are encouraged to publish one or more of below:

• Case reports
• Research
• Review articles
• Meta analysis

Quality Improvement project — All Residents must be actively involved in QI project, and must complete at least one quality improvement project as lead or collaborate.

Other examples of scholarly activities include:

• Poster and podium presentations
• Book chapters
• Webinars
• Peer reviewers
• Editorial board members or editor

Effective: 07/01/2022 · Revised: 06/22/2025

Purpose: The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements mandate that residents participate in scholarly activities during their training. The program and sponsoring institution must allocate adequate resources to support scholarship activities.

Policy: Residents are encouraged to enhance their clinical skills by providing evidence-based patient care, writing case reports, conducting original research or quality improvement projects, presenting at scientific meetings, and publishing their work. At the discretion of the Program Director, residents may attend a medical meeting/conference, one day for presentation plus two days for travel during each year of training. Residents must be in good standing with the program and not on a remediation plan.

All travel requests must be approved by the Program Director prior to booking travel expenses. Prior to approval, the resident must be in good academic standing within the program and must adhere to the processes outlined below.

Conference Abstract Submission and Travel Support Guidelines

The following requirements apply only to residents requesting Program approval for conference attendance, protected educational leave, or financial support (travel, lodging, registration, or other program-funded expenses). Residents who submit abstracts independently without requesting Program support are not subject to these requirements, but still required to get approval for professional time off to attend, so time of can be monitored, and coverage adjusted.

Abstract Review and Approval

• Only one conference with program support per year.
• Residents are responsible for reviewing and complying with the conference's abstract submission requirements and deadlines.
• All abstracts (case reports, quality improvement projects, and original research) must first be reviewed by the resident faculty mentor.
• The abstract must then be submitted to the Program Director for final review and approval.
• All faculty members and co-authors listed on the submission must review and approve the final version before submission.
• Residents should allow at least 2 weeks for Program review prior to the conference submission deadline.
• Program approval must be obtained before the abstract is submitted if Program funding or professional time off is being requested.
• Failure to obtain the required approvals before submission may result in denial of travel approval or financial support.
• Abstracts or posters previously presented at another meeting will generally not be approved for repeat presentation unless they have been formally selected to advance from a regional or local meeting to a national meeting.
• Residents must promptly notify Program leadership upon receiving notification of abstract acceptance.
• Program-funded travel is generally limited to the presenting (first) author.

Travel Approval

• A Conference Travel Pre-Approval Form (available in New Innovations) must be completed and approved by the Program Director at least two months before the conference.
• Travel arrangements should not be finalized until Program approval has been obtained.
• Residents must work with the Program Coordinator to complete all required approvals and documentation.

Required Travel Documentation

Residents requesting Program support must:

• Submit a leave request by email and include the residency leadership team.
• Submit an estimated travel itinerary and anticipated expenses (estimates may be updated if needed).
• Arrange airfare through the Wellstar-approved travel agency and copy the Program Coordinator on all travel communications.
• Ensure that posters and presentations comply with all conference guidelines.

Reimbursement Requirements

• Residents are expected to use the most economical and reasonable method of travel whenever possible.
• Residents are encouraged to apply for travel grants or scholarships offered by the conference organization before requesting Program funding.
• Personal vehicle mileage will be reimbursed based on the home address listed in New Innovations.
• Meal reimbursement is limited to the applicable government per diem and requires itemized receipts.
• Alcoholic beverages are not reimbursable.
• Hotel reimbursement requires the final hotel receipt issued at checkout.
• Air travel must be booked through the Wellstar-approved travel agency.
• Within a reasonable time after travel, all receipts should be combined into one PDF and emailed to the Program Coordinator, who will submit the reimbursement request on the resident's behalf. Residents should not submit expense report in workdays directly, this has caused confusion in the past. Please work with Program coordinator on this.

Effective: 07/01/2022 · Revised: 07/07/2026

Purpose: To establish consistent guidelines regarding the educational funds and meal allowances provided to residents in the Internal Medicine Residency Program, the expenses that are and are not reimbursable under these funds, and the process for requesting and submitting reimbursement.

Policy: The provision of both educational funds and meal allowances is provided as an added benefit to residents; WellStar is not obligated to provide these funds. The amount of funds available is reviewed annually and is subject to change at any time during the academic year. These funds are not published amounts and are provided at WellStar's discretion as part of the overall resident benefits package.

Educational Funds

• The use of educational funds must be approved by the Program Director at their discretion. Residents should work with their Program Coordinator to obtain these approvals.
• All approved expenses must be submitted, per Accounts Payable policy, within 30 days of the expense being incurred. Best practice is to submit within 15 days. No funds roll over at the end of the academic year.

Items NOT covered under educational funds:

• DEA registration
• Full medical license
• Board exams
• Clothing, footwear, lab coats, or scrubs
• Electronic accessories (e.g., Apple AirPods, Apple Watches, cases, etc.)

Items covered under educational funds (with Program Director approval):

• Textbooks
• Board reviews
• Conferences
• Step 3 (single reimbursement for the duration of the residency program; also reviewed annually and subject to change)
• Electronic devices (e.g., desktop, smart phone, laptop, tablet; single reimbursement for the duration of the residency program)
• Medical hardware/equipment (e.g., stethoscopes, scissors, etc.)

Conference-related travel expenses approved under educational funds (mileage, meals, lodging, and air travel) follow the process and limitations described in the Policy on Scholarly Activity Guidelines, including that alcoholic beverages are not reimbursable and that meal reimbursement is limited to the applicable government per diem.

Reimbursement Submission Process

• Retain itemized, original receipts for all reimbursable expenses.
• Submit approved expenses per Accounts Payable policy within 30 days of the expense (best practice: within 15 days).
• Combine receipts into a single PDF and email them to the Program Coordinator, who will submit the reimbursement request on the resident's behalf. Residents should not submit reimbursement requests directly.
• No funds roll over at the end of the academic year.

Exceptions

Any exception to the items listed above must be approved in writing by the Program Director. Exceptions made prior to the effective date of this policy will be honored. Residents should work with their Program Coordinator with any additional questions or comments. These funds are provided as an added benefit during a resident's time with the Program, consistent with WellStar's commitment to being an employer of choice.

Effective: 07/01/2022 · Revised: 10/22/2023

Purpose: To establish a policy regarding resident fatigue recognition and management for the purposes of mitigating harm to both patients and housestaff members.

Policy: Fatigue monitoring requires a joint effort by all individuals involved in the training of residents. Sleep loss and sleepiness are pervasive problems during residency training and may lead to serious professional errors and personal problems. Although often difficult to recognize, faculty and residents must be alert for signs of fatigue among housestaff. These signs include, but are not limited to, frequent yawning, falling asleep, irritability, inability to focus during rounds, increased tolerance to risk, apathy, and careless medical errors. When faculty and residents observe these signs, the resident should be questioned about sleep loss and fatigue. Brief counseling should be provided if a sleep deficit is identified. This counseling may include information about naps, use of caffeine, and good sleep hygiene. If the symptoms continue, referral to the Program Coordinator or program director should occur.

Whereas there are many ways to deal with the sleepiness and fatigue, the only real treatment is ensuring adequate sleep. Other fatigue mitigation strategies include strategic napping, use of caffeine and overall improved sleep hygiene. Education related to the concept of "sleep debt" which accrues too many residents over the course of days/weeks — not simply just to those in the post-call period — is essential to fatigue management.

Should a resident' fatigue symptoms be deemed sufficient to jeopardize patient care, the resident or attending physician discovering the problem should consult immediately with the PD or Associate program director so that the she/he may be immediately relieved of duty and an alternative mechanism to safely care for his/her patients ensured. Patient care will be delivered by other members of the team or by another resident as per Jeopardy schedule.

If a resident is too fatigued to drive home after a shift, resident can take an Uber/Lyft or taxi and then submit for reimbursement.

Effective date: July 1st, 2022 · Revised date: 10/22/2023

Purpose: To establish a policy to ensure that the process for patient handoffs is clearly delineated to ensure quality of care during transitions for hospitalized patients.

Policy: Handoffs refer to the transmittal of information which occurs during transitions in the care of a patient. The primary objective of any patient handoff is to ensure accurate transfer of information about a given patient's condition and plan for care. Appropriate hand-off should prevent the occurrence of errors due to failure to communicate important patient care information. Inadequate communication between care providers is frequently associated with sentinel events which are defined as unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof. Such events are called "sentinel" because they signal the need for immediate investigation and response.

Numerous studies have provided evidence that hand-offs between residents are often inadequate. Implementation of ACGME duty hour restrictions have resulted in the increased need for exchange of patient information between residents with unintended patient consequences if communication is inadequate or fails to occur. Internal Medicine and surgical residents have reported that resident-to-resident handoffs are frequently poor and were judged to result in major and minor harm to patients. "Sign-out" failures have been associated with two types of dysfunction: failures due to omission (medications, active problems or pending tests omitted) or those due to failure of communication (e.g. lack of face-to-face communication).

Residents while on the Hospital Medicine and ICU Services are expected to appropriately sign-out their patients in face-to-face interactions to the on-call intern and/or resident. Face-to-face interactions allow the incoming physician the opportunity to ask questions and seek clarification from the outgoing physician.

Residents will utilize a hand-off form to ensure that critical data is listed for all patients. Such will include the following: Patient Name, Room number and Medical Record number (MR#) Major current medical issues, Concerns and follow-up items; provision of guidance by out-going team regarding management of potentially anticipated events, and Code Status.

It is the expectation that such handoffs occur in a quiet setting with minimal interruptions and that such transfers include meaningful information. In the morning, the on-call intern and resident are expected to sign-out to the Hospital Medicine teams all major issues which occurred over night so as to permit continuity of care.

Handoff Logistics

I-PASS format must be utilized during all Hand-offs.

Additionally, each resident on the Hospital Medicine Service and ICU is expected to provide patient sign-out to his/her resident counterpart before any scheduled day(s) off.

A comprehensive handoff is expected to provide to his/her resident counterparts at the end of rotations.

This same expectation applies to interns. As such, this both ensures proper continuity of care and reinforces professional obligations.

For the reasons enumerated above, such sign-out responsibilities are considered to be paramount for patient safety and quality patient care and failure to comply with such constitutes a violation of professional responsibility.

Effective: July 1, 2022 · Revised: 10/22/2023

Purpose: To establish a policy to ensure that the resident responsibilities for patients on non-teaching services are delineated so as to ensure the provision of appropriate emergency care to all hospitalized patients and to prevent inappropriate service-related reliance on residents, and in compliance with ACGME program requirements.

Policy: Service responsibilities must be limited to patients under teaching service. Residents must have continuing responsibility patients they admit, unless transferred to non teaching service. In keeping with these guidelines, the on-call in-house residents will provide comprehensive care only for patients on the internal medicine teaching services. However, on-call residents must render immediate care to patients under the following circumstances when the patient condition is critical:

a) Patients for whom transfer to a medicine ICU appears imminent b) Emergent situations need immediate attention to save life or adverse outcome. c) Code situations, attended by Intensivist and ICU residents

In all such circumstances, it is the resident's duty to inform the attending physician of the events occurring and document such events in the medical records.

Effective: 07/01/2022

Purpose: Wellstar Spalding Regional Hospital holds the wellbeing of its residents, fellows, and faculty as one of its core values. This policy serves to outline the ways we support our team while ensuring clinical competence.

Definitions

Well-being — Is a state of being comfortable, happy, or healthy. It is a multidimensional sense best described as a balance between the key elements of physical, psychological, social, spiritual, intellectual, and economic needs.

Resilience — Is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands.

Burnout — Is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands.

Policy

Residents, fellows, and faculty are at increased risk of burnout, depression, and suicide. Self-care is an important part of professionalism and helps ensure a happy, healthy career. Residents, fellows, and faculty are encouraged to prioritize their well-being. To support this, resources are available at the institutional, departmental, and program levels. All of these resources are clearly outlined on the residency wellness website via e-source.

Any resident, fellow, or faculty member with concerns about their own well-being, or the well-being of others, should escalate these concerns to the Program Director, APD, or institutional leadership.

• Employee Assistance Program (EAP) is available 24/7 and provides confidential, professional counseling on a variety of financial and mental health topics. Employees are eligible for a limited number of free visits per topic. Team members may self-refer, or referral may be suggested, but cannot be required, by program leadership.
• Onsite fitness center with a nutritionist and personal trainer.
• Available employee coaching.
• Free membership to Headspace and Sharecare apps.
• Onsite access to medical care.
• Lactation rooms and fridges in close proximity to clinical areas.
• Membership to the Well-Being Index, a validated tool to monitor well-being and access resources.
• GME Wellness Committee arranges departmental wellness events.
• Access to water and snacks in the resident/physician lounge 24/7.
• Free, unlimited access to all items in the cafeteria, including breakfast, lunch, and dinner, for residents and faculty.
• If fatigued, access to Uber/Lyft reimbursement and onsite call rooms are available. Please see the Fatigue Policy.
• Residents can attend medical, mental health, and dental care appointments, including those scheduled during work hours. Residents must follow the program's procedures for scheduling and notification of these appointments in advance, as discussed in the Leave of Absence Policy.
• During orientation and periodically during training, all residents receive teaching about the signs of burnout, fatigue, depression, sleep deprivation, suicidal ideation/violence, substance abuse, and ways to improve resiliency, including self-care.
• The program has procedures in place to monitor resident hours to ensure appropriate work-life balance.
• The program has a backup structure to provide coverage and continuity of care in the event that a resident is not able to attend to his/her patient responsibilities for any reason, including but not limited to fatigue, illness, family emergencies, or other significant unanticipated absences.

The program's goals are to:

• Provide each interested resident with a faculty "point person" to whom they can turn for advice and support throughout their training.
• Further enhance the development of meaningful professional relationships between residents and faculty.
• The program director will be closely working with residents and their advisors.

We have further defined the key roles as below:

• Advisor (on career goals and development)
• Advocate (providing assistance to mentees as needed throughout their residency)
• Role Model
• Guide (to help with professional development and networking)
• Facilitator (for establishing contacts and possible mentorship from the other faculty as indicated)
• Meet residents quarterly and on a needed basis and complete worksheet attached, and submit to GME office. Attend Annual, and Semi-annual resident meetings upon Program Directors request

The recommendations for residents, include:

• The recognition that a advisors program is not a passive process; residents should demonstrate a willingness to invest time and energy into the relationship with the advisor and an appreciation for the time and energy received.
• Residents should also identify their own short- and long-range goals for their relationship with their advisor.
• Attend meeting

Adviser Meeting Checklist — Resident Progress

Resident: ____ Advisor: ____ Coordinator: ____ Date of Meeting: ____ Time: ____

4 CSR forms must be filled out by Hospitalist faculty during the wards rotation, and 2 CSR forms should be filled by Dr. Madichetty during the ICU rotation.

• Evaluations — Faculty, clinic staff, peers, patients
• Self evaluation
• Mini CEX (6 per each year)
• CSR (6 per each year)
• Quality improvement participation (either individual or own project)
• Research / abstracts / any publications
• Plans for future scholarship
• Safer events entered, and RCA involvement
• Continuity clinic performance data, Metrics, number of patients (Program will provide the Data)
• Ambulatory modules (PEAC, IHI, ACP)
• ITE score
• Step-3
• MKSAP Completion
• Med Study Video Completion (PGY-3)
• Community outreach participation
• Educational funds used, and anticipated needs
• Duty hours compliance
• Procedure log
• Simulations done
• Conference attendance if less than 70%
• Subspecialty rotations (TO DATE), Individual educational activities, and rotation preferences with in availability
• Advisor meeting and progress
• Mentor identification
• Career plans
• Work life balance
• Program's assistance
• Goals for next 6 months as reflected in self evaluation
• Milestone review
• Resident comments and suggestions / feedback / concerns
• Program director comments

This is a one-time requirement for PGY-1 residents. Resident (the presenter) will present a known case including history, physical examination, and all relevant investigations with diagnostic results. Differential diagnoses should be discussed and progressively narrowed in a logical manner. The emphasis is on diagnostic reasoning rather than solely the final diagnosis. At the conclusion, the presenter makes a tentative diagnosis before revealing the confirmed diagnosis.

Prerequisites of a Good Case of the Month Presentation

• Selection
• Preparation
• Presentation
• Discussion

Timeline for CPC Presentation

Case Presentation (15 Minutes):

• History
• Physical Examination
• Diagnostic Workup
• Differential Diagnosis
• Final Confirmatory Diagnosis

Case Discussion (30 Minutes):

• Introduction
• Pathogenesis
• Epidemiology
• Clinical Presentation
• Diagnostic Workup
• Management
• Most Recent Literature Discussion (Not in depth as Journal Club)
• References

Question and Answers: 15 Minutes

Selecting the Case

The choice of case is crucial for presentation effectiveness. Ideal cases are unusual presentations of common diagnoses or typical presentations of unusual diagnoses. Highly complex cases with multiple primary diagnoses or excessive extraneous details should be avoided. Cases must be relevant, solvable, and allow meaningful discussion.

• Relevant: The final diagnosis can be reasonably suspected or deduced based on available data.
• Solvable: The resident should have adequate information to logically deduce the diagnosis.
• Discussable: The case must highlight diagnostic reasoning and logical progression.

Faculty Preceptor

Dr. Gali Krishna Kanth

The case must be discussed and the PowerPoint presentation reviewed with the preceptor at least 2 weeks prior to the presentation.

Critically Appraised Topic (CAT) Conference is a mandatory presentation in the PGY-2 year of the program that fulfills the Program's scholarly requirement for residents. To successfully complete this conference, follow these steps:

• Your initial task is to select a clinically interesting topic or topics of personal interest that can generate a specific clinical question. Ensure that the chosen topic is not overly broad.
• Discuss your selected topic(s) with the Program Director or a designated faculty facilitator to confirm its suitability for the conference.
• Once your topic is approved, do the literature review and reach out to the medical librarian, if needed.
• The goal is to identify the "3 best studies" related to your topic. Time constraints may not permit reviewing more than three studies. If you cannot find at least three relevant studies on your clinical question, revisit the clinical question.
• Familiarize yourself thoroughly with the selected studies in preparation for leading the CAT Conference. While you won't have sufficient time to delve into each study with the same level of detail as in Journal Club presentations (which focus on a single article), you should still possess comprehensive knowledge about the studies. This will enable you to respond to participant questions. The CAT Conference allows 50 minutes for your presentation, followed by a 10-minute question-and-answer session. Make sure to utilize the entire allocated time. During the presentation, you should:
• Succinctly summarize the background issues.
• Summarize the key details of each of the three articles individually, including clinical trial descriptions, methodologies, and findings.
• Synthesize the findings from the studies.
• Present your "conclusion" regarding the best evidence-based answer to your clinical question.
• If you have any questions, reach out to the Program Director or their designated representative for clarification and guidance.

The MMI conference is a mandatory presentation in the PGY-3 year of the program that fulfills both the Program's scholarly requirement for residents and the ACGME requirement. To successfully complete this conference, follow these steps:

Objective

• Provide a safe venue for residents to identify areas of improvement and promote professionalism, ethical integrity, and transparency in assessing and improving patient care.
• Identify cases involving an adverse event, medical error, or near miss.
• Focus on systems failures or vulnerabilities, not individual blame.
• Encourage a non-punitive, blame-free environment.
• Promote leadership, research, and scholarly activity by incorporating the six ACGME core competencies into a learning opportunity.
• Teach quality improvement and medico-legal issues to residents and students.
• Foster a climate of openness and discussion about medical errors.

Process

• Identify a case you were involved in at some point during training that led to an adverse event, medical error, or near miss, or consult the Quality Department for cases to discuss in this conference.
• Consult the Quality Department to obtain any additional details.
• Consider waiting a sufficient time to let the dust settle after the event.
• Discuss the case with the Dr. Kanugula and Dr. Berhe.
• Interview key people involved in the case to obtain additional information.
• Invite all key people to the conference to promote interdisciplinary discussion and collaboration.

Organization

• Remind all participants that this is a privileged and confidential meeting subject to peer review and medical review protections in Georgia.
• Inform all participants that identifying patient information will not be included in the presentation.
• Present cases in a timeline format, including patient presentation, hospital course, and patient outcome.
• Invite members from varied disciplines if relevant or have knowledge on case (e.g., nursing, pharmacy, administration).
• Invite members from Quality department.
• Invite physicians from relevant departments if has knowledge on the case.
• Incorporate approximately 15 minutes for audience-generated discussion of possible system improvements.
• Create 4-5 small breakout groups among residents to identify issues or causes in fishbone categories and ACGME Competencies. Provide handouts.
• Close the conference with rescripted learning points and ad hoc learning points generated during the discussion.
• Consider forming a group of residents led by a faculty member to follow up with quality department regarding potential process improvements at system level that we think of, however it is important to note that GME intention is to provide input but will not play any role and does not have any intent or assume responsibility developing on hospital policies or procedures.
• The Mortality and Morbidity Conference is an internal GME activity and an essential part of the residency curriculum requirement. It should not be considered a substitute for related hospital conferences or any similar processes.

Preceptors: Dr. Kanugula, and Dr. Berhe

This presentation is Mandatory for PGY-3 residents. The objective of this scholarly presentation is to gather and present information from various medical journals, society recommendations, guideline updates, and medical news such as recalls, warnings, and policy/guideline changes issued by federal or state healthcare entities, including public health departments, the CDC, and the FDA.

This presentation should typically be assigned to PGY-3 residents during their Ambulatory Block, at least once.

Journal Review: The resident should review articles from various medical journals, preferably those with a high impact factor, although any relevant journal may be used. For each article, the resident should discuss the study type, objective, and conclusion. Each discussion should last no more than 2-3 minutes to allow for a broader range of topics and journals to be covered.

Society Guidelines: Present any changes or updates to guidelines, with a focus on those relevant to internal medicine and its subspecialties.

Medical News: Provide updates on recalls, alerts, and warnings from agencies, ensuring the audience is informed of any important developments.

Preceptor: Dr. Kanugula

Slides must be sent at least two weeks prior to presentation.

Journal Club (JC) may be scheduled to occur once a month, during one of the noon conferences.

Together, each of the two interns and 1-2 seniors assigned to the Ambulatory Block rotation will lead the journal club twice per year. On occasions where there may be a different number of interns or residents in the Ambulatory block, the faculty lead and Program Director will advise on how to share the presentation/teaching responsibilities.

Who is expected to attend: All residents should attend JC unless scheduled in the medical ICU or on Vacation or nights or emergent patient responsibilities during that time.

Format: This is to be an intern-led discussion of the article. It is the role of the discussants (typically three to four discussants) to help engage the group in a discussion about the article.

• PGY-1 Discussant #1 will facilitate the discussion of the introduction, background, and clinical question of the article. It should take 10 minutes.
• PGY-1 Discussant #2 will facilitate study design, methods, and outcomes by discussing those. The discussion should draw out potential strengths, and weaknesses of the study design. Any figures related to the study should be discussed. It should take at least 20 minutes.
• PGY 2/3 Discussant #3 will focus on the results and discussion/conclusion, Critique and teaching points of sections of the article. The tables and figures related to the results should be reviewed and discussed by the group (i.e., get the participants to review tables, graphs, etc. and interpret the findings – rather than just telling them what the authors say they found). It is expected that some basic information will be discussed related to the statistical tests used in the analysis. It should take approximately 20 Minutes.

Drs. Ehleben, or Dr. Kanugula can help with this, when needed.

Preparation:

Select 2-3 articles of interest that you jointly decide to present. Journal articles with practice-changing findings are preferred. Not all studies necessarily are randomized controlled trials. Observational trials (e.g., case-control and cohort studies) should also be considered. The articles should be vetted by JC faculty (i.e., either Dr. Ehleben or Kanugula) and the final "selection" should be completed at least 10-14 days before the scheduled JC.

Send a pdf of the selected article to Dr. Ehleben, Residents and Faculty.

After you have both read the article, meet with the JC facilitating faculty to discuss the plans for your presentation and to review the JC curriculum elements that should be covered in the discussion. Faculty members will be at the JC to help augment the discussion, as needed.

Purpose: To enhance patient care by integrating social determinants of health which are currently being screened, into treatment plans, improving healthcare access, and addressing barriers faced by the underserved population served at the continuity clinic. This will be part of Continuity clinic curriculum.

Objectives:

1. Identify and address SDOH impacting patient outcomes.
2. Develop actionable follow-up plans that incorporate identified SDOH into care strategies.
3. Facilitate interdisciplinary collaboration to optimize patient care.
4. Align with CMS guidelines by systematically incorporating SDOH screening and intervention into patient care plans.

CMS Guidelines and Requirements: According to CMS, healthcare organizations must:

1. Screen for SDOH: Identify factors affecting patient health, such as housing, food security, transportation, education, and social support.
2. Incorporate SDOH into Care Plans: Address identified needs through care coordination, community resources, and social support.
3. Ensure Continuity of Care: Integrate follow-up measures and document progress within the Electronic Health Record (EHR).
4. Promote Interdisciplinary Collaboration: Engage healthcare teams to address SDOH through coordinated care.

Meeting Details:

• Frequency: Every two weeks
• Day/Time: Fridays, 10:00 - 11:00 AM
• Location: Continuity Clinic Conference Room, with virtual option
• Duration: 1 hour

Purpose

The QI in Action: Quarterly Resident Improvement Forum is a structured educational conference designed to promote continuous quality improvement, patient safety, systems-based practice, and scholarly activity throughout the residency program. The conference provides residents with the opportunity to present the progress of their active Quality Improvement (QI) projects, receive constructive feedback from faculty and peers, and share interventions that may improve patient care across our health system.

Residents are encouraged to present projects at various stages of development. The objective is to foster continuous learning and improvement rather than only showcasing completed projects.

Conference Format

The conference is held once every two months during the Noon Conference (12:00 PM–1:00 PM).

Each active QI project will be presented by the principal resident investigator in an 8–10 minute presentation, followed by audience discussion and faculty feedback. Faculty mentors are expected to attend whenever possible and provide guidance regarding project methodology, implementation, and sustainability.

Presentation Content

Project Title

• Project title
• Principal resident investigator(s)
• Co-investigator(s)
• Faculty mentor/preceptor

Problem Statement

• Briefly describe the clinical or systems issue being addressed.
• Explain why the problem is important and its impact on patient care, safety, efficiency, or healthcare quality.

SMART Aim Statement — Clearly define the project's specific objective. Include:

• What will improve
• By how much
• By when
• Target population or clinical setting

Baseline Data

• Present the current state before any intervention.
• Include available baseline measures such as percentages, rates, counts, or other relevant metrics.
• Identify the source of the data (e.g., Epic reports, chart review, audits).

Interventions

• Describe the interventions implemented to address the identified problem.
• Discuss workflow modifications, educational initiatives, clinical tools, checklists, protocols, or other improvement strategies.
• Identify all key stakeholders involved, including nursing, pharmacy, case management, physicians, administrative staff, or other interdisciplinary team members.

PDSA Cycle(s) — Summarize each Plan-Do-Study-Act cycle completed to date. Describe:

• Plan
• Do
• Study
• Act

Projects may be presented even if only the initial PDSA cycle has been completed.

Results

• Compare current performance with baseline data.
• Discuss observed improvements, unchanged outcomes, or unexpected findings.
• Negative or neutral results remain valuable and should be presented honestly.

Barriers and Lessons Learned

• Discuss challenges encountered during project implementation.
• Identify obstacles, unexpected findings, and lessons learned.
• Explain modifications planned for future improvement cycles.

Questions and Discussion

• Conclude with a brief discussion period to obtain feedback from faculty and residents regarding future directions, sustainability, and opportunities for broader implementation.

Educational Expectations

Residents are expected to actively participate in discussions, provide constructive feedback to colleagues, and apply quality improvement principles to their own clinical practice. Faculty mentors should assist residents with project development, data interpretation, and implementation strategies while encouraging scholarly dissemination when appropriate.

Successful completion of a QI project may serve as a foundation for poster presentations, regional or national conference presentations, and future scholarly publications.

Will take place every Monday, Wednesday, and Thursday morning beginning at 11:30 AM. AMR takes place in Clinic Conference Room. During Ambulatory Morning Report, residents will present outpatient cases, as assigned, from either their continuity clinic or subspecialty clinic experiences. During this highly interactive conference, one case-based presentation will be used to highlight teaching points garnered from the outpatient practice of medicine.

Presentation should be approximately 30 minutes in duration (20 minutes of the case presentation and 10 minutes dedicated to a teaching point related to the case).

1. Only permitted during PGY-2 year
2. Only One away elective during the 3 years of training
3. No vacation allowed during that rotation
4. Needs approval from program prior to peruse, and at least 6 months in advance
5. All paperwork and responsibility for finding the elective falls on the resident, and reach out to Program Coordinator, and GME Director for assistance.
6. If rotation is available at Spalding, residents must do that rotation internally first.
7. Must be a compelling reason to do the away rotation that is outlined by resident, and most of the time with fellowship interests
8. Must score 50th percentile or higher on last ITE
9. Cannot have ever been on probation or had a remediation plan at our program.
10. Must be in good standing in training and Clinical Competency committee needs to review.
11. Program is not responsible for any expenses involved for this rotation as it is not a program requirement
12. Approval at the discretion of Program Director and DIO