Applies to: Residents in the WSU Internal Medicine Residency – Everett program.
Date: May 16, 2023
1.0 Policy Statement
It is the WSU College of Medicine Internal Medicine Residency (IMR) Everett policy to assure consistent standards and processes for appointment renewal and promotion of residents.
2.0 Definitions
Accreditation Council for Graduate Medical Education (ACGME)
Accredits Sponsoring Institutions and residency and fellowship programs, confers recognition on additional program formats or components, and dedicates resources to initiatives addressing areas of importance in graduate medical education.
Appointment
Position in a training program.
Clinical Competency Committee
A required body comprising three or more members of the active teaching faculty who is advisory to the program director and reviews the progress of all Trainees in the program.
Designated Institutional Official (DIO)
The individual in a sponsoring institution who has the authority and responsibility for oversight and responsibility of all of the ACGME accredited programs.
Graduate Medical Education Committee (GMEC)
The WSU College of Medicine Graduate Medical Education Committee (GMEC) is an institutional committee of WSU College of Medicine Graduate Medical Education Office and is charged with the responsibility of monitoring and advising on all aspects of residency and fellowship education.
Mentor/Faculty Advisor
Program-assigned faculty member responsible for developing a plan for professional identity development and career planning (faculty mentor) or responsible for portfolio review and performance coaching and feedback around clinical competencies (faculty advisor).
Physician in Training Agreement (PITA)
Contractual document used by the WSU College of Medicine for Trainees who have an appointment in a WSU residency or fellowship program. The PITA outlines the appointment conditions including PGY level and appointment period.
Program Director
The individual designated with authority and accountability for the operation of a residency/fellowship program.
Promotion
Progressing within a GME program to a more advanced training level or toward completion of the program generally requiring demonstration of increasing competency, and ability to function with progressive independence and assumption of greater responsibility.
Renewal
Renewal of a residency contract (Physician in Training Agreement) or appointment with the purpose to extend training in a current PGY level or advance to another PGY level in the training program.
Scholarly Activity
Engagement in creative work designed to generate or disseminate new knowledge (e.g. writing a book chapter, clinical research, quality improvement work, assessment of community engagement programs, health policy research or reflection on health advocacy, generation of or assessment of didactic or curricular materials).
Trainee
A physician in training at an ACGME accredited graduate medical education program, the term includes Interns, Residents, and Fellows or other trainee enrolled in an educational program whose education falls under the purview of the Elson S. Floyd College of Medicine Office of Graduate Medical Education.
3.0 Responsibilities
The Clinical Competency Committee, DIO, and Program Director make decisions for determining the renewal and promotion policy. The Program Director makes the final decision regarding promotion of Trainees after receiving a formal recommendation from the Clinical Competency Committee.
4.0 Procedures
The WSU Internal Medicine Residency-Everett shall have a comprehensive Trainee evaluation system in place. Through the course of training, a Trainee is expected to acquire increasing competence in the discipline in which he/she is training. Promotion to the next level of training is based on the achievement of program specific competence and performance parameters. These can include specific cognitive, clinical, technical, interpersonal and communication skills, professional behaviors and ethical conduct as determined by the program and/or the sponsoring institution, such as level appropriate completion of curricular objectives, mastery of clinical materials and/or technical skills,
and requirement of completion of certification examinations.
The Trainee will receive summative evaluation at minimum twice yearly throughout their time in the program. The second evaluation will include a determination on whether they will be promoted to the next PGY level. Trainees will be alerted 60 days ahead of time when the program determines that they will not be promoted prior to the end of their PGY training year.
The program director must provide a final evaluation for each Trainee upon completion of the program. The final evaluation must: become part of the Trainee’s permanent record maintained by the program and must be accessible for review by the Trainee in accordance with institutional policy; verify that the Trainee has demonstrated the knowledge, skills, and behaviors necessary to enter autonomous practice; consider recommendations from the Clinical Competency Committee; and be shared with the Trainee upon completion of the program.
Promotion/Appointment Renewal
The Program Director, in collaboration with the Clinical Competency Committee (CCC), will make decisions regarding each Trainee’s promotion to the next year of training. Those decisions will be based on the evaluation and promotion criteria developed by the program and influenced by the ACGME Milestones. While it is expected that Trainees will be promoted to the next level of responsibility annually, Trainees that fail to meet the program’s criteria for promotion will not be advanced solely on the basis of time served. See Corrective Action Policy and below Promotion Criteria and Consequences of Non-Promotion for further detail.
Promotion Criteria
To be considered for promotion from PGY1 to PGY2
- A trainee must remain eligible to practice medicine on a limited license in Washington.
- A Trainee must remain up to date with required BLS/ACLS certification.
- A Trainee must participate in creation of an Individualized Education Plan during their PGY1 year and be actively engaged in self-directed learning and development.
- A Trainee’s trajectory of performance across the competency milestones, especially those in patient care and communication, should be nearing a level which preserves patient safety in the setting of indirect supervision.
- A Trainee must be actively and consistently engaging with any interventions recommended by the CCC within their Individualized Education Plan.
- A Trainee should not have a pattern of professionalism concerns or egregious violations of professional conduct.
- The CCC has the authority to review professionalism information regarding a Trainee’s performance or behavior from myriad assessment tools or routes of feedback and to make recommendations based on concerns.
- Patterns which may highlight gaps in Professionalism may be based on behavior, clinical performance, attendance, engagement with recommended educational interventions, or completion of administrative duties related to clinical job, including delinquent medical records or responding to requests related to being a physician.
- Completion of the PGY1 In-Training Exam unless one is granted an approved absence. Reasonable accommodation for the ITE test is available via Human Resources. Due to limited opportunities to take the exam annually, if a Trainee misses due to illness, family emergency, or leave, the program will attempt to substitute a similar opportunity.
- A Trainee must demonstrate active engagement in all assigned rotations.
- A Trainee must complete at least 80% of the preceptor/rotation evaluations they are assigned to complete within MedHub.
To be considered for promotion from PGY2 to PGY3
- A Trainee must remain eligible to practice medicine on a limited license in Washington.
- A Trainee must remain up to date with required BLS/ACLS certification.
- A Trainee must participate in the refinement of an Individualized Education Plan during their PGY2 year and be actively engaged in self-directed learning and development.
- A Trainee’s performance should demonstrate upward trajectory across all competency milestones from a level which preserves patient safety in the setting of distant indirect supervision toward independent practice. Not only do senior Trainees need to be able to perform competent clinical care with distant supervision, but they also need to provide safe and supportive oversight of PGY1 Trainees providing patient care.
- A Trainee must be actively and consistently engaging with any interventions recommended by the CCC within their Individualized Education Plan.
- A Trainee should not have a pattern of professionalism concerns.
- The CCC has the authority to review professionalism information regarding a Trainee’s performance or behavior from myriad assessment tools or routes of feedback and to make recommendations based on concerns.
- Patterns which may highlight a room for development in Professionalism may be based on behavior, clinical performance, attendance, engagement with recommended educational interventions, or completion of administrative duties related to clinical job, including delinquent medical records or responding to requests related to being a physician.
- A Trainee must demonstrate active engagement in all clinical rotations.
- A Trainee must have passed USMLE Step 3 or COMLEX Level 3 before promotion to a PGY3 year.
- A Trainee must complete at least 80% of preceptor/rotation evaluations they are assigned to complete within MedHub.
- A Trainee must be actively engaged in scholarly activity within the program.
- They must be engaged in a board study plan approved by their mentor, Pod Coach or faculty advisor.
To be considered for promotion from PGY3 to Board Eligible Graduate of an IM
Residency
- A Trainee must remain eligible to practice medicine on a limited license in Washington.
- A Trainee must remain up to date with required BLS/ACLS certification
- A Trainee must participate in the refinement of an Individualized Education Plan during their PGY3 year and be actively engaged in self-directed learning and development.
- A Trainee should demonstrate performance of safe clinical care requiring little to no supervision in most clinical scenarios, signifying the ability to practice independently. Graduates of an internal medicine residency need to be able to perform competent clinical care without supervision. They must demonstrate competency specific knowledge, skills and attitudes which enable them to perform safe clinical care, identify their boundaries, and be able to seek out new knowledge and assistance when needed to provide timely, safe, comprehensive patient care.
- A Trainee must be actively and consistently engaging with any interventions recommended by the CCC within their Individualized Education Plan.
- A Trainee should not have a pattern of professionalism concerns.
- The CCC has the authority to review professionalism information regarding a Trainee’s performance or behavior from myriad assessment tools or routes of feedback and to make recommendations based on concerns.
- Patterns which may highlight room for development in Professionalism may be based on behavior, clinical performance, attendance, engagement with recommended educational interventions, or completion of administrative duties related to clinical job, including delinquent medical records or responding to requests related to being a physician.
- A Trainee must demonstrate active engagement in all clinical rotations.
- A Trainee must complete 80% of preceptor/rotation evaluations they are assigned to complete within MedHub.
- A Trainee must have engaged in the process of logging clinical procedures completed during the residency program within MedHub.
- A Trainee must be actively engaged in scholarly activity within the program.
- They must be engaged in a board study plan approved by their mentor, Pod Coach or faculty advisor.
Consequences of Non-Promotion
Prior to considering promotion, the Program Director, after consultation with the DIO, may offer a Trainee additional time in any given Post Graduate Year to allow the Trainee to achieve the required level of proficiency for promotion. A Trainee accepting this condition must be given a written summary of deficiencies, a delineation of the Individualized Learning Plan and the criteria for advancement.
Failure to Promote
A decision by the program to not promote a Trainee to the next level of training will necessarily be accompanied by one of two recommendations:
- Retain the Trainee at the current level of training for a specified period of time prior to re-evaluation, and/or until competency level is achieved, or
- Dismiss the Trainee from the training program (non- renewal). In either instance, the Trainee has the right to appeal this decision, as outlined in the Elson S. Floyd College of Medicine GME Corrective and Disciplinary Action Process policy.
If a decision is made to not promote the Trainee and retain the Trainee in the current level of training, the Trainee shall receive at least 60 days advance written notice of the on promotion prior to the end of the appointment period.
Non-Renewal
In situations where a Trainee is not making adequate progress towards advancement to the next level of training, the program may decide against renewal of the trainee’s agreement. In this situation, it is expected that the Trainee will receive at least 90 days advance written notice. If the reason for non-renewal occurs within the 90 days prior to the end of the current contract, it is expected that the program will provide the Trainee with as much written notice of its intent not to renew as the circumstances will reasonably allow. Prior to considering a non-renewal or termination, the Program Director must consult with the DIO.
5.0 Related Policies
Corrective Action Policy
6.0 Revision History
GMEC Approval: May 16, 2023
Revision/Review Date(s):
Responsible Office: WSU Internal Medicine Residency – Everett
Policy Contact: Program Director
Supersedes: N/A