I.  Introduction and Welcome to New Rheumatology Fellows

On behalf of the faculty, staff, residents and fellows, welcome to the Division of Rheumatology at the University of Minnesota.  We hope that the time you spend with us will be both educational and enjoyable.

The Institution manual contains guidelines and policies that apply to all residents and fellows, unless otherwise noted, throughout the University of Minnesota Academic Health Center.  The Program Manual is specific to the Department of Medicine and policies are written in accordance with the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education.  The Fellowship addendum is specific to the Division of Rheumatology.  Policies apply to all educational experiences within the program and are subject to periodic review and change by the faculty, Program Director, Fellowship Director and Department Chair.

The Institution manual contains information about benefits, policies and procedures that apply to all residents and fellows in a training program at the University of Minnesota.  Should information in the Program Manual or Fellowship addendum conflict with the Institution Manual, the Institution Manual takes precedence.

Fellows are responsible for knowing and adhering to the policies and guidelines contained in this handbook.  When in doubt, fellows are responsible to contact the program coordinator or director.

Program Overview

The Rheumatology Fellowship is a two-year training program with an option for additional years of training in research. The program uses two training sites:

1.   The University of Minnesota Medical Center is a tertiary care hospital with a diverse patient population, which   includes common and unusual diseases. The hospital is a world recognized specialty center for solid organ and bone marrow transplantation.  Rotations at the University Hospital include inpatient consultative Rheumatology, outpatient Rheumatology consultations, and a continuity clinic. 

2.      The Minneapolis Veterans Affairs Medical Center is a modern facility serving a large veteran referral population. 

3.      Regions Hospital offers ambulatory rheumatology clinic experience in a private practice community rheumatology setting. Additionally the inpatient rheumatology consult rotation at Regions offers the trainees the opportunity to manage an extremely varied and busy consult service including many patients with vasculitis and complex multisystem illness. Electives offered at Regions will provide mentoring in ambulatory orthopedic problems as well as training in geriatric orthopedics at Regions. Two musculoskeletal radiologist and three rheumatology faculty will provide supervision of the fellows during the rotation. 

4.      Hennepin County Medical Center is an academic medical center and public hospital. The Hennepin County Medical Center rotation will provide fellows with the opportunity to learn musculoskeletal radiology in a small group tutorial format and the opportunity to provide consultative care to patients with specialized metabolic bone disorders. The highly rated resident education program in rheumatology at HCMC will afford fellows the increased opportunities to practice teaching skills in a variety of settings. Rheumatology in-patient and rheumatology OPD clinics will significantly increase the number of Systemic Lupus patients cared for by the fellows.

II. DEPARTMENT MISSION STATEMENT

The mission of the Department of Medicine is to enhance the health of the people of Minnesota, the nation and the world, through innovation and research, education and patient care. It is the mission of the Department of Medicine Residency Program to provide excellent training in the practice and science of Medicine by immersion in patient care, with emphasis upon critical reasoning, scholarship, and professional responsibility, and to promote personal and professional satisfaction.

III. Program Mission Statement

The educational mission of the Division of Rheumatology Fellowship Program is to provide an atmosphere of learning and academic curiosity and to provide strong basic training in clinical rheumatology. We seek to fulfill this mission through a structured fellowship program that is characterized by educational objective-based learning experiences, effective and timely feedback to fellows, ongoing critical analysis of the program and faculty and close clinical and research mentoring to promote lifelong habits of self-study and learning. 

SECTION I.  STUDENT SERVICES

(Please refer to Institution Policy Manual for Medical School Policy on the following: Academic Health Center Portal Access; Child Care; Computer Discount; Credit Unions; Disability Accommodations; Legal Services; Library Services; Medical School Campus Maps; Residency Assistance Program; Tuition Reciprocity; University Card (U Card); University Recreation Sports Center; University Events Box Office).

University Pagers

Each fellow will be assigned a universal pager to be carried throughout the training.  Fellows will not have to switch beepers when they switch sites.  Pagers have an 80-mile radius.  Batteries for pagers are available at all Medicine Offices at each of the hospital sites.  Fellows should turn in their pagers to the main lobby of University of Minnesota Medical Center Information Desk if their pager needs repair, and a temporary pager will be assigned.  At the end of training, fellows must return their pagers to the fellowship coordinator.

E-mail Addresses and Internet Access

Fellows are assigned an e-mail account at the beginning of their fellowship.  Fellows may consult their divisional faculty and staff for addresses.  E-mail addresses can also be found by searching through the University of Minnesota web site at http://www1.umn.edu/tc/lookup.cgi.  We regularly send announcements about the program via e-mail and we ask that you check email at least once a week.  You are required to forward your University email account to whichever email service that you use. (Yahoo, hotmail, etc.)  You may do this by contacting the email helpline.  A computer with internet access will be available in the fellows' room in Mayo.

Websites

www.med.umn.edu/rheum/ (U of M Rheumatology Dept. website)

Campus Mail

Many important mailings are sent directly to fellows¿ homes.  Fellows must check their mail regularly.  Fellow will have mailboxes located in their division office.  Unclaimed mail will be forwarded to each fellow's home address at the end of the rotation.  Fellows should update their addresses with their fellowship coordinator.

Campus Mail Address:  Mayo Building, MMC 108

HIPAA Training

All incoming fellows are required to participate in HIPPA Clearance / Computer Lab during their initial mandatory orientation.  The four mandatory modules include: Introduction; Safeguarding PHI on Computers; Privacy and Confidentiality in Research and; Privacy and Confidentiality in Clinical Settings.

SECTION II.  BENEFITS

(Please refer to Institution Policy Manual for Medical School Policy on the following:  Boynton Health Services; Employee Health Services; FICA; Dental Insurance; Health Insurance; Life Insurance; Voluntary Life Insurance; Long-Term Disability; Short-Term Disability; Insurance Coverage Changes; Loan Deferment; Minnesota Medical Association Membership; Optional Retirement Contribution; Pre-Tax Flexible Spending Accounts; Professional Liability Insurance; Resident/Fellow Exercise Room; Resident/Fellow Leave: Bereavement Leave; Parental Leave; Extended Medical Leave; Holidays; Jury/Witness Duty; Military Leave; Personal Leave of Absence; Professional/Academic Leave; Vacation/Sick Leave; Policy on Effect of LOA for Satisfying Completion of Program; Stipends; Worker's Compensation Benefits; Veterans Affairs Benefits).

Stipend Levels (See also Institution Manual)

Listed below are the 2007-08 base stipends for the Department of Medicine:

                     PGY-4    $49,045

                     PGY-5    $50,433

                     PGY-6    $52,204

                     PGY-7    $53,873

RESIDENT AND FELLOW LEAVE

Vacation and Sick Policy

In accordance with ABIM policy, all fellows will be given one month (i.e., four weeks) of leave, to be used for both vacation and sick leave. Any leave that exceeds one month will be unpaid and must be made up at the end of the training.  There is no carry over of vacation or sick time from one year to the next.  For details, please refer to the ABIM policy located on the web at www.abim.org.

For sick time, fellows are responsible for notifying the program director, Dr. Segal, at 612-624-1182 or the Fellowship Coordinator (612-624-6843), and the appropriate faculty member of their rotation as soon as possible. Up to 5 days of paid sick leave per training year will be approved for legitimate illness.

Vacation time includes 15 weekdays, and 6 weekend days (i.e. during scheduled weekend call, staff will be responsible to cover call). Vacation days cannot be carried over to your next academic year.  Vacation days cannot be transferred between weekday/weekend days. All vacation requests should be submitted on the form provided (also used for canceling clinic) and submitted to the Fellowship Coordinator who will obtain approval from the Program Director.  Please be aware that any vacation time which will necessitate closing a UMMC clinic must be submitted 35 days in advance to allow time for approval and submission to the scheduling office (requires 28 days notice). 

Vacation time will be divided between the four hospital sites (UMMC, VAMC, Regions, HCMC).  Please notify the appropriate hospital if vacation time will interfere with a clinic.

A specific vacation request will not be approved until the fellow has turned required paperwork into the program director's office.  This paperwork includes mid-year and year-end evaluations, and E-Value logs. 

The Division recognizes the need for fellows to schedule interviews for post-fellowship practice or academic positions.  Interview time must be scheduled to create minimal disruption to the fellow's schedule.  Each fellow must make arrangements with their rotation director to take time off to interview (see clinic cancellation policy).

Holidays

Fellows are exempt from being on call for the following holidays (weekends where appropriate):  Labor Day, Thanksgiving, Christmas, New Year's, Memorial Day, and Independence Day.  Attending staff will cover these weekends.  Fellows are not allowed to trade or substitute on holiday weekends. 

Jury/Witness Duty

Upon request to the program director, leave is provided to trainees who are called to serve on a jury.

Trainees do not lose pay when serving on a jury or testifying as described above.  The training program and the trainee may write a letter to the court asking that the appointment for jury duty be deferred based on hardship to the trainee and the program.

Upon request to the program director, leave is provided to trainees who are subpoenaed to testify before a court or legislative committee concerning the University or the federal or state government.

Military Leave

In the event a trainee is called to active military duty, it is incumbent upon the Program Director to notify both the individual RRC and the Board of this change in status.  Trainees on military leave for up to five years generally are eligible for reinstatement to their training programs once active duty is completed.  Trainees may resume their training at the PG-Y level they were in when called to duty or may be required to repeat earlier training experiences.  The appropriate level of training upon return will be determined based on several factors:  length of leave; medical duties, if any, performed by the trainee while in military service; curricular changes in the training program during the trainee's absence, etc.

Personal Leave of Absence (See Program Manual)

Divisional Contact: Angie Simonson, 612-624-6843

Professional and Academic Leave Policy (includes conferences and CME): (See the Institution Manual) Fellows are allowed 5 days of academic leave per year to attend professional meetings in addition to the specified one month of vacation/sick leave. If a fellow is required to attend a meeting to present an abstract, the time taken does not count as vacation leave as long as the Program Director approves the absence and the appropriate amount of notice required for cancellation of clinics is given.

Bereavement Leave (See the Institution Manual)

Departmental Contact:  Troy Christensen @ 612-626-0119

Maternity/Paternity Leave (See the Institution Manual)

Divisional Contact: Angie Simonson, 612-624-6843

Extended Medical Leave (See the Institution Manual)

Departmental Contact:  Troy Christensen @ 612-626-0119

Policy on Effect of Leave for Satisfying Completion of Program (See Program Manual)

Health and Dental Insurance Coverage (See the Institution Manual)

Departmental Contact:  Troy Christensen @ 612-626-0119

Long-term and Short-term Disability Insurance (See the Institution Manual)

Departmental Contact:  Troy Christensen @ 612-626-0119

Professional Liability Insurance (See Program Manual)

Life Insurance (See Program Manual)

Departmental Contact:  Troy Christensen @ 612-626-0119

Meal Tickets

There is no allotment for meals to fellows in Rheumatology.

Laundry Service

White coats should be given to administrative staff for placement in the laundry bag located in A-530 Mayo Utility Room.  Coats take approximately two weeks to be laundered.  It is suggested that you write your name on the collar of the coat prior to sending it out to be cleaned.

Unauthorized Leave (See Program Manual)

Unexcused or unsupportable absences or unauthorized leave and therefore significant tardiness from mandatory clinical or educational activity constitute unprofessional conduct.  Under your signed employment contracts unprofessional conduct is one behavior, which will subject the fellow to discipline for non-academic reasons.  Such discipline may be in the form of a written warning, probation, suspension or termination.

Leave of Absence Policies (See the Institution Manual and Program Manual)

Educational Allowance

Each fellow is granted $500 annually (July 1-June 30) for education-related expenses. Valid expenses include items such as memberships to medical societies, subscriptions to medical journals, registration fees for conferences, and medical textbook purchases.  Fellows should contact the Associate Administrator, Angie Simonson, for reimbursement of expenses and reimbursement questions.

Parking

Contract parking is provided at each hospital site.

Fellow on Rotation at UMMC

Parking is provided for the fellow currently on rotation at UMMC in the Oak Street Ramp, two blocks east of the hospital.  A parking card is issued on the first day of orientation and is to be used throughout the program.  At the end of the UMMC rotation, the fellow is to transfer the parking card to the incoming fellow.

Fellow on Rotation at VAMC

Fellows are issued a photo ID/parking card at orientation that is active throughout the entire training period. You will need to go to the Security Office for an ID Badge and indicate your need for physician parking set up on your badge. Parking is provided in the physician/staff lot east of the main hospital entrance. 

Fellow on Rotation at Regions

Fellows are provided with parking cards during their orientation.

Fellow on Rotation at HCMC

Fellows will obtain a parking card from the parking office on the first day of their HCMC rotation. A $50 deposit is required for the parking card; it will be returned when you turn in your parking card at the end of your training.

To attend UMMC continuity clinics, lectures and conferences while on rotation at another hospital:  parking before 3:30 pm is available in the Washington Street Ramp with the use of our VIP stamp.

All Fellows'  Non-Peak Hour Parking (conference attendance, call, etc.)

Please use this option whenever feasible because it is to no cost to you or the division.

Delaware Street Patient Parking Ramp (non-peak hours)

Monday-Friday, 3:30PM - 5:30AM

Saturday-Sunday, All Day

To obtain a parking card:

   Go to the Parking Office- Mayo B340

Hours are 7:30am-4pm

   Complete a parking application

   Fellow will be required to submit a $25.00 deposit, which will be refunded when you return

your card.

SECTION III.  DISCIPLINARY AND GRIEVANCE PROCEDURES

(Please refer to Institution Policy Manual for Medical School Policy on the following: Discipline/Dismissal/Non-Renewal of Residents/Fellows; Conflict Resolution Process for Student Academic Complaints; University Senate on Sexual Harassment Policy; Sexual Harassment and Discrimination Reporting; Sexual Assault Victim¿s Rights Policy; Resident Dispute Resolution Policy).

SECTION IV.  GENERAL POLICIES AND PROCEDURES

(Please refer to Institution Policy Manual for Medical School Policy on the following: AHC Student Background Checks Policy; Appointment Documentation Requirements; Blood Borne Diseases Policy; Classification Policy; Compact Between Resident Physician and Their Teachers; Disaster Policy; Dress Code Policy; Duty Hours/On-Call Schedules; Duty Hours Policy; Duty Hours Prioritization of On-Call Rooms; Eligibility and Selection of Residents/Fellows; Essential Capacities for Matriculation, Promotion and Graduation; Evaluation Policy; Gift Policy; GME Core Curriculum Seminar Series; GMEC Resident Representative Policy; Health Insurance Portability and Accountability Act; Immunization and Vaccinations; Impaired Resident/Fellow Policy and Procedure; Institution Duty Hour Survey Policy and Procedure; Institution and Program Requirements; International Medical Graduates Visa Requirements; Licensure/Residency Permit Policy; Moonlighting Policy; Nepotism Policy; New Training Program Policy; Observer Policy; Post-Call Fatigue Cab Voucher Policy; Program Oversight; Registered Same Sex Domestic Partner Policy; Release of Resident/Fellow Contact Information Policy; Residency Closure/Reduction; Resident Management Suite (RMS) Resident/Fellow Responsibilities; Resident/Fellow Standing and Promotion Policy; Restrictive Covenants; Short Term Disability Policy; Stipend Level Policy; Supervision Policy; Transitional Year Policy/Procedure; USMLE Step 3 Policy; Voluntary Life Insurance Procedure; Without Salary Appointment Policy).

Moonlighting

In addition to the Moonlighting Policy set forth in the Institution manual, fellows must adhere to the following guidelines specific to the Internal Medicine training programs.

Moonlighting may NOT conflict with duties assigned in the training program.  This includes (but is not limited to) leaving the hospital early in order to go to a moonlighting location, moonlighting while on call from home, or using vacation or sick days or other days off in order to moonlight.

§                     Moonlighting requires a prospective, written statement of permission from the program director that will be made part of the residents' file;

§                     Residents and Fellows are not required to engage in Moonlighting;

§                     Moonlighting activities will not be allowed to conflict with the scheduled and unscheduled time demands of the educational program and its faculty;

§                     The Resident/Fellow's performance will be monitored for the effect of these activities upon performance and that adverse effects may lead to withdrawal of permission; and

Internal Moonlighting must be counted toward the 80-hour weekly limit on duty hours

Hours spent moonlighting must not exceed mandated guidelines of the ACGME for consecutive hours on call or otherwise engaged in patient care during training.  Similarly, hours spent moonlighting and hours with training duties must not cumulatively exceed these guidelines.

Resident/fellows holding J1 visas under sponsorship of the ECFMG may NOT moonlight.

Grievance Policy and Due Process (See Program Manual for additional information)

Divisional Contact: Angie Simonson, 612-624-6843

ACGME Competencies

All University of Minnesota Medical School Residency/Fellowship training programs define the specific knowledge, skills, attitudes, and educational experiences required by the RRC to ensure its residents/fellows demonstrate the following:

§                     Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

§                     Medical knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

§                     Practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.

§                     Interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals.

§                     Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

§                     Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value.

Rheumatology Fellowship Methods of Evaluation

See Curriculum portion of manual

Supervision / Progressive Responsibility for Patient Management

While fellows are gradually given more responsibility as they progress through the program, at all times final responsibility for the case rests with the faculty. All reports must carry an attending name and electronic signature, which signifies that the attending has verified the findings and assessment. The Program Director ensures, directs and documents adequate supervision of fellows at all times. Fellows are supervised by teaching staff in such a way that the fellows assume progressively increasing responsibility according to their level of education, ability, and experience. On-call schedules for teaching staff are structured to ensure that supervision is readily available to fellows on duty.

In all our clinics, the fellow sees the patient and presents each case to the attending physician throughout the 2 years of their fellowship. As they progress, fellows are given more responsibility. In the ambulatory setting, they continue to check out all patients with the attending, but give a full presentation only of problem cases as their competency increases.

*As assessed by supervising faculty based on observation of fellow's performance. Clinical proficiency levels correspond approximately with the first, second, and third 6-month blocks of clinical experience, but individual fellows move through the levels at different rates depending on their rate of developing the relevant competencies.

Statement of the Rheumatology Fellow and Faculty Responsibilities

See Curriculum portion of manual

Monitoring of Resident Well-being (See Duty Hours)

The Rheumatology division chief and training program director are available to discuss Rheumatology fellow well-being issues and to direct assistance.  If the fellow is fatigued or stressed, or unable to provide patient care, they should page the program director and attending faculty. 

On-Call Rooms (See Institution Manual)

Since all RAD call is taken from home, it is not expected that fellows on call will want or need to use hospital site on-call rooms.

Support Services  (See the Institution Manual)

Patient support services, i.e. intravenous services, phlebotomy services, and laboratory services, as well as messenger and transporter services, must be provided in a manner appropriate to and consistent with education objectives and patient care.

Security/Safety (See the Institution Manual)

Medical Records (See the Institution Manual)

Laboratory/Pathology/Radiology Services (See the Institution Manual)

Advisor System

Fellows will be able to choose a faculty advisor during their intern year/first year of fellowship, from which they can seek consult throughout their training.  The role of the advisor is to:

·        Serve as a mentor and support person throughout the training

·        Keep the resident/fellow informed regarding faculty and medical center issues

·        Provide advice regarding rotation schedules

·        Actively follow the academic progress of the resident/fellow including reviewing the mid-year evaluations and  year-end evaluation and the results of the in-training examination

·        Provide advice regarding career choices

·        Facilitate problem solving

Fellows and their advisors must meet a minimum of twice per academic year, and should also communicate regularly either by phone or via email.  If you wish to have a minority professional advisor from the Metropolitan community, contact the Program Director or Mary Tate, in the Medical School Office of Minority Affairs.

Duty Hours /On-Call Schedules

§         Duty Hours are defined as all clinical and academic activities related to the training program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences.  Duty hours DO NOT include reading and preparation time spent away from the duty site.

§         Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.  Work hours are generally 8:00 a.m. to 5:30 or 6:00 p.m. weekdays, and night and weekend call is at home via pager.  Rheumatology fellows are not assigned on-call in-house duty. 

§         Residents/Fellows are provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call.

§         The training program provides adequate time for rest and personal activities, which consists of a 10-hour time period provided between all daily duty periods and after in-house call.

§         Include information on department¿s tracking of duty hours

§         In compliance with ACGME guidelines, fellows must take one day off per week, on average, on all rotations.  This means that fellows will not have any responsibility to be available on that day.  This day off should not occur on a scheduled continuity clinic day.  It is the responsibility of the individual fellow, in cooperation with his/her patient care team, to determine the most appropriate day off.  Rheumatology fellows will be assigned weekend call from home every other weekend.  This will ensure that four weekend days per month will be assigned to each fellow as days off without pager responsibilities.

When averaged over any 4-week rotation or assignment, fellows must not spend more than 80 hours per week in patient care duties.

Rheumatology Call Schedule

In-house call is defined as those duty hours beyond the normal work day when residents/fellows are required to be immediately available in the assigned institution.  In-house call must occur no more frequently than every third night averaged over a four hour period.  Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours.  Residents/Fellows may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics and maintain continuity of medical and surgical care 

1. Fellows will be responsible for consults (UMMC) Monday through Friday 8AM-5PM.  Weekday evening call from 5 pm to 8 am is the responsibility of the Consult Attending. Weekend call begins at 5 pm Friday and extends to 8 am Monday. Fellows take 1^st call from home; the consult attending should be advised of all hospital consults. In most instances both senior staff and the fellow would see the inpatient consult.
    

2.  Designated holidays: Fellows are exempted from call coverage; New Years Day, Christmas Day, Thanksgiving Day, Memorial Day, July 4^th and Labor Day. The consult attending during those dates is solely responsible for call.
    

3. A weekend call schedule has been established on a training year basis (July-June) equally sharing the responsibility between the two fellows.  Each fellow is allowed 6 weekend days of vacation per training year (i.e., a vacation from scheduled weekend call).  When fellows schedule weekend vacation days, call is the responsibility of the Consult attending.  The fellow should formally request these vacation days through the Fellowship Coordinator.  Changes to the weekend call schedule may only be made by:  (1) utilizing weekend vacation time; or (2) trade with the other fellow.  When difficulties arise in arranging weekend call coverage, the program director should be advised and will assist in making arrangements for coverage.  Please utilize your weekend vacation days as indicated, they cannot be carried over or exchanged for weekday vacation.  Please inform the Fellowship Coordinator of any call trades made as quickly as possible.  The Coordinator will inform the Page Operator of the schedule change.
    

4. During the research months, fellows have no IPD consult neither responsibility nor general rheumatology clinic responsibility. Continuity Clinics at FUMC and VAMC are maintained as usual.

** (See Fellow Call Schedule)** Consult Attending

IPD Consult Rounds

1.      The "official" time for rounds is 3 to 5 pm. Every effort should be made to insure that teaching rounds are concluded by 6 pm. On occasion when late consults are called in the staff may elect to reserve non urgent consults for the following day in order to avoid lengthy evening rounds. Management plans will be made in consultation with the attending that will staff every patient.

2.  On no occasion should fellows be expected to see IPD consults during morning clinics or to add OPD consults on to clinic schedules unless approved by the Program director