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ACCOMMODATIONS FOR DISABILITIES POLICY
It is the policy of East Tennessee State University, James H. Quillen College of Medicine to provide reasonable accommodations as necessary for qualified individuals with disabilities who are accepted in to our post graduate training programs.  We will adhere to all applicable federal and state laws, regulations and guidelines with respect to providing reasonable accommodations as required in accordance with the policies and procedures of the University.


University Policies and Procedures link:http://www.etsu.edu/humanres/relations/procedures.aspx

The Graduate Medical Education Office will work with the University Office of Disability Services in determining if a resident has a disability and what accommodations may be reasonable and necessary for the College of Medicine to provide.  Residents will still be required to meet all program educational requirements with or without accommodations as they must be able to demonstrate proficiency in all of the ACGME defined competencies and programs must certify that they are able to practice the specialty in which they have been trained competently and independently upon completion of training.  This includes the ability to perform the required technical and procedural skills of the specialty.  Patient safety must be assured as a top priority in these determinations. 

Residents must request accommodations in writing to the Program Director.  At that time the resident will be required to provide medical verification of a medical condition that he or she believes is a disability.  The resident is responsible for the costs of obtaining verification.  The Program Director must notify, within five (5) working days of the request, the Designated Institutional Official and the Executive Associate Dean for Graduate Medical Education.  

CLOSURE/REDUCTION POLICY
The College of Medicine Graduate Medical Education Program recognizes the need and benefits of graduate medical education and sponsors training programs which emphasize personal, clinical and professional development.  The College of Medicine residency programs are conducted in substantial institutional and program requirements of the ACGME and its individual Residency Review Committees.

In the event the College of Medicine has to reduce the number of positions in or closes a residency training program or to close a program, the College of Medicine will notify the GMEC, DIO, and residents in training as soon as possible.  If possible, reductions will be made over a period of time to allow all residents to complete training.  In the event that an ACGME action or decreased financial or educational resources force the closure of a training program, the College of Medicine will allow the residents already in the program to complete their education or assist them in locating another ACGME accredited program in which they can continue their education.

DELINQUENT MEDICAL RECORDS
Residents are expected to maintain all appropriate and reasonable medical records in a timely fashion.  A resident who is identified as having delinquent medical records (any record considered delinquent by hospital bylaws) will be notified and given five (5) days to report to the hospital to complete the records. Any records not available to the resident at that time will become the responsibility of the attending physician of record.  If the resident does not report within the five (5) day period, he/she will be subject to suspension.  Each day of suspension will be counted as one day of annual leave; if there is no available annual leave, the resident will be placed on leave without pay. Extended lengths of suspension may require make-up duty, as outlined by the ACGME/RRC.

DISASTER POLICY
The James H. Quillen College of Medicine, East Tennessee State University, acknowledges its ongoing support of graduate medical education in the face of any disaster (natural or otherwise) that interrupts the hospital/clinic based educational process.  This ongoing support consists of the following commitments:

  1. The Dean and College of Medicine administration, working with the graduate medical education affiliated hospitals, will strive to ensure financial and logistical support of residents until normal educational site(s) resume clinical activity.

  2. The Office of Graduate Medical Education will maintain contact with all residents during any times of disruption, and provide assistance toward resuming the educational experience as soon as possible.  To fulfill this commitment, resident demographic data will be collected and electronically secured off-site from the College of Medicine/University campus.

  3. The Office of Graduate Medical Education, working with the various departments and training programs, will coordinate efforts to provide an alternate educational venue that is convenient and provides appropriate educational experience.

Specifically, programs will focus on strategies to utilize the existing Mountain States Health Alliance, Wellmont Health System, and Veterans’ Affairs Health System to provide temporary clinical settings for the displaced residents.  If these regional clinical sites are not available, the Program Director and Chair, along with the Graduate Medical Education Office, will strive to place residents in an educationally rewarding environment as close to this region as possible.  The various programs will coordinate their efforts with the appropriate Residency Review Committee and the ACGME to ensure an approved experience for the displaced  residents. In the aftermath of the disruption of graduate medical education, the College of Medicine will work to restore the clinical teaching environment as soon as possible so that residents may return to their pre-disaster hospital/clinic setting.  

DRESS CODE
Professional appearance and demeanor are a demonstration of respect for the patient, the profession and of self respect.  This professional appearance and demeanor should be maintained at all times.In accordance with departmental policy, training program directors shall ensure that all residents are properly attired and appropriately groomed for their patient care roles.  Access to, usage and proper maintenance of scrubs, lab coats and similar attire shall follow hospital and/or departmental regulations.  Special accommodations will be made for residents whose cultural and/or religious beliefs require certain types of attire.  Residents must wear white coats and official identification at all times when interacting with patients.

Residents are required to wear white lab coats with their identification badge attached and visible at all times.  Lab coats with departmental patches will be provided for the residents by the department at the beginning of their residency.

DUE PROCESS AND TERMINATION OF A RESIDENT
This outline of Due Process is applicable to any resident who wishes to appeal an adverse decision by his/her program director or departmental chair.  Adverse actions include: non-renewal of contract; suspension from residency program; termination for residency program; imposition of limitation on resident’s professional responsibilities; or imposition of disciplinary action resulting from violation of residency policy or procedure.

The house staff shall consist of residents and clinical fellows regularly appointed at the James H. Quillen College of Medicine, East Tennessee State University.  Its members shall be under the supervision of the department in which they are appointed.

The members of the house staff shall abide by the rules and regulations set by the program directors, the hospitals and the Dean.  Failure of a member of the house staff to perform his/her duties or to abide by the College of Medicine and the affiliated hospitals rules and regulations shall be reported to his/her departmental chair and/or program director.  The department shall then institute appropriate disciplinary action.

A member of the house staff who wishes to appeal an adverse decision by his/her program director or department chair may appeal the decision of the department and request a hearing before an ad hoc committee.  This committee shall consist of not less than five (5) faculty members and two (2) residents to be appointed by the Dean.  The five faculty members will be from specialities other than those represented by the resident and will have little or no personal involvement with the resident’s instruction or evaluation.  One of the two resident representatives will be selected from a list supplied by the resident making the appeal and the other selected from the Chief Residents Committee.  The Executive Associate Dean for Graduate Medical Education will chair the committee.  In the event that the Executive Associate Dean for Graduate Medical Education is involved in the hearing, the Dean will appoint a chair.  The committee shall convene a hearing at a date agreeable to all parties, but in no case more than four (4) weeks after receiving the written request for the appeal.  Committee witnesses will include those on a list provided by the resident to speak in his/her behalf.  The committee will also request testimony from those in the program responsible for evaluations and decisions which led to an adverse action.  The ad hoc committee may request from the department copies of all evaluations and documents leading to an adverse action.  The resident making the appeal has the right to have an advocate present.  The advocate cannot be a practicing attorney.  The resident has the right to hear all witnesses and to ask any questions under the direction of the chair of the ad hoc committee.  An electronic recording of the proceedings may be made, but only for the purpose of producing a written transcript; at which time all recordings will be destroyed.  This transcript and all other records related to the appeal will be available to the appellant upon request.  The chair of the committee will not have a vote in the committee’s decision, but will submit his/her recommendation along with the recommendations of the committee to the Dean.  The decision of the Dean is final.

ETHICAL GUIDELINES GOVERNING GRADUATE MEDICAL EDUCATION

Policy and Guidelines for Interactions between the James H. Quillen College of Medicine, East Tennessee State University, and commercial interests (i.e.,any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients). Adopted April 1, 2009.

Purpose
The purpose of this policy is to establish guidelines for interactions with commercial interests for medical staff, faculty, staff, students, and trainees of the James H. Quillen College of Medicine, East Tennessee State University.  The intent of this policy to recognize the potentially positive and important value of many of the interactions with commercial interests while providing a framework for an ethical relationship that avoids conflicts of interest that could influence patient care, research objectivity, the integrity of our education and training programs, or the reputation of individual faculty members or the institution.

Policy Statement
It is the policy of the James H. Quillen College of Medicine that interactions with commercial interests should be conducted so as to avoid or minimize conflicts of interest. When conflicts of interest do arise they must be managed appropriately, as described herein.

Principles for Interaction
As the James H. Quillen College of Medicine and commercial interests both share the goal of improving the health of our population, the following principles should be used in guiding interactions:

1.    The interactions should serve to enhance the health of the public.
2.    The interactions should be transparent.
3.    All of the interactions must reflect high standards of medical professionalism that reach beyond applicable laws and regulations.
4.    The interactions should involve reciprocal communications, with knowledgeable parties on both sides of the interactions.
5.    The interactions should support and enable the free exchange of information     in appropriate settings, assuring such exchanges are evidence-based and free of bias to the maximum possible extent.

Scope of Policy and Guidelines for Interaction
This policy addresses many types of interactions with commercial interests, e.g. pharmaceutical and device marketing, training, educational support of students and trainees, and continuing medical education.    Its scope includes interactions with commercial interests both on-site and off-site. 

1. Gifts to Individuals

a.  Personal gifts from commercial interests may not be accepted anywhere at the Quillen College of Medicine, college clinical offices, or training sites.  It is strongly advised that no form of personal gift from commercial interests be accepted under any circumstance. 

b.  Examples of prohibited transactions include but are not limited to the following:

i.  Individuals may not accept gifts or compensation for listening to a sales talk by an industry representative.

ii.  Individuals may not accept gifts or compensation for prescribing or changing a patient's prescription.

iii.  Individuals must consciously and actively divorce clinical care decisions from any perceived or actual benefits expected from any company.  It is unacceptable for patient care decisions to be influenced by the possibility of personal financial gain.

iv.  Food supplied by a commercial interest is considered a personal gift and is not permitted at the Quillen College of Medicine, college clinical sites, or functions.  This does not apply when food is provided in connection with ACCME accredited programming or through unrestricted grants to departments or divisions that follow ACCME guidelines.

v.  Individuals may not accept compensation from commercial interests, including the defraying of costs, for simply attending a CME or other activity or conference unless the individual is speaking or otherwise actively participating or presenting at the event.

2. Pharmaceutical Samples

a.  Sample medications are centrally managed at all ETSU facilities, in accordance with guidelines outlined by MEAC, ETSU Family Medicine and Associates, and individual departments.

b.  Sample medications may only be dispensed to patients.

3. Site Access by Industry Representatives

a.  Access of the representatives of commercial interests to individuals is limited to non-patient areas (e.g., private physician offices at a practice location or conference rooms) and must take place by appointment or the invitation of a faculty member, with the following exceptions:

i.  Access by device manufacturer representatives to patient care areas is permitted by appointment or invitation by faculty members or clinic supervisors.

ii.  Device manufacturer representatives may not be present during patient interactions unless there has been prior disclosure and consent by the patient.  Such interactions must be limited to in-service training or assistance on devices and equipment.

b.  Medical students and trainees may be included for educational purposes.  These interactions must occur under the supervision of a faculty member.

4. Support for Educational and other Professional Activities

a.  The Office of Continuing Medical Education administers all accredited CME activities to ensure compliance with ACCME standards (www.accme.org). 

b.  All educational events sponsored by the James H. Quillen College of Medicine and its departments or divisions must be compliant with ACCME Standards for Commercial Support (www.accme.org) whether or not CME credits are awarded, and whether or not they are held on or off campus.    

5. Participation in Programs Sponsored by Commercial Interests

a.  Faculty, staff, students, and trainees are strongly encouraged to avoid attending or speaking at meetings and conferences that are exclusively or primarily organized, underwritten, or presented by commercial interests because of the high potential for perceived or real conflict of interest.  This provision does not apply to meetings of professional societies that may receive partial support from commercial interests or to meetings supported by commercial interests governed by ACCME Standards.  It also does not apply to special and specific training on the use of new patient care medical devices for which alternate sources of education and training are not available.    

b.  Individuals who participate (e.g., by giving a lecture, organizing the meeting) in meetings and conferences supported in part or in whole by commercial interests and not governed by ACCME Standards should follow these guidelines:

i.  Financial support by commercial interests is fully disclosed by the meeting sponsor.

ii.  The meeting or lecture content is determined by the speaker and not the commercial interest. 

iii.  Participants, including the ETSU participant, are being expected to provide a fair and balanced assessment of therapeutic options and to promote objective scientific and educational activities and discourse.

iv.  The ETSU participant is not required by a commercial interest to accept advice or services concerning speakers, content, etc., as a condition of the sponsor's contribution of funds or services.

v.  The ETSU participant makes clear that content reflects individual views and not the views of ETSU.

vi.  The use of the ETSU name in non-ETSU events is limited to the identification of the individual by his or her title and affiliation.

6. Sponsorship of Scholarships and Other Educational Funds for Trainees by Commercial Interests

a.  Educational grants that are compliant with the ACCME standards (www.accme.org) may be received from commercial interests but must be administered by the Office of Continuing Medical Education, departments or divisions and not by individual faculty.

b.  No quid pro quo may be involved for donated scholarship or educational funds.

c.  The evaluation and selection of recipients of scholarships or grants is the sole responsibility of ETSU or of a nonprofit-granting industry, with no involvement by the donor commercial interest. 

7. Professional Travel

a.  Direct payments by commercial interests to ETSU faculty, staff, students, and trainees is not allowed other than for reimbursement of direct travel when the faculty, staff, student, or trainee is providing a legitimate service for which the travel is necessary and is reasonable in relation to the services provided.

8. Ghostwriting

a.  ETSU faculty, staff, students, and trainees are prohibited from having publications or professional presentations of any kind, oral or written, ghostwritten by any party, industry or otherwise.

b.  This does not apply to transparent writing collaboration with attribution between academic and industry investigators, medical writers, and/or technical experts. 

9. Boards of Directors, Advisory Boards, and Consulting

a.  ETSU faculty, staff, students, and trainees are allowed to interact as members of boards and/or as consultants via professional service agreements, as long as such activities are conducted in full compliance with the ETSU Conflict of Interest Policy (http://www.etsu.edu/research/ConflictofInterest.htm) and ETSU training program policies (http://www.etsu.edu/com/gme/reshandbook.aspx and Handbook2009.pdf)

10.   Publications

a.  In scholarly publications, individuals must disclose their related financial interests in accordance with the International Committee on Medical Journal Editors (http://www.icmje.org)

11.   Purchasing

a.  Individuals having a direct role in making institutional decisions on equipment or drug procurement must disclose any financial interest they or their immediate family have in companies that might substantially benefit from the decision.  They must also disclose any research or educational interest they or their department have that might substantially benefit from the decision.  This provision does not include indirect ownership such as stock held through mutual funds. 

HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACTS OF 1996 (HIPAA)

All Graduate Medical Education activities will be conducted in strict compliance with University policies pertaining to HIPAA.  For further information and requirements, please refer to the ETSU Notice of Privacy Practices on the College of Medicine webpage: http://com.etsu.edu/default.asp?V_DOC_ID=1619.

HOSPITAL SUSPENSION OF A RESIDENT
The affiliated hospital administration may find cause to suspend a resident from clinical activities.  When such a suspension occurs, the hospital administration will immediately notify the appropriate departmental chair and program director.  Within five (5) working days the program director will convene a committee of two departmental faculty selected by the program director and two representatives from the involved hospital selected by the hospital administration.  This committee, chaired by the program director, will investigate the incident and recommend appropriate action to the departmental chair.  Such action will also be communicated to the hospital administration representative in charge of graduate medical education.  If the hospital administration is not agreeable with the committee’s recommendation to the chair, the issue will be submitted to the Executive Associate Dean for Graduate Medical Education.  If agreement can still not be reached with the hospital administration, the issue will be referred to the Dean of the College of Medicine and the CEO of the appropriate hospital.  The ultimate decision regarding resident clinical privileges shall be made by the Hospital.

If the resident disagrees with the final recommended action, the resident has access to the grievance process outlined in the grievance policy.

MECHANISM TO RESOLVE RESIDENT INITIATED GRIEVANCES
It is desirable for resident’s concerns to be resolved within the departmental structure.  When resolution is not obtained the resident’s grievance regarding the residency program should be expressed to his/her preceptor, program director, department chair, or any other faculty member or administrative officer of the College of Medicine who will help to resolve the issue or agree on further action.If not resolved, the problem then will be brought by the involved resident and appropriate faculty member to the attention of the resident’s program director and the Executive Associate Dean for Graduate Medical Education.If there is still no resolution of the problem, the Executive Associate Dean for Graduate Medical Education will convene an ad-hoc committee and proceed with the due process.If the resident’s grievance is against the Executive Associate Dean for Graduate Medical Education, program director, department chair of any clinical department or any other person who might otherwise take part in the process of resolving the problem, the above steps will be structured to exclude the involvement of that person from the judging process.

MEDICAL ETHICS

POLICY STATEMENT
TENNESSEE STATE BOARD OF MEDICAL EXAMINERS
POLICY: PRINCIPLES OF MEDICAL ETHICS

Preamble
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient.  As a member of this profession, a physician must recognize responsibility not only to patients, but also to society, to other health professionals, and to self.  The following principles adopted by the American Medical Association and the Tennessee Board of Medical Examiners are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

  1. A physician shall be dedicated to providing competent medical services with compassion and respect.

  2. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.

  3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

  4. A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law.

  5. A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

  6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services.

  7. A physician shall recognize a responsibility to participate in activities contributing to an improved community.


Adopted by the Board of Medical Examiners February 20, 1996.
Oscar M. McCallum, M.D., President
Tennessee Board of Medical Examiners

NON-RENEWAL OF RESIDENT CONTRACT
Appointments are made on a year-to-year basis.  Continuation during a yearly residency appointment and reappointment at the end of each year are conditioned upon a showing of satisfactory competence, clinical proficiency, and the availability of training positions at the University, and funding.  Should the University decide not to renew the appointment, the Physician will be notified no later than four months prior to the end of the current agreement.  However, if the primary reason(s) for the non-renewal occur(s) within the last four months prior to the end of the agreement, the University will provide the Physician with as much written notice as circumstances will reasonably allow, prior to the end of the agreement.

OUTSIDE EMPLOYMENT (MOONLIGHTING)
Moonlighting refers to professional medical activity in which a resident engages outside the context of the residency program.  Residents should not engage in moonlighting activities that may interfere with the responsibilities to their program, especially in the context of work hour limitations.

Residents agree not to engage in any outside employment or professional medical activity without first notifying the program director in writing.  The terms of the outside employment should be in writing and placed in the resident’s personnel file, along with the number of hours the resident will be moonlighting.  Program directors reserve the right to deny any moonlighting activity that is deemed inconsistent with University policy regarding conflict of interest, work hours or other relevant policies.  Any resident failing to comply with moonlighting guidelines is subject to departmental disciplinary action.

Any resident engaged in moonlighting must be licensed for unsupervised medical practice in the state where the moonlighting occurs.  It is the responsibility of the institution where moonlighting occurs to determine whether such licensure is in place, whether adequate liability coverage is provided, and whether the resident has the appropriate training and skills to carry out assigned duties.

Professional liability insurance coverage provided by the University DOES NOT extend to any medical practice or activities outside the medical education program of the University.

The University is not encouraging its residents to engage in outside employment.  The University does not require residents to engage in moonlighting.  The University accepts no responsibility for the financial consequences to residents who engage in moonlighting if permission for that employment is withdrawn as a consequence of poor performance in the training program, conflict with work hour limitations, or for other cause.

POLICY ON A DRUG-FREE CAMPUS

I.      Policy
It is the policy of this university that the unlawful manufacture, distribution, possession, use of alcohol and illicit drugs on the ETSU campus in the workplace (on or off campus), on property owned or controlled by ETSU, or as part of any activity of ETSU is strictly prohibited.  All employees and students are subject to applicable federal, state and local laws related to this matter.  Additionally, any violation of this policy will result in disciplinary action.

II.     Legal Sanctions
Various federal, state and local statutes make it unlawful to manufacture, distribute, dispense, deliver, sell or possess with intent to manufacture, distribute, dispense, deliver or sell, controlled substances.  The penalty imposed depends upon many factors which include the type and amount of controlled substance involved, the number of prior offenses, if any, whether death or serious bodily injury resulted from the use of such substance, and whether any other crimes were committed in connection with the use of the controlled substance.  Possible maximum penalties for a first-time violation include imprisonment for any period of time up to a term of life imprisonment; a fine of up to $4,000,000 if an individual; supervised release; any combination of the above; or all three.  These sanctions are doubled when the offense involves either: 1.) distribution or possession at or near a school or college campus or, 2.) distribution to persons under 21 years of age.  Repeat offenders may be punished to a greater extent as provided by statute.  Further, a civil penalty of up to $10,000 may be assessed for simple possession of “personal use amounts” of certain specified substances under federal law.  Under state law, the offense of possession or casual exchange is punishable as a Class A misdemeanor; if there is an exchange between a minor and an adult at least two years the minors senior, and the adult knew that the person was a minor, the offense is classified a felony as provided in T.C.A. Section 39-17-417. ( 21 U.S.C. Section 801, et. seq.; T.C.A. Section 39-17-417)

It is unlawful for any person under the age of twenty-one (21) to buy, possess, transport (unless in the course of his employment), or consume alcoholic beverages, wine, or beer.  Such offenses are classified as Class A misdemeanors punishable by imprisonment for not more than 11 months, 29 days, or a fine of not more than $2,500, or both. (T.C.A. Sections 1-3-113, 57-5-301)  It is further an offense to provide alcoholic beverages to any person under the age of twenty-one (21), such offense being classified as a Class A misdemeanor (T.C.A. Section 39-15-404).  The offense of public intoxication is a Class C misdemeanor punishable by imprisonment of not more than 30 days or a fine of not more than $50, or both (T.C.A. Section 39-17-310).III.        Institutional/School SanctionsEast Tennessee State University will impose the appropriate sanction(s) on any employee or student who fails to comply with the terms of this policy.

A.         Employees
As a condition of employment, each employee, including student employees, must abide by the terms of this policy, and must notify the Office of Human Resources of any criminal drug statute conviction for a violation occurring in the workplace (on or off campus) no later than five days after such conviction.  A conviction includes a finding of guilt, a plea of nolo contendere, or imposition of a sentence by any state or federal judicial body.  Possible disciplinary sanctions for failure to comply with this policy, including failure to notify of conviction, may include one or more of the following depending on the severity of the offense:

  1. termination;

  2. suspension;

  3. mandatory participation in and satisfactory completion of drug/alcohol abuse program, or rehabilitation program;

  4. recommendation for professional counseling;

  5. referral for prosecution;

  6. letter of warning;

  7. probation.

Moreover, the following certification and notification requirements apply (responsibility of Research and Sponsored Programs in coordination with Human Resources):

  1. A certification statement will be placed in all federal grant requests that the institution is complying with the Drug-Free Workplace Act of 1988 and the Drug-Free Schools and Communities Act Amendments of 1989.
  2. All employees involved in the performance of federal contracts and grants will be furnished a written copy of this policy statement.  In addition, they must certify that they will abide by the terms of the policy. 
  3. Upon receiving notice of a drug conviction by an employee involved in the performance of a federal contract or grant, the appropriate federal agency will be notified (upon approval by the University President) within ten (10) days of the notice of conviction.

B.         Students
Possible disciplinary sanctions for failure to comply with the terms of this policy may include one or more of the following depending on the severity of the offense:

  1. expulsion;
  2. suspension;
  3. mandatory participation in, and satisfactory completion of a drug/alcohol abuse program, or rehabilitation program;
  4. referral for prosecution;
  5. probation;
  6. restriction of privileges;
  7. educational project;
  8. assignment of volunteer work hours;
  9. referral to the University Counseling Center
  10. written warning;
  11. reprimand.

IV. Health Risks Associated With the Use of Illicit Drugs and the Abuse of Alcohol
There are many health risks associated with the use of illicit drugs and the abuse of alcohol including organic damage; impairment of brain activity, digestion, and blood circulation; impairment of physiological processes and mental functioning; and, physical and psychological dependence.  Such use during pregnancy may cause spontaneous abortion, various birth defects or fetal alcohol syndrome.  Additionally, the illicit use of drugs increases the risk of contracting hepatitis, AIDS and other infections.  If used excessively, the use of alcohol or drugs singularly or in certain combinations may cause death.

V. Available Drug and Alcohol Counseling, Treatment, Rehabilitation Programs, and Employee Assistance Programs

The university and local community provide a variety of educational programs and services to respond to the problems associated with alcohol and drug abuse.  The Campus Alcohol and Other Drug (AOD) Program at East Tennessee State University is designed to serve university students by providing information related to alcohol awareness and chemical dependency.  The Office of the Vice President for Student Affairs offers several educational programs which seek to involve university student organizations.

Below is a list of campus and community agencies which also provide referral, information, and/or counseling to students and/or employees:

ETSU Counseling Center (students only) 439-4841
ETSU Department of Public Safety                                                        439-4480
ETSU Employee Assistance Program                      439-5825
State of Tennessee Employee Assistance Program              1 (877) 237-8574
Alcoholics Anonymous                                                     928-0871
Comprehensive Community Services                      
(Alcohol & Drug Counseling & Prevention Center)		 928-6581
Woodridge Hospital 928-7111
Watauga Mental Health Center                                                  232-6200

POLICY ON SEXUAL HARASSMENT
East Tennessee State University desires to maintain an environment which is safe and supportive for students and employees and to reward performance solely on the basis of relevant criteria.  Accordingly, the University will not tolerate sexual harassment of students or employees.

Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitute sexual harassment when:  (1)      Submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment or academic standing;  (2)    Submission to or rejection of such conduct by an individual is used as a basis for employment or academic decisions affecting an individual; or;  (3)   Such conduct has the purpose or effect of unreasonably interfering individual’s work or academic performance or creating an intimidating, hostile or offensive working or academic environment.

Recommended actions to be taken by anyone who believes he or she is being sexually harassed:

  1. In circumstances where you think you will not be jeopardizing your  personal safety, your job, or your academic status, communicate clearly to the offender that the behavior is not humorous or welcome and should cease immediately.

  2. Keep a record of what happened and when it took place.  Should there be any Witnesses, ask for their names to include in your documentation of the incident.

  3. If the harassment continues, or if you choose not to confront the offender directly, you many report the situation to the Affirmative Action Officer, Office of the President.  You may also report the situation to any of the other persons listed below who will assist you in preparing charges to be reported to the Affirmative Action Officer:
               

Assistant Dean and Director of Women in Medicine
Box 70430, (423) 439-8849
Associate Vice President of Student Affairs
Box 70725, (423) 439-4210
Affirmative Action Officer for ETSU
Office of the President, 206 Dossett Hall (423) 439-4211

Source:  Tennessee Board of Regents (TBR) Personnel Policy No: 5:01:02:00; TBR Personnel Guide No. P-080.

PROMOTION OF RESIDENTS
Residents are promoted from one year to the next based on satisfactory completion of training as determined by evaluations and performance standards.  Recommendations for promotions will be reviewed by the Program Director, Departmental Chair, and the departmental residency committee.

RESIDENT BACKGROUND CHECK POLICY

All residents will undergo a criminal background check as required by the State of Tennessee.  This will include a check of state elder abuse, national sex offender and the TBI sex offender registries in any state the resident has lived in seven years prior to employment.

Residents may not start work until their background check has been cleared.  In the event that a report comes back with a problem, a committee will convene within forty-eight (48) hours.  This committee will consist of the Executive Associate Dean for Clinical Affairs, Executive Associate Dean for Academic & Faculty Affairs, and the Associate Dean for Student Affairs.  They will review the background check and make a recommendation to the Dean for the College of Medicine.  The Dean will make a final decision.

RESIDENT DUTY HOURS

Resident duty hours must reflect and reinforce the physician’s obligation for adequate, continuous patient care while at the same time recognizing that prolonged and physically difficult hospital duties detract from this obligation.

Each residency program will develop policies and procedures concerning resident duty hours.  Duty hours and on-call schedules must be consistent with the ACGME Institutional and Program Requirements that apply to each program and these policies and procedures will be submitted to the GMEC for approval and annual review.

Effective July 1, 2011, the following requirements will apply to all residency training programs:

Duty Hours

1.    Duty hours must be limited to 80 hours per week, averaged over a 4-week period, inclusive of all   in-house call activities and all moonlighting.

2.    Residents must be scheduled for a minimum of one day free of duty every week (when averaged      over four weeks).  At-home call cannot be assigned on these free days.

3.    Duty periods of PGY-1 residents must not exceed 16 hours in duration.

4.    Duty periods of PGY-2 and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.

5.    Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.

6.    PGY-1 residents should have 10 hours, and must have eight hours free of duty between scheduled duty periods.

7.    Intermediate-level residents (as defined by the Review Committee) should have 10 hours free of duty, and must have 8 hours between scheduled duty hours.  They must have at least 14 hours free of duty after 24 hours of in-house duty.

8.    Residents in the final years of education (as defined by the Review Committee) must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods.

9.    Residents must not be scheduled for more than six consecutive nights of night float.  PGY-2 residents and above must be scheduled for in-house call no more frequently than every third night (when averaged over a four week period).

10.   Time spent in the hospital by residents on at-home call must count towards the 80-hour maximum hour limit.

Moonlighting

1.    Time spent by residents in Internal Medicine and External Moonlight (as defined by ACGME) must be counted towards the 80-hour Maximum Weekly Hour Limit.

2.    PGY-1 residents are not permited to moonlight.

RESIDENT ELIGIBILITY
Resident applicants must have one of the following qualifications for appointment to the James H. Quillen College of Medicine residency programs:

  1. Graduates of medical schools in the U.S. and Canada accredited by the Liaison Committee on Medical Education (LCME), or;
  2. Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA).
  3. Graduate of medical schools outside the United States and Canada who meet one of the following qualifications:

    1)  Have received a currently valid certificate from the Educational Commission for Foreign Medical graduates prior to appointment, or,

    2)  Have a full and unrestricted license to practice medicine in a US licensing jurisdiction in which they are training.

RESIDENT EVALUATION
Residents are evaluated in writing at the end of each clinical rotation by their attending faculty.  In addition, at least twice per year, formal meetings will be held with each resident to review rotational evaluations and other evaluative data relating to individual residents.

PROCEDURES:
Each residency program will have stated goals for the entire residency which are compatible with the ACGME special requirements and the appropriate specialty board.

Specific objective and performance standards will be defined for each rotation or curriculum segment of each residency program.

Each residency program will have a defined curriculum.

The residency program director for each program will be responsible for developing and implementing an on-going evaluation process of the program and of the individual residents in the program.The evaluation process will ensure that each resident is evaluated on a regular basis.  This should include monthly rotation evaluations or periodic evaluations at a suitable interval of specific curriculum segments.  Evaluations will be performed in writing and retain on file by the program director.

All faculty members will be expected to review their evaluations of a resident’s performance with that resident and to provide appropriate feedback and comments to the residents.

Periodically, formal meetings will be held with each resident to review rotational evaluations and other evaluative data relating to individual residents, such as results of in-training examinations.  These feedback sessions should occur at a minimum of twice per year.  These meetings will be conducted by the program director or by another faculty member designated by the program director and will be documented in writing.  Such documentation will be signed by both the resident and the program director/designated faculty. 

Evaluations will include cognitive, psychomotor and affective (or professional) domains of the resident’s experience.

The evaluation process will solicit residents to provide evaluations of their rotations, services, faculty and the institution, as well as other appropriate educational processes as deemed relevant by the program director.

RESIDENT SELECTION
Residents are selected on a fair and equal basis without regard to sex, race, age, religion, color, national origin, disability, or veteran status.  Performance in medical school, personal letters of recommendation, official letters of recommendation, achievements, and humanistic qualities will be used in the selection process.

All programs will participate in the NRMP and will select residents according to NRMP policies and procedures.  Each program will develop specialty specific criteria according to its own program’s needs and those of the institution.  These criteria may encompass personal, professional and educational characteristics of the candidate.

The enrollment of non-eligible residents may be a cause for withdrawal of accreditation of the involved program.

  1. The Sponsoring Institution must ensure that its ACGME accredited programs select from among eligible applicants on the basis of residency program-related criteria such as their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation and integrity.  ACGME-accredited programs must not discriminate with regard to sex, race, age, religion, color, national origin, disability, or any other applicable legally protected status.

  2. In selecting from among qualified applicants, it is strongly suggested that the Sponsoring Institution and all of its programs participate in an organized matching program, such as the National Resident Matching Program (NRMP), where such is available.

RESIDENT SUPERVISION
The appropriate program director and departmental chair are responsible for ensuring appropriate supervision of all resident clinical activities to ensure the provision of safe and effective patient care and to fulfill the educational needs of the resident.  Individual resident clinical activities are supervised by their assigned attending (clinical or full-time faculty), who is ultimately responsible for the resident’s clinical interaction with the attending physician’s patient.  The program directors will annually provide a written description of each resident’s level of experience and capabilities to each of the affiliated hospitals.  Each hospital shall then credential residents regarding supervised activities in that hospital.As part of the training program, residents should be given progressive responsibility for the care of patients appropriate to the residents’ level of education, competence and experience and to act in a teaching capacity and provide supervision to less experienced residents and medical students.  It is the decision of the attending physician, with advice from the program director, as to which activities the resident will be allowed to perform within the context of the assigned levels of responsibility.  The overriding consideration must be the safe and effective care of the patient. 

RESTRICTIVE COVENANTS/ “NO COMPETE” CLAUSE
In accordance with ACGME accreditation standards, no house staff member enrolled in an accredited training program sponsored by the College of Medicine shall be required to sign any type of non-competition agreement or restrictive covenant.  This policy does not apply to clinical activities outside the scope of the training program during the time in which the resident is enrolled (“moonlighting”).

SOCIAL NETWORKING
The Graduate Medical Education Committee recommends that residents and fellows exercise caution in using social networking sites such as Facebook or MySpace.  Items that represent unprofessional behavior posted by residents on such networking sites are not in the best interest of the University and may result in disciplinary action up to and including termination.

Residents and Fellows are expected to exhibit a high degree of professionalism and personal integrity consistent with the pursuit of excellence in the conduct of his or her responsibilities.  They must avoid identifying their connection to the University if their online activities are inconsistent with the values or could negatively impact the University's reputation.

If using social networking sites, residents and fellows should use a personal e-mail address as their primary means of identification.  Their University e-mail address should never be used for personal views.  Residents who use these websites must be aware of the critical importance of privatizing their websites so that only trustworthy friends have access to the websites/applications.

In posting information on personal social networking sites, residents may not present themselves as an official representative or spokesperson for a residency/fellowship program, hospital, or the University.  Patient privacy must be maintained and confidential or proprietary information about the University or hospitals must not be shared online.  Patient information is protected under the Health Insurance Portability and Accountability Act (HIPAA). Residents have an ethical and legal obligation to safeguard protected health information and posting or e-mailing patient photographs is a violation of the HIPAA statute.

TERMINATION OF A RESIDENT
Termination of a resident may occur based on two situations: 1)  Unacceptable personal behavior serious enough to call for immediate temporary or permanent suspension.  This action  may be taken when the resident’s performance endangers the health or safety of others, or, for any other reason is deemed unacceptable by the Program Director and/or the Dean; or; 2)   Failure to meet academic standards despite a carefully planned remediation program.

TOBACCO-FREE CAMPUS
Policy
Effective August 11, 2008, ETSU is a Tobacco-Free Campus, with smoking and all other tobacco usage permitted only in private vehicles.  This policy applies to all university buildings/grounds; ETSU-affiliated off-campus locations and clinics; any buildings owned, leased or rented by ETSU in all other areas; and ETSU facilities located on the campus of the James H. Quillen Veterans Affairs Medical Center at Mountain Home.  Tobacco use is also prohibited in all state vehicles. This tobacco-free policy is in effect 24 hours a day year-round. 

Background
The university promotes a healthy, sanitary environment free from tobacco smoke and tobacco-related debris.  The ETSU community acknowledges that long-term health hazards may accrue to people who use tobacco products or who are subjected to second-hand smoke.  The failure to address the use of tobacco products on campus would constitute a violation of the Americans with Disabilities Act, the Vocational Rehabilitation Act and Tennessee law.Support

Understanding the addictive nature of tobacco products, ETSU will make every effort to assist those who may wish to stop using tobacco. 

The university offers current information about available resources via http://www.etsu.edu/humanres/relations/SmokingResources.aspx

Compliance
It is the responsibility of all members of the ETSU community to comply with this Tobacco-Free Campus Policy.  Violations of the policy will be dealt with in a manner that is consistent with university procedures.  There shall be no reprisals against anyone reporting violations of this policy.

UNSATISFACTORY PERFORMANCE BY A RESIDENT
Residents who experience a deviation from expected performance will be identified in a timely manner by the program director.A resident deemed to be deficient in any aspect of his/her performance will be given verbal and written notification and, if warranted, may be placed on departmental probation.  Departmental probation is utilized when it is anticipated that there will be a successful remediation on the part of the resident.  The probationary period will be left to the discretion of the program director, but generally will be 3 to 6 months.

When such action occurs, the program director will inform the resident in writing of the deficiencies in academic or clinical performance which were noted.  A written plan of remediation will be developed for the resident by the program director.  The written plan will include the length of departmental probation.  When necessary this approach will include the appointment of one or more faculty to work with the resident on a regular basis using a planned individual format.  If the problem appears to involve psychiatric or substance abuse issues, efforts to obtain appropriate counseling/psychotherapy will be made.  Anytime a resident is removed from his/her clinical duties the office of the Executive Associate Dean for Graduate Medical Education must be notified as soon as possible.

If the resident does not satisfactorily remediate deficiencies during the departmental probationary period or if, in the Program Director’s opinion, the resident’s original deficiency may result in termination, the resident will be placed on institutional probation, generally not to exceed three (3) months.  Again, the resident must be notified in writing of the deficiencies, remediation, and length of the institutional probation.  The resident must also be notified in writing of the possibility that the institutional probation may lead to termination form the program.  The Office of the Executive Associate Dean for Graduate Medical Education must be notified in writing by the Program Director when a resident is placed on institutional probation.

At the end of the probationary period the resident’s performance will be reassessed and the resident will be notified in writing as to his/her status.  The resident may be removed from probation if the stated deficiencies have been remediated, or the probation may be continued if the resident’s performance has improved but deficiencies remain or new deficiencies uncovered; or the resident may be terminated.  The resident is notified in writing as to the reasons for termination.  The Program Director also notifies the Office of the Executive Associate Dean for Graduate Medical Education of the termination.

VISAS AND FOREIGN MEDICAL GRADUATES
Graduates of foreign medical schools who are not permanent U.S. residents must be willing to work on a J-1 Visa.  No exceptions will be made except under extraordinary circumstances.  Decisions regarding exceptions will be made by the Office of Graduate Medical Education.

Any resident on a Visa is responsible for notifying ETSU and Immigration immediately of a change of address.  This must be done within ten (10) business days.  Failure to comply will result in a violation of status and grounds for deportation.  Form AR-11 can be found on line at www.ice.gov.

Travel Alert - IMG’s should avoid travel outside the United States.  This alert is given in order to avoid delays with IMG’s return to the U.S. to resume GME training.  If a visit to a U.S. Embassy or Counsel abroad is required, IMG’s could be delayed in returning in a timely manner to the U.S. due to security clearance.  There is no way to expedite security clearance.