PA Resident Program Manual
I. GENERAL DESCRIPTION
The PA Residency is a 12-month, full-time, intensive program with focused training in inpatient and outpatient obstetrics and gynecology.
The primary objective of this PA Residency Program is to provide an opportunity for PA’s with an interest in OB/GYN to receive focused training in obstetrics and gynecology and to prepare these PA’s to be competent and versatile in assisting a supervising physician in the provision of women’s healthcare.
Our program follows the standards for post-graduate Physician Assistant training as set forth by Accreditation Review Committee for PA’s (ARC-PA.) We are currently actively in the process of receiving formal accreditation by the ARC-PA. Our program is affiliated with the Association of Postgraduate Physician Assistant Programs, Inc.
The program teaches PA Residents to manage complicated and non-complicated antepartum, intrapartum, postpartum, postoperative and acutely ill obstetric and gynecologic patients. The curriculum also includes L&D triage management, ER consultations, assisting in obstetrical and gynecologic surgery, as well as experience with evaluating and treating common gynecological complaints, and routine OB care.
The didactic portion consists of daily morning rounds, weekly lectures by attending physicians, twice monthly PA lectures, monthly journal clubs, morbidity and mortality conferences, assigned readings, and self-directed learning.
II. PROGRAM REQUIRMENTS
A. Applicant Qualifications
1. Be a graduate of an ARC-PA accredited PA Program
2. Be NCCPA certified
3. Hold California State Licensure or be eligible for California State
Licensure.
4. Complete application process and participate in an on-site interview if selected.
B. Resident Selection Process
The selection process is designed to be consistent and fair and based on academic achievement, personal interviews, dedication to Women’s Health, and letters of recommendation. An application package shall be considered complete once the following items have been received:
1. A completed application form.
2. Copy of PA program diploma/certificate.
3. National Certifying examination (PANCE) scores sent directly from NCCPA.
4. Copy of PA educational transcript
5. Copy of California State Licensure.
6. Personal Statement
7. Three Letters of Recommendation
8. Copy of Current CPR certification
9. Curriculum Vitae
Once the application is complete, the candidate will be contacted by our department, will be advised of the status of the application and if indicated an interview will be scheduled. In the case of new graduates, interviews will often be scheduled prior to receiving board scores. Admission may be offered contingent upon a passing score attained on the PANCE.
C. Interviews
Interviews are normally scheduled between the months of May and September for anticipated acceptance into the upcoming class. The program director, members of the faculty, and a resident representative will participate in the interviews. In most cases, the interview process takes place over a half day to allow applicants to meet with various members of our faculty and residency, as well as tour the facility. There is no bias with regard to race, sex, or religion.
III. TECHNICAL STANDARDS
A. Introduction
All Physician Assistant Residents must possess the physical and mental skills and abilities necessary to successfully complete the Residency Program Curriculum and achieve all didactic and clinical goals. To achieve the optimal educational experience, residents are required to participate in all phases of the training program.
The PA OB/GYN Residency requires a specific set of minimum physical, mental, emotional and social abilities that are needed to be successful. Residents must possess all of the abilities listed in the five categories below. The use of an intermediary that would, in effect, require as resident to rely on someone else’s power of observation and/or communication would not be permitted.
B. Observation
1. Visually observe materials presented in the learning environment including; audiovisual presentations, written documents, microscopic examination of microorganisms, tissues and gross organs in the normal and pathologic state and diagnostic images.
2. Observe patients accurately and completely, both at distance and directly. This requires functional vision, hearing and sensation.
C. Communication
1. Effectively speak, write, hear, read and use a keyboard and/or essential electronic devices necessary for patient care.
2. Perceive non-verbal communications, including facial expressions, body language and affect.
3. Communicate effectively and sensitively with patients and their families via speech as well as reading and writing.
4. Communicate in oral and written form with the healthcare team in an effective, accurate and efficient manner.
D. Motor
1. Elicit information from patients via palpation, auscultation and percussion, as well as carry out diagnostic maneuvers.
2. Execute movements reasonably required to provide general medical care and emergency treatment to patients. These skills require coordination of gross and fine motor movements, equilibrium and sensation. (Delivery of infants, Suturing and tying in the operative room, pelvic exams, colposcopy etc)
3. Manipulate equipment and instruments to perform basic laboratory tests and procedures as required to attain curricular goals (needles, stethoscope, doppler, scalpel etc)
E. Intellectual/ Conceptual, Integrative and Quantitative Abilities:
1. Perform calculations necessary to solve quantitative problems as required by the curriculum.
2. Collect, organize, prioritize, analyze and assimilate large amounts of technically detailed and complex information in a timely manner. This information will be presented in a variety of educational settings, including lectures, small group discussion, and individual clinical settings. The applicant should be able to analyze, integrate and apply this information appropriately for problem solving and decision-making.
3. Apply knowledge and reasoning to solve problems as outlined by the curriculum.
4. Comprehend the three dimensional spatial relationships of structures.
5. Remain awake and alert.
F. Behavioral, Emotional and Social Attributes
1. Possess the emotional health to fully apply his/her intellectual skill, exercise good judgment and to complete all responsibilities attendant to the diagnosis and care of patients.
2. Develop a mature, sensitive and effective relationship with colleagues.
3. Tolerate the physical, mental and emotional stress experienced during training and patient care.
4. Possess the qualities of adaptability, flexibility and the ability to function in the face of uncertainty.
5. Form a compassionate relationship with his/her patients while maintaining appropriate boundaries for a professional relationship
6. Behave in an ethical and moral manner consistent with professional values and standards.
7. Exhibit sufficient interpersonal skills, knowledge and attitudes to interact positively and sensitively with people from all parts of society, ethnic backgrounds and belief systems.
8. Cooperate with others and work corroboratively as a team member.
9. Being on time and complying with scheduled clinical experiences.
10. Being able to take constructive feedback regarding performance and making behavioral changes accordingly.
The faculty of the Arrowhead – Riverside OB/GYN PA Residency program is responsible for adhering to these standards during the selection of resident applicants for acceptance into the residency program.
If you have any questions about this document or whether you meet the standards described above. Please contact the Residency Administrative Coordinator or Residency Program Director.
IV. RESIDENT DUTIES
1. In-patient Notes/ Morning Rounds. PA residents along with the OB First year residents are responsible for following the care, writing morning notes, and discharging all antepartum patients on the OB/GYN service unless the patient is on labor and delivery ward. PA residents should be competent in writing notes on all patients admitted to the OB/GYN service. PA residents are required to participate in morning rounds and consult the perinatologist as needed. PA residents are excused from rounds on the morning of their individual Continuity Clinic.
2. Labor and Delivery. PA residents, along with the Physician residents and Midwives, are responsible for the triage and management of obstetrical patients. PA residents will perform vaginal deliveries, and 1st-assist in Cesarean Sections and Bilateral Tubal ligations. PA residents may perform D&Cs, Pelvic Exams under Anesthesia (PEUAs), and other minor procedures. In the triage area, PA residents will perform informal ultrasounds, and assess, discharge, and admit patients. PA residents, along with the OB residents, are responsible for proper documentation on all patients on their L&D shift including, but not limited to, completed triage sheets, admission notes, shift notes, pre-operative notes, operative notes, physician orders, delivery notes, and consent forms. PA residents will be under the direct supervision and close surveillance of both the attending physician and senior OB residents during their training on L&D. Depending upon the progress of the PA resident, the supervision will be adjusted accordingly.
3. Women’s Health Clinic. PA residents will see obstetrical and gynecologic patients as scheduled in ARMC’s outpatient Women’s Health Clinic in the following format: take history, perform exam, write up case, present case and management plan to attending physician, write up management plan, order tests/scans/labs/consults as necessary, write prescriptions as necessary, sign and obtain attending physician co-signature on patient’s visit notes, and have billing sheet completed by attending physician. PA residents, along with the OB residents, must complete the “chart checks” for the day prior to departing from the clinic for the day.
4. Continuity Clinic. Each PA resident will have a half-day clinic in which patients are specifically assigned to that PA resident. All follow-up care for these patients will continue with that specific PA resident in his or her continuity clinic for the rest of the year. Delivery of a patient being followed in a PA resident Continuity Clinic is at the discretion of the PA resident (PA resident will decide if he or she is willing to be paged to come in on his or her off-time for the delivery). PA residents must notify Administration and the Women’s Health Clinic if they are going to be out (sick, vacation, etc.) on the day of their Continuity Clinic so that patients may be rescheduled.
5. Off-site Clinic. After the initial 3-months of the residency, PA residents may be required to train at an off-site clinic affiliated with ARMC or Valley OB/GYN as part of their continuing education. During this time, PA Residents will be under the supervision of staff certified nurse midwives.
6. Dictations. PA Residents must dictate the operative report of all surgeries in which they are the first-assistant unless told otherwise. PA residents along with the OB residents are also responsible for dictating the discharge summaries of all antepartum patients on the OB/GYN service. Dictations must be completed within 24 hours of the surgery or on the day of discharge. PA residents may be asked to dictate other notes as necessary.
7. Assignments. PA residents may be assigned textbook readings and will take written obstetrics and gynecologic examinations during the residency year. PA residents, along with the Physician residents, will take turns in presenting articles for Journal Club and cases for Morbidity and Mortality Conference. PA residents will be asked to present selected lecture topics to peers, and may be assigned to present a case for pre-operative conference. PA residents may also receive occasional special assignments from staff.
8. Call-Schedule and Vacations. PA residents are required to take 2 -3 calls per month. (24 hour call shift) The chief resident makes the call schedule. It is each PA resident’s responsibility to be aware of the month’s call schedule. If conflict exists, the PA Resident should attempt to resolve the issue by trading calls with other residents and then contact the chief resident and program director with the new changes. Vacation requests (form available from the administration office) must be submitted to the chief resident and program director by the 10th of the month prior to the proposed dates of absence. Approval will be based on service demands and the order in which the requests were received.
9. Night Float. PA residents are required to take at least 2 months of Night Float. No vacation can be taken during these months.
10. Limitations. PA residents must know their individual limitations. At any time, if a PA resident is uncomfortable with his or her task, duty, or responsibility, the PA resident must immediately notify a senior resident or attending physician.
V. PROGRAM FACULTY
The teaching faculty of our program is composed of a core faculty as well as an affiliated faculty. These faculty members are Board-Certified in their areas of specialty and sub-specialty.
A. Core Faculty
Guillermo J. Valenzuela, MD, MBA, FACOG is Chairman of the Department of Women’s Health at ARMC and Chief of Obstetrics and Gynecology at Riverside County Regional Medical Center. He is also the Medical Director for the PA OB/GYN Residency Program. He is board-certified in Obstetrics and Gynecology and Maternal Fetal Medicine. He directs all department research activities and actively participates in resident education.
Christine Sims, PA-C, MMS is the Program Director and is a strong advocate for PA’s in Women’s Healthcare. She has completed the PA residency training and has been active in teaching the PA residents as well as PA students. She has been directing the PA residency since her graduation from the program in 2005.
Paul Sinkhorn, MD, FACOG is Vice-Chair of Women’s Health at ARMC. He is a generalist in Obstetrics/Gynecology with special interest in operative laparoscopy, laser surgery, urogynecology and pelvic relaxation, surgical colposcopy. He also has extensive interests in advanced education and information technology in medical informatics.
Ramon Cestero, MD, FACOG has particular interests in HPV research, colposcopy, hysteroscopy and medical-legal issues. He has served as President of the American Society of Forensic Obstetricians and Gynecologists and as a Quality of Care reviewer for ACOG.
Juan Jose Arce, MD, FACOG is a specialist in Maternal-Fetal medicine, is director of the Maternal-Fetal Medicine Department, A Clinical Professor of Obstetrics and Gynecology, and co-sponsor of resident education. Dr. Arce also works in the high-risk obstetrics and the perinatal genetics clinics.
Dennis Carden, DO, FACOG, FACOOG is the Program Director for the D.O. Residency Program. He is a generalist obstetrician and gynecologist with special interest in pelvic reconstructive surgery.
Talal Muhtaseb, MD, FACOG, is a Board Certified Generalist in Obstetrics and Gynecology. He has been a surveyor for the IMEQ/Joint Commissions for 10 years and serves as a medical expert consultant for the Medical Board of California.
Hans Davidson, MD, PhD holds subspecialty certification in Reproductive Endocrinology.
Desiah, MD, FACOG is a specialist in Gynecologic Oncology who is associated with the University of California, Irvine. He does extensive basic oncological research and has interest in computer applications in medicine.
Bradley Monk, MD, FACOG, specialist in Gynecologic Oncology. He is also associated with the University of California, Irvine. Also has an interest in basic oncological research.
Loni Castro MD is a board certified maternal fetal medicine specialist who performs Perinatology services at Riverside County Medical Center. She is a professor and chair of the Dept. of Ob/Gyn at Western University of the Health Sciences. She is also a certified diplomat of the National Board of Medical Examiners
Ruben Avagimov MD is a board certified in Family Medicine. He also performed a fellowship in Ob/Gyn and in Reproductive Endocrinology.
Carlo Garibaldi DO is a Board Certified Generalist in Obstetrics and Gynecology.
Larry Francis MD is a Board Certified Generalist in Obstetrics and Gynecology with a particular interest and specific training in Uro-gynecology. Dr. Francis is also involved with SART, a group who work with victims of sexual assault.
Hugo Rauld MD is a Board Certified Generalist in Obstetrics and Gynecology.
John Lyons MD is a Board Certified Generalist in Obstetrics and Gynecology with a special interest in uro-gynecology and related surgical procedures.
Shirley Wong DO is a Board Certified Generalist in Obstetrics and Gynecology. She also acts as associate director of the DO OB/GYN residency program and serves as an advocate for both PA’s and DO’s in the community. She coordinated much of the didactic program provided to PA and physician residents.
B. Affiliated Faculty
Members of the affiliated faculty will assist in training by providing clinical cases from their private practices. Duties may include direct supervision in obstetrical deliveries and gynecological surgery. Preparation of didactic material by the affiliated faculty is encouraged. Pertinent evaluations by affiliated faculty will be obtained by the program director and discussed with the resident at regular intervals.
VI. ACADEMIC AND PROFESSIONAL EXPECTATIONS
A. Clinical Skills Progression
After Month two –
1. Accurate 75% of cervical examinations
2. Evaluate normal and abnormal pre-natal labs and commonly ordered labs on Labor and Delivery. (PIH labs/hyperemesis labs/SAB labs.)
3. In clinic/ Triage area – take adequate history and perform physical examinations
4. Present succinctly to Resident Physician/Staff PA the patients complaints and physical findings.
5. Know commonly ordered pre-natal labs and studies and know at what gestation they should be ordered.
6. Limited Ultrasound- including perform AFI, early gestation for viability, fetal position checks.
After Month three or four (depending on completion of first month of Night Float) -
1. Perform Routine Delivery without Assistance
2. Repair moderate 1st or 2nd degree laceration or episiotomy
without assistance.
3. Identify non-reassuring fetal heart tracing (repetitive
decelerations or non-reactive pattern.) and inform attending
physician or physician resident
4. Evaluate post-partum hemorrhage and know the steps in diagnosis and treatment
5. Manage first trimester bleeding in the triage area
6. Evaluate hyperemesis gravidarum and know admission
criteria
7. Evaluate Labor and Rupture of Membranes and accurately access who meets admission criteria.
8. Be able to recognize and obtain help quickly for an
obstetrical emergency.
9. Know indications/contraindications and how to insert fetal scalp electrode and intrauterine pressure catheter.
After Month six -
1. Proficient in antepartum rounds – succinct, pertinent antepartum notes. Good assessment of diagnosis and plan for patients admitted for pyelonephritis, diabetes, pregnancy induced hypertension, premature prolonged rupture of membranes, and hyperemesis gravidarum.
2. Able to first assist in cesarean section
3. Know the steps in performing a colposcopy and cervical biopsies – beginning to formulate a colposcopic impression.
4. Be able to insert an IUD, know the contraindications to IUD placement, and the necessary work-up that precedes placement.
5. Know when an endometrial biopsy is indicated, the preceding work-up, and proficiently perform an endometrial biopsy.
6. Diagnose and manage pyelonephritis during pregnancy. To include knowledge regarding antibiotic choices and use of urine culture and sensitivity.
7. Be aware of when antibiotic prophylaxis is indicated to prevent recurrent UTI’s and pyelonephritis.
8. Diagnose and treat common vaginal and urinary infections (include Chlamydia, Gonorrhea, Bacterial vaginosis, Vulvovaginal candidiasis, Trichomoniasis, Herpes, Condyloma, UTI,)
After Month 8 -
1. Recognize when an operative vaginal delivery is indicated verses a cesarean section.
2. Proficient in first assisting during a cesarean section
3. Know the work-up for abnormal uterine bleeding, post-menopausal bleeding, amenorrhea, recurrent spontaneous abortions, infertility
After Month 10 -
1. Proficient in colposcopy and development of colposcopic impression.
2. Proficient in diagnosis and management of pregnancy
induced hypertension in the full term patient, including when
and how magnesium sulfate is used to prevent eclamptic
seizures.
3. Proficient in work-up and management of chronic hypertension and diabetes during pregnancy.
4. Knowledgeable in the medications used to treat chronic hypertension and diabetes during pregnancy.
5. Be able to identify risk factors for intrauterine growth restriction, and how to use ultrasound to confirm suspected diagnosis.
After Month 12 -
1. Able to place word catheter.
2. Able to perform pessary fitting
3. Exposure and experience in the work-up and management of
urinary incontinence and cystocele.
4. Exposure and experience in first assisting in common gynecologic surgeries (to include total abdominal hysterectomy, total vaginal hysterectomy with or without bilateral salpingoophorectomy, as well as exploratory laparotomy and operative laparoscopy for pelvic masses and ectopic pregnancies.)
5. Exposure and experience with common labs and procedures performed in the evaluation of infertility.
6. Proficient in work-up for infertility.
7. Exposure to pre-natal and antenatal counseling for genetic diseases as well as antenatally detected fetal anomalies.
8. Exposure and experience in management of gynecologic cancer, to include knowledge of the use of biochemical markers and imaging to aid in the diagnosis of primary disease and recurrence.
B. Professional Behavior
By accepting a place in our program the resident agrees to the following responsibilities:
· To demonstrate academic honesty, professional demeanor, and ethical behavior with colleagues, staff, patients and the general public;
· To strive for the highest ideals of professional conduct;
· To practice within the limits of one’s capabilities;
· To achieve the objectives of the residency training program;
· To provide comprehensive and continued care for a panel of patients assigned at Arrowhead Regional Medical Center and Riverside County Regional Medical Center,
· To furnish patients the best possible care;
· To educate patients about health problems and health maintenance;
· To maintain satisfactory work records, which include logs, evaluations, and other required forms;
· To complete study and reading assignments;
· To pursue independent study;
· To assist in the clinical instruction of junior health staff officers;
· To attend all activities fully prepared and on time;
· To attend all department or OB/GYN didactic sessions and other meetings as recommended by program director;
· To abide by the rules and regulations of Arrowhead Regional Medical Center, Riverside County Regional Medical Center and by all state regulations regarding Physician Assistants;
· To report needle sticks/work injuries to administrative offices (Valerie Reinhardt and/or Program Director at 909-580-6320). As residents are not employees of the hospital, Valley OB-GYN’s Human Resources Dept. must be notified of all needle sticks and other work injuries.
· To interface in a professional/ethical way with colleagues, attending physicians and students regarding patient care; and
· To complete medical records in a timely manner per Arrowhead Regional Medical Center guidelines. C. Ethical Considerations
ARMC residents are expected to conduct themselves in an ethical and professional manner at all times. In observing medical ethics the PA resident will:
· Give primary concern to the patient’s best interests;
· Be available to one’s patients at all times or delegate responsibility
to another capable individual
· Practice within the limits of one’s capabilities;
· Maintain patient confidentiality;
· Not indulge in rumor propagation;
· Maintain a respect for the patient’s right to privacy;
· Refrain from discussing any confidential information outside the
clinical settings or in any public areas, including general nursing
stations.
VII. RULES AND REGULATIONS
A. Dress Code/Resident Appearance
Residents are expected to appear as professionals in all assignments, especially those involving patient care. White coats are issued by the hospital and shall be worn over the appropriate clothing while on duty. ARMC badges must be worn at all times. White coats shall be worn over scrub clothing when the residents are outside the surgical or obstetrical suites. The resident will dress in a professional manner when attending patients in the OB/GYN clinic.
B. Work Hours
Morning rounds start at 6:30 am. Antepartum notes must be completed by that time. Night shift starts at 5:30 PM except on Fridays, which start at 4:30 PM, and Saturday which starts at 6:30PM. PA residents must keep track of their work hours. PA Residents will not work more than 80 hours per week (averaged over four weeks.) See PA resident Contract for more details on work hours.
All time-off requests should be submitted to the chief resident and program director immediately upon knowledge of desired time off and preferably by the 10th of the month prior to the proposed dates of absence. PA residents must contact Administration and the OB resident phone (to have message passed on to the chief resident) if they are unable to make their assigned shift upon short notice.
C. Night Float
The resident will be assigned to two to three months of night float. Night float consists of Sunday through Thursday night (5:30pm to 7:00am.)
D. Medical Records
Progress notes are to be written in a timely fashion. Operative reports, for which resident assisted in are to be dictated immediately upon completion of a procedure. Discharge summaries will preferably be dictated within a day of release, but in all instances within one week.
Being tardy on chart completion creates administrative problems for the attending physician as well as hospital administrators and the billing office. In addition, there are medial/legal concerns regarding delayed completion of records. Poor attention to medical record responsibilities will not be tolerated.
E. Logs
Residents are to log their work hours, vaginal deliveries, cesarean sections, and gynecologic surgeries on line in new innovations. Residents are encouraged to keep logs of gynecologic procedures/colposcopies. Resident logs are to be completed on a monthly basis and to be submitted to the Program Director at the end of the year.
VIII. Supervision of PA Residents
During the year training program, PA residents are supervised by attending physicians, senior residents, certified nurse midwifes, and/or staff physician assistants.
PA residents in the Women’s Health Center are supervised and have 100% of their charts signed off by attending physicians. All clinic procedures are supervised until the minimum number required are signed off by a senior resident, attending physician, or staff PA.
On labor and delivery, the attending physician is present during all deliveries. Senior residents and staff PA’s may supervise PA residents as they learn the management of labor and how to perform cervical examinations and place internal monitors.
If a PA resident goes to an outside clinic to see low risk obstetrical patients, they may be supervised by a certified nurse midwife.
IX. RESIDENT EVALUATION
The resident evaluations are conducted on a quarterly basis. A summary report will be compiled by the Program Director and feedback and recommendations will be discussed with the PA Resident.
X. LIST OF REQUIRED/RECOMMENDED TEXTS
Required:
1. Pharmacopeia or equivalent software on handheld device.
2. Obstetrics, Gynecology and Infertility: Handbook for Clinicians; Pocket.
Recommended:
1. Blueprints: Obstetrics and Gynecology. Author: Aaron B Caughey
XI. POLICIES FOR MEDICAL LEAVE/VACATION
A. Medical Leave.
If there is an extended medical leave greater than thirty (30) days, it will be the general policy of the program to extend the resident’s training by that length of time that is missed. This is to ensure that the resident achieves all the goals and objectives in appropriate rotations. The residency Director reserves the right to modify this depending on the resident’s performance and evaluation.
B. Vacation/Sick time
PA residents are given 15 days of paid time off. Vacation time is allowed to all residents on a priority basis approved by the chief resident and program director. The residency program must be given sufficient time in which to reschedule continuity patients, etc, therefore all residents are asked to submit their requests by the 10th of the month prior to the proposed dates of absence.
XII. PA RESIDENT CONCERNS AND REMEDIATION
PA resident concerns may be discussed with the program director at any time. At quarterly review, PA residents will always be asked if they have any academic concerns and/or concerns regarding program or faculty. If the item of concern relates to the program director, it may be discussed with the Medical Director. Program and faculty evaluations will be formally submitted twice during the residency year; however, constructive feedback may be received at any time.
A. Due Process Policy
If at any point during the residency year, it is noted by attending staff, L&D nurses, PA staff, or Physician residents that a PA residents’ performance is sub par a written description of the concern is submitted and/or will be requested for review by both the program director and medical director. After the concern has been reviewed, the validity of the concern will be corroborated or dismissed by the program director. The program director will gather information from other attending physicians, physician residents, or information will be obtained by direct observation by the program director or medical director to make that determination. A written evaluation of the concern/complaint will be recorded by the program director.
If a concern/complaint is validated, a meeting will be held with the PA resident, program director, and an administrative assistant. Depending on the severity of the concern, the medical director or other core faculty may be present. A plan will be written out, as to how the PA resident can amend the criticized behavior/performance. That PA resident will have one month to improve after verbal and written counseling is provided and an improvement plan is set. If the deficiencies have not been corrected, then a formal one month probationary period is put in place. At the beginning of the formal one month probationary period, a written list of goals is discussed with the PA resident and a copy is provided to the PA resident. The resident must agree to the goals, and may request a hearing if he/she believes they are unreasonable/unfair. The goals must be met during that one month period or the PA resident may be dismissed from the program. The PA resident will be evaluated by the program director, medical director, and two members of the clinical faculty to determine if the goals have been met.
B. Grievance Policy
If resolution of a complaint is not reached at the interview stage the resident will have the right to file a grievance and has the right to a hearing. The hearing committee is composed of a four member committee. Three members shall be members of the active medical staff and shall be selected by the program director and medical director. One member shall be a member of the administrative staff. No member shall be selected by the committee who is materially involved in the consideration of the adverse recommendation. The grievance policy allows the PA resident to file a formal grievance related to a complaint or action that could result in their dismissal or non-renewal of contract. The formal grievance will be taken to the four member hearing committee, which will be composed of four members of staff as described above.