Policies for Fellowship Program

Policy on Trainee Eligibility and Selection

Recruitment, selection and appointment of residents and fellows are performed by the Program Director with oversight by the Institution's GMEC and in accordance with ACGME and California Medical Board requirements.

1. Applicants
   To be eligible to be a UCLA house officer, applicants must fulfill the following selection criteria:
   1. A graduate of an LCME accredited (Liaison Committee on Medical Education) medical school or Canadian accredited medical school or:
   2. A graduate of a college of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA).
   3. A U.S. citizen or possess a Permanent Resident Card or an appropriate educational visa.
   4. If a graduate of a medical school outside the United States, they must have a valid certificate from the ECFMG and have a Letter of Evaluation from the Medical Board of California indicating that they are eligible for resident selection, or a valid California medical license.
   5. Meet all State of California licensing requirements at the start of the appointment. Applicants who fail to meet State of California licensing requirements by the original contract start date of their training program will not be appointed.
   6. A graduate of an ACGME accredited orthopaedic surgery, general surgery or plastic surgery residency program as applicable to the fellowship.
2. Selection
   The selection of trainees will be made via the San Francisco Match or NRMP as applicable to the fellowship.
   1. Applicants submit applications directly to the San Francisco Match or NRMP as applicable to the fellowship.
   2. Applications are reviewed by the Program Director and selected faculty. Required documents include:
      Curriculum vitae
      Personal Statement
      Examination scores from USMLE Part I, II, and III.
      4 Letters of recommendation
      2x2 color photograph of the applicant
      Universal application as applicable to the fellowship
   3. The Program Director and appointed faculty will select applicants who will be offered an opportunity for a personal interview.
   4. Each applicant will be separately interviewed by four or five sports medicine faculty members.
   5. This program will not discriminate based upon age, race, sex, religion, ethnicity, national origin, sexual orientation, physical or mental disability, marital status or veteran status.
   6. Group discussion and rank ordering of applicants will be performed following the final date of interviews.

Policy on Work Hours

The David Geffen School of Medicine at UCLA requires that the fellowship training programs foster both quality fellow education and facilitate quality patient care. Overall, fellow work hours in all programs must be consistent with the Institutional and specific program Residency Review Committee (RRC) accreditation requirements established by the Accreditation Council for Graduate Medical Education (ACGME). The structuring of work hours schedules focus on the needs of the patient, continuity of care and the educational needs of the fellows.

Work hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. Work hours do not include reading and preparation time spent away from the hospital.

Fellows must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period. One day is defined as one continuous 24-h our period free from all clinical, educational, and administrative activities. Fellows must also be provided at least 10 hours between duty assignment periods to obtain adequate rest.

Fellows are required to report and log all work hours in MedHub. Fellow must log in at least once every week. The Program Director and coordinators will run reports on a weekly basis to review each fellow's reported work hours to ensure compliance and address potential violations.

Compliance with Work Hour regulations must be monitored by everyone involved with the fellowship program, including fellows, faculty and program coordinator. It is the responsibility of the program director to assure complete compliance with the work hour regulations. The program director, faculty and fellows are charged with monitoring the demands of all clinical activities and make the necessary adjustments in scheduling to deal with excessive service demands and/or fatigue.

Policy on Working Environment

UCLA GME office (sponsoring institution) provides a working environment for fellows/residents which comply with ACGME policies. The residents/fellows will have an opportunity to evaluate the quality of the educational program and work environment at an annual town hall meeting. Residents/fellows who have specific concerns can address these in writing to the program director or Chairman of the Department of Orthopaedic Surgery. If the problems or concerns are not resolved at this level, these should be brought up to the GMEC for review.

Policy on Moonlighting

SUBJECT: PROFESSIONAL ACTIVITIES OUTSIDE THE SCOPE OF TRAINING

POLICY: Professional activities outside the scope and intent of residency training detract from the education experience and may adversely affect patient care. It is the policy of the Department of Orthopaedic Surgery that no such activities or any type of outside employment may occur during assignment to clinical rotations unless approved by the Program Director and Chair.

It is the responsibility of the fellow to notify the program director if they wish to moonlight. The fellow must submit a request to the GME Office for final approval. The program director will monitor fellow performance to ensure that moonlighting activities are not adversely effecting patient care or learning. If the program director determines that the fellow performance is deficient, the fellow may be subject to withdrawal of permission or disciplinary actions. The program director may require detailed information on the timing and level or activity to assure it does not cause fatigue or interfere with patient care and the goals and objectives of the program.

Violation of this policy may result in immediate dismissal from the training program.

Policy on Supervision

OBJECTIVE: To establish guidelines for appropriate supervision of fellows in patient care activities.

SCOPE:
These minimal guidelines apply to all fellows enrolled in a UCLA Orthopaedic Fellowship Program, and attending surgeons of all integrated and affiliated institutions who are involved with the UCLA Orthopaedic Fellowship Programs.

POLICY: The UCLA Orthopaedic Fellowship Programs will provide all fellows with appropriate supervision that is consistent with proper patient care, the educational needs of the fellows, and all Institutional Requirements, Common Program Requirements, and specialty/subspecialty-specific Program Requirements of the Accreditation Council for Graduate Medical Education.

All patient care must be supervised by faculty, with such supervision designed to ensure safe and effective patient care as well as ensuring fellows assume progressively increasing responsibility according to their level of education, competence, and experience. Fellows must be provided with rapid, reliable systems for communicating with supervising faculty. On-call schedules for faculty must be structured to ensure that consultation and supervision is readily available to fellows on duty. The level of responsibility assigned to each fellow must be determined by the Program Director and faculty. The Program Director is responsible for ensuring, directing and documenting adequate supervision of residents at all times.

Lines of Supervision and Communication

Consistent with the philosophy of graded levels of responsibility, it is expected that the fellow will directly communicate with, and be, in turn, supervised by the assigned attending. In urgent, or emergent situations, immediate communication with the attending surgeon by the fellow on the team is expected.

General Guidelines

• The level supervision and communication between the attending surgeon and fellow should be more than sufficient to ensure that the clinical care delivered meets the established community standard of care.
• The fellow can identify and contact a responsible attending surgeon for a given patient at all times.
• In the event that an attending surgeon will not be available to provide supervision, he or she must designate an alternate or covering attending and identify that person to the fellow.
• For ambulatory or non-urgent care, an attending surgeon is required to be available on-site at the facility during daytime hours of operation.
• For inpatient admissions, an attending surgeon or fellow will be notified of the admission and such notification will be documented in the admitting fellow's admission note. An attending surgeon will personally see and evaluate each assigned inpatient admission within twenty-four (24) hours of admission, and co-sign the fellow's admitting note or create their own written or printed documentation.
• For inpatients, fellows should maintain ongoing communication at least one (1) time per day with the designated attending surgeon. The attending surgeon should document such communication by co-signing the fellow's progress note, or the fellow will include in his progress note that the case has been discussed with the attending surgeon.
• It is assumed that there is a mutual responsibility on the part of both the attending surgeon to recognize the need for increased frequency and quality of communication, and attending surgeon participation in the following circumstances:
  1. limited experience of the fellow
  2. increased acuity of the patient's condition (e.g. transfer to intensive care unit, need for higher level of clinical care, etc.)
  3. higher risk of complication or mortality associated with the clinical intervention being considered

Invasive Procedures and Operations

• An attending surgeon or fellow will be physically present with the patient for all invasive procedures.
• An attending surgeon or fellow will be physically present with the patient for all operations. In the event that an attending surgeon is not physically present for an operation, the fellow will ensure that appropriate documentation of the attending surgeon's notification and approval of the operation was obtained prior to proceeding with the operation.
• An attending surgeon or fellow will see and evaluate each patient prior to the operation and ensure that appropriate documentation of a preoperative note has been performed.
• An attending surgeon or fellow will ensure that an appropriate and adequate informed consent has been obtained and documented in the medical record.
• An attending surgeon or fellow will ensure that appropriate documentation of the procedure has been included in the medical record at the time of the procedure or operation.

Progressive Fellow Responsibility
Attending Staff supervise participants in professional graduate medical education programs in their patient care responsibilities in a manner commensurate with the Fellow's level of training and experience. The Chief of Service (School of Medicine Department Chair) is responsible for ensuring that the degree of professional responsibility accorded to each Fellow is progressively increased through the course of training, commensurate with his or her skill, training and experience. The respective Chief of Service makes decisions about individual fellow graded responsibility and progressive involvement and independence in specific patient care activities. The attending physician is also responsible for determining in an individual case the degree of fellow independent functioning. Structured evaluation processes for the fellowship programs are developed which may include combinations of daily attending evaluations of individual performance, regular written evaluations of each fellow and program director fellow evaluation meetings