Policies & Procedures
* All policies and procedures for Fellow Selection, Evaluation, Promotion, and Dismissal are in compliance with both ACGME requirements and with the institutional policies and procedures of Thomas Jefferson University Hospital.
As a requirement for application, all candidates applying to the as above Program must meet all ABMS Specialty Board-related eligibility prerequisites required to enter training in the related specialty program at Jefferson.
Further, all candidates must satisfy the requirements of the State of Pennsylvania Board of Medical Licensure for appointment at the specific level of training for which the position is offered.
In addition, applicants must meet one of the CR residency qualifications to be eligible to apply for the Residency in Colon and Rectal Surgery:
- Graduates of medical schools in the United States and Canada accredited by the LCME;
- Graduates of osteopathic medicine in the United States accredited by the AOA;
- Graduates of medical schools outside the United States who meet one of the following qualifications:
- Have received a currently valid certificate from the ECFMG; or
- Have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction.
- Graduates of medical schools outside the United States who have completed a Fifth Pathway program provided by an LCME-accredited medical school.
Applicants must also have completed a residency in general surgery at an ACGME-approved residency in the United States; candidates with appropriate credentials from the Royal College of Physicians and Canada can also be considered. Resident applicants will be evaluated on the basis of their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation, honesty, and integrity. The program does not discriminate with regard to sex, race, age, religion, color, national origin, disability, sexual orientation, or veteran status.
All prerequisite prior training must be successfully completed prior to beginning a fellowship in the Division of Colon and Rectal Surgery.
All applications are initially reviewed by the Residency Director (Dr. Gerald Isenberg). The decision to offer an interview to an applicant is made by the Residency Director, based upon the following criteria: academic credentials, ability, aptitude, communication skills, three letters of recommendation, and personal qualities such as motivation, honesty, and integrity.
All interviews are conducted in person. Interviews are conducted on weekdays during the time period prescribed by the NRMP. All applicants are interviewed by at least two faculty, and preferably the entire division. The interviewing committee consists of all faculty in the Division of Colon and Rectal Surgery.
After the interview process, the match list is constructed in the following manner:
- the faculty arranges one-two meetings during which all candidates are evaluated and;
- a rank order list is reached by consensus (based upon the same criteria used to select applicants for interview)
All offers of employment at TJUH are contingent upon approval of the GMEC, licensure, and satisfactory completion of training in an ACGME-approved program, or where applicable, an AOA-approved program. Fellows entering their first year of training must have passed USMLE Steps I, II, and III in order to qualify for appointment.
All residents in the Division of Colon and Rectal Surgery are expected to complete at least 12 months of training. Residents must complete the minimum number of months of training required (12) by their certifying board for eligibility for certification as a component of successful completion of fellowship training at Jefferson.
Residents must develop the knowledge, skills, attitudes, behaviors, and judgment to assume responsibility for independent practice at the completion of their education. This process involves the sequential assumption of progressive responsibility, and requires assessment of proficiency and fitness to complete the educational program. In the Division of Colon and Rectal Surgery, the following constitute criteria for promotion:
Each resident must successfully complete a 12 month period of training and demonstrate competency as a subspecialty consultant to the relevant clinical services. Competency consists of the consistent, effective use of the knowledge, skills, attitudes, and behaviors characteristic of a Colon and Rectal surgeon. The faculty evaluates each fellow’s data gathering skills, data interpretation skills, case synthesis skills, humanistic attributes, and professional attributes. These skills are assessed informally on a daily basis and monthly with the program director and written evaluations by all faculty biannually.
Residents who fail to meet the performance standards required for promotion and outlined above will receive formative as well as summative feedback concerning their performance, and be provided with the opportunity to correct or improve the deficiencies identified. Written documentation of these evaluations will be maintained by the Program. Remediation efforts will be evaluated and documented in writing. Department of Surgery, Division of Colon and Rectal Surgery.
As stated in the ACGME's Program Requirements for General Surgery:
"Residency training in surgery is a full-time responsibility; activities outside the educational program must not interfere with the resident's performance in the educational process, as determined by the program director, nor must they interfere with the residents' opportunities for rest, relaxation, and study."
While the department does not have the authority to oversee all activities of residents while they are not on duty, the department reserves the right to speak with residents regarding their outside activities when those activities adversely impact on their performance as residents. The department does not wish to encourage residents to moonlight; in fact, it officially discourages that activity.
The resident written evaluations will be compiled for review on a biannual basis. Residents may review their evaluations at any time by requesting such a review with the program director and/or associate program director. Residents may not remove evaluations from the file, copy evaluations, or alter evaluations. Quarterly reviews will be held with each resident to review their performance and case numbers to provide appropriate constructive feedback. Written summaries of the sessions will be maintained in the resident's file. A final written evaluation of the resident's performance will be prepared by the program director at the completion of the resident's training, and will be maintained indefinitely in the department.
The resident will meet with the program director on the first Tuesday of each month to review performance and discuss any pertinent issues.
Residents also have the opportunity to review their attendings, rotations, and the overall educational program. Evaluation forms of attendings and rotations will be provided to the residents on a periodic basis.
Finally, residents will be evaluated by office staff, nursing staff and patients to complete the residents overall evaluation.
The department reserves the right to discipline residents who fail to abide by the policies of the department as stated in this policy manual, or who fail to conduct themselves in a fashion which would be considered reasonable and prudent by the leadership of the department. Disciplinary actions available to the department are as follows:
- WARNING. Residents who perform in an unacceptable fashion or violate policy in a minor way may be given a warning. Warnings may be either verbal, in the case of a minor infraction, or written, for a more significant misstep. Although a written warning will be placed in the resident's file for documentation purposes and for subsequent review by the program director, warnings will generally not be reported when subsequent inquiries are made by state medical boards or other credentialing bodies. Repeated warnings about same or similar offenses may be cause for further review, however, and may possibly lead to a more serious disciplinary action.
- REPRIMAND. Residents who perform in a more egregious fashion or violate policy in a more significant way may be given a formal reprimand. The reasons for the reprimand must be fully discussed between the program director and the resident, and appropriate documentation must be provided. A copy of the reprimand will be kept in the resident's file, and will be forwarded to the house staff office. For preliminary residents, a copy will be forwarded to their sub-specialty program director as well. Note that a reprimand will be reported when subsequent inquiries are made by state medical boards or other credentialing bodies.
- PROBATION. Indications for probation include, but are not limited to: major violations of departmental or hospital policy, behavior deemed unacceptable by the leadership of the department, concerns regarding a resident's clinical abilities, abrogation of clinical/professional duties, sexual misconduct, persistent or uncorrected unacceptable performance on the yearly In-Service Training examination, failure of a resident to progress academically or develop necessary clinical/operative skills, or dishonesty in any form. The reasons for the probation must be fully discussed between the program director and the resident and appropriate documentation provided. The term of the probationary status and the provisions for the probationary status to be lifted must be discussed as well. A formal record of the reasons and terms of the probation will be kept in the resident's file, and a recommendation for probationary status will be forwarded to the house staff office for approval by an executive office of the hospital. Probationary status must be assigned by the Chief Executive Officer of TJUH after review by the Associate Dean for Academic Affairs and Affiliations. Note that a probationary action will be reported when subsequent inquiries are made by state medical boards or other credentialing bodies.
Placement of a resident on academic probation is a significant formal TJUH institutional status, and is grounds for the resident to invoke the Formal Grievance Process contained in the Resident Education Agreement.
- DISMISSAL. Indications for dismissal are the same as for probation, except that the Program Director and Chairman deem the offense to be sufficiently egregious to warrant immediate dismissal from the program.
Academic Dismissal. Residents may be dismissed from the program in situations where the resident has been unable to meet the performance standard established by the Department, and documented feedback and remediation efforts have been unsuccessful.
Non-Academic Dismissal. Residents may be dismissed from a program by the program director, with approval of the Chair for gross breaches of professionalism, dishonesty, behavior that jeopardized patient safety, or other egregious behaviors.
Dismissal of a resident is grounds for the resident to invoke the Formal Grievance Process contained in the Resident Education Agreement.
The resident works 12 hour shifts five days a week.
The resident does not take in-house call.
The resident covers the hospital from home every other weekend. This requires two to three hours in hospital time per weekend day.
The Colorectal resident rotates call with the General Surgery resident staff, which follows separate duty hour guidelines developed by the Department of General Surgery.
The program strictly complies with the 80 hour work week. The CRS will keep a monthly record of their hours and submit it to the Program Director at their monthly meetings.
The position of Ombudsperson for the faculty and post-docs was established several years ago for the purpose of providing these two categories of Jefferson professional staff a voluntary avenue to informally and, most importantly, confidentially discuss personal concerns and interpersonal conflicts and/or disagreements that may have arisen during the person's employment at Jefferson. A major purpose of having an Ombudsperson available is to help the individual try to clarify their concerns, and develop a plan to address or resolve conflicts/concerns/issues or complaints before they reach a level of personal frustration or dissatisfaction that can lead to the filing of a formal grievance or more significantly, to the resignation and subsequent departure of a valued Jefferson employee. When conflicts or misunderstandings can be resolved successfully and minor disagreements/miscommunications amicably worked through on individual bases, the general work environment can be improved. While not necessarily achieving perfection, in a more supportive or less uncomfortable setting individuals are better able to optimize their potential and productivity. In turn, this improved atmosphere increases the sense of empowerment and job satisfaction for the individual and helps Jefferson achieve its stated mission of continuing to deliver outstanding healthcare services, educational opportunities and research programs.
Your Ombudsperson is authorized to provide independent, confidential advice/assistance or direction. He can offer a neutral venue, and through this role he is in a position to help bring together all parties involved in conflicts. Meetings can occur on or off campus, at the Ombudsman's office or in your own. The Ombudsperson is also available as an interested, but objective "listener" who, because he is not personally or directly involved in a specific concern or conflict, can help the faculty member or post-doc better define and clarify an issue and then work through the problem and focus on finding their own course of resolution. He is also available to help faculty and post-docs work through some of the administrative red tape that often makes academic life appear to be more difficult than it needs to be.
Due to burdensome work or call schedules, if a resident feels that he/she is overly fatigued or is in any other way unable to function at an appropriate level, that resident should notify the chief resident or attending(s) on their service so that alternative coverage arrangements may be made. The affected resident should then be allowed adequate time to rest or sleep so that they may resume their duties at the earliest possible time. This policy does not imply, however, that residents may use their scheduled time off-duty unwisely, not obtaining necessary rest and sleep, and then expect that they can be excused from duty under this clause. This is especially true if a resident engages in an outside activity such as moonlighting. Residents who note excessive fatigue or impaired performance in another resident are expected to bring this matter to the attention of the resident and the appropriate people in charge to ensure that adequate patient care is provided.