Extreme Emergent Situations

• NEWYORK-PRESBYTERIAN HOSPITAL
  GRADUATE MEDICAL EDUCATION
  POLICIES AND PROCEDURES
  TITLE: EXTREME EMERGENT SITUATIONS

PURPOSE:

To set forth guidelines for assigning and supervising residents during extreme emergent situations*, recognizing that the ACGME’s Institutional, Common, and specialty-specific Program Requirements apply in such situations with respect to residents’ clinical assignments.

POLICY:

1. Program Directors are responsible for documenting and reporting to the Vice President Medical Affairs as the Hospital’s Designated Institutional Official (DIO) any significant variations in resident clinical experience, case volume, or educational assignments during an extreme emergent situation. The documentation will be used to explain any such variations identified in future program or institutional accreditation reviews.
2. The DIO is responsible for reporting extreme emergent situations to the ACGME’s Executive Director for the Institutional Review Committee (IRC)
3. The following principles should guide Program Directors and the DIO in assigning residents during extreme emergent situations:
   • Residents are, first and foremost, physicians, whether they are acting under normal circumstances or in extreme emergent situations. Residents are expected to perform as professionals, taking into account their degree of competence, their specialty training, and the context of the specific situation. Residents at an advanced level of training who are fully licensed by New York State may be able to provide patient care independent of supervision.
   • Residents are students. Residents should not be first-line responders without appropriate supervision given the clinical situation at hand and their level of training and competence. Residents who do not hold a New York State license to practice medicine must work under the appropriate level of supervision. Resident performance in extreme emergent situations should not exceed expectations for their scope of competence as judged by program directors and other supervisors. Residents should not be expected to perform beyond the limits of self-confidence in their own abilities. In addition, a resident must not be expected to perform in any situations outside of the scope of their individual license.
4. Decisions regarding a resident’s involvement in extreme emergent situations must take into account the following aspects of his/her multiple roles as a student, a physician, and an institutional employee:
   • the nature of the health care and clinical work that a resident will be expected to deliver;
   • resident’s level of post-graduate education specifically regarding specialty preparedness;
   • resident safety, considering their level of post-graduate training, associated professional judgment capacity, and the nature of the disaster at hand;
   • board certification or eligibility during or after a prolonged extreme emergent situation;
   • reasonable expectations for duration of engagement in the extreme emergent situation; and,
   • self-limitations according to the resident’s maturity to act under significant stress or even duress.

* Extreme emergent situation: a local event (such as a hospital-declared disaster for an epidemic) that affects resident education or the work environment but does not rise to the level of an ACGME-declared disaster as defined in the ACGME Policies and Procedures, II.H.2. (An event or set of events causing significant alteration to the residency experience at one or more residency programs. Hurricane Katrina is an example of a disaster).

Approved by GMEC: October 2009
Approved by The Medical Board: May 2010