The Department of Family and Community Medicine APP Residency works collaboratively with the University of Iowa Hospitals and Clinics (UIHC) and the Iowa Carver College of Medicine to ensure that its standards, and those of relevant accrediting bodies, are met or surpassed for all medical trainees. In accordance with its mission, UIHC is dedicated to achieving the highest quality graduate medical education and has committed the required resources, personnel, facilities, and finances to that end. The Department of Family and Community Medicine APP Residency seeks to educate skilled and effective healthcare providers to best serve the public’s needs. The Department of Family and Community Medicine APP resident must be able to execute the following academic and non-academic criteria.

Required Academic Standards:
The Department of Family and Community Medicine APP Residency uses a comprehensive approach in selecting its candidates. This includes academic performance and intellectual, physical, and emotional abilities needed to meet the curriculum demands and ultimately a successful medical career. The Residency 
admission committee considers character, extracurricular involvement, and commitment to service in 
the healthcare field. Decisions are based upon candidates’ personal statement, CV, letters of 
recommendation and personal interviews.

Criteria:

•  Graduate of an accredited Physician Assistant or Family Nurse Practitioner (FNP) program in the 
   United States.
•  NCCPA certification for PA candidates and ANCC or AANP certification for FNP candidates.
•  Licensed or eligible for licensure in Iowa by the start of the APP residency program.
• Demonstrated interest in Family Medicine
• Satisfactory academic performance throughout the Physician Assistant or Family Nurse 
  Practitioner program 

Required Technical Standards: 

Technical standards refer to criteria that go beyond requirements for admission and are essential to meeting the program's academic requirements. These standards describe the essential functions residents must demonstrate and are required for entrance, continuation, retention, and completion of residency training. Candidates with or without disabilities are expected to meet the same requirements. Reasonable accommodation will be provided to assist in learning, performing, and satisfying the technical standards listed below.

1. Observation: Residents must be able to observe a patient accurately, noting non-verbal and 
verbal signals. Visualize and discriminate findings on diagnostic tests (X-ray, ECG, etc.). Residents 
must make sufficient use of the senses necessary to perform a physical examination.

2. Communication: Residents must be able to relate reasonably to patients and establish sensitive, 
professional relationships with patients, colleagues, and staff. They are expected to 
communicate the results of the history and examination to the patient and to their colleagues 
with accuracy, clarity, and efficiency. Residents must be able to read and understand a large 
volume and breadth of materials (scientific, clinical) and prepare complete summaries of 
individual patient encounters.

3. Motor: Residents are expected to Perform a physical exam utilizing palpation, auscultation, 
percussion, and other diagnostic maneuvers.

4. Intellectual, Conceptual, Integrative, and Quantitative Abilities: Residents must be able to 
learn to analyze, synthesize, solve problems, and reach reasonable diagnostic and therapeutic 
judgments. Residents are expected to display good judgment in the assessment and treatment 
of patients. They must be able to learn to respond with prompt and appropriate action in 
emergency situations. Residents must also be able to manage several tasks or problems 
simultaneously. 

5. Behavioral and Social Attributes: Residents are expected to accept criticism and respond with 
appropriate modification of their behavior. Residents are also expected to possess the 
perseverance, diligence, and consistency necessary to complete the APP residency curriculum 
and enter independent practice. They must demonstrate professional and ethical demeanor and 
behavior in all dealings with peers, faculty, staff, and patients. Residents are expected to be able 
to function at a high level in a high stress environment and demonstrate flexibility to adapt to 
changing environments.

6. Cultural Competency: Residents must be able to communicate with and care for persons whose 
culture, sexual orientation, or religious beliefs are different from their own. They must be able 
to perform a complete history and physical exam on any patient regardless of the student’s and 
patient’s race, religion, ethnicity, socioeconomic status, gender, age, or sexual preference. 
Similarly, students must be able to interact professionally with colleagues and other healthcare 
professionals without regard to race, religion, ethnicity, socioeconomic status, gender, age, or 
sexual preference. Residents must be aware that they may have a different model of “health” 
than their patient and be able to communicate in a culturally responsive manner.

The Family Medicine APP Residency program does not offer academic credit. A certificate is presented at the completion of the program.

Graduation Requirements

To successfully complete the requirements for training in Family Medicine at the University of 
Iowa Family Medicine APP Residency Program, residents must demonstrate sufficient 
professional ability to practice independently as a Family Medicine APP proficiently in all six core 
competencies. 

Specifically, a resident must:

• Perform satisfactorily in the required clinical services.
• Acquire and apply appropriate medical knowledge specific to Family Medicine.
• Provide patient care that is professional, compassionate, appropriate, and effective for the treatment of health problems in Family Medicine.
• Learn to effectively utilize a given health care system to optimize patient care.
• Incorporate and establish habits of practice-based learning and improvement into their own practice
• Effectively communicate with patients, family, and the healthcare team.
• Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.
• Actively participate in the required planned weekly didactic Family Medicine conferences. This is further detailed in the “Conferences” portion of the APP Residency Handbook.
• Duty hours must be adhered to. Reference the “Resident Supervision & Duty Hour Policy”.
• All documentation of patient encounters must be completed in the Electronic Medical Record (EMR) within 3 business days of the visit.
•  If educational activities, patient follow-ups, and patient documentation are consistently not performed in acceptable manner resident remediation will be required. Remediation may take the form of scheduled structured time in the educational area to complete the activities, individualized procedural training, or other activates as determined by the residency program leadership.
• Participate in elective rotations tailored to interests and educational needs.
• Perform at a level commensurate with your training.
• Regularly meet with program faculty (monthly check-in) and reflect on performance and develop plans for continual improvement.
• Be up to date on hospital compliances.
• Adhere to all applicable UIHC and departmental policies.  

Unsatisfactory Performance/Remediation
On occasion, a resident’s performance is less than what is expected for their level of 
training. If a resident receives below average evaluations, fails to adhere to ethical 
standards, fails to adhere to program policies, or fails to demonstrate proficiency in 
required skills or abilities set forth in the program learning objectives, the Program Director 
may refer the resident to the RRC (Residency Remediation Committee) for remediation.

Reference the “Remediation, Probation and Dismissal Policy”

The Family Medicine APP Residency program does not offer advanced placement.

Anti-Harassment | Policy Manual (uiowa.edu)

The University of Iowa Department of Family and Community Medicine APP Residency has applied for Postgraduate Accreditation – Provisional from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The University of Iowa Department of Family and Community Medicine APP Residency anticipates review of its application for Postgraduate Accreditation – Provisional status at the September 2024 ARCPA meeting.

Several educational experiences that are designed to complement the resident clinical learning are offered by the APP Family Medicine Residency program. The curricular components of the Family Medicine APP program include weekly didactic conference, clinic conference, refresher course, certification in BLS, Nexplanon Training and Journal Clubs.

The clinical experiences for APP residents occur at the University of Iowa Hospitals and Clinics (UIHC) and area community clinics. APP residents spend the bulk of their clinical time working and learning in the Family Medicine Clinic (FMC) at UIHC. The volume, diversity, and medical complexity of patients cared for in the FMC provides a robust learning experience. While working clinically in the FMC, APP residents are directly supervised by faculty providers who have decades of clinical experience for trainees to learn from. In addition to time spent in the FMC, APP residents receive training in other specialized areas of Family Medicine.

The Department of Family and Community Medicine at UIHC strives to make the experience of residency rewarding for 
the APP resident. This policy provides a mechanism for APP residents to obtain answers or resolve 
disputes or disagreements that may arise during the residency. These may include issues related to the 
work environment, academic performance, program faculty or administrative matters. The policy aims 
to minimize conflicts of interest.

The following avenues are available for the APP resident to address/resolve concerns:

     A. Program Director: All questions and concerns should first be directed to the Program Director or their designee. 
          They will be best able to address most questions or concerns. 
     B. Human Resources Representative: Questions regarding benefits or other administrative matters that cannot be resolved by the
         Program Director may be directed to the Department of Family and Community Medicine Human Resources Representative.
     C. Department Administrative Review: Other concerns or questions that are not able to be resolved by the Program Director or are 
          related to the Program Director’s performance may be directed to a Department Administrative Review Committee (DARC). 
          This committee will be comprised of the Department Chair, Department Administrator, Vice Chair for Education, and 
          the PA Residency Medical Director. The APP resident will be required to present a written description of the concern. 
          The APP resident may be asked to meet with one or more members of the committee to discuss the concern. 
          The committee will provide a written response of the concern to the APP resident.
    
Due Process and Grievance Procedures – Discipline and Dismissal

     A. Dismissal: If the APP resident is dismissed from the training program, the procedures specified in Article IV Section 7 of the Bylaws,
         Rules and Regulations of the University of Iowa Hospitals and Clinics and Its Clinical Staff will be followed.  
         Statement on House Concerns
     B. Other Disciplinary Action (other than Dismissal): 
            a. The Program Director will provide the APP resident a written notification of the disciplinary action.
            b. The APP resident may request a review of any disciplinary action by the DARC within 10 business days of the APP resident
                becoming aware of the action. 
            c. The DARC will submit its recommendations to the Program Director. The DARC may recommend a change to the 
                disciplinary action to the Program Director will then reconsider the disciplinary action. 
            d. The resulting decision of the Program Director shall be provided to the APP resident, the DARC, and UIHC administration 
                 (if needed) in writing. 
            e. The decision will be final unless the APP resident believes the disciplinary action could significantly threaten their intended 
                career development.
            f. If the APP resident believes the disciplinary action could significantly threaten their intended career development, 
               the APP resident must submit a written request to the CEO/Director of UIHC within 10 business days of the receipt 
               of the Program Director’s written decision. 
           g. The CEO/Director will determine if the alleged threat is significant and review the decision.
           h. The CEO/Director may seek the advice of the Professional Practice Subcommittee as part of the review.
           i. If the CEO/Director approves the Program Director’s decision, the decision shall be given to the APP resident and is final.
           j. If the CEO/Director recommends the Program Director modify the decision, the Program Director will then reconsider the
             disciplinary action in consultation with the CEO/Director. The resulting decision of the Program Director, with the  
             CEO/Director approval shall be provided to the APP resident in writing and is final

Moonlighting is strictly prohibited during APP residency.

Paid Time Off 
Family Medicine APP Residents are afforded 15 days of paid leave (Monday-Friday) during their 12-month contract period. This can be used for vacation, illness, personal business, leave, etc. Residents enter their absence request in QGenda where it is approved by the Program Director and/or Program Coordinator. Absence requests should be submitted 20 weeks (4 blocks) in advance and no later than 8 weeks in advance. Department policy dictates that clinic sessions may not be cancelled within 8 weeks. 
Illness/Acute Absence
If a resident is unable to attend clinic or their assigned rotation on a given day due to illness, the resident must email the Family Medicine Absence Line at FamilyMedicineAbsenceLine@healthcare.uiowa.edu before 7:30am on the day of the absence. Include the Program Director, Clinic Medical Director, Program Coordinator, and clinic frontline supervisor on the email. If resident is on a rotation outside of Family Medicine, the resident must contact the rotation coordinator and clinic staff of the affected rotation.
Leave requested under the federal Family and Medical Leave Act of 1993 will be treated in accordance with the rules and regulations of the University of Iowa as set forth in the Operations Manual 22.7. This is not to exceed 12 weeks. 
Pregnancy/Adoption
If residents expand their family during the residency, the program will continue beyond the original 12-month appointment to compensate for time taken to care for the new family member. This is not to exceed 12 weeks.

https://uihealthcare.policytech.com/dotNet/documents/?docid=11675
 

Cost estimates related to the program that the trainee may incur are listed below.
     1. Travel to and from the non-primary site (ie, satellite clinic locations)
     2. Additional cost above stipend for conferences

A recommendation to modify the resident complement or to close the training program must be made by the individual Program Director via a petition to the Family Medicine Department Chair. 

A recommendation to close the training program, to reduce the size of the program, or to close the sponsoring institution by UIHC must be communicated to the Department Chair and the Advanced Practice Provider residents as soon as possible. Such recommendations will then be presented to the Family Medicine Vice Chair for Education for review and approval. 

If UIHC is to be closed or if an individual program is closed, reduced, or interrupted for any reason, including a disaster or interruption in patient care, the following procedures will govern: 

1) The Program Director will give the affected APP residents written notice of the program reduction or closing as soon as possible following the decisions and approval by the Department Chair and Vice Chair of Education, as applicable. This notice will include specific dates and the terms by which the program is closing or downsizing.

 2) Any APP resident not completing the affected program will be assisted in the continuation of his/her education in one of the following ways: 

      The APP resident will be allowed to complete the program, if possible, depending on the dates of the program 
      closure/reduction and on the APP resident’s demonstration of satisfactory progress; or 

      The APP resident will be assisted by the Program Director in identifying and enrolling in another program at UIHC; or 

      The APP resident will be assisted by the Program Director in identifying and enrolling in another program outside of
      UIHC, by making the necessary communications. 

       A meeting with the APP resident, the Program Director, and the Vice Chair of Education for Family Medicine will occur
       to decide the best strategy for the affected APP resident. 

3) The Department of Family and Community Medicine Administration Office will assist the APP resident with issues concerning stipend, benefits, contract, and other administrative issues caused by the change or closure of the program. 

4) Financial obligations of UIHC will follow the terms of the APP resident’s contract but will not include any reimbursement for expenditures due to relocation.

The Family Medicine APP Residency Program does not require any tuition or fees; therefore, no refund will be granted. Any unused CME/book money will not be refunded.

Concerns regarding APP resident performance may be referred by any faculty member to the Program 
Director for consideration for remediation. Other stakeholders (staff members, consultants, other 
residents) may bring concerns to a faculty member, who may then relay those concerns to the Program 
Director.

The Program Director may refer the concern to the Resident Remediation Committee (RRC) to review 
and provide formal recommendations. 

It is expected that residents will participate in all aspects of the APP residency curriculum. If a resident 
receives below average evaluations, fails to adhere to ethical standards, fails to adhere to program 
policies, or fails to demonstrate proficiency in required skills or abilities set forth in the program learning 
objectives, the Program Director may refer the resident to the RRC for remediation. The RRC in 
collaboration with the resident will create a remediation plan. The plan will be provided in writing to the 
resident and the Program Director. The RRC may elect to include the Senior Associate Dean for Medical 
Education in making its decisions.

Failure to complete a remediation plan successfully may lead to dismissal from the program and/or 
termination of employment.

PA trainees may be dismissed from the APP Residency Program for failure to meet the qualifications of a 
Family Medicine APP Resident including but not limited to failure to obtain licensure and credentialing 
within the designated time, unacceptable professional conduct or sustained unacceptable performance. 
Performance is based on all trainee evaluations and assessments both written and discussions within 
the RRC committee. Dismissal will be considered in cases where significant deficiencies in 
professionalism or clinical performance are identified, remedial training is provided, and there is either 
failure to improve based on defined metrics or there is continued worsening of these deficiencies.
 

The RRC consists of:

Leadership: Medical Director of the APP Residency

Faculty/Staff: Vice Chair for Education/Residency Program Coordinator

The APP Resident Remediation Committee (RRC) is chaired by the APP Residency Medical Director and 
includes the Vice Chair for Education and Program Coordinator. The RRC provides recommendations to 
the APP Residency Program Director, regarding resident performance. This includes reviewing 
deficiencies in meeting program requirements, review of any remediation process, and 
recommendations for dismissal. The RRC is responsible for reviewing APP resident evaluation data and 
making recommendations to the Program Director. The committee will meet on an as needed basis at 
the request of the Program Director if a resident is identified as having performance concerns. The RRC 
will provide a written summary of its meetings and recommendations

Financial Support
The University of Iowa Hospitals and Clinics Department of Family and Community Medicine supports post-graduate training for advanced providers through the provision of a yearly stipend. The purpose of this stipend is to enable each resident and his/her family to maintain a comfortable standard of living within 
the Iowa City community.
Family Medicine APP resident stipend will be $70,000 per year of training.

Paid Time Off
Family Medicine APP Residents are afforded 15 days of paid leave (Monday-Friday) during their 12-
month contract period. Residents enter their absence request in QGenda where it is approved by the 
Program Director and/or Program Coordinator. Absence requests should be submited 20 weeks (4 
blocks) in advance and no later than 8 weeks in advance. Department policy dictates that clinic sessions 
may not be cancelled within 8 weeks. 

Illness/Acute Absence
Family Medicine APP Residents are eligible for 5 sick days (Monday-Friday) during their 12-month 
contract period. 
If a resident is unable to attend clinic or their assigned rotation on a given day due to illness, the resident 
must email the Family Medicine Absence Line at FamilyMedicineAbsenceLine@healthcare.uiowa.edu
before 7:30am on the day of the absence. Include the Program Director, Medical Director, Program 
Coordinator, and clinic frontline supervisor on the email. If resident is on a rotation outside of Family 
Medicine, the resident must contact the rotation coordinator and clinic staff of the affected rotation.
Leave requested under the federal Family and Medical Leave Act of 1993 will be treated in accord with 
the rules and regulations of the University of Iowa as set forth in the Operations Manual 22.7. This is not 
to exceed 12 weeks. 

Pregnancy/Adoption
If residents expand their family during the residency, the program will continue beyond the original 12-
month appointment to compensate for time taken to care for the new family member. This is not to 
exceed 12 weeks.

Benefits
Resident benefits are outlined at the UIHC benefits website. Resident is employed for a 1-year contract 
period. Residents must participate in a retirement plan and will enroll in a plan upon hire. Residents are 
afforded single coverage health insurance. UIHC dental insurance plan is available for purchase by 
Resident.

Resident Selection: 
The University of Iowa Hospitals and Clinics ensures that programs select from among eligible applicants based on their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation and integrity. Programs must not discriminate regarding sex, race, age, religion, color, national origin, disability, or veteran status. Family Medicine APP program leadership will consider the following when reviewing applications.

• Community Service/Volunteerism
• Contribution to Diversity, Equity, and Inclusion 
• Healthcare Experience
• Leadership Experience
• Letters of Recommendation 
• Research/Scholarly Activity 
• Transcripts/GPA

Resident Eligibility: 
Applicants with the following qualifications are eligible for appointment to the Family Medicine APP Residency Program.

• Graduates of an accredited APP program in the United States 
• PA applicants must be NCCPA certified and FNP applicants must be certified by either ANCC or AANP at the time of enrollment 
•  Eligible for employment in the United States 
•  Licensed or eligible for licensure in Iowa by the start of residency program 
•  Evidence of excellent written and verbal communication skills 
•  Demonstrated interest in Family Medicine 
•  Demonstrated multi-tasking and conflict resolution skills 
•  Effective in a team-based setting 
•  Highly motivated learner.

Policy:
Patient health and safety are the paramount concern; therefore, all suspected cases of provider 
impairment must be reported to the program director, to a designated hospital official, or the 
appropriate hospital or medical staff committee. Residents will be strongly encouraged to seek help 
or assistance for any problems with alcohol, drugs or mental illness that affect their ability to 
function as a resident. The program's intent is to assist the resident to successfully complete the 
residency training program and safely practice.

Definition:
The AMA defines physician impairment as any physical, mental, or behavioral disorder that interferes 
with ability to engage safely in professional activities. This definition is extended to Advanced Practice 
Provider Residents.

Procedures:
All processes for intervention and management of the impaired provider are confidential to the 
degree possible.
     1. Impairment in a provider may be subtle or overt but is most often first noticed as a significant and persistent change 
         in behavior. Such changes may be noticed in any or all the physical, emotional, family, social, educational, 
         or clinical areas of life. These behavioral changes are often referred to as “red flags.” If a faculty member, non-
         physician hospital staff member, resident, student, or Program Coordinator notices these “red flags,” they will notify
         the Program Director immediately.
     2. The Program Director will immediately contact and meet with the resident.
     3. If the resident acknowledges a problem with alcohol, substance abuse or emotional problems, they will be removed
         from the clinical area and be tested for impairment. The resident will be placed on an administrative leave of absence
         pending a further evaluation of their condition. The resident will be encouraged to self-report to the Iowa Practitioner
         Program (IPP) via online form. Physician Assistants | Department of Inspections, Appeals, & Licensing (iowa.gov).
         The resident may be reinstated by the Department Chair in consultation with the Program Director, Medical Director,
         and Vice Chair for Education based on the results of the evaluation.
     4. If a resident requires intervention in the form of inpatient treatment, they will be placed on a leave of absence. 
         The resident may be reinstated by the Department Chair in consultation with the Program Director, Medical Director,
         and the Vice Chair for Education, based on results of the treatment.
     5. If a resident refuses to acknowledge a problem with alcohol, substance abuse or emotional problems, they will be
         removed from the clinical area. The resident will be asked to submit to a drug/alcohol urine test to rule out these
         factors. If the resident refuses to submit to this test, they will be immediately suspended from the residency program.
        The terms for reinstatement from the suspension will be determined by the Department Chair and the Program
        Director, in consultation with the Medical Director, and the Vice Chair for Education.
     6. If the resident fails to accept the terms of reinstatement from a leave of absence or from a suspension, or if the
         resident fails to satisfy the terms of their reinstatement or treatment, they will be dismissed from the residency
         program.

The University of Iowa Hospitals and Clinics (UIHC) and the Department of Family and Community Medicine provide an opportunity to expand clinical skills through participation in training programs. The Family Medicine APP training program like other training programs within UIHC is designed to ensure that residents:

• Can provide compassionate, appropriate patient care and effective treatment of health problems and promotion of health.
• Have the requisite medical knowledge about established and evolving biomedical, clinical, and cognates (e.g., epidemiological, and social behavioral) sciences and can apply this knowledge to patient care. 
• Establish and improve learning skills that involve investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvement of patient care. 
• Develop interpersonal and communication skills that result in effective information exchanges and teaming with patients, their families, and other health professionals. 
• Incorporate professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and a sensitivity to a diverse patient population. 
• Demonstrate awareness of and responsiveness to the larger context and system for health and the ability to effectively call on system resources to provide optimal care.

Residents are expected to:

• Develop a personal program of learning to foster continued professional growth with guidance from the teaching staff. 
• Participate fully in the educational activities of the program. 
• Evaluate the quality of the education provided by the program and teaching staff. 
• Complete all mandatory training modules for UIHC. 
• Complete clinical documentation in a timely manner as per program policy. 
• Participate in program reviews and accreditation site visits. 
• Exhibit behavior always that follows the Bylaws, Rules and Regulations of UIHC, the polices of the Department of Family and Community Medicine and the program as well as all state and federal rules, regulations and laws. 
• Maintain a valid license to practice in the State of Iowa.

With respect to participation in patient care activities, overall professional training and academic affairs, the resident is responsible to the Program Director of the Department of Family and Community Medicine APP Residency, the members of the clinical staff and UIHC under whose supervision they may serve, and to the Chair of the Department of Family and Community Medicine.

APP residents who wish to withdraw from the program must submit a written request to the Program Director. The written request must state the reasons for withdrawal prior to completion of the 12-month program. An 8-week notice is preferred. This will become part of the resident’s permanent record. The Program Director will meet with the APP resident to approve or deny the withdrawal request.

The University of Iowa has a full policy available for review: Manual

Social media is an increasingly current way to communicate, both at work and in our personal lives. Because many people use social media for both personal and professional communication, it is possible for the personal and professional arenas to overlap within social media contexts. Sometimes, personal use of social media can have an impact on professionalism and interfere with one’s professional roles and duties. Social media can blur the line between personal and professional. This policy is intended to provide guidelines and clear expectations about the resident's use of social media. 

Policy: 

1. Residents may use social media tools for personal and professional communication. 

2. Residents are expected to consider the possible impact on their professional reputation and on interactions with patients, and to err on the side of caution, when using social media tools. 

3. For electronic communication with patients, residents are encouraged to use MyChart. This is a safe, encrypted form of communication with patients. Email is discouraged. 

4. Residents are prohibited from using personal social media accounts to communicate with patients regarding patient care issues. 

5. Residents are encouraged to consult with their mentor or one of the program staff if they are uncertain about whether specific communications or practices using social media tools are professional and/or appropriate. 

Procedure: There is no specific process for monitoring resident use of social media. Residents are expected to use their best judgment when using social media tools. It is never permissible to post Protected Health Information (PHI). If a peer or a patient raises a concern about a resident’s use of social media, the program director will investigate the situation and discuss further with the resident as appropriate.

Nondiscrimination-statement 

Affirmative Action and Equal Employment Opportunity Statement Policy and Purpose 

Resident Supervision 
This policy is:

• Given to each resident by the program at the outset of their training. •
• Applicable at all sites where the residents rotate. 
• Each site must provide supervision and engage residents in transition of care (hand-off) that facilitates communication among team members, continuity of care, and patient safety.

Supervisors:

• Responsible practitioner: Each patient must have an easily identifiable, credentialed, and privileged faculty physician or licensed independent practitioner who is responsible for each patient’s care; in every setting, the care of patients is supervised by faculty physician. 
• Residents’ access to identified supervisor: Faculty physician supervision is designated for both daytime and nighttime hours, and this call schedule is distributed on Qgenda (Departmental Clinical Scheduling software). The on-call faculty physician is always available by telecommunications technology. 
• Role clarification: Resident and faculty members must introduce themselves and inform every patient of their respective roles in each patient’s care. Provider ID badge must be clearly displayed. 
• Guidelines for residents to communicate with supervisors:
  • Inpatient: Residents must notify faculty physician of all admissions to the Family Medicine Inpatient and Obstetrical Teams. In addition, they must notify the faculty physician of any change in status of patients in a timely fashion, including transfers to intensive care units. Residents will contact the faculty physician by telecommunications technology. Residents are expected to document patient care events in the electronic medical record and send these notes to the faculty physician for review and co-signature. Daily attending rounds are made by the faculty physician who remains actively involved in directing patient care. The faculty physician and senior resident assign patients to the junior residents, advanced practice provider, and students based on complexity of the patients’ care plans. 
  • Outpatient: In the outpatient setting, faculty physicians assigned to precept in the Family Medicine Clinic review and co-sign all charts and encounters for the first 6 months of the APP residents’ training. Faculty physicians are assigned to clinics with a ratio of no more than one faculty physician per four residents providing patient care. The faculty physicians are immediately accessible to all residents caring for patients in the Family Medicine Clinic. Additional faculty physicians provide supervision for special procedures, such as colposcopy, biopsy, and treadmill stress testing. Residents will communicate through the electronic medical record all patient results to the responsible supervising faculty physicians to review the patient care plan. Each resident is assigned a panel of patients that they follow for continuity of care. 
  • External Rotations: Each rotation, on- or off-site, has direct supervision available.

Levels of Supervision: The program ensures that residents assume increasing responsibility according to each resident’s level of education, ability, and experience. Supervision does not equate merely to the presence of more senior physicians or with the absence of independent decision making on the part of residents. These supervision standards encompass the concepts of graded authority, responsibility, and conditional independence. The program uses the following classifications of supervision to assign the privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care to each resident, as appropriate:

• Direct Supervision – The supervising physician is physically present with the resident and patient. 
• Indirect Supervision
  • with direct supervision immediately available – The supervising physician is physically present within the hospital or other site of patient care and is immediately available to provide direct supervision. 
  • with direct supervision available – The supervising physician is not physically present within the hospital or other site of patient care but is immediately available by means of telecommunications technology and is available to provide direct supervision.
• Supervision Levels:
  • Initial 6 months – Residents are supervised directly while they acquire basic knowledge and skills specific to the specialty. 
  • 6 months-12 months – Residents are supervised either directly or indirectly with direct supervision immediately available as appropriate to the patient situation and resident capability.

Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty physician. For many aspects of patient care, the supervising physician may be a more advanced resident or fellow, based on the needs of the patient and the skills of the individual resident. Other aspects of care provided by the resident can be adequately supervised by the immediate availability of the supervising faculty physician or resident physician, either in the institution, or by telecommunications technology. In some circumstances, supervision may include post-hoc review of resident-delivered care with feedback as to the appropriateness of that care. 

Duty Hours 
In general, the PA resident is expected to work a standard 40-hour work week with any additional time needed to complete documentation or follow-up patient care. Certain parts of the curriculum, such as the Inpatient Service, require extended work hours, typically up to 12 hours/day. The APP residency follows ACGME (Accreditation Council for Graduate Medical Education) guidelines which caps Resident duty hours at 80 hours/week.