Resident training does not always proceed as smoothly as one hopes. Sometimes a patient may experience an adverse event as a result of care provided by a resident. A resident may also raise a potentially significant grievance with the training institution involving actions by a particular supervising physician or program operations more generally. Hospitals should plan for such situations in advance, so they can respond quickly and confidently. This brief article identifies some of the relevant compliance requirements that guide and inform hospital policies in this regard.
The most significant risks to hospitals in these types of situations typically involve potential malpractice allegations (in the case of patient adverse events) and/or employment disputes (in the case of resident grievances). Depending on the particular issue, there also could be reimbursement implications if teaching physician billing and GME payment requirements have not been satisfied.
Notably, there also could be important programmatic concerns if the situation implicates compliance with accreditation requirements by either the hospital or the program. For example:
- The Accreditation Council for Graduate Medical Education (ACGME) maintains Institutional Requirements, a set of standards that must be met by any training institution seeking ACGME-accreditation as a sponsoring institution (SI), requiring every SI to have a graduate medical education committee (GMEC) that has policies and procedures in place to address (among other things) adverse events involving residents. SIs also must have policies addressing due process for residents facing non-promotion, non-renewal or dismissal, and for handling resident grievances.
- ACGME's Common Program Requirements, a basic set of standards applicable to all ACGME-accredited residency training programs, include specific provisions addressing patient safety events and disclosure of adverse events, requiring residents to receive training and education regarding how to prevent and respond to adverse events. The resident is always under supervision, and the attending physician is ultimately responsible for the care of the patient. The resident needs to share in responsibility and accountability by knowing the "chain of command," and the program policies regarding reporting, investigation and follow-up for adverse events, near misses and unsafe conditions.
Accreditation issues can be disastrous. The GME @ Dentons team can answer your questions about these or any other issues that may arise in the context of your institution's residency training programs.
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