Resident Benefits at Swedish

SERVICE EXCELLENCE COMMITMENTS
Swedish Medical Center is committed to providing our patients with the highest-quality healthcare. As part of that commitment, all Swedish employees are expected to demonstrate these service commitments when performing our job responsibilities.

Patient-Centered Care and Service:
To demonstrate this value, I will:

• Introduce myself to patients and make them my only focus when speaking to them.
• When speaking with patients, families or visitors, take the time to ask what they need and if there is anything else I can do for them before I leave.
• Maintain privacy by announcing myself before entering a patient's space, and keeping curtains drawn before I leave.
• Assist people who are lost or unsure of their location to ensure that they get to their destination.
• Refrain from discussing professional or personal problems in front of patients.

Respect, Caring and Compassion:
To demonstrate this value, I will:

• Listen twice as much as I speak and not interrupt people when they are talking.
• Strive to meet time commitments.
• Welcome patients, team members and visitors, and interact with them as a respected guest.
• Step aside for people entering and exiting the elevator, hold the door open for others, and assist people if they are struggling with what they are carrying.

Teamwork and Partnership:
To demonstrate this value, I will:

• Speak positively about co-workers, other departments and Swedish Medical Center.
• Help team members and work together to solve problems.
• Be generous with compliments and "thank you's."

Continuous Learning and Improvement:
To demonstrate this value, I will:

• Solicit input, take ownership and learn from my mistakes.
• Try new things and adapt to change.
• Take responsibility for improving my knowledge and skills, and participate in required education.

Leadership:
To demonstrate this value, I will:

• Set a positive example for others in everything that I do.
• Participate in organization-wide and department activities to help assure and improve patient comfort, safety and care.
• Provide honest feedback to others in a constructive manner.
• Take responsibility and ownership even if I didn't create the problem.

1. Financial Support for the Resident
For Swedish residents in surgery, podiatry, and family medicine training programs, annual stipends are paid as shown in the Agreement of Appointment. Note: Chief residents may receive additional compensation per the respective residency policy.

2. Vacation Policies
Vacation benefits cannot be carried over from one year to the next. No vacation time will be allowed during the last two weeks of the appointment year. Vacation time must be taken as it is earned, since no reimbursement is given for vacation not taken. It is best to plan well in advance. Check your specific Residency Program Manual for the approval procedure.
Official holidays include July 4, Labor Day, Memorial Day, Presidents' Day, Thanksgiving, Christmas Day, and New Year's Day. Holiday scheduling information and restrictions are detailed in your Residency Program Manual.

3. Professional Liability Insurance
Each resident is covered by a professional-liability insurance policy. Residents are only covered by this policy during approved residency assignments for clinic and hospital patients.
Residents who are not part of residency training are not covered for employment and professional experiences.
See Risk Management Reporting Procedure in the Swedish Resident Manual.

4. Professional Liability Insurance (Tail Coverage)
At the completion of training, tail coverage is provided for Swedish-covered residents for activities that occur as part of the residency-training program.

5. Disability Insurance
Residents regularly scheduled to work at least twenty (20) hours per week are provided with basic long-term disability (LTD) by Swedish Medical Center. Once enrolled, coverage for eligible residents begins on the date of hire, subject to the limitations of pre-existing conditions. Employees may elect to purchase supplemental LTD plan coverage that will provide a larger benefit on a payroll-deduction basis. A summary brochure describing the benefits of the plan and specific requirements is available in the Human Resources department and provided at new-resident orientation.

Residents are covered for disability under two (2) programs: Swedish Medical Center provides a long-term disability income plan that provides 50% of your monthly earnings up to $1,000 per month should a resident sustain an injury or illness that prevents him/her working. This coverage is effective the first of the month following the hire date. Swedish Medical Center has a Workman's Compensation Plan for residents which will provide a maximum of $1,700 per month should the resident sustain an injury or an illness on the job which prevents working. This monthly benefit preempts the benefits of the first program. Considering these two options, residents may wish to purchase additional disability coverage. Contact the Human Resources Office at 206-320-7547 if you have questions.

6. Health Insurance
Swedish Medical Center provides health insurance for the resident, spouse, and children. Residents are encouraged to carefully select the program that best meets their needs. It is important to read carefully the specifications and requirements of each policy. Special attention should be given to the limitations on mandatory second opinion and to the pre-admission certification (PAC) and continued-stay review (CSR) requirements for hospitalization. This information can be found in the Plan document that new residents will receive with the benefits enrollment materials during orientation.

Residents may choose from the various health insurance plans offered by Swedish Medical Center to its employees. There are two PPO plans and one consumer-driven health plan (CDHP). Once a plan is chosen, no changes can be made outside of open enrollment without a qualifying event.

The Standard PPO and Consumer Choice (CDHP) plans are available at no charge to the resident. The Advantage PPO plan requires a monthly premium. Residents may enroll eligible dependent(s) on the same medical plan at an additional premium cost. Swedish provides residents dental, basic life and basic LTD at no charge. Another benefit for residents is that health insurance coverage becomes effective the first day of employment, unlike other employees who must wait until the first of the month following their hire date.

If an eligible Swedish resident, spouse, or dependent is hospitalized at Swedish, the balance is the responsibility of the resident. If you or your family receive services or are hospitalized at a Swedish facility, your out-of-pocket expenses may be lower than at other facilities. The facility charges, i.e., room and board, at Swedish Medical Center will be covered at 100% after deductible under the PPO plans. Other services provided will be covered at the coinsurance rate for the appropriate PPO plan. The Consumer Choice Plan works a little differently from the PPO plans. It features a Healthcare Savings Account (HSA) that offers first-dollar coverage for your healthcare needs, after which a deductible will apply. Residents should read the Plan document and review the Benefit Summary Matrix carefully when selecting a medical plan.

Please note:
Items that are not reimbursed include co-pay for office visits, co-pay for prescriptions, and deductibles for any of the policies selected.

Plan Options:
Employees may choose one of three (3) Swedish Medical Plans. There are two PPO plans; one has a $250 deductible and 80/20 coinsurance; one has a $150 deductible and 90/10 coinsurance. This deductible starts when the resident is hired and then starts over in January of each subsequent year. The Consumer Choice has a higher deductible that starts after the Healthcare Savings Account (HSA) is exhausted.|
Vision and pharmacy benefits are included in all three plans. All three plans offer the same vision and prescription coverage. As an added benefit, employees can fill their prescription at any Swedish pharmacy and receive a discount.

It is to the resident's benefit to review each plan carefully. The resident is advised to check the types of services most likely to use for the coverage and any related referral requirements. Each resident should be prepared to complete enrollment paperwork during orientation and to identify a physician covered by the plan selected.

Reimbursement Accounts:
The resident may also wish to sign up for the "Healthcare and/or Dependent-Care Reimbursement" accounts. These accounts will allow the employee to pay for certain expenses with pre-tax dollars. Some qualified expenses under the Healthcare Reimbursement account include deductible, co-pays, and co-insurance. For example, using a reimbursement account for the deductible will save paying income taxes on the $250, or about 30% depending on your tax bracket. This system is also advantageous for those residents who have day-care expenses. Questions: Soklinh Khoi 206-386-6845.

Default Benefits:
If you fail to enroll within 31 days of your effective date of coverage (your first day as a resident), Swedish automatically assigns default benefits which cannot be changed until the following calendar year by electing different coverage during open enrollment in the fall. The default benefits DO NOT cover benefits for your dependents. The Default Benefit Plan is the Swedish Standard PPO Plan that has a $250deductible and 80/20 coverage, dental, basic life and basic long-term disability.

Open Enrollment Dates for Benefits Changes:
An open enrollment is held in the fall of each year for a January 1 effective date. Employees may at that time elect to switch coverage from any of the plans. This is the only time an individual will be allowed to change medical plans. Eligible dependents may be added to the employee plan at this time. New enrollment forms must be completed prior to any changes taking effect.

Prescriptions for Residents:
Residents may not prescribe for themselves or members of their family. The resident is encouraged to select an established practicing physician to provide appropriate care. All deductibles and co-payments are the responsibility of the resident.

7. Dental Insurance
Premiums for dental insurance through Washington Dental Service are provided for the resident by Swedish Medical Center. Residents may obtain dental insurance for dependents by paying additional premiums. The deductible portions and additional fees not covered by the dental plan are the responsibility of the resident.

8. Life Insurance
Swedish Medical Center residents are provided a life-insurance policy with death benefits equal to the resident's annual stipend. The resident may obtain an additional equivalent amount of life insurance by paying the additional premium.

9. Professional Education Benefits
Check with your individual residency program for the specific benefits and funds available. If you are not already certified, ACLS is provided to incoming residents during orientation. You must have a current Basic Life Support certification when you begin your first day of residency. Please note that you must follow the organizational Purchasing and Travel Policies when using these funds.

10. Parental Leave of Absence Benefits
Female residents are eligible for up to six (6)- to eight (8)-weeks' leave of absence for maternity leave. This leave is without pay after use of accumulated sick leave benefits and vacation time. Swedish Medical Center policy does not allow use of sick leave days for paternal leave. Parental leave requested must use accrued vacation time first, then use unpaid. The leave must have the approval of the Benefits department. Make-up time will be considered in order to complete program requirements.
In the case of family and maternity leaves, all residents complying with legal requirements including the Family and Medical Leave Act and the Americans with Disabilities Act will be granted leave and will be reinstated in accordance with the law. Please refer to the current policies under Swedish Human Resources standards for more details.

11. Sick Leave Benefits
Sick leave accumulates at the rate of one (1) day per month. In case of sickness, the resident's established practicing physician is responsible for recommending excused sick time from duty. It is necessary to provide a physician's written recommendation to the Program director, or the director's designee, in order to make appropriate arrangements and prepare required documentation. The practicing physician is also responsible for recommending appropriate timing for return to duty.

12. Leave of Absence Policy
A leave of absence is any approved extended absence from work (whether paid or unpaid) when the resident is not available to work the normal regular schedule. A request for leave is given to the Residency Program director in advance of the date requested. Benefits will not accrue during the leave period; however, no loss of earned benefits will occur because of the leave.

13. Policy on Effect of Leave for Satisfying Completion of Program
An extended leave of absence from the residency program due to sickness or maternity will be evaluated by the Program director to determine the need for make-up time in order to complete the training and qualify for specialty board examinations. The Program director will work in consultation with the Graduate Medical Education Committee using ACGME-established training time requirements and related Board requirements as a guide.

14. Conditions For Living Quarters, Meals, Laundry, Call Rooms and Lockers:
Chief Residents will orient the resident to the assigned call rooms and procedures. Each resident is expected to bring a personal lock to use on lockers for security.

Medical Staff Lounges:
Residents may use the Medical Staff Lounge on either campus. Appropriate behavior, attire, and respect of protocol are expected. Please note: In the Medical Staff Lounge on the First Hill campus, lunch charges do apply for residents, as well as other medical staff members. The meal cards issued for on-call nights cannot be used to pay for these lunch purchases. When assigned to specific services and campuses, check with your Chief Resident for additional lounges available.

Meals Benefits When On-Call:
Meal benefits will be provided to each resident to cover an evening meal and breakfast the following morning for nights on-call in-house. The on-call benefits are pre-loaded onto the Swedish photo identification badge for food purchases at the main cafeterias. You may add personal funds to cover meals at other times. In order to receive the 20% employee discount, you must use the photo ID badge payment system (GEMPay)

Food Purchase Discounts:
A resident is eligible to receive the 20% employee discount at the main cafeterias when purchasing meals. In order to receive the discount, you must use the Swedish photo ID badge payment system (GEMPay).  IOUs ARE NOT PERMITTED AT THE CASH REGISTER.  In addition, it is hospital policy that dishes, trays, and utensils may not be removed from the cafés; disposable items are available.

Designated Smoking Areas:
Swedish Medical Center is committed to the promotion of good health and the prevention of disease. Smoking is recognized as both a health and a fire hazard. In the interest of health and safety, the following regulations on smoking will be observed. Smoking IS ONLY permitted within designated areas.

Uniforms:
Residents are expected to be neat and professional in appearance and behavior at all times. This reflects concern and respect for patients and their families. It is mandatory that residents wear their photo identification badge when on the hospital floors and in the cafeteria. Name and photo must be clearly visible.

Scrub suits are to be worn only in the surgery and delivery-room suite areas and may be used for sleeping in at night. To assist in maintaining a neat appearance and to protect personal clothing, Swedish Medical Center residents will be issued white coats. Residents may wear either a long or short white coat.

Operating Room Dress Code:
When in the Operating Room, residents must adhere to the dress code policy for the OR facilities. For residents in surgical areas, the wearing of specific OR apparel is confined to the OR suites. When leaving the OR suite, OR apparel may be worn within the confines of the hospital campus (e.g., cafeteria, credit union, personnel office, parking garage), provided that it is clean and covered with a fastened-up white coat. Head and shoe coverings are to be removed. The in-house dress code policy will be adhered to when outside of the OR suite.

Surgical Scrubs Policy:
All personnel entering the semi-restricted and restricted areas of the surgical suite should be in proper OR attire. The OR suites and adjacent areas are designated into three separate areas:

Restricted Area/Operating Rooms:
OR attire consists of scrub suit or dress, shoes, panty hose or socks, head covering, and mask. Visitors from departments such as Pathology may wear jumpsuit over street clothes, head coverings and masks. Impervious shoe covers are required when the possibility of contamination of the feet or lower legs by blood or body fluids is significant.

Semi-Restricted Area:
Peripheral support area of surgical suite. In storage areas for clean and sterile supplies, work areas for storage and processing of instruments, corridors to the Restricted Area, appropriate OR attire consists of scrub suit/dress and head coverings.

Unrestricted Area:
Where street clothes are permitted. This area permits limited access for communication among personnel in the surgical suite or hospital and with patient families.

Off Campus:
Anyone traveling off-campus to nearby banks, restaurants, and retail shops must be in street clothes. Swedish Medical Center's standards of grooming require that special-care area uniforms are to be worn only in the areas for which they are intended and are not to be worn out of those areas or off the hospital campus. Swedish Medical Center and the resident's personal professional image are to be considered at all times.

15. Counseling, Medical, Psychological Support Services
Psychiatric care (by a psychiatrist, psychologist or other qualified professional) is provided to residents through their individual insurance plan. The PPO plans will pay up to 50% of applicable charges after the deductible has been met. The HMO plan also has coverage for mental-healthcare. The aim of psychiatric care, as in other care, is to bring the resident to a state of health such that the resident may continue residency training. Psychiatric care for spouse and/or dependents is provided to the limit paid by the individual plan selected by the resident. The balance is the responsibility of the resident.
Residents are also eligible for the services of the Employee Assistance Program.
For more information, see
http://intranet.swedish.org/wellness/EAP%20page.html from a campus computer.

16. Physician Impairment and Substance Abuse
It is the policy of Swedish Medical Center to provide a drug-free workplace and workforce. Residents are subject to the same policies as other employees of Swedish Medical Center. Employees are expected and required to report to work in condition to perform their responsibilities safely and efficiently and must remain in such condition while at work and while on call. The fitness-for-duty policy has been established to help assess employees when there is reason to be concerned about substance abuse-based impairments.

17. Professional Behavior Policy
Every patient who comes to a Swedish facility for care trusts that all personal and healthcare information will remain confidential. It is expected that limited access to all confidential healthcare information is maintained, not just in the medical record but on computers, requisitions, and worksheets, whether sent by fax, email, or voicemail. Residents are to maintain control of all forms of private healthcare information and to be aware of the surroundings when discussing patient information.

Unacceptable disruptive conduct may include, but is not limited to, behavior such as:

1. Attacks (verbal, written or physical) leveled at an employee, student, volunteer, member of the medical or allied health staff, patient or visitor which are personal, irrelevant or go beyond the bounds of fair professional conduct.

2. Inappropriate comments (or illustrations) made in the patient medical record, or other written documents regarding employees, students, volunteers, members of the medical or allied health staff, patients, visitors, or Swedish Medical Center and its policies.

3. Non-constructive criticism addressed to its recipient in such a way as to intimidate, undermine confidence, belittle or imply stupidity or incompetence.

4. Conduct that demeans the dignity of any person(s) or disrupts the orderly operation of the medical center or that is inconsistent with the mission and values of Swedish Medical Center.

Swedish prohibits all forms of unlawful and unacceptable harassment, including harassment due to race, color, religion, sex, national origin, age, marital status, sexual orientation and disability. Sexual harassment is a form of discrimination and is expressly prohibited. Conduct, which may constitute sexual harassment, includes repeated, unsolicited verbal comments, gestures, drawings, e-mail, or physical conduct of a sexual nature, which is unwelcome and damaging to the integrity of the employment relationship.

Examples of such conduct include:
1. Unwelcome or unwanted physical advances of a sexual nature. This includes patting, pinching, brushing up against, hugging, cornering, kissing, fondling or any other similar physical contact unacceptable to another individual.

2. Requests of demands for sexual favors. This includes subtle or blatant expectations, pressures, or requests for any type of sexual favor accompanied by an implied or stated promise or preferential treatment or threat of negative consequences concerning one's employment status.

3. Verbal abuse or joking that is sexually oriented and unacceptable to another individual. This includes comments about an individual's body or appearance where such comments go beyond a mere compliment; sexually oriented comments, innuendoes, or actions ("dirty jokes") that should reasonably be known to be unwanted or offensive to others.

4.  Any type of sexually oriented conduct that unreasonably interferes with another's work performance.

Pleasant, courteous, mutually respectful and non-coercive interaction between individuals that is acceptable to all the parties involved is not sexual harassment. It is the role of healthcare providers to help patients to make the best medical decisions based on the patient's own beliefs and values. It is not appropriate for health professionals to impose their own beliefs and values on their patients. Though it is not possible to provide a comprehensive list of the possibilities of such intrusions, areas that must be treated carefully with patients include, but are not limited to, politics, sexuality and orientation, lifestyles, and religious practices. As an example, prayer may be important to a patient, and a physician may respond to a request from a patient to pray. However, if a physician solicits a patient to pray with the physician, the physician's beliefs and values are inappropriately imposed on the patient. Since healthcare providers may be considered to be in a position of authority or power over patients, it is critical that providers refrain from any action that could be interpreted as attempting to change or influence the beliefs or values of patients.

Procedure to Investigate a Complaint:
Problems that cannot be resolved informally, including allegations of harassment or disruptive behavior and complaints involving allegations of unprofessional or disrespectful conduct, will be investigated and resolved in accordance with this policy.

If an employee, resident, volunteer, member of the medical or allied health staff, patient, or visitor is subject to or observes harassment or disruptive behavior, it is appropriate to intervene (on one's own or on another's behalf) if at all possible, requesting that the behavior cease. It is desirable that the parties involved speak calmly, privately, and resolve the incident between them in a positive and constructive manner on an informal basis and as soon as possible.

If a problem cannot be resolved informally by the individuals directly involved or if one of the parties refuses to meet to discuss the incident, the following process should be pursued:

1. A resident, medical student or employee should notify the Residency Program director or the Resident Organization ombudsman within 14 days of the incident and provide a written account of what occurred. Patients or visitors who experience disrespectful or disruptive behavior may contact Patient Relations.

2. If the person receiving the report decides the situation warrants further action, the Director of Medical Education or the vice president for Medical Affairs will be asked to help arrange a meeting and facilitate resolution of the incident. The goal of this meeting will be to enhance understanding of each other's perspectives, to make it clear that the disruptive behavior or sexual harassment is unacceptable, and to develop an agreement about future working relationships. Summary notes of the meeting will be written by the Director of Medical Education or the vice president for Medical Affairs and submitted to the Program director responsible and kept in the individual's permanent training file.

Voluntary resolution is the preferred methodology. If effective resolution cannot be achieved; if it is determined that disrespectful or disruptive conduct or sexual harassment occurred; or if there appears to be a pattern of disrespectful or disruptive behavior, disciplinary action may be pursued as per the Status, Disciplinary, and Appeals Policy in the Resident Manual.

The role of the Resident Organization Ombudsman:

• to serve as a liaison between the Resident Organization and Swedish Administration including the Residency Program directors
• to assist the Resident Organization and leaders in understanding the medical staff structure and regulations
• to review policies related to the residents to assure appropriate alignment with the Medical Staff bylaws and governance documents
• to serve as a advisor for Resident Organization leaders in developing communications from the residents to the medical staff
• to serve as a representative of the residents in situations where the residents prefer that any concerns be expressed by a neutral party
• to participate or assist in identifying representatives to the Second Level Review when an institutional review or grievance is initiated

18. Policy on Faculty Supervision of Residents and Med Ed Fellows
The Graduate Medical Education Committee (GMEC) at Swedish Medical Center (SMC) is directly responsible for oversight of all resident and medical student educational programs, as well as the fellows who train at Swedish with restricted Washington State Medical Licenses. The vice president for Medical Affairs for SMC sits on the GMEC and provides administrative oversight at the senior management level for the medical staff and governing bodies of the hospital for the GME programs. The patient must have daily contact with the attending physician.  The medical record must reflect the nature of the attending physician contact with the patient and supervision of the care.

Attending Oversight
Medical Care:
Medical care provided by residents at Swedish Medical Center is done only under the supervision of attending physicians. The requirements to be an attending physician include:

Active medical staff membership at SMC and adherence to the Residency Program and medical staff policies regarding resident supervision; current unrestricted license as a physician in the state of WA (allopathic, osteopathic or podiatric); Board certification or Board-eligibility in the appropriate discipline as stated in the Medical Staff Bylaws; and clinical privileges at SMC in the procedures/care being provided to patients. 

Procedures:
Resident-performed procedures are adequately supervised and assurance provided that residents learn procedures and techniques adequately while promoting patient safety. The attending physicians are ultimately responsible for the care provided to their patients whether or not they are present at the time the care is provided by the resident. Residents are expected to gain increasing autonomy as they proceed through their training years. While it is not necessary to have an attending physician present for every aspect of care provided by a resident, Resident autonomy is not allowed until competence is demonstrated and documented for specific aspects of care, especially invasive procedures.

Resident physicians are required to notify an attending physician when a procedure is to be performed, whether or not the resident requires the direct supervision by either a more senior resident or an attending physician, unless prior agreement has been made. Generally, attending physicians or senior Residents will directly supervise first-year residents. Residents in the second through fifth-year level may not require a supervising attending physician to be present, depending upon the nature of the procedure and whether the resident has adequate prior experience and demonstrated competency. This supervision policy does not include the specific additional requirements that may be applicable for billing third-party payers.   

Each resident's training experience is unique.  Resident-performed procedures must be evaluated separately by the attending.  Documentation of the procedure is the responsibility of both the resident and the Residency Program as it may be required for future privileging.  Each resident is evaluated by the attending physicians who have supervised the resident during or at the end of each rotation.

Informed Consent
The attending physician must obtain the informed consent of the patient in accordance with Swedish Medical Staff Rules and Regulations. Consent must be obtained in accordance with the Swedish Policy for Special Consent in the Clinical Standards Manual.  When authorized by the attending, fifth-year chief surgical residents on the Swedish/First Hill Campus may obtain informed consent from the patient.

Medical Records
A resident may write in the medical record, including dictation of the operative report.  In accordance with Medical Staff Bylaws/Policies and Rules and Regulations, only the attending practitioner may complete the signature portion of the face sheet. The attending's signature on the face sheet satisfies the regulation relative to verification that the chart is complete and accurate.

A resident may issue a written or verbal pass for an inpatient who is being followed by the resident with the approval of the attending.

Additional Requirements
Additional Requirements: Refer to the respective Residency Program Manual for faculty supervision requirements for specific procedures performed by a resident. 

19. Resident Obligations
As part of the Agreement of Appointment, the resident agrees to fulfill the educational requirements of the Residency Program and to accept and comply with obligations and responsibilities as outlined in the Resident Manual and the respective Residency Program Manual.

Each resident must comply with the laws, regulations, and policies to which Swedish Medical Center employees and the residency programs are subject, as well as the Medical Staff Bylaws, Rules and Regulations, Swedish Resident Manual, and specific Residency Program Policies and Procedures.

All patients admitted to the Teaching Service will be the responsibility of the residents. Each resident will provide care for all patients admitted to the service with the guidance and supervision of the attending physician. Except in emergency circumstances, residents will not be expected to provide care for patients of physicians who are not members of the teaching staff. In such circumstances, however, it will be expected that all physicians, including residents, will render whatever service is needed in the interest of patient welfare. The residents will be expected to carry out a timely, complete workup on all newly admitted patients, arrange for necessary pre-operative care and evaluation, participate in the operative procedure and provide appropriate postoperative care, including intensive care.

Residents are responsible, as are all physicians, for keeping accurate and complete medical records. All records must be completed on a timely basis. The patient's chart should be completed within twenty-four (24) hours after the patient's discharge. Operative notes must be dictated within twenty-four (24) hours of the operation.

20. Duty Hours
In accordance with the ACGME requirements, residents in all specialties will be limited to eighty (80) hours per week, averaged over four (4) weeks. There will be a ten (10)-hour minimum rest period between duty periods, and a twenty-four (24)-hour limit on continuous duty time, with an added period of up to six (6) hours for transfer of appropriate management and continuity of care and didactic activities.

One 24-hour day in seven (7) must be free of patient care responsibilities. In-hospital call will be scheduled no more frequently than every third night. If a resident is taking call from home or via pager, if called in, the time spent in the hospital must be counted toward the eighty (80)-hour weekly limit. The respective residency program will assign the normal weekday hours. Refer to your Residency Program Manual for more information.

If the ACGME RRC of a specific program allows that an exception for training time may be in order, up to ten percent additional hours per week, the Swedish Residency Director may petition the Swedish Graduate Medical Education Committee for consideration of this exception for the individual residency. The proposed schedule and specific rotations must be presented to the GME Committee for pre-approval to exceed the eighty (80) hours per week.

The Graduate Medical Education Committee will hear a report from the Chief Residents regularly to oversee compliance with the duty-hour requirements for each program and the institution. The survey will include assessment of the priority of education over service in scheduling, adequacy of supervision, and faculty support, consultation, and availability.

An annual report of compliance with duty-hour standards and resident survey results will be given to the Swedish Medical Executive Committee and Board of Directors as part of the GME Committee Annual Report.

Swedish Medical Center adheres to all ACGME mandates related to duty hours:

• No more than 80-hour workweek averaged over 4 weeks
• 1 day off out of 7
• On call no more than every 3rd night
• 10 hours rest after daily duty or in-house call
• In-house call = 24 hours + up to 6 (must leave at 30 hours)
• Check your residency-specific policies for scheduling details

21. Confidentiality
Residents will likely handle information that is sensitive to the patient, Swedish Medical Center, or protected by federal or state law. Therefore, the resident is expected to ensure the confidentiality of information by actively protecting it from improper disclosure. Residents will not share, or allow to be shared, any information received on a privileged basis except as needed by other individuals in the performance of work responsibilities.

Patient information, patient records, employee records including personnel and payroll, hospital financial and operating data, electronic mail, and any other information of a private or sensitive nature is considered confidential. This definition applies to confidential information stored on any medium, including written records and electronic files. All Swedish employees, residents, and medical staff members are required to sign the Swedish Confidentiality and Non-Disclosure Agreement.

Residents will adhere to Health Information Portability and Accountability Act (HIPAA) and protect confidential information by limiting access to and discouraging the inadvertent or negligent disclosure of such. Confidential information must only be discussed in the appropriate work setting, and not in public areas, such as the cafeteria, elevators, or outside Swedish Medical Center. Residents are not authorized to accept a patient's request for special restrictions for the use and disclosure of the patient's protected health information (PHI). Any such request is to be directed, in writing, to the Swedish Privacy Officer. Any resident who violates the confidentiality of any information will be subject to discipline, including discharge.

Residents must follow the Information Confidentiality and Non-disclosure Policy and sign the agreement included in Section 38 of this document.

22. Prescribing Narcotics
Strict interpretation of the present rules and regulations of the Washington State Board of Medical Examiners and the Board of Pharmacy allows only licensed physicians to write prescriptions. The prescription for a narcotic drug must also contain the physician's DEA number. It is advisable that a minimal quantity of medication be prescribed. R1 and R2 residents will have a Swedish Medical Center Pharmacy assigned DEA number. At the beginning of the R3 year, when residents obtain a permanent Washington State license, they may obtain their own DEA number. The application is for a three-year period.

23. Resident Appointment/Visas
Swedish Medical Center participates in the National Resident Matching Program (NRMP) in graduate medical education to provide the opportunity for both programs and applicants to consider selection options. Applications are submitted through the Electronic Residency Application Service (ERAS) offered by the Association of American Medical Colleges (AAMC).  Once the NRMP matching process is completed, a letter of appointment is sent to each resident confirming the match to train at Swedish Medical Center. Once the resident has accepted the appointment, an Agreement of Appointment is finalized. The Resident Manual becomes a portion of that Agreement of Appointment, along with the expectations outlined in the respective Residency Program Manual.

Swedish will sponsor International Medical Graduates who meet the qualifications for J1 visas.
Residents wishing to obtain a J1 visa to participate in training at Swedish Medical Center must meet the requirements for sponsorship through the Educational Commission for Foreign Medical Graduates (ECFMG) and participate in the Electronic Residency Application Service.

Should a vacancy occur beyond the first year of training, applications are submitted directly to a search committee appointed by the individual residency in which the vacancy occurs. The search committee in accordance with the individual residency program's policy will determine the selection of new residents.

The purpose of these appointments is to complete the specific Graduate Training Program in accordance with the standards of the "Essentials of Accredited Residencies" adopted by the Accreditation Council for Graduate Medical Education. Each party is to fulfill and comply with these standards.

The Swedish Medical Center Programs and the participating institutions fully endorse and support the primary purpose of the appointment of a resident to one of its approved graduate training programs. The ability of Swedish Medical Center to maintain the current programs is supported by the Administration of Swedish Medical Center.

The Graduate Medical Education Committee includes representative program directors and residents from both Swedish Medical Center programs and from affiliated training programs in order to ensure communication and cooperation among the programs and adherence to the regulatory agencies, Residency Review Committees, and specialty Board guidelines.

24. Duration of Appointment
Initial appointments at the R1 level for family medicine and surgery will be offered within the framework of the National Matching Program and will be subject to the acceptance of the resident. No appointment will be for more than twelve (12) months. Notification of reappointment will be made at least six (6) months prior to the termination of the resident's existing appointment.

Podiatry residents are matched through the Central Application Service for Podiatric Residencies.

It is expected that residents matching in the Family Medicine Residency, Podiatry, and the Categorical Surgery Residency positions will continue throughout the respective three (3), three (3), and five (5) years of the training programs.

25. Conditions for Reappointment
Swedish Medical Center maintains Accreditation Council for Graduate Medical Education (ACGME) approved three-year Family Medicine and five-year General Surgery residency programs, as well as CPME approved Rotating Podiatric Residency (PSR-12) for 12 months and Podiatric Surgical Residency (PSR-24) programs in podiatry. A separate Agreement of Appointment is made each academic year between Swedish Medical Center and the resident. Providing the resident performs the expected training requirements and progresses satisfactorily through the curriculum, Swedish Medical Center will maintain an appointment relationship until the completion of the Residency program. The spirit of this Agreement of Appointment is based on the premise that both the resident and the program share mutual responsibilities which are intended to result in the successful completion of the program to qualify the resident for certification examination by the appropriate specialty board.

Note: Two preliminary positions are offered in the Surgical Residency Program for individuals desiring one or two years of general surgery prior to subspecialty training. These preliminary appointments are for twelve (12) months.  Three additional preliminary appointments are made for twelve (12) months in conjunction with the University of Washington Diagnostic Radiology Residency Program.

26. Conditions of Non-Renewal of Appointment
If a resident fails to meet the conditions of the initial Agreement of Appointment, the Program director must inform the resident of non-renewal of appointment for a subsequent year of training in writing four (4) months in advance of the usual termination of the current annual Agreement of Appointment. This decision is based on demonstrated knowledge, skills to perform at the next level of training, and successful completion of all required rotations. The resident may request a one (1)-month reassessment, and the Director of the Residency Program may grant this extension at his discretion. However, both parties must agree to set aside the four (4)-month advance notification of termination as noted above.

Note: Termination by suspension may occur at any time during the resident's year, based on the probation and suspension process, if required.

In all cases, the aggrieved individual shall be kept informed, as appropriate, of action taken to resolve the complaint. To the extent possible, the report or complaint will be handled in a confidential manner. Swedish Medical Center's Department of Medical Education expressly prohibits any retaliation against anyone who makes a complaint or who provides information about possible violations of this policy.

27. Policy on Moonlighting
Swedish Medical Center discourages moonlighting activities for pay for its residents outside the educational program, believing that the time and effort required for training are incompatible with additional part-time work. In addition, professional liability protection is not provided for activities outside the approved educational program.

Residents with a limited license in Washington state are restricted to practice medicine in conjunction with the duties as a resident physician under the supervision and control of a physician licensed in Washington.  Residents in training at Swedish Medical Center are not required, nor encouraged, to moonlight.
 
Residents engaged in moonlighting must have a full medical license for independent medical practice in the state where moonlighting occurs. The Program director must have full knowledge of any moonlighting activities and keep written acknowledgment of that activity in the resident's permanent file. All hours worked in any internal moonlighting setting must be tracked and reported to the director of the residency program.  Any moonlighting must be counted as part of the compliance with the ACGME duty-hour regulations and cannot cause the resident to exceed the regulations.

28. Policy on Professional Activities Outside the Residency Program
For residents who volunteer without pay at events which are not endorsed by or associated with their residency training program, it is the responsibility of the Resident to use good judgment in allowing sufficient rest time between work duties and volunteer duties.  Swedish professional liability insurance coverage for the resident does not extend to those volunteer activities outside the scope of the program.

It is advisable for the resident to discuss in advance any extra volunteer activities outside the program with their faculty advisor and program director.

29. Grievance Procedures
If a resident or a group of residents has a grievance concerning the education experience and/or benefits as understood in the Agreement of Appointment with the hospital, this complaint should be made known in writing to the director of the respective program. If reasonable progress towards correction has not been made within one month, the resident or a group of residents has the right to submit the grievance to the Department Review Committee as outlined in the Appeals Process below (Section C. 33).

Changes in a Residency Training Program's educational goals, objectives, or curriculum are excused from the one-month time constraints of this section and must realistically occur over a year's time as the residency program evolves.

30. Policies on Gender or Other Forms of Harassment

Non-Discrimination Policy:
It is the policy of Swedish Medical Center that no individual shall, on the grounds of race, color, age, sex, sexual orientation, martial status, religion, national origin, or disability, be excluded from participation, denied the benefits of, or subjected to discrimination in employment or under any program or activity at Swedish Medical Center. It is the intent of Swedish Medical Center to maintain a work environment that is free from discrimination.

Harassment: 
It is the intent of Swedish Medical Center to maintain a work environment that is free of all forms of harassment, including harassment based on race, color, age, sex, sexual orientation, marital status, religion, national origin, or disability. Harassment is defined as behavior that creates an intimidating, hostile or offensive environment. Prohibited harassment includes verbal or written abuse, slurs, jokes, innuendoes, cartoons, and pranks which are reasonably offensive to employees or patients, and physical harassment.

Sexual Harassment:
Policies and procedures are in place in your respective Residency Program Manuals and in the Human Resources department that outline the manner in which complaints of sexual harassment and exploitation are investigated. The purpose of these policies is to protect residents from being sexually harassed and exploited.

Sexual Misconduct:
The prohibition against sexual contact between a physician and a patient is well established and embodied in the Hippocratic Oath. 

If allegations of misconduct for any of the above are found to be accurate, disciplinary action up to and including dismissal from the residency program may be taken according to the dismissal procedure outlined in section 26 below.

31. Residency Closure/Reduction Policy
At least eighteen (18)-months' notice will be provided in case of a planned residency closure or reduction in numbers of existing positions. This decision would require involvement of the Graduate Medical Education Committee and Swedish administration in planning a smooth transition. The Director of Medical Education and the respective Program director would facilitate transfer of residents to another program for completion of training.

In the event of a natural disaster in which the institution could no longer provide training for residents for an extended period, the residency program directors will work with the ACGME and CPME to identify appropriate training opportunities for the residents. To the extent possible, these placements will be done to geographically convenient hosting programs. Related Medicare count would be assigned to the hosting institution in order to provide support for the residents' salaries and benefits as well as related expenses during training.  At the point the institution could reopen, residents would return to Swedish to complete their program with authorization from the respective certifying Board to assure meeting the qualifications to apply for board certification.

32. Evaluations
Rotation Evaluation of Each Resident:
Attending evaluates each resident on each rotation for these characteristics:

1. Basic medical knowledge
2. Clinical analysis and problem solving
3. Clinical judgment
4. Ability to take appropriate responsibility
5. Interest and willingness to work
6. Relationship with staff and patients
7. Personal and professional ethics
8. Personal and professional growth

Although there are variations in the evaluation form used by the various attending physicians and residency programs, the above categories are consistent features for each evaluation. In addition, age-specific competency assessment will be included in the appropriate rotation evaluation. Residents meet with the Program director or the Director's designee quarterly for a review of their performance and professional growth.  At the time of this evaluation-interview, concerns with respect to a resident's abidance of rules and regulations as stipulated in the Resident Manual, as well as suggestions for improved performance or corrective behavior, will be made by the evaluator. This process provides an opportunity for the Program director to encourage the resident and compare individual progress to accepted standards that lead to readiness for board certification.

Annual Composite Evaluation of the Resident:
At least annually, the Program director and faculty will conduct a performance evaluation of each resident. The resident's evaluation will include assessment of ACGME-defined core competencies including patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The annual review will also include assessment of age-related competencies in relevant areas of practice. After the evaluation is discussed with the resident, both the faculty advisor and the resident will sign the written document. This will be kept in the permanent records of the residency program. 

Resident Evaluation of the Program and Faculty:
Residents are given the opportunity and have the obligation to express concerns regarding any deficiencies in their education experience or in the hospital's fulfillment of benefit obligations as presented in the Residency Agreement, Residency Program Manual or the Resident Manual. At least annually, residents will confidentially evaluate the program, faculty, and director to provide input for continuing improvement of the training programs.

Off-Site Rotation Performance:
When a concern for a resident's performance occurs on a rotation assignment away from the Swedish Residency Program site, this concern must be based upon standards and educational objectives defined for that rotation. These are determined in advance as part of the institutional agreement between the Residency Program director and the Director of the Educational Rotation to which the resident is assigned. The resident must follow the rules and regulations of the institution or rotation site.

Evaluations for residents will include training and advancement in the core competencies, as defined by ACGME. These include:

• Medical knowledge - evidence-based practice, residency curriculum
• Professionalism - patient-centered care, sign-out systems, behaviors policies, ethics
• Interpersonal skills and communication - interdisciplinary teams, Balint Groups, ethics
• Patient care - inpatient and clinical experience, clinical information systems, PDAs
• Practice-based learning and improvement - quality improvement training, M&Ms, chart audits, evaluations
• Systems-based practice - organizational structures, financial, quality systems

Note:  Family medicine uses Curriculum Objectives and Rotation Evaluation (CORE)

33. Resident Status and Disciplinary Policy
This policy defines the performance status of residents in Swedish-sponsored residency and fellowship programs. There are two categories of status: good standing (which includes "Period of clarification of critique") or probation. In addition, this policy describes the criteria for suspension from the program. The policy for institutional level appeal of decisions made at the residency program level is defined below.

In Good Standing:
Residents should seek and obtain regular feedback on their performance. Minimally, residents are expected to meet with their advisor for regular evaluations throughout the academic year as specified by their residency evaluation plan. Advisors will review rotation and continuity clinic evaluations during these meetings.

At times, concerns may arise about a resident in good standing. Advisors can chose to use two weeks to obtain clarifying information, and may determine that a concern is unlikely to require further action. Concerns might include patient or staff complaints, unsatisfactory rotation evaluations, or preceptor or colleague concerns.

The process of clarifying may include:

• Informing the resident of the critique received.
• Assuring the person whom brought the concern to light that the issue is being investigated.
• Soliciting other viewpoints from the faculty and chief resident(s) during faculty meeting.
• Obtaining information that clarifies the problem, both in nature and scope.
• During this time, the resident remains in good standing.

Most often, the period of clarification results in the concern being resolved, and the resident remains in good standing. 

Depending on the nature of the problem, the faculty may place the resident on probation or initiate a period of observation if one or more of the following circumstances apply:

• A problem is part of a pattern of deficit
• Clarification cannot be achieved within the two week period or with the resources provided
• The problem is unlikely to resolve without more intensive feedback to the resident

Observation:
Residents on observation are considered to be in good standing with the program. The purposes of observation are to produce more information for the faculty and resident, to avoid immediate probation and help resolve any discrepancy between faculty and resident, and to determine whether a problem exists. It also is an opportunity to fully clarify whether any existing problem is a matter for the program to address or one that is the resident's prerogative, and should be up to the resident to address on his/her own.   

When a resident is placed on observation, faculty members and the chief resident(s) will review the individual's performance in a faculty meeting. The faculty will then form a Faculty Subcommittee of two or three members, including the resident's advisor. The faculty subcommittee will be responsible for formulating information about the possible deficit, the terms of observation, and the instruments to measure performance. The Faculty Subcommittee will evaluate all information gathered during the observation period and then recommend the next step. The program director and the advisor will then meet with the resident and review the terms of the observation. The standard period of observation is one month, but may be modified if necessary. The resident should meet with the advisor no less than every two weeks, and the advisor should report to the full faculty at least every two weeks. At the end of the review, the Faculty Subcommittee can recommend one of three steps: discontinue observation, extend observation for another month, or place the resident on probation.

Steps in the Observation Process:
Resident problem is presented to faculty meeting and chief resident(s).
The faculty decides during this meeting to initiate observation status.
A Faculty Subcommittee of two faculty members, including the advisor, is formed to handle the intervention.
The Faculty Subcommittee articulates the possible deficit and terms of the observation.
These items will be documented in a letter to the resident that includes:

• Reason for observation (areas of concern)
• Statement clarifying observation status and describing the observation goals
• Length of observation (no less than 30 days)
• Specific expectations necessary to meet observation requirements and the time frame within which improvement is expected
• Assistance that will be available to meet those requirements
• The mechanism for measuring improvement (clearly defined standards)
• The consequences of failure to meet observation requirements

The advisor meets with the resident every week.
The advisor informs the faculty every one or two weeks.
The instruments that the committee defined are implemented to measure resident compliance.
These evaluations are collected and reviewed by the Faculty Subcommittee.
The Faculty Subcommittee recommends one of the following to the full faculty.

• Discontinue observation
• One additional month of observation
• Probation

Probation:
This is a status that will follow the resident throughout their career, and needs to be initiated with care. Examples of deficiencies that require probation include:

• Failure of a rotation
• Unprofessional behavior
• Significant breach of standard of care

A resident can be placed on probation immediately by the program director, or by the resident's advisor in consultation with the faculty, chief resident, and director. Probation may lead to dismissal from the residency program.
 
Once the decision is made to place a resident on probation, they are informed immediately, ideally in person and by the director. A process similar to the observation cycle is initiated, with every step documented in paper in the resident's file. 
1. The findings of the Faculty Subcommittee related to the resident's performance are presented at a full faculty meeting, and the faculty decides to place the resident on probation.
2. An ad-hoc committee is formed to review the problem(s) in more detail.
3. This ad-hoc committee of three faculty members will write a probationary letter. The faculty will review the probationary plan generated by the committee. 
4. The probationary letter will contain the following:

• Reason for probation (deficiencies)
• Statement clarifying probationary status
• Length of probation (no less than 3 months nor more than 6 months)
• Specific expectations necessary to meet probation requirements and the time frame within which improvement is expected
• Assistance that will be available to meet those requirements
• The mechanism for measuring improvement (clearly defined standards)
• Consequences of failure to meet probationary requirements

5. The resident will meet with his/her advisor weekly, and the faculty, on a regular basis, will review progress at least monthly.
6. The ad-hoc committee will gather information regarding the resident's performance over the probation period and recommend the next step.
7. The resident will either return to good standing (with or without observation), continue probation, or be expelled from the residency. Failure to meet all standards and remedial goals outlined in the observation plan at the monthly review will be grounds for dismissal from the program. 

Suspension:  
If in the judgment of a program director, a resident disregards hospital rules and regulations and/or is unable to provide safe care to patients because of medical problems or immoral or illegal behavior, the resident may be summarily placed on leave of absence without salary, but with continuation of benefits. Justification for suspension by the program director must be documented, and may be a single episode of blatant disregard or repeated lesser infractions despite admonishment, or a reversion to less than performance standards following a probationary period.

Dismissal:
Dismissal from the residency program may occur via the probation process, following a suspension, or direct dismissal. In the event of a dismissal in any form, the resident may appeal for reconsideration at the institutional level to the Medical Staff Department Review Committee.

Failure to Appeal:
An appeal to a dismissal by probation or a suspension must be made in writing and submitted to the Director of Medical Education within ten (10) weekdays of notice of the disciplinary action. Failure to appeal within the time frame noted will constitute acceptance of the decision of the program director.

34. Institutional Level Appeal Process

Department Level Review:
Any resident who wishes to have the dismissal decision from the residency program reviewed may appeal. Appeals must be made in writing and directed to the Director of Medical Education within ten (10) weekdays upon receipt of the written notification of dismissal. This process also applies to grievances that are not resolved at the residency program level.

The Medical Staff Department Review Committee shall be made up of the department chair, a member of the department's teaching faculty, and a resident from the specific residency program; the Director of Medical Education selects the latter two members. This committee shall be formed and meet within fifteen (15) weekdays of the Director of Medical Education's receipt of the resident's written appeal requesting a review of the dismissal decision.

During the next fifteen (15) weekdays, the Department Review Committee will consider objections by the dismissed resident, hear the program director's response, and investigate the procedures for dismissal (probation and suspension) followed by the program director.  The resident may have a peer attend with him/her during the resident's portion of the Department Review Committee meeting. If either party is not satisfied with the action and/or decision of the Department Review Committee, a second review may be requested by notifying the Director of Medical Education in writing within ten (10) weekdays of receiving the Department Review Committee's decision. If a request for a second review is not made within ten days, the decision stands.

Second Level Review:
The Second Level Review Committee shall consist of two residents from two Swedish residency programs selected by the residents of the respective program, and two members of the teaching faculty selected by members of the respective teaching faculties. These residents and faculty may be from any Swedish-sponsored residency program. A fifth member from the active medical staff shall serve as the chair of the committee and be appointed by the Director of Medical Education. This chair shall not be from the department or residency program involved. This Second Level Review Committee shall hear and make their recommendation by a majority vote. This process shall be completed within twenty (20) weekdays of receipt of the request for review.

Final Appeal Review:
If the resident or program director disagrees with the decision of the Second Level Review Committee, an appeal for final review may be made to the Director of Medical Education. This appeal must be made in writing, within ten weekdays of the communication of decision of the Second Level Review Committee.

The Swedish Graduate Medical Education Committee conducts the final review within a period of twenty (20) weekdays. The chair of the Second Level Review Committee will present the findings to the GME Committee. The resident and involved program director will each have the opportunity to make a brief statement either in support or opposition of the Second Level Review Committee's findings and recommendations. Only information or witnesses used in the initial appeal or second-review process will be allowed. The decision of the Graduate Medical Education Committee will be made by a quorum of the members present. There is no further appeal after the decision of the Graduate Medical Education Committee.

35. Authorization for Release of Training Records
By signing the Agreement of Appointment, the resident authorizes release of residency training information to requests from governing bodies, subspecialty training programs, accreditation organizations, state licensing agencies, etc. 

36. Institutional Support of Graduate Medical Education
Swedish Medical Center has supported and been actively involved in Graduate Medical Education (GME) since 1920. GME is considered an integral part of our activities and responsibilities. Our mission is to improve the health and well being of the people we serve through the provision of high quality healthcare. Our vision is to provide the highest quality, best value healthcare for each person we serve. Our strategic goals, which ensure the ability to meet our mission, include being the best place to practice, to work, to receive care, to purchase care, and to be a healthcare partner. The support and enthusiasm of the medical staff indicate the high value of residency teaching involvement as an important element of making Swedish the best place to practice.

As a major urban medical center, Swedish has a responsibility to society and the medical profession to support educational activities that will ensure a continuing supply of well-trained professionals to meet healthcare needs. Excellent GME programs attract excellent physicians to the medical staff who view teaching responsibilities as part of their professional life. Through these lifelong learning and teaching opportunities, physicians will maintain their knowledge and skills, and provide high-quality, cost-effective care. GME is an important element in our Continuing Medical Education program. The resident and attending staff interactions involved in teaching and patient care encourage open communication, which is essential in assuring the quality of medical care.

Principles of Support:
Swedish Medical Center has committed sufficient educational, financial, and human-resource funding to support GME activities appropriate to intent and scope of our Accreditation Council for Graduate Medical Education (ACGME) and Council on Podiatric Medical Education (CPME) accredited programs. The planning process to identify and track program funding includes input from the residency program directors, the Director of Medical Education, and Swedish administration. These funds are approved annually by the Swedish Medical Center board of trustees.

The Director of Medical Education serves as the Designated Institutional Official (DIO). The DIO administratively supports the Graduate Medical Education (GME) Committee and is responsible to the Chief Medical Officer (CMO). The CMO serves as an agent of the board of trustees and Swedish Administration for the appropriate distribution of these resources. The major principles involved in this distribution are:

• The necessary resources to support broad medical specialties, both clinical- and hospital-based, where there is a high interest on the part of medical staff to participate in providing an educational training experience for resident physicians;
• Resources to support the size of each residency program appropriate for maintaining a critical mass, thereby assuring a proper education-to-service relationship;
• Support for administration of relationships with the University of Washington School of Medicine and other geographically and educationally appropriate affiliations where there is mutual interest;
• Opportunity to seek training in other geographic locations, both nationally and internationally, funding permitting.
• Support for computers and technological advances to support educational efforts, including patient information, electronic databases, e-mail and Internet access.

Relationship and Responsibilities to the Administration and the Medical Staff Organization 
Swedish Medical Center has institutional agreements with the National Residency Matching Program (NRMP) and the Central Application Process for Podiatry Residents (CASPR) for the selection of residents. The respective program director, residents, and faculty of each residency program conduct the selection process.

The appointment of the teaching staff in each residency program is the responsibility of the program director and the respective faculty, as is the supervision of a resident's daily activity. The mechanism for these appointments and supervisory activity is part of the program directors' annual report to the GME Committee. The director and faculty of each program are responsible for curriculum development, as well as attention to the ethical and professional environment in which the residents train.

The GME Committee, which has representation from the residents and program directors of each accredited program, as well as appointees by the chief of staff, determines the evaluation and frequency of formal residency evaluation encounters. The evaluation mechanism must be followed in order for a program director to consider nonadvancement or dismissal of a resident for unsatisfactory performance. The GMEC is responsible for assuring due process for residents and the teaching staff. The evaluation process, the dismissal procedure, and due process are delineated in the Resident Manual.

In order to facilitate communications and the complementary educational environment, the GME Committee also includes representation from the medical directors from affiliated training programs who are overseeing rotations at Swedish Medical Center.

Each residency program director, with the assistance and advice of faculty, is responsible for developing the goals and objectives of the program, developing an effective plan of instruction, and evaluating whether these goals and objectives are being achieved. The program director and department faculty are responsible for developing criteria by which to measure the individual resident's progress, as well as the faculty's effectiveness. The program director and faculty are required to follow due process should a member of the teaching faculty or a resident have a complaint related to evaluations. Written descriptions of the curricular design, evaluation process, and core-competency training outcomes are part of each program director's annual report to the GME Committee and the Medical Staff Executive Committee.

Resident Agreement of Appointment:
 
Each resident signs an Agreement of Appointment which delineates the dates of employment; the stipend for the duration of the appointment; and fringe benefits including uniforms, parking, vacation time, food, and, when on-call, liability insurance, healthcare benefits, dental insurance, and life-insurance benefits. The Agreement of Appointment also contains references to the Swedish Resident Manual and the relevant Residency Program Manual. The Resident Manual is developed through the GME Committee to document further delineation of rules and regulations governing resident responsibility to the institution, policies, and performance of duties, evaluation procedure, and method of due process. Each Residency Program Manual contains the relevant residency program's statement of goals and objectives; describes the educational experience expected; and outlines the department responsibility.

37. Benefits at a Glance

BENEFIT ELIGIBILITY EXPLANATION OF BENEFIT EFFECTIVE PROVIDED BY
Swedish Medical Program
(Health Insurance) All benefits-eligible employees in an assigned FTE position of 0.5 (20 hours per week) or greater. Medical coverage including hospitalization, preventative care and prescriptions.
Programs include Swedish Advantage PPO; Swedish Standard PPO; Swedish Consumer Choice.

Opt Out:  $50 per month taxable income; must have proof of other group medical coverage. Date of hire The resident must enroll within 31 days of hire. Otherwise, default coverage will take effect.
 
The Standard PPO plan is the only plan available at no charge to the resident.

Dental Insurance All benefits-eligible employees in an assigned FTE position of 0.5 (20 hours per week) or greater. Plan pays 100% preventative and diagnostic; $50 deductible for other services; 80% routine; 50% major. $1,500 yearly maximum. Ortho coverage for adults and children. Must use Washington Dental Service member dentists to receive maximum benefits. Date of hire Swedish pays monthly premium for employee only. 
Residents pay premiums to cover additional family members.
Vision Coverage All benefits-eligible employees in an assigned FTE position of 0.5 (20 hours per week) or greater. Included in medical plan. Annual exam up to $75 with $10 co-pay;  $250 hardware benefit every 24 months; may use any licensed provider and then be reimbursed for eligible expenses up to plan limits. Date of hire Included in medical plan.
Employee Life & AD&D Insurance All benefits-eligible employees in an assigned FTE position of .5 (20 hours per week) or greater. Basic benefit provides a policy equal to an employee's annual salary at no cost.   Date of hire Swedish provides.
Supplemental Life Insurance All benefits-eligible employees in an assigned FTE position of .5 (20 hours per week) or greater. Option to purchase additional insurance up to four times annual earnings. Date of hire Resident pays via payroll deduction.
Dependent Life Insurance All benefits-eligible employees in an assigned FTE position of .5 (20 hours per week) or greater. Option to purchase life insurance for spouse and/or child. Must choose supplemental life coverage for yourself. Date of hire Resident pays via payroll deduction.
Long-Term Disability All benefits-eligible employees in an assigned FTE position of .5 (20 hours per week).  Date of hire Swedish pays up to 50% of monthly salary up to a max of $1,000 per month. Contact is Nicole 206-386-2740. 
Supplemental Long-Term Disability All benefits-eligible employees in an assigned FTE position of .5 (20 hours per week) or greater. Additional coverage that replaces a percentage of lost income if injury or illness prevents employee from performing essential job functions. Options: 90 or 180-day waiting period. Date of hire Resident pays via payroll deduction. Provides up to 60% of earnings up to monthly cap of $10,000.
Healthcare Reimbursement Account All benefits-eligible employees in an assigned FTE position of .5 (20 hours per week) or greater. Allows employee to reduce taxable income to pay for benefits not covered by the above plans as defined by the IRS $3,000 maximum/year. Only expenses incurred during plan year of employee's eligibility are reimbursable expenses. Date of hire Resident via payroll deduction.  Reimbursed via submittal of claim form with receipts for covered services.
Dependent Care Reimbursement Account All benefits-eligible employees in an assigned FTE position of .5 (20 hours per week) or greater. Allows employee to reduce taxable income to pay for eligible day care expenses as defined by the IRS $5000 maximum/year.  Only expenses incurred during plan year of employee's eligibility are reimbursable expenses. Date of hire Resident via payroll deduction.  Reimbursed via submittal of claim form with receipts for covered services.
403(b) Program All employees Allows employee to reduce taxable income by contributing via payroll deduction to own retirement. Maximum $13,000/year, according to IRS regulations. Enrollment date is optional. No waiting period. Resident pays via payroll deduction.                                     

Options include Aetna/ING, Lincoln, Safeco Mutual and Fidelity

Holiday Pay Exempt Staff Eight paid holidays per year which include employee birthday (prorated for part-time). Date of Hire Swedish provides
Sick Leave All employees Eight hours accrued per month for regular staff; maximum 720 hours, pro-rated for part-time employees. Date of Hire Swedish provides
Vacation Exempt staff Specified paid vacation per year as shown in agreement of appointment: hours can not be carried over from one year to the next. Date of Hire

Eligible upon approval from program director. Swedish provides
Direct Deposit of Pay All employees Direct deposit of paycheck to resident's choice of participating automated clearinghouse. Takes two pay cycles to implement. Completion of required paperwork. Swedish provides
Employee Advancement Center All employees Assist employees in obtaining employment, career and work life goals via career counseling, goal setting, assessment testing, interviewing skills and computer resources. Date of Hire Swedish provides
Employee Assistance Program (EAP) All employees Confidential resource for work/ family issues, etc. Three free visits/ year/family member. Dependent Care referrals. Date of hire Swedish provides
Emergency Fund All employees Amounts vary depending on need and final approval by committee. Contact Foundation at
 (206) 386-2738 for specifics. Date of hire   Swedish provides
Leaves of Absence All employees subject to length of service with Swedish requirements and other applicable laws/regulations. Upon approval, an extended absence from work, paid or unpaid. Types include FMLA, maternity, and military. Varies depending on type of leave. Paid or unpaid depending on type of leave.  Refer to Swedish policy.
SHARE Credit Union All employees Provides low cost loans, Visa & Exchange cards. Payroll deduction available to checking/savings accounts. Date of hire SHARE FCU
Professional Education SMC residents Please refer to your individual Residency Program Manual. Arrange with program director. Swedish provides some benefits. In addition, most CME programs on campus are available for Resident participation at no charge if preregistered.
Transit/Parking SMC residents Parking pass is provided.
 Date of hire Swedish provides.