III.

The Sponsoring Institution and each of its ACGME-accredited programs must provide a learning and working environment in which residents/fellows have the opportunity to raise concerns and provide feedback without intimidation or retaliation, and in a confidential manner, as appropriate.

The Sponsoring Institution is responsible for oversight and documentation of resident/fellow engagement in the following:

Patient Safety: The Sponsoring Institution must ensure that residents/fellows have:

access to systems for reporting errors, adverse events, unsafe conditions, and near misses in a protected manner that is free from reprisal; and,

opportunities to contribute to root cause analysis or other similar risk-reduction processes.

Quality Improvement: The Sponsoring Institution must ensure that residents/fellows have:

access to data to improve systems of care, reduce health care disparities, and improve patient outcomes; and,

opportunities to participate in quality improvement initiatives.

Transitions of Care: The Sponsoring Institution must:

facilitate professional development for core faculty members and residents/fellows regarding effective transitions of care; and,

in partnership with its ACGME-accredited program(s), ensure and monitor effective, structured patient hand-over processes to facilitate continuity of care and patient safety at participating sites.

Supervision and Accountability:

The Sponsoring Institution must oversee:

supervision of residents/fellows consistent with institutional and program-specific policies; and,

mechanisms by which residents/fellows can report inadequate supervision and accountability in a protected manner that is free from reprisal.

Clinical Experience and Education:

The Sponsoring Institution must oversee:

resident/fellow clinical and educational work hours, consistent with the Common and specialty-/subspecialty- specific Program Requirements across all programs, addressing areas of non-compliance in a timely manner;

systems of care and learning and working environments that facilitate fatigue mitigation for residents/fellows; and,

an educational program for residents/fellows and core faculty members in fatigue mitigation.

The Sponsoring Institution, in partnership with its ACGME- accredited program(s), must ensure adequate sleep facilities and safe transportation options for residents/fellows who may be too fatigued to return safely home.

Sleep facilities must be safe, quiet, and private, and must be available and accessible for residents/fellows to support education and safe patient care.

Professionalism:

The Sponsoring Institution, in partnership with the program director(s) of its ACGME-accredited program(s), must provide a culture of professionalism that supports patient safety and personal responsibility.

The Sponsoring Institution, in partnership with its ACGME- accredited program(s), must educate residents/fellows and faculty members concerning the professional responsibilities of physicians, including their obligation to be appropriately rested and fit to provide the care required by their patients.

The Sponsoring Institution must provide systems for education in and monitoring of:

residents’/fellows’ and core faculty members’ fulfillment of educational and professional responsibilities, including scholarly pursuits; and,

accurate completion of required documentation by residents/fellows.

The Sponsoring Institution must ensure that its ACGME-accredited program(s) provide(s) a professional, respectful, and civil environment that is free from unprofessional behavior, including mistreatment, abuse and/or coercion of residents/fellows, other learners, faculty, and staff members.

The Sponsoring Institution, in partnership with its ACGME- accredited program(s), must have a process for education of residents/fellows and faculty members regarding unprofessional behavior, and a confidential process for reporting, investigating, monitoring, and addressing such concerns.

Well-Being

The Sponsoring Institution must partner with its ACGME- accredited program(s) to address well-being of residents/fellows and faculty members, consistent with the Common and specialty-/subspecialty-specific Program Requirements.

The Sponsoring Institution, in partnership with its ACGME- accredited program(s), must educate faculty members and residents/fellows in identification of the symptoms of burnout, depression, and substance abuse, including means to assist those who experience these conditions. This responsibility includes educating residents/fellows and faculty members in how to recognize those symptoms in themselves, and how to seek appropriate care.

The Sponsoring Institution, in partnership with its ACGME- accredited program(s), must:

encourage residents/fellows and faculty members to alert their program director, DIO, or other designated personnel or programs when they are concerned that another resident/fellow or faculty member may be displaying signs of burnout, depression, substance abuse, suicidal ideation, or potential for violence;

provide access to appropriate tools for self screening; and,

provide access to confidential, affordable mental health assessment, counseling, and treatment, including access to urgent and emergent care 24 hours a day, seven days a week.

The Sponsoring Institution must ensure a healthy and safe clinical and educational environment that provides for:

access to food during clinical and educational assignments; and,

safety and security measures for residents/fellows appropriate to the participating site.