This document serves as an Agreement between the AU

Residency

Program Name

Program and the Charlie Norwood VA Medical Center involved in resident education.

This Letter of Agreement is effective from Date, and will remain in effect for five years,

Program Name

or until updated, changed or terminated by the AU Program and the Charlie Norwood VA Medical Center.

1.	Persons Responsible for Education and Supervision

Residency Training

Program Director

At Sponsoring Institution:

Site Director

At Participating Site:

List other faculty by name or general group:

Program Name

Group Name: AU

The above-mentioned people are responsible for the education and supervision of the residents while rotating at the Charlie Norwood VA Medical Center.

2.	Responsibilities

The faculty at the Charlie Norwood VA Medical Center must provide appropriate supervision of residents in patient care activities and maintain a learning environment conducive to educating the residents in the ACGME competency areas. The Charlie Norwood VA Medical Center faculty must evaluate resident performance in a timely manner during each rotation or similar educational assignment and document this evaluation at completion of the assignment.

Department/Program Name

The Charlie Norwood VA Medical Center faculty shall also be responsible for: orientating the residents; assigning didactic material as appropriate; arbitrating problems between residents and attending physicians and/or staff; working to ensure numbers and variety of cases commensurate with residents’ experience; reporting to

the AU Department of
Residency Program Evaluation

Committee as necessary; co-signing residents’ notes; and providing regular and timely feedback to residents.

In cooperation with 

the faculty at the Charlie Norwood VA Medical

Program Director,

Enter information concerning the

Center are responsible for the day-to-day activities of the Residents to ensure that the outlined goals and objectives are met during the course of the educational experiences at the Charlie Norwood VA Medical Center. The duration(s) of the assignment(s) to the Charlie Norwood VA Medical Center is as follows:

duration.

The resident is expected to keep an up to date procedure log during the month. Current ACGME duty hour rules will apply.

Evaluation:

1.	Daily milestone-based feedback by Name of Specialty Board board certified physicians providing on-site supervision of the Program Name resident.
2.	
Program Name

Formal written evaluation of resident at end of rotation by on-site
supervising faculty, within 30 days of rotation completion. Written evaluation of

Program Name

rotation by the rotation.
3.	Formal testing on annual

residents will take place at the end of each

Name of Specialty Board

In-Training Examination and

departmental quizzes on topics addressed on the rotation and accompanying didactics.
4.	Annual curriculum review by Program Director, faculty, and residents.

3.	Content and Duration of the Educational Experiences

The content and duration of the educational experiences has been developed according to ACGME Residency Program Requirements; is specified in the AU Department of

Program Name

Resident Manual; and includes the following goals and objectives:

Clinical activities:

Program

Name

Training will occur at the Charlie Norwood VA Medical Center during all AU rotations. Supervision will be by Name of Specialty Board board certified or
board eligible physicians working in the department.  Name of Participating Site

Faculty

will provide the primary on-site supervision. Residents will participate in all aspects of patient care. Residents will be given responsibilities consistent with their level of training.

INCLUDE GOALS AS SHOWN IN THE EXAMPLE BELOW

Goals:

1.	To acquire the knowledge and skills necessary to provide optimal, compassionate care for a diverse group of patients presenting for treatment in a modern emergency department.
2.	To gain experience practicing emergency medicine in a non-AU environment.

INCLUDE MILESTONES AS SHOWN IN THE EXAMPLE BELOW

	Objectives for Performance at Each Training Level		
	Core Competency			Objective		
	Medical Knowledge			EM1			Progressively develops diagnostic approach to common		
	(Command of emergency medicine				ED presentations. Recognizes potential life-threatening conditions.		
	facts and overall knowledge base)				
				EM2			Possesses a solid diagnostic approach to common ED presentations.		
							
			Independently recognizes and treats common life threatening		

Patient Care
(Application of knowledge, data gathering, ability to initiate
therapy, perform procedures and make appropriate dispositions.)

Systems-Based Practice (Effective resource utilization to provide optimal health care.)

Professionalism
(Commitment to carrying out professional responsibilities, adherence to ethical principles, sensitivity to an diverse patient population.)
Interpersonal and Communication Skills (Use of interpersonal and communication skills that result in effective information exchange with patients, families, and
professional associates.)
Practice-Based Learning
(Use of evidence in clinical decision-making, learns from previous patient encounters.)

conditions. Can provide an extensive differential.
EM3	Has mastered diagnostic approach to common ED presentations, life threatening presentations and resuscitation issues. Is able to teach and supervise more junior residents and students.
EM1	Provides compassionate, timely and effective care. Appropriately prioritizes patients based on acuity. Proficient in basic procedures.

EM2	Maintains adequate patient flow. Proficient in all resuscitation procedures. Effectively directs care of critical patients.
EM3	Maintains flow of an entire team. Facilitates patient dispositions.
Troubleshoots administrative problems. Supervises all ED procedures. Anticipates delays in diagnosis and therapy.
EM1	Uses resources judiciously. Utilizes consultants appropriately.
EM2	Uses system resources to provide optimum patient care.
EM3	Effectively supervises the utilization of system resources by more junior residents and students. Anticipates delays.
EM1	Punctual. Completes patient related tasks prior to departure.
EM2	Maintains ethical and professional behaviors even in the face of higher acuity patients, increased patient loads, stress.
EM3	Teaches and acts as a behavioral role model for supervisees.

EM1	Communicates effectively to patients, families, and healthcare providers. Utilizes interpreter services appropriately.
EM2	Communicates effectively during resuscitations. Manages conflict.
Documents appropriately.
EM3	Communicates effectively to all team members. Manages conflict.
Documents appropriately.
EM1	Actively seeks feedback and appropriately modifies practice.
EM2	Routinely incorporates scientific evidence into medical decision-making.
EM3	Teaches evidence-based methodologies to supervisees.

4.	Policies and Procedures that Govern Resident Education

Residents will be under the general direction of the Medical College of Georgia’s Graduate Medical Education Committee and the Policies and Procedures of the AU

Program Name

training program.

	    Medical College of Georgia

    _____________________________		________________________________
     Program Director Name        Date		Site Director                                 Date
    AU Program Director,	           VA Program Name Program
      Program Name					Site Director

_______________________________		__________________________________	
           Thomas J. Hartney, MD	           Date		Natasha M. Savage, MD
           Acting ACOS, Affiliations and Education		Senior Associate Dean for Graduate			Charlie Norwood VA Medical Center	 	Medical Education and DIO