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Domestic and International Off-Site Rotation Policy

I. Purpose of Policy

The purpose of this policy is to ensure that the Graduate Medical Education Committee (GMEC) and the Graduate Medical Education (GME) Office, provide a fair and approved process to programs that desire to assign residents to non-Dartmouth-Hitchcock (D-H) affiliated teaching locations, either domestic or international.

II. Policy Scope

The policy applies to requests for non-D-H affiliated rotations in all residency and fellowship programs.

III. Definitions

Resident: Any physician in an accredited graduate medical education program, including interns, residents, and fellows.


IV. Policy Statement

  • Residency Review Committee (RRC) Notification Requirements
    • Program Directors must follow all established RRC for obtaining prospective approval, if required, for off-site educational experiences.

    • It is the sole responsibility of the Program Director to verify that all non-DH affiliated rotations will count towards meeting the requirements for board eligibility in their respective specialty.

    • Presentation to, and approval by, the GMEC of any proposed additions or deletions of major participating sites or participating sites is required prior to their submission through the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System (ADS).

    • Following GMEC approval, the Program Director must submit any additions or deletions of participating sites routinely providing an educational experience, required for all residents, of one month duration or more through the ACGME ADS.


  • GME Office Notification Requirements - Domestic Rotations
    • Program Directors must notify the GME Office using the standard "Request for Off-Site Rotation" template when seeking to establish a new off-site experience.

    • Requests for off-site rotations must be received by the GME Office in a timely fashion

    • If the rotation is to a facility located in New Hampshire, the request must be made a minimum of 60 days in advance of the rotation start date

    • If a rotation to a facility outside of New Hampshire, the request must be made a minimum of 90 days in advance of the rotation start date

    • The "Request for Off-Site Rotation" form must:
      • Establish the educational rationale and defined clinical need for the proposed off-site rotation;
      • Identify the location, hospital/clinic name (if applicable), and responsible "site director;
      • Distinguish between a clinical rotation (with direct or indirect patient care responsibilities) and an observership (with no direct or indirect patient care responsibilities);
      • Document that appropriate approval has been obtained, from the respective RRC, if required;
      • Verify that the off-site rotation will comply with all ACGME work environment regulations including supervision and duty hour guidelines;
      • Identify the individual responsible for evaluating the resident's performance;
      • The request must be signed by the Program Director.


  • GME Office Notification Requirements - International Rotations
    • All requirements noted above for domestic rotations must also be met for international rotations.

    • The GME Office will provide a travel card for International SOS documenting institutional support for:
      • Medical transportation or care
      • Coordination of medical fees
      • Evacuation to a center of medical excellence if local care is inadequate or to a secure location
      • Provide help if safety is at risk

    • In addition, the following requirements must also be met prior to departure by all those approved to participate in an international rotation:
      • Resident sign-off on the GME letter reviewing the status of health insurance benefits and malpractice coverage while out of the country;
      • Consultation with the D-H Travel Clinic to review food/water precautions, vaccination recommendations, and additional travel prescription recommendations based on the travel location(s). Appropriate vaccinations and travel prescriptions can be provided at the time of this visit.

    • Additional recommendations that we strongly encourage those traveling internationally to consider include:
      • Review the "Tips for Traveling Abroad" section of the State Department's website;
      • Sign-up for the State Department's "Smart Traveler Enrollment Program (STEP)";
      • Resident should leave a copy of the itinerary, as well as a copy of a passport data page, with your program coordinator and a friend or family member so that you can be contacted in case of an emergency;
      • Resident should become familiar with local conditions and laws.

  • The GME Office will not approve requests for international rotations to countries currently on the U.S. Department of State Travel Warning list or Centers for Disease Control and Prevention Warning Level 3, Avoid Nonessential Travel list.

  • The GME Office does support resident involvement in short-notice relief efforts coordinated through Dartmouth/Partners In Health. Residents involved in these efforts must submit all required documentation noted above for international experiences to the GME Office prior to departure. The GME Office will provide expedited review of these requests.

V. References

U.S. Department of State Website http://www.state.gov

Centers for Disease Control and Prevention Website http://www.cdc.gov


D-H Policy ID: 11312

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