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Extreme Emergent Situation Policy

I. Purpose of Policy

The purpose of this policy is how the Graduate Medical Education Committee (GMEC) as the Dartmouth-Hitchcock (D-H) governing body for graduate medical education will state the principles to be applied when considering residents for clinical duties during a Local Extreme Emergent Situation, and, alert the Accreditation Council for Graduate Medical Education (ACGME) that a Local Extreme Emergent Situation has occurred.

II. Policy Scope

This policy applies to all ACGME-accredited residency and fellowship programs at D-H.

III. Definitions

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


Designated Institutional Official: The individual in a sponsoring institution who has the authority and responsibility for all of the ACGME-accredited Graduate Medical Education programs.


Local Extreme Situation: An event that affects resident education or the work environment but does not rise to the level of an ACGME-declared disaster which could impact an entire community or region for an extended period of time. Example: a hospital-declared disaster for an epidemic. An extreme emergent situation is localized to one sponsoring institution, a participating institution, or another clinical setting.


IV. Policy Statement

  1. Duties of Residents during Local Extreme Emergent Situations
    • Residents are first and foremost, physicians, whether they are acting under normal circumstances or in extreme emergent situations. Residents must be expected to perform according to society’s expectations of physicians as professionals and leaders in health care delivery, taking into account their degree of competence, their specialty training, and the context of the specific situation. Many residents at an advanced level of training may even be fully licensed in the state and therefore may be able to provide care independent of supervision.

    • Residents are students. Residents should not be first-line responders without appropriate supervision given the clinical situation at hand and their level of training and competence. If a resident is working under a training license from a state licensing board, they must work under supervision. Resident performance in extreme emergent situations should not exceed expectations for their scope of competence as judged by Program Directors and other supervisors. Residents should not be expected to perform beyond the limits of self-confidence in their own abilities. In addition, residents must not be expected to perform in any situations outside of the scope of their individual license. Expectations for performance under extreme circumstances must be qualified by the scope of licensure.

    • Decisions regarding a resident’s involvement in local extreme emergent situations must take into account the following aspects of his/her multiple roles as a student, a physician, and an employee:
      • The nature of the health care and clinical work that a resident will be expected to deliver;
      • The resident’s level of post-graduate education specifically regarding specialty preparedness;
      • Resident safety, considering their level of post-graduate training, associated professional judgment capacity, and the nature of the disaster at hand;
      • Board certification eligibility during or after a prolonged extreme emergent situation;
      • Self-limitations according to the resident’s maturity to act under significant stress or even duress.


  2. Defined Responsibilities Concerning a Local Extreme Emergent Situation
    • Responsibilities of the D-H DIO
      • Serve as the point of contact for Program Directors for answers to questions.
      • The DIO should contact the Executive Director, Institutional Review Committee (ED-IRC) via telephone only if an extreme emergent situation cause serious, extended disruption to resident assignments, educational infrastructure or clinical operations that might affect D-H or any of its programs’ ability to conduct resident education in substantial compliance with ACGME Institutional, Common and individual Program Requirements. On behalf of D-H, the DIO will provide information to the Ed-IRC regarding the extreme emergent situation and status of the educational environment for its accredited programs resulting from the emergency.
      • At the ED-IRC’s request, the DIO will submit a written description of the disruption at the institution and provide details regarding activities undertaken in response. The DIO will provide updates as requested.
      • The DIO will receive electronic confirmation of this communication with the ED-IRC which will include copies to all EDs of Residency Review Committees (RRC). The DIO will distribute this confirmation to D-H Program Directors.
      • The DIO will notify the ACGME when the extreme emergent situation has been resolved.

    • Responsibilities of the Program Directors
      • Upon receipt of the electronic confirmation of the correspondence between the DIO and EDIRC, Program Directors may contact their respective EDs-RRCs if necessary to discuss any specialty-specific concerns regarding interruptions to resident education or effect on the educational environment.
      • Program Directors are expected to follow their institutional disaster policies regarding communication processes to update the DIO on the results of conversations with EDs-RRCs regarding any program specific issues.

    • Other Responsibilities Related to Local Extreme Emergent Situations
      • The ED-IRC will alert EDs-RRCs when D-H reports an extreme emergent situation. These communications will be included as interim correspondence in institutional and program files.
      • Program Directors from affected institutions may communicate directly regarding specialtyspecific concerns once local extreme situations have been confirmed through the ED-IRC.
      • After communication between a Program Director and an ED-RRC, the ED-RRC will notify the ED-IRC if there is a perception of substantive institutional accreditation issues occurring within D-H during the event.
      • The ED-IRC will notify all EDs-RRCs when institutional extreme emergent situations have been resolved.


D-H Policy ID: 11306

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