Domestic and International Off-Site Rotation Policy

I. Purpose of policy

This policy defines the requirements for Residents in Accreditation Council for Graduate Medical Education (ACMGE)-accredited graduate medical education (GME) programs rotating to domestic or international teaching locations not affiliated with Dartmouth-Hitchcock (D-H).

II. Policy scope

The policy applies to Residents, Program Directors and Program Coordinators of ACGME-accredited training programs and to GME Office staff at D-H.

III. Definitions

Clinical Rotation: A rotation with direct or indirect patient care responsibilities.

Major Participating Site: A Review Committee (RC)-approved site to which all Residents in at least one program rotate for a required educational experience, and for which a master affiliation agreement must be in place.

Observership: A rotation with no direct or indirect patient care responsibilities.

Participating Site: An organization providing educational experiences or educational assignments/rotations for Residents.

Program Letter of Agreement (PLA): A contract between Mary Hitchcock Memorial Hospital (MHMH) and the Participating Site.

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

IV. Policy statement

  • Review Committee Notification Requirements
    • Program Directors must follow all established Review Committee requirements for obtaining prospective approval, if required, for off-site educational experiences.
    • It is the sole responsibility of the Program Director to verify that all rotations will count towards meeting the requirements for board eligibility in the respective specialty.
    • Presentation to, and approval by, the Graduate Medical Education Committee (GMEC) of any proposed additions or deletions of Participating Sites is required.
      • 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 Accreditation Data System (ADS).
  • GME Office Notification Requirements - Domestic Rotations
    • Program Directors must notify the GME Office using the standard Request for Off-Site Rotation form when seeking to establish a new off-site experience.
    • Timing for domestic rotation requests.
      • Rotation to a facility in New Hampshire: Request must be made a minimum of 60 days in advance of the rotation start date.
      • Rotation to a facility outside of New Hampshire: Request must be made a minimum of 90 days in advance of the rotation start date.
    • Information required on the Request for Off-Site Rotation form:
      • The educational rationale and defined clinical need for the proposed off-site rotation.
      • The location, hospital/clinic name (if applicable), and responsible site director.
      • Type of rotation: clinical rotation or Observership.
      • Documentation of appropriate approval from the respective RC, if required.
      • Verification that the off-site rotation will comply with all ACGME work environment regulations including supervision and duty hour guidelines.
      • Name of the individual responsible for evaluating the Resident’s performance.
      • Program Director’s signature.
    • The GME Office is responsible for preparing and coordinating the execution of a Program Letter of Agreement with the off-site location where the rotation is to take place.
      • A written PLA must be in place to document and define the relationship between Mary Hitchcock Memorial Hospital (MHMH) and the Participating Site.
      • At no time will a rotation be allowed to commence without a completed, current PLA on file in the GME Office.
  • GME Office Notification Requirements - International Rotations
    • All requirements noted above for domestic rotations must also be met for international rotations with the exception of the need for a PLA.
    • The following requirements must also be met prior to departure by all those approved to participate in an international rotation:
      • Resident must sign the letter from GME reviewing the status of health insurance benefits and malpractice coverage while out of the country.
      • The Resident must consult 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.
    • Residents are strongly encouraged to consider:
      • Reviewing the “Tips for Traveling Abroad” section of the State Department’s website.
      • Enrolling in the State Department’s “Smart Traveler Enrollment Program (STEP)”
      • Leaving a copy of the itinerary and a copy of the passport data page with the Program Coordinator and a friend/family member in case of emergency.
      • Becoming familiar with local conditions and laws for the international location.
    • The GME Office will provide a travel insurance card from International SOS documenting institutional support for:
      • Medical transportation or care.
      • Coordination of medical fees.
      • Evacuation to a center of medical excellence if there is inadequate local care or a secure location is necessary.
      • Help if safety is at risk.
  • 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 supports 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

Specialty Specific Program Requirements. (2018). Retrieved from

U.S. Department of State Website

Centers for Disease Control and Prevention Website

D-H Policy ID: 11312