TAGME Legal, Ethical, and Policy Frameworks in GME 5 — Questions and Answers
Question 1: A resident files a complaint with the Equal Employment Opportunity Commission (EEOC) alleging sex discrimination. During the investigation, the GME office is legally prohibited from:
- Cooperating with the EEOC investigation
- Taking adverse action against the resident for filing the complaint (Correct answer)
- Conducting its own internal investigation simultaneously
- Disclosing the complaint to the program director
Correct answer: Taking adverse action against the resident for filing the complaint
Federal anti-retaliation provisions prohibit any adverse employment action against an individual for filing an EEOC complaint, regardless of its merits.
Question 2: Under the Family and Medical Leave Act (FMLA), which of the following statements about resident leave is CORRECT?
- FMLA leave always extends the residency training period by an equivalent amount
- Residents at institutions with fewer than 50 employees are not covered by FMLA (Correct answer)
- FMLA guarantees paid leave for up to 12 weeks per year
- Program directors may deny FMLA leave if patient care needs are critical
Correct answer: Residents at institutions with fewer than 50 employees are not covered by FMLA
FMLA applies only to employers with 50 or more employees within a 75-mile radius, so residents at smaller sponsoring institutions may not be covered.
Question 3: When a resident's due process rights are at stake during a disciplinary proceeding, which document serves as the PRIMARY source of procedural guarantees in GME?
- The ACGME Institutional Requirements
- The institution's housestaff agreement or resident contract (Correct answer)
- The program's clinical competency committee charter
- The state medical practice act
Correct answer: The institution's housestaff agreement or resident contract
The housestaff agreement or resident contract is the primary contractual document that specifies procedural due process rights and remedies available to residents.
Question 4: A sponsoring institution is considering using a third-party staffing agency to supplement resident coverage during a shortage. This arrangement is problematic primarily because:
- Third-party physicians cannot be credentialed within 30 days
- The ACGME prohibits fee-for-service arrangements in teaching hospitals
- It may compromise program accreditation if educational objectives are not maintained for enrolled residents (Correct answer)
- State licensure boards prohibit temporary physician staffing in academic centers
Correct answer: It may compromise program accreditation if educational objectives are not maintained for enrolled residents
Using outside coverage in ways that reduce residents' supervised educational experiences can jeopardize program compliance with ACGME educational standards.
Question 5: Which of the following best describes the legal concept of 'ostensible agency' as it applies to GME risk management?
- Residents acting outside their scope of practice during off-duty moonlighting
- A hospital may be held liable for a resident's negligence even if the resident is employed by the medical school, if patients reasonably believed the hospital employed them (Correct answer)
- The supervising attending's direct liability for all resident errors
- An institution's obligation to indemnify residents for acts outside training
Correct answer: A hospital may be held liable for a resident's negligence even if the resident is employed by the medical school, if patients reasonably believed the hospital employed them
Ostensible agency (apparent agency) holds that hospitals can be vicariously liable for residents' negligence when patients reasonably perceive the resident as a hospital employee.
Question 6: The ACGME Institutional Requirements mandate that Sponsoring Institutions maintain a Graduate Medical Education Committee (GMEC). Which of the following is a REQUIRED function of the GMEC?
- Setting individual resident salaries and benefit levels
- Approving all patient care protocols used by residents
- Overseeing the quality of GME and the learning and working environment for all residents (Correct answer)
- Reviewing faculty promotion decisions across all departments
Correct answer: Overseeing the quality of GME and the learning and working environment for all residents
The GMEC is required by ACGME to oversee the quality of education and the learning and working environment across all accredited programs at the sponsoring institution.
Question 7: A program director learns that a graduating resident planning to enter private practice was the subject of an unresolved patient complaint. When contacted by a prospective employer for a reference, the program director's BEST course of action is to:
- Decline to provide any reference to avoid liability
- Provide a complete and accurate reference including relevant factual information, after consulting legal counsel (Correct answer)
- Confirm only dates of employment and provide no additional information
- Inform the employer that the resident's records are sealed under HIPAA
Correct answer: Provide a complete and accurate reference including relevant factual information, after consulting legal counsel
Program directors have both ethical and, in some jurisdictions, legal duties to provide accurate reference information about residents, especially regarding patient safety concerns, after appropriate legal review.
TAGME Legal, Ethical, and Policy Frameworks in GME 5
A resident files a complaint with the Equal Employment Opportunity Commission (EEOC) alleging sex discrimination.
During the investigation, the GME office is legally prohibited from: