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CREDENTIALING OF RESIDENTS AND

CLINICAL FELLOWS IN ACGME AND NON-

ACCREDITED PROGRAMS

Revised/Effective: 12/12/06Reviewed: 12/12/06Reaffirmed by GMEC:Supersedes: 4/13/06Originally adopted: 4/13/04Approved by: Graduate Medical Education CommitteeWeb address: http://gme.med.nyu.edu/house-staff/gme-policies-and-forms

Applies to: Residents and Fellows enrolling in ACGME accredited and non-accredited programs

I. Preamble

NYU School of Medicine (NYUSoM) is committed to meaningful and enriching educationalexperiences for its residents and clinical fellows. This includes assurance that these residentsand clinical fellows have the appropriate credentials to work in a clinical setting and be gainfullyemployed while assuring meaningful education, personal health and safety for patients. TheAccreditation Council for Graduate Medical Education (ACGME) has established guidelines

governing the selection of residents and clinical fellows enrolled in ACGME approved programs.In addition, the NYS Department of Health and the affiliate hospitals of NYUSoM have set rulesand regulations for House Staff to be in compliance with these criteria.

II. Definitions

A. Resident - a physician who is enrolled in an accredited NYUSoM Training Program for aclinical specialty.

B. Clinical Fellow - a physician who is enrolled in an accredited or non-accredited NYUSoM

Training Program of a clinical subspecialty.

C. NYUSoM Training Program a specialty or subspecialty graduate training program atNYUSoM, which may be either an Accredited NYUSoM Training Program or a Non-Accredited NYUSoM Training Program.

D. Accredited NYUSoM Training Program - a NYUSoM Training Program that is accreditedby ACGME, ABMS, or any other recognized accrediting agency.

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III. Policy

A. Residents Responsibilities - The Resident/Fellow is required to comply with allrequirements of each Affiliated Hospital to which s/he is assigned.

1. Credentialing -The Resident agrees to comply with each Affiliated Hospitals credentialverification and appointments procedure. The Resident will be permitted neither to begina training program nor to receive any other benefits under this contract without havingmet such credentialing requirements, which include:

a. Completion of application for house staff appointment. The Resident must submit allthe requested information to the NYU Office of Graduate Medical Education prior tothe Residents date of hire;

b. Proof of graduation from medical school

c. ECFMG Certification if the Resident is an International Medical School Graduate;

d. A valid New York State medical license or limited permit if the Resident/Fellow isentering a non-ACGME accredited training program. This license must be obtainedbefore training can begin.

e. Documentation of identity and right to work, including fingerprinting and backgroundchecks as required by any of the Affiliated Hospitals; and

f. Proof of compliance with NYUs immunization policy, which is included in theResident Handbook

2. Licensure-The Resident agrees to abide by New York State licensure requirements forphysicians in training, which can be found at: http://www.op/nysed.gov.

3. Employment All employment requirements must be satisfied prior to commencementof training. These include but are not limited to, satisfaction of all pre-employmentemployee health requirements, successful completion of all background checkprocesses, (questionnaires, fingerprinting, etc.), passing a urine toxicology screeningtest, and completion of the I-9 (employment eligibility form).

a. Failure to satisfactorily complete the credentialing process nullifies the contract andis not subject to appeal.

b. All level one aspects of credentialing and employment must be satisfied to obtain,clearance to begin training. Within 60 days of beginning training the resident orfellow must satisfy any remaining level two requirements.

c. Failure to satisfy all the requirements within the 60 day grace period will result in theresident/fellow being placed on a Leave of Absence (LOA) status until allrequirements are satisfied. The resident/fellow may not work or receive training creditfor anytime during this LOA.

d. Missed training time may result in an extension of the training program in order tosatisfy training requirements, in accordance with the program policy.

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4. Appointment After submission of required documents and review and approval by theProgram Director, and verification by the House Staff Committees at the affiliatehospitals, residents should be appointed as follows:

a. A House Staff Officer who has not completed at least one year of service in anACGME approved training program shall be placed at the PGY-1 level.

b. A House Staff Officer who has completed one or more years of service in an ACGMEapproved training program in his/her specialty shall be placed at the PGY level whichequals the number of such years of service plus one (e.g., a House Staff Officer whohas completed two years of service in such training program shall be placed at PGY-3). A House Staff Officer required to spend a prerequisite period of service in anACGME training program in a specialty other than that in which he/she is servingshall be classified on the basis of cumulative years of such service. However, in theevent a House Staff Officer changes his/her specialty, he/she shall receive amaximum credit of two years for prior service in such other ACGME approvedtraining program.

c. When some or all of the prior service of a House Staff Officer has been in a non-ACGME approved training program, he/she shall, at minimum, be classified at the

PGY level appropriate to the years of service he/she has completed in an ACGMEapproved training program. Additional credit, if any, for non-ACGME approvedtraining programs to be granted in establishing the appropriate PGY-level for aHouse Staff Officer shall be determined by the House Staff Officer and his/herDirector of Service at the time of appointment. If, after such determination, aSpecialty Board should grant increased standing or credit, then an appropriateadjustment shall be made in the PGY level retroactive to the appointment datepreceding notice of such adjustment.

B. Office of GME Responsibilities The Office of GME will track the submission of alldocuments and completion of all processes to obtain the status of clearance and satisfactionof all credentialing items.

A full list of all requirements follows below:

Required Documents for All Trainees

NYU Resident/Fellow Application Form

HHC Application for Residency

BHC House Staff Application

Original Medical/Dental School diploma

Original final Medical/Dental School Transcript with Seal and 4th Year Grades (mustindicate ''Degree conferred'')

A letter from medical school verifying graduation (in lieu of diploma or transcript)

Letter of Recommendation #1 (dated within the last six months) from a doctor whosupervised clinical work of applicant

Letter of Recommendation #2 (dated within the last six months) from a doctor whosupervised clinical work

Current Curriculum Vitae (Must be updated within the last six months)

Dean's Letter from Medical/Dental Degree-Granting Institution

Signed NYU House Staff Contract

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Required Documents for All Trainees (Contd)

Letter of Offer from Director of Service or Program

License Requirements

NYS License (U.S. and Naturalized Citizens & Permanent Residents)

NYS Registration

NYS Limited Permit (Oral Surgery and Non-Citizens only)

Non-Accredited Programs requirements

Scope of Practice

International Medical School Graduates (IMGs) Requirement

Original, Valid Educational Commission for Foreign Medical Graduates (ECFMG)Certificate or Fifth Pathway Certificate

Requirement for Residents Who Have Had Previous Training in the U.S.

Original Certificate(s) of Training or Letter(s) from Program Director(s) certifyingsuccessful completion of all accredited training.

NYULMC Human Resources Requirements

NYU Application for Employment (House Staff/Faculty Questionnaire)

NYUHC I-9 Form (with appropriate original forms of ID)

New Hire Sheet

Consent and Disclosure Authorization Form (Sterling Testing Systems)

Background Check Questionnaire

State Central Register Form

Tisch Hospital W-4

Tisch Hospital IT 2104

Addendum Letter (rubella vaccine)

Confidentiality Agreement

Patent Agreement

Drug Free Workplace Attestation Form

Tisch Hospital Benefits

Visa Requirements

DS 2019 with valid coverage period (on a J Visa)

I-94 with "Duration of Stay" stamp (on any visa)

NYUHC I-9 Form and Taxation Analysis Form (Finalize these forms at the Immigrationoffice)(on any visa)

I 797 Form (on an H1 or O Visa)

NYULMC Employee Health Requirements

Physical Exam within the Past Year

Proof of Immunity to Rubella and Rubeola (Addendum Letter)

Proof of Varicella (Chicken Pox) Immunity

Tuberculosis Screening #1

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NYULMC Employee Health Requirements (Contd)

Tuberculosis Screening #2

Tuberculosis Fit Test (health assessment)

Proof of Hepatitis B Immunity

Mumps

Respirator FIT Testing

Bellevue Hospital Requirements

Bellevue Hospital W-4 Form

Physician Agreement

Bellevue Hospital I-9 Form

Personal Data Form (PDF)

Visi Card (Buff/folded)

NYC HHC Employment Application

BHC Fingerprinting

Electronic Fingerprinting/Payroll Deduction Authorization Form

BHC Benefits Enrollment FormBHC Benefits Waiver Form

BHC TDA Enrollment Form

BHC Deferred Compensation Forms

BHC Direct Deposit Form

BH Appointment Form

BH Employment History Card (Yellow Card)

Infection Control Certificate

Proof of Identity (and copy of visa, if applicable)

405 Attestation

Toxicology ScreeningResults

Miscellaneous Requirements

Orientation

NYU Code of Conduct

HIPAA

Corporate Compliance

Veteran's Administration Hospital Requirements

VA Packet