Requirements and Standards

Essential Requirements and Technical Standards for GME Trainees

Introduction

All candidates for any Duke Graduate Medical Education programs must meet the criteria and perform the functions necessary to successfully complete the program. To achieve the optimal educational experience and to maintain patient safety, trainees are required to participate in all phases of the training program. The study of medicine and its specialties and subspecialties is not a pure intellectual exercise. Rather a demonstration of observation, communication, motor, intellectual/conceptual, integrative and quantitative abilities, behavioral and social attributes and ethical and legal standards are needed to be a successful intern, resident or fellow. To be successful, one must progress with increasing independence throughout the program and by the time of program completion must be capable of competent and independent practice in that field consistent with programmatic core competencies including patient care, interpersonal communication skills, medical knowledge, systems based practice, practice based learning and improvement and professionalism. The essential functions of the trainee’s role required to meet these core competencies will increase and evolve as the trainee advances through the training program.

Essential abilities and characteristics required for the completion of the training program consist of certain minimum physical and cognitive abilities and sufficient mental and emotional stability to complete the entire training program. Trainees must possess all of the requirements defined as technical standards listed in the six categories below, which in conjunction with individual program qualification criteria constitute the training program. Although these standards serve to delineate the necessary abilities of all candidates and successful trainees, they are not intended to deter any individual for whom reasonable accommodation will enable the performance of the essential functions to complete the training program. Individuals with questions regarding technical standards are encouraged to contact Duke’s Office of Employee/Occupational Health and Wellness immediately to begin to address what types of reasonable accommodations may be considered. Individuals with questions about Duke’s reasonable accommodation process may contact the office of Employee Accommodations with the Disability Management Systems at (919) 684-8247.

Individual programs may require more stringent, specific or extensive abilities or additional essential functions as appropriate to the requirements for training in that specialty. Individuals are encouraged to contact specific Duke Programs to see if additional expectations apply.

Programs that do not oversee all of the services required by their own discipline must work closely with other program directors with authority over services on which their trainees will be required to rotate. This is necessary in order to obtain copies of the other programs’ most recent technical standards and ensure trainees meet technical standards in all areas required for completion of their program.

Technical Standards

  • Observation-related Patient Care: Trainees must be able to:
    • Observe materials presented in the learning environment including, but not limited to, audiovisual presentations, written documents, tissues and gross organs in the normal and pathologic state and diagnostic images.
    • Accurately and completely observe patients and/or their records both at a distance and directly in order to assess findings.
    • Where relevant to specialty, obtain a medical history and perform a complete physical examination in order to integrate findings based on these observations and to develop an appropriate diagnostic and treatment plan for management of patients.
  • Communication: Trainees must be able to:
    • Communicate effectively, efficiently, accurately, respectfully and sensitively with patients, their families and members of the health care team.
    • Perceive non-verbal communications, including facial expression, body language and affect.
    • Respond appropriately to emotions communicated verbally and nonverbally.
    • Synthesize accurately and quickly large volumes of medical information from different types of written forms and formats, electronic medical records, both typed and hand written, that constitute the medical history.
    • Record information accurately, clearly, and timely.
    • Communicate effectively in English with other health care professionals in a variety of patient settings including a variety of hand written and computerized record systems.
  • Motor Function-Patient Care (may vary based on specialty): Trainees must be able to:
    • Elicit information from patients and perform physical examinations and diagnostic maneuvers, such as palpitation, auscultation, and percussion, as required by the specialty.
    • Carry out diagnostic maneuvers required by the specialty (e.g. positioning patients, coordinating gross and fine motor movements).
    • Respond to emergency situations in a timely manner and provide general and emergency care that may necessitate the coordination of gross and fine motor movements, equilibrium and sensation.
    • Adhere to universal precaution measures and meet safety standards applicable to inpatient and outpatient settings and other clinical activities.
    • Manipulate equipment and instruments to perform basic diagnostic tests and procedures as required to attain training program standards (e.g. stethoscope, central line sets, ultrasound etc.).
  • Intellectual/Conceptual, Integrative, & Quantitative Abilities/Medical Knowledge: Trainees must be able to:
    • Perform calculations necessary to solve quantitative problems as required by patient care and testing needs.
    • Collect, organize, prioritize, analyze, synthesize and assimilate large amounts of technically detailed and complex information in a timely fashion and with progressive independence. This information will be presented in a variety of educational and clinical settings including lectures, small group discussions and individual clinical settings. Attendance may be required in person and/or virtually.
    • Analyze, integrate, and apply information for problem solving and decision-making in an appropriate and timely manner for the clinical situation.
    • Comprehend and learn factual knowledge from multi-modal education teaching materials including but not limited to written material, didactic sessions, simulation, video.
    • Apply knowledge and reasoning to solve problems as outlined by the curriculum.
    • Recognize, comprehend and draw conclusions about three dimensional spatial relationships and logical, sequential relationships among events.
    • Formulate and test hypotheses that enable effective and timely problem solving in diagnosis and treatment of patients in a variety of clinical modalities.
    • Develop habits for lifelong learning and professional development.
  • Behavioral and Social Attributes/Professionalism: Trainees must be able to:
    • Demonstrate the maturity and emotional stability required for full use of intellectual skill, exercise good judgment, and have the ability to complete all responsibilities attendant to the diagnosis and care of patients.
    • Develop and demonstrate a mature, sensitive and effective relationship with patients and colleagues.
    • Tolerate work hours consistent with ACGME duty standards and specialty requirements, including call, sustained work periods and up to 80 hours/week of clinical work or the specialty-specific duty hours.
    • Function effectively under stress, display flexibility and adaptability to changing environments during training and patient care, and manage a variable and increasing clinical workload.
    • Function effectively in the face of uncertainty and ambiguity in rapidly changing circumstances.
    • Behave in an ethical and moral manner consistent with professional values and standards.
    • Exhibit sufficient interpersonal skills, knowledge, and attitudes to treat all patients, colleagues and health team members with respect regardless of race, ethnicity, primary language, disability, gender, sexual orientation, socioeconomic status, religion or age.
    • Cooperate with others and work collaboratively as a team member.
    • Demonstrate insight into personal strengths and weaknesses.
    • Seek the advice of others when appropriate.
    • Demonstrate regular and reliable attendance sufficient to meet patient care needs and to have sufficient concerted opportunities to observe, practice and develop and improve clinical diagnostic, technical and decision-making skills.
    • Be punctual and present at all assignments when expected or notify supervisors according to program policy.
    • Complete work including documentation and dictations in a timely manner.
    • Recognize, acknowledge, and take appropriate responsibility for conflicts of interest, mistakes and adverse outcomes and cooperate in their resolution.
    • Remain awake and alert for assigned duty periods and teaching activities within duty hours and abide by rules and policies.
  • Licensure and Legal Standards:
    • Trainees must meet the legal standards to be licensed to practice medicine in the State of North Carolina. As such, applicants must acknowledge and provide written explanation of any felony offense or disciplinary action taken against them prior to matriculation in any Duke GME Program.
    • Should the intern, resident or fellow be convicted of any felony offense, or any offense that puts medical licensure at risk, while in a GME Program, he/she agrees to immediately notify the Program Director and the Director of GME as to the nature of the conviction.
    • Failure to disclose prior or new offenses can lead to disciplinary action that may include dismissal.


 

Process

Program directors must recognize and meet their responsibilities to verify that at program completion, trainees are have demonstrated the knowledge, skills, and behaviors necessary to enter autonomous practice within the specialty or subspecialty consistent with applicable Board requirements.

Duke’s Office of Graduate Medical Education has a commitment to provide equal opportunities for qualified interns, residents and fellows with disabilities who apply for admission to any of Duke’s GME programs, and is equally committed to supporting those who may develop a disability during training. Duke’s Office of GME is a leader in diversity and individual rights, with a strong commitment to full compliance with state and federal laws and regulations (including the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990). Admitted candidates who have a disability and need accommodations to perform the essential functions of the training role should initiate discussions with the Program Director as soon as the offer of admission is received and accepted. The Program Director should refer trainees to Duke’s Disability Management System for further guidance. Current trainees who have a new disability during training can also access the Disability Management System directly or with the assistance of their program director, the office of GME or Employee and Occupational Health.

If you have any questions about this document, program expectations or the disability accommodations process, please contact Duke’s Disability Management System at 919-668-1267, or the Office of GME at (919) 684-3491.

Revision History:
February 2024