RMS New Resident/Fellow Training RMS Resident Training

RMS Resident Training - 2019
RMS New Resident/Fellow Training RMS Resident Training Welcome to RMS resident training. This training takes about 30 minutes in length and covers why RMS is used and how it works. At the end of the training, you will be given a chance to log your time and ask any questions you have about this process.

RMS New Resident/Fellow Training
Objectives Learn why work hours are logged in RMS Review current ACGME work hour regulations Understand your role/responsibilities in using RMS to record and approve your duty hours Know who to go to in your program for support Learn tips for logging hours to prevent violations How your program utilizes the optional RMS modules This training is designed to teach you how to use RMS. The objectives for this training are: Learn why work hours are entered in RMS Review the ACGME workhour rules that went into effect July 1, 2017. Understand your role and responsibilities in using RMS to record and approve your work hours Know who to contact if you need help using RMS Learn tips and tricks for logging your hours to prevent work hour violations.

Tracking Work Hours: Why?
RMS New Resident/Fellow Training Tracking Work Hours: Why? Why is it important to track my work hours? Financial support Monitoring ACGME work hour violations Program management of rotations/locations in relation to violations Tracking your work hours (also called duty hours) is important to our program for a few reasons: 1. Tracking your hours helps our program receive funding from the locations where you train. Without your work hour entries, hospitals and training sites are unable to claim you and receive reimbursement for your time. 2. Our program and sponsoring institution are both responsible for monitoring work hours to make sure your workload is manageable and if there are any problems with violations, they are being addressed. 3. By accurately tracking your hours, you can help identify locations or particular rotations that are a source of frequent violations and help us to make necessary changes. On the next slides, we will go into more detail about each of these three things.

Tracking Work Hours: Funding
RMS New Resident/Fellow Training Tracking Work Hours: Funding Residents are funded through three primary sources: 1. Medicare and Other Governmental Funding 2. Training Grants 3. Training Department First, let’s talk a little about program and resident & fellow funding. There are 3 main sources of funding for accredited programs: Medicare and other governmental funding. This is the largest source of funding for most programs and will be discussed more on the next slide. Training grants. Grants are often funded by the National Institutes of Health, various professional organizations or certain hospitals or clinics. These can cover a resident’s full year of training or a particular/specialized rotation. The training department/program is responsible for funding anything that remains.

How Governmental Funding Works
RMS New Resident/Fellow Training How Governmental Funding Works 2. Residents train at affiliate hospitals 3. Hospitals receive governmental funding for resident time 4. Hospitals pay programs for resident stipend benefits 5. Programs pay residents & continue services 1. Programs hire residents Again, the largest source of funding for residents/fellows in accredited programs is Medicare or other governmental aid. Your role in the funding cycle is crucial to make sure the program is able to continue training and graduating residents and to support your activities while in the program. Here’s how the cycle works: Programs hire new residents. Residents train at affiliate hospitals. While you are doing your training, you will be logging the activities you are doing and the places they occur. This step is the basis of how all funding is determined. Where you train and what type of learning experiences you are participating in determine how billing and reimbursement take place. Depending on the type of activity and place it is being done, your time is split proportionately for reimbursement and billing. Hospitals use the information inputted by you in RMS (which we will talk about later) to submit to the government for reimbursement. Based on determined amounts, hospitals then receive money from the government for your activities and time logged. With the money that’s received, hospitals pay our program for the services you provide. The money that’s received by the program goes toward paying your stipend and benefits and to continue providing services to hire, support, and graduate residents. As you can see from this cycle, hospitals use the data you provide to directly apply for funding. Without your accurate information, hospitals and programs risk losing their biggest funding source. This is one of the main reasons why adding your time to RMS is so important. On the next slide, we will talk more about another reason why logging your time helps you and your program.

Tracking Work Hours: ACGME Rules
RMS New Resident/Fellow Training Tracking Work Hours: ACGME Rules In addition to reimbursement, tracking your time helps your program and institution monitor ACGME work hour rules and violations. Work hour tracking is required for accreditation It helps ensure both patient and resident/fellow safety Allows your program/institution the ability to monitor problematic sites & rotations and to make changes Allows YOU better management of your time by seeing violations and adjusting your schedule to prevent them Aside from reimbursement, entering your time is important to help our program and institution track Work Hour rule violations. Tracking work hour violations is a requirement for our program accreditation and it is important to ensure both you and your patients’ safety. <Discuss how your program tracks violations and what is done with the information.> In addition, when we see patterns or violations that occur frequently for a particular site or rotation, we can use these to discuss what is happening with the site and come up with ways to minimize the violations by shifting workloads or altering services. Finally, the ability for you to see violations when you are entering your time should also allow you to better manage your schedule, making adjustments as necessary to try and prevent violations. For example, if you end up working late one night and you know you will be violating a rule by not having enough time off, you should work with your supervisor and co-workers to arrange coming in late the next morning.

Your Role is Crucial in the Process
RMS New Resident/Fellow Training Your Role is Crucial in the Process Hospital Reimbursement Institution Your Program ACGME YOU YOU are really the key ingredient to making sure this whole process flows smoothly. Many people are depending on your to enter your duty hours so that they can complete their job to secure funding, report work hour violations and continue accreditation of your program.

ACGME Rules Effective July 1, 2017 The ACGME – the council that oversees most accredited graduate medical education programs in the US – sets rules for accreditation of programs. With recent changes to the rules, we frequently monitor your duty hours so that our program can make changes, if needed, to ensure these standards are met. NOTE: If your program’s accrediting body is not the ACGME, update this slide with the correct information.

Work Hour Tracking - Rules
RMS New Resident/Fellow Training Work Hour Tracking - Rules ACGME work hour rules that programs are responsible for are following: Maximum 80 Hour Work Week (Averaged Over 4 weeks) Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting. NOTE: These are the standard rules outlined by ACGME. If your program follows slightly different rules, you will have to modify these slides so they are accurate for your program! Here are the work hour rules (read off slide.)

RMS New Resident/Fellow Training Work Hour Tracking - Rules Call Frequency: Trainees must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period). Time spent on patient care activities by trainees on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every- third-night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks.

Maximum Hours: Clinical and educational work periods for trainees must not exceed 24 hours of continuous scheduled clinical assignments. Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or trainee education. Hours off between shifts: Trainees should have 8 hours off between scheduled clinical work and education periods Trainees must have 14 hours free of clinical work and education after 24 hours on duty

RMS New Resident/Fellow Training Work Hour Tracking - Rules Day Off: Trainees must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days. Night Float: Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements. Moonlighting: Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program, and must not interfere with the trainee’s fitness for work nor compromise patient safety.

So, how do I track my hours?
RMS New Resident/Fellow Training So, how do I track my hours? Programs use a system called RMS to track duty hours RMS stands for “Residency Management Suite” The RMS software was created by a company located in Ohio called New Innovations RMS is used by all accredited residency and fellowship programs in the Twin Cities area (including programs at HCMC, Regions, Allina, TRIA, and the U of M) Now that you know why it’s important to track your hours, it’s time to learn more about how to log them. Our program uses a system called RMS to track duty hours for violations and reimbursement purposes. You’re probably wondering what RMS is and what you need to do with it. RMS stands for Residency Management Suite and it’s an online product developed by a company called New Innovations (that’s located in Ohio.) Once you log into the system, there are many activities that can be done, including logging time. By logging your hours on the RMS website, this data is available to support reimbursement and other ACGME-related training requirements and audits. The same program is used by all residents and fellows in the Twin Cities to allow for consistent duty hour reporting and tracking across the hospitals and programs involved. However, each program uses the system slightly differently so if you came from another program using RMS (or have friends in another program currently,) you may be doing slightly different things in the system.

YOUR Responsibilities in RMS:
RMS New Resident/Fellow Training YOUR Responsibilities in RMS: Accurately record your daily activities in RMS in a timely fashion. Ensure that all of your time from the previous month is entered by the 5th working day of the current month. Request new activities from your Program or RMS Coordinator if you don’t see the entries you need in your assignment list. Bottom Line: YOU are the source of truth and your program and the places you rotate depend on YOU to provide accurate information! Your role in using RMS is very important. We depend on you to accurately record and approve your daily assignments in RMS in a timely manner so that we can ensure our reporting and reimbursement is correct. You are the one who ultimately knows where you are and what you are doing so we rely on you to make sure your Work Hours are up to date and correct. We recommend you enter your activities daily so that you are able to keep track, especially if you are traveling to many places. Your program/RMS coordinator will be checking often to make sure you are logging your time on a regular basis. All time for the month must be entered by the 5th working day of the new month <or the date you would like your residents to have time entered, if prior to the 5th working day> to ensure that billing and other audits can be complete. Although many of your daily activities will already appear in the list to be selected, from time to time, you may be going to a new facility or doing a new activity that does not show up in the list. If this is the case, you should work with your program coordinator to make sure that the activities that you are doing and places you go are added to the list and are accurate. The bottom line is that YOU are the true source of your activities and both the program and hospital people rely on YOU to provide accurate information about the hours and places you have worked.

Using the RMS System Logging In Home Page Changing your Password What to Log What NOT to Log How to Log Duty Hours Duty Hour Violations Tips and Tricks Now I’m going to demonstrate some activities within the program. For the first part of the demo, you can leave your machines off/closed so that I can show you some of the basics of using RMS. At the end of training, you will have a chance to practice in the system. First, I’m going to talk about the steps to log in and how to navigate in the system. Then, we will cover how to log some of the different tasks you may be doing, and finally, you will be able to enter your time from Orientation/the first week of the program.

Logging in to RMS Navigate to: Click on the “Login” button ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS): You can log in for the demo using your own login (be aware that you have more security than residents so you will see more options than they do.) Or, you can log in using a demo resident: Department: MMCGME-External Training Department Username: ggresident Password: 2017 _________________________________________________ To get to RMS, you will go to and click on the “client login” button near the top. In general, it’s best to use Internet Explorer on a PC when you’re logging your time. Although some things work with Mozilla, Chrome, or other browsers, you’ll have the least amount of problems with IE. If you ever have any trouble logging in, please contact your Program/RMS Coordinator for help. Try to gather as much information as possible about any error messages or other issues you receive so that we are able to investigate any problems.

Enter Username and Password
RMS New Resident/Fellow Training Enter Username and Password Institution Login: mmcgme Username and Password: First initial, last name (e.g., Jane Doe = jdoe) On the next screen, click “ Continue” After clicking submit, you will then be taken to the login page. Now you’re ready to enter your username and password into the boxes. At the end of this training, I will be handing out a sheet with each of your usernames/passwords as well as the login information we just covered, but for now, you can just watch my as I log in. Once you have entered your username and password, click on the “Log In” hyperlink to continue. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Home Page After logging in, you will be directed to your Department Home Page which provides an overview of all your activity. After completing login, you will be directed to our Department Home Page. This page provides you with a quick snapshot of the department. If there are any department notices, they will appear here. **Training Note: If your program uses the department home page, you may wish to point out forms (in Department Notices) or other relevant information that is stored here. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Change your password Hover over your name on the top right of the screen Select “Change Password” The resident/fellow password defaults to the first initial of their first name and full last name. Upon their initial login to RMS, they will be prompted to immediately change their password. To change a password after the initial update, hover over your name and select Change Password. Trainer Note: Instruction on how to verify resident/fellow usernames is included on page 6 of the facilitator guide distributed by MMCGME Service in conjunction with this PowerPoint. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Notifications Links take you directly to: Evaluation Tasks Curriculum Reviews Scholarly Activity Duty Hours Sign-Off The Notifications pod is located on the Home Page and directs the user to various activities awaiting completion throughout the software. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

My Favorites Navigate: Click My Favorites Select an Activity The My Favorites area includes quick links to commonly utilized modules/reports/activities, etc. The My Favorites pod is located on the Home Page and can be customized by selecting the “Add/Remove” link in the bottom right corner of the pod. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Navigating Navigate through the software by selecting a Module and then choose the area in which you wish to work. You can navigate through the software by clicking on the Main menu bar and selecting the module you would like. Again, during this training, we are going to be focusing on the Duty Hours module so that’s what you will be selecting from the list. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

The Duty Hours Module – What to Log
RMS New Resident/Fellow Training The Duty Hours Module – What to Log The Duty Hours module is where you will be log daily activities. What activities need to be logged in RMS? Any activity required by your accrediting body including: ALL Patient Care Activities (Inpatient, Clinics & Clinical Research) Didactics (Conferences, Required Journal Clubs, etc.) Non-Clinical Research Rotations In-House Call Home Call, including any time called in Time Away (Sick, Vacation, PTO, etc.) Moonlighting (Internal & External) Working at home The Duty Hours module is the place you go to log all of your daily activities. There are things that NEED to be logged and then there are things that you DON’T NEED to log. This slide shows the activities that need to be logged. In general, anything that is required by the ACGME <your accrediting body> needs to be logged. These include: Regular patient care-related activities including both inpatient and clinic time. Any required didactics or learning-related classes that must be taken such as required conferences, journal clubs, M&M, etc. Time that is spent doing research In house and Home-call. We will discuss both of these in more detail later, but both of them must be logged in RMS. Finally, any time away that you take including sick leave, vacation, other PTO, etc. If you have any questions about what needs to be logged, please ask your program coordinator.

The Duty Hours Module – What NOT to Log
RMS New Resident/Fellow Training The Duty Hours Module – What NOT to Log Which activities do NOT need to be logged in RMS? Regular days off (weekends or other scheduled days off) Holidays that you are not working Study or prep time (unless told otherwise) Travel time between activities – for this, include travel time into the activity before or after so that there are no gaps Now, let’s look at what doesn’t need to be logged in Duty Hours. Regular days off. Whether they are on the weekend or during the week, scheduled days off do not need to be logged in the system. Holidays that you are not working. If your program or clinic is closed for the day and you are not working, you do not need to log any activities on this date. Study or prep time. <Mention any program-specific assignments that may be related to study or prep time that your program would like residents to log.> If you are preparing for something in your off time, you do not need to log these hours. Travel time between activities. Instead of logging travel time specifically, it is ok to lump this time into the assignment before or after so that there is no gap between assignments.

The Duty Hours Module – How to Log
RMS New Resident/Fellow Training The Duty Hours Module – How to Log It is important to make sure you are logging your assignments to the correct location. Common hospital locations include: ABNW = Abbott Northwestern FVRS = Fairview Riverside RGHP = Regions Hospital UMMC = U of M Medical Center (Fairview) UNTD = United Hospital VAMC = Minneapolis VA Heath Care Important Note: UMN is used for any activity that takes place in a campus building that is not part of UMMC (e.g., some conferences, dept meetings, etc.) You should verify that each assignment definition you use corresponds with: The activity you performed The location where it was performed At the top of this slides are some common hospital abbreviations that are used, however there are many more for clinic and other assignments. Your role is to verify that the assignment definition that has been applied to your schedule matches the activity that you actually did during that time period. ***Note: It may be beneficial to review your actual assignment list with residents to ensure they are aware of any uncommon abbreviations for the sites they rotate to. Schedules > Assignment Definitions

The Duty Hours Module – How to Log
RMS New Resident/Fellow Training The Duty Hours Module – How to Log The Duty Hours module contains Assignment Definitions set up specifically for your program activities. Assignment definitions are named using the following convention: [Location]-[Activity Information] Example: ABNW-Cardiology-ICU Within the Duty Hours module, you will be entering the hours and places you have worked. For each of your activities, there is something called an assignment definition that’s set up in RMS. Each assignment definition is made up of a naming standard for the task you perform. These naming standards give programs and hospitals the ability to understand a lot of information about each activity that you are involved in. The naming standard for each assignment definition begins with the location where the activity is being done, for example ABNW (or Abbott Northwestern). Following the location is information about the task you are performing; cardiology in the example on the screen. Next is the actual activity you are performing. Finally, if there is any other information specific to the program, it will come at the end.

Adding Assignments using the Graphical Method
RMS New Resident/Fellow Training Adding Assignments using the Graphical Method Go to Duty Hours > Log Hours > Preferences Select the Preferences link to update duty hour entry options. Select the Horizontal radio button, choose a month/date on the calendar, and then click Continue. The graphical method is an easy way to log hours for a day or two at a time. By default, the system defaults to a vertical entry view, however, we recommend using the horizontal version because it is easier to see the assignment definitions. Once you have selected all of your options, you can click the continue button and it will take you to the logging screen. Once the resident selects “Horizontal” as their preference, RMS will automatically default to this setting. NOTE: It’s our preference to view the duty hour entry in the Horizontal view but this is not required and completely up to the users preference. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

RMS New Resident/Fellow Training Adding Assignments using the Graphical Method Using the Assignment drop-down menu, find the abbreviation for the site you would like to log and then select the activity that took place. Select a day and time on the graph and hold down the left mouse button, “painting” your time from left to right across the screen. To erase: move your mouse backward over the entry until the color disappears. NOTE: When you are finished logging, you MUST click the Save button! You will know your entry has been saved when the screen refreshes and your entries appear with a cross-hatch pattern. From the graphical screen, select an assignment definition from the drop down list. Do NOT change your “department/division” from the default. All of the assignment definitions you need should be available in the defaulted list. Make sure the assignment definition fits the location you were at and the activity you were doing. Once you find an assignment that fits, you can use your mouse to “paint” the squares of time that you were doing that assignment. If you accidentally make a mistake or want to erase hours, click on the square again and the coloring will go away. Once you have finished adding your time, select the Save button in the lower left hand corner. Very Important: You must click Save in order for your time to appear! Once you have saved your entries, the hours will be grayed out with a cross-hatch pattern. This means that they have successfully saved. In addition, if you have any duty hour violations, the affected period will be outlined in red. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). The next slide shows what the graphical screen looks like when hours are being logged.

RMS New Resident/Fellow Training Adding Assignments using the Graphical Method ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). This is a screenshot of what the graphical screen looks like (what we just talked about on the last slide.) You can see the assignment definition drop down menu near the top of the screen. At the bottom are options to save, edit entries in bulk, cancel your entries, clear them, or change your preferences.

Viewing and Editing Assignments
RMS New Resident/Fellow Training Viewing and Editing Assignments Go to Duty Hours > View Hours > Edit in Bulk From the Action drop-down menu, select Edit/Approve, Delete or Did Not Work. The Start or End dates, time and assignment may also be edited. Click Save. In addition to adding your assignments, you may need to edit them from time to time. If you notice that something you already put in is incorrect, or if you would like to view your hours, you can do that by going to the “My Duty Hours” option in the Duty Hours module. From this screen, you can enter a time frame by selecting “Preferences”, select “Update,” Then choose “Edit in Bulk” and you will see a list of entries that you have logged during that time period. If you need to make any edits to the entries, you can do so by selecting an action from the “Action” drop-down menu (Edit/Approve, Delete, Did Not Work). In addition, you may alter the start date, end date, start time, end time and/or assignment for each duty hour entry. Note: This option allows you to edit multiple entries at once. The next slide demonstrates how to edit a single entry. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Editing Assignments – Alternate Option
RMS New Resident/Fellow Training Editing Assignments – Alternate Option Go to Duty Hours > View Hours To edit a single duty hour entry, go to the “View Hours” tab and hover over the far left on the line of the instance that needs editing. A double-down arrow symbol will appear. Click edit and a new pop-up window will appear. From this new window you can change the assignment, start date, start time and/or duration, then click the “Save” button. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Training Note: It’s up to your discretion whether you wish to demonstrate the edit in bulk or single assignment edit option, or both.

Tips/Tricks The next few slides will cover some tips and tricks that will make logging your hours in RMS easier. In addition, we will cover how to log the following: In-House Call and Post-Call Home Call Vacation/Leave Other General Tips and Tricks Now that you know the basics of how to log your time, we’re going to go over a few common scenarios that can be tricky. Particularly, in-house and post-call, home call, vacation, and some general tips that will make logging your time easier.

Logging In-House Call Call should be logged the same as regular assignments According to ACGME Duty Hour Rules, second year and above residents/fellows may take call, seeing new patients for up to 24 hours You may use one assignment for the entire duration if your call lasts 24 hours or less (e.g. HCMC-Call) The first 24 hours of in-house call should be logged the same as any other assignment. You may use one assignment for the entire duration of your call if it is 24 hours or less. According to duty hour rules, residents/fellows who are in their 2nd year and above make work 24 hours consecutively seeing new patients.

Logging Post-Call After 24 hours, residents are not allowed to see new patients, but may work an additional 4 hours, for a total of 28 consecutive hours Use a post-call assignment if you are still in the hospital but are no longer seeing new patients You may also use research, conference or other didactic assignments during this period After 24 hours of seeing new patients, according to ACGME Duty Hour rules, a resident may work up to 4 more hours, provided this time is used for transferring of care, follow-up with current patients, or didactic activities. Seeing new patients is not allowed during the last 4 hours of a 30 hour call. For this 4 hour, post-call period, you should use the post-call assignment - provided you are no longer seeing new patients. You may also use assignments for conferences, didactic assignments, or lab research during this time. If you are no longer seeing new patients, make sure to switch your assignment to post-call or another “no new patients” assignment to avoid false duty hour violations from appearing on your schedule.

Logging Home Call Use a “Home Call-Not Called In” assignment for the period you are on call at home Phone calls taken at home should be counted as “Home Call- Not Called In” If you go into the hospital, choose a Home Call-Called In assignment particular to the institution you worked. (Ex. HCMC- IM Home Call-Called In or RGHP-Home Call-Called In) Remember to fill in all periods surrounding call with the “Not Called In” assignment Home call can be a little bit trickier to log. If you are on call at home, you should use a “Home Call-Not Called In” assignment to cover the period you are on call at home. If you do not go into the hospital, this assignment should be used consecutively from start to finish of the home call. Phone calls at home do not count and should be included in the regular “home call-not called in” assignment. If you have to go into the hospital, you should choose a “Home Call-Called In” assignment that reflects the hospital/institution (and sometimes program) you worked at. If you end up returning home after you get called in, remember to fill in the periods surrounding the “called in” part with the regular Home Call-Not Called In assignment. Note: Some hospitals have program specific Called-In assignments. Ex: HCMC-Surg-Home Call - Called In, HCMC-IM-Home Call - Called In, etc. On the next slide is an example of a home call scenario.

Logging Home Call (Cont.)
RMS New Resident/Fellow Training Logging Home Call (Cont.) Example of Home Call: Resident was on home call overnight from 6pm to 6am, took a phone call from 10pm-10:30pm, went into the hospital from 2am- 4am How to Log in RMS: 6pm-2am – Home Call-Not Called In 2am-4am – RGHP-Home Call-Called In 4am-6am – Home Call-Not Called In In this example, you are on home call from 6pm until 6am. During that time, you take a phone call from 10-10:30pm and you are called into the hospital from 2am-4am. To log your time in RMS, this is how it would look: From 6pm to 2am, you would use the Home Call-Not Called In assignment. Although you took a phone call during this time, that does not get included in the time you went into the hospital. Then, from 2am to 4am, you went into the hospital and were working in the Region’s OR, so you would select RGHP-Called In as that indicates you were called in to Regions Hospital. (Each institution has it’s own “Called-In assignment for you to choose from.) Finally, from 4am to 6am, you went home again so you would use the Home Call-Not Called In Assignment. Again, it is really important to surround the time you go into the hospital with the home call assignment in order to prevent duty hour violations from showing up.

Logging Time Off Log vacation, sick leave, and other PTO time in the Duty Hours module For most regular vacation/leave, the assignment you select should be: “Time Away-Does Not Extend Training- Short” If you are going to be gone for an extended period of time, work with your coordinator to update RMS ***Training Note: If you have your residents contact you to add vacation or are using the time off manager, you may need to edit this slide. If you need to add vacation to your schedule, you will have to go through the Vacation/Leave section of Duty Hours. Once you are there, you will select the start and end dates of your vacation and select the save button. Make sure you are using the “Time Away-Does Not Extend Training SHORT” assignment for regular vacation, sick, PTO, etc. If you are going to be away from the program for an extended period of time, work with your coordinator to update RMS. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Logging Time Off (Cont.)
RMS New Resident/Fellow Training Logging Time Off (Cont.) ***Training Note: If you have your residents contact you to add vacation or are using the time off manager, you may need to edit this slide. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Select the Time Away Short assignment from the Assignment Definition drop-down menu (If logging time away long, please check with your program coordinator [or other designated contact as decided upon by the program] to ensure it’s entered appropriately) Note the Start time of each entry defaults to 8:00 AM with a duration of 9 hours which should be sufficient, unless the program has an alternate preference Select the first date of vacation from the calendar on the left then wait for the screen to refresh Select the last date of vacation from the calendar on the right Click Save

Tips/Tricks Enter duty hours by the 5th working day of each month. Minimize gaps in your schedule. Time logged for past activities is automatically approved. If you are logging future activities, you will have to go back and approve them once they have occurred (your program may not allow logging future hours). Items that overlap or conflict appear with a red asterisk next to them and won’t be approved. Here are some helpful hints to take into account when logging your time. If you come across a scenario that you are unsure how to handle, contact your program/RMS coordinator. Make sure your time is entered and complete for the entire previous month by the 5th working day of the new month Try to avoid gaps in your schedule as much as possible. If you are traveling between sites, travel time may be included in the assignment before/after. The same with short breaks or lunches. These may all be included in the regular assignment definitions. Time that is logged in the past will automatically be approved. If you add an assignment for the future (or try to log in advance) the system will let you enter the time but you will have to go back and approve it once the time has passed. If you are having any problems with the Duty Hours screen or RMS, please check your browser and computer. RMS works best on PCs that use Internet Explorer. Although some functionality has been built to work with Safari, Chrome, and Firefox, New Innovations only guarantees that its functionality will work on PCs using the latest version of Internet Explorer. Items that overlap or conflict appear with a red asterisk next to them. Items that overlap cannot be approved until the conflicting item has been corrected. If you have hours that you think you approved that are not showing up, check to see if there are conflicts and fix them in order to approve.

Work Hour Violations Duty Hours > View Hours Duty hour violations will appear in red To add a comment, click on the notepad icon To add a cause, click on “Details” to the far left of the log. View Hours Duty Hours > View Hours When viewing/editing in bulk the duty hour entries, violations will appear in red as illustrated in the screenshot. Comments can be entered by clicking on the notepad icon associated with the entry in questions. Notice that if a comment is already entered, the notepad displays with a green checkmark. To add a “cause” for the violation, click on Details to the left of the log. In the Graphical Entry (Not Pictured) violations will display as a red outline around each cell. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Edit Delete Details

Duty Hour Violations You may use the “Violations” tab to see your violations. You may add a “cause” for the violation by clicking on the Rule that was violated for that log. Another way to view violations is to click on the “Violations” tab in the “My Duty Hours” section. Once you are on this tab, you can see your violations in the last 30 or 90 days, 6 or 12 months in the “Violations” box. The ACGME allows residents to stay or return to duty for a limited number of reasons including for continued care of an extremely ill patient, extraordinary/rare training experience, or other compassionate reason. If you have violated your hours for one of these reasons, you can add cause by clicking on the rule for that. log. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Causes for Violations Duty Hours > Violations The resident/fellow has the option to click on the hyperlinked name of the rule to get more detail on the violation. From there, the resident/fellow can click on “Add a cause” to select a cause for the violation. Note: Causes can also be accessed from the Violations tab. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Add Cause Duty Hours The resident/fellow can select a cause from the drop-down menu, then click “Add.” Multiple causes may be selected for one violation (as many as necessary). Administrators will also have the ability to add a cause on behalf of a resident/fellow. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Other RMS Modules You Will Use
RMS New Resident/Fellow Training Other RMS Modules You Will Use View Rotation Schedules View and Approve Curriculum View Conferences/Conference Reports Complete Evaluations/Run Reports Enter Scholarly Activities & Journal entries View Portfolio Reviews Enter & View Procedures View Milestones Report ***Training Note: Customize this slide to include only the modules that your program uses. Also, only cover the following slides for modules that your program uses.

My Rotation Schedule & Curriculum
RMS New Resident/Fellow Training My Rotation Schedule & Curriculum Curriculum Information Rotation Information Schedules > My Rotations Curriculum is hyperlinked in the resident/fellow block schedule. Clicking on the hyperlinked curriculum (noted on the screen by the green “Curriculum” box), will allow the resident/fellow to view curriculum associated with the specific rotation (as pictured in the next slide). ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

My Rotation Schedule & Curriculum
RMS New Resident/Fellow Training My Rotation Schedule & Curriculum This page is accessible by clicking on the hyperlinked curriculum via the block schedule (as pictured in the previous slide). The resident/fellow can click on the hyperlinked document(s) in the “Curriculum” column to view the attached documents. The resident/fellow must then click on the “Confirm” hyperlink to the right-hand side, to date and time stamp confirmation of reading the required document(s). Note: Residents/fellows will only be able to confirm reading the documents x (determined by the program) number of days before the rotation begins, but at any point after the rotation starts. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Conference Schedule This slide demonstrates how a resident can access their conference calendar (Conferences > Calendar). Click on the conference occurrence in the calendar to get more details on a specific conference. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Conference Surveys Click Complete to fill out the survey or click Skip to remove it from the grid This slide demonstrates how to access Conference Surveys via the Notifications tab on the Home page. From here, you can either complete or skip the conference surveys. Residents can also access conference surveys from the top menu ribbon by selecting Conferences > My Surveys. (The method in which trainees access surveys is up to trainee/program preference.) ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Conference Attendance
RMS New Resident/Fellow Training Conference Attendance This slide demonstrates how a resident can access their Conference Attendance Report (Conferences > My Attendance). The Conference Attendance Report will display a list of all conferences for the program and whether the resident was marked present, tardy or excused. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Conference Attendance
RMS New Resident/Fellow Training Conference Attendance Sample of the My Conference Attendance Report. The report will only display information for the resident/fellow logged in. It lists each conference by conference category, topic, date, sub-content (if applicable), rotation, CH=Credit Hours (not required), OCH-Other Credit Hours (not required), and whether they were marked present, tardy or excused. The bottom section of the report lists your overall conference attendance percentages by conference category. If the percentage is highlighted in red, it means that you are nor meeting the attendance requirements determined by your program. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Evaluations The Notification pod (Pictured above) is located on the resident/fellows Home page. Note that if the Evaluation Notifications only appear when there are evaluations due for completion. Clicking on the “x evaluations to complete” hyperlink will open a page where each evaluation can be completed. Click each instance of an evaluation to complete. There is a display panel to the right side of this screen (not pictured) that provides an overview of current evaluations either available for completion or in draft form. Residents/fellows can also access this area from the top menu ribbon by selecting Evaluations > Complete an Evaluation. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Assess Enter feedback, sign, and submit Sample Evaluation. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

View Completed Evaluations
RMS New Resident/Fellow Training View Completed Evaluations This allows the resident to view all evaluations that they completed on other people, rotations, or the program and view evaluations that others have completed on them (excluding any anonymous evaluations). Evaluations > Completed Evaluations ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Evaluation Reports Evaluations >Reports The Overall Report shows the results from every question on every evaluation form that was used to evaluate the resident/fellow. Comments are displayed by default. This report displays the following information: Name of the evaluation form Question text Grade scale used Their average on that question The Minimum and Maximum scores received, along with the Standard Deviation Check Scoring Details to view a graphic representation of the results ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Tags Report The Tags report displays the results from Custom Tags placed on General questions. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Comments Report There are four reports that can be generated to show evaluators' comments about you: Comments by Evaluator Comments by Rotation Comments by Tag Comments by Form

Other Reports Subcompetency Report The Subcompetency tab displays the results of evaluations completed on the resident where the questionnaires contain the following: Actual subcompetencies Responses mapped to subcompetencies, such as EPAs, custom subcompetencies and custom questions Milestones Report The Milestones tab displays the results of milestone questions. Competency Report The Competency tab displays data collected about the resident from Custom Questions where the Categories have been linked to Core Competencies. Compliance Report This report shows if the resident is compliant with completing evaluations assigned to them. Exportable Data This tab shows the actual scores given to the resident on each question. Click Excel to export this data to a spreadsheet format.

View Your Portfolio Reviews
RMS New Resident/Fellow Training View Your Portfolio Reviews Portfolio > Reviews Allows the resident to view all Portfolio reviews that have been completed on them. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

View Your Portfolio Reviews (Cont.)
RMS New Resident/Fellow Training View Your Portfolio Reviews (Cont.) Sample Portfolio review ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Add Your Comments & Signature
RMS New Resident/Fellow Training Add Your Comments & Signature Designated area for the resident to enter comments on the Portfolio review and also sign the review. NOTE: The option to allow subject signatures on the review form must be configured in your program specific review form template(s). To configure this setting, select Portfolio > Form Templates (Under Review Header) > Click Edit (Or New if creating a new Form) > Under the Signatures & Comments section, check the box for “Allow comments from Subject” (and any other status types that may apply). Keep in mind that this only adds the comment option going forward, it does not retroactively allow for comments on completed reviews. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Add Scholarly Activities
RMS New Resident/Fellow Training Add Scholarly Activities Portfolio > Scholarly Activity > New> Select a scholarly activity from the drop-down menu > Log the selected activity This slide demonstrated how the residents access the scholarly activity portion of the Portfolio module to log new activities. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Add Scholarly Activities
RMS New Resident/Fellow Training Add Scholarly Activities Enter Activity Details Select Core Competencies Add files and Contributors Demonstration of logging a scholarly activity. Enter the activity details (those noted with an orange asterisk are required), then select the core competencies to which the log applies, choose the contributors and add pertinent files. Portfolio > Forms (under the Scholarly Activities header) > ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Journaling Residents can complete Journal entries via the Portfolio module. Journals are collections of individual journal entries created by users in the Portfolio module. Anyone who has access to the Portfolio module can create journal entries independently. These journal entries can be kept private so that only the author may access them. Or they can be made public, which means that the Program Director, Associate Program Director, Advisor and Program Administrator can see the entry. Anyone who has access to the entry can comment on it. Alternately, administrators can create journaling assignments for trainees in their program. Portfolio > Journal ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Journaling Public Journal Entries can be seen by administrators and key educators like the Program Director and Advisors Private Journals can only be seen by the author Demonstration of how to complete a Journal entry. Select “Add New Journal Entry” (displayed on previous slide). Then, can click over “My Journal Entry” to begin typing a header. You may click over “Start writing here…” to begin typing the journal entry. You can select whether the entry should be public or private. Under Core Competencies, clicking on the hyperlink (Practice-Based Learning and Improvement) will open a checklist where you can select which core competency this journal entry is related to. Then either select Save Draft, Publish or Cancel. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Journaling Assignments
RMS New Resident/Fellow Training Journaling Assignments Portfolio > Journal > Show Assignments This slide demonstrates access to the Journal assignments. Clicking the “Show Assignments” link opens a window where you can complete the assignment. The next slides demonstrates completing a Journal assignment. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Journaling Assignments
RMS New Resident/Fellow Training Journaling Assignments Note the instructions and click the journal page to begin writing. Click Publish to submit the assignment Once the assigned journal entry is complete, be sure to click the “Publish” button. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Resident Introduction

Log Procedures Enter Procedure Details Select Supervisor Save and Retain information or Save and Clear the form Click View Log Listing to see Procedures logged Logger > Procedures The procedure logger form is configured by a program administrator for residents/fellows to complete. Note: Clicking the “Add Procedure” link allows you to add another procedure to the same patient. Be sure to click the “Save” button at the bottom of the screen once the entry is complete. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

View Log Listing Logger > Procedures and choose the View tab / Alternately, the log listing can be accessed by selecting Logger > Procedures > View Log Listing Note that the date range can be edited as pictured on the slide. The list displays all procedures logged by the resident/fellow be date, Procedure type, supervisor, passed/not passed, confirmation status & confirmation date. Once a procedure has been confirmed by the supervisor, it can no longer be edited or deleted by the resident/fellow. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS). Change date range and Choose what to view from the “Show” drop-down menu.

Milestones – Resident Review Report
RMS New Resident/Fellow Training Milestones – Resident Review Report Portfolio > My Milestones The Milestones feature is variable by program. Be sure to modify the information you share to fit how your program manages the milestones: How often are the reviews performed? How are the results shared? Who will they talk to about their results? The Resident Review Report is a spider graph that displays the Milestone Review scores given to the resident for each review period with the detail below providing information on the current period. Each spoke of the spider graph represents a sub-competency, such as Patient Care 1 (PC1) and the concentric circles represents the scores from 0 to 5. ***Demo – you may want to demo this for your residents/fellows rather than going through the slides (Hide this slide if doing a demo and switch to RMS).

Next Steps Begin using RMS immediately Use RMS at least weekly to enter the assignments you worked Contact your Program/RMS Coordinator if you have any questions about which assignment(s) you should be using Remember: Your work hours are viewed by many people including your PD, Program Coordinator, GME office, hospital coordinators and billing and reimbursement people who all depend on you to accurately enter your activities! Read your curriculum and complete your evaluations on a timely basis! So what are your next steps? First, begin using RMS immediately (Program Coordinator will conduct periodic audits to ensure information is accurate and current). Next, go into RMS regularly to approve/update your schedule. If you are unable to find an assignment definition that fits what you are doing, contact your Program Coordinator for help or so that they can add a new assignment for you to use. Finally, remember that a lot of people depend on and will be viewing your work hours so it is essential that you enter them accurately and on time.

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