Policy on Local Extreme Emergent Situations, Disasters, and Interruption of Patient Care or Residency Training Programs
This policy defines the responsibilities of graduate medical and
dental education programs at the University at Buffalo in the event
of a disaster that significantly alters the residency experience at
one or more residency programs, or a local extreme emergent
situation (hereafter referred to as LEES) that directly impacts or
disrupts resident education and/or the operation of clinical
training sites and/or in the event of other situations which impede
or prevent the continued operation of a training program in any
specialty. It is the general policy of the University at
Buffalo that, in the event of a disaster or LEES, appropriate steps
by residents and available faculty will be taken to provide
assistance and support in the care of the sick and injured who are
patients of or present to any affiliated program training site(s).
Medical care and related services will be provided according to
this policy, the policies and procedures governing the management
of disasters or LEES at the respective training sites and, in the
case of residents, under the appropriate supervision by qualified
faculty. All ACGME Institutional, Common, and
specialty-specific Program Requirements remain in effect in extreme
emergent situations within the sponsoring institution (University
at Buffalo School of Medicine) and each training program. In the
event that the continued operation of a training program is impeded
permanently or for an extended period for any reason, timely and
appropriate steps will be taken collaboratively by the Office of
Graduate Medical Education and the respective program director to
secure arrangements suitable for completion of the training of
residents enrolled in the program. The Office of Graduate Medical
Education and each program are committed to reconstituting and
restructuring residents’ educational experiences as quickly
as possible following interruption/cessation, or termination of an
educational program due to unforeseen circumstances.
This policy applies to all graduate medical and dental residency
and fellowship training programs sponsored by the University at
Buffalo. Necessary action will be assessed and plans will be
implemented upon the occurrence of an emergency situation
(including disasters or LEES). Re-assessment will occur and
plans will be re-evaluated on an on-going basis until the emergency
A local extreme emergent situation (LEES) is herein defined as a
situation that is confined to a participating institution or
another clinical setting (e.g. a hospital-declared disaster for an
epidemic), impacts resident education and work environment, but
does not rise to the level of an ACGME-declared disaster.
A disaster is herein defined as any event or set of events
causing significant alteration to the residency experience at one
or more residency programs.
Interruption or termination of a training program in the context
of a disaster or for other reasons, as herein defined, refers to
the cessation of a training program either in its entirety or at an
affiliated site for reasons beyond the control of the program
director or the sponsoring institution.
Designated Institutional Official (DIO)
- Maintains familiarity with the policies of the ACGME related to
LEES or disasters.
- Maintains a current contact list of Program Directors, Chairs,
hospital representatives on the GMEC, and other key Institutional
officials (Dean, School of Medicine) including e-mail addresses,
telephone and cell phone contact numbers.
Graduate Medical Education Committee
- Periodically review, appropriately modify, and approve the
Institutional Policy on LEES, Disasters, and Interruption of
Patient Care or Residency Programs.
- Maintain familiarity with the policies of the ACGME and
sponsoring institution related to LEES and disasters.
Program Directors and Department Chairs
- Maintain familiarity with the LEES and disaster policies of the
sponsoring institution and their respective programs’
affiliated training sites and assure that all residents and faculty
are aware of their roles and responsibilities in the event of a
disruption of training.
- Maintain general awareness of local, regional, and other health
care facilities that might be called upon to participate in the
restructuring of their respective programs in the event of serious
interruption or termination of their programs.
Response to a Disaster
Following declaration of a LEES or a disaster, the DIO will work
with the affected department chair(s), program director(s) and
hospital representatives on the GMEC to determine the short-term
(up to 72 hours), intermediate term (up to one week) and longer-
term impact of the event on any training program(s). The parties
will work together to facilitate adequate response to emergency
care needs while assessing the potential impact on training
programs at risk of disruption. The educational objective will be
to restructure or reconstitute the residents’ experience as
soon as possible following the disruption to continue to ensure
that training needs are met. The DIO will be the primary contact
and coordinator of that effort.
To maximize the likelihood that trainees will be able to
complete program requirements within the specified time as required
for board certification eligibility in that specialty, the
following steps will be taken:
- If the affected hospital(s) cannot provide the needed
experiences for trainees, training needs will be accommodated at
other local sites; or
- If local sites affiliated with the sponsoring institution
cannot provide for the training needs, the DIO, on behalf of the
sponsoring institution, will work with the director(s) of the
affected program(s) to arrange temporary transfer of residents to
other sponsoring institutions able to accommodate them until the
sponsoring institution and its affiliates are able to resume
providing the educational experience.
- If the disruption permanently prevents the sponsoring
institution from re-establishing an adequate educational experience
within a reasonable period of time, then permanent transfers of
trainees will be arranged.
Designated Institutional Official (DIO)
- Promptly ascertain the potential impact of the disruption on
specific residency programs.
- Contact the affected department chair(s), program director(s)
and hospital representatives on the GMEC to advise them of the
situation and engage them in the preparation of the Institutional
response and direction of faculty at the affected site(s).
- Convene the Graduate Medical Education Committee, which will
review regular reports regarding the effects of a disruption and
act on recommendations for action regarding any affected training
programs received from the DIO, affected department chairs, program
directors and/or hospital representatives on the GMEC.
- Contact the Executive Director, Institutional Review Committee,
via telephone if a Local Extreme Emergent Situation causes serious,
extended disruption to resident assignments, educational
infrastructure or clinical operations.
- Implement the actions recommended by the Graduate Medical
- Coordinate and facilitate the response as it affects any
training program(s). If a longer term impact on training is
evident, assist and support the chair(s) and program director(s) in
making the necessary arrangements for their respective
- Throughout the response and related planning, assure adherence
to the policies of the ACGME related to LEES and disasters.
Program Directors and Department Chairs
- Establish and maintain contact with the office of the DIO and
with faculty at the affected site(s) to give direction with respect
to the deployment and supervision of residents at that and, if
appropriate, at other affiliated sites, in response to the
disruption. If interruption of a program is threatened for any
other reason, notify the DIO immediately and work with him/her to
develop an action plan.
- Monitor the situation to assess the likelihood of intermediate
and long-term impact on the training program.
- As necessary and in a timely manner, review options for
alternate arrangements for residents to minimize the impact on
their training experience.
- If alternate placements of residents for the short-term or
long-term are required, work with the DIO to make the necessary
arrangements (subject to the approval of the Graduate Medical
- At the outset of a temporary resident/fellow transfer, the
program must inform each transferred resident of the minimum
duration and the estimated actual duration of his/her temporary
transfer, and continue to keep each resident informed of such
durations. If and when a program decides that a temporary
transfer will continue to and/or through the end of a residency
fellowship year, it must so inform each such transferred
- Communicate with the appropriate Residency Review Committee
Executive Director with information and/or requests for
Interruption of a Training Program
In the event that the operation of a training program is
threatened or disrupted for reasons other than related to an
ACGME-declared disaster (e.g. interruption of care at an affiliated
site for any reason; for example an epidemic; notice of withdrawal
of support by an affiliated hospital site; inability of the program
to provide sufficient required training experiences or patient
volume for residents; loss of faculty in sufficient number to
assure adequate supervision and training), it is the policy of the
Sponsoring Institution to work with the program director and
participating site(s) to satisfactorily remediate the reason for
- The DIO will communicate with the affected program director(s),
department chair(s), and hospital representatives on the GMEC. An
effort will be made to identify options to maintain the integrity
of the program, including local realignment of the program’s
affiliations in the community.
- The Graduate Medical Education Committee (GMEC) will be
informed of the problem and efforts to develop a satisfactory
- If no local solution to the problem is possible, the DIO will
work with the program director to:
- ensure that policies of the ACGME that apply to such situations
- facilitate the placement of residents at alternate sites to
ensure that interruption of the training experience is
- The DIO will seek the approval of the GMEC for any action(s)
- The DIO will contact the Executive Director, Institutional
Review Committee (ED-IRC) via telephone only if a LEES causes
serious, extended disruption to resident assignments, educational
infrastructure or clinical operations that might affect the
Sponsoring Institution’s or any of its programs’
ability to conduct resident education in substantial compliance
with ACGME Institutional, Common, and specialty-specific Program
Requirements. On behalf of the Sponsoring Institution, the DIO will
provide information to the ED-IRC regarding the LEES and the status
of the educational environment for its accredited programs
resulting from the emergency.
- The DIO will submit any program reconfigurations to the ACGME
within 10 days of an ACGME-declared disaster and inform each
affected program’s residents of resident transfer decisions
no later than 30 days after the disaster.
It is the responsibility of the DIO to ensure that the
provisions of this policy are carried out.
The Policy will be reviewed and approved periodically by the
GMEC Approved Date: March 21, 2017