GME Policy on Grievances

I. PURPOSE

The Accreditation Council for Graduate Medical Education (ACGME) requires that every Sponsoring Institution (SI) have a policy that outlines the procedures for submitting and processing resident/fellow grievances at the program and institutional level and that minimizes conflicts of interest.

II. POLICY

New York Medical College (NYMC) supports the resolution of conflicts via collegial discussion.  In circumstances in which grievances are unable to be adequately resolved at the program level, residents/fellows may address grievances with the Designated Institutional Official (DIO) via the NYMC GME Office or formally submit grievances to the NYMC Graduate Medical Education Committee.  NYMC does not tolerate retaliation.

III. SCOPE

This policy applies to all ACGME- or CODA-accredited or recognized programs sponsored by NYMC.  For this policy, “grievance” is defined as any controversy or claim arising out of an alleged violation of any provision of program or NYMC GME policies or ACGME or CODA requirements, other than: (1) evaluation of academic or clinical performance or professional behavior, a non-reappointment decision, or any other academic matters including but not limited to probation, suspension, or dismissal. Appeals related to these academic matters are covered under the “Promotion, Appointment, Renewal & Dismissal” policy; (2) controversies or claims related to an employment contract or collective bargaining agreement (CBA) which may be grieved according to the process outlined in the employment agreement; or (3) complaints of illegal discrimination, including but not limited to, sexual harassment, that should be directed to the employing hospital’s Title IX or other appropriate office.

IV. DEFINITIONS

Resident refers to any person enrolled in a residency program accredited by the ACGME or CODA and sponsored by NYMC.
Fellow refers to any person enrolled in a fellowship program accredited by the ACGME and sponsored by NYMC.
ACGME is the Accreditation Council for Graduate Medical Education.
CODA is the Commission on Dental Accreditation.
DIO is the Designated Institutional Official.
GMEC is the New York Medical College Graduate Medical Education Committee.
Sponsoring Institution is New York Medical College.
Hospital refers to the hospital or other clinical site employing Residents or Fellows.

V. PROCEDURES

A. Program Level

1. Residents and Fellows are encouraged to first address concerns with chief residents, supervising program faculty, program faculty mentors, site directors, associate/assistant program director(s), and their program director, as appropriate to the situation.  Programs are encouraged to have mechanisms in place to address resident/fellow concerns confidentially, such as concern boxes, anonymous e-mail accounts, and the “confidential comments to the program director” function in New Innovations.  Programs are also encouraged to anonymously survey their residents, in addition to the ACGME survey, to assist in identifying trends and shared concerns.

2. If the Resident or Fellow does not believe that their concern is being adequately addressed by the informal mechanisms above, they may submit a formal grievance to their program director via e-mail with a copy to the program coordinator.  The e-mail should state that a grievance is being reported and include a factual description of the grievance, the steps previously taken to address the grievance, the program, NYMC GME, or ACGME/CODA policy or requirement that may have been violated, the date on or around which the grievant(s) first became aware of the alleged violation, any attachments or additional documentation relevant to the grievance, and the remedy sought.  Such grievances may be submitted by an individual resident/fellow or group of residents/fellows.  The program director (or their designee) must schedule a meeting within 14 calendar days with the grievant(s), the program coordinator or designee, and any other pertinent personnel (as determined by the program director).  Within 14 calendar days of the meeting, the program director (or designee) must respond to the grievant(s) via e-mail with a summary of the meeting, the conclusion(s) of the program director or designee regarding the grievance and any associated follow-up and/or remedy.   The program director (or designee) must submit a copy of the grievance and post-meeting response to the grievant(s) to the NYMC GME Office.

3. If the program director (or designee) is unable to offer a meeting within 14 calendar days, the resident/fellow should submit the grievance to the NYMC GMEC via the DIO, as below.

B. NYMC Level

1. If a Resident/Fellow does not feel comfortable addressing a concern at the program level or believes that their concern has not been adequately addressed at the program level, there are several mechanisms through which they may bring concerns to the DIO.  First, Residents/Fellows may e-mail or call the NYMC GME Office.  Residents/Fellows may also access the NYMC GME reporting link to share concerns anonymously or confidentially.  Additionally, Residents/Fellows may share concerns at regularly scheduled NYMC Resident/Fellow Town Halls, or via Resident/Fellow NYMC GMEC members.

2. Anonymous concerns submitted to the DIO via the NYMC GME Office will be investigated and addressed as soon as possible and appropriately.  Residents/Fellows submitting confidential concerns will be contacted by the DIO (or designee) and offered a meeting with the DIO to determine appropriate investigation and/or action.  Concerns submitted via these mechanisms will be shared with the NYMC GMEC at the discretion of the DIO.

3. Formal grievances submitted to the NYMC GMEC via the DIO must first undergo the formal grievance process at the program level. The grievance should be submitted via e-mail to the NYMC GME Office and should state that a grievance is being reported and include a factual description of the grievance, the steps previously taken to address the grievance, the program, NYMC GME, or ACGME/CODA policy or requirement that may have been violated, the date on or around which the grievant(s) first became aware of the alleged violation, any attachments or additional documentation relevant to the grievance, and the remedy sought.  Such grievances may be submitted by an individual Resident/Fellow or group of Residents/Fellows.

4. The DIO or designee will convene an ad hoc grievance subcommittee and schedule a meeting within 21 calendar days with the grievant(s), a member of the NYMC GME Office staff, and any other pertinent personnel (as determined by the DIO).  The ad hoc grievance subcommittee will consist of the DIO and at least 3 additional NYMC GMEC members, at least one of which being a Resident/Fellow. GMEC members from the Resident/Fellow grievant’s program will not serve on the ad hoc grievance subcommittee. The DIO and ad hoc grievance subcommittee will interview the grievant(s), program director or designee, and other meeting participants as determined by the DIO.  The DIO and ad hoc grievance subcommittee will then convene to review the grievance and any supporting information as indicated, and issue findings and recommendations by majority vote.  The DIO will vote in the case of a tie.

5. Within 14 calendar days of the meeting, the DIO or designee will respond to the grievant(s) via e-mail with a report including a summary of the meeting, the findings of the ad hoc grievance subcommittee, and any recommendations.   A copy of the report with be shared with the NYMC GMEC.

6. A final appeal to the Dean of the School of Medicine or the Vice Chancellor for Interprofessional Dental Education, as applicable may be filed by either party to the grievance. This appeal shall be in writing and include all letters, documentation, and written responses from each level. The Dean/Vice Chancellor or his/her designee will issue his/her final decision within 14 calendar days of receipt of the appeal of the grievance, unless more time is required in which case the Dean/Vice Chancellor shall notify the parties of the expected time frame of the issuance of his decision but not to exceed an additional 14 calendar days.  A copy of the Dean/Vice Chancellor’s final decision will be shared with the grievant(s) and the NYMC GMEC.

C. Resident/Fellow Support Personnel – At any meeting to address concerns or formal grievances with the program or NYMC GMEC, a Resident/Fellow may have a program faculty member or program/hospital staff member present with them.  This individual may not directly address the meeting, except to introduce themselves.  As applicable, a collective bargaining representative may accompany the Resident/Fellow to such meetings. Attorney representatives may not attend grievance meetings for any party.  It is the resident’s/fellow’s responsibility to facilitate participation of such individuals and to inform the program director or DIO, as applicable, in advance of their planned attendance. 

D. Time Limits – The Resident/Fellow(s) must initially file a grievance as set out in the following section within the current academic year (July 1 to June 30) or within 90 calendar days after the Resident/Fellow knew or should have known of the act or omission upon which the grievance is based, whichever time period is longer.

E.  Retaliation – Retaliation for good faith submission of concerns and grievances or toward individuals participating in grievance processes is never permitted.  Reports of potential retaliation must be submitted to the DIO via the NYMC GME Office.  Such reports will be investigated and addressed, as appropriate.  The DIO or designee may review Resident/Fellow or program faculty evaluations and/or audit program Clinical Competency Committee meetings as part of such investigations.  Reports of retaliation by the DIO or NYMC GME Office must be submitted to the Dean of the School of Medicine/Vice Chancellor of Interprofessional Dental Education.

VI. EFFECTIVE DATE

This policy is effective immediately.

VII. POLICY MANAGEMENT

Executive Stakeholder: Dean of the School of Medicine
Oversight Office: Office of Graduate Medical Education