Summative Letter

Purpose:
In order to comply with the Essentials of Accredited Residencies for Graduate Medical Education, this policy is set forth by the The University of Arizona/UPHH-Kino Graduate Medical Education Consortium Graduate Medical Education Committee (GMEC) to assure that At the conclusion of the residency, or at any significant milestone within the residency period, the program director will prepare a summative letter for each resident.

Policy: 

1. At the conclusion of the residency, or at any significant milestone within the residency period, the program director will prepare a summative letter, which outlines to what extent the resident has mastered each component of clinical competence, including:
   
   1. patient care
      
   2. medical knowledge
      
   3. practice-based learning and improvement
      
   4. interpersonal and communication skills
      
   5. professionalism
      
   6. systems-based practice
   
   In addition, the summative letter should verify that the resident has demonstrated sufficient professional ability to practice competently and independently based upon a composite evaluation obtained from teaching faculty within the department.
   
   
2. Following a meeting with the resident to discuss the contents of the summative letter, the resident will sign the letter, acknowledging that s/he has had an opportunity to review and to discuss it with the program director, and that s/he either agrees or disagrees with its content.  If, after discussion with the resident, the program director determines that the letter should/could be changed, s/he should do so.
   
   
3. Program directors are required to provide verification of residency education for any residents who may leave the program prior to completion of their education.  Written documentation must include verification of previous educational experiences, a statement regarding the performance evaluation of the resident and, an assessment of competence in the six general competencies noted above.
   
   
4. The GMEC will document that each program is preparing a summative letter for each resident.  The process of documentation will be included in the Internal Review.
   
   
5. A release of information (see attached) will be prepared, which the program director will present to the resident, along with the prepared summative letter.

1. All requests for information should be documented in the resident's file.  A copy of a written request, along with the response to the written request, should suffice to keep a log of inquiries.
   
   
2. When an inquirer seeks information, the program should send a copy of the summative letter, without augmentation or verbal comment.  Each residency program should maintain a centralized system for responding to requests for information, so that copies are disseminated only from one source.
   
   
3. If the resident has signed a release as set forth above, it is not necessary to send a copy of the summative letter to the resident each time an inquiry regarding his/her tenure with the University is received.
   
   
4. Records relating to employment of residents at The University of Arizona are personnel records and are subject to the provisions of Arizona Board of Regents Policy 6-912, which states, in relevant part:
   
   
   1. Access or Disclosure to Third Parties
      Access to or disclosure of personal records or information shall not be provided to individuals or agencies other than those designated by the universities as mentioned in sections A and B above, except as follows:
      
      1. The following information regarding present or former employees may be disclosed:
         
         1. Name
            
         2. Titles or positions (including academic degrees and honors received)
            
         3. Fact of past or present employment
            
         4. Dates of employment
            
         5. Salaries or rates of pay
            
      2. An individual's dates of attendance at work and home address may be disclosed in response to a subpoena issued by a properly identified law enforcement authority.
         
      3. Access to personnel records or disclosure of personnel information may be provided when necessary to protect the interests of the institution when the institution believes the actions of the individual violate the conditions of employment or otherwise threaten injury to the institution or others, to a properly identified law enforcement authority when the institution reasonably believes that an applicant, employee or former employee may have engaged in illegal activities, or pursuant to a federal, state or local government statute or regulation that specifically requires disclosure of certain information to certain parties.
         
         
      4. Access to certain personnel records or disclosure of personnel information may be provided in response to a lawfully issued administrative summons or judicial order, including a search warrant or subpoena, provided:
         
         1. that legal counsel has reviewed the matter and approved disclosure; and
            
         2. that, if the request is not issued on behalf of the affected employee(s), a reasonable effort has been made to notify the affected employee(s) of the request prior to compliance therewith
            
         3. In addition, the institution receiving such a summons or subpoena may seek a protective order to prevent disclosure of certain documents, such as promotion and tenure files, letters solicited from outside reviewers who were given a promise of confidentiality, and performance evaluations, on the basis that a qualified privilege exists to protect documents in the employee evaluation system for making determinations of employment retention and the granting of tenured or continuing status.
            
         4. Access to personal records or disclosure of personnel information may be provided in compelling circumstances affecting the immediate health or safety of the individual or others.
         
         
      5. Public Documents Statute
         Personnel records and information are confidential and their disclosure, other than as provided for in this policy, would be contrary to the best interests of the state.  Accordingly, except as provided for in this policy, personnel records shall be treated as exempt from the public documents statute.
      
      Unless a resident has signed a release as set forth above, the only information that may be disclosed about a residents is that permitted by ABOR Policy Manual 6-912.
   
   Arizona Medical Board Inquiries
   A.R.S. § 32-1451 requires physicians and other providers of health care to report evidence that a physician is incompetent or guilty of unprofessional conduct to the Board.Any information supplied in good faith to the licensing board will not subject the individual to an action for civil damages as a result thereof.  It would still be helpful to have a signed release in cases where a resident is applying for licensure, to defend against a charge of gratuitously providing defamatory information.

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