Wright State University Boonshoft School of Medicine
Sponsored Graduate Medical Education Programs
Item 201 Residents - Selection
Item 203 Residents - Goals and Responsibilities
Item 204 Residents - Appointment to SOM Special Faculty Status
Item 205 Residents - Air Force Emergency Room and Medical Officer of the Day (MOD)
Item 206 Physical Examinations and Immunizations
Item 207 Diplomas
Item 208 Fatigue, Supervision, Duty Hours
Item 209 Rotations Between and Among Programs
Item 210 Patient Care Activities Outside of the Educational Program ("Moonlighting")
Item 211 Benefits, Leaves, Support
Applicants with one of the following qualifications are eligible for appointment to WSU sponsored programs:
- Graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME).
- Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA).
- Graduates of medical schools outside the United States and Canada who meet one of the following qualifications:
- Have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates, or
- Have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction.
- Graduates of medical schools outside the United States who have completed a Fifth Pathway program provided by an LCME-accredited medical school.
Programs will select from among eligible applicants on the basis of their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation and integrity. Programs will not discriminate with regard to sex, race, age, religion, color, national origin, disability, or veteran status.
In selecting from among qualified applicants, WSUSOM sponsored programs participate in the National Resident Matching Program (NRMP), and Armed Forces Selection Boards whenever available and applicable. All selections are made by the program director in collaboration with the teaching faculty.
The qualities of an effective physician include professional attitudes and interaction with peers, teachers, patients, and other members of the health care team. In addition to excellence in cognitive and performance aptitudes, residents are expected to develop and display impeccable professional attitudes and behaviors that meet the needs and expectations of the community and the medical profession.
Residents should view these responsibilities from three distinct but overlapping perspectives:
- as a physician for patient care,
- as a program trainee to the attending physicians and to the administrations of sponsoring hospitals and the Boonshoft School of Medicine, and
- as a physician to the community and to society in general.
As enumerated in the WSUBSOM Graduate Medical Education Agreement, residents agree to:
- develop a personal program of self-study and professional growth.
- participate in safe, effective, and compassionate patient care under supervision, commensurate with his or her level of responsibility.
- participate fully in the educational activities of his or her program and, as required, assume responsibility for teaching and supervising other fellows, residents, and students.
- participate in institutional activities involving the hospital medical staff and adhere to established practices of the institutions.
- participate in institutional committees, especially those that relate to patient care review activities.
- apply cost containment measures in the provision of patient care.
- obtain a training certificate to practice medicine and a permanent license as required in the Resident and Fellow Manual.
- conform to all policies as set forth in the Resident and Fellow Manual.
Residents can be licensed by the state to practice medicine. Licensure assistance will be provided by the program director and the director of medical education of a resident's employing hospital (see Item 301 and Item 302). State licensure is mandatory if a resident assumes responsibility for patient care outside of the supervision of an accredited training program. Physician responsibility assumed in caring for patients is distinctly different from that assumed by a non-clinical graduate student.
Resident appointments are considered full-time commitments. The specific hours of duty for each program will be determined by the program director in collaboration with the teaching program's faculty. Any work outside of the program, such as "moonlighting," must have specific approval by the program director.
To advance to the next year of training, the resident must:
- demonstrate the competence, efficiency, and maturity necessary to assume increasing responsibilities for teaching and supervising other residents, fellows, and students.
- acquire appropriate cognitive medical knowledge.
- competently obtain thorough medical histories, perform complete physical exams, develop rational differential diagnoses, and implement appropriate management plans for treatment of patients appropriate to his or her level of responsibility to advance to the next level of training.
- assume appropriate responsibility for patient care.
- demonstrate approved creativity in the advancement of patient care and medical knowledge appropriate to his or her level of responsibility to advance to the next level of training.
The Boonshoft School of Medicine expects that residents will be able to demonstrate the following at the conclusion of their educational program:
- Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
- Medical knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
- Practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
- Interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals
- Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population and
- Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value.
BSOM residents are eligible for special faculty appointments. These appointment terms extend only through the approved period of training in a residency or fellowship program. Because of the educational intent and defined term of these programs, special faculty members are not considered for continuance that is applied to regular faculty members. Residents/Fellows in BSOM-sponsored programs receive the title Resident (Fellow) Instructor. Residents/Fellows in affiliated programs can receive the title Clinical Resident (Fellow) Instructor.
At the present time, there is no MOD requirement for military residents assigned to Wright-Patterson Medical Center. However, the BSOM supports in principle the assignment of duties as MOD for Air Force physicians in training, provided that the MOD duties do not interfere with the ability of the resident to meet training program requirements and obligations. Should the need of the Air Force change in the future, resident assignment to MOD schedules could be resumed, and added to the usual requirements of the residency program. Any such duty would be monitored closely to prevent total work hours per week from exceeding mandated standards.
All residents must agree to a health evaluation upon initial appointment. The health evaluation may be done at the employing hospital. The institution providing the health evaluation shall absorb the costs of such evaluation.
All residents must have a TB skin test annually unless they are positive reactors, in which case they must have a chest X-ray annually. Residents must be in compliance with infection control policies of the affiliated hospitals.
Residents shall have the option of an annual follow-up health evaluation during the term of their employment.
Health evaluations shall include any testing required by the employing institution.
If the health evaluation reveals a condition requiring specific diagnostic studies or treatment, the resident is expected to choose a physician to conduct such studies or treatment. Costs not covered by the health insurance plan must be borne by the resident.
Because of occupational exposure to certain infectious agents, healthcare workers constitute an important target for immunizations. Many residents may be able to provide evidence of immunity or previous immunizations. If not, however, the following immunizations are required for all residents unless a specific contraindication to immunization exists:
- Hepatitis B Vaccine
In addition, all residents must be in compliance with the immunization policies of the institution which employs them.
Upon completion of a program, the resident will receive a diploma of completion, considered an official document, as distinct from a legal one. In both sponsored and affiliated programs, and where participating and cooperating hospitals and the BSOM chair think it appropriate, residents may request and receive a diploma from the individual hospital. If evidence of completion of an internship is needed, the appropriate hospital will prepare documentation in the form of a letter.
Upon recommendation of the program director, residents who have successfully served a portion of a residency program shall receive a residency diploma for the served training period. This will confirm participation in an accredited residency program.
Upon completion of a fellowship program, the fellow will receive a diploma, signed by the dean of the Boonshoft School of Medicine and the program director.
Graduate medical education programs should produce competent physicians capable of independent practice. PGY-1 residents will be regularly and directly supervised by experienced physicians, including by more senior residents and faculty. Senior residents should have well-developed patient care skills and should require only periodic, indirect supervision. Residents must assume progressive responsibility for patient care and recognize their limits, seeking consultation from attendings and supervisors in a timely fashion.
In residency training, impaired performance means missed opportunities for learning and, at worst, hazards to patients.
- Fatigued residents typically have difficulty with:
- Appreciating a complex situation while avoiding distraction
- Keeping track of the current situation and updating strategies
- Thinking laterally and being innovative
- Assessing risk and/or anticipating consequences
- Maintaining interest in outcome
- Controlling mood and avoiding inappropriate behavior
- Signs of fatigue include:
- Involuntary nodding off or waves of sleepiness
- Problem of focusing
- Irritability or mood lability
- Poor coordination
- Difficulty with short-term recall
- Tardiness or absences at work
- High risk times for fatigue-related symptoms are:
- Midnight to 6:00 a.m.
- Early hours of day shifts
- First night shift or call night after a break
- Change of service
- First two to three hours of a shift or end of a shift
- Beginning of residency or new to night call
- Methods to limit fatigue-related problems include:
- Following the 80-hour limit of the total number of hours worked.
- Establishing a workload that allows for as little variation in work schedules as is feasible. Rapid or frequent shifts from day to night work are known to increase the risk of fatigue.
- Creating individualized schedules to accommodate idiosyncratic energy cycles.
- Encouraging residents to consult their primary care physicians if daytime fatigue seems out of proportion to the workload. Sleep studies may be warranted.
- Obtaining diagnosis and treatment to determine if fatigue is depression or other psychiatric syndrome.
Residents must develop the knowledge, skills, and attitudes to deliver patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. A supervisor must continuously assess the skills of residents, the amount of independence to be granted, and the level of supervision required. This supervisory level must assure the provision of safe patient care, maintain expected professional standards, and encourage the pursuit of orderly intellectual and professional growth.
Individualized Learning Priorities
At the onset of each rotation, supervisors should assess the professional experience of their residents including areas of strength and weakness. This evaluation can start with the review of written evaluations of previous performance and continue through discussion with the resident as well as close observation of early performance in all phases of patient care. Each educational rotation should be individualized and emphasize areas where residents need more attention to achieve ideal patient-care skills. The supervisor and the resident should jointly formulate those learning objectives. The supervisor should also recognize individual differences among residents, such as special areas of interest, and compensate for them. Residents should know the goals and objectives they are expected to achieve during the rotation.
The Supervisor's Role
The supervisor should motivate residents toward independent learning, self-reliance, and intellectual competence, as well as cultivate curiosity, critical thinking, and mature understanding. Residents need assistance in evaluating, integrating, and correlating clinical information. They must solve problems at the highest taxonomic levels. Supervisors should articulate the thought processes used in problem solving so that residents can develop their individual analysis and synthesis processes. The supervisor should help residents learn with clear instruction that correlates with their levels of understanding.
The supervisor should be readily available to guide and support residents with patient responsibilities and must recognize that the faculty and residents have collective responsibility for patient safety and welfare. When approached by residents about patient care problems, the supervisor should be helpful and considerate. The supervisor should actively encourage questions, opinions, and comments. Learning is enhanced by reasonable flexibility and the willingness to allow discussion of alternative ideas of management suggested by residents. The supervisor should discuss patient care problems with residents to stimulate profound thought. New psychomotor skills should be demonstrated first by the supervisor and then performed by residents under observation until the residents attain proficiency.
The supervisor should recognize the resident's concurrent personal, ethical, and social development. Residents need to develop an individual system of productive self-assessment and self-confidence. These attributes can be facilitated by an observant, thoughtful, and dedicated supervisor. The supervisor must monitor for signs of resident fatigue and intervene to assure safe patient care and learning.
Evaluation of Performance and Feedback
Resident performance evaluation and provision of feedback should be continuous processes. The supervisor should use fairness, patience, and tact, always treating residents with respect. The supervisor should observe while residents perform procedures, interact with them during rounds and conferences, evaluate them in all aspects of patient care, and then provide them with constructive critique and helpful suggestions. All supervision must be done in a tactful and confidential manner. Written evaluations should be precise and honest and include detailed descriptions of actual observed performance. Performance evaluations should be discussed with and acknowledged by residents and communicated only to appropriate administrators of the program.
Recognizing the relationship between resident duty hours, quality patient care, and quality education, programs must follow these requirements in regard to duty hours for residents and fellows.
Maximum Hours of Work per Week
Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. When residents are on call at home and are called into the hospital, the time then spent in the hospital must also be counted towards the weekly hour limit.
- In emergency room assignments, residents should be scheduled to work a maximum of 12 hours to be followed immediately by 12 hours off duty.
Duty Hour Exception
The Graduate Medical Education Committee (GMEC) must review and endorse any program's exception request before the request is submitted to the program's RRC. The GMEC will only consider requests for duty hour exceptions when the program can clearly show that the exception is necessary for educational reasons. Only programs accredited in good standing, i.e., without a warning or a proposed or confirmed adverse action, may request that an exception be considered.
The program director must submit a written request for GMEC review. The program's responsibility is to make a clear showing that the exception is necessary for educational reasons. The proposal must include the following documentation:
- Patient Safety: Information must be submitted that describes how the program will monitor, evaluate, and ensure patient safety with extended resident work hours.
- Educational Rationale: The request must be based on a sound educational rationale, which should be described in relation to the program's stated goals and objectives for the particular assignments, rotations, and level(s) of training for which the increase is requested. Blanket exceptions for the entire educational program should be considered the exception, not the rule.
- Moonlighting Policy: Specific information regarding the program's moonlighting policies for the periods in question must be included.
- Call Schedules: Specific information regarding the resident call schedules during the times specified for the exception must be provided.
- Faculty Monitoring: Evidence of faculty development activities regarding the effects of resident fatigue and sleep deprivation must be appended.
- Program improvement: Evidence of improvement related to citations from the last program review, either internal or by the RRC, must be included.
If approved by the GMEC, the GMEC chair and the designate institutional official (DIO) will sign a letter documenting GMEC endorsement. The GMEC endorsement letter and a copy of this policy must be included in the RRC proposal.
Residents are not required to perform patient care activities outside of the educational program ("moonlighting "). Any moonlighting that occurs within the residency program and/or its primary clinical site(s), i.e., internal moonlighting, must be counted toward the 80-hour maximum weekly hour limit. Moonlighting by residents must be approved by the program director, in compliance with Policy 210 Patient Care Activities Outside of the Educational Program ("Moonlighting") and the guidelines of the program and only if the activities do not adversely affect patient care and the resident's educational program. PGY-1 residents are not permitted to moonlight.
Mandatory Time Free of Duty
Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days.
Maximum Duty Period Length
Duty periods of PGY-1 residents must not exceed 16 hours in durations.
Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities.
Residents may be allowed to remain on-site in order for effective transitions for patient safety and resident education. This period of time must be no longer than an additional four hours.
Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.
In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. Under those circumstances, the resident must:
- Appropriately hand over the care of all other patients to the team responsible for the patients’ continuing care; and
- Document the reasons for remaining to care for the patient in questions and submit that documentation in every circumstance to the program director.
The program director must review each submission of additional service and track both individual resident and program-wide episode of additional duty.
Minimum Time Off between Scheduled Duty Periods
PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.
Intermediate-level residents [as defined by the review committee] should have 10 hours free of duty, and must have eight hours, between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty.
Residents in the final years of education [as defined by the review committee] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. This preparation must occur within the context of the 80-hour, maximum duty period length, and one-day-off-in-seven standards. While it is desirable that residents in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances [as defined by the review committee] when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty. The program director must monitor these circumstances of return-to-hospital activities.
Residents must not be scheduled for more than six consecutive nights of night float. [The maximum number of consecutive weeks of night float and maximum number of months of night float per year may be further specified by the review committee.]
Maximum In-House On-Call Frequency
PGY-2 residents and above must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).
Time spent in the hospital by residents on at-home call must count towards the 80-hour maximum weekly hour 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 duty when averaged over four weeks.
At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.
Residents are permitted to return to the hospital while on at-home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80- hour weekly maximum, will not initiate a new “off-duty period.”
Transitions of Care
Each program should have a documented process in place for ensuring the effectiveness of transition of patient care.
Monitoring of Duty Hours
Each program must have written policies and procedures consistent with the ACGME Requirements for resident duty hours and the working environment. Monitoring of duty hours is required, at sufficient frequency to ensure compliance with the Common Program Requirements regarding duty hours, as well as individual program requirements.
Each program is required to submit to the DIO a written report for the past year and upcoming plans for the next year. The program's annual report must include data obtained through the program's duty hour compliance efforts, areas of potential non-compliance, and plans for addressing any problems identified, including needed resources.
Occasionally, two or more programs or institutions may agree to provide complementary facilities, teaching staff, and teaching sessions. Such arrangements should be approved in advance. For rotations between sponsored programs in the same hospital, the program directors must agree. For rotations between sponsored programs in different hospitals, the directors of medical education (DME) must also agree.
For rotations between sponsored programs and affiliated programs within the same hospital, the departmental chair and program director must agree. For rotations in different hospitals, the DMEs in both involved hospitals must also agree.
For rotations between affiliated programs in the same hospital, the program directors must agree. For rotations in different hospitals, the DMEs in both involved hospitals must also agree.
For rotations of residents between SOM sponsored programs and other programs in non-affiliated hospitals, the departmental chair or program director and DME must make arrangements with their counterparts at the other institution. For Air Force residents, this requires 90 days advanced notice.
For rotations of residents between affiliated programs in BSOM affiliated hospitals and other programs, the program director and DME must make arrangements with their counterparts at the other institution.
Residents are not required to perform patient care activities outside of the educational program ("moonlighting").
Moonlighting contributes to resident work hours and may produce fatigue that affects performance. Outside employment for residents may serve the following purposes: (1) meet a genuine community need; (2) provide educational experiences; and (3) supplement income insufficient to meet current obligations, particularly educational debt. However, participation in outside employment may leave insufficient time for rest and restoration to promote the resident's educational experience and safe patient care.
All moonlighting activity MUST be prospectively approved. The resident must submit a letter of request to the program director for any moonlighting. The letter must describe the place, nature, dates, time of employment, and the professional liability (malpractice) insurance coverage, which will be in effect. The program director must investigate and approve only activities including medical practice that do not interfere with the educational goals and objectives of the participant's residency or fellowship program. Active duty military residents and other federal employees cannot participate in outside employment. PGY1 residents are not permitted to moonlight.
The program director will determine the maximum number of hours of outside employment permitted for each resident. This temporal limit will not usually exceed 30 hours in four consecutive weeks. Time spent by residents in internal and external moonlighting must be counted towards the 80-hour maximum weekly hour limit.
The program director can permit a resident to engage in limited off-duty outside employment if the resident:
- is a licensed physician in the state of Ohio or state of medical practice,
- has demonstrated and continues to demonstrate prescribed educational and professional growth within a residency program, and
- will be employed in a situation that will continue such growth.
The program director must document review of any requests for outside employment and make this information part of the resident's file.
The effect of outside employment on resident performance must be monitored by the program director. Failure of an individual resident to demonstrate proper professional growth within the residency or fellowship program will mandate the program director's reduction or withdrawal of permission for moonlighting.
A resident's failure to comply with this policy is a breach of contract and grounds for termination of appointment and contract.
Fiscal support, fringe benefits, and professional liability coverage for outside employment are the responsibilities of the resident and the outside employer, and not the SOM or any of its employing affiliates.
Workmen's Compensation. Except for active duty military residents, all residents are covered by the Workmen's Compensation Law of Ohio for all on-the-job injuries, and thereby, receive medical expense benefits as well as disability payments and death benefits to dependents.
When a resident is injured while on duty at a hospital other than the employer, initial emergency care will be provided by the hospital. Application for workmen's compensation should be made through the employing institution.
Professional Liability. The employing institution provides each civilian resident with professional liability coverage for the duration of training. This coverage provides legal defense and protection against awards from claims reported or filed after the completion of graduate medical education (GME).
For residents on active duty with the U.S. Air Force who are assigned to a federal hospital, liability coverage is determined by provisions of the Federal Torts Claims Act. Non-federal hospitals will provide liability insurance coverage for military residents for claims regarding alleged acts or omissions occurring while the military resident was on duty at that hospital. This coverage provides legal defense and protection against awards from claims reported or filed after the completion of GME.
Coverage is not provided for duties that are not assigned as part of the resident's training program.
Disability Leave of Absence. The employing institution governs disability leaves of absence.
Educational Leave. Residents may, at the discretion of the program director, receive educational leave to attend local, regional, or national special courses, continuing education programs, and professional meetings consistent with career goals.
For the first-year resident, the amount of time and stipend level is at the discretion of the program director. The program director must give prior approval and pay for it from departmental funds. The first-year resident may attend local, one-day educational programs within driving distance without overnight stay.
In all cases, educational leave must have prior approval of the program director and the employing institution. If a resident attends a meeting without prior approval, the resident assumes responsibility for all expenses. The money available to underwrite this cost is subject to quarterly review in relation to the employer's institutional budget. Appropriate receipts are required for reimbursement. Educational leave may not be taken as vacation time. The director of medical education will provide specific information related to this action.
Personal Leave of Absence. A leave of absence may be granted by the program director and the resident's employer under extenuating circumstances for personal reasons. Because a leave of absence may be disruptive to the residency program and the participating hospital(s), it should only be considered as an alternative of last resort. Leaves of absence are different from educational leave, sick leave, or vacation leave, in that ordinarily a resident has to make-up the time to fulfill training requirements if so determined by the program director.
To request a leave of absence, submit a written letter to the program director, with a copy to the director of medical education of the employing institution, if applicable, stating why leave is needed, how the time will be spent, and when leave will begin and end. Leaves of absence must be approved in advance by the program director and the employing institution, if applicable. In making the request, provide as much lead time as possible to minimize disruption to the program and the participating institution(s).
A leave of absence is granted when the resident would benefit from a temporary relief from duties due to personal reasons. When a leave of absence is granted, it is anticipated that the resident will return to the program and assume all normal responsibilities at its termination. Since the residency program and the participating institution(s) have a vested interest in the return and resumption of duties, the program director may elect to approve the request with specific and reasonable stipulations related to the activities in which the resident should or should not participate.
Leaves of absence may be paid or unpaid at the discretion of the employer. Fringe benefits may be continued at the discretion of the employer.
For residents in Boonshoft School of Medicine programs who are on active duty in the United States Air Force (USAF), USAF rules and regulations shall apply.
Sick Leave, Parental Leave and Absences. The employing institution governs sick leave, parental leave and absences.
Temporary Military Duty. If a resident is a member of a military reserve unit and must report for temporary military duty, defined as the usual two-week training program for reservists, she will receive the difference between her predetermined weekly salary and any compensation received for military duty, for each week of that two week period.
Vacation. The employing institution governs vacation.
Notification of effects of leave on board eligibility. Any leave (time away from the program) above and beyond approved vacation must be considered by the program director in determining whether the resident has satisfactorily completed the training program in accordance with the appropriate specialty requirements and what effect extension of training will have on an individual's eligibility to sit for the specific specialty board exam.
Housing. The resident is responsible for securing personal living quarters. On-call quarters, if required by the program, is provided by the hospital to which the resident is assigned. Furnishings, complete linen supplies, and maid service are provided. When on duty, residents sleep in the assigned on-call rooms.
Lockers and Mail Boxes. Residents will be provided locker space and mail boxes at each of the hospitals participating in the training program. These will be provided at no cost.
Meals. Residents are not provided with meals. Individual hospital policy will govern on-duty days.
Parking. Residents will be assigned designated parking areas at each of the hospitals. When a resident must return to a hospital to complete medical records, parking should be without charge.
Prescription Drugs. The health insurance benefits policy of the employing institution governs the provision of prescription drugs.
Uniforms. A total of four uniforms as prescribed by the hospitals will be issued at no charge to each resident. Uniforms should always be worn when on duty. The hospital to which the resident is assigned will provide uniform laundry at no charge.