Policies, Agreements, and Benefits

ACGME - The Accreditation Council for Graduate Medical Education

AIR – Annual Institutional Review

APE – Annual Program Evaluation

CCC – Clinical Competency Committee; program level resident/fellow review committee

CODA - Commission on Dental Accreditation; formerly American Dental Associates (ADA)

DIO - Designated Institutional Official; the ACGME designated leader of MUSC-GME.

ECFMG - Educational Commission for Foreign Medical Graduates; overseen by Intealth.

GME- Graduate Medical Education

GMEC – Graduate Medical Education Committee

MUSC COM - Medical University of South Carolina College of Medicine; sponsoring institution

NST – Non-Standard Training; defined below

PCM – Parental, Caregiver, Maternal Leave

PD - Program Director

PEC - Program Evaluation Committee; program level review committee

PIP – Performance Improvement Plan

USMLE – United States Medical Licensing Examination

Resident - an individual who is participating in any GME program and whose relationship to the patient is under the auspices of the medical education program. Resident physicians have completed medical school and are undergoing further training (residency) in a specific medical specialty under the supervision of an attending physician.

Fellow - an individual who has completed residency training and is pursuing further specialization in an advanced program (fellowship) and may in some circumstances function as an attending physician.

Non-ACGME program – a program that provides training for fellows in advanced subspecialty for which there is no ACGME accreditation and may be accredited by other societies or accrediting bodies.

NST (Non-Standard Training) Recognition – a program that provides clinical training for fellows in advanced subspecialty who are foreign national physicians for which there is no ACGME accreditation or American Board of Medical Specialties member board certification. Foreign national physicians receive J-1 visas sponsored by the ECFMG to enable their participation in NST programs.

The MUSC COM GME Committee (GMEC) is responsible for oversight of all MUSC COM-sponsored GME programs in accordance with the ACGME Institutional Requirements. Annual Program Evaluations (APEs) and Action Plan for Improvement for all ACGME-accredited programs are reviewed by GMEC or its subcommittees which present summaries and recommendations to the GMEC each year as part of the Annual Institutional Review (AIR). 

In the event the sponsoring institution or one of its GME programs is reduced or closed, MUSC COM is committed to ensuring that residents/fellows enrolled in its GME-sponsored residency programs are provided the opportunity to complete their training through one of its sponsored programs or assist them in enrolling in another ACGME or CODA-accredited program in which they may continue their education.

The GMEC has oversight of decisions that may result in the reduction or closing of the sponsoring institution or one of its GME programs.

It is the policy of MUSC Health to comply with the “Lewis Blackman Hospital Patient Safety Act” as enacted by the General Assembly of the State of South Carolina. Lewis Blackman Act

Updated: April 2025

In the event of a disaster impacting the programs sponsored by the MUSC COM GME Office, we will protect the well-being, safety, and educational experience of residents/fellows enrolled in our training programs.

Definitions

Extreme emergent situation is defined as a local event (such as a hospital-declared disaster for an epidemic) that impairs the ability of MUSC COM GME Office to support resident education or the work environment but does not rise to the level of an ACGME-declared disaster as defined by ACGME policies and procedures.

Disaster is defined as an event or set of events causing significant alteration to the ability of MUSC COM GME Office to support many residency programs as defined by the ACGME policies and procedures (e.g., Hurricane Katrina).

Declaration of Extreme Emergent Situation

A declaration of an extreme emergent situation may be initiated by the DIO in collaboration with the hospital chief executive officer, chief operating officer, chief medical officer, and affected PDs. The first point of contact for answers to questions regarding a local emergent situation shall be the GMEC/DIO. When possible, an emergency GMEC meeting will be convened to assess the situation.

Declaration of a Disaster

When warranted, the ACGME Chief Executive Officer, with consultation of the ACGME Executive Committee and the chair of the Institutional Review Committee, will make a declaration of a disaster. A notice will be posted on the ACGME website with all information relating to ACGME’s response to the disaster.

Supervision refers to the dual responsibility that an attending physician has to enhance the knowledge of the resident/fellow and to ensure the quality of care delivered to each patient by any resident.

Resident Supervision Policy (MUHA, MUSC-P)

Updated: May 2025

Specialty and subspecialty residents/fellows may apply to do clinical rotations at MUSC. The required onboarding steps are outlined on the GME website.
The MUSC supervising physician must notify the visiting resident's/fellow’s PD if any adverse events, involving the visiting resident/fellow, take place during the rotation at MUSC.

Updated: December 2025

Updated: December 2025

Resident/Fellow Reappointment
Resident/Fellow Agreements are one (1) year terms or to completion of training, whichever comes first. Residents/Fellows can and should expect to complete their GME program providing they successfully complete the previous year's training requirements, and they adhere to the program's and institution's established policies and procedures. Each PD will create program-specific criteria for promotion and/or renewal of a resident/fellow’s appointment. (IR 4.4) Each reappointed resident/fellow is required to sign a Resident/Fellow Agreement with the GME Office.

Promotion: A resident/fellow is promoted to the next PGY level on the basis of acceptable, periodic clinical evaluations, which may be augmented by other evaluation methods, by recommendation of their department's Clinical Competency Committee (CCC) and the PD to the DIO.

Non-Promotion or Non-Renewal Decisions: In cases where a resident/fellow is not promoted or their appointment is not renewed, such decisions may follow the implementation of a PIP (PIP). For further guidance, refer to the Academic Evaluation, Promotion, and Corrective Action Policy.

Resignations and Transfers Out of Program or Institution
Any resident/fellow may request permission to resign from the current program or to transfer to another program at MUSC or another institution during the academic year. The resident/fellow must request to resign in writing to his/her PD. The resident must make the request on or before March 1 of the current academic year. Requests after March 1st will be considered on a case-by-case basis.

Updated: October 2025

The MUSC COM GME Office mandates that neither the sponsoring institution nor any of its ACGME-accredited programs will require a resident/fellow to sign a non-competition guarantee or restrictive covenant. 

Each program will maintain a program file for each resident/fellow. The file will contain a record of the resident's/fellow’s specific rotations and other educational experiences (including procedural logs, if applicable), final summative evaluation (End of Program Evaluation) by the PD, any disciplinary actions (i.e. suspension, probation, termination), and other information concerning the resident/fellow that the PD judges appropriate to maintain in the file for educational and/or credentialing purposes. 

The GME Office will maintain an electronic file within the electronic residency management system or other secure archived source. 

The resident’s/fellow’s program file will be treated as a confidential document. Files will be maintained in a secure location and will be available only to the PD, the DIO, and the resident/fellow. The resident’s/fellow’s access to his or her file should be under direct supervision of a designated staff member of the program or the GME Office. 

The PD may disclose the program file, or portions thereof, to others judged to have a legitimate need for the information, for reasons relating to the accreditation of the program or of the program’s participating institutions. The PD may also disclose the file, or portions thereof, to others, as authorized in writing by the resident/fellow. 

Updated: April 2025

Policy

MUSC College of Medicine GME provides residents and fellows with appropriate time off to ensure well-being and to comply with the policies and applicable requirements for accreditation and/or specific specialty/subspecialty board certification. All time away from training must also adhere to the program level policies and procedures.

Scope

This policy applies to all residents and fellows contracted by the MUSC College of Medicine GME Office. All leave is provided annually, does not accrue over time and does not roll over to the next academic year. Unused leave is not paid out at the end of the contract year.

Definitions

Leave of Absence is an extended time away from training that may be paid or unpaid. This can refer to FMLA, parental leave, caregiver leave, medical leave, professional leave of absence, or other non-vacation period away from work.  

A week is defined as 5 weekdays (Monday-Friday) and adjoining 2 weekend days (Saturday-Sunday).

Leave Categories and Allocations

• Annual Leave
  • Definition: Non-training related (vacation, job interviews, board exams, meetings and conferences, FMLA, etc..)
  • Duration: 3 weeks paid per contract year (12 months) 
  • Notes: Time away for job interviews, board examinations, meetings, and conferences must be taken as annual leave unless other arrangements are approved by the program director according to departmental policy.
• Sick Leave
  • Definition: For yourself or for an immediate family member for mental and physical illness, injuries and health conditions as well as to obtainmedical care, diagnostics, or preventative care.
  • Duration: 3 weeks paid per contract year (12 months)
  • Notes: A resident who is absent for 6 or more consecutive days due to illness must present a clearance letter from the principal treating physician or receive written approval from the program director before returning to the program. Program Directors (or designee) are entitled to require residents to provide medical evidence for support reason for absences or if absences exceed 3 consecutive workdays. 
• Parental, Caregiver, Medical (PCM) Leave
  • Definition: 
    • Parental Leave: Time off to bond with a newborn, newly adopted, or newly fostered child, or a minor from whom legal guardianship has been newly appointed.
    • Caregiver Leave: Time off to care for a resident's spouse, child, or parent who has a serious health condition.
    • Medical Leave: Time off to care for a serious health condition that makes the resident unable to perform essential job functions.
  • Duration: 1 PCM leave = 6 week paid leave
  • Notes:
    • PCM Leave is available in addition to sick and annual leave allotments.
    • 1 PCM leave available for residents/fellows in 1-3 year programs.
    • 2PCM leaves available for residents/fellows in programs longer than 3 years. 
    • PCM leave is not required to be consecutive. No more than 12 weeks of paid leave can be utilized in a contract year. 
• Family and Medical Leave Act (FMLA) Leave
  • Definition: Federal law which entitles eligible employees up to 12 weeks of unpaid, job-protected leave per year for specified family and medical reasons. 
  • Duration:  up to 12 weeks unpaid leave per calendar year.
  • Notes: Provides up to 12-weeks of protected leave for residents and fellows with 12 months (and 1250 hours) of MUSC completed employment for qualifying medical and family reasons. It is not paid leave but unused paid annual, sick, parental, caregiver, or medical leave may be used concurrently with FMLA. 
• Bereavement Leave
  • Definition: For the death of an immediate family member (i.e. parents, siblings, grandparents, children, or spouse)
  • Duration: 3 days paid leave
• Military Leave
  • Definition: For those called upon by the government for service in the U.S. Armed Forces, members of the National Guard or the active reserve unit.
  • Duration: 3 weeks paid leave
  • Notes: Thirty additional days will be granted without charge against earned leave or loss of pay when called to active duty for state or national emergencies.
• Jury Duty or Court Appearance Leave
  • Defintion: For those summoned for jury duty or subpoenaed for court appearances.
  • Duration: Paid Leave
  • Notes: No reduction in annual leave.
• Holidays
  • Defintion: For purposes of residency/fellowship scheduyling and leave administration, holidays are defined by residents/fellows respective department policy.
  • Duration: Departmental Policy
  • Notes: Residents are expected to carry out any duties or assignments as directed by their program director on federal or state holidays, unless permission is granted by the program director (or designeee) according to departmental policy.
• Extend Unpaid Leave
  • Defintion: Time away from training without pay that exceeds the standard leave allocation due to significant extenuating circumstances
  • Duration: Varies
  • Notes: Leave cannot extend beyond the end of a contract without DIO approval.

Impacts of leave on Training

if the program specialty board requires a minimum amount of time for board eligibility or required rotations cannot be met as a result of an extended absence, additional training time may be required. Prior to approving leave, programs are required to notify residents and fellows if the request may result in extended training time.

MUSC is committed to fostering an open and supportive community that promotes learning, discovery, and healing. This commitment includes maintaining an educational and working environment, as well as other benefits, programs, and activities, that are free from discrimination, harassment, and retaliation (collectively, “Prohibited Conduct”). To ensure compliance with federal and state civil rights laws and regulations, and to affirm its commitment to fairness, MUSC has developed internal policies and procedures that will provide a prompt, fair, and impartial process for those involved in an allegation of discrimination, harassment, or retaliation. MUSC values and upholds the equal dignity of all members of its community and strives to balance the rights of the parties in what is often a difficult time for those involved.

The Nondiscrimination, Anti-Harassment, and Equal Opportunity Policy covers nondiscrimination in both employment and education. Any member of the MUSC community who acts to deny, deprive, or limit the educational or employment access, benefit, or opportunity of another member of the MUSC community, guest, or visitor based on their actual or perceived membership in a protected class is in violation of the policy. When brought to the attention of MUSC’s Title IX coordinator, any such discrimination will be promptly and fairly addressed and remedied according to the resolution processes described in the policy.

A copy of the full policy may be obtained online or directly from the Division of Organizational Engagement and Excellence.

It is the policy of the University to comply with the provisions of the various applicable state and federal laws prohibiting discrimination against applicants and residents or based on disability, pregnancy, childbirth, or related medical conditions; including but not limited to lactation. Such laws impose various prohibitions on discrimination and require reasonable accommodation to enable covered individuals to perform the essential functions of and enjoy the various benefits of employment. Such laws impose various prohibitions on discrimination and require reasonable accommodation to ensure that no otherwise qualified individual with a disability is excluded from participation in, denied the benefits of, or subjected to discrimination and have equal access to all benefits and privileges of employment that are available to similarly situated applicants and residents/fellows without disabilities.

To comply with these laws, MUSC has adopted the Reasonable Accommodations Policy (U-HR-024).

A resident/fellow can be terminated or suspended at any time and without notice for a significant patient safety concern. Residents and fellows are expected to abide by all state and federal laws. It is not possible to list all acts and omissions which may result in disciplinary action. 

A resident/fellow can be terminated or suspended at any time and without notice if it is determined by the PD, CCC, or DIO that there is a significant concern regarding patient safety.

A resident/fellow, who is charged with violating state or federal laws, may have corrective action initiated by their PD or DIO. If a resident/fellow is arrested or formally charged with any infraction of the law, other than a minor traffic violation, they shall report such violation or charges to their PD and/or the DIO at first available opportunity. 

Any resident/fellow assisting other residents/fellow or employees to breach any standards, before, during or after the fact, can expect to receive the same disciplinary action as the offender.

Action by the State Board of Medical or Dental Examiners revoking or suspending a resident/fellow’s license or placing them on probation shall automatically suspend all their hospital privileges and may result in dismissal from the residency program.  

Updated: June 2025

This policy does not alter the right of MUSC-to assess and address a Resident/ Fellow behavior according to the following policies:
Drug Free Workplace

Related GME Links: Academic Deficiency, Misconduct, Leave of Absence, Resident in Distress
MUHA Link: Employee Health

It is the responsibility of all care team members to report any healthcare practitioner when there is reasonable suspicion of impairment. Residents and fellows are strongly encouraged to proactively seek help or assistance for any physical, mental, or behavioral concern(s) that may interfere with their ability to engage safely in their professional activities as a resident/ fellow.

Definitions
Impairment
A physician is impaired when they lack the ability to exercise appropriate medical judgment and/or the ability to practice with reasonable skill and safety resulting in jeopardy to patient care or patient safety. In addition, a resident/fellow may be considered “impaired” if the resident/ fellow is unable to carry out duties, assignments, or requirements of the program due to a health condition or the adverse influence of alcohol or any substance.

Reasonable Suspicion
Suspicion that is based on observance of specific behaviors and reasonable inferences that can be drawn from those facts and is specific to the individual. Reasonable suspicion does not require certainty, but it should be supported by specific circumstance and/or facts.

Behaviors that might indicate Impairment
Significant changes in personality such as dramatic mood swings, abusive behavior, changes in social interactions, apathy toward patient care, suicidal ideation or behavior or insubordination; difficulty in motor coordination such as poor muscle control, unsteady walking, nervousness, changes in speech; impaired short term memory or logical thinking; deterioration of job performance such as excessive absenteeism or tardiness, increasing medical errors, inability to carry out duties or assignments; and deterioration in appearance.

MUSC will protect, to the extent possible, the identity of the individual reporting suspected impairment. MUSC does not tolerate retaliation against individuals making good-faith reports of suspected impairment.

Updated: December 2025

Clinical decision-making, education, and research activities must be free from influence created by any financial relationships with, or gifts provided by, Industry. For purposes of this policy, "Industry” is defined as all pharmaceutical manufacturers, and biotechnology, medical device, and hospital equipment supply industry entities and their representatives. In addition, clinicians, residents/fellows and MUSC staff should not be the target of commercial blandishments or inducements - great or small -the costs of which are ultimately borne by our patients and the public at large. These general principles should guide all potential relationships or interactions between the MUSC COM GME personnel and Industry representatives. The MUSC COM GME personnel should consult in advance with their PD or senior administrators to obtain further guidance and clarification. Charitable gifts provided by industry in connection with fundraising done by or on behalf of the MUSC COM GME shall be subject to other policies.

The Enterprise Industry Relations policy provides additional clarification.

Updated: October 2025

Each PD is responsible for determining the criteria for promotion and/or renewal of a resident’s/fellow’s appointment. Each PD will create program-specific criteria for promotion and/or renewal of a resident’s/fellow’s appointment. (IR 4.4)

PDs along with their CCCs should assess and monitor each resident’s/fellow’s academic and professional progress including knowledge, skills and professional behavior as well as adherence to any applicable departmental, GME, and hospital policies and procedures. Failure to meet the established academic standards will result in corrective action(s) up to and including dismissal from the program.

Updated June 2025

All MUSC training programs are required to create evaluation forms and systems to assess resident/fellow performance. Each program must establish formal written criteria and processes for the evaluation of residents/fellows including a CCC. These policies are to be included in the appropriate sections of each program’s Policies and Procedures manual. These evaluations should be shared electronically with the resident/fellow and discussed with the PD or their delegate as part of the semi-annual, annual, and end of training evaluation process at minimum.

Updated: October 2025

A resident/fellow has a right to a review process and may request a panel review for grievances following suspension, non-renewal, non-promotion, or dismissal.

Updated: June 2025

Physicians must recognize their responsibility to meet their obligations to their patients, their communities, and their profession. Deficiencies or concerns of professionalism may be identified by various sources and methods. The PD or DIO (or delegate) triage the concern(s) and determine an appropriate evaluation process.

Residents/fellows must be given the opportunity to submit anonymous and confidential written evaluations of both the faculty and the program annually. This information should be utilized by the PEC and PD to direct both program improvement and Faculty development efforts.

Equivalents of USMLE Step 3 include the COMLEX Step 3 and the MCCQE.

All PGY-1 residents/fellows are required to register for and take the USMLE or COMLEX Step 3 exam prior to completion of the PGY-1 year. If a resident/fellow does not take the Step 3 exam or has not passed Step 3 by June 30th of the PGY- 1 year, the resident/fellow will be placed on a Performance Improvement Plan (PIP) for the PGY-2 year. If other concerns of professionalism have been raised regarding the resident/fellow, the GME office may bypass the PIP for other processes, to include up to dismissal.

If a returning resident/fellow on the Step 3 PIP does not pass the exam by March 1st of the PGY-2 year, the resident/fellow will receive a notice of non-renewal.

If a resident/fellow enters the training program at the PGY-2 level, the resident/fellow must pass the Step 3 exam by March 1st of the PGY-2 year.

If a resident/fellow does not pass the Step 3 exam by March 1st of the PGY-2 year, the resident/fellow will receive a notice of non-renewal.

All specialty and subspecialty residents/fellows accepted into the MUSC COM GME programs at the PGY-3 level or above MUST have already passed the Step 3 exam BEFORE entering the residency program.

Updated: June 2024

Residency training is a full-time educational experience. Extramural paid activities (moonlighting) must not interfere with the resident's/fellow’s educational performance; nor must those activities interfere with the resident's/fellow’s opportunities for rest, relaxation, and independent study. As a result, residents/fellows are not required to engage in moonlighting activities as a condition for appointment to an MUSC residency program.

Who may not Moonlight:  

PGY-1 Residents, Residents under H1-B sponsorship by the condition of their visas, Residents on a PIP, and Residents of a Program that does not allow moonlighting.

Moonlighting for J1 Visa Holders:

Activities must take place within the same institution or primary clinical site as the physician’s accredited or non-standard training program (i.e. Internal moonlighting only).  Activities must be educationally appropriate and not extend the training period.  Prior written approval from both the PD and Institution Training Program Liaison are required. Completion and submission of a new attestation of supplemental clinical activity form (available on the Forms and Memos page of the ECFMG website) constitute this approval. Individual J-1 physicians must initiate these requests.

Updated: October 2025

The MUSC COM GME Office recognizes the importance of the well-being of our residents/fellows and faculty and works with the residency programs to ensure that processes are in place to assist the residents/fellows in developing the skills to achieve and faculty members to maintain their personal well-being. 

Each residency program shall have policies and schedules in place that spell out ways in which the residents/fellows will be supported in their efforts to become competent, caring, and resilient physicians. 

Programs must: 

• Educate all faculty members and residents/fellows to recognize the signs of fatigue and sleep deprivation 
• Educate all faculty members and residents/fellows in alert management and fatigue mitigation processes 
• Encourage residents/fellows to use fatigue mitigation processes to manage potential negative effects of fatigue on patient care and their learning 

Each program must have a process in place to ensure the transfer of responsibilities in patient care if a resident/fellow is unable to perform their patient care duties.

The sponsoring institution must provide adequate sleep facilities and safe transportation options for residents/fellows who self-identify or are recognized to be too fatigued to safely return home.  

Updated: September 2025

GME encourages telehealth curricula and practice for residents/fellows.  Key criteria for telehealth practice should include adequate supervision, reliable technology, and a private HIPAA-compliant space. 

During a weather event, there may be an opportunity for residents and fellows to participate in telehealth visits.  Every weather event is different and therefore a blanket statement of approval is not possible. PDs will consider GME guidance to determine if telehealth capability is feasible.   

Updated: June 2025

Individual residency and fellowship programs must design schedules and clinical assignments to maximize the learning experience for residents, respect duty hour requirements, and to optimize patient safety. This includes efforts to minimize transitions of care. Programs that provide direct patient care must ensure that their residents and core faculty members have received specialty specific training on handoffs and transitions of care and are evaluated on their competency. All PGY1 residents and new fellows are required to undergo formal handoff training during GME orientation. 

Updated: December 2025

Educational curriculum and supervised clinical patient care must be balanced to ensure safe patient care and protected time for learning in the allotment of resident time and energies.

GME must oversee resident/fellow clinical and educational work hours consistent with the Common and specialty/subspecialty-specific Program Requirements across all programs, addressing areas of non-compliance in a timely manner. (IR 3.2.e)

Updated: March 2026

These agreements outline the terms of appointment, compensation, benefits, responsibilities, policies, and renewal conditions for residents and fellows at MUSC.

The 2025 - 2026 Resident Agreements are available as PDFs:
Resident Agreement - Medical (PDF)
Resident Agreement - Dental (PDF)

These agreements outline the terms of appointment, compensation, benefits, responsibilities, policies, and renewal conditions for residents and fellows at MUSC.

The 2026 - 2027 Resident Agreements are available as PDFs:

Resident Agreement - Medical (PDF)
Resident Agreement - Dental (PDF)

The benefits below are provided to all ACGME and CODA residents/fellows contracted through the GME Office.

• Wellness Center – GME covers the cost of MUSC Wellness Center membership for resident/fellow.
• Meal Funds – a base monthly allowance, plus additional funds for in-house call shifts.
• Malpractice – occurrence-based policy provided through the Insurance Reserve Fund
• Salary Advance – provided to incoming PGY1 residents
• Work cell phone provided
• Employee Assistance Program
• Assistance Abroad
  • MUSC Travel Registry
• Uber Home Safely – vouchers available providing free transportation for residents/fellows when too fatigued to drive home
• Additional benefits may be provided at the programs, departments, or other sites.

• University Human Resources
• Health Insurance
• Dental and Vision Insurance
• Interim Insurance and COBRA
• Life Insurance
• PEBA Perks
• Retirement
• Disability
• Care.com

Effective July 1, 2026, the following pay levels were established: (IR IV.C.2.C)

PGY-1  $65,614.00  
PGY-2  $67,118.00  
PGY-3 $69,172.00 
PGY-4 $71,757.00 
PGY-5  $74,932.00
PGY-6  $78,044.00
PGY-7  $81,246.00
PGY-8  $85,854.00

Resident/Fellows may be eligible for an additional incentive of up to 4% of the annual salary in accordance with the South Carolina State Human Resource Regulations,, based on achieving identified metrics.