Resident Appointment

Scope

This policy applies to all Indiana University School of Medicine (IUSM) Graduate Medical Education (GME) resident physicians.

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Policy Statement

Initial and ongoing resident appointment depend upon the completion of all onboarding and promotion requirements as established by IUSM and its affiliate hospitals.

All residents entering an IUSM GME program must meet all guidelines outlined in the Eligibility and Selection of Residents policy (see Reference 8). A new resident will not be approved to begin training until all onboarding requirements are verified as complete at the program, GME, and School levels.

All residents continuing in an IUSM GME program must meet all guidelines outlined in the Evaluation and Promotion of Residents policy (see Reference 9).

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Reason for Policy

IUSM is committed to selecting, hiring, and training the most capable residents in support of its strategic goals.

This policy defines required procedures and guidelines for initial resident appointment to an IUSM GME training program, which includes the verification of certain credentials and criminal and other background information as a condition of employment.

This policy also clarifies that while the ACGME uses “Agreement of Appointment” and “Contract” interchangeably to describe the document that outlines the terms and conditions of a resident’s appointment, IUSM refers to this document as a Letter of Appointment, which is issued for each year of training.

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Procedures

After the selection process is complete, program coordinators should submit an Appointment Request according to GME Office instructions to begin the onboarding process. GME onboarding involves processing trainee appointments into the residency management system, assigning onboarding requirements, and verifying resident credentials as well as requirement completion prior to a resident’s start.

Resident Appointment Requirements

• Initial Onboarding Requirements
• Background Checks
• Letters of Appointment
• Hiring

In addition to the specific requirements outlined below, various other employment and training requirements may be assigned for completion prior to the resident’s Hire Date or Clinical Start Date, including but not limited to hospital-specific onboarding tasks, required training modules, etc.

A resident’s Clinical Start Date (CSD) is their first official day of GME training. This is the start date printed on a completion certificate at the end of a GME training program.

A resident’s Hire Date is their first day as an IU employee, whether CSD, GME Orientation Date, or the first day of program orientation, whichever comes first. This is the effective date for Hire documentation in University systems as well as the start date for the I-9 employment eligibility verification process.

Initial Onboarding Requirements

Initial onboarding requirements must be completed before the GME Office is able to request a background check, which is a pre-requisite for program appointment and hiring. This includes an authorization for the completion of a background check as well as a self-disclosure questionnaire, among other requirements. See Attachment 1: Background Check Authorization, Self-Disclosure & Initial Onboarding Requirements for details related to background check pre-requisites.

Background Checks

IUSM and its affiliate hospitals require background checks for all incoming residents. A resident’s background check must meet institutional standards before the resident can be hired by IUSM as well as before the resident’s initial Letter of Appointment can be prepared. See Attachment 1: Background Check Authorization, Self-Disclosure & Initial Onboarding Requirements for further information on the specific processes required for background check completion.

All residents must disclose any arrests, charges, convictions, and/or the disposition of any outstanding charges in the background check disclosure form during initial employment. After the initial background check for employment is complete, residents must report any arrests, charges, and/or convictions, within 72 hours, to his/her program director and the Office of Graduate Medical Education. This includes any occurrences at any time during the length of training.

Review of Drug- and Alcohol-Related Offenses

As part of the background check review process, drug- and alcohol-related offenses (including but not limited to DUI and reckless driving involving drugs or alcohol) will be evaluated based on the time elapsed since the offense and the information disclosed by the resident. The following framework may be used to guide review and follow-up actions:

• Less than 2 years since offense:
  A phone discussion will occur with the resident. If no Physician Assistance Program (PAP) was completed, a referral to the Indiana State Medical Association (ISMA) may be required. Following discussion with the resident, the Program Director will be notified.
• 2–5 years since offense:
  A phone discussion will occur with the resident. Referral to ISMA may be considered if there is concern for an ongoing issue. Following discussion with the resident, the Program Director will be notified.
• 5–10 years since offense:
  The resident will be asked to submit a written personal statement describing the event, outcomes, changes since the event, and how the experience has informed their approach to medicine.
• More than 10 years since offense:
  No additional follow-up is required beyond standard background check review.

Failure to self-disclose relevant information may result in additional review or actions in accordance with this policy.

After completion of the initial background check, residents who work with children must also undergo both a criminal background check and a sex offender registry check at least once every five years in alignment with Indiana University Policy PS-01 Programs Involving Children.

Trainees may be subject to additional background check processes as required by the hospital affiliates where they rotate.

Letters of Appointment

All residents must have an active, complete Letter of Appointment verified by the GME Office in order to engage in training.

A Letter of Appointment for an incoming resident may be prepared once the resident’s background check results are returned to the GME Office with confirmation that they meet required standards.

A Letter of Appointment must be signed by both the resident as well as the Program Director before it routes to the GME Office for review, receipt, and approval.

Any resident whose Letter of Appointment is not complete on the first day of training indicated within the appointment period must not engage in training activities or patient care until the letter is fully executed, received, and approved by the GME Office.

Hiring

In addition to GME appointment, a resident must also be hired as an IU employee according to the requirements and procedures established by the University and School.

See Attachment 3 for further information on specific requirements for hiring and appointment as well as their due dates.

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Definitions

ACGME is the Accreditation Council for Graduate Medical Education.

A resident is an IUSM resident or fellow.

A resident’s Training Start Date (TSD) is their first official day of GME training. This is the start date printed on a completion certificate at the end of a GME training program.

A resident’s Hire Date is their first day as an IU employee, whether TSD, GME Orientation Date, or the first day of program orientation, whichever comes first. This is the effective date for the Hire eDoc (in HRMS) and the start date for the I-9 verification process (completed in HireRight).

A Letter of Appointment is a written agreement of appointment outlining the terms and conditions of a resident’s appointment to a GME training program.

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Implementation

The Designated Institutional Official (DIO) for Graduate Medical Education is responsible for implementation of this policy. 

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Oversight

Policy authority for this document resides with the Graduate Medical Education Committee.  The DIO and the Graduate Medical Education Committee are responsible for oversight.  This policy will be reviewed every three years or more often if deemed necessary.

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History

1. Policy gme-adm-0048 approved by GMEC and published on 21 August 2024.
2. Policy updated 14 January 2026.
3. Policy approved by GMEC 21 January 2026. 

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