Policy for Supervision and Duty Hours
Academic Year 2011 to 2012
Neonatal-Perinatal Medicine Fellowship Training Program
Department of Pediatrics
During the required 3 years of subspecialty apprenticeship training in Neonatal-Perinatal Medicine, fellows receive 11 to 12 months of inpatient and outpatient care activities supervised by division faculty. The majority of the remaining time is devoted to scholarly, research activities. In all training activities, trainees are provided with individualized, progressively graduated experiences based on their accomplishments and competence as judged by division faculty. During training, fellows actively engage in all facets of neonatal and infant care including, but limited to, inpatient and outpatient management, consultation with referring physicians, directing infant transports from referring hospitals, and interaction with clinical care and consultant staff. In these activities:
- fellows are assisted by and provide supervision and teaching for pediatric residents, nurse practitioners, medical students, and other non-physician medical support staff; and
- fellows participate as key healthcare team member along side nursing staff and others, e.g., respiratory care, social service, etc. with the goal of providing excellent patient care needed to achieve the best clinical outcomes possible.
Inpatient Clinical Experiences
Division faculty on clinical service have ultimate responsibility and authority for all patient care matters. He/she provides continuous supervision of and backup for fellows on clinical duty. Faculty members on clinical duty are available to trainees at all times (including nights, weekends and holidays) for consultation and backup of any and all situations. While faculty are constantly attuned to detect fellow fatigue, fellows are educated in and are mandated to immediately self-report any significant fatigue they experience to the clinical attending.
During periods of clinical duty, fellows are required to report supervising faculty:
- their findings and plans for diagnosis and care of all newly admitted patients;
- any significant adverse change in any individual patient’s condition; and
- any significant problem in the NICU with the potential for adversely affecting patient care.
Outpatient Clinical Experiences
Under direct faculty supervision, fellows participate in our Neonatal High-Risk Continuity Follow-Up Clinic activities by providing care for high-risk infants they have cared for as inpatients. This provides continuity with patients, patient’s families, and community healthcare providers. Fellows interact closely with neonatal follow-up clinic nurse practitioners who are in charge of the operation of this clinic. During clinic visits, the fellow performs a history and physical examination, the results of which, along with patient care plans, are discussed with the faculty member. Fellows are responsible for completing a written clinic visit summary for the patient’s electronic medical record within 24 hours of being seen. Summaries are reviewed and finalized by the faculty member.
Division faculty support the ACGME’S principles that form the basis for the “Resident Duty Hours in the Learning and Working Environment” the duty hours requirements themselves. Faculty communicate both of these to division fellows verbally and in writing, and they encourage and expect full compliance as follows:
1. Duty hours are limited to 80 hours per week, averaged over a 4-week period, and inclusive of all in-house duty activities, including moonlighting. Any moonlighting activities must be done with knowledge and permission of the program director.
2. In-house call is limited to no more frequently than every third night, averaged over a 4-week period.
3. One day in seven free from all educational and clinical responsibilities, averaged over a 4-week period is provided.
4. A 10-hour time period between all daily duty periods and after in-house call is provided to assure adequate time for rest and personal activities.
5. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Fellows are permitted to remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, care for outpatients, and maintain continuity of medical and surgical care
6. No new patients can be accepted after 24 hours of continuous duty.
The scheduling of clinical activities is the responsibility of and is overseen by the division program director, but with input from division faculty and fellow as appropriate. The call schedule is kept on the hospital’s website. During clinical assignment periods, Neonatal-Perinatal Medicine fellows are expected to be present in the hospital as needed for patient care activities. During weekdays this is generally from 0800 to 1700, and on weekends and holidays this is generally from 0800 to 1200. During night and weekend clinical duty, fellows take call in the hospital. The only exception to this is when another neonatology fellow in house doing moonlighting duty in the NICU at the same time. At these times the fellow may take call from home, but must return to the NICU to assist with patient care as warranted or when directed to do so by the neonatal faculty attending.
During all other periods of training (exclusive of paid time off which includes vacation), fellows are expected to be present in the hospital from 0800 to 1700 on weekdays unless after being on clinical duty the night before. Neonatal-Perinatal Medicine fellows are encouraged to pursue scholarship activities on nights and weekends as they see fit, taking care these activities do not result in fatigue compromising their patient care activities.