Policy on Supervision and Assignment, and Duty Hours of Fellows
The University of Iowa Hospitals and Clinics Surgical Pathology Fellowship Program ensures that it provides appropriate supervision for our fellows, as well as a duty hour schedule and a work environment that optimizes quality patient care, fortifies the educational trajectory of house staff members, and addresses all applicable program requirements. On-call duties are necessary components of the UIHC clinical care systems and educational programs; these duties are managed to ensure adequate periods of rest with appropriate levels of supervision to deliver safe, effective patient care.
The Surgical Pathology Fellowship Program demonstrates that the appropriate level of supervision is in place for all patients cared for by the fellow. The clinical activities of fellows are supervised by faculty in such a way as to ensure that the fellow assumes progressively increasing responsibility according to the fellow’s level of education, ability and experience as appropriate to the patient situation and fellow capability. Supervision does not equate merely to the presence of more senior physicians nor with the absence of independent decision making on the part of fellows. These supervision standards encompass the concepts of graded authority, responsibility and conditional independence that are the foundation of delegation of authority to more senior house staff members.
The faculty determines the level of responsibility accorded to the fellow. All rotations provide for daily personal faculty interaction. The clinical involvement of faculty and the low trainee to staff ratio assures that these interactions are frequent and instructive. The intensity and closeness of supervision varies considerably with the experience and abilities of the fellow. These factors are judged individually after formal discussions by faculty, and review of fellow evaluations. Level of supervision is not dependent solely on length of time in training.
Faculty are always reachable by pager to respond to the need for fellow supervision, during both routine work hours and on-call. At least indirect supervision is available by phone and/or electronic modalities, and faculty are always available to provide direct supervision, if needed. Few billable procedures are performed directly on patients in pathology, however when they are, a credentialed faculty member is present for the critical part of the procedure. To that end, all preliminary diagnoses and billable frozen sections are reviewed and verified by faculty in a timely manner to insure high quality patient care, as well as to provide an instructive interaction for the fellow. In addition, all final reports are proofed, edited and signed by faculty.
The Surgical Pathology Fellowship Program tracks fellow duty hours electronically in MedHub which is monitored by the program director. Most fellows begin their workday at 7:00 – 7:30 AM when the operating rooms open and/or teaching conferences begin. These fellows are usually finished by 6:00 PM. One fellow is responsible for late surgical pathology gross room coverage including teaching and oversight of junior residents. This fellow’s workday starts at 10:00 am and extends until approximately 9:00 pm. This fellow also covers frozen section call weeknights (M-Th). Fellows rotate responsibility for call on a monthly basis and coverage can be arranged with other fellows or faculty if conflicts arise.
Call is taken from home. Fellows’ on-call responsibilities require them to be available to cover off-hours frozen sections and to handle questions or issues that arise in the surgical pathology laboratory. Fellows may occasionally be required to return to the hospital when on call. Total in-house on-call time in the hospital typically does not exceed 2-3 hours per week. There is no weekend call for surgical pathology fellows. The fellow must be scheduled for a minimum of one day duty free every week (when averaged over four weeks).
Specific duty hour requirements are as follows:
1. Maximum Hours of Work Per Week: The duty hours of the fellow must be limited to 80 hours per week (or other applicable limit as specified by the appropriate Residency Review Committee (RRC), when averaged over a 4-week period, inclusive of all in-house call activities and any moonlighting activities. Any time spent in the UIHC or at another institution for clinical and academic purposes, related to the fellowship program, shall count toward the weekly maximum. Additionally, the weekly maximum shall include time spent for administrative duties related to patient care, the transfer of patient care, scheduled academic activities such as conferences, research related to the program, and any time the resident spends on-site after being called in to the hospital. Not included in the weekly maximum is time spent outside of UIHC (or outside another institution related to the program’s academic purposes) for academic preparation, reading, and studying.
2. Maximum Duty Period Length: No schedule shall exceed a maximum of 24 hours of continuous duty in the hospital, with no more than 4 additional hours used for any transitional activities.
3. Mandatory Time Free of Duty: The fellow must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). This day off shall not include home call nor shall the fellow be required to carry a pager. A day is defined as 24 consecutive hours.
4. Minimum Time Off Between Scheduled Duty Periods: The Fellow can participate in transition to practice activities when they are preparing to care for patients over irregular or extended periods. It is still desirable that the fellow have 8 hours free of duty between scheduled duty periods, but there may be circumstances where the fellow must stay on duty to care for their patients or return to the hospital after shorter intervals. The Program Director monitors time off between scheduled duty periods.
5. Home Call:The fellow returning to the hospital from home call must count time spent in the hospital towards the 80-hour maximum weekly hour limit. The frequency of home call is not subject to the every-third-night limitation but must satisfy the requirement for 1 day in 7 free of duty, when averaged over 4 weeks.
- Home call activities must not be so frequent as to preclude rest and reasonable personal time for the fellow..
- The fellow is permitted to return to the hospital while on 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.”
6. Moonlighting: Moonlighting is not permitted in the Department of Pathology.
The Surgical Pathology Fellowship Program meets the requirements of this policy as well as any applicable standard set by the ACGME, the appropriate RRC, or other accrediting or certifying body. This policy is distributed by the GME Office to all GME contract holders, as well as given to the fellows during orientation. The Surgical Pathology Program monitors fellow duty hours with a frequency sufficient to ensure compliance with this policy and the ACGME/RRC/other accrediting or certifying body’s rules.