Supervision and Duty Hours
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.
Duty Hours
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.