IMC Fellowship Policies and Procedures


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IMC Fellowship Policies and Procedures

  1. 1. THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS CARDIOLOGY FELLOWSHIP POLICIES AND PROCEDURES 2006-2007 GENERAL RESPONSIBILITIES A. Work Schedule: Although there are no specific “work hours” for the fellowship program, fellows should expect to be at the hospital or clinic no later than 8:00 a.m. and to leave no earlier than 5:00 p.m. Monday through Friday. Individual rotations will often require fellows to be present much earlier or later, depending on the particular clinical schedule or patient-related need. B. Call responsibilities: In general, call begins at 5:00 p.m. and runs through 8:00 a.m. the following day during the week and on weekends from 5:00 p.m. Friday through 8:00 a.m. Monday morning. The nighttime and weekend call schedule is developed for the entire academic year and distributed by July 1st. You are free to arrange call coverage with another fellow at the same clinical level. However, the Fellowship Coordinator must be informed of changes in the call schedule so that the monthly schedule can be clearly communicated to the appropriate personnel, which includes (but may not be limited to) the consult service, CCU staff, emergency room staff, and hospital operators. It is the responsibility of the fellow whose name appears on the printed monthly schedule to ensure that proper notification occurs. Unless there has been formal notification of a change in the schedule, the fellow listed on the call schedule distributed by the division prior to the first of each month will be responsible for that call period. Please see "Duty Hours and Work Environment" document for further description of call responsibilities and regulations. C. Departmental and Divisional Activities: There are no required Internal Medicine departmental activities, although fellows are very strongly encouraged to attend cardiology related conferences, particular Medical Grand Rounds that relate to cardiovascular medicine. Conferences: there are three required divisional conferences each week. 1. The fellows “Core Curriculum” lecture series meets from 7:00 – 8:00 a.m. every Friday in the St. Paul 9th floor conference room. 2. The divisional “Cardiology Grand Rounds/Clinical Conference” meets every Thursday from 7:30 – 8:30 a.m. at the St. Paul auditorium. 3. The Donald W. Reynolds Center Research Conference will take place from 12:00-1:00 pm every Tuesday in the F4 conference room. All clinical fellows are required to be prompt and to attend these three conferences. It is a requirement for our fellowship program accreditation that we document 75% fellow attendance at our conferences. Therefore, there will be a sign-in sheet at these conferences, and it is the responsibility of each individual fellow to sign the roster each Rev. 7/22/10
  2. 2. week. In the absence of extenuating circumstances, attendance that falls below the 75% level will result in adverse performance evaluations and the following actions: 1. First year fellows who have not attended the required number of conferences must attend 75% of conferences in the second year + the number short of 75% from their first year. 2. Any conferences short of 75% by the second year must be completed in the third year, regardless if this is a clinical or research year. Fellows will not be certified for board eligibility unless these conferences are completed. Poor conference attendance that remains uncorrected will lead to academic probation and/or dismissal from the training program. RESEARCH Research is an integral component of an academic cardiovascular fellowship training program. All fellows are required to do at least one year of dedicated research and are also expected to regularly attend the Tuesday afternoon Reynolds Research Conference. Each fellow must also complete at least one manuscript or grant every year. OFF SITE EMPLOYMENT (“MOONLIGHTING”) Moonlighting must be approved in advance by the Program Director (form attached). As a general principal, moonlighting by fellows should be “invisible” to your colleagues here at UT Southwestern. Practically speaking “invisible” means that moonlighting can only occur when you have no responsibilities at the University as part of your fellowship training. Specifically, no moonlighting should occur during the normal working week, or at times when you have any call responsibilities (i.e., first or second call for the Parkland and VA coronary care units or call for St. Paul Medical Center or Zale Lipshy University Hospital). In addition, moonlighting should not prevent attendance at conferences, or result in tardiness for morning rounds. It should not result in excessive fatigue, which might limit your ability to learn, care for patients, or perform research during the day. Finally it should not interfere with your ability to perform self- study at night and on weekends. We are committed to ensuring that patient care is un- compromised. Therefore, any violation of this policy will be taken very seriously. Malpractice insurance is provided for cardiology fellows, by the University of Texas System, and this coverage only applies to UT Southwestern Medical Center and affiliated hospitals; it does not cover any moonlighting activity. VACATION AND PROFESSIONAL TRAVEL Fellows are allowed up to three weeks of vacation time per year. Vacation time is not specifically scheduled, and thus it is up to each fellow to plan ahead for time off and arrange appropriate coverage for clinical and call duties. Specific rotation vacation allowances are as follows: 1. Vacation prohibited: PMH CCU, VA CCU, VA Cath Lab, St.Paul consult (If vacation is imperative during this time, the fellow must find appropriate coverage) Rev. 7/22/10
  3. 3. 2. Attending and Program Director Approval required: PMH Consult, VA Consult (please ensure that at least one rotating housestaff will be present during this vacation if approved) In general, fellows should try to take only one week of vacation per rotation. Two consecutive weeks of vacation require special approval from the attending on service. A leave request form (attached) must be completed when requesting leave time which includes (a) the signatures of the fellow who is covering clinical and/or call responsibilities; (b) the attending(s) working with the fellow during the affected rotation; and (c) the fellowship training program director. This form is available from the fellowship coordinator and should be completed at least six weeks prior to the vacation. It is the fellows responsibility to notify JoJo and Elvie of Parkland and VA clinic cancellations at least six weeks in advance, and they will process the necessary paperwork. Upon receipt of all approvals, a copy of the leave request will be kept in each fellows training file. No more than three weeks of vacation may be used for each clinical training year, and unused vacation time is not “carried over” to subsequent years. There is no financial compensation for unused vacation time, and there is no additional paid time off allocated for moving at the beginning or end of the fellowship training period. No more than one week of vacation may be used at the end of the academic year in June. Scientific Meetings: The Cardiology Division will provide funds (currently a maximum of $1200) for professional travel to attend a scientific meeting of the fellow’s choosing during the clinical training years, and fellows are strongly encouraged to attend such meetings. Additional travel costs are the responsibility of the fellow and his or her research mentor. Unused travel funds are the property of the cardiology division and are not available to fellows for other discretionary use. As with scheduling vacation, a leave request form must be completed documenting coverage for clinical duties at least six weeks in advance. FORMAL PERFORMANCE EVALUATIONS Each month, the supervising faculty member working with the individual fellow completes an on-line evaluation, which includes comments as to “clinical competence”, “personal attributes” and “effort and effectiveness”. These evaluations are reviewed and cosigned by the program director and will be available for electronic review by the fellow. In addition, each month the clinical fellows are required to complete a confidential faculty/rotation evaluation for review by the fellowship program director. On a semi-annual basis, the program director will meet with individual fellows to discuss overall performance in the training program. Fellows will review and co-sign the monthly faculty evaluations, problems and/or concerns are discussed, and goals are set for the next six months of training. A report of this meeting is generated and placed in the permanent training folder. On an ad hoc basis, special counseling sessions are held between the program director and individual fellow. These sessions are designed to inform fellows of concerns of declining or inadequate performance. A report of this meeting is generated and placed in the permanent training folder, and a copy is forwarded to the fellow. Rev. 7/22/10
  4. 4. When a fellow fails to meet minimum standards of competency on any rotation, that fellow is placed on formal academic probation. A performance improvement plan is developed. A report of this meeting is generated and copies of the report and improvement plan are forwarded to the fellow, Cardiology Division Chief and Chairman of Medicine. When a fellow fails to meet goals delineated in the improvement plan while on academic probation, and with the unanimous agreement of the Director of Cardiology Fellowship Program, Cardiology Division Chief and Chairman of Medicine, the fellow is dismissed from the training program. PROFESSIONAL EQUIPMENT Fellows are provided with digital pagers and are responsible for repair or replacement costs only in cases of obvious negligence. Fellows are issued two lab coats at the beginning of each year of training. Additional coats may be ordered through the fellowship coordinator at the fellow’s expense. Free laundry service is provided with drop off in the St. Paul Academic office. Lead glasses are issued to each fellow for use during radiographic procedures. If corrective lenses are need, a written prescription must be provided to the Fellowship Coordinator during July of the first fellowship year. RADIATION SAFETY Understanding proper radiation safety is an important part of cardiology fellowship training. Fellows will be provided with radiation film badges at the first of each month and are responsible for wearing the badges at all times that radiation exposure is possible. The Radiation Safety Department asks that the previous badges be returned by the 10th. It is very important that you return the badge, whether or not you have received exposure. Unreturned badges will be credited with the maximum exposure after several months' time, and our department could be held in violation of safety policies. Badges can be picked up from and returned to the Fellowship Coordinator. MISCELLANEOUS ADMINISTRATIVE ISSUES 1. Mailboxes: these are provided for each fellow and are located in the St. Paul Academic office. Fellows are responsible for checking their mail on a regular basis. Many divisional functions and/or special requirements are announced through the campus mail, and failure to retrieve mail is not considered an appropriate excuse for missing a deadline or meeting. A UT Southwestern badge is required to access the Academic office after hours. If you are paid by PMH you will also have a mailbox in the House-staff Lounge on the first floor of the hospital. This room is located on the right side of the hall immediately after passing from the doors that connect UT with PMH. 2. Personal Computers: Fellows are provided access to personal computers on the 8th floor of the Rev. 7/22/10
  5. 5. “H” building and in the fellows work room in the St.Paul offices. Access to these rooms are secured and restricted to cardiology fellows. Each fellow is issued an e-mail address and are expected to access their messages on a regular basis as institutional, divisional and fellowship information and announcements are regularly distributed via e-mail. 3. Paychecks: PMH paid fellows will pick up paychecks in the House-staff office on the first floor every two weeks. Checks must be picked up by 5:00 p.m. that payday. Paychecks that are not picked up are forwarded to Nursing Administration located on the 1st floor and will remain there until 9:00 a.m. the following Monday after payday. Nursing Administration is open 24 hours a day seven days a week for your convenience. UT paid fellows will pick up checks in the St. Paul Academic office the first working day of each month. Direct deposit is available and its use encouraged. 4. Xeroxing facilities. You will be given a code to use the copy machine in the St. Paul Academic office and the copy machine in the Cath Lab in PMH. You will also be given an individual card to use the copy machines in the Library. These numbers should be kept confidential. Please limit your copying to documents relative to your fellowship training. 5. Long-distance calls: You will be issued an individual forced access code (FAC) to allow you make long distance calls from University phones for business purposes. Use of University phones for placing non-business long distance calls is not allowed. Please use a personal calling card when making personal calls. Division administration receives and reviews monthly reports summarizing all long distance calls. Personal checks can be cashed at UT (1st floor, “B” building) or at the PMH Business Office (1st floor). There are several automated tellers throughout the medical center, including near the ZLUH lobby and UTSW food court. You may list 214/645-7521 as your professional phone number, which rings to the Fellowship Coordinator. In general, you will be contacted through your pager. It is divisional policy not to reveal your pager number. Rev. 7/22/10
  6. 6. UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER POLICIES AND PROCEDURES LINES OF RESPONSIBILITY FOR CARDIOLOGY FELLOWSHIP TRAINEES I. POLICY It is the policy of UT Southwestern to delineate clear lines of responsibility between cardiology fellows, cardiology faculty, and internal medicine residents in a manner consistent with the educational goals of the residency and fellowship programs and proper patient care. II. LINES OF RESPONSIBILITIES Cardiology Fellows 1. The lines of responsibilities are identical at all teaching hospitals, namely Parkland Health and Hospital System (PHHS) and Veterans Affairs North Texas Health Care System (VANTHC), and St. Paul University Hospital 2. Cardiology Fellows will be closely supervised by attending physicians during every clinical experience throughout the fellowship in a manner that is consistent with the ACGME program requirements. Supervision shall be structured to provide fellows with progressively increasing responsibility commensurate with their level of education, ability and experience. For each rotation, cardiology fellows will be given a clear means of identifying supervising faculty, who share responsibility for patient care on each rotation. There must be a prompt means of accessing input and assistance from these physicians. 3. During rotations where there are no internal medicine interns or residents, the cardiology fellow will provide care to patients under supervision by faculty and will directly report to the supervising faculty. 4. During rotations where the cardiology fellow is present with internal medicine residents the following lines of responsibility apply. The internal medicine interns and senior residents will take care of assigned patients commensurate with their degree of knowledge and level of training and will maintain their lines of responsibility as outlined by the Internal Medicine Program Director. The cardiology fellow will provide supervision of the internal medicine residents on the service and will directly report to the attending on that rotation. The cardiology fellow will be a senior member of the team and will provide guidance and instruction to the internal medicine residents, under supervision of the attending physician, commensurate with the level of experience and skill of the cardiology fellow. The cardiology fellow is responsible to and directed by the Attending Physician on that rotation. The faculty attending is responsible for all medical care and teaching on that rotation. The Attending Physician’s decisions are final. 5. During rotations where the cardiology fellow provides consults to other services, the cardiology fellow is supervised by the cardiology attending on that rotation. The cardiology fellow may supervise and advise internal medicine residents rotating on the consult services, under the overall supervision of the attending physician. Rev. 7/22/10
  7. 7. 6. On procedural rotations, including cardiac catheterization, electrophysiology, and transesophageal echocardiography, the cardiology fellow will perform the procedures under the direct supervision of the attending faculty only. 7. On rotations in which the fellow interprets imaging studies, including cardiac catheterization, echocardiography, nuclear cardiology, MRI, and CT angiography, all fellow interpretations will be reviewed and corrected by the attending faculty before the report is finalized and available for review by clinicians. II. LINES OF RESPONSIBILITIES Legal Responsibilities The ultimate legal responsibility of the program is vested in a) Chair of Internal Medicine b) Program Director of the Internal Medicine Program and c) Cardiology Fellowship Program Director. Rev. 7/22/10
  8. 8. POLICY ON ORDER WRITING BY CARDIOLOGY FELLOWS 1. All orders must be signed by a physician who is an active member of the medical staff or a house officer or fellow who has a Postgraduate Medical Permit from the Texas State Board of Medical Examiners or a regular Texas license. 2. On all inpatient cardiology services at Parkland, the Dallas VA, and St. Paul University Hospital, orders will be written by the internal medicine house staff on service. Attending faculty will write orders only if the house staff is not available. Cardiology fellows may write orders on patients on the inpatient cardiology service, including in the coronary care unit and telemetry units, but should communicate these orders to the internal medicine housestaff. 3. At Parkland Hospital and the VA hospital cardiology consult services, cardiology fellows may not write orders for patients on Internal Medicine services, except in case of emergency or when procedural orders are required. For patients on surgical and OB/GYN services, cardiology fellows should only write orders after speaking with the team and being given verbal permission by the team to write the order. 4. For consultations performed on patients on nonteaching services, cardiology fellows may write orders directly, but must communicate with the consulting physician. 5. Telephone orders may be accepted but must have a written signature within 24 hours. 6. Cardiology fellows will write pre- and post-procedural orders for procedures in which they participate, under the supervision of attending faculty. 7. DNR and restraint orders must follow hospital and external regulatory agency requirements and should be countersigned by the Attending Physician. 8. Laboratory, procedural, and radiologic orders must be accompanied by ICD9 code or a clinical reason for the test. Rev. 7/22/10
  9. 9. POLICIES & PROCEDURES CARDIOLOGY FELLOWSHIP TRAINING PROGRAM ACKNOWLEDGEMENT OF RECEIPT This acknowledges my receipt of the Policies and Procedures for the Cardiology Fellowship Training Program including the Duty Hours and Work Environment documents. I understand that it is my responsibility to be knowledgeable and adhere to their contents. Date: _________________________________________________ Printed Name: ___________________________________________ Signature: ______________________________________________ Please sign/date and forward to the Fellowship Coordinator Rev. 7/22/10