Fellows Job Description

GRADUATED LEVELS OF RESOPONSIBILITY

Graduate medical education is based on the principle of progressively increasing levels of responsibility, in caring for patients, under the supervision of faculty. The Fellowship Program Director and all Faculty are responsible for evaluating the progress of each resident in acquiring the skills necessary for the resident to progress to the next level of training. Factors considered in this evaluation include the resident’s patient care experience, medical knowledge and judgment, professionalism, communication skills, technical skills, practice-based learning and improvement and systems-based practice. These levels are defined as post-graduate years (PGY) and refer to the clinical years of training that the resident is pursuing. The requirements for training in the primary care specialties such as pediatrics, internal medicine, and family practice require an intensive three years of academic training. Other specialties such as anesthesia and ob/gyn require four years of training. This training, traditionally called fellowship, includes considerable autonomy especially in the tasks already mastered in the core program. At each level of training, there is a set of competencies that the resident is expected to master.

As these are learned, greater independence is granted the resident in the routine care of patients at the discretion of the Fellowship Program Director and the Faculty who, at all times, remain responsible for all aspects of the care of the patient. Each fellow is formally evaluated at least twice each year with on-line assessments by all subspecialty faculty and 360-degree assessments by nurses and division staff who work with each fellow. The subspecialty program director then reviews all written assessments with each subspecialty fellow after formal presentation of fellows at a faculty meeting. At these times, decisions are made about each fellow’s progressive involvement and independence in specific patient care activities. Examples of expected competencies and responsibilities for each level are noted below.

PGY4

The first year fellow is on the impatient service for ten months. The fellow is always on the clinical service with a faculty attending. The fellow and attending make rounds together each morning evaluating all patients on the gastroenterology and hepatology inpatient services. As long as they are not urgent, consultations are completed the same day after the fellow has had an opportunity to independently assess the patient. The fellow then communicates the plan to the physicians who requested the consultation. During inpatient rounds the fellow presents each patient to the attending, and formulates the diagnostic and therapeutic plan for the day. The fellow also is the person who communicates with the pediatric residents and consulting attendings. It is the fellow’s responsibility to educate the resident about the patient’s condition, plan for overall care of the patient and function as gastroenterology and hepatology consultant. Fellows also impart knowledge to each other and to younger resident colleagues and medical students. The gastroenterology fellow is responsible for all patients admitted to the pediatric gastroenterology and hepatology hospital services in addition to the pediatric and neonatal intensive care unit. In these latter settings, the subspecialty resident communicates with the Critical Care Medicine service after discussion of the acutely ill patient with the gastroenterology and hepatology faculty.

The first year fellow is on the impatient service for ten months. The fellow is always on the clinical service with a faculty attending. The fellow and attending make rounds together each morning evaluating all patients on the gastroenterology and hepatology inpatient services. As long as they are not urgent, consultations are completed the same day after the fellow has had an opportunity to independently assess the patient. The fellow then communicates the plan to the physicians who requested the consultation. During inpatient rounds the fellow presents each patient to the attending, and formulates the diagnostic and therapeutic plan for the day. The fellow also is the person who communicates with the pediatric residents and consulting attendings. It is the fellow’s responsibility to educate the resident about the patient’s condition, plan for overall care of the patient and function as gastroenterology and hepatology consultant. Fellows also impart knowledge to each other and to younger resident colleagues and medical students. The gastroenterology fellow is responsible for all patients admitted to the pediatric gastroenterology and hepatology hospital services in addition to the pediatric and neonatal intensive care unit. In these latter settings, the subspecialty resident communicates with the Critical Care Medicine service after discussion of the acutely ill patient with the gastroenterology and hepatology faculty.

The first year fellow attends the pediatric gastroenterology clinic for one-half day per week. The fellow has the opportunity to select new and return patients who have a variety of gastroenterologic, pancreatic, and hepatic disease. The fellow follows these patients for the duration of three-year training. It is the responsibility of the fellow to formulate a plan of evaluation and care, which is discussed with a faculty attending. The fellow also has the responsibility to interact with ancillary staff who with the gastroenterology and hepatology training program, including Nurse Clinicians, Physician Assistants, Pediatric Nutritionists, Clinical Pharmacists, and Pediatric Social Workers. A patient review conference generally occurs at the end of each clinic.

PGY 5 and PGY 6

The inpatient experience for the second year fellow is essentially the same as noted above. However, the advanced trainee is only on the clinical service for two months. The third year fellow on the clinical rotation for two months of the year assumes greater responsibility for the inpatient service. However, the senior subspecialty residents make formal rounds with the faculty attending on a daily basis including review of consults. Also, the faculty gastroenterologist and hepatologist attend all procedures with the third year fellow (as is done during PGY-4 and PGY-5 years). The greater independence given to the third year fellow involves all patient care activities in addition to active supervision and teaching of residents and medical students.

The second year fellow attends the continuity clinic for one-half day per week and has the same fellows, in addition to residents and medical students. During the third year, the fellow attends clinic for one-half day per week.

ALL YEARS

Residents at every level are expected to treat all other members of the health care team with respect and with recognition of the value of the contribution of others involved in the care of patients and families. The highest level of professionalism is expected at all times, as is treatment of all others with respect, compassion, and consideration one would expect for oneself. The resident must understand that personality conflicts are not conducive to good patient care that the stress of a busy practice can precipitate conflict. The resident must learn to be aware of situations where accentuation of stress is more likely to occur and attempt strategies to de-escalate the troublesome situation.

The resident is expected to develop a personal, ongoing program of learning and improvement. Besides general reading in the specialty, residents must utilize computer skill for evidence-based learning, especially prior to performing or assisting in subspecialty procedures. Also, residents are expected to attend and present at core curriculum conferences at the clinical service and program level. The conference program is designed to provide a didactic forum to augment the resident’s general learning and clinical experience.

Residents shall follow hospital policies and procedures and support the mission, vision, and values of the facility. Residents shall always maintaining a professional appearance and promote safety of the patients.