Graduated Levels of Responsibility
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 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 a 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 the 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 inpatient service for eleven months. The fellow is always on the clinical service with a faculty attending. It is the fellow’s responsibility to round on patients on the inpatient pediatric GI service, perform hospital consults for other services, and help lead rounds with the resident and medical student team.
The first year fellow attends the pediatric gastroenterology clinic for one-half day continuity clinic per week. The fellow follows these patients for the duration of three-year training. The fellow also has the responsibility to interact with ancillary staff with the gastroenterology and hepatology training program, Physician extenders, Pediatric dieticians, Clinical Pharmacists, and Pediatric Social Workers.
PGY 5 and PGY 6
The second and third year fellows have fewer clinical duties, as the focus of these two years is the completion of a scholarly project. The senior fellow attends continuity clinic for one-half day per week and procedures one half day per week. The third year fellow returns to the inpatient setting for one month, as “pretending”, to take on a greater leadership role with the residents and during rounds.