Policies

Fellow Eligibility and Selection

It is the policy of the Section of Neonatal-Perinatal Medicine of St. Christopher’s Hospital for Children to select through the match (or directly) qualified applicants.

Procedures:

  1. Fellow Eligibility
    1. Qualified applicants include:
      • Graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education.
      • Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association.
      • Graduates of medical schools outside the United States and Canada who meet one of the following qualification:
      • Have received a currently valid certificate from the Education Commission for Foreign Graduates (ECFMG) prior to appointment as a fellow
      • Have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction in which they are in training
      • Graduates of medical schools outside the United States who have completed a “Fifth Pathway” program provided by an LCME accredited medical school.
      • All candidates must be qualified to obtain a Pennsylvania training license.
  2. Fellow Selection
    1. Eligible applicants are selected on the basis of their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation and integrity. Candidates will not be discriminated against with regard to gender, race, age, religion, color, national origin, disability, sexual preference, or veteran status.
    2. Interested candidates will submit the following credentials (directly or through on electronic data base):
      • An application form
      • A curriculum vitae
      • USMLE scores or equivalent
      • Letter from their pediatric residency program director
      • Two other letters of recommendation from faculty in their pediatric training program
      • International medical school graduates must submit a photocopy of their
      • ECFMG certificate or 5th Pathway Certificate
    3. Completed applications are reviewed by the program director or the assistant program director. Applicants meeting the program’s eligibility criteria may be invited for a personal interview. Interviews are conducted by the program director, members of the teaching faculty and fellows.
    4. The program director, in consultation with members of the teaching faculty will assess the applicants and will rank them in order of preference. The rank list will be submitted to an organization charged to match the fellows with fellowship programs once that process is established.

Approved: March 13, 2007
Revised: August 14, 2008

Fellow Responsibility: Expectations of Neonatal Perinatal Medicine Fellows Education

The fellow will attend all physiology, clinical, and research conferences. (Attendance at the research and clinical conferences is excused when on service on rotations outside St. Christopher’s Hospital Department of Pediatrics.) A significant number of absences will jeopardize the fellow from being advanced to the next year of training.

When on service at Hahnemann University Hospital, the fellow will attend Ob-Neonatal Conferences and the monthly Genetics conference.

The fellow will be responsible to coordinate with the senior obstetrics resident, the presentation of patients at the Ob-Neonatal conference. The fellow will be responsible that either the resident present the case or else the fellow will present the case.

The fellow will present at least one journal club per year.

The fellow will discuss one interesting patient from the hospital while they were on service. This discussion will usually be held the second week after the month they were on service. (If the resident feels that there were no interesting patients that month, the resident will discuss this with the attending that was also on service. If the resident is still at a loss about what to discuss, then the resident will discuss an evidence based consensus approach to a topic: e.g. what is the best O2 saturations for preterm babies, how fast should protein concentration in the TPN be increased per day, at what level should a baby be transfused, etc.)

The fellow will present at least evidence based clinical practice/consensus report per year.

When on service, the fellow will give at least one teaching session per week to residents each month. The topics taught should be different each time. The attending will be encouraged to write down the topics taught on monthly evaluations.

Research

The fellow is to meet the research requirements of the American Board of Pediatrics.

It is the fellow’s responsibility to see that these requirements are met by the time he/she finishes the fellowship. The director of the Neonatal Perinatal Fellowship and director of the Division of Neonatal Perinatal Medicine are always available to help accomplish these goals.

When the fellow is rotating on a research month, the fellow should arrange to meet with Dr. Zubrow weekly (when he is also in the lab) to review the weekly progress made on their project and the plans for the next week. When Dr. Zubrow is not in the lab, the fellow may come to where Dr. Zubrow is on service to have a meeting (as necessary).

The fellow should attend the weekly lab meeting usually held on Monday mornings at 8:30. During research months the fellow is expected to reach the lab promptly after the end of conference; if the fellow is delayed for any reason, he/she is to call and leave a message.

Clinical

The fellow is responsible to ensure a high quality of care is extended to all patients.

  • The fellow leads rounds.
  • The fellow will follow-up with any plans made on rounds to ensure that the patient has received care.
  • The fellow will be current with the clinical status of the baby and their lab results, X-ray results, consultants’ opinions, etc. The fellow will notify the attending of any major change in the patient’s clinical condition.
  • The fellow will teach the residents how to do procedures; therefore, the expectation is that the resident will have the first opportunity to do all intubations, umbilical line placements, and spinal taps under the direct supervision of the fellow. (The fellow will attempt placement of PICC lines and not the residents.)
  • The fellow will go on transports as needed. A note should be written about the transport.

The fellow will attend at least 20 follow-up sessions per year. They will keep a list of the patients that they have seen as well as a problem list pertinent to that patient.

The fellow will keep a log of procedures that they have performed. The log will include the date, the patient’s name, the procedure, the responsible attending and was the attending in the vicinity at the time of the procedure. Procedures that should be included are: arterial punctures, umbilical artery catheterization, umbilical venous catheterization, PICC line placement, chest tubes, intubations and lumber punctures. (This is a requirement of the RRC and you may have to show this documentation to get privileges at a hospital once you leave the fellowship).

The fellow will provide to the secretary affiliated with the fellowship, a brief synopsis of patients who died while they are on service. This report is due by the second week after their month on service.

The fellow who is on service at Hahnemann University Hospital will respond to consult requests made by obstetricians.

The fellow will write an admission note on all patients admitted when they are the responsible fellow. If any significant change occurs in the patient’s condition, the fellow will ensure that the change is noted in the chart.

The fellow will fill out the data base forms when they are on service and if a patient is discharged during their time on-call. The fellow on-service will provide to the secretary at St. Christopher’s Hospital a summary of the clinical course of any baby that died during their month on service.
This is to be completed within 2 weeks of finishing that month on service. Fellows will also complete monthly statistics of the number of admissions and deaths by weight and gestational age.

Revised: August 14, 2008

Fellow Supervision

It is the policy of the Section of Neonatal-Perinatal Medicine of St. Christopher’s Hospital for Children to assure that each fellow has appropriate supervision guidelines that are consistent with the overall hospital’s guidelines as well as proper patient care and the educational needs of the fellows.

Procedures:

  1. All fellows are supervised by teaching faculty.
  2. On-call schedules for teaching faculty are structured to ensure that supervision is readily available to the fellows and residents on duty.
  3. The fellow supervision allows fellows to assume progressively increasing responsibility according to their level of education, ability, experience, and skills.
  4. The fellow’s evaluation is the basis to determine the degree of resident supervision required.
  5. The fellows will supervise any residents that are also on-service with them. The fellows may delegate to the resident responsibilities for patient care according to their level of education, ability, experience, and skills.

Approved: March 13, 2007
Reviewed: August 14, 2008

Grievance Policy

Any fellow with a complaint or grievance shall follow the policy outlined in the institutional GME Policies and Procedure Manual.

Grievances include but are not limited to, those concerning working conditions, benefits, and any failure of the Hospital to meet its obligations under the Resident Physician/Fellow Agreement or when a fellow believes that a situation is an infringement on personal, religious, cultural or other beliefs, or ethics.

The fellow shall submit any grievance in writing to the Program Director who will respond in writing. If the grievance is not resolved to the fellow’s satisfaction or the grievance involves the Program Director, the fellow may appeal to the Section Chief. If the grievance is not resolved to the fellow’s satisfaction, the fellow may appeal to the Chair of the Graduate Medical Education Committee. The Chair of the GME will appoint a committee of members of the GME Committee including a fellow to hear the grievance. The decision of the GME Committee will be binding. (All time frames shall be as determined by the institutional GME Policies and Procedure Manual.)

Revised: August 14, 2008

Lines of Responsibility

All lines of responsibility are to be in compliance with the policy and procedures of St. Christopher’s Hospital for Children. It is the policy of the Section of Neonatal-Perinatal Medicine that a faculty member is on-service/on-call at St. Christopher’s Hospital and at Hahnemann University Hospital 24 hours-a-day/7 days-a-week.

The fellows within the Division of Neonatal-Perinatal Medicine are under the supervision of the faculty within the Section of Neonatal-Perinatal Medicine. If there is a problem needing faculty input about a patient or if there is an administrative problem, the fellow should notify the attending on-service or on-call about the problem. If for any reason, the fellow is not able to reach that attending, the fellow may call the director of the Section of Neonatal-Perinatal Medicine. If the fellow still cannot reach a faculty member, the fellow may call any faculty member for help dealing with the problem.

Moonlighting Policy

  • Any moonlighting performed must be in compliance with St. Christopher’s Hospital’s policy on moonlighting. Fellows must adhere to the institutional GME policy and procedures for moonlighting.
  • The official St. Christopher’s Hospital for Children’s “House Staff Approval of Other Employment” form must be completed each academic year.
  • The fellow must have an unrestricted medical license in the state in which these activities are to be conducted (including if the fellow is working at St. Christopher’s Hospital.)
  • Moonlighting performed internally or externally is considered a privilege granted by the Section of Neonatal Perinatal Medicine and may be withdrawn at any time primarily based upon the work performance of the fellow.
  • Decisions of the Program Director and the Director of Graduate Medical Education are final and not grievable with respect to other employment and/or moonlighting.
  • Any fellow who wants to moonlight inside or outside of the St. Christopher’s Hospital and Hahnemann University Hospital setting must get the written permission of the Program Director.
  • Moonlighting hours will be counted in the total weekly average.
  • At no time will the fellow be permitted to work more than 80 hours per week averaged over a 4 week period.
  • Duty hours need to be documented in accordance with the procedures adopted by the GME office.

Approved: November 8, 2006
Reviewed: August 14, 2008

Planned and Unplanned Absences

The fellow is to notify the Fellowship secretary (Maria Cruz) of all planned or unexpected absences. If the absence was not anticipated, the fellow is to notify the responsible physician where he/she has been assigned for that day.

For example:
SNAP clinic - notify Maria Cruz plus Dr. Fee
Research - notify Dr. Delivoria

Reviewed: October 25, 2004
Revised: August 14, 2008

80-hour Work Week

Fellow Duty Hours

  1. When on service, fellows will have night call (at the most) on Friday or Saturday nights and possibly 1 night during the week.
    • Therefore, the fellows on service will always have at least 1 day in 7 off.
    • The fellow will go home after their night coverage on Saturday or Sunday morning when the next day fellow or NNP arrives. Holidays will be treated the same as a weekend day.
    • During the week, fellows will be relieved of their clinical obligations at 5 P.M.; thus, they will have greater than 10 hours between clinical service obligations.
    • The faculty may allow the on-service fellow to cover in-house during the weekdays at the faculty’s discretion knowing that the fellow may only work a 24 hour shift.
  2. The remaining nights and weekends will be covered by the other fellows and NNPs. A first-year fellow will work 73 on calls per year made up of a combination of nights and weekend days (24-hour shift). A second-year fellow will work 61 on calls per year made up of a combination of nights and weekend days (24-hour shift).A third-year fellow will work 53 on calls per year made up of a combination of nights and weekend days (24-hour shift).
    • An on call schedule will be made out for the entire year to guarantee that the appropriate number of calls is assigned in a way to ensure that no fellow works too many hours.
    • Fellows will not work more often than every third night averaged over a 4 week period.
    • If there are any open slots, then fellows will be allowed to moonlight as long as they are not on service.
    • Moonlighting hours will be counted in the total weekly average.
    • Any fellow who wants to moonlight outside of the St. Christopher’s and Hahnemann University setting must get the written permission of the Program Director and Director of Graduate Medical Education. These hours will be counted within the 80 hours.
      • Moonlighting is considered a privilege granted by the Section of Neonatal Perinatal Medicine and may be withdrawn at any time primarily based upon the work performance of the fellow.
    • Fellows must adhere to the institutional GME policy and procedures for moonlighting.
    • If there are unassigned slots in the schedule due to fellows working their maximum nights and hours, then as what already happens now, the attending staff will stay in-house.
  3. At no time will the fellow be permitted to work more than 80 hours per week averaged over a 4 week period.
    • Required research time is to be counted in the 80 hour total per week. If the fellow conducts research on their own time, the hours need not be counted in the 80 hours but the combined hours spent on self-directed research and program required activities dictates that the fellow be reasonably rested and alert when he or she participates in patient care.
    • Duty hours need to be documented in accordance with the procedures adopted by the GME office.

First Approved: February 5, 2003
Revised: June 1, 2005
Revised: November 8, 2006
Revised: December 12, 2006
Revised: August 14, 2008