General Information

DHMC Cardiology Fellowship Program

July 2005

There are a number of administrative issues in the cardiology fellowship that require a position statement or operative policy. The goal of this communication is to review the majority of these issues.

A. Vacation Policy

The Office of Graduate Medical Education (GME) permits a total of 21 calendar days of vacation per year for housestaff and fellows above the PGY1 level. The 21 days includes weekend days, not just the normal business hours of Monday through Friday. The vacation weeks must be taken one week at a time, usually encompassing the weekend before and the weekend after the Monday to Friday sequence. This scenario is counted as 7 days. If the fellow wishes to vacation from Wednesday to Wednesday, that would also count as 7 days. If unused, a maximum of 5 vacation days may be carried over to the next academic year (July to June).

Vacations may not be taken during the Coronary Care Unit or ICCU (4E) rotations. With that exception, vacations can be taken at any time but Consultation coverage must be arranged by the fellow planning vacation. It is essential that the impact on rotations at DHMC and the VA be evenly distributed. In short, no rotation should bear the brunt of repeated vacations by fellows. To minimize any maldistribution of vacation time on rotation coverage, fellows should identify their preferred weeks early in the academic year. To be fair to all concerned, last minute decisions on vacation aways must be avoided. With rare exceptions for unforeseen circumstances, vacation requests with less than one month prior notification will not be honored.

The other key component to any absences from the normal fellowship schedule is formal notification in writing. Any aways, be they for vacation, illness, family crisis, or conference attendance, require the completion of an Away Form that can be obtained from Holly Hilliker (ext. 5-5920). These official notices are required for us to document your absences to GME. Given that some absences may affect your clinic patients, please provide as much advance notice as possible.

B. External Conferences

At the discretion of the program directors, cardiology fellows are allocated an additional 6 days per year for attendance at national meetings (AHA or ACC) or other extramural conferences. During the first two years of the program, fellows are to use their CME time to attend each of the two national meetings (AHA in November, ACC in March). The program director must approve attendance at conferences other than the national meetings and the priority is meetings credentialed by the ACC. If prior approval is granted, fellows may attend an academic conference and take a consecutive vacation week. This limitation is applied to reduce the impact of aways on clinical rotations and night call coverage. Likewise, a maximum of six general cardiology fellows may be away for conference attendance at one time. The section will provide financial support for each fellow to a maximum of $1500/year for tuition, travel and lodging expenses. Expenses in excess of this amount must be born by the fellow. In the case of unused funds, fellows may apply a maximum of $500.00 to purchase other learning materials such as textbooks, CDs, etc. The residual money is not to be used for non-educational purchases.

Fellows are occasionally supported by electronics or pharmaceutical companies to attend educational sessions that are not ACC-accredited extramural programs. Attendance at these programs must be approved by the program director in advance. It is understood that the total time away for educational activities is not to exceed 6 working days per fellow per year. One important exception to this guideline is attendance at national or ACC sponsored meetings (ACC, AHA, NASPE, TCT, National ECHO meeting) in which the fellow will be presenting a research paper or poster. Latitude for expense coverage and time away will be extended with enthusiasm for this type of academic enterprise.

C. Job Interviews

We recognize that senior fellows must engage in interviews for prospective employment following their cardiology training. It is reasonable, however, that senior fellows budget their away time for the interviewing process in order to minimize the impact on the rotation and on call schedules. Specifically, senior fellows are encouraged to plan interviews that would permit travel over weekends or to use some vacation time for this purpose. A maximum of 7 work days is allowed before senior fellows must utilize vacation days for job interviews. The program will attempt to be as accommodating as possible for fellows entering the job market.

D. Internal Conference Attendance

A monthly schedule will be distributed listing the subspecialty and topic-related conferences. Unless precluded by patient care emergencies, attendance at conferences is mandatory for all fellows on DHMC-based rotations. Conference preparation is time consuming and there is little that discourages a presenter more than a poor showing from colleagues. Furthermore, the accreditation of the cardiology fellowship hinges in part on the presence of a robust conference program. In addition, Core Competencies will be the focus of conferences throughout the year and the ACGME/RRC mandate that the fellowship incorporate these important learning objectives in the curriculum.

It is possible that you may encounter subtle pressure to remain at a non-emergent clinical activity (e.g. completing or initiating a cath case, performing a dobutamine stress) that is likely to invade conference time. Those responsible for lab operation know that the priority is the conference. In short, you must overcome the sense of obligation to the schedule and "through-put" in order to maximize the educational component of the program. Furthermore, the program director will need to be aware of any resistance, either implied or stated, to your attendance at the mandatory conferences.

E. Bi-Directional Feedback

The performance of fellows is critiqued by the appropriate attending staff following each rotation using direct verbal methods and the E*Value system. The program director will track the progress of each fellow and provide an overview of the rotation evaluations every six months during direct meetings with individual trainees. Further, the program director will promptly notify the fellow of any adverse evaluations in order to address the issue(s) and plan corrective action.

Faculty performance requires constructive feedback as well. The program directors will summarize the educational efforts of the faculty on an annual basis. In an effort to guard the anonymity of the trainee's assessment of faculty, this summary will be a composite of the input from all fellows. Performance evaluations of the program director will be channeled through the chief of cardiology. Faculty will receive comments regarding their teaching efforts based on the feedback from the cardiology trainees.

G. Grievances

Situations occasionally arise when conflict resolution is required. Fellows are strongly encouraged to apprise the fellowship director of any disagreements or concerns which may result from interpersonal or patient care related issues. It is understood, however, that the majority of these frictions should be resolved by the parties involved in a professional manner without the need for administrative input. The program director is committed to providing fellow advocacy in any disputes with other services, nursing or hospital administration or cardiology faculty. Where necessary, the offices of the chief of cardiology may be employed to arbitrate a dispute. A formal process for full airing of more serious issues involving trainees is available at DHMC and outlined in detail in the GME handbook. Fellows should review key features of this mechanism and other important information as contained in the GME manual for trainees.

H. Professionalism

The cardiology staff takes pride in fostering a collegial atmosphere for clinical care and learning with high standards of professional behavior and competence. Cardiology fellows are a crucial component of our clinical, research and teaching operations and we expect all fellows to maintain similar standards. Fellows are expected to conduct themselves in a respectful and emotionally controlled manner in all interactions germane to their responsibility as trainees. In particular, a sensitivity to avoid inappropriate comments, gender-related issues and other potentially offensive behaviors must be ensured at all times.

I. Duty Hours

The cardiology fellowship is in full compliance with the ACGME Duty Hours Regulations. Specifically, no fellow is permitted to work more than 80 hours per week averaged over 4 weeks or more than 30 continuous hours. Further, there must be a 10 hour break between shifts and 24 hours off without medical responsibility each week. Cardiology fellows take call from home and the 10 hour limit applies when one must return to the hospital for provision of inpatient or emergency care. Fellows are to leave the next work day by 1300 hours if they are in violation of the 30 hour or 10 hour rules and self-policing of this policy is expected. In addition, faculty are aware that they must provide the necessary inpatient or clinic coverage in instances when the fellow is unable to remain due to the duty hours compliance.

Fellows are required to log their duty hours every two weeks in the E-VALUE system supported by DHMC GME. The GME office will provide oversight of duty hours compliance and the cardiology fellowship director will be notified whenever a fellow is in violation. The compliance with logging duty hours and remaining within guidelines is considered a “Professionalism” issue and will be judged as such during the training program.

J. Moonlighting Policy

The program director and GME of DHMC are aware that financial pressures may necessitate that fellows participate in moonlighting activity during their training. However, moonlighting must not detract from daily performance and the educational obligations of the cardiology fellowship. Further, fellows must follow the rules for moonlighting established by the GME office of DHMC as outlined in the Housestaff Manual. Likewise, moonlighting by cardiology fellows must be approved in advance by the cardiology fellowship program director. Inhouse moonlighting (at DHMC or the WRJ VA) is tabulated with duty hours constraints for the overall program and fellows must recognize these limitations.

K. Contacts

Jan L. Willey is the Cardiology Fellowship Coordinator for all three programs – general cardiology, electrophysiology, and interventional. Jan is responsible for the "bookkeeping" part of your fellowship. She will maintain a binder for each fellow consisting of academic, administrative, and evaluation information, so please be sure to give Jan copies of any published articles or manuscripts, copies of any boards you sit, and research projects you are involved in for this binder. She also keeps track of your away time (vacation, CME, and interview days). At the beginning of each rotation, you will be assigned a faculty member who is responsible for orienting you on the structure, educational objectives, and any other logistics for the rotation identified. If a direct discussion has not taken place within the first two business days of the rotation, please let Jan know so she can contact the faculty member. At the end of each rotation, she will notify staff members as well as fellows through E*Value that evaluations of the rotation are due. She will also monitor on a regular basis the logging in of your duty hours. It is imperative you post your duty hours in a timely fashion for accuracy not only for our records but the GME office and RRC as well. If you need letters to attend meetings, perspective employers, or credentialing at other facilities, please let Jan know and she will arrange to have these processed. You can reach Jan at ext. 5-5077 or E-mail her at Jan.L.Willey@Hitchcock.org with any questions you may have.

Jean Metz will assist you in reimbursement of funds for meetings, books, etc. You can reach Jean at ext. 5-5704 or E-mail her at Jean.E.Metz@Hitchcock.org.

EC.7/05