University of Missouri-Columbia

Department of Child Health

Resident Manual

 

2009-2010

 

 

Tiger Edit

 

 

 

Table of Contents

 

 

Page(s)

 

 

General Department Information

 

 

Salary / Benefits

Book Money

3

4

 

Vacation / Absences / Leave of Absence / Maternity Leave / Sick Leave

 

5

 

 

 

Guidelines / Policies

 

 

Call

6

 

Moonlighting

7

 

Duty Hours

7-9

 

State of Missouri Temporary License

9

 

Certification (BLS, PALS, NRP)

9

 

University of Missouri’s Policy on Nondiscrimination

9

 

Substance Abuse Policy

9-10

 

Sexual Harassment Policy

11-12

 

Resident Grievance Policy

12-13

 

 

 

Resident Education / Evaluation / Competencies

 

 

Resident Advisor Program

14

 

Pediatric Curriculum

15

 

Pediatric Core Competencies

16-18

 

Required Procedure List

    19-20

 

Conference Attendance Policy

21

 

Conference Common Goals and Objectives

21-23

 

Individual Learning Plan

24

 

Supervisory Roles

24

 

Goals and Objectives by Level of Residency

24-28

 

American Board of Pediatrics Evaluations

29-30

 

 

 

 

 

 

Selected Internet Links

30

 

UMHC Policy

 

 

ABP

 

 

ACGME

 

 

RRC

 

 

 

 

 

General Department Information

 

Salary / Benefits

 

PG-1     $45,081

PG-2     $46,745

PG-3     $48,408

PG-4     $50,556

 

Malpractice Insurance

 

Provided at no cost to the resident for activities associated with the residency program.

 

Medical, Dental, Vision Insurance

 

Individual or family policies are available on a cost-sharing basis through the University of Missouri.  Policies can be individual or can include family members.  Insurance costs are taken out of your paycheck as a pre-tax benefit.

 

Long-Term Disability and Life Insurance

 

This insurance is free for basic coverage, e.g., the disability will cover 60% of your salary after five months and the life insurance is equal to 1x your annual salary.  Additional coverage options are available at extra cost.  Low cost family policies are also available.

 

403B Plan and Roth IRA’s

Residents may withhold a part of their salaries for retirement to a 403B plan (the educational institution’s equivalent to the 401K plan in industry).  Any money withheld contributed to a 403B are witheld pre-tax and will grow tax free until it is taken out.  However, it cannot be touched, without penalty, until 59½ years of age.  For details about a 403B plan contact Laray Kostal in Benefits at 573-882-6582

 

Most of you will also qualify to start Roth IRA’s.  These can have post-tax money put into them but still grow tax free.  They are another great instrument for savings and they are not as strict as 403B’s in terms of access, though rules still apply.  See a financial advisor for detail about this.

 

Miscellaneous

 

Residents are eligible for student rates to cultural events as well as access to student facilities such as the student recreation center, craft shops, bowling alley, etc.  A discount is offered by the UNIVERSITY OF MISSOURI-COLUMBIA Bookstore (10%) and some other businesses and colleges in Columbia.

 

The physicians’ lounge at the University Hospital provides meal to residents at no charge.  Columbia Regional Hospital provides 2 meals per day with additional meals for nights and weekends available at no charge through the cafeteria.

 

Parking permits at Maryland Avenue garage are available for a monthly fee.  Parking with the faculty/staff permit (resident permit) is allowed on the levels 3,4,5.  Permits for CRH-Columbia Regional Hospital are provided at no charge for the designated areas.

Book Money

 

The Department provides each resident with $400.00 per year to be used for educational resources, such as textbooks, medical equipment, etc.  Appropriate usage is at the discretion of the Program Director.

 

Time Off

Vacation

The American Board of Pediatrics allows a maximum of 1 month per year.  This is based on the requirement of 33 months of clinical training completed in order to be board eligible.  Our current vacation policy allows 4 weeks per year.  If there are multiple days missed for any reason (i.e. family or personal illness) vacation days MUST be used to make up the time off in order to ensure an on-time residency completion date.  You may not work on your day off as a means of making up time you have missed, as this would violate the ACGME duty hour guidelines.

 

Vacation will be provided in two 2-week blocks for interns.  Vacation for senior residents will be provided in two 2-week blocks with the option of a single 4-week block under special circumstances with the prior approval of the chief resident and program directors.  Vacations dates are inclusive, and vacation begins at 7:30 am on the first designated day.  This means you may be on call the day before your vacation begins.

 

Initial vacation requests are given at the end of the previous year (June).  Changes in vacation may not be made during the first 6 months of the year.  Thereafter, changes may be made after discussion and approval by the Chief Resident.  However, changes are subject to approval by the Program Director and coverage must be maintained.  Vacation time may not be allowed during certain times of the year, specifically Block 1, Block 7, and Block 13.  You may roll-over vacation days into the next academic year. 

 

Leave of Absence

Residents may be granted a leave of absence (unpaid and without credit) for a period up to, but not exceeding four months.  This is at the discretion of the Program Director who may consult the resident’s advisor, and the Chief Resident.  The most common reason for a leave of absence is maternity leave.  This period of leave must be made up.

Procedure:

A written request for a LOA (leave of absence) must be completed and given to the Residency Program Director and an appointment must be scheduled with said director.  The LOA will be approved or denied after review by the director as well as the Pediatric Education and Evaluation Committee.

 

Sick days

Time off due to illness must come from vacation time.  You must notify the Chief Resident on the day of your illness.  The Chief Resident will arrange for your patient coverage when necessary and will notify the Attending, the Program Coordinator, and the Program Director.

 

Residents are not allowed to cancel continuity clinics without approval by the Program Director and continuity attending physician.  They are expected, however, to turn in clinic cancellation forms for approved vacations.  Any cancellations secondary to illnesses must be done by the Chief Resident.  Post-call clinics are cancelled by the resident.

 

All missed call due to illness will be made up.  If another resident covered for you, you will need to pay back that resident.  A backup resident call system is in place to cover when needed.

 

Days off each week

An average of one day per week (or four days per four week block) is scheduled as a day off.  This may be a weekend - day or weekday depending on the needs of the rotation.

 

Requests for specific days off must be made in advance, in writing or email to the Chief Resident.  All reasonable efforts will be made to accommodate the request but cannot be guaranteed.  Multiple requested days off in a month may result in a call free month, vacation or an elective, or simply may not be able to be arranged based on call pool or staffing needs.  Should you need to exchange days with another resident, after the schedule is released, you may do so on your own with the approval of the Chief Resident.

 

Most often, your days off will not follow one of your call days.  However, in the rare event it does and you are on the wards or in the NICU, you must stay long enough to check your patients out to the resident who will be taking over.

 

“Golden weekends” or multiple days off on a selected weekend are built into the inpatient wards schedule for senior residents (day / night float).  Golden weekends are not allowed on the NICU rotation.

 

Call free months

There is a maximum of one month without call responsibility in the second year and two months in the third year of residency built into the resident schedules at the beginning of the year.  This is the maximum amount of call free time allotted.  If a resident adjusts their call schedule that results in the elimination of their call free month, their call free months are not adjusted.

 

National Meetings/Conferences

Residents will be allowed to attend a conference if they are presenting an abstract or with the approval of the program directors.  The cost of the conference will be covered by the department if the resident is a presenter at the conference.  The meeting must be a major meeting and must be approved by the Chief Resident and the Program Director. 

Residents are also allowed to use their book funds to help pay for a conference in their senior year of residency.

 

 

Tests

You are expected to take USMLE Step 3 by the mid-point of your residency. You must pass Step 3 prior to the start of the PL-3 year.  The test must be prearranged and preapproved by the Chief Resident by the first of the month, at least two months in advance.  Since taking Step 3 is a requirement for residency you will not be charged with vacation days in order to take the exam.

 

Guidelines and Policies

 

On Call Guidelines

 

Frequency of Call

According to the American Board of Pediatrics and the ACGME requirements, in-house call should average every 4th night when residents are on clinical services that require call.

 

Back-Up Call

A backup call resident is available in case of illness/absence of a resident or for unforeseen circumstances that may jeopardize patient care. The back up call system is activated by the Chief Resident.  The back up call resident must be immediately available via beeper and would be expected in the hospital within 60 minutes of being called in.

 

ER back-up

For Inpatient Duties – prior to leaving the hospital after his or her shift, the ER resident should check-in with the Inpatient team to ensure adequate patient care coverage overnight. The pediatrics program does not utilize a home-call system at this time.

 

Code Pagers-Beepers

The code pager are the responsibility of the senior ward residents.  Senior and intern residents should carry a code pager/beeper during the day and then pass them off to the night-team at check-out.  Those who will be in the specialty clinic building should not carry a code beeper.  It is imperative that these beepers are well cared for.  The batteries should be replaced monthly by the senior ward residents at the start of their 4 week ward rotation.

 

Call Room Availability

 

NICU

Call rooms are available in the area of the NICU for both the intern and the senior residents.  These two rooms are located directly inside the main unit doors and share a bathroom/shower area.

 

Ward Residents on Call

Call room is available on the 7th floor including a general purpose area for working and access to computers.

 

Post Call Policy

Post call residents must leave by 30 hours, or six hours after a 24 hour shift has ended when their notes are written and a thorough patient hand-off is completed.  Please become very familiar with Duty Hours Regulations noted below. 


Moonlighting

 

NICU Moonlighting

Moonlighting opportunities are available at the UMHC NICU for upper level pediatric and Med-Peds residents under to following guidelines.  Eligible residents must be approved by the Program Director under the following guidelines.  Hours spent moonlighting within our hospital system will be applied to the resident’s total duty hours, so moonlighting will not be approved if duty hour violations occur.  A resident who accepts a moonlighting call is responsible for finding a replacement if he/she is not able to keep that commitment.  Anyone who agrees to moonlight, but fails to keep that commitment without prior arrangement for coverage, will be taken off the list of potential moonlighters for a minimum of six months.

 

Typical weeknight shifts are 14.5 hours (1700-0730) and weekend shifts are 24 hours (0730-0730) on average.  The reimbursement rate for moonlighting in the NICU is $35 per hour and will be applied to your monthly paycheck. 

 

Under special circumstances and with approval of the appropriate Program Director, residents with a permanent Missouri License, BNDD, and DEA numbers may moonlight at an outside institution.  Please be aware that your University malpractice coverage does not cover your activities at an outside institution.

 

Duty Hours (from the ACGME)

 

Duty hours and the working environment providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being.  Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on the residents to fulfill service obligations.  Didactic and clinical education must be a priority in the allotment of residents’ time and energies.  Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of the patients.

 

1.    Supervision of Residents

a.) All patient care must be supervised by qualified faculty.  The Program Director must ensure, direct, and document adequate supervision of residents at all times.  Residents must be provided with rapid, reliable systems for communicating with supervising faculty.

b.) Faculty schedules must be structured to provide residents with continuous supervision and consultation.

c.) Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.

 

2.    Duty Hours

a.) Duty hours are defined as all clinical and academic activities related to the residency program, i.e. patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences.  Duty hours do not include reading and preparation time spent away for the duty site.

b.) Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

c.) Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call.  One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

 

3.    On-Call Activities

The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period.  In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution.

 

a.)  In-house call must occur no more frequently than every third night, averaged over a four-week period.

b.)  Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours.  Residents may remain on duty for up to 6 addition hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements.

c.) No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty.

 d.)  At-home call (pager call) is defined as call taken from outside the assigned institution.

1.)           The frequency of at-home call is not subject to the every third night limitation.  However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident.  Residents taking at-home call must be provided with 1 day in 7 completely free from educational and clinical responsibilities, averaged over a 4-week period.

2.)           When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.

3.)           The Program Director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary it mitigate excessive service demands and/or fatigue.

      4.)        Moonlighting

a.) Because residency education is a full-time endeavor, The Program Director must ensure that moonlighting does not interfere with the ability of the resident to achieve the goals and objective of the educational program.

            b.) The Program Director must comply with sponsoring institution’s written             policies and procedures regarding moonlighting, in compliance with the Institutional Requirements III.D.1.k

            c.)  Moonlighting that occurs within the residency program and/or the sponsoring institution or the non-hospital sponsor’s primary clinical site (s), i.e. internal moonlighting, must be counted toward the 80-hour weekly limit on duty hours.

5.)        Oversight

            a.) Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment.  These policies must be distributed to the residents and the faculty monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service.

            b.) Back up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create residents fatigue sufficient to jeopardize patient care.

 

6.)        Duty Hours Exception

            An RRC may grant exceptions for up to 10% of the 80-hour limit, to individual programs based on a sound educational rationale.  However, prior permission of the institution’s GMEC is required.

 

Duty Hours Tracking

All residents are expected to track their work hours by using the New Innovation software for each rotation while on Child Health.  The information gathered will be used by the Chief Resident and Program Director in order to better track our compliance with the duty hour guidelines set forth.  Failure to document hours in a timely fashion may be reflected in the residents’ individual competency evaluations.

 

State of Missouri Temporary License

Licenses are obtained by physicians so they may do postgraduate training in the State of Missouri through AMA or AOA approved training program.

 

1.  With a temporary Missouri License, you are allowed to see patients and write prescriptions “as a part of your training within your department” as long as it is part of the “physician-patient” relationship.  You will be covered under the University BNDD number.

 

2.   You are not allowed to:

      a. Write prescriptions of self.

      b. Write prescriptions for any family member.

      c. Write prescriptions for your secretary, nurse, etc. (unless it is a patient-                              physician relationship with documentation in a patient chart.)

 

Certifications

Residents are expected to have successfully completed BLS, PALS, and NRP training and to remain up-to-date with these certifications.  Med-Peds residents must also complete ACLS.

 

University of Missouri’s Policy on Nondiscrimination

If you have special needs as addressed by the Americans with Disabilities Act and need any test or course materials provided in an alternative format, notify your instructor immediately.  Reasonable efforts will be made to accommodate your special needs.

 

Substance Abuse Policy

The Dean of the University of Missouri-Columbia School of Medicine has established the following program to address the issue of substance abuse and impairment by individuals in graduate medical education programs operation under the auspices of the University of Missouri-Columbia School of Medicine. Physicians hold a unique place in society.  Professional standards require that persons seeking care can be assure that their physicians are not impaired by reason of substance abuse or mental illness.  The purpose of this policy is:

 

A.  To assure that patients receiving care from resident physicians and clinical fellows, operating under that auspices of the University of Missouri-Columbia School of Medicine, receive the highest quality health care from individuals not only well-trained and highly-motivated, but unimpaired by reason of substance abuse or mental illness.

 

B.  To assure that individual involved in graduate medical education have access to appropriate health care and assurance of continued access to training so long as they comply with institutional requirements and standards.

 

Physician Health Committee

·         The University of Missouri Health System Physicians Health Committee has need established by the Dean of the School of Medicine to assume responsibility for oversight of the Health Sciences Center Physician Health Program.

·         Membership of the Health System Physicians Health Committee is:

1.    Two members of the clinical faculty appointed by the Dean, School of Medicine.  Of these, one must be serving as a Residency Program Director.  Appointment is for three years.  Individuals may be appointment at the discretion of the Dean.  One of these individual will be designated by the Dean to Chair the committee.

2.    One resident physician or clinical fellow appointed by the House Staff Organization.  Term of service will be one year.  This individual may be reappointed at the House Staff Organization.

3.    The Health Science Center Physician Health Committee will meet as often as necessary to fulfill its obligation.

 

·         All information presented at meeting of the Health System Physician Health Committee, and all actions of the committee will be considered to be confidential except as provided herein and except that such information will be available to the Dean, School of Medicine and otherwise as required by law.

 

Responsibilities of the Health System Physician Health Committee

It is the responsibility of the Health System Physician Health Committee to receive any allegations of impairment of resident physicians or clinical fellows due to substance abuse or mental illness.

The Health Sciences Center Physician Health Committee may inform the Residency Program Director if the committee suspects the accused is impaired by substance abuse or mental illness.  If there is probable cause to believe that impairment due to substance abuse is present, allegations related to possible substance abuse must be reported to the Missouri Physicians Health Committee for further investigation and action.  If there is probable cause to believe that impairment due to mental illness is present, the Health Center Physician Health Committee shall require psychiatric evaluation by a psychiatrist approved by the Health Science Center Physician Health Committee.

 

Upon determination that a resident physician or clinical fellow is impaired due to substance abuse or mental illness, the Health Sciences Center Physician Health Committee will notify the Dean, School of Medicine and the Residency Program
Director.

 

Permission to continue clinical responsibilities

If the resident physician or clinical fellow has been removed from clinical responsibilities by the Residency Program Director, permission to resume clinical responsibilities will be granted only with the agreement of the Health Sciences Center Physician Health Committee and the Clinical Program Director.

Continuation in Residency Training Program

Resident physicians and clinical fellows found to be impaired by reason of substance abuse or mental illness may not be dismissed from the residency program prior to full evaluation of their impairment.  They may, however, be removed from clinical responsibility.

 

Resident physicians and clinical fellows found to be impaired by reason of substance abuse or mental illness may not be terminated based upon such substance abuse or mental illness during the term of their contract with they are compliant with the requirements of the Health System Physician Health Committee.

 

Termination of Appointment of Resident Physician or Clinical Fellow

A resident physician or clinical fellow who has been found to be noncompliant with the Health System Physician Health Committee or the Missouri Physicians Health Committee will be reported to the Dean, School of Medicine and the Program Director.

 

Such noncompliance may be grounds for immediate dismissal from the graduate medical education program.  Any dismissal shall conform to applicable University procedures.

 

Sexual Harassment Policy

The University of Missouri policy aims for an increased awareness regarding sexual harassment by making available information, education and guidance on the subject for the University community.

 

Policy Statement

It is the policy of the University of Missouri, in accord with providing a positive discrimination-free environment, that sexual harassment in the work place or the educational environment is unacceptable conduct.  Sexual harassment is subject to discipline, up to and including separation from the institution.

 

Sexual harassment is defined for this policy as either:

·         Unwelcome sexual advances or requests for sexual activity by a University employee in a position of power or authority to a University employee or a member of the student body, -or-

·         Other unwelcome verbal or physical conduct of a sexual nature by a University employee or member of the student body to a University employee or a member of the student body, when:

1.    Submission to rejection of such conduct is used explicitly or implicitly as a condition for academic or employment decisions; or

2.    The purpose of effect of such conduct is to interfere unreasonably with the work or academic performance of  the person being harassed; or

3.    The purpose or effect of such conduct to a reasonable person is to create an intimidation, hostile, or offensive environment.

 

Non-Retaliation

This policy also prohibits retaliation against ant person who brings an accusation of discrimination or sexual harassment or who assists with the investigation or resolution of sexual harassment.  Notwithstanding this provision, the University may discipline an employee or student who has been determined to have brought an accusation of sexual harassment in bad faith.

 

Redress Procedures

Members of the University community who believe they have been sexually harassed may seek redress, using the following options:

 

1.    Pursue appropriate informal resolution procedures as defined by the individual campuses.  These procedures are available from the campus Affirmative Action/Equal Opportunity Officer.

 

2.    Initiate a complaint or grievance within the period of time prescribed by the applicable grievance procedure.  Faculty are referred to Section 260.010, “Academic Grievance Procedures”; staff to Section 280.010, Discrimination Grievance Procedure for Students”.

 

Pursuing a complaint or informal resolution procedure does not compromise one’s rights to initiate a grievance or seek redress under state and federal laws.

 

Discipline

Upon receiving an accusation of sexual harassment against a member of the faculty, staff or student body, the University will investigate and if substantiated, will initiate the appropriate disciplinary procedures.  There is a five year limitation period from the date of occurrence for filing a charge that may lead to discipline.

 

An individual who makes an accusation of sexual harassment will be informed:

 

·         At the close of the investigation, whether or not disciplinary procedures with be initiated; and

 

·         At the end of any disciplinary procedures, of the discipline imposed, if any.

 

GRIEVANCE POLICY FOR RESIDENTS/FELLOWS

 

Purpose

To establish fair policies and procedures for the adjudication of resident grievances related to the actions which could result in dismissal, non-renewal of agreement of appointment, or any other action that could threaten a resident’s intended career development.

 

A grievance procedure shall not be used to question a rule, procedure, or policy established by an authorized faculty or administrative body.  Rather, it shall be used as due process by a resident who believes a rule, procedure or policy has not been followed or has been applied in an inequitable manner.  An action may not form the basis of a grievance if the resident merely challenges the judgement of the faulty as medical educators in evaluating the performance of the resident.

 

For purposes of this policy, a grievance is defined as an allegation that:

 

1.    There has been a violation, a misinterpretation, an arbitrary or discriminatory application of University policy, regulation or procedure.  This could be related personally to the resident physician—to the privileges, responsibilities, or terms and conditions of the residency training program, including academic or other disciplinary actions or the employment of the resident physician; or

 

2.    The resident physician has been discriminated against on the basis of race, color, religion, sex, national origin, age, disability, or status as a veteran.

 

Filing a Grievance

A resident physician who has a grievance shall initiate action by filing a signed, written account of the grievance with the Program Director within thirty (30) days of the event out of which the grievance has arisen.  The Program Director and the Department Chair have the discretion to discuss the grievance with the resident and other involved parties in an effort to resolve the grievance.  If the grievance is resolved in this manner the terms of the resolution will be put in writhing and signed by the Program Director and the resident.  If the grievance is not resolved, the Program Director shall respond to the grievance in writing within thirty (30) calendar days of the receipt of the written grievance.

 

If the resident is uncomfortable approaching his/her Program Director, The resident is encouraged to discuss the issue with the GME office.

 

Grievance Appeals to the Dean

Should the resident physician be dissatisfied with the response of the Program Director, he/she may, within ten (10) calendar days of receipt of such response, submit a written appeal to the of the School of Medicine, through the Associate/Assistant Dean having responsibility over Graduate Medical Education.  Upon receipt of the written appeal, a grievance panel will be formed by the Dean’s office.  The panel will consist of one Program Director, one other faculty member and one resident member drawn at random for the pool of participants in each group.  The pool of participants in each group will be solicited annually for all members of each group.  The list of volunteers will be maintained by the GME office.  Names will be drawn randomly by the Associate/Assistant Dean responsible for Graduate Medical Education.  No member of the panel may be from the department of any of the involved parties.  If a person whose mane is drawn is not able to participate because of prior commitments, another name will be drawn.  The panel may gather evidence, interview individuals and request further information from the involved parties.  Within thirty (30) days of the receipt of the appeal, the grievance panel will give a written copy of their recommendation to the Dean.  If the decision of the panel is not unanimous, the dissenting party may submit a written dissenting opinion at the same time.  The Dean will respond in writing within five (5) working days of receipt of the panel’s recommendation.  The Dean may accept the recommendation, amend it, reverse it or refer if back to the panel for reconsideration.  The decision of the Dean is final.

 

Also see the University of Missouri Employee Grievance Policy: 380.010 GRIEV

 

Resident Evaluation/Education

 

Resident Advisor

Each resident is assigned a faculty advisor at the beginning of his/her residency.  Residents who did undergraduate training at the University of Missouri are welcome to choose an advisor at the beginning of residency.  Other residents may elect to choose an alternative faculty member as an advisor as their career goals/interests develop.  The goal of the resident advisor falls into 3 main categories:

 

·         To provide interns and residents an advocate, friend, and counselor, in an atmosphere of trust, confidence, and confidentiality.

 

·         To obtain feedback from residents and interns on the structure of the pediatric training program.

 

·         To act as the resident’s advocate if any disciplinary action is being considered.

 

Residents and advisors should meet quarterly and any other time the advisor or resident feels it would be beneficial.

 

Curriculum

In accordance with the guidelines put forth by the American Board of Pediatrics, the curriculum will consist of 39 blocks (4 weeks each) of structured experience.  During the 39 blocks, each intern will have their own continuity clinic one half-day per week, each second year resident will have their own continuity clinic one to two half days per week, and each third year resident will have their own continuity clinic one to two half days per week.  Upper level residents have the option to participate in a subspecialty or private general pediatric continuity clinic of their choosing as their second continuity experience.

 

 

University of Missouri-Children’s Hospital Sample Pediatric Curriculum

Please note: the curriculum is dynamic and will vary slightly in individual structure and content from resident to resident.

 

PL1             Ward x 4 blocks with ward call

PICU

WBN

NICU x 2 blocks with NICU call

Elective

General Pediatrics (GM) with GM call

ER

Developmental Pediatrics/Community Block (call pool)

Vacation x 4 weeks

TOTAL:      13 blocks (8 inpatient, 4 outpatient)

 

PL2             Ward x 1 block

Ward Night Float x 1 block

PICU

General Pediatrics (GM) (GM call)

Pulmonary Outpatient (call pool)

NICU Senior (NICU overnight call)

Peds Surgery (call pool)

Neurology (call pool)

Adolescent (call pool)

Elective x 2(call pool)

Hem/Onc (call pool)

Vacation

TOTAL:       13 blocks (5 inpatient, 7 outpatient)

 

PL3             General Pediatrics (GM) (GM call)

NICU Senior (NICU overnight call)

Ward x 2 blocks

Night Float 2-4 Weeks

Devo/Community Block (call free)

ER

WBN (call pool)

Elective x 4 (call pool x 4)

Vacation x 4 weeks

TOTAL:       13 blocks (4 inpatient, 8 outpatient)

 

Note:  Goals and objectives for each individual rotation are posted under “Education” on the website.  In addition, they will be sent out electronically via New Innovations prior to the start of each rotation.
Competencies

In February 1999, the Accreditation Council for Graduate Medical Education (ACGME endorsed general competencies for residents in the following areas:

 

Ø  Patient Care

Ø  Medical Knowledge

Ø  Practice-Based Learning and Improvement

Ø  Interpersonal and Communication Skills

Ø  Professionalism

Ø  Systems based Practice

 

Identification of general competencies is the first step in a long-term effort designed to emphasize educational outcome assessment in our residency program and in the accreditation process.  During the next several years, the ACGME’s Residency Review and Institutional Review Committees will incorporate the general competencies into their requirements.

 

The residency program must require its residents to develop the competencies in the six (6) areas below to the level expected of a new practitioner.  The following areas will be evaluated as you go through your residency with periodic review of the resident’s progress at the biannual Program Directors meetings.

 

1. PATIENT CARE

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

 

w  Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.

w  Gather essential and accurate information about their patients

w  Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgement.

w  Develop and carry out patient management plans.

w  Counsel and educate patients and their families.

w  Use information technology to support patient care decisions and patient education.

w  Perform competently all medical and invasive procedures considered essential for the practice of Pediatrics.

w  Provide health care services aimed at preventing health problems or maintaining health.

w  Work with health care professionals, including those from other disciplines to provide patient-focused care.

 

2. MEDICAL KNOWLEDGE

Residents must demonstrate knowledge about established and evolving biomedical, clinical and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.  Residents are expected to:

 

w  Demonstrate an investigatory and analytic thinking approach to clinical situations.

w  Know and apply the basic and clinically supportive sciences which are appropriate to their discipline.

3. PRACTICE-BASED LEARNING AND IMPROVEMENT

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.  Residents are expected to:

 

w  Analyze practice experience and perform practice-based improvement activities using a systematic methodology.

w  Locate, appraise, and assimilate evidence from scientists studies related to their patients’ health problems

w  Obtain and use information about their own population of patients and the larger population for which their patients are drawn.

w  Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.

w  Use information technology to manage information, access on-line medical information, and support their own education.

w  Facilitate the learning of students and other health care professionals

 

4. INTERPERSONAL AND COMMUNICATION SKILLS

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patient families, and professional associates.  Residents are expected to:

 

w  Create and sustain a therapeutic and ethically sound relationship with patients.

w  Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills.

w  Work effectively with others as a member or leader of a health care team or other professional group.

 

 

5. PROFESSIONALISM

Residents must demonstrate a commitment of carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.  Residents are expected to:

 

w   Demonstrate respect, compassion, and integrity; a responsiveness to the needs of the patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development.

w   Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practice

w   Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

 

 

 

 

 

 

 

 

6. SYSTEM-BASED PRACTICE

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care the ability to effectively call on system resources to provide care that is of optimal value.  Residents are expected to:

 

w   Understand how their patient care and other professional practices affect other health care professionals, the health care costs and allocating resources.

w   Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.

w   Practice cost-effective health care and resource allocation that does not compromise quality of care

w   Advocate for quality patient care and assist patients in dealing with system complexities

w   Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.

 

CHILDREN’S HOSPITAL PROCEDURE COMPETENCY LIST

REQUIRED DOCUMENTED COMPETENCY IN THERAPEUTIC/TECHNICAL PROCEDURES

 

Becoming adept at pediatric procedures in an extremely important aspect of your training.  You must be aggressive at attempting procedures.  Draw your own blood work, including ABG’s whenever you have the chance.  Start IV’s as frequently as possible.

 

To complete your Pediatric Residency Training at our institution, you must document that you successfully performed the procedures listed on the Children’s Hospital Procedure List.

 

After performing a procedure successfully, fill out your procedure log.  It is your responsibility to seek out these procedures and document them on the procedure logs.  Logs will be reviewed biannually for recording procedures with the Program Director.

 

Your procedure must also be recorded online with New Innovations. 

 

Please check with Penny Adams-Kraus for information about your username and password.

ACGME required procedures to be documented during residency training

 

Basic and advanced life support

Endotrachial intubation

Placement of intraosseous lines

Placement of intravenous lines

Arterial puncture

Venipuncture

Umbilical artery and venous catheterization

Lumbar puncture

Bladder catheterization

Gynecologic evaluation of prepubertal and post pubertal females

Wound care and suturing of lacerations

Subcutaneous, intradermal and intramuscular injections

Developmental screening test

Procedural sedation

Pain management

Reduction and splinting of simple dislocations/fractures

 

Procedures to which ACGME recommends exposure

 

Circumcision

Tympanometry and audiometry interpretation

Vision screening

Hearing screening

Simple removal of foreign bodies (e.g. from ears or nose)

Inhalation medications

Incision and drainage f superficial abscesses

Chest tube placement

Thoracentesis

 

 

In general major procedures are not done without attending presence in the Department of Child Health.  In an emergency situation, however, a qualified resident may do any necessary procedure.  The table below details situations in which residents may do procedures.  If a staff member ever questions whether a resident should be doing any procedure he/she should call the attending physician caring for the child.

 

Procedure

PL-1

PL-2

PL-3

(Med-Peds) PL-4

Arterial Lines

AF

AF

AF

AF

Central Lines

AF

AF

AF

AF

Chest Tubes

AF

AF

AF

AF

Exchange Transfusions

AF

AF

AF

AF

Foreign Body Removal

XA

X

X

X

GYN Post-Pubertal

XA

X

X

X

GYN Pre-Pubertal

XA

X

X

X

Incision & Drainage of Abscess

XA

X

X

X

Intra-Dermal Injection

XA

X

X

X

Intra-Muscular Injection

XA

X

X

X

Intra-Osseous Lines

AF

AF

AF

AF

Lumbar Puncture

R

R

R

R

Needle Aspiration of Pneumothorax

AF

AF

AF

AF

Peripheral IV Line Placement

XA

X

X

X

Reduction of Nurse Maids Elbow

A

A

A

A

Resuscitation Neonate >32 weeks

X#

X#

X#

X#

Resuscitation Neonate <32 weeks

AF

AF

AF

AF

Resuscitation Child

RX*

X*

X*

X*

Splinting of Fracture

XA

XA

XA

XA

Subcutaneous Injection

XA

X

X

X

Suturing

XA

X

X

X

Thoracentesis

AF

AF

AF

AF

Swan-Ganz Catheter

A

A

A

A

Umbilical Art Catheter

AF

AF

AF

AF

Umbilical Veinous Catheter

AF

AF

AF

AF

 

X     May perform without attending or upper level resident presence

A     Attending presence necessary, except in an emergency situation

AF   Attending or fellow presence necessary

R     At least upper level resident presence necessary

XA  May perform without attending or resident after checked off on procedure

X#   If Neonatal Resuscitation Certified (NRP class)

 

 

 

Conferences

Residents are expected to attend 50% of conferences including: Noon Conference, Grand Rounds, Problem Conference, and Journal Club.  The attendance percentage is inclusive of night float shifts, days off, and vacation.

 

Common Goals and Objectives for Conferences

 

Morning Report

 

GOAL: To develop the skills to succinctly present recently admitted patients and to critically analyze the initial management in a small group, case-based discussion format.

Objective

Level

Competency

Learners will synthesize and successfully present a concise oral patient presentation.

MS

R-1

C

MK

Participants will list a reasonable differential diagnosis.

MS

R-1: R-4

MK

Participants will rank the different diagnosis based upon clinical data and experience.

R-1: R-4

MK

Learners will discuss an evidence-based approach to evaluation and/or treatment of the condition using a logical, stepwise approach.

R-2: R-4

MK

PC

PBLI

Participants will develop at least one question in each session regarding any facet of the case of the case to stimulate an evidence-based review.

MS

R-1: R-4

PBLI

SBP

Participants will work with the clinical librarian to explore the literature regarding the above question

MS

R-1: R-4

PBLI

SBP

 

 

 

Child Health Departmental Problem Conference

 

GOAL: To use a case-based open lecture format to discuss a pediatric patient from presentation through post-discharge follow up, with an emphasis on diagnosis and management of the condition with which the patient presents.

Objective

Level

Competency

The presenting resident will present a case in a mixed audience of attending physicians, residents, and medical students.

R-1: R-4

C

MK

The audience members will contribute to a broad differential list, initially, that is focused as the case is presented.

MS

R-1: R-4

MK

PK

The upper level residents will be prepared to discuss the logic behind their differential and any additional evaluation or management decisions needed, if asked.

R-2: R-4

MK

PK

 

The audience will list an initial comprehensive evaluation scheme that will be discussed with focus on identification of the most critical elements of a particular evaluation and management plan.

R-2: R-4

MK

PC

Resident will develop a short lecture regarding the condition of interest to be given at the end of the conference.

R-1: R-4

C

MK

PBLI

Presenter will talk about management of the condition, where appropriate.

R-1: R-4

C

MK

PBLI

 

 

Child Health Grand Rounds

 

GOALS: To pertinent education about important topics in Pediatrics, emphasizing current diagnosis and management and research-based changes in management.  Presentations will review recent important literature on the topic, as well as, basic science information, when appropriate.  Once a month Grand Rounds presentations will be primarily research orientated.  Residents are expected to present one Grand Round presentation during their 2nd, 3rd, or 4th years

Objective (Audience)

Level

Competency

Residents will understand current diagnosis and treatment of condition discussed.

MS

R-1: R-4

MK

 

Residents will understand the evidence behind the changes noted.

MS

R-1: R-4

MK

 

When research-orientated Grand Rounds are presented residents will understand the research evidence

MS

R-1: R-4

 

Objective (Presenter)

 

 

Residents will communicate clearly and precisely

R-2: R-4

C

Residents with make easily readable Powerpoint slides.

R-2: R-4

C

Residents will evaluate the literature with their faculty mentor’s help, so they present meaningful literature.

R-2: R-4

PBLI

MK

Residents will present patient information in an ethically sensitive manner.

R-2: R-4

P

 

Pediatrics in Review

 

GOALS: To develop a consistent and topical reading regimen for the residents utilizing an easily readable journal that encompasses general pediatrics topics.  To provide a framework/foundation for the topics that will be covered on the General Pediatric Certification Exam. 

Objective

Level

Competency

Residents will read the assigned journal articles weekly.

R-1: R-4

MK

Residents will complete a short answer, multiple-choice quiz during the session.

MS

R-1: R-4

MK

Residents will actively participate in the discussion of the articles. 

R-1: R-4

MK

C

 

 

Noon Conference

 

GOAL:  To present a majority of the general pediatrics topics listed by the American Board of Pediatrics in a variety of learning styles to broaden retention/understanding.  To teach topics that will help the residents become successful general pediatricians.

Objective

Level

Competency

Interns will learn the “basics” of Pediatric practice during the intern review section of the Noon Conference

R-1

MK

Residents will obtain new knowledge about various topics within the specialty. 

R-1: R-4

MK

Residents will learn ways to approach various medical conditions within Pediatrics.

R-1: R-4

MK

PC

Residents will show improvement on their in-training exams as they progress through residency.

R-1: R-4

MK

Residents will learn important matters about running a practice, based on the practice management seminar part of Noon Conference.

R-1: R-4

C

MK

PBLI

 

Journal Club

 

GOAL:  A monthly session in which residents will meet to discuss research articles in the literature, socialize, and have dinner together.

Objective

Level

Competency

Residents will be able to read research literature critically.

R-1: R-4

MK

Residents will understand research design, the strengths, and weaknesses of different research methods.

R-1: R-4

MK

Residents will learn when it is appropriate to change practice, based on their reading of the literature.

R-1: R-4

MK
PBLI

Residents will enjoy time, in a social setting, with each other and attending physicians.

R-1: R-4

C

 

Individual Learning Plan

Residents will be required to formulate an Individual Learning Plan (ILP) annually.  You can do this by going to the Pedialink part of the American Academy of Pediatrics website (www.aap.org).  You are expected to show your advisor and Program Director your ILP annually.

 

Supervisory Responsibility for Patient Care

Residents on every service will always have an attending physician with direct and immediate availability for patient care.  PL-1 residents in the NICU and on the wards will have in house PL-2 or PL-3 residents to supervise them directly.  PL-1 residents in the ER, and clinics may have a PL-2 or PL-3 resident as a supervisor but most often will have only an attending supervisor.

 

PL-2 and/or PL-3 residents on the wards and in the NICU will have attending physician available for direct supervision, as needed, 24 hours per day, seven days per week.  The attending and resident call schedules are kept up to date in the ER, with the hospital operator, and on the resident bulletin board on the 7th floor.

 

Any resident may contact the attending at any time they feel necessary.  Attendings directly supervise residents on all services but will allow the residents to assume progressively increasing responsibility according to the resident’s ability, level of training; and experience.  This will be done on an individual basis.  If any resident feels inadequately or overly supervised, they should immediately discuss this with the attending.  Unresolved issues should be quickly forwarded to the Chief Resident or Program Director.  Any unresolved disputes of patient care between residents and attending should be forwarded to the Program Director

 or Chairman of the Child Health Department.

 

Goals for Each Level of Residency

 

The Dreyfus Model of Skill Acquisition

 

The research of Hubert and Stuart Dreyfus demonstrated what has become a widely accepted model of how individuals progress through various levels in their acquisition of skills, known as the Dreyfus Model of Skills Acquisition.  The Dreyfus brothers labeled individuals in these progressive stages:

 

1.  Novice—Needs to be told exactly what to do and has very little context on which to base decisions.

2. Advanced Beginner—has more contexts for decisions but still needs rigid guidelines to follow.

3. Competent—begins to question the reasoning behind the tasks and can see longer term consequences.

4.  Proficient—still relies on rules but able to separate what is most important.

5.  Expert—Works mainly on intuition, except in circumstances where problems occur.

The ACGME believes that resident physicians fall, mostly, into the “advanced beginner” and “competent” phases.  The goal, of course, is to help you to become “Proficient” by the end of residency.

 

PL-1 Year

 

The main goals of your PL-1 year will be the following:

 

Skills

Ø     Learn to perform and document excellent histories and physical examinations on your patients.

Ø     Be able to admit patients to the hospital efficiently.

Ø     Be able to perform a focused history and physical examination when indicated.  Understand when it is indicated.

Ø     Be able to present a patient’s history and physical examination thoroughly, yet efficiently.

Ø     Begin the process of learning to give comprehensive patient care with the help of your upper level resident and attending staff.

Ø     Learn the importance and skill of a thorough, yet efficient, check out of a patient to your cross-covering physicians.

Ø     Learn to perform common pediatric procedures: Lumbar punctures, intubations, injections, IV placements, umbilical artery catheters.

Ø     Learn how to distinguish a “sick” form a “well” patient.

Ø     Begin to practice teaching you fellow residents, medical students, and attending physicians about things you have learned.

Ø   Learn how to present at Tuesday Problem Conference.

Ø   Learn to triage patient care issues on a busy Pediatric service.

 

Knowledge

v  Learn the importance of team work.

v  Learn major developmental milestones.

v  Read about illnesses you see in your internship, particularly about management and                         differential diagnosis.

v  Know how to contact the Department of Family Services, when appropriate.

 

Other Attributes

Ø  Spend time with your patients and families so as to understand the illness experience.

Ø  Learning to negotiate treatment plans with patient in a patient-centered manner.

Ø  Begin thinking about your Quality Improvement Project.

Ø  Do Individual Learning Plan (ILP) through the AAP’s Pedialink website.

Ø  Meet with your advisors at least quarterly.

 

 

PL-2 Year

 

Skills

Ø     Continue working on proficiency at performing procedures.

Ø     Begin learning how to manage the patient-care team.

Ø     Help the interns learn to give comprehensive patient care, with the help of your attending                  staff.  Watch patients care carefully while the interns are in the process of developing

           these skills.

Ø     Become proficient at running multi-disciplinary rounds on the inpatient service.

Ø     Become proficient at teaching medical students and interns.

Ø     Begin learning how to bill for services rendered in clinic.

Ø     Increase efficiency of providing care in a busy clinic setting.

Ø     Be able to make more independent decisions on wards, in NICU, and on other

        rotations.  (with support from your attending staff.)

 

Knowledge

v  Delve more deeply into reading about Pathophysiology and management of illnesses seen.

v  Spend time developing your systems-based practice.  That is, help your patients navigate the sometimes difficult waters of our healthcare system and work with other professionals in doing so.

v  Work in second continuity clinic to learn more skills in an area of your interest.

 

Other Attributes

Ø      Learn to be supportive of your intern and medical students when the service is very                        busy.

Ø      Help your medical students do their patient-centered care project by helping them to find              a patient/family to interview.

Ø      Initiate a Quality Improvement Project.

Ø      Perform self-reflection via Individual Learning Plan (ILP) though the AAP’s Pedialink

            website.

Ø      Begin thinking about your Grand Rounds presentation for your third (fourth) year.

Ø      Meet with your advisor at least quarterly.

 

 

PL-3 Year (and PL-4 Year Med-Peds)

 

Skills

Ø      Demonstrate proficiency at required procedures.

Ø      Continue helping the interns learn to give comprehensive patient care, with the help of your attending staff. 

Ø      Continue teaching medical students and interns.

Ø      Become proficient in billing for services rendered in clinic.

Ø      Continue to improve efficiency in providing patient care.

Ø      Be comfortable in making more independent decisions on wards, in NICU, and other rotations (with the support of your attending staff.)

 

Knowledge

v   Begin work on Board Review.  Discuss possibilities with your Program Director and Advisor.

v   Spend time developing your systems-based practice, i.e., help your patients navigate the sometimes difficult waters of your healthcare system and work with other professionals in doing so.  Emphasize learning this during your Community Block.

 

Other Attributes

Ø      Continue to be supportive of your interns and medical students when the service is very busy.

Ø      Continue to help your medical students do their patient centered care project by helping them to find a patient/family to interview.

Ø      Complete work on your Quality Improvement Project

Ø      Perform self-reflection via Individual Learning Plan (ILP) through the AAP’s Pedialink website.

Ø      Help medical students with their observed histories and physical examinations.

Ø      Present your Grand Rounds presentation.

 

Evaluations

Evaluation of medical students, residents, and faculty members is an ongoing process.  Each of us strives to be the best we can be, and our evaluation process is designed to aid us in that endeavor.

 

Medical Student Evaluations

Residents complete monthly evaluations on M-3 students who rotate on the wards.  These are done via internet.  Student grades are held up when evaluations are not returned promptly!  Resident comments are added verbatim to the student’s  Dean’s letters; therefore, document your comments thoughtfully, specifically and legibly.  However, keep in mind that these are summative evaluations, so try to word them professionally.

 

The students very much appreciate and need formative evaluations as well.  Part of their formative evaluation is an observed history and physical, in which you will observe and give feedback about their history taking and physical examination skills.  Any other formative evaluation you can give the students, preferably mid-block feedback, as they rotate through the Child Health rotation is extremely valuable. 

 

Faculty Evaluations

Evaluations are now done on New Innovations (NI).  Residents will receive evaluation forms electronically to complete on faculty performance monthly.  Please complete them quickly via the NI system.  Your comments are collated with comments from other residents and given to the attendings on an annual basis.  Therefore, attendings will not be told who made the comments.  Your anonymity is protected so that you can feel free to make honest comments, both positive and negative.

 

Program Evaluation

Residents will have the opportunity to evaluate the residency program (as a whole) on an annual basis.  There are 3 main survey types:  1.)an annual survey from the program, 2.)Press-Ganey surveys offered by the hospital, and 3.)an online survey from the ACGME.

 

Resident Evaluations

Residents are evaluated on each block by attending physicians, and twice yearly by the Program Director.  You will also be evaluated by nursing staff, peer residents, students, patients, and the Pediatric Education Oversight Committee.  In addition, while on the wards, you should check with your attending mid-block for comments.

 

w  In addition, the Program Director submits a yearly and final evaluation to the American Board of Pediatrics.  You must receive a final passing evaluation from the Program Director before you are allowed to take the American Board of Pediatrics certifying exam.  (Please see the information in the next section)

 

 

The American Board of Pediatrics has a Resident Tracking and Evaluation System explained by the following:

AMERICAN BOARD OF PEDIATRICS EVALUATION

(This policy is the policy of the ABP, not the individual programs policy)

 

The purpose of certification by the American Board of Pediatrics (ABP) is to provide assurance to the public and the medical profession that a certified pediatrician has successfully completed an accredited educational program and an evaluation, including an examination, and process the knowledge, skills and experience requisite to the provision of high quality care in Pediatrics.

 

The Program Director will be asked to provide ongoing evaluations of each resident in those components of comical competence which cannot easily be assessed by a written examination.  These components of competence include clinical judgement, clinical skills, technical skills, professional attitudes and behavior, moral and ethical behavior, humanistic qualities and so forth.  The Program Director will also be asked to evaluate your cognitive knowledge.  This is in keeping with the evaluation process described in the RRC special requirements for all Pediatric Residency Training Programs.  These annual evaluations by the Program Directors will be part of the certifying process of the ABP.  The ABP recognizes that evaluation of non-cognitive skills such as medical judgement, communication, moral and ethical, and behavioral skills are essential components in the verifications of clinical competence in Pediatrics.

 

The Program Director will indicate annually whether each resident performance is satisfactory, marginal or unsatisfactory.  A marginal evaluation is a temporary evaluation and eventually must be changed to a satisfactory or unsatisfactory rating.  If a resident’s performance rating is satisfactory, credit will be given for the year in question (e.g., PL-1 year).  If the rating is marginal, the Program Director will complete an individual evaluation for indication the resident’s level of performance and the status in the program.  The resident will be required to sign this form, which is then returned to the ABP.  Six months later, (18 months) the Program Director will be asked to reevaluate residents with marginal evaluations.  The residents who receive an unsatisfactory rating at the end of the first year may be terminated by the Program Director or given the option to repeat the PL-1 year.  (The same will be true for the PL-2 and PL-3 years if the resident receives an unsatisfactory evaluation.)

 

At 18 months, the resident with a marginal rating must be evaluated again and the Program Director must rate the resident as satisfactory or unsatisfactory.  If the resident is rated as satisfactory at the 18-month evaluation, he/she will receive credit for the year in question (e.g., the PL-1 year). If the resident receives and unsatisfactory rating, the Program Director may terminate the resident or give him/her the option of staying in the program and continuing his/her remediation program.

 

If the resident receives a satisfactory evaluation at 24 months, he/she will receive credit for only the year in question (e.g., the PL-1 year).  It will then be necessary for him/her to satisfactorily complete a PL-2 and PL-3 year and receive satisfactory rating for each year.  If he/she then receives an unsatisfactory rating, he/she may be terminated or given the option to repeat the year in question (e.g. the PL-1 year).  It will then be necessary for him/her to satisfactorily complete a PL-2 and PL-3 year.

 

In the event that the resident elects to transfer to a new program at the 18-month evaluation, the Program Director will inform the ABP of the transfer.  The new Program Director will be informed by the ABP that the previous Program Director should be contacted in order to discuss previous evaluations and remediation.  The new Program Director will be responsible for continuing a remediation program and for the evaluation of the resident at the 24-month evaluation.  They must state whether the resident’s performance is satisfactory or unsatisfactory at that time.  If his/her performance is rated as satisfactory, credit is given for the year in questions, (e.g., PL-1 year).  If unsatisfactory, the resident may be terminated or given the option to repeat the year in question (e.g. PL-1 year) as described above.  If a resident elects to transfer to a new program at any time during his/her training, the Program Director must send a transfer notice to the ABP in order to ensure that the resident continues in the evaluation system.  The new Program Director is encouraged to talk with previous Program Director so that remediation is continued, if necessary.

 

Throughout the evaluation process, the problem resident should receive appropriate remediation so the problems may be corrected.  The resident with a problem has the responsibility to work with the Program Director in the development of an appropriate remediation program.

 

Although the Program Directors have the primary responsibility for keeping the residents informed about their individual evaluations, the residents also have the responsibility to keep themselves informed about their individual evaluations by requesting feedback when not given by the Program Director.  As previously emphasized, a resident must have satisfactory evaluations for each year of training in order to be permitted to that the Pediatric General Certifying Examination.

 

The ABP believes that his system of evaluation will be of direct benefit to the resident by identifying problems early so that remedial measures may be started when a problem arises.  Both verbal and written feedback are vital to your education and continuing professional growth.  Each year, preferably more often, your Program Director or designee should meet independently with you to review your progress in the program.  It is also your responsibility to take every opportunity to ask your Program Director, Attending Physician, and Chief Resident for their assessment of your performance.

 

It is the primary responsibility of the Program Director to complete and send the Annual Evaluation Summary to the ABP.  However, it is the responsibility of the resident to ensure that it is submitted and therefore, to provide the training institution with a signed consent form, which is attached.

 

In the case of adverse actions (marginal or unsatisfactory) by the Program Director, the institution must have a mechanism for appeal (or due process).  The ABP also has an appeal process.  However, appeals should be initiated at the institution where the adverse action was taken.  The ABP will hear candidate’s appeals only after all local remedies to resolve.

 

Internet Links

UMHC policies—www.muhealth.org/~gme/policies.shtml

ABP--www.abp.org

ACGME—www.acgme.org

RRC Pediatric Program Requirement -www.acgme.org/acwebsite/downloads/rrc_progreq/320pr106.pdf