pediatric residency program manual 2016-17 · pdf filefaculty listing and clinical/research...

UCDPediatricResidency

PROGRAMHANDBOOKANDPOLICYMANUAL

2016‐2017

UniversityofColoradoSchoolofMedicinePediatricResidencyProgram

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ProgramPersonnelandContactInformation

FacultyListingandClinical/ResearchInterestsFaculty Clinical/ResearchInterestsMarshaAnderson,MDAssociateProfessorAssistantProgramDirector,PediatricResidency

PediatricInfectiousDisease

JamesBarry,MDAssociateProfessor

Neonatal‐PerinatalMedicine

BernardTimothy,MDAssociateProfessorProgramDirectorChildNeurology

Neurologywithspecialtyqualificationsinchildneurology/stroke

BraunPatty,MD,MPHAssociateProfessor

GeneralPediatrics

BunikMaya,MD,MPHAssociateProfessor

GeneralPediatrics/PrimaryCare

WilliamCampbell,MDAssistantProfessor

Behavior&Development

BetseyChambers,MDInstructor

GeneralPediatrics/WellBabyNursery

EllenElias,MDProfessor

GeneralPediatrics/Genetics

DavidFox,MDAssistantProfessor

GeneralPediatrics

JamesGaensbauer,MDAssistantProfessor

PediatricInfectiousDisease/EvidenceBasedMedicine

JoeGrubenhoff,MDAssistantProfessor

PediatricEmergencyMedicine

MaryKohn,MDSeniorInstructor

GeneralPediatrics/WellBabyNursery

ClaudiaKunrath,MDAssistantProfessor

PICU

OrenKupfer,MDAssistantProfessor

PediatricPulmonology

TaiLockspeiser,MD,MHPEAssistantProfessor

GeneralPediatrics/PrimaryCare/Education

AdamRosenberg,MDResidencyProgramDirectorProfessorofPediatricsPhone:720‐777‐5332Fax:720‐777‐[email protected]

SheilahJimenez/KathyUrbanResidencyProgramCoordinatorsPhone:720‐777‐6738/720‐777‐3846Fax:720‐777‐[email protected]@childrenscolorado.org


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LindseyLane,MD,MSBCProfessorViceChairofPediatrics

GeneralPediatrics/PrimaryCare/Education

MargaretMacy,MDAssociateProfessor

PediatricHematology/Oncology

PatrickMahar,MDAssistantProfessor

PediatricEmergencyMedicine

DanielNicklas,MDAssistantProfessor

GeneralPediatrics/PrimaryCareCurriculum

CarolOkada,MDAssistantProfessorAssistantProgramDirector,PediatricResidency

PICU

ThomasParker,MDAssociateProfessor

NICU/FellowshipEducation

DanielReirden,MDAssistantProfessorProgramDirector–Med/PedsResidency

AdolescentMedicine

LeslieRidall,DOAssistantProfessor

PICU/PediatricUrgentCare

GenieRoosevelt,MD,MPH EmergencyMedicineSassAmy,MD,MPHAssistantProfessorAssistantProgramDirector,PediatricResidency

AdolescentMedicine

MichaelSchaffer,MDProfessor

Cardiology

SeltzLeonard,MDAssociateProfessorAssistantProgramDirector,PediatricResidency

PediatricHospitalist

AndySirotnak,MDProfessor

ChildAbuse&NeglectDirector,ChildProtectionTeam

JasonSoden,MDAssociateProfessor

PediatricGastroenterology

JenniferSoep,MDAssistantProfessor3rdyrClerkship&4thyrMedicalStudentDirector

Rheumatology

DanielleSorrano,MDAssistantProfessor

PediatricNephrology

SusanTownsend,MDAssociateProfessor

NICU

MeghanTreitz,MDAssistantProfessor

GeneralPediatrics/PrimaryCare/Advocacy/3rdyearclerkship

HeatherVarnell,MDInstructor

GeneralPediatrics/PrimaryCare

ProgramCurriculum

OverallEducationalProgramGoals

DidacticsandConferences:


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o AcademicHalfDay:Weeklyo LongitudinalSmallGroups:Monthlyo GrandRounds:WeeklySeptemberthroughMayo M&M:Monthlyo Q.I.andSafety:DuringtheAdvocacycurriculumo EmergencyLectureSeries:WeeklyJulyandAugusto Spanishclass:WeeklyJulyandAugusto Specialtyspecificdidacticswhileonclinicalrotationtoinclude:NICU,GI,Hem/Onc,

pulmonology,primarycarecurriculum,advocacy,andbehavioranddevelopment.

ResearchandScholarlyActivities/Requirements:Allresidentsarerequiredtocompleteascholarlyproject.ExamplesofscholarlyactivityincludeclinicalorbenchresearchwithapresentationattheannualResidentResearchDay,QI.projects,educationresearchanddevelopmentofcurricularmaterials.

Electives:CoreElectives: OtherElectives:Allergy/Immunology AnesthesiaCardiology ChildPsychChildAbuse&Neglect(CAPTeam) CICUDermatology EDElectiveEndocrinology NewbornCareGenetics NewbornCenter(CHCONICU)GI NutritionHem/Onc RadiologyID SportsMedicine Renal ToxicologyNeurology Rural(askcoordinatorforapproved

Pulmonology sites)Rheumatology Research(formmustbeapproved) International(6monthsadvancednotice;

mustbeapproved) GlobalHealth(October2016)

MedicalEducators(JanorMay2017)

Sample/examplesofprogramevaluationformso ResidentEvaluationo FacultyEvaluationo ProgramEvaluation

ProgramManualStatementThe training program complies with Accreditation Council for Graduate Medical Education(ACGME)andCUSOMGraduateMedicalEducation(GME)policies,proceduresandprocesses thatareavailableontheGMEwebsite.Inaddition,directaccessisavailablebyclickingthehyperlinksbelow. The program reviews all GME and program policies, procedures and processes at leastannuallywithresidents/fellows.GMEPolicies


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AdditionalPayforAdditionalWorkPolicyConcern/ComplaintPolicyDisciplinaryActionPolicyDutyHoursPolicyEligibilityandSelectionPolicyEvaluationandPromotionPolicyGrievancePolicyInternationalResidencyRotationsPolicyLeavePolicyMedicalRecordsPolicyMoonlightingPolicyNon‐CompetePolicyPhysicianImpairmentPolicyPrescriptions:ResidentsWritingforStaff,Family&FriendsPolicyProfessionalismPolicyQualityImprovementandPatientSafetyPolicySupervisionPolicyTransitionsofCare(StructuredPatientHand‐off)PolicyPolicyonUSMLE(andCOMLEX)Examinations WorkEnvironmentPolicyKeyUniversityofColoradoPoliciesSexualHarassmentPolicyDisabilityAccommodationPolicyHIPAACompliance


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PROGRAM‐SPECIFICPOLICIES

MedicalStudentLearningObjectives

INFANT,CHILDANDADOLESCENTCAREGOALSANDOBJECTIVES

GATHERAHISTORYANDPERFORMACOMPLETEPHYSICALEXAMONAPEDIATRICPATIENT

Obtainaccuratehistoryforapediatricpatient Conductaneffectivepediatricinterviewbyadaptingtheinterviewtothevisit Performanaccuratecomprehensiveorfocusedphysicalexamonapediatricpatient

minimizingtheirphysicaldiscomfort Performanageappropriatephysicalexaminationonapediatricpatientwithsore

throat Performanageappropriatephysicalexaminationoftheear,demonstrating

appropriateuseofotoscopyandpneumatoscopyanddiscussfindings Performanageappropriatephysicalexaminationofthechestincludinggeneral

observation,palpation,percussionandauscultationanddiscussfindings Performanewbornexam

DEVELOPAPRIORITIZEDDIFFERENTIALDIAGNOSISANDSELECTAWORKINGDIAGNOSISFOLLOWINGAPATIENTENCOUNTER

Synthesizedata,includinghistory,physicalexamination,anddatatoidentifyandprioritizethepatient’sproblems

Developprioritizeddifferentialdiagnosesforthecommonclinicalconditionsinnewborns,childrenandadolescents

RECOMMENDANDINTERPRETCOMMONDIAGNOSTICTESTS Demonstrateknowledgeofandindicationsforandinterpretationofbasicclinical

tests,proceduresandimagingcommonlyencounteredinpediatrics,includingbasicchemistries,completebloodcount,culturesoftheblood,spinalfluidandthroat

PROVIDECOMPLETE,WELL‐ORGANIZEDDOCUMENTATIONOFACLINICALENCOUNTER

Providetimely,effective,accuratedocumentationinwritingtootherphysiciansorhealthcareproviders

PROVIDEACOMPLETE,WELL‐ORGANIZEDORALPRESENTATIONOFAPEDIATRICPATIENT

AccuratelycommunicatedataorallytootherphysiciansorhealthcareprovidersRECOGNIZEAPEDIATRICPATIENTREQUIRINGURGENTOREMERGENTCAREANDSEEKHELPAPPROPRIATELY

Recognizenormalandabnormalfindings Accuratelytrackchangesinthephysicalexamovertimeinapediatricpatient Seekhelpappropriately

COMMUNICATEEFFECTIVELYWITHPATIENTSANDFAMILIES Useverbalandnon‐verbalskillstoestablishrapportwithpatients/familiestaking


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intoaccountthepatient’sageanddevelopmentalstage Communicatewithfamiliesindifficultsituations Understandtheuniqueaspectsoftheadolescentvisitwithrespecttoconfidentiality

andrisk‐takingbehaviors Performanticipatoryguidanceandpreventativehealthmaintenanceuniquetoan

adolescentpatient Performanticipatoryguidanceforanewborn Communicatewithpatient/familyviatelephoneencounterbyperforminga

simulatedtelephonetriageforacommonpediatricproblem:obtainaspecifichistory,elicitcriticalphysicalfindings,assesstheconditionandprovideadviceformanagement,includingindicatorsforurgentevaluation

Demonstratesensitivitytopatientsincludingbutnotlimitedtodifferencesinrace,gender,sexualorientation,andliteracy

EffectivelyuseaninterpreterduringappropriatepatientcarescenariosDEMONSTRATEPROFESSIONALISMBYSHOWINGCOMPASSION,INTEGRITYANDRESPECTFOROTHERS,RESPONSIVENESSTOPATIENTNEEDSANDACCOUNTABILITYTOCOURSEREQUIREMENTS

Documenttruthfully Demonstratecompassionandempathytoallpatients Dressandbehaveappropriately Timelinessinclinicalandprojectwork Maintainconfidentiality,privacy

DEMONSTRATETHEMEDICALKNOWLEDGENECESSARYTOCAREFORCOMMONPEDIATRICCONDITIONS

Demonstratecoreknowledgeofpediatricmedicineinthenursery,outpatientclinic,inpatient/urgentcaresetting

Writeacompletepediatricprescription Writeforbolusandmaintenanceintravenousfluidsforpediatricpatients

AdditionalPayforAdditionalWorkPolicyAdditionalPayforAdditionalWorkPolicy

InadditiontocomplyingwiththeGMEAdditionalPayforAdditionalWorkPolicy,thePediatricResidencyprogram’spoliciesandproceduresare:PediatricResidentsmayworkextrashiftsonlyasPGY2’sandPGY3’singoodstanding.Allrulesbelowmustbefollowedformoonlightingopportunities.

1. Residentsmustcompletethe“additionalworkforadditionalpay”form(availableonMedHub)andsubmittotheGMEofficePRIORtotheirmoonlightingshift.

2. Residentsmaymoonlightataprimarytrainingsite(pulm,heme‐onc,well‐babynursery,NICU)aftertheyhavecompletedthatrotation.

3. Extrashiftsmustbeincompliancewithdutyhourregulations:a. Maxof80hoursworkedperweek,averagedover4weeks


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b. 4daysoffpermonth,averagedover4weeks.c. Maxof24hourshift(+4hoursfortransitionofcare)d. 8hoursminimumoffbetweenshifts(10hourspreferred.)

4. Ifextrashiftsorbeingpost‐callfromextrashiftswouldcausetheresidenttomissAHD,LSG,orcontinuityclinic,theresidentCANNOTtakethatshift.

5. Residentsmayworkextrashifts:a. Whenevertheywishovervacation,butthesehoursareNOTrecordedasduty

hours.b. Onnights,EDorservicemonthswhenextrashiftsareincompliancewith

dutyhoursasdescribedin#4.c. Duringelective/research/CFEB,residentsarebeingpaidfortheirtimeon

elective,research,orCFEBduringtheweek.Therefore,extraworkispermittedonweekenddays/nights(Fridaynight,Saturdayday/night,Sundayday).EffectiveJuly1,2016,residentswillnolongerbeallowedweeknightextrashiftsduringCFEB/elective,exceptinextenuatingcircumstancesatthediscretionoftheProgramDirector.

6. Theresidentjeopardycallsystemdoesnotapplytoextrashifts.Ifaresidenthassignedupforextraworkandisillorunavailableduetoemergency,backupwillbetheresponsibilityofthesiteforwhichtheextrashiftispickedup.

MoonlightingPolicyMoonlightingPolicy

ThePediatricResidencyprogram recognizesthatmoonlightingisnotanactivityassociatedwithpartoftheformaleducationalexperience;thus,residentsarenotallowedtoparticipateinmoonlightingactivities.Residentsareallowedtodoextraworkforextrapay.Pleaseseepolicyasoutlinedabove.


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DutyHoursPolicyDutyHoursPolicyTheUniversityofColoradoPediatricResidencyProgramcomplieswiththeACGMECommonandspecialty‐specificProgramRequirementscopiedbelow.

InadditiontocomplyingwithGMEDutyHoursPolicy,theUniversityofColoradoPediatricResidencyprogram’spoliciesandproceduresare:

1) AllresidentswillreportdutyhourcompliancethroughweeklylogginginMedHub.ResidentswillallparticipateintheUCDSOMGMEsurveyofdutyhourcompliance.Allresidentsareresponsibleforreviewingtheirschedulesatthebeginningofrotationsandcheckingthemforassignmentsthatwouldcauseadutyhourviolation.Ifaproblemexists,itmustbereportedtotheprogramcoordinatorandtotheadministrativechiefresident.Ifresidentsdiscoverthatdailyassignedworkloadscreateasituationwheredutyhourviolationsoccur,theymusttakeimmediateactiontocorrectthesituation.Theymustnotifytheresidencyprogramdirectorthatapotentialproblemexists.Aplantoaddresstheproblemsmustbeestablishedatthattimetocorrecttheproblem.Whennecessary,theprogram’sresidencyleadershipwillassistinensuringthataresolutiontotheproblemisaccomplished.Theonlyviolationsconsideredacceptableareresident‐initiatedtimeextensionstocompletenecessarycareforasinglepatient.Theseextensionsshouldnotexceed90minutes.Eachinstancewillbereviewedbytheprogramdirector.Theonlyotherpotentiallyacceptablebreachofthedutyhourregulationsisareturnforworklessthan8hoursafterendingtheirpreviousshiftinpreparationforenteringunsupervisedpracticeofmedicinewithcareforpatientsoverirregularorextendedtimeperiods.ThisexceptionisonlyallowableduringthePL3year.Ineachcase,thebreachwillbereviewedbytheprogramdirector.

2) Ourresidencyprogramdoesnotuseat‐homecall.

3) Residentsareresponsiblefortrackingtheirleveloffatigue.Supervisingfacultyare

alsoresponsibleformonitoringresidentfatigueontheirclinicalassignments.Iftheresidentorfacultyfindthatlackofadequaterestisinterferingwiththeresidentsabilitytoprovidepropercareforpatients,theprogram’schiefresidentinchargeofthejeopardyschedulemustbecontactedandthejeopardyresidentmustcomeintofinishtheshiftfortheresidentwithexcessfatigue.Thechiefresidentwillnotifythejeopardyresidentoftheneedtorelievethefatiguedresident.Theinformationwillbesharedwiththedirectoroftheresidencyprogram.Theprogramdirectororassociateprogramdirectorwillberesponsibleforcontactingtheresidentwithfatigueproblemstoidentifythecausesofthefatigueproblemandtoworkatboththeindividualandsystemleveltoensurethatcausesareaddressed.Theresidentmayalsochoosetotransitioncaretemporarilytoanotherprovidertoallowarestperiodwithinashift.


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4) Theresidencyprogramhasajeopardysystemwithresidentsoncallforthissystem.

Residentswhofindthemselvesinunmanageablesituationsarerequiredtocontactthechiefresidentoverseeingthejeopardysystemandrequestback‐upsupport.

5) Allresidentswhowishtomoonlightordoextraworkforextrapaymustseek

permissioninwritingfromtheresidencyprogramdirector.Decisionsonaresident’srequestwillbedealtwithinaccordancetotheUCDSOMGMEpolicyonmoonlightingandextraworkforextrapayfoundintheGMEmanual.Allmoonlightingorextraworkmustbecountedinaresident’sdutyhoursandthusmustnotleadtoadutyhourviolation.

6) Residentsarepermittedtotradecall.Allcalltradesmustbedoneinafashionthat

neitherresidentwillviolateanyofthedutyhourstandards.Allcalltradesmustbereportedtotheadministrativechiefresident.Thisincludestradesthataremadewithresidentsinotherspecialtiesthatmaybeworkingwiththeprogram’sresidentsoncertainrotations.Thechiefresidentmayvetoanycalltradethat,intheirjudgment,createsasituationthatwillleadtoadutyhourviolation.AllchangesmustbereflectedintheofficialAMIONcallschedule.

7) Theresidencyprogramcoordinatorisresponsibleformonitoringresidents’

compliancewithcompletionoftheirGMEassigneddutyhoursurveys.Residents’failuretocompletethesesurveyswillberecordedintheirpersonnelfolderandwillbereviewedwithresidentsattheirsemi‐annualreviews.Residentswithapatternoffailurestocompletethissurveywillbesubjecttodisciplinaryactionbytheresidencyprogram.

8) Onamonthlybasis,compliancewithdutyhourreporting,anyreportedviolations,

thecauseoftheviolationandactionplantocorrectarereportedtotheUCDSOMGMEofficerofcompliance.

9) AcopyofthemostrecentACGMEdutyhourrequirementsispostedonMedHub.All

residentsareresponsibleforcarefullyreviewingthisdocument.TheprogramstrictlyadherestoallACGMEmandateddutyhourrestrictions.

EligibilityandSelectionPolicyEligibilityandSelectionPolicy

InadditiontocomplyingwithGMEEligibilityandSelectionPolicy,thePediatricResidencyprogram’spoliciesandproceduresare:


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WeonlyacceptapplicationsthroughtheElectronicResidencyApplicationSystem(ERAS).Pleasedonotmail,e‐mail,orfaxanyapplicationsERASapplicationmustincludethefollowingminimumrequirements:

CV Dean'sLetterorMSPE MedicalSchoolTranscript PersonalStatement Three(3)LettersofRecommendation–lettersfrompediatricfacultyarepreferred UnitedStatesMedicalLicensingExamination(USMLE)StepIScores SuccessfulscoresonbothcomponentsofUSMLEStepIIarerequiredbythemid‐

pointoftheintern(PL1)year,butnottoapplyorinterviewforaposition. COMLEXscoresarenotaccepted.

October31istheapplicationdeadline.Incompleteorlateapplicationswillnotbeconsideredifreceivedafterthisdate.


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Evaluation&PromotionPolicyEvaluationandPromotionPolicy CriteriaforPromotion&Graduation

InadditiontocomplyingwiththeGMEEvaluationandPromotionPolicy,thePediatricResidencyprogram’spoliciesandproceduresare:Promotion/AdvancementRequirementforPGY1to2

1) EachresidentisresponsibleforenteringproceduresintotheelectronicprocedureloginMedHubatleastonamonthlybasis.

2) Eachresidentisrequiredtoevaluatetheirpreceptors/attending,andwhenappropriate,supervisingresidentinMedHub.

3) Eachresidentisrequiredtotakeresponsibilityforbeingevaluatedoneachrotation.Thisincludessolicitingevaluationsonelectiverotations.Foreachassignment,bothdirectobservationsaswellasonesummativecompetencybasedevaluationshouldbecompleted.

4) Eachresidentmusthavereceivedaminimumof2nursingevaluationsand6familyevaluationsperyear.

5) Everysixmonthsthereshouldbeaminimumof12directobservationsofcarebyfaculty.Thesecanbeinpatientoroutpatientandbrief(eg:counseling,portionsofPE,DRexperience,etc.)

6) EachresidentmustfilloutaRotationEvaluationforeachmonthinMedHub.7) EachresidentmustlogdutyhoursweeklyinMedHub.8) Eachresidentmustattend36continuityclinicexperiencesfortheyear.9) Eachresidentisrequiredtoprepareacasepresentationforthenooneducational

conferenceanduploadacopyofallpresentationstotheirlearningportfolioinMedHub.

10) Eachresidentwilldoatleast1journalclub/EBMexercise(EBCEC).TheresidentisrequiredtouploadthepresentationtotheirMedHublearningportfolio.

11) Eachresidentmustcompleteanindividualizedlearningplanwithspecific,attainablelearninggoalsinMedHub.Thisistobeupdatedatleastevery6monthswith3activegoalsatalltimes.

12) ResidentsareexpectedtoattendAcademicHalf‐Day,LSG,morningreportandotherscheduleddidactics.

13) Residentsmustattendschedulededucationalretreats.14) CompleteandpasstheinitialcourseinNRPandPALS.

AcceptablePerformanceforYear1:

1) Allfaculty,resident,nursingandfamilyevaluationsindicatingsatisfactoryperformance.

2) AnITEscoreatthestartofthePL2yearofatleastthenationalmean.3) Completionofallrequiredelementslistedabove,documentedatevery6month

meetingwiththePDorAssociatePD.4) Theclinicalcompetencycommitteewillcarefullyreviewalloftheabovematerials

twiceperyearandinthespringrecommendreadinessforthePL2year.


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Promotion/AdvancementRequirementsforPGY2to3

1) Eachresidentisresponsibleforenteringproceduresintotheelectronicprocedurelogatleastonamonthlybasis.

2) Eachresidentisrequiredtoevaluatetheirpreceptors/attendings,andwhenappropriate,interns,intheelectronicevaluationsystem.

3) Eachresidentisrequiredtotakeresponsibilityforbeingevaluatedoneachrotation.Thisinvolvessolicitingevaluationsonelectiverotations.Eachresidentmustreceiveatleast2nursingevaluationsand6familyevaluationsperyear.


5) EachresidentmustfilloutaRotationEvaluationforeachmonthintheelectronicevaluationsystem.

6) EachresidentmustlogdutyhoursweeklyinMedHub.7) Eachresidentmusthaveattendedaminimumof36continuityclinics.8) Eachresidentmustcompleteanindividualizedlearningplanwithspecific,

attainablelearninggoals.9) EachresidentmusttakeandpassUSMLEpart3beforethemid‐pointofyear2.10) Eachresidentmustidentifyascholarlyprojectandasecondhalfdayexperiencein

year2.11) Eachresidentwillpresentcasesthroughouttheyearatmorningreport.12) EachresidentisexpectedtoattendAcademicHalf‐Day,LSG,morningreportand

otherscheduleddidactics.13) Eachresidentisexpectedtoattendthemandatoryeducationalretreats.14) EachresidentmustrecertifyinNRPinthespringofthePL2year.


1) Allfaculty,resident,nursingandfamilyevaluationsindicatingsatisfactoryperformance.

2) AnITEscoreatthestartofthePL3yearofmorethanthenationalmeanfortrainingyear.

3) Completionofallrequiredelementslistedabove,documentedatevery6monthmeetingwiththePDorAssociatePD.

4) ThedepartmentcompetencycommitteewillcarefullyreviewalloftheabovematerialsinthespringtodeterminereadinessforthePL3year.

CompletionRequirementsforthe3rdYearResident:

1) Eachresidentisresponsibleforenteringproceduresintotheelectronicprocedurelogatleastonamonthlybasis.

2) Eachresidentisrequiredtoevaluatetheirpreceptors/attendings,andwhenappropriate,interns,intheelectronicevaluationsystem.

3) Eachresidentisrequiredtotakeresponsibilityforbeingevaluatedoneachrotation.Thisinvolvessolicitingevaluationsonelectiverotations.Eachresidentmustreceiveatleast2nursingevaluationsand6familyevaluationsperyear.


5) EachresidentmustfilloutaRotationEvaluation”foreachmonthintheelectronicevaluationsystem.


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6) Eachresidentmustlogdutyhoursweekly inMedHub.7) Eachresidentmusthaveattendedaminimumof36continuityclinics.8) Eachresidentmustcompleteanindividualizedlearningplanwithspecific,

attainablelearninggoals.9) EachresidentmusttakeandpassUSMLEpart3beforethemid‐pointofyear2.10) Eachresidentmustcompleteascholarlyproject.11) Eachresidentwillpresentcasesthroughouttheyearatmorningreportand

prepareonesupervisorsconference.12) EachresidentisexpectedtoattendAcademicHalf‐Day,LSG,morningreport

andotherrequireddidactics.13) Eachresidentisexpectedtoattendthemandatoryeducationalretreats.14) EachresidentmustrecertifyinNRPintheSpringofthePL2year


1)Allfaculty,resident,nursingandfamilyevaluationsindicatingsatisfactoryperformance.2)AnITEscoreatthestartofthePL3yearofmorethanthenationalmean.3)Completionofallrequiredelementslistedabove,documentedatevery6monthmeetingwiththePDorAssociatePD.4)Thedepartmentcompetencycommitteewillcarefullyreviewalloftheabovematerialsinthespringtodeterminereadinessforcompletion.

ClinicalCompetencyCommittee

ChargeTheClinicalCompetencyCommittee(CCC)isresponsibleforreviewingtheclinicalandprofessionalcompetencyofpediatricresidentsintrainingatCUSOM.TheCCCreviewsandmonitorstheacademicandprofessionalprogressofresidents,reportsresidentprogresstotheACGMEandprovidesguidancetotheresident,and/orProgramDirectorinsituationswherearesidentmaybeinneedofhelpinmaximizinghisorherpotential.CommitteeGoalsTheprimarygoaloftheCCCistoensurethatresidentshaveeveryopportunitytoattaintheirmaximumpotentialduringtheirtrainingandthattheyhaveaccesstothetoolsnecessarytoaccomplishthis.Theobjectivesofthecommitteewillbethe:

Earlyidentificationofresidentdemonstratinglearningneedsorareasforimprovingtheirprofessionalism

Earlyinterventionforresidentsdemonstratinglearningneedsorareasforimprovingtheirpatientcare

Timelyandclearcommunicationwiththoseidentifiedresidentstoaddresstheirneeds/areasforimprovement

Creatingofalearningplanforaddressingresidentneeds/areasforimprovementwhenneeded;supportincompletinglearningplans

Identificationandcollaborationwithoutsidepersonnel(advisors,mentors,associateprogramdirectors,etc)inordertoaccomplishobjectives

CommitteeFocus


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TheCCCwillparticipateactivelyin: Reviewingallresidentevaluationsbyallevaluatorssemiannually. ReviewofotherdataincludingITEperformance,presentations,conference

attendance,procedurelogsandlearningplans Makingrecommendationstotheprogramdirectorforresidentprogress,including

promotion,remediationanddismissal PreparingandassuringthereportingofMilestonesevaluationsofeachresident

semi‐annuallytotheACGME,beginningJune2014CommitteeStructureTheCCCwillbecomprisedof12members,appointedbytheProgramDirector.TheProgramDirectorwillbeinvolvedincommitteemeetings.ThepositionofCommitteeChairwillbeheldbyanAssociateResidencyProgramDirectorwhowillserveathree‐yearterm.Memberswillservefor1‐yeartermswithre‐appointmentasmutuallydesiredbythememberandtheprogram.Termswillbestaggeredtoallowforcontinuity.CommitteeMeetingsTheCCCwillmeetsemi‐annually.Morefrequentmeetingsmaybeindicateddependinguponresidentstatus/progress.Meetingminutesshallbedocumentedandkeptonfilesecurelyintheofficeofthecommitteechairand/orProgramDirector.Memberswillreviewresidentfilespriortomeetingsandpresentresidentprogressandmilestonesassessmenttothegroup.NovemberandMayresidentmeetingswillfocusonongoingreviewofthoseresidentswhomayneedadditionalassistance.Inaddition,thosemeetingswillgeneratethedatatobereportedtoACGME.CommitteeActionsIfissuesariseonsemiannualreview,orbasedinITEscores,evaluations,orresidentself‐referralduringtheyear,theCCCmayberequiredtoprovideadditionalsupporttoaresident.Thecommitteewillreviewthecaseincludingadditionalavailabledate(evaluations,previousITEscores,USMLEscores)anddeterminewhethernextstepsarenecessary.Onceasuggestedplanofactionhasbeendetermined,theinterventionplanwillbeshared,withtheresidentandtheProgramDirector.Theplanwillbereviewedonaregularbasisandthecommitteewilldeterminewhentheresidenthasbeenabletomaximizetheirpotentialintheachievementofhisorherlearningneeds,andwillnolongerrequiredtheaidofthecommittee.Inraresituations,theCCCmaydeterminethatafacetofacemeetingwiththeresidentisindicated.RecordsfromCCCmeetingsandlearningplanswillbekept,butnothingofthecommittee’seffortswillbeplacedintheresident’sfileunlesstheresidentisreferredtotheGMECforremedialpurposes.ConfidentialityAllinteractionsbetweentheCCCandresidents/facultyareconfidential.Inparticular,anymedicalormentalhealthdiagnosesand/orreferralstoawellnesscenterorothercounselingshallnotbediscussedoutsideoftheCCCcommittee.Whenindicated,theCCCmaycommunicatewithspecificpediatricfacultyaboutaresident’sprogressinordertoensureadequaterotationsupportandfeedback.Otherwise,theCCCmemberswillnotdiscussanyresident’sprogress/concernswithanyonebuttheresident,theresident’sadvisor,andthecommitteeitself.Ifthisconfidentialityisbrokenforanyreason,werequestthatboththeheadofthecommitteeandtheprogramdirectorbecontactedimmediatelyinordertoaddressthisbreachofconfidentiality.


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ProgramEvaluationCommittee

TheUniversityofColoradoPediatricResidencyProgramEvaluationCommittee(PEC)iscomprisedoftheprogramdirector,associateprogramdirectors,servicedirectors,chiefresidents,residentrepresentativesfromeachclass,programcoordinators,andanyinterestedresidentorfaculty.ThePECmeetsannuallytoreviewsurveyresultsanddevelopactionplanstoaddressanyareasinneedofimprovement.Surveysfromwhichdataisgatheredare:

AnnualEndofYearProgramEvaluationSurvey–Residents AnnualEndofYearProgramEvaluationSurvey–Faculty ACGMESurvey–Residents ACGMESurvey–Faculty GMECSurvey–Residents ProgramSurvey–GraduatedResidents InTrainingExamresults AAPBoardCertificationexamresultsfromthepreviousyear

ThefinalresultsofthePECaresentyearlytotheGMEC.


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LeavePolicy LeavePolicy

InadditiontocomplyingwiththeGMELeavePolicy,thePediatricResidencyprogram’spoliciesandproceduresare:Thedurationofgeneralpediatricstrainingis36months.Thirty‐threemonthsofclinicaltrainingarerequired.Onemonthofabsenceisallowedeachyearforleave(eg,vacation,sick,parentalleave).Absencesgreaterthan3monthsduringthe3yearsofresidencyshouldbemadeupwithadditionalperiodsoftraining.Iftheprogramdirectorbelievesthatthecandidateiswellqualifiedandhasmetallthetrainingrequirements,theprogramdirectormaysubmitapetitiontotheABPrequestinganexemptiontothepolicy.Residentsincombinedtrainingorspecialtrainingpathwaysmaynottakemorethan1monthofleaveperyear.TheresidentmustmeetwiththeProgramDirectororoneoftheAssociateProgramDirectorstodiscussleaveoptionsandreceivepermissiontotakeaLeaveofAbsence.


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ProfessionalismPolicyProfessionalismPolicyThePediatricResidencyProgramcomplieswiththeGMEProfessionalismpolicyfortheUniversityofColorado.Allresidents/fellowsmustabidebytheprofessionalismprinciplesandguidelinesasstatedbytheACGMEprogramrequirements,pediatricmilestonesandasdetailedintheGMEProfessionalismPolicy.Inaddition,professionalsareheldaccountabletothefollowingspecialty‐specificboardand/orsocietycodesofmedicalprofessionalismfoundintheAmericanBoardofPediatricsProfessionalismManual. MonitoringResidentProfessionalism

InadditiontocomplyingwiththeGMEProfessionalismPolicy,thetrainingprogram’spoliciesandproceduresareasfollows:Theprogramdirectorandfacultymonitorresidentprofessionalismby:

Evaluationsandfeedbackfromfaculty,peers,nurses,andstaff

ProfessionalismEducation

Theprogramprovidesthefollowingprofessionalismeducationtoresidents:

ResidentsareprovidedprofessionalismeducationviaGMENewResidentOrientationandmodules,programdidacticconferencesanddepartmentgrandrounds.Facultyprovidesverbalfeedbackonacasebycasebasis,bothwhenencountersgoverywellorpoorly.Residentsalsoparticipateinaprofessionalismcurriculumemphasizingpersonalandprofessionaldevelopmentthroughoutthe3yearlongitudinalsmallgroupcurriculum.TheformatisbasedontheAmericanBoardofPediatricsprofessionalismmanualandotherresourcesandincludesbreakoutsessionstodiscussclinicalvignetteswiththeassistanceofafacultymentor.

PleaserefertotheGMEProfessionalismCommitteeProcedureformethodofreviewofreportsofexemplaryprofessionalismorlapsesinprofessionalismbyresidents.Theresidencyalsorecognizesresidentspubliclywhenexemplarybehaviorisdemonstrated.

QualityImprovement/PatientSafetyPolicyQualityImprovementandPatientSafetyPolicy

InadditiontocomplyingwiththeGMEQualityImprovementandPatientSafetyPolicy,theUniversityofColoradoPediatricResidencyprogram’spoliciesandproceduresare:


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Wehaveinstitutedaqualityimprovement,patientsafetyfinancialincentivesystem.ThegoalofthisprogramistoinvolveeverypediatricresidentinQIandpatientsafetyoutcomesthatarealignedwithhospitalinitiatives.Ourprogramhasbeensosuccessful;ithasbeenusedastheframeworkforacampuswideinitiativebeginningwithacademicyear2016‐17.Aspartofourqualityimprovementcurriculumwemodifiedtheformatofourrequiredjournalclubtoevidencebasedclinicaleffectivenessconference(EBCEC).ThisexerciseisdesignedtohaveagroupofinternsevaluateandinterpretdataaboutpracticepatternsatChildren'sHospitalColorado(CHCO),andcomparedatawithaninter‐hospitaldatabase(PHIS)anddataavailableintheliterature.Eachconferencewasmentoredbyfacultyexperts.Thegoalsoftheconferenceare:

1) Engageresidentsinanevidencebasedapproachtoaclinicalproblem.2) Providecomparisondatatocompareourpracticewiththeotherhospitalsinthe

databasetoimproveourclinicaleffectivenessinprovidinghighvaluecare.3) Developqualityimprovementactivitiesasanoffshootoftheconference.

ThegoalsoftheconferencearealsoalignedwiththestrategicinitiativesofCHCOtoimproveclinicaleffectivenessandresourcestewardshiptoprovidehighvaluecare.Theconferencehasbeenverysuccessfulandactuallyresultedinnationalpresentationsinthelast2academicyears.

SupervisionPolicy

SupervisionPolicyInadditiontocomplyingwiththeGMESupervisionPolicy,thePediatricResidencyProgram’spoliciesandproceduresare:

ProgramSupervisionPolicyTheattendingproviderisresponsibleforallcaredeliveredbytrainees.Traineesshallalwaysbeappropriatelysupervisedandthesupervisionoftraineesisultimatelytheresponsibilityoftheattendingprovider,whoisaccountabletotheMedicalBoardofthehospitalsinwhichresidentsrotate.Thepediatricdepartmenthasamechanisminplacethatcommunicatestothetraineestheidentityoftheattendingproviderandback‐upcoveragebyanotherfacultymemberintheeventthattheattendingproviderisnotimmediatelyavailable.Thisisavailable24/7throughChildren’sHospitalColorado,DenverHealthMedicalCenterandUniversityofColoradoHospital.Inaddition,callschedulesarepostedandcommunicatedverballytotrainees.

ProgressiveAuthority&Responsibility,ConditionalIndependence,SupervisoryRoleinPatientCare


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IntheDepartmentofPediatrics,residencytrainingis3clinicalyears.CandidatesbeginatthePgY‐1levelandcompletetrainingatthePGY‐3level.FellowshiporsubspecialtytrainingbeginsatthePGY‐4levelandfinishesatthePGY‐6level.PGY‐1levelresidentswillalwayshavesupervision(PGY‐2andabovelevels)availablearoundtheclockinthehospital.Theminimalacceptablelevelofattendingsupervisionisindirectsupervisionwithdirectsupervisionavailablebasedoneitherrequestfromtheresidentdirectlycaringforapatientordictatedbythepatient’sclinicalstatus.Theprivilegeofprogressiveauthorityandresponsibility,conditionalindependence,andsupervisoryroleinpatientcaredelegatedtoeachresidentmustbeassignedbytheprogramdirectorandfacultymembers.Evaluations:Pediatricresidentsareevaluatedmonthlyontheirrotationsbyattendingfacultyforbothcognitiveandproceduralcompetence.Evaluationsgototheprogramdirectorforthegeneralpediatricresidencyorsubspecialtytrainingwhoevaluateprogressanddeterminesuitabilitytoremainandadvanceinthetrainingprogram.Ayearlyin‐serviceexamisadministeredtoallpediatricresidents.Definitions:Resident: The term resident refers to individuals who are engaged in graduate medicaleducationtraining,includinginterns,residents,andfellows.Fellow: fellow describes residents in training who have completed basic residency in aprimary specialty and have then elected to proceed with additional training in asubspecialty.Theseindividualsmayholdprivilegestoprovideindependentcareintheareaoftheirprimaryspecialty.Supervision:Referstotheauthorityandresponsibilitythatastaffpractitioner,asattending,exercisesoverthecaredeliveredtoapatientbyaresidentorfellow.DirectSupervision:Requires thepresenceof theattending facultyor supervising resident,appropriaterecordkeeping,anddirect involvementof theattending facultyorsupervisingresidentduringpatientcareoraprocedure.Indirect Supervision: Requires appropriate record keeping and discussion with attendingfaculty or supervising resident either before or after the care or procedure. In this case,directsupervisionmustbeeitherimmediatelyavailable(inhospital)oravailable(doesnotrequirepresenceinhospital,butavailableeitherelectronicallyorbyphone).PGY1 residents in Pediatrics have direct supervision or immediately available directsupervisionatalltimes.Attendingcontact:Eachservicehaswrittenguidelinesforwhensupervisingresidentsmustcontactfacultysupervisors.Theseindividualguidelinesaresummarizedbelow.

GuidelinesforWhenResidentsMustCommunicatewiththeAttending

Eachservicehaswrittenguidelinesforwhensupervisingresidentsmustcontactfacultysupervisors.Theseindividualguidelinesaresummarizedbelow.

- Patientadmissiontohospital- Significantchangesinclinicalstatus

o Transferofpatientto/fromICUortoahigherlevelofcareo Needforintubationorventilatorsupporto Newonsetofsignificantneurologicalchangeso Anysignificantclinicalproblemthatwillrequireaninvasiveprocedureo ActivationoftheRapidResponseTeamo Patientdeath


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- Medicationerrorsrequiringclinicalintervention- Patientand/orfamilyrequesttospeaktoattending- Whenevertheresidentisimpededinprovidingnecessarycaretoapatientbecause

ofoperational,workloadorsystembarriers


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ClinicalResponsibilitiesbyPGYLevelsforSupervision

Revised1/14/2014Procedure

MinimumTrainingLevelPerformedby

TrainingLevelRequiredforSupervision*

Comments

PeripheralIV/venipunture

PL1 PL2orPL3 MaybesupervisedbyqualifiedRN

Peripheralarterystick PL1 PL2orPL3 MaybesupervisedbyqualifiedRN

Bladdercatheterization/suprapubic

PL1 PL2orPL3 MaybesupervisedbyqualifiedRN

Thoracentesis PL1 FelloworattendingParacentesis PL1 FelloworattendingPericardiocentesis PL2 FelloworattendingDRResuscitation NRPcertifiedPL1 NRPcertifiedPL2or

PL3Maybesupervisedby

aneonatalNPDRResuscitationlessthan28weeksGA

NRPcertifiedPL1 Neonatalfelloworattending

MaybesupervisedbyaneonatalNP

ResuscitationoutsideoftheDRorNICU

PALScertifiedPL1 CritcareorEDfelloworattending

Endotrachealintubation

PL1 Felloworattending

Proceduralsedation PL2 Hospitalcredentialedfelloworattending

Percutaneouscentralvenousline


Percutaneousarterialline


Centralvenouslinecutdown


Tubethoracostomy PL2 FelloworattendingLumbarpuncture PL1 PL2orPL3 Maybesupervisedin

theNICUbyNNPUmbilicalarterialline PL1 PL2orPL3 Maybesupervisedby

neonatalNPUmbilicalvenousline PL1 PL2orPL3 Maybesupervisedby

neonatalNPCircumcision PL1 PL2orPL3 Maybesupervisedby

neonatalNPImmunizations PL1 ShouldbesupervisedbyqualifiedRNBonemarrowaspirate PL2 H/Ofelloworattending

TransitionsofCareGuidelines–Hand‐offProcessTransitionsofCare(StructuredPatientHand‐off)Policy

InadditiontocomplyingwiththeGMETransitionsofCare(StructuredPatientHand‐off)Policy,theUniversityofColoradoPediatricResidencyprogram’stransitionofcareprocessthatisusedis:


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Astructuredhandoffistheprocessoftransferringinformationaboutandresponsibilityforpatientsduringtransitionsofcare.Transitionsincludechangesinproviders,bothfromshifttoshiftorwhenapatientismovedfromonelocationtoanother(EDtofloor;PICUtofloor).Atransitionofcaremayalsobeindicatedduetocaregiverfatigue.Policydetails:

1) AllresidentsandincominginternswillbetrainedintheuseoftheI‐PASS*systemofstructuredhandoffs(Pediatrics129:201,2012).Internswillreceiveinitialtrainingduringtheirorientation.

2) Allshifttoshifthandoffswillbedonefacetofacewithanaccompanyingpaperorcomputerdocumentthatallindividualswilluseduringthehandoff.

3) Handoffscanbedoneseparatelyasinterntointern;resident(supervisor)toresidentorinagroupsetting.Eveninghandoffsongeneralpediatricinpatientwardswillbedoneinagroupsetting;seniorresidentswillrode‐modelhandoffsforthe1stweekandtheninternswillleadthehandoffsfortherestoftheirblock.

4) Itistheresponsibilitytokeepnoncomputerautopopulatedelementsofthehandoffdocumentuptodateonashiftbyshiftbasis.

5) Juniortrainees(interns)mustbeobservedataminimumofonceamonthonservicerotationsbyeitherfacultyorsupervisingresidentstoreceivefeedbackonthequalityandaccuracyoftheirhandoffs.TheseobservationsmustbedocumentedinMedHub.(aspartofourimplementationprogram,eachinternwillbeobservedatleasttwicepermonthbyanI‐PASSChampionwithafeedbackformcompletedbyelectronicsurvey).

6) Handoffsinwhichapatientismovedfromonelocationtoanothermustbeaccompaniedbyacompletenotereflectingwhattheongoingpatientproblemsareandtheanticipatedplanoffuturecare.Verbalcommunication(overthephoneorfacetoface)ismandatory.

7) Residentsduringashiftwhoarefatiguedorillarestronglyencouragedtorest.Whenaninternorresidentchoosestorestforaperiodoftime,careneedstobetransitioned(asdescribedabove).

8) Allshifttoshiftcaremustbetransitionedwellbeforethe16hourshiftlengthforinternsand28hoursforresidents.

I‐PASS: Illnessseverity–whoareyoursickestpatients Patientsummary Actionlist–“todolist” Situationawarenessandcontingencyplans Synthesis(readback)byreceiver

ACGMESpecificProgramRequirements


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TheprogramwillincorporatethecurrentAccreditationCouncilforGraduateMedicalEducationprogramrequirementswithinthisProgramManualannually.

PediatricsACGMEprogramrequirements

pediatric residency program manual 2016-17 · pdf filefaculty listing and clinical/research...

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