Allergy, Immunology and Pulmonary Medicine | Fellowships | Policies and Procedures

Evaluation and Promotion of Pulmonology Fellows

a. Evaluation
The program director and faculty meet biannually to evaluate the educational and professional progress and achievement of each clinical fellow. The program director also meets with each clinical fellow individually to discuss a written summary of the evaluations every six months, or more frequently as dictated by the individual fellow’s performance.

The evaluations are based on achieving competency in the following elements:

  • Fund of knowledge concerning cell and molecular biology of the lung, pulmonary physiology and mechanics, lung pathophysiology, and clinical topics, and the application of that knowledge to patient care and diagnostic testing.
  • Clinical and technical skills, including expertise in fiberoptic bronchoscopy, bronchoalveolar lavage, and transbronchial biopsy.
  • Clinical and scientific judgment.
  • Personal character traits displayed; interpersonal skills.
  • Teaching skills.
  • Ability to assume increased responsibility for patient care.

An evaluation file shall be maintained by the program director for each clinical fellow and treated as confidential. The file may be reviewed by the resident and by divisional or departmental faculty and staff with legitimate educational and administrative purposes. The Standing Committee on Graduate Medical Education (GME) Program Evaluation will review the evaluation plan of a program at the time of the Internal Review. The reviewer who meets with program faculty may ask to review a representative set of trainee files.

Finally, using a computer-based system, the fellows anonymously evaluate the performance of supervising attending physicians during the course of the academic year. These faculty evaluations are forwarded to the director of the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine and considered in their annual evaluations.

b. Promotion

Promotion of clinical pulmonology fellows to the next level of the program depends upon the fellow's performance and qualifications. The fellow should achieve at least average overall scores in their clinical and research evaluations. Decisions about promotion or reappointment of clinical fellows by the program director are communicated to the trainee as soon as reasonably practicable under the circumstances. In cases where reappointment letters or contracts are issued, communication between program directors and the GME office will occur at least three months in advance of a new appointment year.

Disciplinary Action, Suspension, or Termination

a. Informal Procedures

The program director will use informal efforts to resolve minor instances of poor performance or misconduct. In any case in which a pattern of deficient performance has emerged, informal efforts by the Program Director shall include notifying the fellow in writing of the nature of the pattern of deficient performance and remediation steps, if appropriate, to be taken by the fellow to address it. If these informal efforts are unsuccessful or where performance or misconduct is of a serious nature, the division chief or fellowship program director may impose formal disciplinary action.

b. Formal Disciplinary Action

Disciplinary action may be taken for due cause, including but not limited to any of the following:

  • Failure to satisfy the academic or clinical requirements of the training program.
  • Professional incompetence, misconduct, or conduct that might be inconsistent with or harmful to patient care or safety.
  • Conduct that is detrimental to the professional reputation of the Hospital or School of Medicine.
  • Conduct that calls into question the professional qualifications, ethics, or judgment of the clinical fellow, or that could prove detrimental to the Hospital's or School of Medicine's patients, staff, employees, volunteers, or operations.
  • Violation of the bylaws, rules, regulations, policies, or procedures of the Washington University School of Medicine, St. Louis Children’s Hospital, Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, including violation of the Responsibilities of Clinical Fellows set forth by the Department of Pediatrics.
  • Ability to assume increased responsibility for patient care.
  • Scientific misconduct.

c. Specific Procedures

Formal disciplinary action includes:

  • Suspension, termination, or non-reappointment.
  • Reduction, limitation, or restriction of the resident's clinical responsibilities.
  • Extension of the pulmonology fellowship or denial of academic credit that has the effect of increasing the number of clinical service months or extending the fellowship.
  • Denial of certification of satisfactory completion of the residency program.

The division chief or the fellowship training program director shall notify the clinical fellow in writing of the action taken and the specific reasons. The fellow will be notified in writing of any disciplinary action that would require extension of training or delays in promotion no later than four months before the end of the fellow’s current contract. A copy of the notification shall be furnished to the Associate Dean for Medical Education. The notification should advise the clinical fellow of his or her right to request a review of the action in accordance with the grievance procedure set forth below.

In the case of a suspension, written notification will precede the effective date of the suspension unless the division chief or program director determines in good faith that continued appointment of the clinical fellow places safety or well-being of patients or personnel in jeopardy, or immediate suspension is required by law or necessary in order to prevent imminent or further disruption of activities at the Washington University School of Medicine, St. Louis Children’s Hospital, or Department of Pediatrics, in which case the notice will be provided at the time of suspension.

Division of Pediatric Allergy, Immunology, and Pulmonary Medicine Policy on Duty Hours

The pediatric pulmonology fellowship program has adopted the following policy on duty hours. Graduate medical education in many specialties requires a commitment to continuity of patient care. At the same time as such continuity of care must take precedence (without regard to time of day, hours already worked, predefined call schedules etc), patients have the right to expect their care is being delivered by alert, healthy, responsible and responsive physicians. The program respects that the necessary balance between patient care and education is delicate and has endorsed the following minimal requirement.

We follow the recommendations of the GME Consortium, which states that excluding exceptional patient care needs, clinical fellows should have, on average, at least one day out of seven free from routine responsibilities, and be on call in-house no more frequently than every third night. The latter does not apply to fellows in the pediatric pulmonology training program at Washington University, since we do not have required in-house call. Specifically,

  • The inpatient fellow is responsible for calls regarding current pulmonary inpatients on weeknights.
  • Calls from outpatients are rotated among pediatric pulmonology and allergy faculty and fellows on a daily basis. Outpatient call coverage begins at 4:30 PM and runs through 8:00 AM.
  • All outpatient calls handled by a fellow are reviewed by divisional faculty and staff the following morning.
  • The pulmonology fellows rotate their weekend coverage responsibilities, typically every three to five weekends. Coverage during the weekends and holidays includes both the lung transplantation and pulmonary services.

Division of Pediatric Allergy, Immunology, and Pulmonary Medicine Policy on Moonlighting

Moonlighting is not required, but is permitted provided that such activities do not interfere with the pediatric pulmonology fellow’s clinical responsibilities or hinder their research performance. Authorization for the fellow to moonlight, however, must be approved by the program director in writing and retained on file.

Division of Pediatric Allergy, Immunology, and Pulmonary Medicine Policy on Vacations

A total of 15 days per year of vacation time is allotted according to Washington University School of Medicine and Department of Pediatrics guidelines for post-graduate clinical fellows.

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