AGP Policies and Procedures

Division of General Pediatrics, Department of Pediatrics

Stony Brook University Medical Center, NY

 

Introduction

The Academic General Pediatric (AGP) Fellowship program at the Stony Brook University Medical Center is a three year training program pending accreditation by the Academic Pediatric Association. Policy is determined by the Fellowship Education Committee of the Department of Pediatrics and by the Graduate Medical Education Committee (GME) of the State University of New York.

Mission Statement 

The Academic General Pediatrics (AGP) Fellowship at Stony Brook University Medical Center (SBUMC) is designed to develop the next generation of academic generalists by providing them with expertise in the: 1) planning and execution of patient-oriented and health services outcomes research; 2) development of state of the art educational curricula, strategies and scholarship to pediatric trainees; and 3) clinical care of pediatric patients in the inpatient and outpatient settings.

The overall goal of the program is to prepare a cadre of pediatricians to become the next generation of physician-researchers and academic leaders in primary care pediatric research. The educational program is conducted within an atmosphere of mutual respect for patients, families and colleagues. Learning is facilitated by close and ongoing encouragement and supervision of faculty with expertise in Academic General Pediatrics. Graduates of the program are expected to have developed the foundation upon which to base a lifetime of continued learning and professional growth. Non-compliance with the following policies will result in a deficiency in the Fellow’s file as delineated by the Medical Board of Stony Brook University Hospital, and could result in suspension of hospital privileges.

General Information

Qualifications for Admission: Any trainee who has successfully completed an accredited General Pediatric Residency Training program is eligible to apply for the AGP fellowship

Duration: The duration of the fellowship is three years. In situations where the trainee has had additional experience/training (e.g.: Chief residency, Masters Degree etc) the training period may be shortened to two years

Requirements: The AGP fellowship is primarily a fellowship designed to enhance research skills in patient oriented and health services outcomes research. Completion of a Masters program (MS in Clinical Science or MPH) is required for graduation. In addition, domains of emphasis will be career development, leadership training, administrative training and educational skills development. Fellows have an option to receive an added certification as a Medical Care Quality Scholar through participation in the Quality Scholarship in Hospital Medicine Initiative by additional training and course work through the Department of Medical Regulatory Affairs Department. In addition every fellow is expected to complete a successful scholarly project that is peer reviewed and accepted.

Appendix C lists the Curricular Goals, Objectives, Instructional and Evaluation Strategies

Appendix F lists details of course work and curricular domains.

Board Examinations: American Board of Pediatrics General Pediatric Board Exam must take the board exam the first year of fellowship. If a second year fellow does not pass the board certification exam, their continuation in the fellowship program is contingent upon a full performance review by the Fellowship Education Committee. All first year fellows will begin the board review course with the third year residents, and may stop attending the course when they have passed the board examination.

Emergency Situations: In situations where immediate and emergent medical care is required to preserve life or prevent serious impairment of the health of the patient, Fellows are permitted to do everything possible within the scope of their knowledge and skill to save the life of a patient or protect the patient from serious harm. In this event, attending staff must be notified and consulted as soon as possible.

Documentation in Medical Records 

The medical record is a crucial medical and legal document.  It is each physician’s responsibility as well as in his/her own interest to maintain each patient record completely, accurately and promptly. 

  • All entries must be legible and contain the date, time, physician signature and hospital ID number. 
  • Corrections are to be made by drawing one line through the error, dating and initializing it.
  • Addenda to the medical record must be entered as a new note. No additions should be made to flow sheets or graphs. 
  • Entries written by Fellows must contain evidence of supervision by the attending physician. This requirement can be fulfilled by including phrases such as “case discussed with attending” and “notes and orders reviewed”. Countersignature of notes by the attending is required. Such documentation should appear at the time of admission of the patient, when there is a significant change in the condition of the patient or in the plan of treatment, and at regular intervals during the hospital stay. 
  • All complications and incidents affecting patient care must be objectively documented in the progress notes at the time of occurrence.
  • Notification of all physicians by name must be documented.
  • Admission history and physical: The AGP Fellow is expected to write an admission note including history, physical exam, differential diagnosis and evaluation/management plan on patients admitted to the General Pediatrics Service.
  • Consults: The AGP Fellow is expected to complete the consult on patients who are consulted by the Pediatric Endocrine service in a timely and legible fashion. This note is to include a history, physical exam, pertinent laboratory results, differential diagnosis, and recommendations.
  • Progress notes: When on service, the AGP fellow is expected to write a daily progress note on each patient on the General Pediatric Service, and as clinically necessary on consulted patients. All such notes should indicate evidence of attending supervision.
  • Fellows are responsible for maintaining records which are awaiting anticipated laboratory results and/or radiology reports. When the pertinent results have returned, they must be entered in a timely fashion into the record, and then presented to the responsible faculty member for co signature. All abnormal results must be discussed with the attending faculty member.

Fellow responsibilities to supervisors

  • Fellows must notify the appropriate attending physician of all admissions, consults and any time a patient’s condition significantly changes. If the attending physician on call is unavailable, the Fellow must notify the Chief of Pediatric Hospitalist Medicine or his/her designee. If none of these are available, the Chair of the Department must be notified.
  • Fellows are responsible to the attending physician of record for a given patient. If a disagreement arises between a Fellow and the attending faculty member that cannot be resolved between the two, the dispute should be brought to the attention of the Chief of the division of Hospital Medicine.  
  • The AGP Fellowship program is under the direction of the Program Director who is responsible to the Chief of Pediatric Primary Care Medicine who is responsible to Chair of the Department of Pediatrics, who, in turn, is responsible to the Dean of the School of Medicine.

Teaching of Junior Fellows, Pediatric Residents and Medical Students 

Fellows have a responsibility to teach Fellows, junior to them, as well as Residents and students who are participating in the clinical service. The Fellow is responsible for assigning patients to rotating Residents or students and for supervising their actions.  Students and Residents must be included in inpatient rounds. Fellows are also expected to participate in the teaching and supervision of students and Residents in the outpatient area. Fellows are expected to provide feedback to students and Residents and will be asked to evaluate students and Residents who rotate on the service. 

Interface with other Services

Fellows are expected to interact with other services that are involved in the care of patients on the General Pediatrics Service. This includes nursing, dietary, social work, child life, surgery, radiology, pathology, etc. 

Conferences

Fellows are expected to attend all weekly conferences except when on vacation or excused for other reasons. Fellows are expected to participate in these conferences, by providing case discussions, journal clubs, presentation of a particular topic including some of the core curriculum topics, or presentation of research plan and findings.

Research

All Fellows are expected to participate in scholarly activity. This can be fulfilled by carrying out a hypothesis driven research project under the supervision of a mentor.   Since this is a lengthy process, usually requiring review and approval by regulatory committees (i.e. the Committee on Research involving Human Subjects, CORIHS), Fellows are encouraged to begin this process in the first year of Fellowship. See https://www.abp.org/ABPWebSite/ for more information and specifics. Fellows will choose a research mentor and will have the support of an individualized Scholarship Oversight committee. Here are the timelines for the Scholarly activity:

1st 6 Months Explore the literature and project ideas.
Define SOC membership.
2nd 6 Months Initial project plan should be defined.
First SOC meeting should take place.
2nd Year Project approval by IRB if needed during 1st 6 months.
SOC Progress Meetings every 6 months.
Research/Data collection.
3rd Year Results and presentation.
Work on manuscript (if applicable).
Work product should be complete by June 1st.

 Evaluation

AGP fellows will be evaluated periodically by the pertinent research and clinical faculty in the Departments of Pediatrics, Preventive Medicine and Medical Care and Regulatory Affairs. The evaluations will be reviewed with the Fellow by the Program Director. At least twice a year, the individual SOC and the faculty meets to discuss progress of Fellows. Any corrective action required will be brought to the attention of the Fellow. Fellows who are not progressing adequately in any of the six ACGME competencies will be reviewed at the Fellowship Education Committee. At the end of the Fellowship, the Program Director will write a summary of the Fellows performance and capabilities which will become part of the Fellow’s permanent record and the basis upon which future letters of recommendation will be written.

Once a year, the fellowship program will be evaluated and reviewed by the fellows and faculty with an eye towards improvement. The AGP fellowship will be periodically reviewed by the Fellowship Education Committee.

Licensure

Fellows are expected to apply for state licensure immediately following successful completion of all prerequisites.

General Policies on Advancement, Time off, Due Process

Promotion

Promotion from one year to the next will be based on performance and evaluations. 

Probation:

Academic Probation: Evidence that a Fellow has serious deficiencies in knowledge, skill, or progress making questionable his/her ability to advance educationally without remedial work, will be grounds for academic probation. A remedial plan will be developed and implemented by the faculty. In the case of emotional difficulties or mental health, a plan incorporating counseling and professional evaluation and treatment will be implemented. While involved in a remediation program, the Fellow must show evidence of timely progress and improvement to an adequate level of knowledge and skill to be removed from probationary status. 

Disciplinary Probation: Deficiencies in conduct or attitude (i.e. disorders of professionalism) will also lead to disciplinary probation.  Situations which could lead to disciplinary probation include poor participation in conferences, absenteeism or chronic lateness, failure to meet documentation requirements (see above), failure to participate in the credentialing process, lack of cooperation as a team member, failure to carry out clinical or research responsibilities, lack of interest in the educational process or intellectual dishonesty. Fellows placed on academic probation will be accorded due process as outlined in the policies and procedures set forth by the Graduate Medical Education Committee of the Medical Board of Stony Brook University Hospital (see Grievance Process / Due Process).

Dismissal

Continued deficiency in previously identified areas of training despite placement on probationary status and implementation of a remediation program will result in non- renewal of contract or dismissal. A Fellow has the right to an impartial review and open hearing prior to dismissal as accorded though due process (see Grievance and Due Process).

Vacation and Benefits Guidelines

Fellows may not accept secondary employment or moonlight. Fellows will accrue vacation days in accordance with the collective bargaining agreement which is based on years of service. Vacation time must be approved by the program director in advance. 

Benefits – As an employee of the State University of New York, you are eligible to receive standard benefits such as health, dental, vision, and disability insurance as well as participation in a pension plan. A full explanation of State benefits is available at the following website:  http://www.stonybrook.edu/hr/benefits/state/.

Absence from Service

In the event of an unanticipated necessary absence, the Program Director must be notified. Prolonged absences for an illness may require a note from the Fellow’s personal physician. In the absence of a personal physician, the Fellow may access healthcare through the Office of Employee Health. Attempts will be made to compensate those who must work extra time for those who have unanticipated absences.

  • Prolonged or multiple unplanned absences resulting in significant loss of work time will require an extension of the Fellowship beyond the 3 years at the discretion of the Program Director.
  • All unexcused absences will be recorded in the personnel file along with vacation and extended leave time. 

Extended Absences or Leave

If a Fellow anticipates the need for time off exceeding the usual vacation allotment, the Fellow must submit a written request to the Program Director at least 4 months prior detailing the rationale for the request, the amount of time needed, and the preferred mechanism of making up the time (see below). Extended absences of more than 8 weeks are not likely to be considered in the absence of extenuating medical conditions or pregnancy. 

If the Fellowship is extended or the requirement for make-up is waived, salary eligibility will be determined by the Payroll Department based on the Fellow’s accrued leave time. In addition, the Program Director may require rearrangement of the Fellow’s schedule to accommodate these requirements. Extended leave that cannot be anticipated (i.e. illness, family crisis) is subject to the above guidelines.

Conference attendance

Attempts will be made to enable 2nd and 3rd year Fellows to attend a regional or national meeting each year provided funds are available. 

Outside Rotations

Currently, there are none. If a Fellow has a strong reason to do a month’s rotation at another institution, he/she should discuss this with the Program Director. Due to malpractice related issues, requests for rotations outside of New York States are unlikely to be granted. 

Dress and Comportment

Fellows are expected to dress and conduct themselves in a professional and responsible fashion, and must be aware of and follow HIPAA regulations regarding confidentiality of personal medical information. Discussions about patients should take place in private places, never in elevators, cafeteria lines or in close proximity to the ears of others who are not involved in the patient’s case. When a patient’s condition is discussed at the bedside, it is the responsibility of the physicians to explain to the patient and/or parents what was said. Hand washing between patients is an important means of disease prevention and must be followed. Office and laboratory space is limited. It is helpful if Fellows carry out conversations in a soft voice so as not to disturb those in proximity.

Correspondence with agencies outside of SUSB

Patient-related correspondence must be compliant with HIPAA regulations and must be on Departmental letterhead or personal prescription forms. 

Letters of Recommendation

Letters of recommendation may be requested of the Program Director or any faculty member. Such requests should include a list of addressees.

Grievance Procedure / Due Process

If an issue cannot be resolved between a Fellow and faculty member, the Program Director should be consulted.  If that faculty member involved is the Program Director or the problem cannot be resolved with the input of the Program Director, the Chair of the Department of Pediatrics should be consulted. If these mechanisms are unsuccessful to bring a resolution to the problem, the Fellow may utilize the GME committee, medical staff or University or bargaining agent levels. The following is a description of the grievance process through the GME committee:

            “Dismissal, or any action, including non-renewal of agreement, which may significantly threaten a Resident’s intended career development, may be recommended by a Program Director based on substantial non-compliance, egregious behavior or clinical or professional incompetence of a Resident. An appeal process is available as described in the current House Staff Manual, distributed at Orientation, as well as in the GME Policy and Procedure Manual (Grievance Procedure/Due Process, revised 11/24/03. This policy also includes the process for a Resident to have their complaints and grievances, related to the work environment and/or issues related to the program or faculty, addressed.”

Appeals must be made within 5 business days from receipt of notification of the disciplinary action. 

Further information may be obtained at the following site:

http://www.hsc.stonybrook.edu/som/gme/gme_institutionalreq.cfm

Last updated by Webmaster on September 12, 2013

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