Complete and strict observance of the moonlighting policy and work-hour regulations as expressed in section #13 of this curriculum is mandatory, and willful violation of these policies and regulations constitutes grounds for dismissal from the training program.
The University GME office audits every resident’s/fellow’s duty hours every two weeks Our program structure has been deliberately engineered to keep our trainees easily within the framework of the work hour rules. One such program design feature is the limitation of first year call weekends to only those weeks in which the first year fellow does not participate on the consult service.
Fellows generally rotate an evening of call during weekdays, Monday through Thursday, so that they are on about 2 weekdays in a month. Weekends are rotated so that they are on every 9th weekend on average over an academic year.
All call is taken from home. During the weekday, urgent and emergent consultations called to the on-call fellow from 5PM – 8AM should be seen promptly, and then reviewed with the on-call attending. Nurses should not be called until the attending has determined that a procedure will be performed that evening. Consultation notes should indicate that the case was reviewed with the on-call attending, Dr. “x”. The on-call fellow is obligated to provide a sign-out of the case to the Consult fellow the next morning so that appropriate follow up and disposition of the patient case may occur. However, it is the consult fellow who will add any procedures onto the endoscopy schedule, and secure attending staffing of the consultation if not done the prior evening, generally with the on-service Consult attending, and not the on-call attending of the previous evening.
Phone calls require particular attention and comment. Physicians are responsible for their assessments and recommendations made by phone, and trainees must learn to document these encounters for their own protection as well as to facilitate patient care and follow up. The fellow should at the earliest opportunity directly document the encounter by typing into the Electronic Medical Record, with a copy to the responsible attending or advanced practice provider.
The Consult Service fellows are responsible to sign-out whatever cases require follow-up over the weekend to the on-call fellow for the weekend. In particular, the GI Consult Service must daily follow those patients for whom a GI attending is the admitting attending of record, and the GI attending must leave a note every day in the medical chart of those patients.
In particular, a fellow’s performance of on-call duties focus an attending’s evaluation of the fellow’s competencies of patient care, interpersonal skills and communication, and professionalism.
Fellows are reminded that they are essentially the ambassadors and representatives of the GI division to colleagues, other physicians and patients. The faculty places a high premium on the fellow performing on-call duties with grace, professional composure, promptness and courtesy at all times, although we remain sensitive to the many factors that strain these qualities.
Finally, please review the Work Hour, Moonlighting and Attending Supervision policies (later sections) for further clarification on work hours and Attending supervision while on call.