Trainee Responsibility and Supervision

Trainee Responsibility

With the advice and support of faculty, the fellow should:

• Define individual goals, make these goals known to the program director in regular meetings, and assure that the program helps the fellow meet these goals successfully.

Clinical Responsibilities

• Perform consultation on a broad spectrum of hospitalized patients with infectious diseases, including patients with HIV infection, elderly patients, immunocompromised patients (e.g. with cancer, neutropenia, solid organ and stem cell transplant recipients), surgical patients, complicated general medical patients, indigent and privately-insured patients, and immigrants.

• Evaluate a broad spectrum of outpatients with infectious diseases, including those with HIV infection, tuberculosis, sexually transmitted diseases, immigrants, and patients with chronic infections, and provide follow-up of patients seen in the inpatient setting.

• Perform longitudinal primary care for a cohort of HIV-infected patients for at least 24 months in a continuity clinic.

• Ambulatory training must include longitudinal care (at least 12 months of direct supervision of each patient) of at least 20 patients with HIV infection.

• Participate in a Journal Club with colleagues on a biweekly basis to evaluate the current medical literature.

• With skilled and experienced senior staff, observe and develop effective consultative skills for the efficient evaluation of patients referred for infectious disease consultation, learning how to communicate with referring physicians and other members of the health-care team, and coordinating responsibilities and information with the patient’s primary care physician to ensure uninterrupted patient care.

• Learn to recognize and avoid potential conflicts of interest and self-interested behavior as they relate to patient care and professional interactions.

• Recognize the appropriateness and acceptability of recommendations on actual patient care and the financial feasibility of such recommendations for the patient and care conditions.

• Through participation in Infection Control committee activities and other experiences, develop an understanding of and demonstrate competency in systems-based practice.

• Develop an understanding of and demonstrate competency at practice-based learning.

Non-Clinical Responsibilities

• Learn to recognize and avoid potential conflicts of interest and self-interested behavior as they relate to patient care and professional interactions.

• Learn to speak and write effectively by regularly giving well-planned lectures and discussions to colleagues and by writing manuscripts for publication.

• Develop an independent research program with the guidance and support of one or more faculty members. Perform and complete a project, and present and publish results in peer-review journals. Learn how to write a competitive research grant application, and prepare a grant application to support fellowship or post-fellowship research efforts.

• Seek and respond effectively to feedback and advice.

• Provide feedback regarding the fellowship program and the faculty members. 

Moonlighting

Moonlight is allowed, but must be approved by the Program Director before any work takes place. A GME form must be completed by the fellow, and sent to the Program Director for approval and signature. If it is approved, the Program Coordinator will upload it into New-Innovations, and then moonlighting can be scheduled.

Fitness for Duty

Fellows are required to report to work physically and mentally capable of safely performing the functions of their job. Fellows must not report to work if they are impaired for any reason. Fellows must not consume alcohol or any controlled substance while on call, including “at home call.” Fellows must self-regulate their use of prescribed or over the counter medications to ensure these medications do not cause impairment. Fellows must manage their sleep to avoid excessive fatigue. The program has a responsibility to remove fellows from patient care activities if the fellow's impairment poses a threat to patient safety.  

Fatigue

Faculty and fellows are educated to recognize the signs of fatigue and will adopt and apply policies to prevent and counteract its potential negative effects. Fellows are encouraged to use fatigue mitigation processes to manage the potential negative effects of fatigue on patient care and learning. Fellows are reassured that there will be no negative consequences and/or stigma for using any fatigue mitigation strategies, including reaching out to others to transition care as needed. Likewise, fellows are responsible to act if they recognize fatigue in others that can pose negative health and care of others.

Well-being

The Medical School and fellowship program are committed to promoting and supporting the health and wellbeing of each fellow. Faculty members and program directors need to make sure each fellow functions in an environment that has safe patient care and a sense of well-being. If, at any time a fellow feels this is not the case, they are asked to bring this to the attention of education site directors, the Program Director or other faculty leadership they are comfortable with.  

The Medical School has a number of support resources available on its website for fellows, and fellows have access to appropriate tools for self-screening of well-being. The Program Director is available at any time to provide support and information for any reason. Fellows are granted time away from training for vacation, illness, parental or family leave, or pregnancy-related disabilities. Vacation leave is essential and should not be forfeited or postponed. Any emergent issue is to be communicated to the site or program leadership to ensure the health and safety of fellows and patients.

Monitoring of Wellbeing links to UMN GME Health Task Force Resources.

Trainee Supervision

The institution's Supervision Policy is here. At each institution and on all rotations, fellows are supervised by the attending physician (faculty) on-call or in charge of the clinical activity. Each institution complies with known lines of responsibility for the care of patients from students, residents, fellows, to attending physicians. Fellows are to be provided with reliable systems for communication and interaction with supervisory physicians and are responsible for contacting supervisory physicians for all areas of patient care. Fellows have the opportunity and are expected to assume increasing responsibility for patient care commensurate with their level of training, under faculty supervision, as they progress through the program. On-call schedules for teaching staff ensure that supervision is readily available to fellows on duty. The level of responsibility accorded to each fellow is determined by the teaching staff.  

Fellows are supervised closely in all their activities by designated faculty members, i.e. the assigned infectious diseases consult service attending during consult months, the assigned clinic attending during continuity clinic, and the designated research mentor for research activities. All patient care decisions and recommendations made by the fellow are discussed with the relevant faculty member, and changes (if any) are communicated to the primary teams or patient, as appropriate. Faculty members confirm relevant aspects of the history and physical examination, as assessed by the fellow, to the extent necessary, to ensure that clinical decision making is appropriate and documentation is accurate. When fellows supervise residents and students in providing patient care, the fellow is responsible for seeing that the decisions and recommendations made by the trainees are appropriate, which then is verified by the responsible faculty member. The program director has overall responsibility for ensuring that fellows are performing and progressing satisfactorily, as ascertained from the standardized evaluations submitted periodically by the supervising faculty members and from direct discussions with these faculty members as needed to clarify any questions raised by the standardized evaluations.

Management of Patients with Progressive Responsibility and Independence

The following list addresses the expected progression of fellow responsibility towards independence. This progression is expected to be made by each fellow and assessed so the fellow with be deemed competent and ready for unsupervised practice at the time of program completion.

Behavior of beginning ID Fellow

• Requires direct supervision to ensure patient safety and quality care

• Requires direct supervision to manage problems or common chronic diseases in all appropriate clinical settings

• Inconsistently provides preventive care in all appropriate clinical settings

• Requires direct supervision to manage patients with straightforward diagnoses in all appropriate clinical settings

• Unable to manage complex inpatients or patients requiring intensive care

• Cannot independently supervise care provided by other members of the physician-led team

Behavior of ID Fellow who is advancing and demonstrating improvement in competency

• Requires indirect supervision to ensure patient safety and quality care

• Provides appropriate preventive care and chronic disease management in all appropriate clinical settings

• Provides comprehensive care for single or multiple diagnoses in all appropriate clinical settings

• Under supervision, provides appropriate care in the intensive care unit

• Initiates management plans for urgent or emergency care

Behavior of ID Fellow who demonstrates the actions of a physician ready for unsupervised practice

• Independently manages patients across applicable inpatient, outpatient, and ambulatory clinical settings who have a broad spectrum of clinical disorders, including undifferentiated syndromes

• Seeks additional guidance and/or consultation as appropriate

• Appropriately manages situations requiring urgent or emergency care

• Effectively supervises the management decisions of the team in all appropriate clinical settings

Attending Physician Notification Guidelines (i.e., Trigger Card)

Every fellow carries this card and it lists certain changes in a patient’s status or other events that will prompt the fellow to contact the attending physician. This is not meant to be an all-inclusive list, but is a guideline to assist in decisionmaking. If a fellow is uncertain whether to call, they are instructed to call.

• Severe malaria with the potential need to request IV artesunate

• Suspected or confirmed case of an agent of bioterrorism

• Request for ID clearance for organ harvesting or transplantation

• Cases of potential rabies exposure

• Patient with potential need for placement in the Special Pathogen Unit

• Case of suspected or confirmed Stevens-Johnson syndrome

• Possible infectious indication for IVIG

Conference Attendance Requirements

Conferences and didactics are listed under Program Curriculum and attendance is expected as noted.