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Shared Educational Resources - Critical Care Fellowship Programs

Leadership / Administrative Structure

  1. Administration of the Critical Care (CC) fellowships is a shared responsibility between the Fellowship Program Directors (FPD) and the Section Chief of Critical Care.
  2. There is a CC Fellowship Program Director from each discipline who has the direct responsibility for all aspects of a fellow's clinical and educational program; including meeting discipline specific RRC requirements
    1. The specific CC FPD's are:
      • Pulmonary/CCM;
      • Internal Medicine/CC;
      • Anesthesiology/CC; and
      • [Surgery/CC; planning underway].
    2. The Pulmonary/CCM Program Director is responsible for fellows with a medicine background in the combined Pulmonary/CCM program while the Internal Medicine/CC FPD is responsible for fellows with a medicine background who are not combining CC with Pulmonary. The Anesthesiology CC FPD is currently responsible for fellows with a background in surgery or anesthesiology, as well as fellows with an emergency medicine background. If a Surgery Fellowship is approved, the Surgery CC Program Director will become responsible for fellows with a background in surgery.
    3. Each CC Program Director is responsible for:
      1. discipline specific aspects of the educational curriculum;
      2. collectively developing and maintaining the common elements of the curriculum;
      3. coordinating the relationship between CC and other residency training programs with their respective Core (parent) Program Director (Internal Medicine for Pulmonary/CCM and IM/CC; Surgery; and Anesthesiology);
      4. oversight of RRC requirements in coordination with their respective Core Program Director and the Associate Dean for Graduate Medical Education (on behalf of the Graduate Medical Education Committee);
      5. the supervision, evaluation, and certification of competency and professional behavior for their respective fellows (as per GME and ACGME policies).
    4. All program directors are Associate Directors of the Adult Intensive Care Unit
  3. The Section Chief of Critical Care responsibilities include:
    1. the coordination and collaboration of the individual Critical Care Fellowship Programs;
    2. the oversight of clinical practice and professional issues related to Critical Care (as per MHMH Bylaws, Article VII Section 1; Review of Professional Staff Performance and Conduct).
    3. supervision and oversight of the Critical Care Faculty in their adherence to the highest standards of trainee education. The Section Chief of Critical Care will provide an important primary conduit for implementation of the fellowship program directors' fundamental prerogatives concerning the quality of the educational environment, addressing concerns over the intellectual rigor of work/teaching rounds, and the selection of faculty best suited to provide the highest level of fellow training in the ICU environment. The roles of the Section Chief in the implementation of the program directors' prerogatives are further detailed in Section 1.d. (below).
  4. Reporting Structure and Oversight for Educational/Training Issues:
    1. In the event that a Fellowship Program Director is dissatisfied with any aspect of the implementation of their recommendations and prerogatives concerning the quality and rigor of fellowship training, or the commitment of individual faculty to upholding the educational expectations of that Program, Program Directors have the option (and obligation) to report those concerns to their core (parent) Program Director (IM, Anesthesiology or Surgery). The Core Program Directors may address the situation directly with the Section Chief of Critical Care, or may involve Section Chiefs, and/or Department Chairs, as needed, depending upon the nature of the concerns and at the sole discretion of the Core Program Director.
    2. Importantly, any of these individuals may bring their concerns to the Associate Dean for Graduate Medical Education (on behalf of the Graduate Medical Education Committee) or the ICU Oversight Committee (consisting of the Chairs of Medicine, Surgery, and Anesthesia, as well as the Chief Medical Officer of DHMC). This governance body, to be convened by the Chair of Anesthesiology on a quarterly basis, is charged with responsibility for advice and consent on any issues which have potential impact across traditional Departmental lines as well as review of the implementation of important policies pertaining to maintenance of superior quality of care and education. This is a critical structural element of the governance of this multidisciplinary ICU, which provides absolute assurance that the interests of three independent, yet interdependent, Departments are represented, but that the larger interests of the provision of superior care and education in the Intensive Care Unit supersedes the interests of any individual Department.

Selection of Fellows

  1. Fellows can be accepted into a Critical Care (CC) Program after completing an accredited residency in Medicine, Surgery, Anesthesiology, or Emergency Medicine. Fellows who have completed a residency in Medicine can either combine their CC with Pulmonary Medicine or focus solely on CC. Fellows from the other disciplines are committed to CC only.
  2. There will not be any pre-specified quota of fellows from each of the various pathways. Rather, fellows will be selected based upon their competitiveness and clinical / academic potential.
  3. Each CC Fellowship PD will evaluate the candidates from their pathway and select those candidates warranting further review.
  4. All of the CC FPD's will meet to review the available candidate applications, grant interviews, and review candidate files at the end of the interview process.
  5. Selection of candidates is a shared responsibility between the FPD's. Should CC pursue a match in the future, determination of the match rank list will similarly be a shared responsibility.
  6. All involved parties agree that this section (Selection of Fellows) is open to revision in the future to maintain alignment with changing RRC-specific requirements and/or coverage requirements for the individual ICU teams.

Educational Structure

  1. All fellowship program directors are responsible for collectively coordinating the clinical aspects of the training program.
  2. Each FPD is responsible for reviewing the curriculum of their pathway(s) annually. The review will include:
    1. the type, number, and timing of required clinical rotations and elective experiences;
    2. the research environment, including fellow research publications and presentations; and
    3. a written curriculum for the program based upon the six core competencies and designated by PGY level.
  3. Each FPD will review the curriculum of their pathway with the Section Chief of CC annually.

Evaluation and Feedback

  1. Evaluation system
    1. The ICU will use a web-based, anonymous evaluation system to track performance of fellows, faculty, and rotations.
    2. The ICU will utilize the web-based evaluation system supported by the GME office.
  2. Fellow Evaluation
    1. Faculty will evaluate each fellow at the end of each overlap period / block of 1 week or greater.
    2. Each FPD will be responsible for evaluating the fellows in their pathway(s) on an ongoing basis, including six month reviews and promotion / graduation decisions.
    3. FPD's are responsible for all reporting of fellow performance to their respective Boards.
  3. Faculty Evaluation
    1. Faculty will be reviewed by fellows at the end of each teaching block / overlap of 1 week or greater.
    2. Fellow evaluations of faculty must be anonymous, and all data gathered will be presented as grouped data only.
    3. Grouped fellow evaluations of faculty data will be reviewed with individual faculty members on an annual basis.
  4. Program Evaluation
    1. Each individual rotation will be evaluated at the conclusion of each block by fellows in an anonymous fashion.
    2. Each of the CC pathways will be evaluated annually by the fellows in an anonymous fashion.
    3. Data from both rotation and programs will be available to and reviewed by all of the FPD's and the Section Chief of CC. The FPD's, the Section Chief of CC, faculty representatives, and fellow representatives will meet to review these evaluations and help plan for changes and improvements in the program on an annual basis.

Educational Quality Assurance

  1. The Section Chief of Critical Care will be responsible for the leadership and implementation of all QA processes in the ICU.
  2. Clinical guidelines / Evidence Based Medicine / Quality Outcomes
    1. The ICU will maintain an ongoing QA committee to review clinical outcomes in the ICU which will meet at least monthly.
    2. The committee must include representatives from all clinical disciplines and fellowship pathways in the ICU, and will be open to all ICU faculty, staff, and fellows who wish to participate.
    3. The committee will examine, in an ongoing process, areas of ICU care that are controversial or where differences of opinion between faculty members exist. The review will consist of:
      1. A literature review and discussion of best practices and practice guidelines.
      2. Follow-up to ensure continued improvement in quality metrics.
    4. Fellows should be active participants in the QA process with appropriate faculty oversight.
  3. Anonymous reporting
    1. There will be an anonymous reporting mechanism whereby anyone working in the ICU can report concerns about the quality of care delivered in the ICU. Faculty, fellows, and staff will all be made aware of this system on a regular basis and encouraged to report “near misses” and any concerns about the quality of care in the ICU.
    2. A committee including faculty and fellow representatives will review each reported incident and suggest further follow-up or actions.
  4. Faculty Teaching Quality Assurance
    1. The Fellowship program directors and the Section Chief of CC will meet at least twice annually to review faculty evaluations.
    2. The Section Chief of CC will meet with any faculty member demonstrating less than satisfactory teaching performance, and develop a plan for improvement.
    3. Faculty failing to improve their teaching performance will be removed from direct fellow and/or resident oversight, and mechanisms for resolving any disagreements over such matters are detailed in Section 1.d.

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