Selection of housestaff
In order to qualify for the Clinical Cardiac Electrophysiology (CCEP) subspecialty exam, a candidate must train for a minimum of 4 years in Cardiology and Clinical Cardiac Electrophysiology combined. Like many programs, we feel an additional 5th year of training is necessary to achieve competency in complex ablation. Housestaff are eligible for 2 years of Clinical Cardiac Electrophysiology training after they have completed 3 years of general Cardiology training. Housestaff will advance to the second year only if the faculty determine that the candidate has adequately fulfilled the requirements of the first year of training (see separate policy on CCEP Resident Advancement Criteria). The maximum amount of training offered in Clinical Cardiac Electrophysiology at Dartmouth is 2 years.
Duty hours
Duty hours average 10 to 11 hours Monday through Friday. On occasion, during clinically busy periods, the day will be longer. On conference and procedure days, the day begins at 7:00 am. On other days, the day begins at 8:00 am. The fellows will rotate weekend call, taking call every 4th weekend (with faculty back-up). Duty hours average four hours on weekend on-call days.
The CCEP fellowship is in full compliance with the Accreditation Council for Graduate Medical Education (ACGME) Duty Hours Regulations. Specifically, no fellow is permitted to work more than 80 hours per week averaged over 4 weeks or more than 30 continuous hours. Further, there must be a 10-hour break between shifts and 24 hours off without medical responsibility each week. CCEP fellows take call from home and the 10-hour limit applies when one must return to the hospital for provision of inpatient or emergency care. Fellows are to leave the next workday by 1:00 pm if they are in violation of the 30-hour or 10-hour rules and self-policing of this policy is expected.
CCEP fellows are advanced trainees (PGY-7 or PGY-8) who do not take in-house call or mid-week call. Call takes place approximately once a month on a weekend (Saturday plus Sunday), and involves rounding for approximately 1/2-day with an occasional call back for an urgent consultation. In the unlikely event that the fellow meets the duty hour limit, the fellow is expected to turn over patient responsibility to the CCEP faculty member on call.
Fellows are encouraged to submit their duty hours electronically on a weekly basis, and these are reviewed monthly by the Program Director and also reviewed by the Graduate Medical Education (GME) office. Due to the fact that CCEP fellows are advanced trainees in a consultative specialty that allows for in-home call and few emergencies, there is minimal risk for duty hour violations.
A CCEP faculty member is always on call and available 24 hours a day, as back up to the CCEP fellow and other residents in Internal Medicine. If unexpected circumstances create fellow fatigue or threaten a duty hour violation, the CCEP fellow is dismissed and the CCEP faculty member assumes patient care responsibilities.
Moonlighting
The clinical cardiac electrophysiology training program has adopted the moonlighting policy of GME at Dartmouth Hitchcock Medical Center. View the Moonlighting Policy (PDF)