Policy for Clinical Supervision

The pediatric anesthesiology fellow will be under the direct supervision of an attending physician during all clinical educational experiences.  The attending physician has ultimate authority and responsibility for patient care.  The attending anesthesiologist will be physically present for induction and emergence during all anesthetics assigned to the fellow, and will be immediately available throughout the case.

Pre-operative Patient Preparation

The fellow is to discuss the assigned cases with the designated attending the day before the scheduled procedures. Inpatients are to be seen and evaluated by the fellow and then discussed with the attending.  For patients arriving the day of surgery and with a Preoperative Evaluation completed in the Presurgical Clinic, the fellow is required to review the Preoperative evaluation in the medical record and discuss these case with the designated attending.

The fellow is to identify the anesthetic issues, propose an anesthetic management strategy, and be able to identify potential complications and how to handle those complications.

Intra-operative Management

During the general OR months, the fellow will be exposed to all of the pediatric surgical subspecialties except cardiac surgery.  The attending will be physically present for induction, emergence, and during critical points of all anesthetics.  The attending will be immediately available at all times during any anesthetic performed by the fellow.

As the fellowship year progresses, and particularly in the second half of the fellowship year, the fellow is expected to assume more independence in anesthetic design and case management.  In the final three months of the fellowship year, the fellow will have the opportunity to supervise residents with attending backup.

The attending is always required to speak with the legal guardians of patients prior to anesthetics performed by the fellow, and is to sign the preoperative evaluation and the anesthesia consent.

Post-Operative Follow-up

The fellow is to see all of their postoperative patients who are inpatients and to report back to the attending with whom they were assigned to that case.   If that attending is unavailable, the fellow is to speak with the Anesthesia Coordinator in the OR about any postoperative issues.

For outpatients, the fellow is to check with the PACU staff member who is performing the postoperative telephone calls the day after surgery.  Any issues are to be discussed with the attending or Anesthesia Coordinator.

Cardiac Anesthesiology

The fellow spends two months with the pediatric cardiac anesthesiology faculty.  During the cardiac anesthesia rotation, the fellow is assigned one-on-one with a pediatric cardiac anesthesiology attending who is present at all times during cardiac anesthesiology cases.  The fellow is to adhere to all policies and procedures of the Nemours Cardiac Center.

Pain Service/Presurgical Clinic

The fellow spends one month on the Pain Service and participating with the Presurgical APN staff in the Presurgical Clinic.  The fellow will be directly supervised by the attending assigned to the Pain Service/ Presurgical Clinic. All pain consultations will be reviewed with the attending.  The attending will see all pain management patients, including patients evaluated by the fellow. The fellow will participate with the APN staff in the Presurgical Clinic in the medical evaluation of medically complex patients.  All Presurgical Clinic consultations the fellow is involved in will be reviewed by the attending.

Pediatric Intensive Care Unit

The fellow will do a one-month rotation in the pediatric intensive care unit.  The fellow will function as a rotating resident and will be under the direct supervision of the critical care attending.  The fellow is to adhere to the pediatric intensive care unit house staff policies and procedures. The fellow is responsible for attending daily rounds, completing all patient care duties, attending all critical care conferences, and participating in scheduled overnight call.  The fellow will be on call on average every fourth night; the day following call is free from clinical duties.  The critical care attending will be immediately available at all times.

Call Supervision

General OR Anesthesiology rotations: The fellow will be on call approximately once per week during the general OR anesthesia rotations.  Call consists of late OR duty until 9 PM, then call from home for appropriate educational cases (neonatal emergencies, major intra- abdominal/thoracic/cranial emergencies, major trauma, transplants).  If the fellow is working past midnight, then the following day is free from clinical duties.  The attending will be present for all cases the fellow participates in on call.  The clinical schedule is to be constructed to ensure the fellow is free of all patient care responsibilities for twenty-four hours each week.

The fellow will have a designated call room if attending overnight call.  The cafeteria has night hours, and the fellow gets a call meal ticket when on overnight call.

Moonlighting

Moonlighting outside the institution is discouraged, and is only allowed with explicit permission of the Department Chairman and Program Director.  Fellow moonlighting is to be in alignment with AIDHC GME Policy. Moonlighting within the Department is allowed with Chairman and Program Director permission.  All fellow supervisory policies are in effect while the fellow is moonlighting within the institution.  Moonlighting hours must be included in the weekly Duty Hours monitoring process.  Following a twenty-four hour or overnight moonlighting shift, the fellow is off of clinical duties the following day.  It is imperative that moonlighting not interferes with core clinical education.