Inpatient Clinical Responsibilities
Year one: 3 months on service
Year two: 4 months on service
Year three: 4 months on service
All patients admitted on the Endocrinology Consultation Service will be assigned to the fellow when he or she is covering the inpatient clinical service. The average number of inpatients is 1-5 ongoing management patients and 2-5 new consults per week. The fellow is a consultant; the daily care of these patients is entrusted to the house staff. Patients are regularly admitted to University of Minnesota Children 's Hospital Patient Care Units 5A and B, the Pediatric Intensive Care Unit, the Neonatal Intensive Care Unit, the Child or Adolescent Psychiatry Units, or the Masonic Day Hospital . Occasional consults originate from Children's Rehabilitation, Obstetrics, the adult Medical/Surgical wards, or Hennepin County Medical Center .
While the attending faculty member is ultimately responsible for all inpatients, the fellow acts as the first-line consultant. A second year pediatric resident on the Endocrine rotation accompanies the fellow. The fellow's responsibilities include the primary interactions with the patient/family/nursing staff, with the support and supervision of the attending faculty member. The fellow is responsible for providing a plan for diagnosis and treatment, and arranges for needed consultations and special testing procedures. The fellow is the primary contact with parents of hospitalized children. This includes education of parents, and any needed work with social services and psychological services. The fellow is teacher to the medical students and house officers who are also assigned to the patient through the ward assignment mechanism.
It is policy that all consultation requests are answered and completed within 24 hours of receipt. Completion includes staff supervision, including examination of the patient by faculty and review and signing of the consultation note written by the fellow. One-on-one teaching is done at this time, including initiation of literature searches. Rounds are conducted daily on all wards where a patient is hospitalized. The fellow is instructed by the attending faculty member on an ongoing basis centered on patient care.
During the inpatient rotation, the fellow takes home-call every night Monday through Friday, unless prior arrangements have been made with the attending physician (on average, the fellow and attending need to come in to the hospital at night once every two months). The fellow is off from 8am Saturday morning to 8am Monday morning every other weekend when on service. There is no night call or weekend call when the fellow is not on the inpatient service.
Outpatient Clinical Responsibilities
The fellow will attend one half day of endocrinology clinic alternating with one half day of diabetes clinic per week each week during the three year fellowship. Fellows have the option of attending the Metabolism Clinic at FUMC for a half day a week while on the clinical service. This clinic is supervised by Dr. Susan Berry, Professor of Pediatrics. It is conducted with the same format as Endocrine Clinic in regard to supervision and teaching.
The fellow is assigned one or more new patients at each clinic. In addition, the fellow is assigned several return patients each week. An attempt is made to provide a breadth of experience for each fellow by regulating which patients are seen. Assignment of each clinical patient to the appropriate trainee is monitored by a faculty member. The fellow is the first physician to see the patient. He or she then narrates the history and physical to a member of the faculty on completion of this work-up. The faculty member uses this time for teaching and review of the work-up done by the fellow. Each patient is then seen by the faculty member, and the pertinent parts of the work-up are personally checked. The fellow is then responsible for that patient's continuing care while attending that clinic. In addition to reviewing the further studies that might be done with the faculty member, the fellow dictates a summary letter to the referring physician or agency. This letter is reviewed, corrected and signed by the faculty member.
During the first year of fellowship, the fellow is encouraged to attend as many different clinics as possible to get the greatest breadth of experience in terms of both patients and care providers. During the second year and the third year, the fellow will have continuity clinics in endocrinology and diabetes.
Diabetes Camp
The fellow will spend one week each summer at Camp Needlepoint (diabetes camp), where, under the supervision of a pediatric endocrinologist, they will supervise the insulin dosing of campers with diabetes both in camp and out on trail.
Goals of Inpatient and Outpatient Clinical Training
The clinical training goals will be presented to the fellows during their initial orientation and will be repeated and reinforced annually and signed by the fellow and the Program Director. Goals may be modified annually based upon changing program requirements and feedback from the fellows. The fellow will keep a running list of diagnoses encountered in clinic and on the wards. Annually, the program director will review the list to ensure that the fellow is adequately exposed to the entire clinical spectrum of pediatric endocrinology. The goal of the training program is that the fellow will demonstrate competence in the following areas during the fellowship program: