I.POLICIES AND PROCEDURES...... 1

A.Prerequisites...... 1

B.Fellowship Selection Process...... 1

C.Duration of Program...... 1

D.Duties...... 1

E.Call Schedule...... 2

F. Compensation...... 2

G. Moonlighting Policy...... 2

H. Work Hours Policy...... 3

I. MalpracticeInsurance…………………………………………………………………....3

J. Curriculum

K.Self Instruction

L.Documentation of Training

M.Conduct

N.Policy on Professionalism and Learning Environment

Process for implementing Professionalism Policy

Monitoring Implementation of the Policy on Professionalism

O.Policy on Effective Transitions 6

P. Policy on Alertness Management / Fatigue Mitigation Strategies

Q.Supervision and Progressive Responsibility Policy

Oversight

R.Policy on Mandatory Notification of Faculty

S. Policy on trainees staying longer than 24+4

Policy and Process

How Monitored:

T.INSTITUTIONAL POLICY ON DUTY HOURS and Work Environment

Maximum Hours of Work Per Week

Mandatory Time Free of Duty

Maximum Duty Period Length

Minimum Time Off between Scheduled Duty Periods

Maximum Frequency of In-House Night Float

Maximum In-House On-Call Frequency

U.Policy on Moonlighting

V.Policy Ensuring Fellows Have Adequate Rest

W.Department and Institutional Policies and Procedures

II.CURRICULUM AND FACILITIES

Clinical Curriculum - Touro...... 18

ILH...... 19

Ochsner Kenner and Ochsner Main Campus

Ambulatory Care Clinics...... 21

Research Curriculum

Research Activities

Optional Programs

General Curriculum as outlined by ACGME competencies

Program Experiences Listed by Specific ACGME-Identified Focus Areas

III.EDUCATIONAL RESOURCES

IV.EVALUATION OF FELLOWS...... 35

A.ACGME Six Clinical Competencies...... 35

Patient Care...... 35

Medical Knowledge

Practice-based Learning and Improvement...... 36

Interpersonal and Communication Skills...... 36

Professionalism

Systems-based Practice...... 37

B.Clinical Evaluation

C.Research Activity...... 39

D.Advancement to succeeding training year

E. Disciplinary Actions...... 39

V.EVALUATION OF FACULTY

VI. EVALUATION OF THE PROGRAM...... 40

VII. APPENDIX...... 40

Disclosure of Outside Employment (PM 11 Form A)...... 42-44

The Section of Infectious Diseases of Louisiana State University Health Sciences Center in New Orleans offers a training program for graduates of Internal Medicine residency programs designed to produce experts in the area of Infectious Diseases (ID). The successful trainee will be prepared to pass the ABIM test to become a Board-certified ID physician. The program is designed to give the candidate a wide exposure to the principles and practice of both clinical ID and research techniques in ID. The program consists of 2 integrated years in which the candidate is exposed to clinical material, didactic teaching, reading material and research experiences necessary to pursue a career either as a clinician or academician. This document outlines the specifics of this program.

Any and all questions concerning this fellowship, this manual or other professional issues can be directed either to the Chief of the Section (Dr. David Martin) or the program director.

I.POLICIES AND PROCEDURES

A.Prerequisites

Fellows must hold a MD or DO degree from an accredited medical school. Graduates of foreign medical schools must be graduates of schools recognized as accredited by LSUHSC. Fellows must have satisfactorily completed a residency program in Internal Medicine or Medicine-Pediatrics.

B.Fellowship Selection Process

The Section participates in the Electronic Residency Application Service (ERAS) and the Medical Specialty Match Program (MSMP) through the Association of American Medical Colleges (AAMC). Potential fellow applicants must submit an application consisting of updated curriculum vitae, 2 letters of recommendation, and a personal statement prior to consideration for a personal interview. After the personal interview with the program director and at least 3 other faculty, this faculty submits a candidate evaluation form. After completion of the interviews of all potential candidates, a committee consisting of the program director and 3 faculty involved in the interview process rank the candidates according to interview evaluation ratings. The rank list is submitted to the MSMP. If fellowship slots are available after the match, the potential candidates are asked to submit applications and are interviewed by the faculty on a first-come-first-serve basis. After each applicant is interviewed and evaluated, the fellowship selection committee meets to discuss whether to offer the position on a first-come-first-serve basis.

C.Duration of Program

The program lasts a minimum of two years. A third and fourth year are available for candidates wishing to pursue an academic career.

D.Duties

The fellowship includes both clinical, research, and quality improvement/patient safety responsibilities. It will be the duty of the fellow to carry out the clinical responsibilities of the services to which the fellow has been assigned. This includes not only clinically evaluating

patients, following their progress and implementing therapy but also teaching of medical students and residents. Specific duties for each rotation are outlined in separate guidelines that are distributed to the fellows, other trainees, and attending staff prior to the beginning of the rotation. Each fellow also obtains copies of these guidelines at the beginning of the fellowship.

In the area of research the fellow must carry out a project under the guidance of a faculty mentor. This project should culminate in both publications and scientific presentations accomplished by the fellow. It is recognized that in all of these duties the fellow is a trainee and thus must discuss all plans and actions with the appropriate faculty member. In all cases of disagreement the judgment of the faculty will take precedence.

In the area of quality improvement/patient safety, the fellow will be assigned to an ongoing hospital or clinic QI committee at the beginning of the fellowship. The fellow will attend committee meetings, develop a QI project in conjunction with the faculty mentor and the committee leadership, and present the results of that project by the end of fellowship.

E.Call Schedule

Fellows will be on call when he/she is on an inpatient service. The fellow who is on the inpatient consultation will take the call as outlined in the rotation-specific guidelines. If they are taking call, they will be the first call on all clinical cases referred to the infectious diseases service. They will be allowed to take call from home in the evenings and on weekends. They will be expected to see the patient consulted in a timely manner. This may occasionally involve coming into the hospital at any time of the day or week. Duty hour rules will apply if rounds or after-hours consults go past 9PM to assure that fellows have 10 hours of off time between shifts. The fellow who is taking call will be completely off the call schedule one 24 hour period in seven days (averaged over the 4 week rotation). Call on that day will be taken by the attending with the resident on the service. Further guidelines for beeper call are outlined in the rotation-specific guidelines.

F.Compensation

Compensation is set by the Department of Medicine. The first year the fellow is considered at the PGY 4 and the second year they are PGY5. Other benefits are those designated by the Department of Medicine for residents of the same level. These are provided by the Department of Medicine. Vacation and sick leave are as provided by the Department of Medicine.

G.Moonlighting Policy

Professional activity outside of the scope of the fellowship program, which includes volunteer work or service in a clinical setting, or employment that is not required by the program (moonlighting) shall not jeopardize any training program of the University, compromise the value of the trainee's education experience or interfere in any way with the responsibilities, duties and assignments of the fellowship program. It is within the sole discretion of the Section Head and/or Program Director to determine whether outside activities interfere with the responsibilities, duties and assignments of the fellowship program. Before engaging in activity outside the scope of the House Officer Program, House Officers must receive the written approval of the Department Head and/or Program Director of the nature, duration and location of the outside activity.

Fellows while engaged in professional activities outside the scope of the fellowship are not provided professional liability coverage under LSA-R.S. 40:1299.39 et seq., unless the professional services are performed at a public charity health care facility. A fellow providing services outside the scope of the fellowship program shall warrant to University that the fellow is and will remain insured during the term of any outside professional activities, either (1) insured against claims of professional liability under one or more policies of insurance with indemnity limits of not less than $500,000 per occurrence and $1,000,000 in the aggregate annually; or (2) duly qualified and enrolled as a health care provider with the Louisiana Patient's Compensation Fund pursuant to the Louisiana Medical Malpractice Act, LSA-R.S. 40:1299.41 et seq. or (3) that the fellow is provided such coverage by the person or entity who has engaged the fellow to provide the outside professional services.

Fellows shall not provide outside professional activities to any other state agency (e.g., Department of Health and Hospitals, Department of Public Safety and Corrections, Office of Mental Health, etc.) by means of a contract directly between the fellow and the other state agency. Should a fellow desire to provide outside professional services to another state agency, the contract must be between the LSU School of Medicine in New Orleans and the other state agency for the fellow's services, and the fellow will receive additional compensation through the LSU payroll system. Fellows should speak with the Medicine Departmental Business Administrator to arrange such a contract.

H.Work Hours Policy

The fellowship program strictly adheres to the ACGME requirement concerning work hours as reflected in the LSU Institutional Policy. To this end, fellows will not work more than 80 hours/week during any rotation. As fellows do not have in-house call, these provisions do not apply to the ID fellowship. Moonlighting hours will be included in this calculation. The program director will monitor work hours by monthly rotation surveys performed by the fellows and at the semi-annual evaluation conducted with each fellow. In addition, questions about work hours will be added to the end on month rotation survey. Moreover, the GME office will conduct semi-annual surveys of all trainees at LSU.

All clinical faculties have been instructed on the work hours policy and the detection of fatigue in trainees at the annual section retreat. Supervising faculty will monitor fellows for signs of fatigue and report these findings to the program director as soon as possible. Appropriate action (e.g. relief of duties for rest, modification of duties to insure adequate rest, cancellation of moonlighting privileges) will be instituted by the program director after discussion with the fellow and faculty. The LSU Ombudsman is available to field questions or complaints by trainees about duty hours or remediation. The fellow can be completely anonymous in this interaction.

I.Malpractice Insurance

Malpractice insurance is that provided by the State of Louisiana to the medical residents for medical practice related to the fellowship training. This coverage does NOT cover outside moonlighting practice as noted in the Moonlighting section.

6

J.Curriculum

The majority of the clinical teaching occurs during clinical service months in the form of teaching rounds and case conferences. Thus, the material discussed will depend upon the clinical material that presents itself. Both the inpatient consult services and the inpatient HIV/TB ward over the two year fellowship period provide a broad exposure to all aspects of ID. The specific rotations and experiences that the fellow will partake in are described in a subsequent section. In addition to these clinical exposures, there are also research experiences and didactic sessions to provide a well-rounded experience. These too are described in the curriculum section.

K.Self Instruction

It is the philosophy of the program that fellows should be highly motivated and develop lifelong habits of self-instruction. Thus, fellows are expected to use the medical literature to solve clinical problems before the cases are presented to the faculty. Further, although most disorders seen in ID will eventually be seen during the two-year fellowship, some disorders will not. Thus, it is expected that the fellow will identify these areas and obtain articles from the medical literature so that they at least have a conceptual understanding of these disorders. Of course, the faculty is always available for guidance and suggestions.

L.Documentation of Training

The program will keep a folder on each fellow which will include copies of their evaluations, copies of their summaries, letters of recommendation and any other document pertinent to their training and performance. The fellow may view this folder at any time.

M.Conduct

It is imperative that the fellow learns appropriate behavior of a professional during their experience. It is recognized that health care is best delivered when physicians are collegial, yet frank with each other and respectful and caring of their patients. It is thus the responsibility of the fellow to be dressed appropriately. Faculty should be notified if the conduct of the fellows is ever considered less than professional. The section chief will discuss such incidents with the fellow in question.

The use of illicit drugs will not be permitted at any time and alcohol shall not be consumed by anyone who is on call or on active duty. Anyone found in violation of these rules will be treated in accordance with departmental and school policy.

Sexual harassment by fellows of anyone at the university will not be tolerated and will be grounds for referral to the department's administration. At the same time no fellow should ever be the subject of sexual or other harassment. Any complaint of such behavior should be reported to the section chief, the program director, or the department chairman.

Finally, the section recognizes the advantages of diversity amongst its members and supports their rights to different religious, political, economic, and artistic beliefs. Thus, any discrimination or harassment of a fellow, or any other member of the section, because of these differences should be reported.

6

These policies and procedures are supplemented by the policies and procedures outlined for the Department of Medicine and the LSU Graduate Medical Education Office. These manuals are provided at the beginning of the fellowship and available on the Infectious Diseases web site, in the Department office, or the Graduate Medical Education Office.

N.Policy on Professionalism and Learning Environment

In keeping with the Common Program Requirements effective 7/1/2011 our GME programs wish to ensure:

1. Patients receive safe, quality care in the teaching setting of today.

2. Graduating fellows provide safe, high quality patient care in the unsupervised practice of medicine in the future.

3. Fellows learn professionalism and altruism along with clinical medicine in a humanistic, quality learning environment.

To that end we recognize that patient safety, quality care, and an excellent learning environment are about much more than duty hours. Therefore, we wish to underscore any policies address all aspects of the learning environment not just duty hours. These include:

  1. Professionalism including accepting responsibility for patient safety
  2. Alertness management
  3. Proper supervision
  4. Transitions of care
  5. Clinical responsibilities
  6. Communication / teamwork

Fellows must take personal responsibility for and faculty must model behaviors that promote:

  1. Assurance for fitness of duty
  2. Assurance of the safety and welfare of patients entrusted in their care
  3. Management of their time before, during, and after clinical assignments
  4. Recognition of impairment (e.g. illness or fatigue ) in self and peers
  5. Honest and accurate reporting of duty hours, patient outcomes, and clinical experience data

The institution further supports an environment of safety and professionalism by:

  1. Providing and monitoring a standard Transitions Policy as defined elsewhere.
  2. Providing and monitoring a standard policy for Duty Hours as defined elsewhere.
  3. Providing and monitoring a standard Supervision Policy as defined elsewhere.
  4. Providing and monitoring a standard master scheduling policy and process in New Innovations.
  5. Adopting and institution wide policy that all fellows and faculty must inform patients of their role in the patient’s care.
  6. Providing and monitoring a policy on Alertness Management and Fatigue Mitigation that includes:
  7. On line modules for faculty and fellows on signs of fatigue.
  8. Fatigue mitigation, and alertness management including pocket cards, back up call schedules, and promotion of strategic napping.
  9. Assurance of available and adequate sleeping quarters when needed.
  10. Requiring that programs define what situations or conditions require communication with the attending physician.

(Professionalism and Learning Environment policy adopted from ACGME Quality Care and Professionalism Task Force AAMC Teleconference July 14, 2010.

1.Process for implementing Professionalism Policy

The programs and institution will assure effective implementation of the Professionalism Policy by the following:

  1. Program presentations of this and other policies at program and departmental meetings.
  2. Core Modules for faculty and fellows on Professionalism, Duty Hours, Fatigue Recognition and Mitigation, Alertness Management, and Substance Abuse and Impairment.
  3. Required LSBME Orientation.
  4. Institutional Fitness for Duty and Drug Free Workplace policies.
  5. Institutional Duty Hours Policy that adopts in toto the ACGME Duty Hours Language.
  6. Language added specifically to the Policy and Procedure Manual, the House Officer manual and the Fellow Contract regarding Duty Hours Policies and the responsibility for and consequences of not reporting Duty Hours accurately.
  7. Comprehensive Moonlighting Policy incorporating the new ACGME requirements.
  8. Orientation presentations on Professionalism, Transitions, Fatigue Recognition and Mitigation, and Alertness Management.

2.Monitoring Implementation of the Policy on Professionalism

The program and institution will monitor implementation and effectiveness of the Professionalism Policy by the following: