Policies

Stanford Pediatrics Resident Caps (Inpatient)

Both MD and DO residents are issued a postgraduate training license by the CA medical board at the start of residency. All residents are required to take Step 3 (for MDs) or COMLEX level 3 (for DO’s) during intern year to qualify for your unrestricted (P&S) California Medical License. You must apply for your P&S license in the final month of internship (unless you are an international medical graduate, in which case you need to apply for your P&S license in the final month of your PGY2 year). Step 3/Level 3 is a 2-day exam and should be scheduled when you can easily be away from the program for at least one of those days. Step 3/Level 3 must be scheduled during outpatient rotations, vacations, or electives. 

• To get reimbursed by GME for CA Medical License, plan to take and have passed your Step 3/Level 3 by May 1st of your intern year
  
• As soon as your exam is scheduled, at least 4 weeks in advance of your exam, please email the chief residents AND the rotation director if you are missing any days of the rotation. Rotation directors are listed on the 5 minute summary documents for each rotation.
  
• Please try to include a weekend day (not required, just encouraged) in order to miss only one day of your rotation
• Please do not schedule the same day as night float weekend shifts or jeopardy weekends.
• Please avoid scheduling on your continuity clinic day, particularly if your clinic is at Gardner as the patients on your panel would have to be rescheduled. If this is not possible, please discuss with chiefs before scheduling your exam.
• Schedule during the following rotations:
  • Adolescent
    
  • Red outpatient
  •  Green outpatient
  • Yellow outpatient
  • Elective
  • Development & Behavior
  • ID/Endo
  • Community (avoid Tuesdays or Thursdays when possible)
  • Vacation

•   •    Ask the chiefs if you need help deciding when to take the exam 

PALS and NRP Certification expire every 2 years. Most juniors will be PALS re-certified during junior retreat and most NRP will be re-certified during the NICU rotation. However, if this is missed for any reason, please contact the chiefs to arrange for a make-up session.

Supervision Policy for Department of Pediatrics

1. Supervising medical staff physicians will adhere to the ACGME requirements pertaining to the level of supervision for residents in a training program. Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty member (direct supervision). For many aspects of patient care, the supervisor may be a more advanced resident, fellow or mid-level provider, e.g. APP. Other portions of care provided by the resident can be adequately supervised by the immediate availability of the supervising faculty member or resident physician, either in the institution (indirect supervision with direct supervision immediately available); or by means of telephonic and/or electronic modalities (indirect supervision with direct supervision available). In some circumstances, supervision may include post-hoc review of resident delivered care with feedback as to the appropriateness of that care (oversight).
2. To ensure patient safety and quality patient care while providing the opportunity to maximize the resident educational experience, supervising medical staff physicians need to be available to the resident in person or by telephone 24 hours a day when on clinical duty.
3. When a resident is involved in the care of the patient, the responsible supervising staff physician must maintain personal involvement in that patient’s care. The supervising staff physician is fully responsible to oversee the care of the patient and directs the appropriate intensity of resident supervision based on the nature of the patient’s condition, the likelihood of major changes in the management plan, the complexity of care, and the experience and judgment of the resident being supervised. All patient care services must be rendered under the oversight of the responsible supervising staff physician, a supervising provider or be personally furnished by the supervising staff physician or provider.
4. The residency program leadership will consistently ensure that residents know which supervising medical staff physician is on call and how to reach this individual.
5. Supervising medical staff physicians will demonstrate compliance with any residency review committee citations related to this supervisory function.
6. Residents may only exercise privileges for patient activities and procedures for which his/her supervising physician or supervising provider has been appropriately credentialed.
7. Supervising medical staff physicians are responsible for determining when a resident is unable to function at the level required to provide safe, high quality care to assigned patients. They have the authority to adjust duty hours downward to ensure that residents that are overly fatigued do not place patients at risk.
8. Individual residents must be aware of their limitations and not attempt to provide clinical services or do procedures for which they are not trained. They must know the graduated level of responsibility described for their level of training and not practice outside of that scope of service.
9. Each resident is responsible for communicating significant patient care issues or changes in patient condition to the supervising medical staff physician and such communication must be documented in the medical record, inclusive but not limited to, significant decline in patient condition, a rapid response call to patient bedside, request to discharge patient against medical advice, patient transfer to the ICU, patient/family request for DNAR order, patient need for any invasive procedure, patient death.
10. Failure to function within graduated levels of responsibility, communicate significant patient care issues to the supervising physician, or appropriately document the level of supervising physician oversight may result in the removal of the resident from patient care activities.

Graduated Levels of Responsibility

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members. As they advance in their training program, residents should be given progressive responsibility for care of patients. The determination of a resident’s ability to provide care to patients without a supervising physician present, or to act in a teaching capacity is based on the resident’s clinical experience, judgment, knowledge, and technical skill. It is the decision of the supervising physician as to which activities the resident will be allowed to perform within the context of the assigned levels of responsibility.

1. The Residency Program Director defines the levels of responsibilities for each year of residency training by preparing a description of the types of clinical activities residents may perform. Graduated levels of responsibility will be in accordance with ACGME and JCAHO guidelines and this documentation will be made available to the LPCH Medical Staff Office annually. These activities are delineated for each resident on: https://www.stanfordchildrens.org/en/mss/policies/index
2. In compliance with ACGME standards, PGY-1 residents should be supervised either directly or indirectly with direct supervision immediately available.

Documentation of Supervision of Residents

The medical record must clearly demonstrate the involvement of the supervising medical staff physician in resident patient care. Documentation of supervision must be entered into the medical record by the supervising physician or reflected within the resident progress note or other appropriate entries in the medical record (e.g., procedure reports, pathology reports, imaging reports, consultations, discharge summaries).

Definitions:

• Levels of Supervision and Responsibility:
  • Direct supervision: the supervising physician is physically present with the resident and the patient
  • Indirect supervision with direct supervision immediately available – the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide direct supervision.
  • Indirect supervision with direct supervision available – the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision
  • Oversight – The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Supervisors:

• Supervising Medical Staff Physician The attending level physician responsible for patient care
• Supervising provider  A more advanced resident,  fellow or mid-level provider who can offer oversight for activities and procedures for which that advanced level resident, fellow or provider is credentialed to perform independently   

• Stanford Pediatrics Trade Guidelines
• 2024-2025 Trade Requests

Resident Driven Clinic Trades Guidelines

Attendance and presentations at national conferences are encouraged.  However, given the limited number of residents available to cover extra shifts, residents attending these conferences should make call switches with colleagues well in advance.  Consider asking fellow residents on elective or outpatient rotations. After a call switch is agreed upon between residents, please submit an electronic trade request from the link on the peds.stanford.edu homepage for chief approval. If a resident is unable to find someone to cover their shifts, please discuss with the chiefs. Please do not register for the conference or make travel arrangements prior to finding coverage. The chiefs will try to assist in finding extra coverage, but accommodating all requests is not always possible.   

All residents receive $2000 per year ‘educational fund’ to use for travel, hotel and registration at conferences (direct deposited in paycheck). There is an additional $500 educational materials/conference fund available to each resident over the course of residency. All expenses using this fund must be pre-approved by the coordinators prior to purchase. In addition, if you are presenting research that you intend to publish, you may apply for the Scholarly Concentrations Travel Grant.

The purpose of electives in our residency program is to allow individual residents opportunities to explore a clinical field that is not a required aspect of the curriculum. The American Board of Pediatrics (ABP) requires that time in residency is clinical training. Therefore, electives must have a clinical component to meet the ABP requirements. 

In order to optimize a resident’s experience during an elective period, it is important that electives be chosen well in advance of starting the elective so that the sponsoring faculty members or Divisions are prepared to integrate the resident into the clinical service and plan the individual’s experience.

Another important consideration is the auditing of resident rotations for Graduate Medical Education (GME) funding. In the past, children’s hospitals have not received significant GME funding for residency training. With new legislation and funding of GME, we are required to monitor and record resident rotations since funding is dependent on providing information about rotation schedules for each resident in the program.

Therefore, in order to meet the ABP requirements, to optimize the elective experience and to meet GME audit requirements, it is necessary that we have a formal elective policy and that all residents comply.

Elective Policies

Background
The purpose of electives in our residency program is to allow individual residents opportunities to explore clinical or scholarly areas that are not a required aspect of the curriculum. 

In order to optimize a resident’s experience during an elective period, it is important that electives be chosen well in advance of starting the elective (see below for timelines). Additionally, in order to meet the ABP and GME audit requirements, it is necessary that we have a formal elective policy and that all residents comply.

General Elective and Elective Change Policy

Residents must indicate their electives before the start of each residency year. We recognize that elective preferences may occasionally change during the year and you will be able to change electives prior to the start of your scheduled elective block depending on the type of elective, pending availability: 

To change clinical electives at Stanford, requests should be made at least 2 weeks in advance of the elective block (some rotations require further advanced notice) and the rotation director and APD must approve the request.

To change to a research elective, requests and research goals should be submitted at least 2 weeks in advance of the elective block and the research mentor and APD must approve the request. 

To change to a global health or away elective, requests must be submitted at least 12 weeks in advance of the elective block and must be approved by the GH leaders and APD. 

To change to a custom elective, requests should be submitted at least 2 weeks in advance of the elective block and must be approved by the faculty mentor and APD. 

You will be responsible for completing an Elective Change & Request Form, and it needs to be approved by the Chief Residents and your advising Associate Program Director. Seniors will be given first priority in the initial scheduling process as it is their final opportunity to partake in a particular elective. However, if a senior changes their selection later in the year, a previously scheduled junior will not be displaced to accommodate the senior. Additionally, for electives requiring resident-written goals and objectives (specifically research and custom electives), failure to submit goals and objectives by the due date may result in the resident being placed on a jeopardy rotation instead of an elective. 

Custom and Away Electives

Requests for custom electives, research electives and away electives are subject to an approval process. You MUST complete the proposal forms after your elective schedule is finalized and before the start of the new academic year. Revisions may be made, but must adhere to the elective change policy above. 

Electives outside of this institution (including international electives) require a separate approval process and additional time and planning. The Program Director and Ann Dohn (DIO) must approve off-site electives and ensure that residents have malpractice coverage. This process requires at least 2-3 months of planning.  If you are planning on participating in an away elective please reach out to  Carrie McGaughey or Michelle Brooks after you receive your final elective schedules.  Please see the specific Away Elective Policy for additional details.

Stanford Pediatrics Residency Physician Scientist Track: Guidelinesfor Clinical and Curricular Time During Research Blocks April 2020

For residents in the Physician Scientist Track, research/elective time is in the same category and residents can select whether they would like to do some clinical electives during their research time. Total research time is dependent on which pathway residents select (IRP, ARP, R38). The following guideline is specific for residents on the Physician-Scientist track:

The following activities will be required during research time:

• Clinical
  • Clinical service at ½ day continuity clinic every week, or option of full day continuity clinic every 2 weeks
  • For residents on the IRP during both PGY2 and PGY3 years, 2.5 blocks of research will be call-free while 2.5 blocks of research may include weekend cross-coverage or jeopardy.
    
  • For residents on research during Thanksgiving, Christmas or New Year’s, Holiday coverage will be required
    
  • For residents on research during class retreats and step-ups (winter-spring), cross-coverage will be required

• Scholarly Concentrations:
• Research retreats
• SOCs
• Required Scholarly Concentrations blocks (resident will choose 1 SC, and SC blocks are part of total research time):
  
  • ICCR for Clinical Research Scholarly Concentration
  • Scholarship Academy for Basic Science Scholarly Concentration
  • Other Scholarly Concentration Blocks for Med Ed, QI, StAT, Global Health

• Education:
  • PALS recertification (during PGY2 year before junior retreat)
  • End-of-year Step-up

• The following activities will be optional during research time:
  • Academic Half Days (Clinical teaching)
  • Class retreats(apart from PALS, which is required)

While on research blocks, physician-scientist track residents may be asked to cross-cover during the above class-wide and program-wide events (holidays, class retreats, step-ups), but will not be asked to cover research retreats or AHDs