Policy for Promotion of Fellows.
Interval Evaluations and Counseling of Fellows. All attending physicians that have contact with the
fellows formally evaluate them every 3 months. These evaluations are based upon the ACGME
recommended core competencies of patient care, medical knowledge, professionalism, practice-based
learning and improvement, and systems-based practice. Faculty contact with fellows occurs both in
inpatient and outpatient settings. Each faculty member evaluates the fellow and completes an evaluation
form at 3-month intervals, and the written records are maintained in the program directors office. The
fellows are expected to document competencies in a folio developed for each fellow. They are given a
time schedule of evaluations, which describes what documents and competencies will be reviewed at
each evaluation. After each evaluation the program director meets with the fellow and reviews the
evaluations. The program director and fellow sign off on the evaluation.
At 6-month intervals, the program director writes a formative narrative evaluation and makes
recommendations for improvement, if any, to the fellow. If problems occur prior to that evaluation, the
faculty member calls it to the attention of the training program director for formal documentation and
discussion with the fellow. Annually, a summative formative evaluation is performed and documented
formally.
Monitoring and documentation of each trainee's acquisition of skills in the performance of the
procedures utilized in this subspecialty. Fellows are supervised and evaluated in the performance of
fine needle aspiration of thyroid nodules. Every time they perform a procedure, the procedure must be
signed by the attending indicating successful completion of the procedure. The list of procedures is
submitted to the program director for the formal record.
Fellow’s performance of ultrasound-guided thyroid aspirations are observed and evaluated closely. The
fellow’s skill for thyroid aspirations is developed with repeated procedures. First, the fellow observes
thyroid aspirations. When the attending endocrinologist is confident that the fellow is knowledgeable
about a procedure, the fellow is allowed to perform the procedure under supervision. When the
performance is judged satisfactory, the fellow can then perform a procedure in the absence of an
attending physician. In general, the physician of record is present at all procedures.
Promotion. Performance at the end of the PG4 year including evaluations in the ACGME recommended
six core competencies, and procedural skills are reviewed by the program director and fellowship
evaluation committee. If the fellow is judged to be competent by objective evaluations and achieved a
level of competence and independence of action in the care of his patients, and there is a consensus
among the faculty, the fellow is advanced to the second year of fellowship. Fellows are required to
successfully meet all PGY-4 level specific goals and objectives before being promoted to PGY-5.
The evaluation process is repeated during the second year of training. Upon successful completion of the
PGY-5 level goals and objectives and with consensus of fellowship evaluation committee, the fellow is
graduated from his/her fellowship.
Response by Fellow. The program director reviews the evaluations with the fellow during a scheduled
meeting every 3 months. The fellow has an opportunity to read and respond to their evaluations. The
fellow signs off on the evaluations. The fellow can review his/her evaluations at any time between
scheduled evaluations.
If the fellow fails in a particular competency, the program director gives the fellow a warning about his/her
deficiencies and develops a remedial plan with the fellow to correct the deficiency within a 3-month
period. If the fellow continues to fail, the fellow is put on probation and given a 3-month period to correct
the deficiency. The two-year program cannot be ended on probation or with a warning, and the training
period must be extended 3-6 months if such a situation occurs. If the fellow fails again after being place
on probation, the fellow is dismissed from the program. The fellow can appeal the decision with due
process following GMEC policy.