Frequently Asked Questions: Pediatric Hematology-Oncology Review Committee for Pediatrics ACGME Question Answer Introduction How much time should be devoted The Committee expects that the program will provide fellows with at least 12 months of clinical to clinical activity in any of the threeyear experience. subspecialties? [Program Requirement: Int.B.] Program Support Is the 20-35 percent minimum required protected time for program leadership per individual or combined time? [Program Requirement: I.A.4.] Does research funding count toward the minimum required protected time for program leadership? The minimum total of 20-35 percent protected time for the administration of the program is the combined time required for the program director, associate program director, and/or other faculty members of the program leadership; it does not include time devoted to the program by the fellowship coordinator or other support personnel. Individual members of the program leadership are not required to have 20-35 percent protected time each. Research grant funding does not count toward the minimum required protected time for the administration of the program. [Program Requirement: I.A.4.] Can there be a single coordinator for multiple programs? [Program Requirement: I.A.5.] A coordinator s professional time does not have to be dedicated exclusively to one program. It is acceptable for a program coordinator or other support personnel to assist with other programs, if time permits. When determining how much time is sufficient for the coordinator, the program should consider factors such as experience, accreditation status of the program, size of the program, number of institutions involved, etc. 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 1 of 7
Program Personnel and Resources What specialty qualifications are For a program director who has not achieved subspecialty certification from the ABP, the acceptable to the Review Committee Review Committee will consider the following criteria in determining whether alternate if the program director does not have qualifications are acceptable: current certification in the subspecialty by the American Board completion of a fellowship program in the discipline of Pediatrics (ABP)? leadership in the pediatric subspecialty field [Program Requirement: II.A.3.b)] scholarship within the pediatric subspecialty field; specifically, evidence of on-going scholarship documented by contributions to the peer-reviewed literature in the subspecialty, and presentations at national meetings in the subspecialty active participation in national pediatric subspecialty organizations current clinical activity in the specialty What qualifications are acceptable to the Review Committee if a member of the physician faculty does not have current pediatric subspecialty certification by the ABP? [Program Requirement: II.B.2.] Alternate qualifications will not be accepted for individuals who have completed ACGMEaccredited fellowship education within the United States and have failed the ABP certification exam, or have chosen not to take the ABP certification exam. Years of practice are not an equivalent to specialty board certification, and neither the ABP nor the Review Committee accepts the phrase "board eligible." For a faculty member who has not achieved subspecialty certification from the ABP, the Review Committee will consider the following criteria in determining whether alternate qualifications are acceptable: completion of a fellowship program in the discipline leadership in the pediatric subspecialty field scholarship within the pediatric subspecialty field; specifically, a significant record of publication in peer-reviewed journals involvement in pediatric subspecialty organizations current clinical activity in the specialty Alternate qualifications will not be accepted for individuals who have completed ACGMEaccredited fellowship education within the United States and have failed the ABP certification exam, or have chosen not to take the ABP certification exam. 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 2 of 7
Fellow Appointments Is Review Committee permission required for increasing the fellow complement? [Program Requirement: III.B.] Educational Program Are fellows expected to participate in a quality improvement project? [Program Requirement: IV.A.5.c).(4)] If a faculty member is a recent graduate of a subspecialty program, the Review Committee expects that individual to take and pass the next eligible ABP subspecialty certifying examination. Years of practice are not an equivalent to specialty board certification, and neither the ABP nor the Review Committee accepts the phrase "board eligible." Provision of documentation of alternate qualifications is the responsibility of the program director. All requests for changes in complement must be submitted to the ACGME via the Accreditation Data System (ADS) and be prior-approved by the Review Committee. Guidelines for requesting an increase in complement can be found on the Documents and Resources page of the Pediatrics section of the ACGME website. Programs must have adequate resources to accommodate an increase. Of particular concern are the inpatient and outpatient populations and the number of faculty members. The program must document that fellows (working alone or in a practice group) actively participate in an exercise in which they can examine some aspect of their practice to identify an area in need of improvement, and then implement a plan to bring about improvement. An exercise that examines some aspect of their educational activities can be used to meet this requirement if it is related to patient care. Fellows will need instruction in quality improvement methods. This process is best learned when fellows are able to work with those skilled in quality improvement. Some examples of acceptable projects are summarized here: Example 1 A group of fellows has decided to work on how growth in patients in the continuity clinic can be better tracked. First, they document their current tracking percentage; they look at 100 charts. Then they introduce a reminder system to improve such data. Several months after the change has been implemented, they check another 100 charts to see if the change has resulted in improved tracking. Example 2 A fellow has decided to work on reducing infection rates for a particular procedure. He thinks his rates exceed those of other fellows for the procedure. He decides to work on compliance 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 3 of 7
with techniques known to reduce infections associated with the procedure. The fellow then introduces a new system of doing the procedure that increases the chance of completing the procedure in the expected way without infection. The fellow tracks the technique used and the rate of infection in the future related to the procedure. Example 3 A fellow has studied her sign-outs on the inpatient service and noticed that the information she often provides has omissions and errors. At the urging of a faculty mentor, she decides to examine her own performance along with that of her colleagues. With the help of the Quality Improvement Department at the hospital, she gathers a sample of morning, evening, and weekend sign-outs. The sessions are analyzed for omissions and errors. An SBAR format is implemented, and the sign-out template is revised. Fellows are trained to use the new format and omissions and errors are reviewed again two months later. The fellow documents improvement in her own performance, as well as reduced errors for all involved in the new approach. Data are used to further modify the sign-out template. This project can be seen as an example of a practice-based learning and improvement or a systems-based practice project. Since the project enhanced and improved individual practice, it was framed as a practice-based learning and improvement example, but since it also had a positive effect on the overall system within which the fellow works, it can also be seen and presented as an example of a systems-based practice project. Example 4 A fellow feels that her shift assignments in the Emergency Department (ED) are too long. She is convinced that after eight hours, she works slower and is more likely to make errors. She works with the faculty member in the ED to identify ways to track the patients seen by fellow providers. All medication errors are tracked through the electronic medical record (EMR). After obtaining IRB approval, the fellow and faculty member work to randomly assign fellows to either eight- or 10-hour shifts. The fellow reviews and compares her own performance relative to performance errors, and reports are generated across all fellows. Results are presented at the annual program evaluation and an action plan is determined. This example can also be seen from either a practice-based learning and improvement or systems-based practice perspective. Because this was conceived of and implemented by an individual fellow to improve her work, it is a practice-based learning and improvement example. However, because the project had an impact on the overall system, it is also an example of a systemsbased practice project. 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 4 of 7
What is the expectation for fellows to participate in identifying system errors and implementing potential systems solutions? Programs need to document that fellows have actively participated in identifying systems issues that increase the risk or occurrence of errors and implemented a plan to correct them. This can be accomplished by an individual fellow or by a group of fellows and health care team members. [Program Requirement: IV.A.5.f).(6)] What is the difference between a practice-based learning and improvement quality improvement project and a systems-based practice project? [Program Requirement: IV.A.5.f).(6)] A practice-based learning and improvement quality improvement project involves fellows looking at ways to improve their own individual practice outcomes. A systems-based practice project is aimed at identifying systems issues within the program or institution that increase the occurrence of errors or maintain barriers to quality care. The goal of a systems-based practice project is to create changes to improve all providers work environment. However, as noted in several of the examples above, a project can be seen as both, depending on how it is planned, implemented, and presented. Two additional systems-based practice project examples are provided here: Example 1 Fellows notice that the wrong size bag and mask are at the bedside when they are called to provide care to an infant in respiratory distress. The fellows work with other health care team providers and those skilled in evaluating and addressing systems problems to analyze how often such errors occur. An intervention is implemented to reduce such errors. The fellows monitor error incidence rates after the intervention has been made. How often should a scholarship oversight committee meet with fellows during the program? [Program Requirement: IV.B.2.a)] Example 2 A fellow is concerned with the lack of proper patient monitoring after undergoing a procedure. Working with those skilled in evaluating and addressing systems problems, she determines the frequency and consequences of this problem, and tries to compare it to rates of occurrence elsewhere. She studies possible interventions and implements one. She then tracks the frequency of improper monitoring and/or its consequences as a result of the intervention. Scholarly experience must begin in the first year and continue for the entire period of education. As such, the Review Committee expects that each scholarship oversight committee will meet with each fellow at least once during the first year and at least twice during the second and third years. The Review Committee will also review fellows scholarly productivity to determine the adequacy of the oversight provided by the scholarship oversight committee. 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 5 of 7
How much time should be devoted to research and scholarly activity during the course of the educational program in any of the three-year subspecialties? [Program Requirement: IV.B.2.c)] Evaluation Are global evaluations acceptable for assessing fellows' abilities with the competencies acceptable? [Program Requirement: V.A.2.b).(2)] Are proprietary patient satisfaction surveys an acceptable evaluation method to assess fellows abilities with the competencies an acceptable evaluation method? [Program Requirement: V.A.2.b).(2)] Should patients and their families be included as evaluators? [Program Requirement: V.A.2.b).(2)] How will the Review Committee interpret board pass rates for small programs? As noted, scholarly experience must begin during the first year and continue through the entire educational program. The Review Committee recommends that programs provide fellows at least 12 months for research and scholarly activity. The Review Committee will use evidence of scholarly products by fellows in assessing the adequacy of the amount of time devoted to research. The use of global evaluations on their own is not acceptable. The Review Committee expects programs to use multiple methods and evaluators to assess the abilities of fellows with regards to the competencies. Multiple evaluation methods provide more comprehensive and accurate assessments of skills. Proprietary surveys generally do not provide feedback specific to an individual fellow. The Review Committee has cited programs who use only such instruments to assess the competencies because: (1) there is no documentation that multiple evaluation methods are being used; and (2) the survey data is not useful, meaningful, or actionable information because it is not fellow-specific. The Review Committee expects that families and patients are involved in assessing fellows professionalism and interpersonal and communication skills. Inclusion of these individuals provides more comprehensive and meaningful feedback, since their interactions with fellows are different from those of faculty members. It also documents that programs are complying with the requirement for multiple evaluation methods to assess fellow competence. An exception to the required pass rate may be made for programs with small numbers of fellows. [Program Requirement: V.C.4.] 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 6 of 7
The Learning and Working Environment Are there situations when fellows Nurse practitioners, physician assistants, psychologists, physical and occupational therapists, may be supervised by licensed speech and language pathologists, dieticians/nutritionists, counselors, and audiologists may independent practitioners? serve as teachers and/or supervisors for fellows, as appropriate. [Program Requirement: VI.A.2.a).(1)] Who should be included on the interprofessional teams? [Program Requirement: VI.E.2.] Nurses, physician assistants, advanced practice providers, pharmacists, social workers, childlife specialists, physical and occupational therapists, speech and language pathologists, audiologists, respiratory therapists, psychologists, and nutritionists are examples of professional personnel who may be part of the interprofessional teams. 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 7 of 7