Specific Standards of Accreditation for Residency Programs in Adult Infectious Diseases 2016 VERSION 2.0 INTRODUCTION A university wishing to have an accredited program in adult Infectious Diseases must also sponsor an accredited program in Internal Medicine. The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in adult Infectious Diseases. This document should be read in conjunction with the General Standards of Accreditation and the Objectives of Training and Subspecialty Training Requirements in Adult and Pediatric Infectious Diseases. STANDARD B1: ADMINISTRATIVE STRUCTURE There must be an appropriate administrative structure for each residency program. Please refer to Standard B1 in the General Standards of Accreditation for the interpretation of this standard. The program director must be certified in Infectious Diseases, or equivalent acceptable to the Royal College. STANDARD B2: GOALS AND OBJECTIVES There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The general goals and objectives for adult Infectious Diseases are outlined in the Objectives of Training and Subspecialty Training Requirements in Adult and Pediatric Infectious Diseases. Based upon these general objectives each program must develop rotation specific objectives suitable for that particular program, as noted in Standard B2 of the General Standards of Accreditation. STANDARD B3: STRUCTURE AND ORGANIZATION OF THE PROGRAM There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright 2016 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission. Please forward a copy of the final product to the Office of Specialty Education, attn: Associate Director, Specialties. Written permission from the Royal College is required for all other uses. For further information regarding intellectual property, please contact: documents@royalcollege.ca. For questions regarding the use of this document, please contact: accred@royalcollege.ca. Page 1 of 9
the subspecialty. The structure and organization of each accredited program in adult Infectious Diseases must be consistent with the specialty training requirements as outlined in the Objectives of Training and Subspecialty Training Requirements in Adult and Pediatric Infectious Diseases. Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience; this must include the provision of afterhours coverage specifically for the infectious disease service. At some point in the program, under appropriate staff supervision, each resident must assume the role of junior attending. In addition to offering the components noted in the specialty training requirements all accredited programs in adult Infectious Diseases should offer participation in communitybased rotations. STANDARD B4: RESOURCES There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the Royal College specialty training requirements. In those cases where a university has sufficient resources to provide most of the training in adult Infectious Diseases but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, sexual orientation, culture, and ethnicity appropriate to adult Infectious Diseases. 1. Teaching Faculty There must be a sufficient number of qualified and dedicated teaching staff to supervise residents and provide teaching in the basic and clinical sciences related to Infectious Diseases in both adults and children. This requires a minimum of four physicians with an academic appointment who specialize in adult Infectious Diseases. 2. Number and Variety of Patients The number and variety of patients available to the program for teaching must be sufficient to meet the educational needs of the resident as outlined in the Objectives of Training and Subspecialty Training Requirements in Adult and Pediatric Infectious Diseases. The resident must have the opportunity to assume responsibility for patients over a sufficiently long period to observe the history of disease and the benefits and complications of therapy. Page 2 of 9
3. Clinical and Non-clinical Services Specific to Adult Infectious Diseases a) Inpatient i) There must be adequate volume and variety of patients in whose management the service participates, and appropriate clinical supervision for the resident to develop proficiency in the following areas of adult Infectious Diseases: - acute community-acquired infections (including bacteremia, pneumonia, meningitis, osteomyelitis, complicated urinary tract infections, orbital infections) - diseases of travel and immigration - infections associated with medical devices - infections in the immune compromised host, including patients with human immunodeficiency virus (HIV) infection, and solid organ and hematopoietic stem cell transplant patients - infections in critically ill patients (including intensive care unit, burns, trauma) - infections during pregnancy - infective endocarditis - nosocomial, including postoperative infections - sexually transmitted diseases - systemic mycoses - tuberculosis and other mycobacterial infections There must be an adequate patient number to provide at least 300 supervised consultations per resident, per year of clinical training. ii) Residents must have experience to inpatient pediatric infectious diseases that is separately and specifically identified (see Specialty Training Requirements). This training should be undertaken within an accredited pediatric Infectious Diseases residency program. If this is not available at the same university, the only two acceptable alternatives for the pediatric component of the adult residency program are: o Pediatric infectious diseases experience at the same university requires: - At least one full-time pediatric Infectious Disease specialist, whose qualifications are acceptable to the program director, to supervise the resident's clinical pediatric Infectious Diseases training. - An adequate patient number to provide at least 200 pediatric consultations per year at the facility, providing experience with the main types of neonatal and pediatric infectious diseases. - Clinical exposure to a broad base of neonatal and pediatric infectious diseases. - Supplementation of the clinical exposure with lectures, reading, and Page 3 of 9
discussions to cover areas where clinical material is not available. OR b) Ambulatory - Training in an accredited pediatric Infectious Diseases residency program at another Canadian university. i) Adult outpatient clinics in which the resident acts as an Infectious Diseases consultant must be available for the investigation and treatment of a broad variety of infections not requiring hospitalization (including diseases of travel and immigration, tuberculosis (TB), and sexually transmitted diseases) as well as for post-discharge follow-up, in order for the resident to experience the outpatient management of common infectious diseases. ii) Adult outpatient clinics in which the resident acts as the Infectious Diseases physician responsible for the ongoing management of patients with chronic infections (e.g. HIV, hepatitis B and C, outpatient intravenous [IV] therapy) must be available in order for the resident to gain experience in the outpatient management of those chronic infections that are frequently managed primarily by an Infectious Diseases physician. iii) There should be a regularly scheduled longitudinal resident clinic at least one-half day per week or equivalent. c) Afterhours Coverage The program must provide opportunity for afterhours coverage for the infectious diseases service, as permitted by provincial, hospital, and residency organizational agreements, or as approved by the program director. This should generally not be in-house, but must be relevant to infectious diseases training. d) Community Learning Experiences The program must offer and encourage community learning experiences and rotations, particularly in areas of sexually transmitted diseases, TB, travel medicine, public health, and HIV management. Community experiences must provide a learning environment with appropriate supervision, sufficient volume and variety of patient encounters. At least one (1) block selective in community infectious diseases, under the supervision of an Infectious Diseases specialist, is strongly encouraged. e) Epidemiology and Public Health There must be organized and supervised opportunities in public health for the resident to acquire and utilize the principles and methods of epidemiology and public health as applied to infectious diseases in the community setting and, wherever possible, participate in the investigation of an epidemic. Page 4 of 9
f) Hospital Infection Prevention and Control There must be a formal, structured and supervised rotation in infection prevention and control where the resident will learn relevant principles of hospital epidemiology and become familiar with the methods and problems related to hospital infection prevention and control activities, attend meetings of the hospital Infection Prevention and Control Committee, and participate fully in all aspects of the hospital infection prevention and control program. g) Antimicrobial Stewardship There must be a formal, structured and supervised rotation in antimicrobial stewardship where the resident will learn and incorporate into practice the principles of judicious antimicrobial prescribing at the patient, facility and community levels, attend meetings of the hospital antimicrobial stewardship committee, and participate fully in all aspects of the hospital antimicrobial stewardship program. h) Laboratory Each resident must gain an adequate experience in diagnostic microbiology in a medical microbiology laboratory. This training must be taken under the direct supervision of a specialist certified in Medical Microbiology, or with qualifications acceptable to the program director. The following areas of laboratory training are considered essential: i) General microbiology - routine techniques including use of different culture media, specimen collection and primary inoculation, and various staining techniques - bench experience and familiarity with special isolation and identification techniques related to urine, respiratory secretions, blood, tissue and body fluids, and enteric and anaerobic bacteriology - antibiotic susceptibility testing and assays for antibiotic levels ii) TB, mycology and parasitology - specimen collection, transport and media for fungi and mycobacteria - staining and antibiotic sensitivity testing for mycobacteria - identification of common fungi including candida, aspergillus, cryptococcus; fungal serology and antigen detection - stool examination for ova, trophozoites, and larvae; concentration techniques; string test; special stains and serology iii) Virology, mycoplasma and chlamydia - viral detection methods for herpes viruses, respiratory viruses, and enteric viruses - viral serology including Epstein Barr Virus (EBV), hepatitis, HIV, measles Page 5 of 9
and rubella - chlamydia and mycoplasma isolation and antigen detection systems iv) Special techniques - quantitative bacteriology, rapid diagnostic techniques, ELISA, immunofluorescence, deoxyribonucleic acid (DNA) probes, and electron microscopy v) Infection control and nosocomial pathogens - role of microbiology laboratory in infection prevention and control and surveillance - laboratory investigation of nosocomial outbreaks, including biotyping, phage typing, and molecular methods 4. Supporting Services - Clinical, Diagnostic, Technical The following services should be available: a) Clinical - Critical care - Emergency department - Transplantation - Ophthalmology - Surgery, including orthopedics, cardiac surgery, neurosurgery, obstetrics and gynecology - Internal medicine - Public health b) Diagnostic - Medical microbiology laboratory - Medical imaging - Pathology - Immunology c) Technical - Information technology - Library services Page 6 of 9
5. Research Facilities Facilities for clinical or basic science research rotations must be available and meet the following requirements: i) the director of the research program must be university appointed; ii) the research program and the role of the resident must be clearly defined; and iii) there must be adequate space, equipment, assistance, and where indicated animal facilities. STANDARD B5: CLINICAL, ACADEMIC, AND SCHOLARLY CONTENT OF THE PROGRAM The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfil all of the CanMEDS Roles of the specialist. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside, in clinics or in the community, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Please refer to Standard B5 in the General Standards of Accreditation, the Objectives of Training, the Subspecialty Training Requirements in Adult and Pediatric Infectious Diseases and the CanMEDS Framework for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS Roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below. 1. Medical Expert In addition to the General Standards of Accreditation, the following requirements apply: - The organized scholarly activities must include dedicated protected time for the resident. It is preferable that this time be allocated as part of the standard working day of the resident and not be scheduled prior to or following the standard working day. - Teaching should include regularly scheduled tutorial activities, seminars, teaching rounds, and journal clubs. Active participation by the resident in both the planning and production of conferences is essential. - Teaching must cover the clinical knowledge essential to the understanding and practice of Infectious Diseases. - The educational program must include the scientific basis of Infectious Diseases. This should include: the structure, physiology, and genetics of microbes; pathogenetic mechanisms; host response to infection; mechanism of action, pharmacology, the toxicology of antimicrobial agents; and epidemiology of infectious diseases. Page 7 of 9
2. Communicator In addition to the General Standards of Accreditation, the resident must be provided with the opportunity to learn specific communication skills related to: - pre- and post-test counselling - contact tracing and public health notification of communicable diseases - educating patients and their partners and/or families about infections and preventive strategies - educating physicians and other health professionals about infection prevention and control and use of antimicrobials 3. Collaborator In addition to the General Standards of Accreditation, the resident must be provided with the opportunity to learn specific collaborative skills related to: - working in patient care teams - working with infection control professionals, microbiology technologists, and public health nurses 4. Manager In addition to the General Standards of Accreditation, the resident must be provided with the opportunity to learn specific management skills related to: - infection prevention and control activities and effective antimicrobial stewardship including participation in relevant institutional committee meetings - patient safety activities, including morbidity and mortality reviews - cost effective use of the microbiology laboratory - outpatient antimicrobial therapy, including intravenous therapy 5. Health Advocate In addition to the General Standards of Accreditation, the resident must be provided with the opportunity to learn specific Health Advocate skills related to: - immunization - risk reduction (e.g., safe needle use, safer sex practices) - post-exposure prophylaxis - patient safety in the health care setting (e.g., infection prevention and control) Page 8 of 9
6. Scholar In addition to the General Standards of Accreditation, the resident must be provided with the opportunity, and sufficient protected time, to learn specific Scholar skills related to: - completion of faculty supervised clinical or basic research that will be submitted to a peer reviewed meeting or journal - education of medical students, residents, and other health professionals 7. Professional The General Standards of Accreditation apply to this section. STANDARD B6: ASSESSMENT OF RESIDENT PERFORMANCE There must be mechanisms in place to ensure the systematic collection and interpretation of assessment data on each resident enrolled in the program. Please refer to Standard B6 in the General Standards of Accreditation for the interpretation of this standard. In addition to regular rotation specific in-training evaluations, each resident in adult Infectious Diseases should have at least one written examination per year, preferably in a short answer question format. Evaluation processes must include a process for conducting an observed clinical encounter for each of the CanMEDS competencies for each resident at least once each year. Evaluation processes must include assessment of the resident s learning portfolio, including but not limited to patient logs, In-Training Evaluation Reports (ITERs), teaching assessments, and observed clinical encounters. APPROVED BY COUNCIL 1998 REVISED Specialty Standards Review Committee June 2012 REVISED Specialty Standards Review Committee May 2016 Page 9 of 9