REVIEW WORKBOOK
FOR RESIDENCY TRAINING
PROGRAMS IN RURAL PEDIATRICS
American Osteopathic Association
and the
American Osteopathic College of Pediatricians
This evaluative workbook is a companion document to the Basic Standards for Rural Track Residency Training in Pediatric Medicine. The purpose of this document is to assist evaluators and institutions to determine if institutions that are currently sponsoring rural track residency training in Pediatric Medicine, or those seeking to sponsor a program, meet the minimum standards of accreditation.
Following the Review of an established program, evaluators will submit this completed workbook to the American College of Osteopathic Pediatricians (ACOP) through the
American Osteopathic Association (AOA) for review at the next scheduled meeting of the Committee on Graduate Medical Education (CGME). Programs will be evaluated according to the scale at the end of this document based on degree of compliance. Following the meeting, recommendations will be submitted to the AOA program and Training Review Committee (PTRC) which will forward the recommendations to the institution.
Section One of this document provides an overall summary of the program, including statistical information and summaries of curriculum vitae of the program’s director, department chair, and core faculty.
Section Two will provide programs with the current standards that must be met to determine the approval or disapproval of the program. New programs meeting the standards on the approval scale will be granted approval for one year with another evaluation visit scheduled within nine months of the first resident beginning training. Established programs will be granted approval based on the total score given the program and based on the scale provided below.
Approval period is determined as follows:
ü Less than thirty-three (33) points – probation
ü Thirty-three (33) points to forty-two (42) points – 3 years Program Approval
ü Forty-three (43) points or above – 5 years Program Approval
The following material should accompany the initial request for approval to the AOA and ACOP as well as programs undergoing evaluation for continuation of approval. Copies of this material should also be available on the day of the evaluation; however the Program Evaluator may request that additional items be available to him or her at the evaluation. He or she will notify the program in advance if additional material is required.
ü Completed application (2 copies).
ü Curriculum Vitae of the Program Director.
ü Written program description.
ü Monthly schedule for residents in the pediatrics emergency department for the last 6 months.
ü List of all residency programs currently offered at the base institution.
ü The program’s pass rates for all Pediatric residents as supplied by the AOBP or ABP.
On the day of the Review, the following material will also be available to the Program Evaluator.
ü Completed application.
ü All resident files, including all evaluations.
ü All affiliation agreements for all rotations not completed at base institution.
ü Department minutes for last 12 months.
ü Conference schedule for last 12 months, including attendance records.
ü Proposed conference schedule for new applications.
ü Additional information requested by the Program Evaluator.
REVIEW WORKBOOK
FOR
RURAL TRACK RESIDENCY TRAINING PROGRAMS
IN
PEDIATRICS
SPONSORING INSTITUTION: (Name the entity, i.e., the university, hospital, health system or foundation that has ultimate responsibility for this program. Specify if sponsor has changed since last review)Name of Sponsor:
Address:
Name of Chief Executive Officer: (Please type)
Affiliation with an Osteopathic Postgraduate Training Institution (OPTI):
Name of OPTI:
Department Chairman:
Name and mailing address of Program Director:Name: / Full Time: Yes No
Title: / Date of Appointment:
Address: / AOBP Certified: Yes No
Telephone:
Email Address: / FAX:
The signatures of the director of the program and the chief of the department attest to the completeness of the information provided on these forms.
Signature of Program Director:
Name of Chief of Pediatrics/Department Chairman: / Signature: Today’s Date
This form must be typed and returned to the Inspector at least one (1) week prior to the scheduled Review.
PRIMARY HOSPITAL (Hospital #1)Name:
Address:
How many months per year is the resident assigned to this site? 1st year: 2nd year: 3rd year:
Other participating institution (Hospital #2)
Name:
Address:
How many months per year is the resident assigned to this site? 1st year: 2nd year: 3rd year:
Does this hospital participate in any other accredited pediatrics program? Yes No
If so, name that program:
Is the hospital used for required rotations, elective experiences or both?
Chief/Chair, Department of Pediatrics: Full time? Yes No
Other participating institution (Hospital #3)
Name:
Address:
How many months per year is the resident assigned to this site? 1st year: 2nd year: 3rd year:
Does this hospital participate in any other accredited pediatrics program? Yes No
If so, name that program:
Is the hospital used for required rotations, elective experiences or both?
Chief/Chair, Department of Pediatrics: Full time? Yes No
Other participating institution (Hospital #4)
Name:
Address:
How many months per year is the resident assigned to this site? 1st year: 2nd year: 3rd year:
Does this hospital participate in any other accredited pediatrics program? Yes No
If so, name that program:
Is the hospital used for required rotations, elective experiences or both?
Chief/Chair, Department of Pediatrics: Full time? Yes No
Other participating institution (Hospital #5)
Name:
Address:
How many months per year is the resident assigned to this site? 1st year: 2nd year: 3rd year:
Does this hospital participate in any other accredited pediatrics program? Yes No
If so, name that program:
Is the hospital used for required rotations, elective experiences or both?
Chief/Chair, Department of Pediatrics: Full time? Yes No
If Clinical Sites, not related to institutions listed above, are used for experiences of one or two months, provide the following information. Identify them as Site A, B, C and provide the following information for each.
Distance from primary hospital: / Miles: / Travel time:
Length of resident assignment in 1st yr:
months or hours: / 2nd yr: / 3rd yr:
Elective Required or both What rotation:
Name(s) of supervisor(s)
Name & address of Site B:
Distance from primary hospital: / Miles: / Travel time:
Length of resident assignment in 1st yr:
months or hours: / 2nd yr: / 3rd yr:
Elective Required or both What rotation:
Name(s) of supervisor(s)
Name & address of Site C:
Distance from primary hospital: / Miles: / Travel time:
Length of resident assignment in 1st year
months or hours: / 2nd year / 3rd year
Elective _____Required _____or both _____What rotation:
Name(s) of supervisor(s)
RESIDENTS IN PEDIATRICS PROGRAM
This page should include all osteopathic residents currently in the program. Use additional pages as needed.
Name / Date began / Osteopathicmedical school and date of graduation / Previous graduate training (type and duration)
First Year (those currently enrolled in post-graduate year 1):
Second Year (those currently enrolled in post-graduate year 2):
Third Year (those currently enrolled in post-graduate year 3):
Medicine – Pediatrics Program:
Name those enrollees in other combined pediatrics programs?
Name program and residents:
Are all residents candidate members of the American College of Osteopathic Pediatricians?
Yes No
RESIDENT COMPLEMENT
1. Specify the number of resident positions funded and filled in this program as of the date of this application.
Pediatric Residency / PL – 1 / PL – 2 / PL – 3 / Total in Peds/IM program / Total in all Other Combined Training (e.g., Ped/EM)Positions funded
Positions filled
2. List the year and number of graduates from the program for the last five years:
Year / # of graduates / # who took AOBP Cert. Exam / # who took ABP Cert. Exam / Total number passed on the first attemptAOBP / ABP
3. Were any transfers accepted into years two or three of training during most recent 3 years? If so, complete the chart below.
Residents who transferred into this program / Previous program / Last training level in previous program / Last calendar year in previous program
RESIDENT COMPLEMENT
4. Give the number of residents who left the program in the past three years prior to completing three years of training. Explain the reasons for each case and state whether each of these residents was provided with documentation of performance and completion of experiences taken in this program.
TEACHING STAFF
Name any previous program directors who served in the past five years, if applicable, and their length of service.
List below major teaching staff who currently participate directly and regularly in this pediatric teaching program.
1. First, list the program director and then the pediatric faculty at the primary hosptial.
2. Then list the other primary teaching faculty at the primary or integrated hospitals.
Name / Specialty/Subspecialty / Location / Certification
Hospital
1,2,3/
Site A,B,C / Ped.
(year) / Recert. (year) / Specifiy other board & year / Recert. (year)
Program. Director.
Attach as Appendix A the curriculum vitae of the program director and all staff members who play a major role in the residency.
Other professional personnel teaching in the pediatric residency training program at the primary hospital
Adolescent
Medicine
Cardiac
Emergency
Medicine
Family
Medicine
General
Pediatric
Genitourinary
Gynecology
Neurosurgery
Ophthalmology
Orthopaedics
Otolaryngology
Pathology
Plastic
Psychiatry/
Psychobiology
Radiology
Sports
Medicine
Thoracic
Hospitalist
Transport
Review Workbook for Residency Training Programs in Rural Track Pediatrics
14
OUTLINE OF BLOCK ROTATIONS REQUIRED BY THE PROGRAM
1. In each block indicate the periods of time (1 month or one 4-week block) that represent the program and designate inpatient (IP), outpatient (OP), or both (IP/OP). Include vacation.2. Identify the site in which each occurs (i.e., Hospital 1, Hospital 2, Site A, B, etc) as designated on pages 1 – 3 of this workbook.
3. Since residents may experience the rotation in different sequence, list all similar rotations sequentially IP IP NICU NICU RS SUB ELEC ELEC EM EM (see example)
4. If a specialty track internship is offered, submit a separate block diagram. Indicate clearly any non-pediatric rotations that differ from those approved as part of the pediatric residency.
5. (Asterisk the rotations that are call free. ) / Use these abbreviations
GP General Pediatrics / DB Developmental/Behavioral
NICU Neonatal Intensive Care / EM Emergency/Acute Illness
NN Newborn Nursery / ELEC Electives (other than subspecialties)
SUB Subspecialty / VAC Vacation
PICU Pediatric Intensive Care / PRM Perinatal Repro Medicine
ADOL Adolescent Medicine / S Surgery
IM Internal Medicine
HOSP Hospitalist
TRANS Transport
EXAMPLE:
Month/4 wk / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13Experience or rotations / GP(OP) 1
GP (IP) 1 / GP
(IP) 1 / GP(IP) 1 / NICU (IP) 2 / NICU (IP) 1 / EM (OP) 1 / SUB / DB (OP) 1 / ELEC 2 / ADOL (IP)1 (OP) B / VAC / N/A
SPECIFY TRACK INTERNSHIP
Month/4 wk / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13Experience or rotations
FIRST YEAR BLOCK DIAGRAM
Month/4 wk / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13Experience or rotations
SECOND YEAR BLOCK DIAGRAM
Month/4 wk / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13Experience or rotations
THIRD YEAR BLOCK DIAGRAM
Month/4 wk / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13Experience or rotations
REVIEW CROSSWALK FOR RESIDENCY TRAINING PROGRAM IN RURAL TRACK PEDIATRICS
Instructions
· Mark each standard as met, not met or met with excellence
· Use the Comments section to explain any standards that are not met or any commendations
Program:Program Number:
Review Date:
Site Reviewer’s Name (print) / Date
Site Reviewer’s Signature / Date
Program Director’s Signature / Date
Review Crosswalk - Rural Track in Pediatrics
Page 32 of 34
STANDARD / SUGGESTED DOCUMENTATION / INTERVIEWS FOR VERIFYING COMPLIANCE / Value0-1 points / Pre-Site Visit (Program Director Self Study) / Current Review
(Site Reviewer) /
Not Met / Met / Not Met / Met /
SECTION V – PROGRAM REQUIREMENTS AND CONTENT
5.1.1 / The Rural Track Residency Training Program in Pediatrics must be three (3) years (thirty-six) 36 months) in general pediatric medicine. / · List of rotations / 1
5.1.2 or 5.1.3 / The first postdoctoral year must be the first year of residency. This position must be known as osteopathic graduate medical education (OGME-1) Resident. Subsequent years will be known as OGME 2, 3.
or
The first postdoctoral year must be a traditional rotating internship OGME-1 Traditional followed by, three (3) years (thirty-six months) of general pediatric medicine. These three (3) years must be known as OGME 2, 3 and 4. / · Review ACOP yearly evaluations both resident and director
· Review ACOP GME residency complete list
· Compare rotations with Basic standards, appendix B / 1
5.2 / At least twenty-four (24) months of the required thirty-six (36) months must be served in the same program unless an exemption is granted by the ACOP. / · Affiliation agreements / 1
5.3.1 / The general educational content of the residency training program must include the neuromuscular component of disease and the osteopathic concept of evaluating and treating the whole patient in inpatient care and ambulatory care settings. / · Review POMT certificates