Application for GMEC Approval of a Non-Accredited Fellowship Program

Application for GMEC Approval of a Non-Accredited Fellowship Program

Background: All clinical training programs within the UW School of Medicine (UWSOM) that provide postgraduate medical education must be accredited by the Accreditation Council for Graduate Medical Education (ACGME), approved by the relevant American Board of Medical Specialties (ABMS) or be approved by the UW Graduate Medical Education Committee (GMEC).

Applications for new and existing Programs: This application is for a postgraduate medical education clinical training program applying for approval by the UW GMEC. For new programs, the program must be a sub-specialty for which ACGME accreditation or ABMS board approval is not available. UW GMEC approval must also be sought for established non-accredited programs that have not obtained and do plan to obtain ACGME accreditation or ABMS board approval. Approval by a professional organization or endorsement by a body other than the ACGME or Board is NOT sufficient to consider the program accredited.

General Instructions

All sections of the form applicable to the program must be completed in order to be accepted for review. The information provided should describe the proposed program. For items that do not apply indicate N/A in the space provided. If any requested information is not available, an explanation should be given and it should be so indicated in the appropriate place on the form.

Please review the GMEC Approved (Non-ACGME Accredited) Programs Policy and Procedure on the GME website at www.gme.washington.edu. If questions, contact Gabrielle Pett, Director of GME, at or 206.543.0069.

Send completed application to the GME Office at 850 Republican St., C-432, Box 358047 or via email at .

Note that the process takes approximately two months from the time the application is received until it is evaluated by the GMEC-Approved Fellowship (GAF) Subcommittee, which is a subcommittee of the UW GMEC.

Attach the following documents to the application:

1. Program policy on eligibility and selection of fellow(s).

1. Policy for supervision of fellow(s) (addresses fellows’ responsibilities for patient care and progressive responsibility for patient management and faculty responsibilities for supervision)

1. Program policies and procedures for fellow(s)’ duty hours, if applicable.

1. Program policy on moonlighting, if applicable.

1. Program policy on effects of leave on board eligibility, if applicable.

1. Overall educational goals for the program.

1. A sample of competency-based goals and objectives for one assignment at each educational level.

1. All Program Letters of Agreement (PLAs) for non-UW Medicine or Seattle Children’s based training experiences.

1. A copy of the forms that will be used to evaluate fellow(s) at the completion of each assignment.

1. Copies of tools the program will use to provide objective assessments of competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

1. A copy of the form that will be used to document the semiannual evaluation of the fellow(s) with feedback.

1. A copy of the final summative evaluation of fellow(s), documenting performance during the final period of education and verifying that the fellow has demonstrated sufficient competence to enter practice without direct supervision.

1. A copy of the form that fellow(s) will use to evaluate the faculty.

1. A copy of the form that fellow(s) will use to evaluate the program.

1. Written program requirements defined by the specialty society or other body, if applicable.

1. Letter from Department Chair confirming appointment of fellowship director and percentage of protected time (i.e., FTE) devoted to program duties.

1. Letter(s) of endorsement from Program Director(s) of other programs that may be impacted by the fellowship program, if applicable.

1. Image of Program Director’s signature for the program’s graduation certificate (in lieu of wet ink signature).

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Program Information

1. Is endorsement/approval of the fellowship available by: ☐ Specialty Society ☐ Other: ______

1. Is accreditation available through the: ☐ ACGME ☐ ABMS ☐ Other: ______

If so, why does the fellowship not plan to seek accreditation?

Trainees

1. How will trainees by appointed (check all that apply)?

1. What percentage of time will fellow(s) devote to training activities versus non-supervised attending responsibilities?

1. Have fellow(s) already been selected for the next academic year? ...... ☐ YES ☐ NO

If “YES”, what is the fellow(s) start date?...... (__/__/____)

Training Sites

1. What are the participating sites of the program?

Resources

1. Describe the adequacy of program administrative support (e.g., FTE).

1. How will the fellow(s) stipend and benefits be funded (e.g., hospitals, SOM, department, grant, billing, combination)? Please describe the funding process.

1. What is the proposed annual stipend by training level?

Faculty

1. Describe the adequacy of program faculty (e.g., description of current faculty expertise).

1. Physician & Non-Physician Faculty Roster

Curriculum & Evaluation

1. Are there written requirements defined by the specialty society or other body?...... ☐ YES ☐ NO

If “YES”, please attach the written requirements.

1. Didactic curriculum

1. Intradepartmental activities

1. Provide provide your didactic schedule below or attached (including lectures, seminars, conferences, and other didactic exercises planned for the fellowship).

1. Describe the fellow(s)' expected participation in planning and conducting conferences and other teaching activities.

1. Will fellows be relieved from clinical duties to attend didactics?...... ☐ YES ☐ NO

If “YES”, by whom?

1. Will the fellow attend didactics when functioning as an attending (if applicable)?...... ☐ YES ☐ NO

1. Describe the fellow(s)’ teaching role and/or supervisory responsibilities of other trainees.

1. Describe the expectations of fellows with regard to scholarly activities, including research opportunities and ongoing projects that will be available to the fellow(s).

1. What provisions will be made for fellow(s) to attend local, regional, and national meetings?

1. Are there adequate clinical resources to support the curriculum?...... ☐ YES ☐ NO

1. Are there adequate research resources to support the curriculum?...... ☐ YES ☐ NO ☐ N/A

1. Describe how fellow(s)’ performance will be evaluated.

1. Will fellow(s) be formally evaluated in writing at least quarterly?...... ☐ YES ☐ NO

1. Will fellow(s) receive a formal semi-annual evaluation?...... ☐ YES ☐ NO

1. Will the program use MedHub for evaluation management?...... ☐ YES ☐ NO

If “NO”, how will evaluations be tracked and monitored?

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1. Block Diagram

The purpose of a block diagram is to give the GAF Subcommittee an overview of what takes place during each year of training.

EXPERIENCES OF ROTATIONS

• In each one month block indicate the following:

(1) the type of activity: educational rotation (i.e., ED, Anes), vacation, or attending duties (ATT)

(2) percentage of clinical (C) and research (R) time (i.e., 50% C; 50% R)

(3) the training site in which the activity occurs

• Provide a key/legend for the abbreviations used (i.e., ED = Emergency Department)
• Add additional years if more than one year of training

Example

ONE YEAR BLOCK DIAGRAM

Total number of clinical months ______

Total number of research months ______

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Recruitment

1. Describe the marketing and recruitment plan for the program, including the size of the candidate pool, how the program will be advertised, etc.

1. Will the program participate in an organized national application system?...... ☐ YES ☐ NO

If “YES”, which?

1. Will the program participate in organized match?...... ☐ YES ☐ NO

If “YES”, which?

1. Will the program accept foreign nationals requiring a visa?...... ☐ YES ☐ NO

If so, which type? ☐ J-1 ☐ H-1B

Certification

1. Will the program issue a UWSOM graduation certificate for fellows who successfully complete the program? ☐ YES ☐ NO

1. Does training lead to additional opportunities for board certification/CAQ?...... ☐ YES ☐ NO

Program Impact

1. Describe anticipated positive and negative impacts on existing accredited and/or non-accredited programs (e.g., competition for case volumes or space, increased teaching opportunities). Please consider impacts both on programs associated with the core specialty, as well as other specificities that share similar cases or spaces. Address how any negative impacts will be mitigated.

1. How will this program contribute to the educational mission of UW Medicine, Seattle Children’s, Seattle Cancer Care Alliance, or the VA Puget Sound Healthcare System?

1. Is there a regional and/or national workforce need in this specialty?

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