New Application: Family Medicine

New Application: Family Medicine

Review Committee for Family Medicine

ACGME

515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000 

BasicMedicalStaffInformation

BasicInformationRegardingPrimaryHospital

1.Istheprimaryhospitaldepartmentalized?[PRII.D.3.c)]...... YES( )NO( )

IfYES,isthereaDepartmentofFamilyMedicine?...... YES( )NO( )

2.Dofamilyphysicianshaveadmittingprivilegesinthehospital(s)wherethemajorityofFamilyMedicineCenterpatientsarehospitalized?[PRII.B.3.a)]. YES( )NO( )

IfNO,explain.

PrimaryandParticipatingHospitals

Copyasmanyofthesesheetsasnecessarytosupplytherequestedinformationforeachparticipatinghospitalinwhichrequiredrotationstakeplace.Statisticaldatashouldbeprovidedforthemostrecentlycompletedfiscal,academicorcalendaryear.[PR I.B.]

Nameand#ofHospital:(aslistedinADS)
Inclusivedatesforthefollowinginformation / from / to
Hospitalstatistics: / Totalnumberofavailablebeds: / Averagedailycensus:

Completethissectiononlyforservicesonwhichtherearerequiredrotationsinthishospital.

#ofMD/DOsonStaff / Annual#ofDischarges / #ofDeliveries / #ofMD/DOsonStaff / Annual#ofDischarges
FamilyMedicine / Pediatrics(excl.newborn)
InternalMedicine / Newborns
Obstetrics-Gynecology / Psychiatry
EmergencyMedicine / Surgery

Iftheprimaryhospitalhasfewerthan135occupiedbeds,provideanexplanationbelow.Theexplanationshouldinclude:adescriptionofthetypesofpatientsandspectrumofdisease,theavailabilityofsupportservicesincludingphysical,humanandeducationalresourcesandaveragenumberofpatientsperresidentontheservice.Describeanyadditionalexperiencesthatcompensateforthelowpatientnumbersattheprimaryhospital.

ProgramDirectorExperience

ExplainhowtheProgramDirectormaintainsactiveexperienceinpatientcare.[PR II.A.3.d)]

ProgramsOperatinginthe1-2Format

Ifyourprogramoperatesinthe1-2format(year1atthecoreprogramandyears2and3atadifferent,oftenrural,site)provideanoverviewofthe1-2programandbrieflyoutlinehowitfunctionsinthespacebelow.Insome1-2programs,year1curricula/experiencesarenotidenticaltothecoreprogram'syear1curricula/experiences:someadditionaltertiarycareexperiencesareofferedinyear1totheresidentsinthe1-2program.Asummaryofsuchdifferences/arrangementsshouldbeprovidedbelowandthenmorefullydescribedintheappropriatesectionsofthe application.Also,ifparticularcurricula/experiencesareprovidedduringyear1andalsoduringyears2and/or3,theytooshouldbebrieflydescribedbelowandthenfurtherdetailedintheappropriatesectionsofthe application.[PR II.A.5; III.B.3.]

PatientCare

ContinuityofCare

1.ContinuityofPatients[PRII.D.2.c).(2)]

Providespecificdetailsofhowtheprogramwillrequireeachresidenttomaintaincontinuityofresponsibilityforhis/herFMCpatientswhensuchpatientsrequirehospitalizationorconsultationwithotherproviders.

2.HomeVisits[PR IV.A.5.a).(2).(a).(iii)]

a)Willresidentsperformatleast2continuityhomevisits?...... YES( )NO( )

b)Isatleastonehomevisitwithanolderadultcontinuitypatient?...... YES( )NO( )

c)Ifa"NO"responsewasprovidedtoeitherquestion,explainbelow.

d)Describehowresidentswillbesupervisedduringthisexperience.

3.NursingHomeVisits[PR IV.A.5.a).(2).(a).(ii)]

a)Willresidentsprovideatleasttwonursinghomepatientscontinuityofcareforaminimumof24consecutivemonths? YES( )NO( )

b)Willthisexperiencebeseparatefromthatwhichresidentsmayhaveaspartofablockrotation?
...... YES( )NO( )

c)Ifa"NO"responsewasprovidedtoeitherquestion,explainbelow.

d)Describehowresidentswillbesupervisedduringthisexperience.

FamilyOrientedComprehensiveCare

Forthefollowingrequiredcurricularelements,indicatewithan’X’thesetting(s)inwhicheachwillbetaught.[PR IV.A.5.a).(2).(b)]

CurricularElements /

Didactic

/ Clinical
FMC /

Inpt

/ Home / Long-termCareFacility / Other
(Specify)
INDIVIDUAL [PR IV.A.5.a).(2).(b).(v)]
Healthassessment
Healthmaintenance
Preventivecare
Acute/Chronicillnessorinjury
Rehabilitation
Behavioralcounseling
Healtheducation
Humansexuality
FAMILY[PR IV.A.5.a).(2).(b).(vi)]
Familystructureanddynamics
Geneticcounseling
Familyplanning
Childrearing/childeducation
Aging
Endoflifeissues
Roleofthefamilyinillnesscare
Familycounseling

PatientCareSkills:DocumentationofProceduresandDiagnoses

1.Describethemechanismbywhichresidentswilldocumenttheperformanceofproceduresandhowtheprogramwillmonitorandensureresidentcompliance.[PR II.A.4.r)]

2.Describehowtheprogramwillretaindocumentationofeachresident'scurricularexperience,theproceduresperformed,andanevaluationoftheresident'sperformance.[PR II.A.4.r)]

3.Facultymembersinmostclinicalsettingsmayobserveandassess,tosomedegree,theresidents’abilitytocounselpatientsandfamilies.Listthesetting(s)/activitiesinwhichthisskillwillbespecificallyemphasizedandevaluated,e.g.,inFMC,givingdischargeinstructions,gettinginformedconsent,etc.[PR II.A.4.r)]

MedicalKnowledge

AdultMedicine

Indicateonthischartwhattheprogramwillrequireinstructuredexperiencesinthecareofadults.

Curricular Area / Inpatient Time / Location / Outpatient Time / Location / Yr(s). of Training in Which Experience Occurs
Adult Medicine
Critical Care

Forthefollowingcurricularareas,indicatewithan‘X’thesetting(s)inwhicheachwillbetaught.IfaseparateblockrotationisusedidentifythePGyearanddurationofexperience.[PR IV.A.5.b).(1)]

CurricularArea /

Didactic

/ InteractionwithConsultants / IntegratedinAdultMedRotations /

SeparateBlockRotations

Year / Duration / Inpatient / Outpatient
CardiovascularDisease
Endocrinology
Pulmonology
Hematology-Oncology
Gastroenterology
InfectiousDisease
Rheumatology
AllergyandImmunology
Neurology
Women’sHealth

Inpatient[PRIV.A.5.b).(1).(b).(ii)]

a)Completethetablebelowthatdescribestherequiredadultmedicineinpatientexperience.Identifyeachhospitalinwhichtheparticularassignmentoccurs.HospitalsshouldbeidentifiedbythesitenumberlistedinADS(i.e.,#1,#2,etc.)

Hospital / Averagedailycensus
ontheservice / Plannedtotal#ofresidentsonserviceprovidingcare / FMorIMservice / Supervisor
(Nameandspecialty) / Willresidentstakecall?
Yes / No

b)IfFMresidentswillrotatewithotherresidentsonservices,brieflydescribetherelationshipbetweenthetwogroupsbelow.

c)Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperienceinadultmedicine.Listnomorethan10procedures.

d)Indicatethetop10diagnosesatthehospitalwhereyourresidentswilltrainbyinsertingnumbers1-10inthefollowingtable.Let1indicatethemostcommondiagnosis.

Diagnosis / Rank
AbdominalPain,NOS
Acutemyocardialinfarction
Alcoholabuse
Alzheimer'sDisease
Asthmaacuteexacerbation
Atrialfibrillation
Backache,vertebrogenic(pain)syndrome
Cellulitisandabscessofleg
Cerebralinfarction
Cholecystitis
Congestiveheartfailure
Convulsivedisorder,NOS
COPD
Coronaryarterydisease
Depression
Depressivetypepsychosis
Dystrophyduetomalnutrition;malnutrition(calorie),NOS
Hemorrhageofgastrointestinaltract
Humanimmunodeficiencyvirus(hiv),aids
Hypertension
Hypokalemia
Hyposmolalityand/orhyponatremia
Influenzawithotherrespiratorymanifestations
Irondeficiencyanemia
Malignantneoplasmofbronchusandlung
Otherchestpain,r/omi
Pancreatitis
Pneumonia,organism,NOS
RenalFailure
Septicemiaduetogram-negorganism
Septicemia,NOS
Syncopeandcollapseblackout;fainting;(near/pre)syncope;vasovagalattack
Typetwodiabetesmellitus
Ulceroflowerlimb,NOS
Urinarytractinfection,pyuria
Volumedepletiondisorder,dehydration;hypovolemia

e)Providetheaveragenumberofpatientsthateachresidentwillpersonallymanageonaday-to-daybasisbyresidentlevel.

Rotation / PGY-1 / PGY-2 / PGY-3
AdultMedicine

f)Describe(1)howresidentswilllearnsupervisoryskills;(2)whatopportunitieswillbeavailableforsupervision;and(3)themechanismsthatwillbeusedtoassessresidents’supervisoryskills.

Limityourresponseto400words

(1)
(2)
(3)

Intensive Care[PRIV.A.5.b).(1).(b).(iii)]

Describehowtheprogramwillensurethateachresidentmanagesthecareofatleast15criticallyillpatients.Describethetrackingmechanismused.

TheOlderPatient[PRIV.A.5.b).(1).(b).(iv)]

Forthefollowingrequiredcurricularelements,indicatewithan‘X’thesetting(s)inwhicheachistaught.

CurricularElements / Didactic / Clinical
FMC / Outpt / Inpt / Home / Long-termCareFacility / Other
(Specify)
Preventiveaspectsofhealthcare
Physiologicalandpsychologicalchangesofsenescence
Social-culturalparameters
Geriatricsyndromes
Functionalassessmentofelderlypatients

a)Forthetrainingthatallfamilymedicineresidentsarerequiredtoreceiveingeriatrics,provideabriefdescriptionofhowastructuredmulti-disciplinaryapproachinvolvingclinicalexperienceintheFMC,hospital,long-termcarefacility,andthehomewillbeimplemented.

CareofNeonates,Infants,Children,andAdolescents

DurationofExperience / Yr(s).ofTrainingExperienceOccurs / Site #s
Inpatient(excludenewborns)
Newbornnursery
Outpatient(excludeFMC)
Other

1.Forthefollowingcurricularelements,indicatewithan‘X’thesetting(s)inwhicheachwillbetaught.Donotfillinthecellsinthetablethatareshadedgrey.[PR IV.A.5.b).(2).(a)]

CurricularElements / Didactic /

Clinical

FMC / Outpt / Inpt / Other(Specify)
Experiencewithneonates
Infantcare(bothwell-babyandill)
Hospitalizedchildren
Ambulatorypediatrics
Emergencycareofchildren
Adolescentmedicine

2.Describethetraininginpediatrics,demonstratinghowtherequiredcomponentswillbeaddressed.

3.WillFMfacultymembersteachandrolemodelcontinuityofresponsibilityforhospitalizedchildren?
...... YES( )NO( )

4.Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperienceinpediatrics.Listnomorethan10procedures.

5.PediatricDiagnoses

a)Indicatethetop10pediatricdiagnosesatthehospitalwhereyourresidentswilltrainbyinsertingnumbers1-10inthefollowingtable.Let1indicatethemostcommondiagnosis.

Diagnosis / Rank
Abdominalpain,NOS
Acuterespiratoryfailure
AllergicReactions
Appendicitis/Appendectomy
Asthma
Bronchiolitis
Burns
Cancer,various
Cellulitis,skinsinfections
ChildAbuse
CongenitalHeartDisease
Croup
CysticFibrosis
Dehydration/Hypovolemia
Depression
Diabetes
Diarrhea
Esophagealreflux
Failuretothrive
Fracture
FUOr/osepsis
Gastroenteritis
HeadTrauma
Headache
Hyperbilirubinemia
Jaundice
Leukemia
Meningitis
Mentalstatuschange
MetabolicDisorder
Osteomyelitis
OtitisMedia
Pneumonia
Poisoning
Renal
RespiratoryDistress(RSV)
Seizure
Sepsis
SickleCellCrisis
Trauma/abuse
UTI/Pyelonephritis
ViralIllness,unknownetiology
ViralMeningitis

b)Providetheestimatedaveragenumberofpatientsthateachresidentwillpersonallymanageonaday-to-daybasisbyresidentlevel.

Rotation / PGY-1 / PGY-2 / PGY-3
PediatricInpatient-Newborn
PediatricInpatient-ExcludingNewborn

MaternityCare

Indicatetheamountoftimerequiredofallresidentsandthesite numberforthestructuredexperienceinobstetrics.DonotcounttimespentintheFMCwhenresidentscarefortheirpanelsofpatients.Reportrequiredtimeinmonthsorhours.Forlocationusesite #,priv.ofc.,clinics,etc.[PR IV.A.5.b).(3)]

Specialty / InpatientTime / Location / OutpatientTime / Location / Yr(s).OfTraininginWhichExperienceOccurs
Maternitycare

Answereachofthequestionsbelow.Put“N/A”ifresidentswillnotparticipateindeliveriesduringoneoftheyearsoftraining.

Supervision / ContinuityPatients / OBRotation
Year-1 / Year-2 / Year-3 / Year-1 / Year-2 / Year-3
Willasupervisingphysicianbepresenton-sitewiththeresidentduringlabor?(YES/NO)
Willasupervisingphysicianbepresenton-sitewiththeresidentinthedeliverysuiteduringlaborwhenriskfactorsarepresent(YES/NO)
Willasupervisingphysicianbepresenton-siteinthedeliverysuitewiththeresidentduringalldeliveries?(YES/NO)

IfyouhaveansweredNOtoanyoftheabove,providedetails

Ifthesupervisorforlaboranddeliveryissomeoneotherthanafacultyphysician,describehis/herqualificationstosuperviseresidents.Ifthesupervisingphysicianwillbeafamilymedicineresident,inwhatyearoftrainingandhowmanydeliverieswoulds/hehavehad?

Namethefamilyphysicianfacultymemberswhoparticipateinlaboranddeliveryandwhosupervisetheresidentsandserveasrolemodelsforthem.Iftherearenone,explainwhowillsupervisetheresidentsintheFMCwhentheycarefortheirpregnantpatientsandiftheyarenotBoardcertifiedobstetricians,documenttheirqualificationstoprovidesuchsupervision.

Iffamilymedicineresidentswillrotatewithobstetricsresidents,describetherelationshipbetweenthetwogroups.

Willanelectiveexperienceinadvancedobstetricsavailableforresidentswhodesireadditionaltraining? YES( )NO( )

IfYES,includethedurationandlocationoftheexperience.

Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperienceinobstetrics.Listnomorethan10procedures.

Provideanestimateoftheaveragetotalnumberofdeliveriesforgraduatingresidents

ResidentName / CesareanDeliveries / VaginalDeliveries / TotalDeliveries / #ofDeliveriesThatWereContinuityPatients

Gynecology

Forthefollowingcurricularareas,indicatewithan‘X’thesetting(s)inwhicheachwillbetaught.[PR IV.A.5.b).(4).(a)]

CurricularElements / Didactic /

Clinical

FMC / Outpt / Inpt / Other(Specify)
Normalgynexam
Gyncancerscreen
Preventativehealthcareinfemales
CommonSTDandinfections
Reproductiveandhormonalphysiologyincludingfertility
Familyplanning,contraception,optioncounselingforunintendedpregnancy
Pelvicfloordysfunction
Disordersofmenstruation
Disordersofperimenopausal,menopauseandosteoporosis
Sexualhealth
Breastdisorders
Managementofcervicaldisease

Documenthowtherequired100hours(oroneblockmonth)ofstructuredexperiencewillbeprovided,excludingtheroutinecareofcontinuitypatientsintheFMCandcallduties.Provideinformationonthenumberofhoursforeachactivityperclinicorsession.Specifywhatpercentageofthe100hoursisnon-clinical.

Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperienceingynecology.Listnomorethan10procedures.

CareoftheSurgicalPatient

1.Indicateonthischarttheamountofrequiredtimeandthelocationforthestructuredgeneralandsubspecialtysurgicalexperiences.DonotcounttimespentintheFMCwhenresidentscarefortheirpanelsofpatients.SpecialtystructuredsurgicalclinicswithintheFMCshouldbelisted.Reportgeneralsurgerytimeinmonthsandsubspecialtytimeinactualhoursofexperiencewithnumberofhoursperdayorsession(excludinglunchorofftime).Forlocationusesite#,priv.ofc.,FMC,etc.Identifywhethertheexperienceallowedforhands-onexperience.[PR IV.A.5.b).(5).(d)]

Specialty /

InpatientTime

/ Location / OutpatientTime / Location / Hands-OnExperience(Yes/No)
GeneralSurgery
Otolaryngology
Ophthalmology
Urology

2.GeneralSurgery

a)Brieflydescribethetwo-monthsofgeneralsurgicalrotations,includingthesupervisionprovided,andthedegreeofresidentresponsibilityforandinvolvementwithpatients.Ifnon-generalistsurgeonsareused,explainhowthisexperiencewillexposeresidentstocommonsurgicalprocedures.

b)Describehowthediagnosisandmanagementofsurgicalemergencieswillbetaught.

c)Describehowpre-andpost-operativecarewillbetaughtandthedegreetowhichresidentswillbeactivelyinvolved.

d)WilltheresidenthavetheopportunitytobefirstassistantintheO.R.?...... YES( )NO( )

Ifnot,howwilltheresidentlearnthesurgicalprinciplesofasepsis,tissuehandling,andtechnicalskills?

e)Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperienceinsurgery.Listnomorethan10outpatientandinpatientprocedures.

MusculoskeletalandSportsMedicine

1.Demonstratehowthestructuredexperienceinorthopaedicsurgerywillbeensured,excludingtheroutinecareofcontinuitypatientsintheFMCandcallduties.Provideinformationonthenumberofhoursforeachactivityperclinicorsession.Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperience.Listnomorethan10procedures.[PR IV.A.5.b).(6)]

Demonstratehowthestructuredexperienceinsportsmedicinewillbeensured,excludingtheroutinecareofcontinuitypatientsintheFMCandcallduties.Provideinformationonthenumberofhoursforeachactivityperclinicorsession.Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperience.Listnomorethan10procedures.

Inthetwotablesbelow,indicatewithan“X”howresidentswillbetaughtaboutthefollowingcurricularcomponents.[PR IV.A.5.b).(6).(a)]

OrthopaedicCurricularComponents / Didactic / Clinical
FMC /

Outpt

/ Inpt / Other(Specify)
Infectious, suppurative, and degenerativearthriticconditions
Evaluationandmanagementofacutemusculoskeletalinjury
Rehabilitationandrestorativefunction
Acutepainsyndromes
X-rayinterpretation
Splintingandcasting
Aspiration/injectionofjoints
Acquired and congenital abnormalities of bones and joints
Musculoskeletal and connective tissue disorders
Evaluation and management of common sprains
Fractures and dislocations
Preventive Care
SportsMedicineCurricularComponents / Didactic / Clinical
FMC /

Outpt

/ Inpt / Other(Specify)
Educationandexperienceinperformingpre-participationphysicals
Educationandexperienceincaringforathleticandrecreationalinjuries
Non-articularrheumaticdisorders

EmergencyCare

1.Provideresponsesintheboxesbelow.Iftwoormorehospitalswillbeusedforemergencyroomtraining,duplicatethissectionandanswerforeach.[PR IV.A.5.b).(7)]

LocationofExperience:

2.Isthereanaccreditedemergencymedicineresidencyprogram?...... YES( )NO( )

IfYES,describetherelationshipbetweentheemergencymedicineandthefamilymedicineresidents.

3.Describehowtheprogramwillmeettherequirementforastructuredclinicalexperienceofatleast200hoursincludinghours,days,shifts,daysperweekandtotalhours.[PR IV.A.5.b).(7).(b)]

4.Educationalcontent:

a)Describethetrainingresidentswillreceiveinstandardcurrentlifesupportskillsandproceduresformedicalemergenciesinpatientsofallages.Iftheywillnotreceivethistraining,explain.[PR IV.A.5.b).(7).(a)]

b)Describethetrainingresidentswillreceiveinstandardcurrentlifesupportskillsandproceduresfortraumaemergenciesinpatientsofallages.Iftheywillnotreceivethistraining,explain.[PR IV.A.5.b).(7).(a)]

c)Willafacultyphysicianbeonsite24hoursaday,7daysaweekforon-sitesupervision?Ifnot,isanyattendingphysicianon-siteatalltimesandresponsiblefortheERandtheresident?Providedetails.[PR IV.A.5.b).(7).(c)]

d)Describethedidacticcomponentoftheemergencymedicineexperience.

e)Listtheproceduresthatallresidentswillberequiredtolearnbytheendoftherequiredexperienceinemergencymedicine.Listnomorethan10procedures

HumanBehaviorandMentalHealth

Forthefollowingcurricularareas,indicatewithan‘X’thesetting(s)inwhicheachwillbetaught.[PR IV.A.5.b).(8)]

CurricularElements /

Didactic

/ ClinicalTeaching
FMC / Inpt /

Priv.Office

/ Other
(Specify)
Diagnosisandmanagementofpsychiatricdisordersinchildrenandadults
Emotionalaspectsofnon-psychiatricdisorders
Psychopharmacology
Alcoholismandothersubstanceabuse
Thephysician/patientrelationship
Patientinterviewingskills
Counselingskills
Normalpsycho-socialgrowthanddevelopmentinindividualsandfamilies
Stagesofstressinafamilylifecycle
Sensitivitytogender,race,age,andculturaldifferencesinpatients
Familyviolence,includingchild,partner,andelderabuse(physicalandsexual),aswellasneglect,anditseffectonbothvictimsandperpetrators
Medicalethics,includingpatientautonomy,confidentiality,andissuesconcerningqualityoflife
Factorsinfluencingpatientcompliance

Forthetrainingthatallfamilymedicineresidentsarerequiredtoreceiveinbehavioralscience,provideabriefdescriptionofhowastructuredapproachinvolvingclinicalexperienceintheFMC,hospital,long-termcarefacility,andthehomewillbeimplemented.Describethefacultymembersinvolvedinteachingthiscurriculumtoresidents.

CommunityMedicine

Forthefollowingcurricularareas,indicatewithan‘X’thesetting(s)inwhicheachwillbetaught.[PR IV.A.5.b).(9)]

CurricularElements[PR IV.A.5.b).(9).(a)-(i)] / Didactic / Hands-OnExperience / Other(Specify)
Assessmentofrisksforabuse,neglect,andfamilyandcommunityviolence
Reportablecommunicabledisease
Populationepidemiology/interpretationofpublichealthstatisticalinformation
Environmentalillnessandinjury
Schoolhealth
Diseaseprevention
Disasterresponsiveness
Community-baseddiseasescreening,prevention,healthpromotion
Factorsassociatedwithdifferentialhealthstatusamongsub-populations

Indicatewhethertheprogramprovidesresidentstraininginthecurricularareasnotedbelow.

ClinicalExperiencesinCommunityMedicine[PR IV.5.b).(9).(j)-(o)] / Yes/No
Experienceinusingcommunityresourcesappropriatelyforindividualpatientswhohaveunmetmedicalorsocialsupportneeds
Structuredinteractionwiththepublichealthsystem
OccupationalMedicineincludingdisabilitydetermination,employeehealthandjob-relatedillnessandinjury
Experienceincommunityhealthassessment
Experienceindevelopingprogramstoaddresscommunityhealthpriorities
Community-basedhealtheducationofchildrenandadults

CareoftheSkin

Demonstratehowtheprogramwillprovidearequiredexperienceincareoftheskinincludingprocedures.Includethecontentoftheexperience,thelocation,whowillsupervisetheresidentsandthequalificationsofthesupervisingfacultymembers.[PR IV.A.5.b).(10)]

DiagnosticImagingandNuclearMedicine

Describehowtheprogramwillteachresidentstheappropriateapplicationoftechniquesandspecialtyconsultationsindiagnosticimagingandnuclearmedicine.[PR IV.A.5.b).(11)]

Conferences

1.Listrequiredconferences,seminars,workshopsand/orotherplannedgroupactivities.Indicatewhethereachconferenceisrequiredthroughouttheyear(R),orrequiredwhenonthatservice(RS).[PR IV.A.3.c)]

ConferenceTitle / R,RS / Frequency / Dofacultyattend? / Willresidentsbeinvolvedinpresentingsomeoftheseconferences?

2.Howwillconferencesbeevaluated?Includebywhomandfrequency.[PR IV.A.3.c).(1).(b)]

3.Inadditiontostructureddidacticconferenceswhatothermethodsoflearningwillyourprogramusetofostercontinuousprofessionaldevelopmentofresidents?Checkallthatapplyandidentifythecontentoftheselearningactivities.

LearningVenue / Placean“X’inthiscolumnifused / ContentAddressed
Self-directedlearningmodules
Smallgroupdiscussions
Journalclub
Workshops
Otherlearningactivities(identify):

ManagementofHealthSystems

1.Willallresidentsreceiveatleastquarterlyreportson[PR IV.A.5.b).(12).(c)]:

a)individual/practiceproductivity...... YES( )NO( )

b)financialperformance...... YES( )NO( )

2.Willresidentsreceivetrainingtoanalyzethesequarterlyreports?...... YES( )NO( )

3.WillresidentsattendatleastannuallyFMCbusinessmeetingswithstaffandfacultymembers?[PR IV.A.5.b).(12).(c)] YES( )NO( )

4.WillresidentsparticipateinprojectstoimprovequalityandservicetoFMCpatients?[PR IV.A.5.b).(12).(d)] YES( )NO( )

5.Willresidentsreceivetraininginhowtoprovideleadershipfor[PR IV.A.5.b).(12).(f)]:

a)aclinicalpractice...... YES( )NO( )

b)ahospitalmedicalstaff...... YES( )NO( )

c)professionalorganizations,and...... YES( )NO( )

d)communityleadershipskillstoadvocateforthepublichealth...... YES( )NO( )

Foreachofthefollowingeducationalelements,indicatewithan“X”wheresuchtrainingwillbetaught/provided[PR IV.A.5.b).(12).(e)].

Didactic / Practice/OfficeEnvironment
Currentbillingpractices
Designingandmanagingabudget
Assessingpracticestaffingneeds
Impactofnewtechnologiesonpractice
Determiningvalueinthemarketplace
Assessingcustomersatisfaction
Measurementofclinicalquality
Tortliabilityandriskmanagement
Officeschedulingsystems
Computersinpractice
Alternativepracticemodels
Employmentlawandprocedures
Principlesofpublicrelations
Mediatraining
Personnelmanagement

7.Explainhowtheprogramwillprovide100hoursofpracticemanagement.[PR IV.A.5.b).(12)]

Electives

1.Statetheminimumandmaximumamountoftimeintheprogramthatwillbeavailabletoallresidentsforelectives.[PR IV.A.5.b).(13)]

2.Brieflydescribetheprocessbywhicharesidentwillselectelectives.[PR IV.A.5.b).(13)]

3.Brieflydescribehowelectiveexperienceswillbeevaluated.[PR IV.A.5.b).(13)]

ResidentScholarlyActivities

1.Willtheprogramensurethatresidentsareprovidedsupervisedexperiencesinresearchorotherscholarlyactivities?[PR IV.B.] YES( )NO( )

2.Willresidentsbeintroducedtothebasicprinciplesofstudydesign,performance,analysisandreporting,andtherelevanceofresearchtopatientcare? YES( )NO( )

FacultyResearchandScholarlyActivitiesandFacultyDevelopment

FacultyDevelopment

Describehowfacultydevelopmentactivitieswillbeconducted.Explainhowresidencyandindividualfacultyneedsassessmentswillbedone,andhowdevelopmentactivitieswilladdressteaching,administrative,andclinicalcomponentsoffacultyperformance.[PR II.B.9.]

Limityourresponseto150words.

FacultyResearchandScholarlyActivities

ListtheacademicachievementsoftheProgramDirectorandfamilymedicinefacultymembers(publicationsorreviewarticles,invitedpresentationsatregional,state,ornationalprofessionalmeetings,honors,etc.),duringthelastthreeyears.(DonotappendreprintsorindividualCVs.)Thisshouldbesubmittedonlyforkeyfamilyphysiciansandotherkeyteachingstaff.Excludeparticipationinhospitalandmedicalschoolcommittees.Providenomorethan5academicachievementsperfacultymember.[PR II.B.5.]

Family MedicinePage 1 of 3

FamilyMedicineCenter

1.List the FMCs used in this program and provide the following information [PR II.D.2.].

Placean“X”inthecellbelowifthisisnewfacilitysincelastreview / NameofFMC / NameofFMCDirector / Milesfromprimaryhospital/traveltime / Scheduledoperatinghours / Squarefeetoffloorspaceavailable / FMpreceptor:residentratio / #ofexamrooms / Maximum#ofresidentandfacultyinFMCsimultaneously / #ofotherlearners
inFMC / NumberofFMCPersonnel
Nursing / Clerical / Technical / Other(specifybelow)
EXAMPLE / JohnstonFMC / TomSmith,MD / 0/0min / 8-8(M-F)
8-1(S) / 10,000 / 1:4 / 16 / 8 / MS=2
OP=1 / 10 / 8 / NA / NA
FMC#1
FMC#2
FMC#3
FMC#4
FMC#5

AdditionalInformation:

#ofotherlearnersintheFMC=specifythetypeandnumberofotherlearnersintheFMC.Usethefollowingcategories:medicalstudents=MS;otherresidents=OR;nursepractitioners=NP;otherprofessionals=OP,e.g.dentists,podiatrists.[PR II.D.2.a).(2)]

OtherPersonnelintheFMC:specify

FMC1 / FMC2 / FMC3 /

FMC4

/ FMC5 / FMC6
2.ANSWERYESORNOTOTHEFOLLOWING:
a)DoestheentrytotheFMChavesignagethatclearlyidentifiesitasanFMC?
b)DoestheresidencydirectorhavecontroloftheeducationactivitiesintheFMC?[PR II.D.2.b).(1)]
c)DoestheresidencydirectorhavecontroloftheactivitiesofthesupportpersonnelintheFMC?[PR II.D.2.b).(1)]
d)DoesthedirectoroftheFMCreporttotheProgramDirector?
e)Doestheappointmentsystemensuremaximumaccessibilityoftheresidenttohis/herpatientsintheFMC.[PR II.D.2.c).(3)]
f)IsthereabusinessofficeorbusinessfunctionareaintheFMC?[PR II.D.2.d).(1)]
g)Isthereaconferenceroomlargeenoughtoaccommodatetheresidents,facultymembers,etc.,atthisFMC?[PR II.D.2.d).(5)]
h)DoFMCpatientshaveconvenientaccesstoimagingservices?[PR II.D.2.e).(2)]
i)DoFMCpatientshaveconvenientaccesstoadiagnosticlaboratory?[PR II.D.2.e).(2)]
j)Dopatientshaveaccesstoaprogramphysicianafterhours?
k)DofamilyphysicianfacultymembersseepatientswithoutresidentsintheFMC?

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Provideresponsesintheexpandableboxesbelow.Ifmultiplecentersareused,specifyifoneanswerappliestothemalloridentifyeachFMCandprovidetheinformation.

3.ForanyNOanswersinquestion2onthepreviouschart,identifythepointandprovideanexplanationordescription.

4.DescribeindetailanyactivitiesthattakeplaceintheFMCthatarenotFMresidencyrelated.

5.Ifotherspecialtiesarelocatedonthesamefloorofthefacility,explainanddemonstrateonthefloorplanhowtheFMCisadiscreteunitthatisseparatefromtheseareas.

6.IfmultipleFamilyMedicineCentersareused,describethefollowing:

a)HowresidentswillbeassignedtotheCentersandwhethertheassignmentsareforallthreeyearsoftraining.Ifnot,providespecificdetailsaboutlevelsoftraininginvolved.

b)ThedegreeofcontactamongtheresidentsfromthemultipleCenters

7.Providethefollowinginformationontherecordsystem[PR II.D.2.g)]:

a)Whatkindofsystemisused?Ifanelectronicmedicalrecordisnotusedcurrently,whataretheprogram’splansforimplementingoneinthenearfuture?

b)IfanEMRsystemisnotused,explainhowpatients'ambulatoryrecordsaremaintainedintheFMCandhoweasyandpromptaccessibilitytotheserecordsisensured.

c)Dopatients'recordscontaindocumentationofallfacetsoffamilycare,includingcareprovidedintheFMC,hospital,home,viatelephoneandinothersites? YES( )NO( )

IfNO,explain.

d)WilltheresidentshaveeasyaccesstotheFMCrecords24hoursaday?...... YES( )NO( )

IfNO,explain.

8.IfpatientvisitsfromasecondFMCand/orotherlongitudinalclinicsareusedtomeettheminimumpatientvisitrequirements,(a)describetheclinic(s)beingusedandhowcontinuityisensured,and(b)identifywhosupervisesresidentsatthesesites.

9.Describehowfacultymemberswillproviderolemodelingforresidents.ForeachFMC,providethenumberofhoursperweekfacultymembersspendseeingpatientsintheFMCwithoutresidents.

10.CopyasmanyofthissheetasnecessarytosupplytherequestedinformationforeachFMC.

NameofCenter:
Address:
NumberofresidentsassignedbyPGY(e.g.,2-2-2):
NameofDirectorofFMC:

Attach(behindthispageonasheetnolargerthan11”X17”)alegibledrawingofthefloorplanoftheFMC.Wheremultiplecentersareused,putthenameandFMC#oneachdrawing.Labeleachroomtoindicateitsfunction.

Besurethatallrequiredareasareclearlyidentifiedaccordingtothekeybelow.Ifanyrequiredareasaremissing,identifytherequiredareaandexplain.ReadthepagethatisentitledFAMILYMEDICINECENTERforguidelinesonexclusivity.DemonstrateclearlyonyourdiagramthattheFMCisseparatedappropriatelyfromotheractivities.

Donotsubmitareducedcopyofablueprint.

UsethekeyprovidedbelowtoidentifytherequiredareasontheFMCdrawing.Usesufficientlylargelettersandnumbersthatareeasilyrecognizableonthedrawing.

A=waitingroom

B=reception/appointmentdeskforFMConly

C=businessoffice

D=records(ifanEMRisnotused)

1=examrooms(providetotalnumberofroomsonthedrawing)

2=procedureroom(s)(separatefromexamrooms)

3=officelab

4=officelibrary

5=residentworkarea

6=preceptingroom

7=other(identifyandexplain)

8=conferenceroom*

9=facultyoffices*

*IfnotintheFMC,providespecificdetailsregardinglocationandproximitytoFMC

IfanyoftheserequiredcomponentsisnotincludedintheFMC,provideanexplanationbelow.

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FamilyMedicineCenterPatientPopulation

Reportestimatedfiguresforaoneyearperiod.[PR II.D.1.]

ForCombinedPrograms:Donotincludeinformationpertainingtoresidentsincombinedprograms,suchasFM/Psychiatry,inthechartbelow.DuplicatethispageandprovidetheinformationforallresidentsinABFMapprovedcombinedprogramsontheseseparatepages.

FMC# / Planned#ofresidentsassignedtoFMC / #ofweeks/yearresidentswillseeptsintheFMC / Plannedaverage#ofhoursinFMC/week / Estimatedaverage#ofptvisits/yearseeninFMC / Estimatedannual#ofptvisitsinFMC(faculty+residents) / #ofptshospitalized/yearfromFMC
PGY-1 / PGY-2 / PGY-3 / PGY-1 / PGY-2 / PGY-3 / PGY-1 / PGY-2 / PGY-3 / PGY-1 / PGY-2 / PGY-3
FMC1
FMC2
FMC3
FMC4
FMC5
FMC6

HowwilltheprogramdocumentthateachresidentprovidescontinuityofcareintheFMC?

DescribeanyscheduledinterruptionsinresidentattendanceintheFMC,e.g.,duringruralrotations.Includedurationofeachandspecifytheyearoftraininginvolved.(Donotincludepersonalinterruptionsforindividualssuchas,sickleaveormaternity/paternityleave.)

DescribethesystemtoauditFMCchartsonaregularbasis.Ifthereisnosystem,explain.

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a)Indicatethe10mostfrequentlyperformedprocedures,forwhichatrainedpreceptorisavailabletoinstructtheresidents,attheFMCwhereyourresidentswilltrain.Let1indicatethemostfrequentlyperformedprocedure.Then,selectallproceduresthatresidentsmustlearnbeforetheygraduatebyplacingan“X“intherowwiththeprocedure.Selectatleast5procedures.

Procedure / 10mostfrequentlyperformedProcedures(1-10) / Proceduresallresidentsmustlearnbeforegraduation(Identifyatleast5)
Androscopy
Anoscopyonly
BladderCatheter
CardiovascularStresstest/Treadmill
CastRemoved
Cast/SplintApplied
CerumenRemoval
CervicalCapFitting
Circumcision,Pediatric
Colonoscopy
Colposcopy
Cryosurgery,Skin
CryosurgeryCervix
DiaphragmFitting
EKGInterpretation
ElectrodesiccationofLesion
EndocervicalCurettage
EndometrialBiopsy
ExcisionalBiopsy,Skin
FlexSigw/woBx
FNABreastCyst
ForeignBodyRemoval,Eye
ForeignBodyRemoval,Skin
GenitalWartTreatment
IandDAbscess,Skin
IandDBartholinCyst
InciseExternalHemorrhoid
IngrownToenailSurgery/Excision
InternalHemorrhoidBanding
IUDInsertion
IUDRemoval
IVStart/IVMedgiven
JointAspiration
JointInjection
LacerationComplex
LacerationSimple
LEEP
Nasopharyngoscopy
NorplantRemoval
NST/CSTInterpretation
OBUltrasound
OsteopathicManipulation
PapSmear
ReduceSubluxedRadialHead
SebaceousCystRemoval
ShaveBiopsy,Skin
SkinPunchBiopsy
SkinTagRemoval
SlitLamp
SpinalTap
Spirometry
SubungalHematomaEvacuation
SutureRemoval
Tonometry
TriggerPointInjection
Tympanometry/HearingTest
Vasectomy
WetMount

b)ForeachFamilyMedicineCenter,recordyourpatientvisitdatabygenderforthepreviousacademicyear.Duplicatethefollowingtableasnecessary.

FamilyMedicineClinic
AgeofPatient / #Females / #Males / #Total
Under2
2-9
10-19
20-29
30-39
40-49
50-59
60-69
70andover

ProgramEvaluation

Explainhowtheprogramwillmaintaincontactwithitsgraduatestoobtaininformationabouttheirpractices.Includethefrequencyofsuchevaluationandhowtheinformationisused.[PR V.C.1.c)]

Limityourresponseto150words.

Duty hours and the Working Environment

1.Night Call: Estimate the frequency of night call in the program and whether this call will be taken in-house (I) or at home (H). [PR VI.7-8.]

Year of training / FM / IM / OB / PEDS / ER / GS / Specialty Rotation / Outpatient Rotation / Maximum Consecutive # Week(s) Night Float / Maximum # Weeks/Yr Night Float / # Call Free Months /Year
PGY-1
PGY-2
PGY-3

2.Briefly describe how the residents’ well being will be supported by a structured and facilitated group specifically designed for resident support and specify the frequency of these group meetings. [PR VI.A.2. and II.A.4.k).(1)]

Limit your response to 150 words.

3.What percentage of the resident’s inpatient experiences includes night float? [PR VI.G.6.]...... ( ) %

Updated: 6/6/2013

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