New Application: Pediatric Gastroenterology

New Application: Pediatric Gastroenterology

Review Committee for Pediatrics

ACGME

COMMON SUBSPECIALTY SECTION

Institutions

Using the table below, provide a summary of the program’s leadership and support staff, including the name and percent FTE protected time. 1.0 FTE is greater than or equal to 40 hours per week. Add rows as needed. [PR I.A.2.-3.]

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Program Leadership / Name / % FTE Protected Time for the Administration of the Program (excluding Scholarly Activity)
Program Director / Name / #%
Associate Program Director(s) / Name / #%
Title / Name / #%
Title / Name / #%
Title / Name / #%
Title / Name / #%
Title / Name / #%
Administrative/Support Personnel / Number of Administrative Personnel / % FTE in This Fellowship Program for Each
e.g., Fellowship Coordinator / 1 / 100%
e.g., Administrative Assistant / 1.5 / 100%/50%
Title / # / #%
Title / # / #%
Title / # / #%
Title / # / #%
Title / # / #%

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Faculty Research

Complete the table below regarding the involvement of faculty members in research. Add rows as needed. [PR II.B.5-5.b).(3); II.B.5.f)-f).(2)]

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Name / # of Current IRB-Approved Research Projects / Total # of Current Funded Research Projects / # of Current Research Projects with Peer-Review Funding (Subset of Total # in Previous Column) / # of Presentations at National Scientific Meetings in Last 5 Years / # of Publications in Peer-Review Journals in Last 5 Years
Program Director:
Name / # / # / # / # / #
Physician Faculty Members within the Program Subspecialty (e.g., for a Pediatric Gastroenterology Program, Only List the Pediatric Gastroenterology Faculty Members):
Name / # / # / # / # / #
Name / # / # / # / # / #
Name / # / # / # / # / #
Name / # / # / # / # / #
Name / # / # / # / # / #
Non-Physician Research Mentors or Physician Faculty Members from Other Subspecialties:
Name / # / # / # / # / #
Name / # / # / # / # / #
Name / # / # / # / # / #
Name / # / # / # / # / #
Name / # / # / # / # / #

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2.List active research projects in the subspecialty. Add rows as needed. [PR II.B.5.-5.b).(3); II.B.5.f).(1)-(2)]

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Project Title / Funding Source / Place An "X" if Funding Awarded by Peer Review Process / Years of Funding (Dates) / Faculty Investigator and Role in Grant (i.e., PI, Co-PI, Co-Investigator)
Project title / Funding source / ☐ / Years of funding / Faculty investigator/role in grant /
Project title / Funding source / ☐ / Years of funding / Faculty investigator/role in grant /
Project title / Funding source / ☐ / Years of funding / Faculty investigator/role in grant /
Project title / Funding source / ☐ / Years of funding / Faculty investigator/role in grant /
Project title / Funding source / ☐ / Years of funding / Faculty investigator/role in grant /
Project title / Funding source / ☐ / Years of funding / Faculty investigator/role in grant /
Project title / Funding source / ☐ / Years of funding / Faculty investigator/role in grant /

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Research Resources

1.Does the program provide research laboratory space and equipment?...... ☐ YES ☐ NO

2.Does the program provide financial support for research?...... ☐ YES ☐ NO

3.Does the program provide computer and statistical consultation services?...... ☐ YES ☐ NO

Program Curriculum

Goals and Objectives

Are there goals and objectives for all training experiences? [PR IV.A.2.] / ☐ YES ☐ NO
Are these rotation- and level-specific? [PR IV.A.2.] / ☐ YES ☐ NO
How are they distributed? [PR IV.A.2.] / ☐ Hard copy ☐ Electronic or web-based
If not web-based, when are they distributed to fellows? [PR IV.A.2.] / ☐ Prior to each rotation☐ Annually
☐ Once in handbook☐ Other
If not web-based, when are they distributed to faculty members? [PR IV.A.2.] / ☐ Prior to each rotation
☐ Annually
☐ Other
If web-based, are reminders sent to access them? [PR IV.A.2.] / ☐ YES ☐ NO
If YES, when are the reminders sent? [PR IV.A.2.] / Click here to enter text. /

Collaboration among Programs

Are there meetings among the core program director and subspecialty program directors? [PR II.A.4.s)] / ☐ YES ☐ NO
How often do these meetings occur? [PR II.A.4.s).(1)] / Click here to enter text. /
Who typically participates in these meetings? (check all that apply) [PR II.A.4.s)] / ☐ Core program director
☐ Subspecialty program director for this specialty
☐ Program directors from other subspecialties

General Subspecialty Curriculum

Topic / Where Taught in Curriculum (Name Should Match Name in Conference List) / Number of Structured Teaching Hours Dedicated to Topic Area / Participants (Place An "X" in the Appropriate Column)
Fellows in this Discipline Attend / All Subspecialty Fellows Attend / Residents and Subspecialty Fellows Attend
e.g., Biostatistics / Research Course / 14 / X
Basic science as related to the application in clinical subspecialty practice [PR IV.A.6.a).(3)] / Click here to enter text. / # / ☐ / ☐ / ☐
Clinical subspecialty content [PR IV.A.6.a).(3)] / Click here to enter text. / # / ☐ / ☐ / ☐
For the topics below, if the topic is not appropriate for the discipline (e.g., lab research for fellows in developmental behavioral pediatrics), enter N/A in Column 2 (Where Taught…).
Biostatistics [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Lab research methodology (if appropriate) [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Clinical research methodology [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Study design [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Grant preparation [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Preparation of protocols for Institutional Review Board [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Principles of evidence-based medicine/critical literature review [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Quality improvement [PR IV.A.6.a).(6)] / Click here to enter text. / # / ☐ / ☐ / ☐
Teaching skills [PR IV.A.5.b).(1)] / Click here to enter text. / # / ☐ / ☐ / ☐
Professionalism/ethics [PR IV.A.5.e] / Click here to enter text. / # / ☐ / ☐ / ☐
Cultural diversity [PR IV.A.5.e).(5)] / Click here to enter text. / # / ☐ / ☐ / ☐
Systems-based practice (economics of health care, practice management, clinical outcomes, etc.) [PR IV.A.5.f)] / Click here to enter text. / # / ☐ / ☐ / ☐

Conferences

1.List regular subspecialty and interdepartmental conferences, rounds, etc. that are a part of the program. Identify the "Site" by using the corresponding number as it appears in the Accreditation Data System (ADS) portion of the application. Indicate the frequency (e.g., weekly, monthly) and whether conference attendance is required (R) or optional (O). List the planned role of the fellow in this activity (e.g., conducts conference, presents case and participates in discussion, case presentation only, participation limited to Q&A component). Add rows as needed. [PR IV.A.6.a).(2)-(4)]

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Conference / Site # / Frequency / Attendance Required (R) or Optional (O) / Role of the Fellow
Conference / Site # / Frequency / ☐R
☐O / Role of fellow /
Conference / Site # / Frequency / ☐R
☐O / Role of fellow /
Conference / Site # / Frequency / ☐R
☐O / Role of fellow /
Conference / Site # / Frequency / ☐R
☐O / Role of fellow /
Conference / Site # / Frequency / ☐R
☐O / Role of fellow /
Conference / Site # / Frequency / ☐R
☐O / Role of fellow /

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2.Describe the mechanism that will be used to ensure fellow attendance at required conferences. State the degree to which faculty member attendance is expected, and how this will be monitored. [PR IV.A.6.a).(2)]

(Limit response to 50 words)

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Scholarship Oversight Committee

1.Will there be a Scholarship Oversight Committee for every fellow? [PR IV.B.2.b)]...... ☐ YES ☐ NO

2.If YES, how often will the committee meet with the fellow? [PR IV.B.2.b)]...... # times per year

Fellow Research Activities

1.Describe how the program will ensure a meaningful supervised research experience for fellows beginning in their first year and extending throughout their training. [PR IV.B.2.a)]

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2.Identify any research mentors outside the division that will be actively involved in mentoring fellows, and describe how liaisons will be used between these mentors and the fellows to allow for meaningful accomplishment of research. [PR IV.B.2.c)]

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The Learning and Working Environment

Night Float/Night Shift

If the program requires night experiences, indicate the frequency of these experiences each year, and describe how they are structured to ensure educational value to fellows. [PR VI.F.6.a)]

(Limit response to 200 words)

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SPECIALTY-SPECIFIC SECTION

Program Personneland Resources

Other Professional Personnel

Indicate with a check mark the personnel who will interact regularly with fellows at each participating site. [PR VII.B.1.c)]

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Team Members / Site #1 / Site #2 / Site #3
Physical Therapy / ☐ / ☐ / ☐
Occupational Therapy / ☐ / ☐ / ☐
Social Work / ☐ / ☐ / ☐
Nutrition / ☐ / ☐ / ☐
Feeding Therapy / ☐ / ☐ / ☐

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For categories of personnel that are unavailable, describe how that function will be addressed in the program.

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Faculty Disciplines for Pediatric Subspecialties

In the table below, indicate the number of faculty that are present in each of the required disciplines [PR: II.B.2.e)-II.B.2.e).(2); VII.A.2.]:

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Discipline / Number of Essential Faculty
Site #1 / Site #2 / Site #3 / Site #4 / Site #5
PEDIATRIC SUBSPECIALTIES
Pediatric cardiology / # / # / # / # / # /
Pediatric critical care medicine / # / # / # / # / # /
Pediatric emergency medicine / # / # / # / # / # /
Pediatric endocrinology / # / # / # / # / # /
Pediatric hematology/oncology / # / # / # / # / # /
Pediatric infectious diseases / # / # / # / # / # /
Neonatal-perinatal medicine / # / # / # / # / # /
Pediatric nephrology / # / # / # / # / # /
Pediatric pulmonology / # / # / # / # / # /
Pediatric rheumatology / # / # / # / # / # /
SPECIFIC TO PEDIATRIC GASTROENTEROLOGY
Allergy and immunology / # / # / # / # / # /
Child and adolescent psychiatry / # / # / # / # / # /
Neurology with specialty qualification in child neurology / # / # / # / # / # /
Nuclear Medicine / # / # / # / # / # /
Medical Genetics / # / # / # / # / # /
Anesthesiology / # / # / # / # / # /
Pathology-anatomic and clinical / # / # / # / # / # /
Radiology-diagnostic / # / # / # / # / # /
Pediatric surgery / # / # / # / # / # /

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Outpatient and Inpatient[PR VII.B]

Indicate the availability of the following:

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Facility/Service / Site #1 / Site #2 / Site #3
Space in an ambulatory setting for optimal evaluation and care of patients [PR VII.B.1.a)] / Choose an item. / Choose an item. / Choose an item. /
An inpatient area with pediatric and related services staffed by pediatric residents and faculty [PR VII.B.1.b)] / Choose an item. / Choose an item. / Choose an item. /
Support services including:

radiology
nuclear medicine
pathology

Choose an item. / Choose an item. / Choose an item. /
Choose an item. / Choose an item. / Choose an item. /
Choose an item. / Choose an item. / Choose an item. /
PICU (indicate total number of beds) [PR VII.B.1.d)] / # / # / # /
NICU (indicate total number of beds) [PR VII.B.1.e)] / # / # / # /
Endoscopy facilities [PR VII.B.1.g)] / Choose an item. / Choose an item. / Choose an item. /
Procedure facility for measuring gastrointestinal motility / Choose an item. / Choose an item. / Choose an item. /

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For every facility/service that is not available at any of the sites, provide an explanation below. Explain how the service is provided for patients.

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In a bulleted format explain how fellows, in caring for patients, will have access to a laboratory that can either perform or assess measures of intestinal absorptive and pancreatic function; nutritional parameters; and specialized serological, parasitological, immunological, metabolic, and toxicological studies applicable to gastrointestinal and hepatobiliary disorders. [PR VII.B.1.f)]

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Patient Data[PR VII.B.2)

Provide the following information for the most recent 12-month academic or calendar year. Note the same timeframe should be used throughout the forms.

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Inclusive dates: / FROM: Click here to enter a date. / TO: Click here to enter a date.
Site #1 / Site #2 / Site #3
Total number of admissions to the Pediatric Gastroenterology service / # / # / # /
Number of new patients admitted each year (“new” refers to those who are seen by members of the Gastroenterology service for the first time.) / # / # / # /
Average length of stay of patients on the pediatric Gastroenterology service / # / # / # /
Total number of consultations by pediatric Gastroenterologists on other inpatients / # / # / # /
Number of consultations provided to the NICU / # / # / # /
Number of consultations provided to the PICU / # / # / # /
Average daily census of patients on the Pediatric Gastroenterology service, including consultations / # / # / # /
Number of patients requiring follow-up care by Gastroenterology service as outpatients during 12-month period reported / # / # / # /

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If the ADC on the pediatric gastroenterology service is less than six, explain how fellows have an adequate exposure to inpatients.

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Provide the following information for the most recent 12-month academic or calendar year for each site used to provide a specific required experience, such as transplant, cardiology, intensive care, etc.Duplicate this table as necessary.Note the same timeframe should be used throughout the forms.

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Inclusive dates: / FROM: Click here to enter a date. / TO: Click here to enter a date.
Site #1 / Site #2 / Site #3
Name of service: / Click here to enter text. /
Total number of fellows and residents on the service / # / # / # /
Total number of admissions to the service / # / # / # /
Number of new patients admitted each year (“new” refers to those who are seen by members of the service for the first time.) / # / # / # /
Average length of stay of patients on the service / # / # / # /
Average daily census of patients on the service, including consultations / # / # / # /

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Educational Program [PR VIII.]

Ambulatory Pediatric Gastroenterology Experience for All Years of Training

Add rows as necessary.

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Name of Experience
Site/Other Setting Identifier / Duration of Experience
(in wks/yr) / Planned Number of Sessions Per Week Per Fellow / Estimated Number of New Patients Per Fellow Per Session / Estimated Number of Return Patients Per Fellow Per Session / Planned Average Number Teaching Attendings Per Session
Click here to enter text. / # / # / # / # / # /
Click here to enter text. / # / # / # / # / # /
Click here to enter text. / # / # / # / # / # /
Click here to enter text. / # / # / # / # / # /
Click here to enter text. / # / # / # / # / # /

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If the experience is in a private office, provide full details, including name and credentials of supervisor, numbers and types of patients, degree of fellow responsibility for their care, frequency of attendance at office, how director will monitor the experience and fellow performance.

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12-Month Summary: Outpatient Clinics/Inpatient Services

During the same 12-month period as used in previous sections, how many pediatric patients with the following gastroenterology problems were: a) seen in the ambulatory settings; b) were admitted to and/or consulted on by the pediatric gastroenterologists at the primary site?

Inclusive dates: / FROM: Click here to enter a date. / TO: Click here to enter a date.
Gastroenterology Diagnosis/Disorder / Outpatients / Inpatients
Total # of patients / Total # of patients on gastro service # on gastro service / Total # of patients seen in consultation
Growth failure and malnutrition [PR VIII.A.8.a)] / # / # / # /
Malabsorption/maldigestion [PR VIII.A.8.b)]:

celiac disease

/ # / # / # /

cystic fibrosis

/ # / # / # /

pancreatic insufficiency

/ # / # / # /
Gastrointestinal allergy [PR VIII.A.8.c)] / # / # / # /
Peptic ulcer disease [PR VIII.A.8.d)] / # / # / # /
Hepatobiliary Disease [PR VIII.A.8.e)]:

biliary atresia

/ # / # / # /

diseases of the gallbladder

/ # / # / # /

fatty liver

/ # / # / # /

intrahepatic cholestasis

/ # / # / # /

autoimmune liver disease

/ # / # / # /

viral hepatitis

/ # / # / # /

metabolic liver diseases

/ # / # / # /
Liver failure (including evaluation and follow-up care of patient requiring liver transplantation) [PR VIII.A.8.e)] / # / # / # /
Congenital Digestive tract anomalies (including Hirschsprung’s disease) [PR VIII.A.8.f)] / # / # / # /
Inflammatory bowel disease [PR VIII.A.8.g)] / # / # / # /
Functional bowel disorders [PR VIII.A.8.h)]

Vomiting (including gastroesophageal reflux)

/ # / # / # /

Acute and chronic abdominal pain

/ # / # / # /

Acute and chronic diarrhea

/ # / # / # /

Constipation

/ # / # / # /

Gastrointestinal bleeding

/ # / # / # /

Motility disorders

/ # / # / # /
Pancreatitis (acute & chronic) [PR VIII.A.8.i)] / # / # / # /
Gastrointestinal problems in the immune-compromised host [PR VIII.A.8.k)] / # / # / # /
Transplantation [PR VIII.A.9]

Liver

/ # / # / # /

Small Bowel

/ # / # / # /

Describe how fellows will gain knowledge of the methods of initial evaluation and criteria for referral and follow-up care of the patient requiring liver transplantation and those with intestinal failure/requiring small bowel transplantation. [PR VIII.A.9]

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List of Diagnoses

List 150 CONSECUTIVE admissions and/or consultations to the gastroenterology service. Identify the time period during which these admissions/consultations occurred. The date range should occur within the same 12-month period used in previous sections. The dates must begin on the date the first patient on the list was admitted and end with the date the 150th patient was admitted (e.g., July 1, 2014 through October 20, 2014). Submit a separate list for each site that provides required rotations. Add additional tables as necessary.

Site Name: / Click here to enter text. /
Give inclusive dates during which these admissions/ consultations occurred: / FROM: Click here to enter a date. / TO: Click here to enter a date.

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Patient ID / Number of days in hospital / Gastroenterologic diagnosis
(may include secondary diagnosis if relevant)
Number / Age
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Skill Objectives

Indicate whether or not the program provides experience in each of the following procedures. Use the same 12-month period as indicated on the previous sections. For procedures not performed at any of the participating sites, provide an explanation.

Give inclusive dates during which these admissions/consultations occurred: / FROM: Click here to enter a date. / TO: Click here to enter a date.

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# performed on service(s) / Site #1 / Site #2 / Site #3
Diagnostic & Therapeutic Colonoscopy (including biopsy) [PR VIII.A.10.a).(1).(a)] / # / # / # /
Diagnostic upper endoscopy (including biopsy)[PR VIII.A.10.a).(1).(b)] / # / # / # /

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Provide a description of the method by which fellows will acquire skills and how their competence is ensured for the required procedures listed above

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Core Curriculum