New Application: Pediatric Pulmonology

New Application: Pediatric Pulmonology

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)]

Pediatric Pulmonology Updated 4/2016

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 Personnel and Resources

Other Professional Personnel

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

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Team Members / Site #1 / Site #2 / Site #3
Nutritionist/ Registered Dietician / ☐ / ☐ / ☐ /
Psychology / ☐ / ☐ / ☐ /
Social Workers / ☐ / ☐ / ☐ /
Relevant healthcare providers (e.g. nurse specialists, PAs) / ☐ / ☐ / ☐ /
Clinical Pharmacologist / ☐ / ☐ / ☐ /
Physical & Occupational Therapist / ☐ / ☐ / ☐ /
Child Life Therapist / ☐ / ☐ / ☐ /
Speech Therapist / ☐ / ☐ / ☐ /
Respiratory Therapist / ☐ / ☐ / ☐ /

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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.a)-VII.A.2.b)]:

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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 / # / # / # / # / # /
Developmental-behavioral pediatrics / # / # / # / # / # /
Pediatric emergency medicine / # / # / # / # / # /
Pediatric endocrinology / # / # / # / # / # /
Pediatric gastroenterology / # / # / # / # / # /
Pediatric hematology/oncology / # / # / # / # / # /
Pediatric infectious diseases / # / # / # / # / # /
Neonatal-perinatal medicine / # / # / # / # / # /
Pediatric nephrology / # / # / # / # / # /
Pediatric rheumatology / # / # / # / # / # /
SPECIFIC TO PEDIATRIC PULMONOLOGY
Allergy and immunology / # / # / # / # / # /
Anesthesiology / # / # / # / # / # /
Thoracic surgery / # / # / # / # / # /
Neurology with specialty qualification in child neurology / # / # / # / # / # /
Child and adolescent psychiatry / # / # / # / # / # /
Medical Genetics / # / # / # / # / # /
Pediatric Otolaryngology / # / # / # / # / # /
Pathology-anatomic and clinical / # / # / # / # / # /
Radiology-diagnostic / # / # / # / # / # /
Pediatric surgery / # / # / # / # / # /

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Facilities and Services[PR VII.C.]

Indicate the availability of the following (for inpatient services, indicate the number of available beds):

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Facility/Service / Site #1
(Yes/No) / Site #2
(Yes/No) / Site #3
(Yes/No)
Space in an ambulatory setting for evaluation and care of patients / Choose an item. / Choose an item. / Choose an item. /
PICU (indicate total number of beds) / # / # / # /
NICU (indicate total number of beds) / # / # / # /
Pediatric pulmonary function laboratory capable of measuring flows, gas exchange and lung volumes including use of body plethysmography, and performing bronchoprovocation studies / Choose an item. / Choose an item. / Choose an item. /
Flexible bronchoscopy capability / Choose an item. / Choose an item. / Choose an item. /
Pediatric polysomnography capability / Choose an item. / Choose an item. / Choose an item. /
Inpatient services capable of meeting the needs of adolescents/young adults with pulmonary disease / Choose an item. / Choose an item. / Choose an item. /
Pathologists with experience/training in pediatric pulmonary pathology / Choose an item. / Choose an item. / Choose an item. /
Faculty with expertise in sleep medicine / Choose an item. / Choose an item. / Choose an item. /
Adult medicine pulmonary consultants for transition care of young adults / Choose an item. / Choose an item. / Choose an item. /

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Patient Population[PR VII.C.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.

Inclusive dates: / From:Click here to enter a date. / To: Click here to enter a date.

Pediatric Pulmonology Updated 4/2016

Site #1 / Site #2 / Site #3
Total number of admissions to the pediatric pulmonology service / # / # / # /
Number of new patients admitted each year (“new” refers to those who are seen by members of the pulmonology service for the first time.) / # / # / # /
Average length of stay of patients on the pediatric pulmonology service / Length / Length / Length /
Total number of consultations by pediatric pulmonologists 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 pulmonology service, including consultations / # / # / # /
Number of patients requiring follow-up care by pulmonology service as outpatients during 12-month period reported / # / # / # /

Pediatric Pulmonology Updated 4/2016

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.

Inclusive dates: / From:Click here to enter a date. / To: Click here to enter a date.

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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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Ambulatory Pediatric Pulmonology 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 # of Sessions Per Week Per Fellow / Estimated # of New Patients Per Fellow Per Session / Estimated # of Return Patients Per Fellow Per Session / Estimated Average # Teaching Attendings Per Session
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 pulmonology problems were: a) seen in the ambulatory settings; b) were admitted to and/or consulted on by the pediatric pulmonologists at the primary site?

Inclusive dates: / From:Click here to enter a date. / To: Click here to enter a date.
Pulmonology Diagnosis/Disorder / Outpatients / Inpatients
Number of Patients / Number on Pulm Service / Number of Consults
Asthma and allergic disorders affecting the respiratory system / # / # / # /
Chronic lung disease of infancy / # / # / # /
Cystic fibrosis / # / # / # /
Lower respiratory tract infections / # / # / # /
Newborn respiratory diseases / # / # / # /
Sleep disordered breathing, such as apnea / # / # / # /
Chronic ventilatory assistance, including home mechanical ventilation such as, bi-level positive airway pressure ventilation, and tracheostomy management / # / # / # /
Aspiration syndromes / # / # / # /
Congenital anomalies of the respiratory system / # / # / # /
Acquired upper airway obstruction / # / # / # /
Chronic suppurative lung disease / # / # / # /
Respiratory infections in the immunocompromised host / # / # / # /
Other diseases such as pulmonary hypertension, interstitial lung disease, hemosiderosis and acute lung injuries / # / # / # /
Pre-operative and post-operative management of children with respiratory disorders / # / # / # /

List of Diagnoses

List 150 consecutive inpatient admissions and/or consultations by the PEDIATRIC PULMONOLOGY 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. Duplicate tables and add rows 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.

Pediatric Pulmonology Updated 4/2016

Patient ID / Number of days in hospital / Pulmonary diagnosis
(may include secondary diagnosis if relevant)
Number / Age
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Pediatric Pulmonology Updated 4/2016

Educational Program [PR VIII.]

Skill Objectives

Will the program provide experience in the following:

Pulmonary Function Testing/Procedures / Number Per Year
Simple spirometry (volume-time or flow-volume) / # /
Whole body plethysmography [PR VII.C.1.b).(1).(b)] / # /
Bronchoprovocation studies [PR VII.C.1.b).(1).(b)] / # /
Pre-post bronchodilator study / # /
Evaluation of respiration during sleep [PR VIII.A.3.b)] / # /
Bronchoscopy [PR VIII.A.3.c)] / # /

Core Curriculum - Specialty Experiences

Identify the activities (clinical experience, conference series, journal club, etc.) and training sites (Site #) learning which will be used to address the required core knowledge area.

Core Knowledge Area / List the Learning Activities Used to Address the Core Knowledge/Skills / List the Corresponding Setting in Which These Learning Activities Take Place / Year(s) of Training
Asthma and allergic disorders affecting the respiratory system
[PR VIII.A.2.a)] / Click here to enter text. / Click here to enter text. / # /
Chronic lung disease of infancy
[PR VIII.A.2.b)] / Click here to enter text. / Click here to enter text. / # /
Cystic fibrosis
[PR VIII.A.2.c)] / Click here to enter text. / Click here to enter text. / # /
Lower respiratory tract infections
[PR VIII.A.2.d)] / Click here to enter text. / Click here to enter text. / # /
Newborn respiratory diseases
[PR VIII.A.2.e)] / Click here to enter text. / Click here to enter text. / # /
Sleep disordered breathing, such as apnea
[PR VIII.A.2.f)] / Click here to enter text. / Click here to enter text. / # /
Chronic ventilatory assistance, including home mechanical ventilation, bi-level positive airway pressure ventilation, and tracheostomy management.
[PR VIII.A.2.g)] / Click here to enter text. / Click here to enter text. / # /
Aspiration syndromes
[PR VIII.A.2.h)] / Click here to enter text. / Click here to enter text. / # /
Congenital anomalies of the respiratory system
[PR VIII.A.2.i)] / Click here to enter text. / Click here to enter text. / # /
Acquired upper airway obstruction
[PR VIII.A.2.j)] / Click here to enter text. / Click here to enter text. / # /
Chronic suppurative lung disease
[PR VIII.A.2.k)] / Click here to enter text. / Click here to enter text. / # /
Respiratory infections in the immunocompromised host
[PR VIII.A.2.l)] / Click here to enter text. / Click here to enter text. / # /
Other diseases such as pulmonary hypertension, interstitial lung disease, hemosiderosis and acute lung injuries
[PR VIII.A.2.m)] / Click here to enter text. / Click here to enter text. / # /
Pre-operative and post-operative management of children with respiratory disorders
[PR VIII.A.2.n)] / Click here to enter text. / Click here to enter text. / # /
Environmental influences on respiratory disease.
[PR VIII.B.1) / Click here to enter text. / Click here to enter text. / # /
Indication and interpretation of pulmonary function tests / Click here to enter text. / Click here to enter text. / # /
Evaluation of respiration during sleep
[PR VIII.A.3.b)] / Click here to enter text. / Click here to enter text. / # /

Inpatient Experiences