DATE SUBMITTED:

Dean’s Resident Manpower Advisory Subcommittee (DRMAC)

NEW TEXAS MEDICAL BOARD (TMB) FELLOWSHIP

DRMAC is a subcommittee of the Graduate Medical Education Committee (GMEC) for the specification of size and distribution of residents and fellows at the affiliated hospitals. Each program petitioning DRMAC will need to complete this form and submit significant data as to what is happening at each affiliated institution and the impact such a change would have upon the educational aspect on the specific program and the Institution. In addition, for any change which would impact funding the program must submit proof of five years funding, OR funding for the life of a trainee, whichever is longer. Departmental funds are not to be used for support of trainees, without prior approval from Finance.

Brief Summary of Proposal

Program Submission Form

Part I: Narrative

Training Program: ______

Director: ______

Parent Program Director Signature (if different): ______

Chairman Signature: ______

Total number of fellows in program: ______

Length of fellowship: ______

Is ACGME accredition available for this specialty? Yes No

Has funding already been approved for the additional trainees? Yes No

Program Director Signature: ______

Chairman Signature: ______

*Please be advised the GME Office requires a $1000 fee for the processing of any TMB Fellowship Application.

Block diagram of training (by month if a one-year program; by year if a multi-year program)

At which locations would training occur?

1.  Harris Health System/Ben Taub Hospital

2.  Texas Children’s Hospital

3.  Baylor St. Lukes Medical Center

4.  Houston Methodist Hospital

5.  Veterans Affairs Medical Center

6.  Other – Please List

Describe the educational/clinical expertise of the proposed fellowship director.

List the entry requirements for the program. If those requirements do not include successful completion of an ACGME-accredited residency program as a minimum, please provide a detailed explanation.

Will this fellowship cause competition with other ACGME residents/fellows for procedures or cases? Explain.

Describe the time allotted/curriculum for scholarly activity.

Will the fellow(s) be involved in supervising other trainees? How? Will training be provided for professional development?

Describe the educational and/or clinical needs met by the formation of this fellowship.

Please complete the second file lisiting common procedures or case diagnoses for your program, and the numbers available.

DRMAC Approves Declines Tables

To be presented at GMEC (date): ______

PLOA approved for: ______

Update due: ______