RESIDENCY REVIEW COMMITTEE FOR INTERNAL MEDICINE

RESIDENCY REVIEW COMMITTEE FOR INTERNAL MEDICINE515 N State, Ste 2000, Chicago, IL 60610 (312) 755-5496 www.acgme.org

PROGRAM INFORMATION FORM FOR TRANSPLANT HEPATOLOGY

FOR CONTINUED ACCREDITATION

INSTRUCTIONS

REVIEW OF AN ACCREDITED PROGRAM OR RE-ACCREDITATION OF A PROGRAM: If the Program Information Form (PIF) is being completed for a currently accredited program, follow the provided instructions to create the correct form. Go to the Accreditation Data System found on the ACGME home page (www.acgme.org) under Data Collection Systems. Using your previously assigned User ID and password, proceed to the PIF Preparation section on the left hand menu and update the Common PIF data. Most data in the Common PIF are updated through annual updates, but some information is required at the time of site visit only. Once the data entry is complete, under Print/Preview PIF, select Generate PIF to review and print the Common PIF (either in HTML or PDF format). Next proceed to the section under the RRC for Internal Medicine to retrieve the Specialty Specific PIF for continued accreditation. Complete the Specialty Specific PIF using your preferred word processor (only after the Common PIF has been completed). Enter page numbers for the Specialty Specific PIF in the bottom center for each page that consecutively follows the Common PIF numbering, combine the Common PIF and the Specialty Specific PIF and complete the Table of Contents (found with the Specialty Specific PIF instructions)

Once the forms are final and ready for signatures, print the entire PIF in either the printer-friendly HTML version or PDF version. After the original has been signed, make two copies. They must be identical and final. Draft copies are not acceptable. The forms should be submitted bound by either sturdy rubber bands or binder clips. Do not place the forms in covers such as two or three ring binders, spiral bound notebooks, or any other form of binding. Mail the original and two copes of the PIF and requested attachments to:

Ms. Cleo WhitfieldSystems Administrator

Residency Review Committee for Internal Medicine515 North State Street, Suite 2000

Chicago, Illinois 60610

For questions/problems regarding:

- the site visit, contact the writer of the letter announcing the site visit.

- the completion of the form (content), contact the Accreditation Administrator.

- the Accreditation Data System data entry, email [email protected].

For a glossary of terms, use the following link – http://www.acgme.org/acWebsite/GME_info/gme_glossary.asp

The forms are designed for use by single institution as well as multi-institution programs. The Program Director is responsible for the collection of data and other information from each participating institution. All the information is to be consolidated and reported on a single set of forms which must be signed by the Program Director and Designated Institutional Official. If more space is required to respond to an item, expand the text boxes as necessary. The information provided should be complete but concise and should not include unrequested material such as reprints, brochures, computer printouts, catalogs, or lengthy CVs.

SPECIALTY SPECIFIC INSTRUCTIONS

FACULTY DATA: List alphabetically and by site the physician faculty to include the following: a minimum of two key clinical faculty, including the program director, who devotes at least 10 hours per week to fellow education. If the program is approved for more than four positions, list additional faculty if required based on the requirement for a minimum faculty to fellow ratio of 1:1.5. In addition, supply a one page CV for each faculty listed.

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http://www.acgme.org/acWebsite/GME_info/gme_glossary.asp

http://www.acgme.org/


Please have the following documents available for the site visitor:

References to Common Program and Institutional Requirements are in parentheses.

1. Policy for supervision of residents (addressing resident responsibilities for patient care, progressive responsibilities for patient management, and faculty responsibility for supervision) (CPR IV.A.4)

2. Program policies and procedures for residents’ duty hours and work environment (CPR II.A.4.j)

3. Moonlighting policy (CPR II.A.4.j; CPR VI.F)

4. Documentation of internal review (date, participants’ titles, type of data collected, and date of review by the GMEC)

5. Overall educational goals for the program (CPR IV.A.1)

6. Competency-based goals and objectives for each assignment at each educational level (CPR IV.A.2)

7. Current Program Letters of Agreement (PLAs) (CPR I.B.1)

8. Files of current residents who have transferred into the program, if applicable (including documentation of previous experiences and summative competency-based performance evaluations) (CPR III.C.1)

9. Evaluations of residents at the completion of each assignment (CPR V.A.1.a)

10. Evaluations showing use of multiple evaluators (faculty, peers, patients, self, and other professional staff) (CPR V.A.1.b.(2))

11. Documentation of residents’ semiannual evaluations of performance with feedback (CPR II.A.4.g; V.A.1.b.(4))

12. Final (summative) evaluation of residents, documenting performance during the final period of education and verifying that the resident has demonstrated sufficient competence to enter practice without direct supervision (CPR V.A.2)

13. Completed annual written confidential evaluations of faculty by the residents (CPR V.B. 3)

14. Completed annual written confidential evaluations of the program by the residents (CPR V.C.1.d.(1))

15. Completed annual written confidential evaluations of the program by the faculty (CPR V.C.1.d.(1))

16. Documentation of program evaluation and written improvement plan (CPR V.C)

17. Documentation of resident duty hours (CPR II.A.4.j; VI.D.1-3)

18. Files of current residents and most recent program graduates

19. Documentation (one-page, print screen from ABIM website) of Program Director, Key Clinical Faculty (minimum required) current ABIM-certification.

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PROGRAM INFORMATION FORM FOR TRANSPLANT HEPATOLOGY

Program Name:

TABLE OF CONTENTS

When you have the completed forms, number each page consecutively in the lower center. Enter page numbers for the Specialty Specific PIF in the bottom center for each page that consecutively follows the Common PIF numbering. Report this pagination in the Table of Contents and submit this page with the completed PIF.

Common PIF Page(s)Accreditation Information

Citation Information

Participating Sites

Faculty/Teaching Staff

Physician Faculty Roster

Physician Curriculum Vitae

Non-Physician Faculty Roster

Resident Appointments

Number of Positions

Actively Enrolled Residents

List of Residents On Leave

Faculty to Resident ratio

Aggregated Data on Residents Completing or Leaving the Program

Residents Completing Program

Transferred, Withdrawn, and Dismissed Residents

Evaluation

Resident Duty Hours

Specialty Specific Page(s)Background Information

Facilities and Resources for Training

Administration of the Transplant Hepatology Fellowship Program

Other Professional Faculty in the Transplant Hepatology Fellowship Program

Rotation/Assignment Description

Educational Program

Ambulatory Experience

Transplant Hepatology Research

Narrative

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SPECIALTY SPECIFIC PROGRAM INFORMATION FORM FOR TRANSPLANT HEPATOLOGY

I. BACKGROUND INFORMATION

A. Sponsoring Institution/Single or Limited Residency Institution (see ACGME Institutional Requirements – if applicable)

For those institutions with multiple residencies accredited by the same Residency Review Committee, the institutional review will be conducted in conjunction with the review of the program. Only programs in this category are to complete the following institutional questions. Complete only if "single/limited site sponsor" field under Participating Site section is YES.

1. Provide an institutional statement that commits the necessary financial, educational and human resources to support the GME program(s) and provide documentation that the statement has been approved by the governing body, the administration and the teaching staff (Appendix A).

2. Describe the formal method by which a periodic evaluation of the program’s educational quality and compliance with the program requirements occurs. Explain how fellows and faculty in the program are involved in the evaluation process.

3. Describe how the institution complies with the Institutional Requirements regarding “Resident Eligibility and Selection” and the development of appropriate criteria for the selection, evaluation, promotion and dismissal of fellows in accordance with the Program and Institutional Requirements.

4. Summarize how the institution complies with the ACGME Institutional Requirements regarding fellow support, benefits and conditions of employment to include the details of the resident contract or agreement as outlined in the ACGME Institutional Requirements. (Do not append the resident contract/agreement to the PIF but state when it is given to the residents and applicants. Have a copy available for verification by the site visitor on the day of the survey with the various items required by the ACGME numbered according to the Institutional Requirements.)

5. Describe in detail the grievance (due process) procedure(s) that is available to fellows, including the composition of the grievance committee, and mechanisms for handling complaints and grievances related to actions which could result in dismissal, non-renewal of a resident’s contract, or other actions that could significantly threaten a fellow’s intended career development.

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II. FACILITIES AND RESOURCES FOR TRAINING

Use the institution numbers and names as they appear in the Participating Sites section under the Common PIF. to complete this facilities checklist for all participating institutions used for routine rotations.

Checklist Institution #1 Institution #2 Institution #3 Institution #4 Institution #5

Number of liver transplants performed each yearNumber of liver biopsies performed each yearNumber of allograft liver biopsies performed each yearUNOS-approved transplant program

( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

Interventional radiology facilities to:

Perform balloon angioplasty ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

Perform transjugular intrahepatic portal systemic shunt


Are the following available:

Fellow office ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

Outpatient clinic facilities ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

Adequate clinic support staff ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

On-site medical library ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

After-hours access to reference materials


Access to electronic medical data base and computerized literature search


Access to medical records at time of outpatient visit


Access to medical records available to inpatient teaching service in a timely manner


On-call facilities:

Sleeping rooms ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

Food facilities ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

Accredited programs in:

Internal Medicine ( ) YES ( ) NO

Gastroenterology ( ) YES ( ) NO

1. Interactions with Other Disciplines:a. Do fellows and faculty share patient co-management responsibilities with transplant surgeons from the

preoperative phase to the outpatient period?......................................................................( ) YES ( ) NO

b. Does the program ensure close interactions and education with an experienced liver transplant pathologist? ........................................................................................................................ ( ) YES ( ) NO

c. Does the program use a multidisciplinary approach to issues in donor selection and evaluation and in recipient criteria? ................................................................................................................ ( ) YES ( ) NO

2. Will fellows be provided autopsy reports after autopsies are completed on their patients? .......( ) YES ( ) NO

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III. ADMINISTRATION OF THE TRANSPLANT HEPATOLOGY FELLOWSHIP PROGRAM

1. Is there is a single program director responsible for the transplant hepatology fellowship program?................................................................................................................................................... ( ) YES ( ) NO

2. Does the sponsoring institution provide adequate salary support for the program director for the administrative activities of the program?........................................................................................................... ( ) YES ( ) NO

3. Does the salary support prevent the program director from the need to generate income to support the administrative activities of the program?....................................................................................( ) YES ( ) NO

4. Are there adequate inpatient facilities (e.g., conference rooms, on-call rooms) for the transplant hepatology fellowship program? .................................................................................................................. ( ) YES ( ) NO

5. Are there adequate facilities in the ambulatory settings (i.e. exam rooms, meeting/conference room, work area) for patient care and the educational components of the program? ..................................( ) YES ( ) NO

6. Does the program director have sufficient authority to:a. Determine number of fellows?............................................................................................. ( ) YES ( ) NO

b. Determine fellow rotations – including amount of fellow off-site time?.................................( ) YES ( ) NO

c. Control fellow work load – including number of patients – on all rotations at principal teaching hospital?................................................................................................................................................. ( ) YES ( ) NO

d. Control teaching space and other facilities relevant to the training program?......................( ) YES ( ) NO

e. Select teaching attendings based on fellow evaluations?....................................................( ) YES ( ) NO

f. Determine fellowship curriculum, including content of conferences fellows usually attend?( ) YES ( ) NO

If the answer to any of the above questions is no, please explain below.

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IV. OTHER PROFESSIONAL FACULTY IN TRANSPLANT HEPATOLOGY

Provide the following information for all other PHYSICIAN faculty who will participate in the transplant hepatology program but devote less than 10 hours per week, on average, to the training program. Duplicate page if necessary.

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NAME SPECIALTY 1 YEAR CERT SPECIALTY 2 YEAR CERT SPECIALTY 3 YEAR CERT HRS/WK WKS/YR

ROLE IN PROGRAM:


ROLE IN PROGRAM:


ROLE IN PROGRAM:


ROLE IN PROGRAM:


ROLE IN PROGRAM:

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V. ROTATION/ASSIGNMENT SCHEDULE

1. Instruction: Provide a rotation schedule that describes the rotations for a typical fellow. Do not include vacation blocks. Use a distinct title for each rotation that allows the Committee to understand the educational nature of the rotation, e.g., Inpatient Liver Transplant. Do not use abbreviations or local terminology (e.g. “Blue 1”). Please define all required experiences. Indicate elective rotations with the term “elective”.

1 2 3 4 5 6 7 8 9 10 11 12

Rotation

Institution/Site

Duration of Experience (weeks

or months)

Average Number of Hours on Duty per

Week

Number of Full Days off per week During

this Rotation/Assignmen

t

Frequency of In House Night Call

(Q3, Q4, etc.)

Direct Patient Responsibility (Yes

or No)

2. Provide a rotation schedule narrative that accurately describes each rotation in your program. Duplicate table as necessary.

Rotation Name:Rotation Narrative:

Rotation Name:Rotation Narrative:

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VI. EDUCATIONAL PROGRAM

A. Curriculum

1. Is there a written curriculum for the fellowship program? ....................................................( ) YES ( ) NO

2. Does the written curriculum define the educational goals and objectives of the rotation/assignment based on the Competencies?......................................................................................................... ( ) YES ( ) NO

3. Is there a written curriculum for each major rotation or learning experience?......................( ) YES ( ) NO

4. Will the written curriculum be distributed to fellows and faculty?.........................................( ) YES ( ) NO

5. Will the rotation goals and objectives be reviewed by faculty with the fellows at the start of each new rotation and assignment?.................................................................................................... ( ) YES ( ) NO

B. Required Conferences

1. Provide information about the following required conferences: Monthly Frequency

Core curriculum conference series

Clinical case conference

Research conference

Journal club

2. Does the program include instruction in the following topics either as separate presentations or integrated into the core curriculum conference series?

a. Clinical ethics...................................................................................... ( ) YES ( ) NOb. Medical genetics..................................................................................( ) YES ( ) NOc. Quality assessment and improvement.................................................( ) YES ( ) NOd. Patient safety....................................................................................... ( ) YES ( ) NOe. Risk management................................................................................ ( ) YES ( ) NOf. Preventive medicine............................................................................( ) YES ( ) NOg. Pain medicine...................................................................................... ( ) YES ( ) NOh. End-of-life care.................................................................................... ( ) YES ( ) NOi. Physician impairment..........................................................................( ) YES ( ) NOj. Critical assessment of medical literature.............................................( ) YES ( ) NOk. Medical informatics..............................................................................( ) YES ( ) NOl. Clinical epidemiology...........................................................................( ) YES ( ) NOm. Biostatistics......................................................................................... ( ) YES ( ) NO

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VII. EDUCATIONAL PROGRAM

A. Subspecialty Experience

Indicate how fellows will obtain experience and if they will be required to demonstrate competence in the following program content areas:

S P E C I F I C P R O G R A M C O N T E N T

Formal Instruction

(Y/N)

Clinical Experience

(Y/N)

DemonstrateCompetence

(Y/N) Prevention, evaluation and management of acute and chronic

end stage liver disease

(includes genetic disorders involving the liver, alcoholic and non-alcoholic steatohepatitis)

Comprehensive management of critically ill patients awaiting transplant with complications including:

Refractory ascites

Hepatic hydrothorax

Hepato-renal syndrome

Hepatopulmonary and portal pulmonary syndromes

Refractory portal hypertensive bleeding

Diagnosis and management of hepatocellular carcinoma and cholangiocarcinoma including transplantation, non-transplantation, surgical and non-surgical approaches

Management of chronic viral hepatitis in the pre-, peri- and post-transplantation settings

Management of fulminant liver failure

Psychosocial evaluation of transplant candidates, in particular those with history of substance abuse

Transplant immunology including blood group matching, histocompatibility, tissue typing and malignant complications of immunosuppression

Drug hepatotoxicity

Interaction of drugs with the liver

Nutritional support of patients with liver disease

Use of interventional radiology in diagnosis and management of portal hypertension, as well as biliary and vascular complications

Ethical considerations relating to liver transplant donors

Performance of at least 30 percutaneous liver biopsies

Indications, contraindications and complications of liver allograft biopsies

Interpretation of at least 200 native and allograft liver biopsies

Appropriate use of ultrasound localized, laparoscopy-guided and transjugular liver biopsies

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B. Subspecialty Didactic Experience

1. Will fellows receive formal didactic instruction in the following content areas:

S P E C I F I C P R O G R A M C O N T E N T

Formal Instruction

(Y/N) Pathogenesis, manifestations and complications of end-stage liver disease and hepatic

transplantation

Appropriate use of laboratory tests and procedures

Anatomy, and physiology related to the liver and biliary tract

Pharmacology related to the liver and biliary tract

Pathology related to the liver and biliary tract

Molecular virology related to the liver and biliary tract

Natural history of chronic liver disease

Factors involved in nutrition and malnutrition and its management

Cost-effective use of special instruments, tests and therapy in the diagnosis and management of liver disorders

Principles and practice of pediatric liver transplantation

Principles and application of artificial liver support

Clinical research issues and transplant hepatology

Principles of living donor selection

C. Subspecialty Clinical Experience

Will each fellow (Y/N)Participate in the primary evaluation, presentation and discussion of at least 10 potential transplant candidates?

Provide follow-up for at least 20 new liver transplant recipients for a minimum of 3 months from the time of transplantation?

Actively participate in the transplant recipients’ medical care including the management of acute cellular rejection, recurrent disease, infectious diseases and biliary tract complications?

Serve as an integral member of the transplantation team?

Participate in making decisions about immunosuppression?

Participate in the follow-up of 20 or more liver transplant recipients 1 year post-transplant?

Provide a minimum of six month follow-up for each of these liver transplant patients?

Acquire a working knowledge of the organizational and logistic aspects of liver transplantation including the role of nurse coordinators and other support staff, organ procurement , and UNOS policies?

Learn the principles of donor selection and rejection?

Participate as an observer in one deceased donor procurement and three liver transplant surgeries?

D. Inpatient and Consultation Teaching1. What is the total teaching time that will be spent in combined management and teaching rounds per

week? _________________

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VIII. AMBULATORY EXPERIENCE

1. Provide information for the fellows continuity experience and patient distribution. List each experience indicating the name of the experience (e.g. Continuity Clinic), the hospital or other training site identifiers, duration of the experience, number of sessions per week per fellow, average number of patients per session, average number of other trainees and teaching attendings and whether faculty supervision will be provided for each experience.

Name of Experience ID Duration SessionsPer Week

Avg # PatientsSeen Per Session

Avg #Other

TraineesPresent

Avg #Teaching

Attendings/ Session

FacultySupervision

On Site(Yes/ No)

2. Provide a narrative which describes how fellows will gain experience in the longitudinal care of patients seen in consultation.

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IX. TRANSPLANT HEPATOLOGY RESEARCH

1. What percentage of the key clinical faculty (listed in the Common PIF) participate in research in the fellowship program?

2. What is the number of papers published in peer-reviewed professional journals by key clinical faculty members from the transplant hepatology program during the last three years?(Please do not include: Case reports, abstracts, presentations, papers submitted/ not published, publications in non-peer-review journals, or publications published more than three years ago. Count each paper only once. Count each book chapter only once. Peer review publication = indexed in Pub Med (or Medline). If not in Pub Med, program must supply evidence of peer review)

3. What is the number of peer-reviewed grants by the key clinical faculty in the past three years?

4. Will all fellows who participate in a research project have a faculty preceptor?........................( ) YES ( ) NO

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X. NARRATIVE

1. List the outstanding or special features of the program.

2. List those aspects of the program and/or its component institutions/other training sites and faculty that warrant strengthening.

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RESIDENCY REVIEW COMMITTEE FOR INTERNAL MEDICINE