The Academic Pediatric Association’s (APA) Academic General Pediatric Fellowship Accreditation Project PAS Meeting May 3, 2009

LOUIS M. BELL, MD Has documented that he has no relevant financial relationships to disclose or COIs to resolve.

Question Why does a pediatric resident have a more difficult time choosing a career in general pediatrics than a career in a pediatric subspecialty?

Resident A Going into a pediatric subspecialty Going into a pediatric subspecialty Finds the listing of all the programs Finds the listing of all the programs Knows all programs are accredited by ACGME Knows all programs are accredited by ACGME Can easily set up interviews Can easily set up interviews Enters an organized match Enters an organized match Completes his/her fellowship and becomes ABP Certified Completes his/her fellowship and becomes ABP Certified

Resident B Wants- Academic General Pediatrics Wants- Academic General Pediatrics Cannot find which programs are available Cannot find which programs are available Not sure of uniformity and quality of programs Not sure of uniformity and quality of programs Has variable timelines for application / selection Has variable timelines for application / selection Will receive no certificate for his/her training Will receive no certificate for his/her training

Background Survey of AGP programs in US (119/199 responded - 60%) Have AGP fellowship program:28% Plan to start one:13% Program duration3 yrs (32%) 2 yrs (64%) Masters degree76% Clinical time31% mean (range 10-90%) Major challengeFunding Cheng, Markakis, DeWitt, Pediatrics. 2007

Background AGP programs typically suffer from : a lack of a unifying structure a lack of a unifying structure variability in the level of “academics” variability in the level of “academics” lack of any fixed curricular requirements lack of any fixed curricular requirements uncertain funding uncertain funding no methods for advertising and promoting programs no methods for advertising and promoting programs

Background This is a great time to be a Academic General Pediatrician… AGP Fellowships may focus on…

Focus on Fellow, Resident, and Medical Student Education Revisiting Duty-Hour Limits – IOM Recommendations for patient Safety and Resident Education January 2009, 123(Suppl 1)

Focus on Health Care Effectiveness, Cost, Equality, Safety Health Services Research Health Services Research Clinical Effectiveness Clinical Effectiveness Quality and Safety Quality and Safety Health Policy Research Health Policy Research

Focus on Community, Environment, Health Information Technology Practice Based Research Networks Practice Based Research Networks Community Participatory Research Community Participatory Research Electronic Health Record / Clinical Decision Support Electronic Health Record / Clinical Decision Support Environment and Health (National Children's Study) Environment and Health (National Children's Study) Applied Genomics Applied Genomics

Focus on Hospital Medicine Sedation Services Sedation Services Inpatient Care Research Inpatient Care Research

A Proposal in 2004 APA becomes the accrediting body for Academic General Pediatric Fellowship programs APA becomes the accrediting body for Academic General Pediatric Fellowship programs APA set standards for programs APA set standards for programs APA provides a consultation service for developing programs APA provides a consultation service for developing programs APA implements a system to support and enrich existing programs and encourages new programs to develop APA implements a system to support and enrich existing programs and encourages new programs to develop

Key Point This is about ACADEMICS This is about ACADEMICS It is not about the clinical training It is not about the clinical training The goal is to improve the academics of fellowship training programs The goal is to improve the academics of fellowship training programs A goal is to prepare the next generation of academic leaders as educators and clinical researchers to improve child health A goal is to prepare the next generation of academic leaders as educators and clinical researchers to improve child health

Objectives 1)Developing curriculum guidelines and program standards 2)Creating a process for program review and consultation that might later be used for accreditation of AGP fellowship programs 3)Pilot test an accreditation process (Funding from DHHS, Bureau of Health Professions) To strengthen academic general pediatrics (AGP) fellowship programs by

Program Development Timeline 2004 Consensus Conference sponsored by the ABP * Curriculum Design/Educational Goals and Objectives Curriculum Design/Educational Goals and Objectives Ambulatory Pediatrics 2007;7:328:339 Ambulatory Pediatrics 2007;7:328:339 Description of Program and Pilot Project Ambulatory Pediatrics 2007;7:340:347 (*funding from DHHS, Bureau of Health Professions)

First… √Developed Curriculum and Educational Goals and Objectives √Develop program requirements √Develop a standardized program description form (Ambulatory Pediatrics 2007;7: )

Essential Elements of a Planned Curriculum Program

AGP Fellowship Project: Accreditation Evaluation Checklist 7 Required Program Elements 1.“Sufficient” institutional support. 2.At least two years of training. 3.The director should have the appropriate skills and experience. 4.Each fellow has a mentor. 5.The three academic competency domains (discussed above). 6.Written final evaluation for each fellow. 7.Annual review and evaluation of the program.

Next… √Site visited 7 programs and summarized lessons learned (Ambulatory Pediatrics 2007;7: )

Site Visit Pilot Project Selection 43 AGP Fellowship programs identified 43 AGP Fellowship programs identified 18 programs volunteered 18 programs volunteered 8 selected for diversity of content, location 8 selected for diversity of content, location 1 withdrew 1 withdrew 7 programs were visited by a pair of evaluators or consultants 7 programs were visited by a pair of evaluators or consultants

Site Visit Pilot Project Process A pre-visit program description form is completed A pre-visit program description form is completed A post-visit assessing report on compliance with program requirements sent to each program A post-visit assessing report on compliance with program requirements sent to each program Site visit team consists of a physician and an educator Site visit team consists of a physician and an educator

Site Visit Pilot Project Results - 1 All programs found process useful All programs found process useful Core curriculum requirement and education of goals were useful Core curriculum requirement and education of goals were useful Programs liked the increased visibility within their institutions as a result of the site visit Programs liked the increased visibility within their institutions as a result of the site visit Preparation for the visit was laborious Preparation for the visit was laborious

Site Visit Pilot Project Results - 2 Five of 7 programs would participate in a future formal accreditation process Five of 7 programs would participate in a future formal accreditation process 1 felt did not have enough academic resources to participate 1 felt did not have enough academic resources to participate 1 felt that the accreditation process was not needed given already a strong academic program in place 1 felt that the accreditation process was not needed given already a strong academic program in place

Site Visit Pilot Project Results - 3 Common areas needing improvement: AGP Fellowship poorly integrated into Department AGP Fellowship poorly integrated into Department Overburdened faculty Overburdened faculty Lack of key research faculty (biostatisticians) Lack of key research faculty (biostatisticians) Failure to adequately evaluate trainees, faculty, and programs as a whole Failure to adequately evaluate trainees, faculty, and programs as a whole Uncertain funding Uncertain funding

Site Visit Pilot Project What we learned: Concerns about rigidity and rules Concerns about rigidity and rules Retain creativity and individuality Retain creativity and individuality Value of accreditation for Value of accreditation for Educational excellence Educational excellence Political party with subspecialty programs Political party with subspecialty programs

Program Development Timeline - continued 2006 – 2008Policies and Procedures for accreditation Developed budget Communicated with ACGME, ABP, AAP May 2008Program and AGPAC approved as an APA ‘core activity’ July-January 2009Applications accepted

Information and all documents required for an application Click on the ‘education’ section

7 Applications Received in 1 st Cycle 6 for accreditation 1 for consultation Fee schedule Initial Application Fee: $3000 (due with application) Annual Registration Fee: $2500 (due July 1 st ) Consultation Visit: $ expenses

CONSULTATION SERVICE will help Develop a new program Develop a new program Restructure an existing program Restructure an existing program Prepare for the application process Prepare for the application process

The Accreditation Process Application evaluation Application evaluation Accreditation pending site visit Accreditation pending site visit 5 yrs – 3 yrs – 2 yrs Site visit Site visit

Absolute Requirements for Accreditation (7 items) Institutional Support Institutional Support Minimum of 2 yrs of training Minimum of 2 yrs of training Director expertise Director expertise Adequate mentorship for trainees Adequate mentorship for trainees Educational activities in three domains Educational activities in three domains Written evaluations Written evaluations Annual review and evaluation of the program Annual review and evaluation of the program

Information and all documents required for an application Click on the ‘education’ section

It’s All About Pipeline

Committee Members Connie Baldwin Connie Baldwin Lou Bell (Chair) Lou Bell (Chair) Tina Cheng Tina Cheng Dan Coury Dan Coury Paul Darden Paul Darden Marge Degnon Marge Degnon Tom DeWitt Tom DeWitt Benard Dreyer Benard Dreyer Anne Duggan Anne Duggan Steve Ludwig (past-chair) Steve Ludwig (past-chair) Peter Szilagyi Peter Szilagyi Teri Turner Teri Turner