New Application: Pediatrics Review Committee for Pediatrics ACGME Institutions [PR I.] Using the table below provide a summary of the program’s leadership and support staff, including the name and percent FTE. Add additional rows as needed. [PR I.A.1-I.A.1.b).(1).(e)] Faculty and Support Staff Name % FTE* in residency program Program Director % Associate Program Director(s) % Liaison(s) (e.g., senior residents, chief residents, junior faculty) % % % % % Administrative Personnel - Professional Position Number of Administrative Personnel % FTE in residency program for each (Example) Residency Coordinator 1 100% (Example) Secretary 1.5 100%/50% % % % % % * 1.0 FTE is greater than or equal to 40 hours per week. Program Personnel and Resources [PR II] Faculty Scholarly Activities and Research [PR II.B.5.b)-b).(4)] List below no more than 10 major on-going research projects in the Department of Pediatrics. Those listed should be representative of the full spectrum of departmental research activities. Insert information in each column for each project. Project title Funding source Funding awarded by peer review process Years of funding (dates) Total cost Faculty investigator and role in grant (i.e. PI, Co-investigator)
Subspecialty Education [PR IV.A.6.b).(3).(c)] Required Pediatric Subspecialty Experience (Excluding Adolescent Medicine, and Developmental-Behavioral Pediatrics) Using the table below; 1) provide information about the 4 key subspecialty experiences, and 2) provide the requested information in the columns. Include only the patients available for resident education. If experiences are located at two sites or clinics, report figures for both, e.g. [1-236/3-100]. In the last column, include residents in combined programs. Pediatric Subspecialties [PR Required of all residents? Selective to meet the 4 required months % Time devoted to IP/OP Inpatient location (Site #1, 2, 3, 4) Outpatient location (hosp 1, 2 or amb site, private office) Total visits per year Total per year (admits + consults) If selective, number of residents doing an educational unit over past 3 years Child Abuse YES NO % / % Medical Genetics YES NO % / % Pediatric Allergy/Immunology YES NO % / % Pediatric Cardiology YES NO % / % Pediatric Dermatology YES NO % / % Pediatric Endocrinology/ Metabolism YES NO % / % Pediatric Gastroenterology YES NO % / % Pediatric Hematology/ Oncology YES NO % / % Pediatric Infectious Diseases YES NO % / % Pediatric Nephrology YES NO % / % Pediatric Neurology YES NO % / %
Identify the additional required subspecialty experiences residents may select to required subspecialty experience and provide the information requested for those subspecialty areas. [PR IV.A.6.b).(3).(c) & (d)] Subspecialty Experience [PR Residents May Select? Child and adolescent psychiatry YES NO Hospice and palliative medicine YES NO Neurodevelopmental disabilities YES NO Pediatric anesthesiology YES NO Pediatric dentistry YES NO Pediatric ophthalmology YES NO Pediatric orthopaedic surgery YES NO Pediatric otolaryngology YES NO Pediatric rehabilitation medicine YES NO Pediatric radiology YES NO Pediatric surgery YES NO Sleep medicine YES NO Sports medicine YES NO Community Experience [PR IV.A.6.b).(4).(a).(i)] Describe how elements of community pediatrics and child advocacy will be incorporated into the residents’ ambulatory experiences for at least two educational units. Limit the response to 500 words. Emergency Medicine (EM)/Acute Illness (AI) Complete the table below for the EM/AI experience during the three years of training. [PR IV.A.6.b).(4).(b)] Total duration in educational units of EM experience: Duration of assignments to an Emergency Department (must be in an EMS receiving setting): Complete the chart below for emergency medicine experiences. Provide data for every site that is used to meet the required educational units (e.g., if an outside ED is used to meet the requirement, list this site and enter the requested data). [PR IV.A.6.b).(4).(b).(i)] Site # Total visits per year If comb. Adult/Ped, % of patients under 22 Actual times staffed by residents (e.g., (not just # of hours) Average number of patients per resident per shift Name of EM Pediatric training supervisor* %
Longitudinal Outpatient Experience [PR IV.A.6.b).(5)] Have documentation that supports the data in the table available for the site visitor. Do not include the report with the application. Add rows as necessary. Name and number consecutively all sites used for continuity clinics Location Site #1, 2, 3, 4; private office or other site Ratio of preceptors to residents Number of residents assigned to this clinic/ # clinic sessions assigned per year Total number of primary care visits per year PL -1’s/# sessions PL -2’s/# sessions PL -3’s/# sessions Combined residents/# sessions