Specific Basic Standards for Osteopathic Fellowship Training in Pulmonary Diseases

Specific Basic Standards for Osteopathic Fellowship Training in Pulmonary Diseases REVIEW CROSSWALK

Program: Program Number: Review Date: Site Reviewer: IV. INSTITUTIONAL REQUIREMENTS GENERAL INTERNAL MEDICINE FELLOWSHIP STANDARDS 4.1 The institution must have an AOA-accredited or an Review most recent AOA or ACGME 1 ACGME-accredited residency in internal medicine. correspondence regarding status of Internal Medicine residency

Program Director Comments (REQUIRED):

Site Reviewer Comments (describe not met or commendations):

4.2 The institution or program must have a supervision policy Supervision policy. It must address 3 that includes, at minimum: how the faculty provides all areas for the standard to be met. supervision (direct, indirect and informal) at all times; how ACOI annual fellow report supervision is graded with regard to level of training; how (supervision question) provided by the program assesses competence (both procedural and ACOI non-procedural) with regard to the need for supervision; Fellow evaluations of rotations and how the policy is monitored and enforced.

4.3 The institution or program must have a fellow service Review fellow service policy. It must 3 policy that includes, at minimum: how the program defines address all areas for the standard to be fellow workload; how the program ensures protected met. educational time for the fellows; and how the policy is ACOI annual fellow report (service monitored and enforced. vs. education question) provided by ACOI Fellow evaluations of rotations Program Director Comments (REQUIRED):

4.4 The institution or program must have a code of conduct for Code of conduct. 1 faculty and fellows. Evidence that the faculty and fellows receive the policy (signature page and email or other electronic audit trail) Interview faculty and fellows as to knowledge of policy. Program Director Comments (REQUIRED):

4.5 The institution's department of internal medicine must have Faculty roster. This should show 1 at least two (2) physicians certified in the applicable board certification. Faculty CVs internal medicine subspecialty by the AOA or the should be available as well. American Board of Medical Specialties (ABMS).

4.6 The program must maintain and annually update a program Program description. It must meet 3 description that includes, at minimum: the program both this standard and the AOA Basic description elements required in the AOA Basic Documents for Postdoctoral Training Documents for Postdoctoral Training; and goals and for program description. objectives of the training program; curricular and rotational structure; description of ambulatory continuity experience; program director responsibilities; and fellow qualifications and responsibilities. Program Director Comments (REQUIRED):

4.7 The program must maintain a list of learning objectives to Written learning objectives. They 1 indicate learning expectations at yearly training levels and must be segregated into yearly goals. provide it to the fellows annually. Evidence that fellows received the objectives (signature page and email or other electronic audit trail) ACOI annual fellow report provided by ACOI Interview fellows on knowledge of objectives Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

4.8 The program must maintain a written curriculum and Written curriculum 1 provide it to the fellows annually. Curriculum available from www.acoi.org is satisfactory. Evidence that fellows received the objectives (signature page and email or other electronic audit trail) Data from ACOI annual fellow report provided by ACOI Interview fellows on knowledge of curriculum Program Director Comments (REQUIRED):

4.9 If applicable in the specific subspecialty, the institution Tour ambulatory site(s) 3/DD must provide a supervised ambulatory site for continuity of Program description for description of care training. Institutional clinics or applicable ambulatory site(s) subspecialists’ offices may be used.

4.10 The program must maintain a file for each fellow Fellows’ files. At least one file 3 containing, at minimum: (paper or electronic) per training year a. Ambulatory logs (if applicable); should be reviewed, including fellows b. Procedure logs; who have graduated since the last c. Rotation evaluation forms; review. The files must contain all d. Quarterly program director evaluations; applicable components. e. Semiannual ambulatory evaluations (if applicable); f. Semi-annual reviews; g. Certificate of completion of an AOA- approved or ACGME-approved internal medicine residency; AOA approval of ACGME training (if applicable)

4.11 The program must be represented every other year at the Data provided by ACOI 1 annual ACOI Congress on Medical Education for Resident Written policy on attendance of ACOI Trainers. meeting Interview program director Interview fellows Program Director Comments (REQUIRED):

SPECIFIC BASIC STANDARDS FOR OSTEOPATHIC FELLOWSHIP TRAINING IN PULMONARY DISEASES REQUIREMENTS 4.1 The base institution or an affiliate must have a pulmonary Program Description 1 laboratory that provides spirometry, lung volume Tour of facilities determination and diffusion studies. Program director interview Program Director Comments (REQUIRED):

4.2 The base institution or an affiliate must have an accredited Program Description 1 respiratory therapy department under the technical Tour of facilities direction of certified respiratory therapists that provides 24 Program director interview hour arterial blood gas service and ventilator care. Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

4.3 The base institution or an affiliate must have a 24 hour Program Description 1 fiberoptic bronchoscopy service. Tour of facilities Program director interview Program Director Comments (REQUIRED):

4.4 The base institution or an affiliate must have a nuclear Program Description 1 medicine department. Tour of facilities Program director interview Program Director Comments (REQUIRED):

4.5 The base institution or an affiliate must have a thoracic Program Description 1 surgery service. Tour of facilities Program director interview Program Director Comments (REQUIRED):

V. PROGRAM REQUIREMENTS AND CONTENT GENERAL INTERNAL MEDICINE FELLOWSHIP STANDARDS A. Program Duration 5.1 The last 12 months of training must occur in the program Fellow files for any fellow who 1 that issues the certificate of fellowship completion. transferred into the program since the last review. If this does not apply please note this as met. Program Director Comments (REQUIRED):

5.2 At least 80 percent of the graduates, averaged on a three- Data provided by the ACOI via the 1 year rolling basis, must take the American Osteopathic AOBIM. Board of Internal Medicine certifying examination within Data that programs keep regarding three years of completion of the program. board pass rate.

B. Transfers and Advanced Standing 5.3 The program must receive written verification of Fellow files for any fellow who 1 previous educational experiences and a statement transferred into the program and/or regarding the performance evaluation of a requested advanced standing since the transferring fellow prior to acceptance into the last review and verify that advanced program. standing was granted.

5.4 The program is required to provide verification of Fellow files for any fellow who 1 fellow education for fellows who may leave the transferred out the program program prior to completion of their education.

Site Reviewer Comments (describe not met or commendations): 5.5 Advanced standing for applicable ACGME-approved Fellow files for any fellow who 1 internal medicine subspecialty training must be approved transferred into the program and by the ACOI Council on Education and Evaluation upon requested advanced standing since the request of the program director and fellow. Approval will last review. Verify that advanced be granted on a case-by-case basis. standing was granted. Program Director Comments (REQUIRED):

C. Osteopathic Philosophy and Osteopathic Manipulative Medicine 5.6 Training in osteopathic principles and practice must be Lecture schedules, journal club and/or 3 provided in both structured educational activities and book club topics. clinical formats. Chart review of both inpatient and clinic charts looking for evidence of documentation of osteopathic assessment and treatment. Program description Interviews with program director and fellows. Program Director Comments (REQUIRED):

D. Medical Knowledge 5.7 The formal structure of educational activities must include Lecture schedules 1 monthly journal clubs. Program description Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.8 The formal structure of educational activities must include Lecture schedules 1 twice-weekly case conferences. Program description Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.9 The formal structure of educational activities must include Lecture schedules 3 four hours per week of structured faculty didactic Program description participation. Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.10 Attendance at required educational activities must be Attendance documentation (paper or 1 documented electronic) for fellow and faculty participation

5.11 Each fellow must participate in internal medicine Lecture schedule 1 subspecialty board review, either in the form of an ongoing Program description program, or by the program sponsoring the fellow’s Attendance documentation (paper or attendance at an internal medicine subspecialty board electronic) for internal board review review course. ACOI will supply names of residents who have attended the ACOI board review course Documentation of attendance of board review course in residents’ files Program Director Comments (REQUIRED):

E. Interpersonal Communication Skills 5.12 The fellow must have training in communication Lecture schedules 1 skills with patients, patient families and other Collaborative rounding process members of the health care team, including patients Communication training modules with communication barriers, such as sensory Methods for language interpretation impairments, dementia and language differences. Simulation center or standardized patient curriculum Program Director Comments (REQUIRED):

F. Professionalism 5.13 The fellow must have training in health care Lecture schedules 1 disparities. Cultural competence training modules Community service experience or expectations for fellows Program Director Comments (REQUIRED):

5.14 The fellow must have training in ethical conduct in Lecture schedules 1 interactions with patients, patient families and other Training module completion members of the health care team.

5.15 The fellow must have training in health information Lecture schedules 1 protection policies Training module completion

Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

G. Practice-Based Learning and Improvement 5.16 The fellow must have training in teaching skills. Lecture schedules 1 Training module completion

5.17 The fellow must participate in the training of students Chart review of student notes 1 and/or fellows. Chart review of resident notes Resident & Student lecture schedules Program Director Comments (REQUIRED):

5.18 The fellow must have training in the use of electronic Lecture schedules 1 health records. Training module completion Program description Demonstration of EHR

5.19 The fellow must have learning activities and participation Description of quality improvement 1 in quality improvement processes. projects Evidence of dissemination of quality improvement projects (abstracts and/or posters) Participation in quality or performance improvement committees or processes. Morbidity & Mortality conference. Program Director Comments (REQUIRED):

5.20 The fellow must have structured learning activities in Lecture schedules 1 medical research throughout the program including, at a Training modules minimum: research types and methodology, biostatistics, Program description health services research and interpretation of medical literature. Program Director Comments (REQUIRED):

H. Systems-Based Practice 5.21 The fellow must have training in practice management. Lecture schedules 1 Training modules Program description Chart audits of coding accuracy Participation in utilization review committees Program Director Comments (REQUIRED):

5.22 The fellow must have training in health policy and Lecture schedules 1 administration. Training modules TIPS program participation

Site Reviewer Comments (describe not met or commendations): SPECIFIC PULMONARY DISEASES REQUIREMENTS I. Program Duration 5.23 The fellowship training program is a full-time Rotational curriculum 1 training program of a minimum of 24 months in Program description duration. Fellow interviews Program director interview Program Director Comments (REQUIRED):

J. Medical Knowledge 5.24 The fellow must have learning activities in Lecture schedules 1 obstructive lung disease including asthma, Program description bronchitis, emphysema, bronchiectasis, Attendance documentation (paper or transplant/reduction surgery, and cystic fibrosis. electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.25 The fellow must have learning activities in Lecture schedules 1 pulmonary malignancy, both primary and metastatic. Program description Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.26 The fellow must have learning activities in Lecture schedules 1 pulmonary infections including tuberculosis, fungal, Program description and those in the immunocompromised host. Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

5.27 The fellow must have learning activities in diffuse Lecture schedules 1 interstitial lung disease. Program description Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.28 The fellow must have learning activities in Lecture schedules 1 pulmonary vascular disease including primary and Program description secondary pulmonary hypertension, vasculitis and Attendance documentation (paper or pulmonary hemorrhage syndromes. electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.29 The fellow must have learning activities in Lecture schedules 1 occupational and environmental lung diseases. Program description Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.30 The fellow must have learning activities in Lecture schedules 1 iatrogenic respiratory diseases including drug- Program description induced lung disease. Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum

5.31 The fellow must have learning activities in acute Lecture schedules 1 lung injury including injuries from radiation, toxic Program description inhalation, and trauma. Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.32 The fellow must have learning activities in Lecture schedules 1 pulmonary manifestations of systemic diseases Program description including collagen vascular diseases. Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.33 The fellow must have learning activities in Lecture schedules 1 respiratory failure including acute respiratory Program description distress syndromes, acute and chronic respiratory Attendance documentation (paper or failure in chronic obstructive pulmonary disease, and electronic) for fellow and faculty in neuromuscular respiratory drive disorders. participation Curriculum

Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

5.34 The fellow must have learning activities in disorders Lecture schedules 1 of the pleura and the mediastinum. Program description Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum

5.35 The fellow must have learning activities in genetic Lecture schedules 1 and developmental disorders of the respiratory Program description system. Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

5.36 The fellow must have learning activities in sleep Lecture schedules 1 disorders. Program description Attendance documentation (paper or electronic) for fellow and faculty participation Curriculum Program Director Comments (REQUIRED):

K. Patient Care 5.37 The fellow must have training and experience in Rotational curriculum 1 pulmonary function tests to assess respiratory Program description mechanics, gas exchange and respiratory drive Fellow interview including spirometry, flow volume studies, lung Program director interview volumes, diffusing capacity, distribution of ventilation, airways resistance, lung compliance, arterial blood gas analysis, and exercise studies to include, at minimum: indications; contraindications; complications; limitations, interpretation and evidence of competent performance. Program Director Comments (REQUIRED):

5.38 The fellow must have training and experience in Rotational curriculum 1 thoracentesis, flexible fiberoptic bronchoscopy and Program description related procedures, endotracheal intubation, Institutional segregated totals percutaneous arterial puncture and cannulation, Fellow interview central venous catheterization, and pulmonary artery Program director interview balloon catheterization to include, at minimum: indications; contraindications; complications; limitations, interpretation and evidence of competent performance Program Director Comments (REQUIRED):

5.39 The fellow must have training and experience in the Rotational curriculum 1 following to include, at minimum: indications; Program description contraindications; complications; limitations, interpretation Institutional segregated totals and evidence of competent performance: Fellow interview Program director interview a. Calibration and operation of hemodynamic recording systems. b. Ventilatory support, including pressure- cycled, volume-cycled, time-cycled and flow-cycled mechanical ventilation. c. Weaning and respiratory care techniques. d. Management of pneumothorax (needle insertion and drainage system) e. Examination and interpretation of sputum, bronchopulmonary secretions, pleural fluid and lung tissue for infectious agents, cytology, and histopathology.

Site Reviewer Comments (describe not met or commendations): 5.40 The fellow must have training and experience in the Rotational curriculum 1 following to include, at minimum: indications; Program description contraindications; complications; limitations and Institutional segregated totals interpretation: Fellow interview a. Imaging procedures including chest Program director interview roentgenograms, pet interd, computed axial tomograms, radionuclide scans, and pulmonary angiograms b. Sleep studies c. Inhalation challenge studies d. Allergy skin testing e. Cardiopulmonary stress testing.

L. Ambulatory Clinic 5.41 The fellow must attend a continuity clinic for a minimum Ambulatory appointment schedules 1 of four hours per week, 46 weeks per year. Segregated totals from ambulatory clinic (visit numbers and type, diagnosis) Ambulatory clinic logs Program Director Comments (REQUIRED):

5.42 The fellow must maintain a log of all outpatient Ambulatory appointment schedules 1 cases. Segregated totals from ambulatory clinic (visit numbers and type, diagnosis) Ambulatory clinic logs

VI. FACULTY AND ADMINISTRATION GENERAL INTERNAL MEDICINE FELLOWSHIP STANDARDS A. Program Director 6.1 The program director must be certified in the Program director CV 3 applicable internal medicine subspecialty by the Program director interview AOA through the American Osteopathic Board of Verified by the ACOI Internal Medicine. Program Director Comments (REQUIRED):

6.2 The program director must have practiced in the Program director CV 1 applicable internal medicine subspecialty for a Program director interview minimum of three (3) years. Verified by the ACOI

6.3 The program director must be an active member of the Program director CV 1 ACOI. Program director interview Verified by the ACOI Program Director Comments (REQUIRED):

6.4 The program director's authority in directing the fellowship Program director job description 1 training program must be defined in the program OGME committee minutes or by-laws documents of the institution. Organizational chart for OGME Program description DME interview Program director interview Program Director Comments (REQUIRED):

6.5 The program director must comply with the requests of the Program director interview 1 ACOI’s Council on Education and Evaluation. Verified by the ACOI

6.6 The program director must have compensated dedicated Program director job description 1 time to administer the training program. OGME committee minutes or by-laws DME interview Program director interview Program Director Comments (REQUIRED):

6.7 The program director must prepare required material for Program director interview 1 on-site program review. Verified by the ACOI Verified by site reviewer Program Director Comments (REQUIRED):

6.8 The program director must submit to the ACOI annual Evidence of completion (web based 1 reports for all fellows by July 31 of each calendar year. or print-out) Final reports for fellows who complete the program in Program director interview months other than June must be submitted within 30 days Verified by the ACOI of training completion. Delinquent annual reports will not be reviewed until a delinquency fee is paid as determined by the ACOI’s administrative policies. Program Director Comments (REQUIRED):

6.9 The program director must attend the annual ACOI Evidence of attendance 1 Congress on Medical Education for Resident Trainers Program director interview every other year. Verified by the ACOI Program Director Comments (REQUIRED):

6.10 The program director must attend the annual ACOI Evidence of attendance 1 Congress on Medical Education for resident Trainers Program director interview in the first year of appointment. Verified by the ACOI

Site Reviewer Comments (describe not met or commendations): 6.11 The program director must notify the ACOI of the fellow’s Evidence of completion 1 entry into the training program by submitting a fellow list Program director interview annually on a form furnished by ACOI. Verified by the ACOI

6.12 The program director must maintain an e-mail address and Program director interview 1 provide it to the ACOI. Verified by the ACOI

6.13 The program director must provide fellows with Fellows interviews information regarding the requirements for certification in the subspecialty. Program Director Comments (REQUIRED):

B. Faculty 6.14 The faculty of the training program must be selected based Faculty selection criteria 1 on their commitment to teaching and the quality of the Evidence of action regarding faculty teaching provided. appointment Program director interview Faculty interviews Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

6.15 The faculty must make available non-clinical time to Program director interview 1 provide instruction to fellows. Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

6.16 The faculty must participate in the program’s learning Lecture schedules 1 activities, such as didactic lectures, case conferences, Attendance documentation (paper or journal clubs, book clubs and board review. electronic) Program director interview Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

6.17 The faculty’s credentials, including CVs, must be on file Faculty list with credentials 1 and available for review at the time of the AOA on-site Faculty CVs program review

VII. FELLOW REQUIREMENTS GENERAL INTERNAL MEDICINE FELLOWSHIP STANDARDS 7.1 The fellows must have completed either an AOA-approved Fellow files 1 or an ACGME-approved internal medicine residency.

7.2 Fellows who completed an ACGME-approved internal medicine residency must gain AOA approval of their training prior to completion of the first year of the fellowship and supply documentation of this to the program director. Program Director Comments (REQUIRED):

7.3 The fellows must be members of the ACOI. Fellow files 1 Verified by the ACOI

7.4 The fellows must submit a fellow annual report online to Evidence of fellow receipt and review 1 the ACOI by July 31 of each calendar year. Final reports of score (paper or electronic) of fellows who complete the program in months other than Program director interview June must be submitted within thirty (30) days of Fellow interview completion of the training year. Delinquent annual reports ACOI Fellow annual report will not be reviewed until a delinquency fee is paid as Verified by the ACOI determined by the ACOI’s administrative policies. Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

7.5 The fellows must attend a minimum of 70 percent of all Lecture schedules 1 meetings as directed by the program director. Attendance documentation (paper or electronic) Program director interview Fellow interviews Program Director Comments (REQUIRED):

7.6 The fellows must participate in hospital committee Hospital committee rosters and 1 meetings directed by the program director. attendance Program director interview Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

7.7 The fellow must describe the title and type of research Verified by ACOI 1 project planned on the first-year Fellow Annual Report that is submitted to the ACOI.

7.8 The fellow must complete one research project and submit Fellow files 1 a research paper to the ACOI Council on Education & Program director interview Evaluation during their subspecialty training. If the project Fellow interviews is a case report, it must be submitted six months prior to the completion of the fellowship. If the project is a report of an original clinical research study, the report must be submitted by the completion of training. For fellowships that are only one-year in duration, case reports may be submitted at the completion of the fellowship (include clinical outcome studies). Program Director Comments (REQUIRED):

VIII. EVALUATION GENERAL INTERNAL MEDICINE FELLOWSHIP STANDARDS 8.1 The faculty and fellows must evaluate the program and Minutes from annual meeting or other 1 curriculum annually to ensure that it is consistent with the evidence of program and curriculum current goals of the program, and further address, at review minimum: pass rates on the applicable AOBIM GMEC committee minutes certification examination; fellow retention rates in the Program director interview program; percent of graduates completing the program in Faculty interviews the minimum time; placement of graduates and Fellow interviews professional accomplishments of graduates. Program Director Comments (REQUIRED):

8.2 Faculty must evaluate the fellow after each rotational Evaluations (paper or electronic) 1 assignment. Program director interview Faculty interviews Fellow interviews

8.3 The program director, with faculty input, will complete Evaluations (paper or electronic) 1 quarterly evaluations of each fellow’s performance. Program director interview Faculty interviews Fellow interviews Program Director Comments (REQUIRED): Site Reviewer Comments (describe not met or commendations):

8.4 The ambulatory clinic director must complete semiannual Evaluations (paper or electronic) 1 written evaluations of the fellow’s performance (if Program director interview applicable). Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

8.5 Completed evaluations must be shared with the fellow to Evaluations (paper or electronic) 1 foster continuous improvement. Program director interview Fellow interviews Program Director Comments (REQUIRED):

8.6 All evaluations must be signed by the person completing Evaluations (paper or electronic) 1 the evaluation, the program director and the fellow. Program director interview Electronic signatures are acceptable. Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

8.7 The program director or a designee must meet with the Evaluations (paper or electronic) 1 fellow semiannually to review and document the fellow’s Program director interview progress. Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

8.8 At the end of each training year, the program director, with Documentation of advancement 1 faculty input, must determine whether each fellow has the (promotion letter, etc.) necessary qualifications to progress to the next training Program director interview year, or be considered program complete. Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

8.9 Fellows must complete a monthly service evaluation of Evaluations (paper or electronic) 1 each rotation and the faculty who supervised their training. Program director interview Faculty interviews Fellow interviews Program Director Comments (REQUIRED):

8.10 Fellows’ identities in faculty evaluations must remain Program director interview 1 confidential. Faculty interviews Fellow interviews

8.11 Faculty performance must be reviewed on an annual basis Evidence of faculty evaluation 1 by the program director. Faculty recruitment and retention policy Program director interview Faculty interviews

8.12 Information provided by fellows must be included as part Evidence of faculty evaluation 1 of the assessment of faculty performance. Faculty recruitment and retention policy Program director interview Faculty interviews Program Director Comments (REQUIRED):

8.13 The program must have a remediation policy for fellows Remediation policy 1 who are performing at an unsatisfactory level. Program director interview Faculty interviews Fellow interviews

Section Number Total Met Total Not Met Maximum Possible IV. V. VI VII VIII Total