Program Director Transition Request
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Program Director Transition Request
Program name: Current program director: Proposed program director: Proposed date of transition: Date proposed program director first appointed as faculty member in the department: Proposed term of the appointment: Interim Permanent Proposed program director phone number: Proposed program director email address for communicating with the ACGME: Form completed by (name and title): Date of submission:
RATIONALE: Provide a brief statement describing the reason for the proposed change in program director. If the proposed is an interim term of appointment, please explain.
Will the current program director remain in the program as teaching faculty?
Yes No
Are there associate/assistant program director(s)? Yes No If yes, please specify the roles, people, and how much time does each devote to the program?
Associate/Assistant Program Director:
SELECTION PROCESS: Provide a detailed explanation of the selection process (including whether or not it involved a national search, a brief description of the selection committee, etc.).
Selection process:
QUALIFICATIONS: Does the nominee meet the ACGME and/or program specific RRC Requirements (e.g., minimum experi- ence as faculty member; length of appointment, etc)? Please check the program’s specific RRC require- ments on the ACGME website.
Yes No
Please summarize the nominee’s qualifications. This may include prior experience as a program director or other educational leadership position (associate/assistant program director, clerkship director), involve- ment in the residency/fellowship training program, serving as a member of an education committee, etc.
Qualifications: RESOURCES: Please provide information on how the nominee will be provided with sufficient amount of support for pro- gram administration. Please check the program’s specific RRC requirements on the ACGME website:
Program Director protected time: Specify % time or # of days per week dedicated for the PD role for which the proposed program director will be compensated:
Administrative support: (Name of Coordinator(s) and FTE(s) of support )
How will the proposed program director responsibilities change, if any, in order to have sufficient time for the role as Program Director? For example, change in % _____in clerical, administrative, research time.
OTHER COMMENTS: Please provide any additional comments or details that you may have in support of the nomination.
Other comments:
REQUIRED ATTACHMENTS:
Candidate’s CV.
Program Director Job Description (template available).
http://www.partners.org/Graduate-Medical-Education/Program-Directors/Pro- gram-Changes-and-GME-Committee-Oversight.aspx
The job description must include requirements stipulated by the ACGME in both the “Common Program Requirements” and specialty program requirements. These may include Program Direc- tor credentials, time commitment, and specific responsibilities. The job description should also specify the frequency and manner of evaluation of the program director, in order to ensure that periodic constructive feedback is provided.
Please return the completed request and all requested documents via email to Irina Knyshevski ([email protected]) for BWH programs or Diane Sheehan ([email protected]) for MGH programs.
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