ACGME Program Requirements for Graduate Medical Education in Emergency Medical Services

Transcription

1 ACGME Program Requirements for Graduate Medical Education in Emergency Medical Services ACGME approved: September 30, 2012; effective: September 30, 2012 ACGME approved categorization: September 30, 2012; effective: July 1, 2013 Revised Common Program Requirements effective: July 1, 2015

2 ACGME Program Requirements for Graduate Medical Education in Emergency Medical Services One-year Common Program Requirements are in BOLD Introduction Int.A Residency and fellowship programs are essential dimensions of the transformation of the medical student to the independent practitioner along the continuum of medical education. They are physically, emotionally, and intellectually demanding, and require longitudinally-concentrated effort on the part of the resident or fellow. The specialty education of physicians to practice independently is experiential, and necessarily occurs within the context of the health care delivery system. Developing the skills, knowledge, and attitudes leading to proficiency in all the domains of clinical competency requires the resident and fellow physician to assume personal responsibility for the care of individual patients. For the resident and fellow, the essential learning activity is interaction with patients under the guidance and supervision of faculty members who give value, context, and meaning to those interactions. As residents and fellows gain experience and demonstrate growth in their ability to care for patients, they assume roles that permit them to exercise those skills with greater independence. This concept-- graded and progressive responsibility--is one of the core tenets of American graduate medical education. Supervision in the setting of graduate medical education has the goals of assuring the provision of safe and effective care to the individual patient; assuring each resident s and fellow s development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine; and establishing a foundation for continued professional growth. Int.B. Int.C. Emergency medical services is a clinical specialty that includes the care of patients in all environments outside of traditional medical care facilities, including clinics, offices, and hospitals. It includes evaluation and treatment of acute injury and illness in all age groups, planning and prevention, monitoring, and team oversight. The educational program in emergency medical services must be 12 months. (Core) * I. Institutions I.A. Sponsoring Institution One sponsoring institution must assume ultimate responsibility for the program, as described in the Institutional Requirements, and this responsibility extends to fellow assignments at all participating sites. (Core) The sponsoring institution and the program must ensure that the program director has sufficient protected time and financial support for his or her Emergency Medical Services 1

3 educational and administrative responsibilities to the program. (Core) I.A.1. I.A.1.a) I.A.1.b) I.A.1.c) I.A.1.d) I.A.2. I.B. I.B.1. The sponsoring institution and participating sites must: provide at least 25 percent salary support or equivalent protected time for program directors; (Detail) provide at least 15 percent salary support or equivalent protected time for faculty members; (Detail) provide support at least 20 percent salary support for a program coordinator(s); and, (Detail) provide other support personnel required for operation of the program. (Detail) The sponsoring institution must also sponsor an Accreditation Council for Graduate Medical Education (ACGME)-accredited residency program in emergency medicine. (Core) Participating Sites There must be a program letter of agreement (PLA) between the program and each participating site providing a required assignment. The PLA must be renewed at least every five years. (Core) The PLA should: I.B.1.a) I.B.1.b) I.B.1.c) I.B.1.d) I.B.2. I.B.3. I.B.4. identify the faculty who will assume both educational and supervisory responsibilities for fellows; (Detail) specify their responsibilities for teaching, supervision, and formal evaluation of fellows, as specified later in this document; (Detail) specify the duration and content of the educational experience; and, (Detail) state the policies and procedures that will govern fellow education during the assignment. (Detail) The program director must submit any additions or deletions of participating sites routinely providing an educational experience, required for all fellows, of one month full time equivalent (FTE) or more through the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System (ADS). (Core) The program should be based at the primary clinical site. (Core) Required rotations to participating sites that are geographically distant from the sponsoring institution should offer special resources unavailable Emergency Medical Services 2

4 locally that significantly augment the overall educational experience of the program. (Detail) I.B.5. I.B.6. I.B.6.a) II. II.A. II.A.1. The number and location of participating sites must not preclude the satisfactory participation by all residents in conferences and other educational experiences. (Core) The program must be affiliated with a medical school. (Core) Program Personnel and Resources Program Director The program must have a written letter of understanding which documents the duties and responsibilities of both the medical school and the program. (Detail) There must be a single program director with authority and accountability for the operation of the program. The sponsoring institution s GMEC must approve a change in program director. (Core) II.A.1.a) II.A.2. II.A.2.a) II.A.2.b) II.A.2.c) II.A.2.d) II.A.2.e) II.A.2.f) II.A.3. The program director must submit this change to the ACGME via the ADS. (Core) Qualifications of the program director must include: requisite specialty expertise and documented educational and administrative experience acceptable to the Review Committee; (Core) current certification in the subspecialty by the American Board of Emergency Medicine, or subspecialty qualifications that are acceptable to the Review Committee; and, (Core) current medical licensure and appropriate medical staff appointment; (Core) at least three years experience as a core physician faculty member in an ACGME-accredited emergency medicine program or emergency medical services program; (Detail) continuation in his or her position for a length of time adequate to maintain continuity of leadership and program stability; and, (Detail) current clinical activity in emergency medical services. (Core) The program director must administer and maintain an educational environment conducive to educating the fellows in each of the ACGME competency areas. (Core) The program director must: Emergency Medical Services 3

5 II.A.3.a) II.A.3.b) II.A.3.c) II.A.3.c).(1) II.A.3.c).(2) II.A.3.c).(3) II.A.3.c).(4) II.A.3.c).(5) II.A.3.c).(6) II.A.3.c).(7) II.A.3.c).(8) II.A.3.d) II.A.3.d).(1) II.A.3.d).(2) II.A.3.e) II.A.3.f) prepare and submit all information required and requested by the ACGME; (Core) be familiar with and oversee compliance with ACGME and Review Committee policies and procedures as outlined in the ACGME Manual of Policies and Procedures; (Detail) obtain review and approval of the sponsoring institution s GMEC/DIO before submitting information or requests to the ACGME, including: (Core) all applications for ACGME accreditation of new programs; (Detail) changes in fellow complement; (Detail) major changes in program structure or length of training; (Detail) progress reports requested by the Review Committee; (Detail) requests for increases or any change to fellow duty hours; (Detail) voluntary withdrawals of ACGME-accredited programs; (Detail) requests for appeal of an adverse action; and, (Detail) appeal presentations to a Board of Appeal or the ACGME. (Detail) obtain DIO review and co-signature on all program application forms, as well as any correspondence or document submitted to the ACGME that addresses: (Detail) program citations, and/or, (Detail) request for changes in the program that would have significant impact, including financial, on the program or institution. (Detail) dedicate an average of 10 hours per week of his or her professional effort to the fellowship, with sufficient time for administration of the program; (Core) develop and implement a written supervision policy that specifies fellow and faculty member lines of responsibility; (Detail) Emergency Medical Services 4

6 II.A.3.g) II.A.3.h) II.A.3.i) participate in academic societies and educational programs designed to enhance his or her educational and administrative skills; (Detail) maintain a collaborative relationship with the program director of the sponsoring core residency program to ensure compliance with the ACGME s accreditation standards; and, (Detail) ensure a unified educational experience for fellows. (Detail) II.B. II.B.1. II.B.1.a) II.B.1.a).(1) II.B.2. II.B.3. II.B.4. II.B.5. II.B.6. II.B.7. II.B.7.a) II.B.7.a).(1) Faculty There must be a sufficient number of faculty with documented qualifications to instruct and supervise all fellows. (Core) In addition to the program director there must be at least two core physician faculty members with EMS experience whose practice makes them available for consultation by fellows. (Detail) These additional core physician faculty members must each devote a minimum of five hours per week of supervision to the fellows. (Detail) The faculty must devote sufficient time to the educational program to fulfill their supervisory and teaching responsibilities and demonstrate a strong interest in the education of fellows. (Core) The physician faculty must have current certification in the subspecialty by the American Board of Emergency Medicine, or possess qualifications judged acceptable to the Review Committee. (Core) The physician faculty must possess current medical licensure and appropriate medical staff appointment. (Core) Program faculty members must have appropriate faculty appointments at the medical school. (Core) All core physician faculty members must be involved in continuing scholarly activity. (Core) The program s core physician faculty members must demonstrate significant contributions to the subspecialty of emergency medical services. (Core) At minimum, each individual core physician faculty member must demonstrate at least one piece of scholarly activity per year, averaged over the past five years. (Core) At minimum, this must include one scientific peer-reviewed publication for every two core physician faculty members Emergency Medical Services 5

7 per year, averaged over the previous five-year period. (Detail) II.B.8. II.B.8.a) II.B.9. II.B.9.a) II.C. Faculty development opportunities must be made available to each core physician faculty member. (Core) Faculty members should participate in faculty development programs designed to enhance the effectiveness of their teaching. (Detail) Consultants and/or program faculty members should be available for consultation and academic lectures. (Detail) Other Program Personnel Consultants and/or program faculty members should include those with special expertise in air medical services, biostatistics, cardiology, critical care, disaster and mass casualty incident management, epidemiology, forensics, hazardous materials and mass exposure to toxins, mass gatherings, neurology, pediatrics, pharmacology, psychiatry, public health, pulmonary medicine, resuscitation, toxicology, and trauma surgery. (Detail) The institution and the program must jointly ensure the availability of all necessary professional, technical, and clerical personnel for the effective administration of the program. (Core) II.C.1. II.D. Resources At a minimum, there must be at least one 0.2 FTE program coordinator dedicated solely to the fellowship program administration. (Core) The institution and the program must jointly ensure the availability of adequate resources for fellow education, as defined in the specialty program requirements. (Core) II.D.1. II.D.2. II.D.2.a) II.D.2.b) II.D.2.c) II.D.2.d) Adult and pediatric medical transports in all types of settings outside of traditional medical care settings must be available. (Core) The primary clinical site must provide: an emergency service that has access to adult and pediatric patients; (Core) access to adult and pediatric inpatient facilities; (Core) disaster planning and response programs; and, (Core) two-way communications between the primary clinical site and surrounding medical transportation services for provision of direct medical oversight. (Core) Emergency Medical Services 6

8 II.D.3. II.D.4. II.D.5. II.D.6. II.D.7. II.E. The primary clinical site should organize and ensure provision of transportation for fellows to provide pre-hospital patient care. (Core) There should be an air medical evacuation and inter-facility transportation service accessible from the primary clinical site. (Core) There must be a patient population that includes patients of all ages and genders, with a wide variety of clinical problems, and that is adequate in number and variety to meet the educational needs of the program. (Core) Fellows must be provided with prompt, reliable systems for communication and interactions with supervisory physicians. (Core) The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities. (Detail) Medical Information Access Fellows must have ready access to specialty-specific and other appropriate reference material in print or electronic format. Electronic medical literature databases with search capabilities should be available. (Detail) III. III.A. Fellow Appointments Eligibility Criteria Each fellow must successfully complete an ACGME-accredited specialty program and/or meet other eligibility criteria as specified by the Review Committee. (Core) III.A.1. III.A.1.a) III.B. The program must document that each fellow has met the eligibility criteria. (Detail) Number of Fellows Prior to entry into the program fellows must have successfully completed an ACGME-accredited residency, excluding transitional year programs. (Core) The program s educational resources must be adequate to support the number of fellows appointed to the program. (Core) III.B.1. IV. IV.A. Educational Program The program director may not appoint more fellows than approved by the Review Committee, unless otherwise stated in the specialtyspecific requirements. (Core) The curriculum must contain the following educational components: Emergency Medical Services 7

9 IV.A.1. IV.A.2. Skills and competencies the fellow will be able to demonstrate at the conclusion of the program. The program must distribute these skills and competencies to fellows and faculty at least annually, in either written or electronic form. (Core) ACGME Competencies The program must integrate the following ACGME competencies into the curriculum: (Core) IV.A.2.a) IV.A.2.a).(1) Patient Care and Procedural Skills Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Fellows: (Outcome) must demonstrate competence in the practice of patient evaluation and treatment of patients of all ages and genders requiring emergency medical services by: (Outcome) IV.A.2.a).(1).(a) IV.A.2.a).(1).(b) IV.A.2.a).(1).(c) IV.A.2.a).(1).(d) IV.A.2.a).(1).(e) IV.A.2.a).(1).(f) IV.A.2.a).(1).(g) IV.A.2.a).(2) gathering accurate, essential information in a timely manner; (Outcome) evaluating and comprehensively treating acutely-ill and injured patients in the pre-hospital setting; (Outcome) prioritizing and stabilizing multiple patients in the pre-hospital setting while performing other responsibilities simultaneously; (Outcome) properly sequencing critical actions for patient care; (Outcome) integrating information obtained from patient history, physical examination, physiologic recordings, and test results to arrive at an accurate assessment and treatment plan; (Outcome) integrating relevant biological, psychosocial, social, economic, ethnic, and familial factors into the evaluation and treatment of their patients; and, (Outcome) planning and implementing therapeutic treatment, including pharmaceutical, medical device, behavioral, and surgical therapies. (Outcome) Fellows must be able to competently perform all medical, diagnostic and surgical procedures Emergency Medical Services 8

10 considered essential for the area of practice. Fellows: (Outcome) must demonstrate competence in the practice of technical skills of patients of all ages and genders requiring emergency medical services by: (Outcome) IV.A.2.a).(2).(a) IV.A.2.a).(2).(b) IV.A.2.a).(2).(b).(i) IV.A.2.a).(2).(b).(ii) IV.A.2.a).(2).(b).(iii) IV.A.2.a).(2).(b).(iv) IV.A.2.a).(2).(b).(v) IV.A.2.a).(2).(b).(vi) IV.A.2.a).(2).(b).(vii) IV.A.2.a).(2).(b).(viii) IV.A.2.a).(2).(b).(ix) IV.A.2.a).(2).(b).(x) IV.A.2.b) Medical Knowledge performing physical examinations relevant to the practice of emergency medical services (Outcome) performing the following key index procedures: (Outcome) participation in a mass casualty/disaster triage at an actual event or drill; (Outcome) participation in a sentinel event investigation; (Outcome) conduction of a quality management audit; (Outcome) development of a mass gathering medical plan and participation in its implementation; (Outcome) emergency medical services protocol development or revision; (Outcome) immobilization of the spine; (Outcome) immobilization of an injured extremity; (Outcome) management of a cardiac arrest in the prehospital setting; (Outcome) management of a compromised airway in the pre-hospital setting; and, (Outcome) provision of direct medical oversight onscene, or by radio or phone. (Outcome) Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socialbehavioral sciences, as well as the application of this knowledge to patient care. Fellows: (Outcome) must demonstrate competence in their knowledge of the following: Emergency Medical Services 9

11 IV.A.2.b).(1) IV.A.2.b).(2) IV.A.2.b).(3) IV.A.2.b).(4) IV.A.2.b).(5) IV.A.2.b).(6) IV.A.2.b).(7) IV.A.2.b).(8) IV.A.2.b).(9) IV.A.2.b).(10) IV.A.2.c) clinical manifestations and management of acutely-ill and injured patients in the pre-hospital setting; (Outcome) disaster planning and response; (Outcome) evidence-based decision making; (Outcome) procedures and techniques necessary for the stabilization and treatment of patients in the pre-hospital setting; (Outcome) provision of medical care in mass gatherings; (Outcome) public safety answering points, dispatch centers, emergency communication centers operation, and medical oversight; (Outcome) experimental design and statistical analysis of data as related to emergency medical services clinical outcomes and epidemiologic research; (Outcome) models, function, management, and financing of emergency medical services systems; (Outcome) principles of quality improvement and patient safety; and, (Outcome) principles of epidemiology and research methodologies in emergency medical services. (Outcome) Practice-based Learning and Improvement Fellows are expected to develop skills and habits to be able to meet the following goals: IV.A.2.c).(1) IV.A.2.c).(2) IV.A.2.c).(3) IV.A.2.d) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; and, (Outcome) locate, appraise, and assimilate evidence from scientific studies related to their patients health problems; (Outcome) demonstrate proficiency in the critical assessment of medical literature, medical informatics, clinical epidemiology, and biostatistics; (Outcome) Interpersonal and Communication Skills Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and Emergency Medical Services 10

12 collaboration with patients, their families, and health professionals. (Outcome) Fellows must demonstrate competence in the following: IV.A.2.d).(1) IV.A.2.d).(1).(a) IV.A.2.d).(1).(b) IV.A.2.d).(1).(c) IV.A.2.d).(2) IV.A.2.d).(3) IV.A.2.d).(4) IV.A.2.d).(5) IV.A.2.e) the ability to relate, with compassion, respect, and professional integrity, to patients and their families, as well as to other members of the health care team, sensitive issues or unexpected outcomes, including: (Outcome) diagnostic findings; (Outcome) end-of-life issues and death; and, (Outcome) medical errors. (Outcome) the ability to work effectively as a member or leader of a health care team or other professional group; (Outcome) effective teaching techniques including teaching peers, emergency medical services personnel, other health care professionals, and patients; (Outcome) maintaining comprehensive, timely, and legible medical records; and, (Outcome) oral and written communication skills. (Outcome) Professionalism Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (Outcome) Fellows must demonstrate: IV.A.2.e).(1) IV.A.2.e).(2) IV.A.2.e).(3) IV.A.2.e).(4) a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices; (Outcome) a commitment to lifelong learning, and an attitude of caring derived from humanistic and professional values; (Outcome) high standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and avoiding conflicts of interest; (Outcome) respect, compassion, and integrity to patients and other members of the health care team; and, (Outcome) Emergency Medical Services 11

13 IV.A.2.e).(5) IV.A.2.f) sensitivity and responsiveness to a patient s culture, age, gender, and disabilities. (Outcome) Systems-based Practice Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. (Outcome) Fellows must demonstrate competence in: IV.A.2.f).(1) IV.A.2.f).(2) IV.A.2.f).(3) IV.A.2.f).(4) IV.A.2.f).(5) IV.A.3. IV.A.3.a) IV.A.3.b) IV.A.3.b).(1) IV.A.3.b).(1).(a) IV.A.3.b).(1).(b) advocating for quality patient care and optimal patient care systems; (Outcome) appropriate resource allocation and utilization; (Outcome) cooperative interaction with other care providers; (Outcome) interprofessional team participation for the enhancement of patient safety and for the improvement of patient care quality; and, (Outcome) leadership skills in the coordination and integration of care across a variety of disciplines and provider types. (Outcome) Curriculum Organization and Fellow Experiences The core curriculum must include a didactic program based upon the core knowledge content of emergency medical services and consistent with the required outcomes specified for medical knowledge. (Core) There must be regularly scheduled didactic sessions; (Core) Didactic sessions must include presentations based on the defined curriculum, administrative seminars, journal review, morbidity and mortality conferences, and research seminars, and should include joint conferences cosponsored with other disciplines. (Core) Educational methods should include problembased learning, evidence-based learning, laboratory-based instruction, and computer-based instruction. (Detail) The program must provide an educational justification if alternative methods of education are used. (Detail) Emergency Medical Services 12

14 IV.A.3.b).(1).(c) IV.A.3.c) IV.A.3.c).(1) IV.A.3.c).(2) IV.A.3.c).(3) IV.A.3.c).(3).(a) All planned didactic experiences must have an evaluative component to measure fellow participation and educational effectiveness, including faculty member-fellow interaction. (Outcome) The curriculum must provide an average of at least three hours per week of planned didactic experiences developed by the program faculty members. (Core) Fellows must participate, on average, in at least 70 percent of the planned didactic experiences offered. (Core) Fellows must participate in planning and conducting didactic experiences, and delivery of didactic experiences to the core emergency medicine program. (Detail) All planned didactic experiences must be supervised by faculty members. (Core) Each core physician faculty member must attend, on average, at least 25 percent of planned didactic experiences. (Detail) IV.A.3.c).(3).(b) Faculty members must present more than 50 percent of planned didactic experiences. (Detail) IV.A.3.d) IV.A.3.d).(1) IV.A.3.d).(2) IV.A.3.d).(3) IV.A.3.d).(4) IV.A.3.d).(5) Fellows experiences must include the following: 12 months as the primary or consulting physician responsible for providing direct patient evaluation and management in the pre-hospital setting, as well as supervision of care provided by all allied health providers in the pre-hospital setting; (Core) experience with regional and state offices of emergency medical services and other regulatory bodies that affect the care of patients in the pre-hospital setting; (Core) ensure exposure and education in medical direction of air medical transports or an experience that would include supervision of air medical crews during medical transports; (Core) participating in administrative components of an emergency medical services system to determine functioning, designs, and processes to ensure quality of patient care in the pre-hospital setting; (Core) providing exposure to clinical services in a variety of emergency medical services systems, including thirdservice, and fire-based, governmental, and for-profit Emergency Medical Services 13

15 services; (Core) IV.A.3.d).(6) IV.A.3.d).(6).(a) IV.A.3.d).(7) IV.A.3.e) IV.A.3.e).(1) providing direct medical oversight of patient care by emergency medical services personnel, including: (Core) experience in an emergency communications center and a public safety answering point utilizing emergency medical dispatching guidelines. (Core) providing evaluations and management of both adult and pediatric aged acutely-ill and injured patients in the prehospital setting; (Core) Fellows should maintain their primary Board skills during their fellowships. (Detail) Fellows must not provide more than 12 hours per week of clinical practice unrelated to emergency medical services averaged over four weeks. (Detail) IV.B. IV.B.1. IV.B.2. IV.B.2.a) IV.B.2.b) IV.B.2.c) Fellows Scholarly Activities The curriculum must advance fellows knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. (Core) Fellows must participate in scholarly activity that includes at least one of the following: peer-reviewed funding and research; (Outcome) publication of original research or review articles; or, (Outcome) presentations at local, regional, or national professional and scientific society meetings. (Outcome) V. Evaluation V.A. V.A.1. V.A.1.a) V.A.1.a).(1) Fellow Evaluation The program director must appoint the Clinical Competency Committee. (Core) At a minimum the Clinical Competency Committee must be composed of three members of the program faculty. (Core) The program director may appoint additional members of the Clinical Competency Committee. V.A.1.a).(1).(a) These additional members must be physician faculty members from the same program or Emergency Medical Services 14

16 other programs, or other health professionals who have extensive contact and experience with the program s fellows in patient care and other health care settings. (Core) V.A.1.a).(1).(b) V.A.1.b) V.A.1.b).(1) V.A.1.b).(1).(a) V.A.1.b).(1).(b) V.A.1.b).(1).(c) V.A.2. V.A.2.a) V.A.2.a).(1) V.A.2.a).(2) V.A.2.b) V.A.2.b).(1) V.A.2.b).(2) V.A.2.b).(3) Chief residents who have completed core residency programs in their specialty and are eligible for specialty board certification may be members of the Clinical Competency Committee. (Core) There must be a written description of the responsibilities of the Clinical Competency Committee. (Core) Formative Evaluation The Clinical Competency Committee should: review all fellow evaluations semi-annually; (Core) prepare and ensure the reporting of Milestones evaluations of each fellow semi-annually to ACGME; and, (Core) advise the program director regarding fellow progress, including promotion, remediation, and dismissal. (Detail) The faculty must evaluate fellow performance in a timely manner. (Core) Faculty members must review evaluations with each fellow at least every six months. (Core) Written evaluations of fellow performance must be available for review. (Detail) The program must: provide objective assessments of competence in patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice based on the specialty-specific Milestones; (Core) use multiple evaluators (e.g., faculty, peers, patients, self, and other professional staff); and, (Detail) provide each fellow with documented semiannual evaluation of performance with feedback. (Core) Emergency Medical Services 15

17 V.A.2.c) V.A.3. V.A.3.a) V.A.3.b) The evaluations of fellow performance must be accessible for review by the fellow, in accordance with institutional policy. (Detail) Summative Evaluation The specialty-specific Milestones must be used as one of the tools to ensure fellows are able to practice core professional activities without supervision upon completion of the program. (Core) The program director must provide a summative evaluation for each fellow upon completion of the program. (Core) This evaluation must: V.A.3.b).(1) V.A.3.b).(2) V.A.3.b).(3) become part of the fellow s permanent record maintained by the institution, and must be accessible for review by the fellow in accordance with institutional policy; (Detail) document the fellow s performance during their education; and, (Detail) verify that the fellow has demonstrated sufficient competence to enter practice without direct supervision. (Detail) V.B. V.B.1. V.B.2. V.B.3. V.B.4. V.C. V.C.1. V.C.1.a) Faculty Evaluation At least annually, the program must evaluate faculty performance as it relates to the educational program. (Core) These evaluations should include a review of the faculty s clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, and scholarly activities. (Detail) Faculty member evaluations must include administrative and interpersonal skills, quality of feedback and mentoring for fellows, and participation in and contributions to fellow conferences. (Detail) A summary of the evaluations, including completion of evaluations, must be communicated in writing to each faculty member. (Detail) Program Evaluation and Improvement The program director must appoint the Program Evaluation Committee (PEC). (Core) The Program Evaluation Committee: Emergency Medical Services 16

18 V.C.1.a).(1) V.C.1.a).(2) V.C.1.a).(3) V.C.1.a).(3).(a) V.C.1.a).(3).(b) V.C.1.a).(3).(c) V.C.1.a).(3).(d) V.C.2. must be composed of at least two program faculty members and should include at least one fellow; (Core) must have a written description of its responsibilities; and, (Core) should participate actively in: planning, developing, implementing, and evaluating educational activities of the program; (Detail) reviewing and making recommendations for revision of competency-based curriculum goals and objectives; (Detail) addressing areas of non-compliance with ACGME standards; and, (Detail) reviewing the program annually using evaluations of faculty, fellows, and others, as specified below. (Detail) The program, through the PEC, must document formal, systematic evaluation of the curriculum at least annually, and is responsible for rendering a written, annual program evaluation. (Core) The program must monitor and track each of the following areas: V.C.2.a) V.C.2.b) V.C.2.c) V.C.2.d) V.C.2.d).(1) V.C.2.d).(2) V.C.3. fellow performance; (Core) faculty development; (Core) progress on the previous year s action plan(s); and, (Core) graduate performance, including performance of program graduates on the certification examinations. (Core) At least 80 percent of the program s graduates from the preceding five years must have taken the American Board of Emergency Medicine written certifying examinations for emergency medical services. (Outcome) At least 80 percent of a program s graduates from the preceding five years who take the American Board of Emergency Medicine certification exams for emergency medical services for the first time must pass. (Outcome) The PEC must prepare a written plan of action to document initiatives to improve performance in one or more of the areas listed Emergency Medical Services 17

19 in section V.C.2., as well as delineate how they will be measured and monitored. (Core) V.C.3.a) V.C.4. The action plan should be reviewed and approved by the teaching faculty and documented in meeting minutes. (Detail) Representative program personnel, at a minimum to include the program director, representative faculty members, and one fellow, must review program goals and objectives, and the effectiveness with which they are achieved at least annually. (Detail) VI. VI.A. VI.A.1. VI.A.2. VI.A.3. VI.A.4. Fellow Duty Hours in the Learning and Working Environment Professionalism, Personal Responsibility, and Patient Safety Programs and sponsoring institutions must educate fellows and faculty members concerning the professional responsibilities of physicians to appear for duty appropriately rested and fit to provide the services required by their patients. (Core) The program must be committed to and responsible for promoting patient safety and fellow well-being in a supportive educational environment. (Core) The program director must ensure that fellows are integrated and actively participate in interdisciplinary clinical quality improvement and patient safety programs. (Core) The learning objectives of the program must: VI.A.4.a) VI.A.4.b) VI.A.5. VI.A.6. VI.A.6.a) VI.A.6.b) VI.A.6.c) be accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events; and, (Core) not be compromised by excessive reliance on fellows to fulfill non-physician service obligations. (Core) The program director and sponsoring institution must ensure a culture of professionalism that supports patient safety and personal responsibility. (Core) Fellows and faculty members must demonstrate an understanding and acceptance of their personal role in the following: assurance of the safety and welfare of patients entrusted to their care; (Outcome) provision of patient- and family-centered care; (Outcome) assurance of their fitness for duty; (Outcome) Emergency Medical Services 18

20 VI.A.6.d) VI.A.6.e) VI.A.6.f) VI.A.6.g) VI.A.6.h) VI.A.7. VI.B. VI.B.1. VI.B.2. VI.B.3. VI.B.4. VI.C. VI.C.1. VI.C.1.a) VI.C.1.b) VI.C.1.c) management of their time before, during, and after clinical assignments; (Outcome) recognition of impairment, including illness and fatigue, in themselves and in their peers; (Outcome) attention to lifelong learning; (Outcome) the monitoring of their patient care performance improvement indicators; and, (Outcome) honest and accurate reporting of duty hours, patient outcomes, and clinical experience data. (Outcome) All fellows and faculty members must demonstrate responsiveness to patient needs that supersedes self-interest. They must recognize that under certain circumstances, the best interests of the patient may be served by transitioning that patient s care to another qualified and rested provider. (Outcome) Transitions of Care Programs must design clinical assignments to minimize the number of transitions in patient care. (Core) Sponsoring institutions and programs must ensure and monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety. (Core) Programs must ensure that fellows are competent in communicating with team members in the hand-over process. (Outcome) The sponsoring institution must ensure the availability of schedules that inform all members of the health care team of attending physicians and fellows currently responsible for each patient s care. (Detail) Alertness Management/Fatigue Mitigation The program must: educate all faculty members and fellows to recognize the signs of fatigue and sleep deprivation; (Core) educate all faculty members and fellows in alertness management and fatigue mitigation processes; and, (Core) adopt fatigue mitigation processes to manage the potential negative effects of fatigue on patient care and learning, such as naps or back-up call schedules. (Detail) Emergency Medical Services 19

21 VI.C.2. VI.C.3. VI.D. VI.D.1. VI.D.1.a) VI.D.1.b) VI.D.2. Each program must have a process to ensure continuity of patient care in the event that a fellow may be unable to perform his/her patient care duties. (Core) The sponsoring institution must provide adequate sleep facilities and/or safe transportation options for fellows who may be too fatigued to safely return home. (Core) Supervision of Fellows In the clinical learning environment, each patient must have an identifiable, appropriately-credentialed and privileged attending physician (or licensed independent practitioner as approved by each Review Committee) who is ultimately responsible for that patient s care. (Core) This information should be available to fellows, faculty members, and patients. (Detail) Fellows and faculty members should inform patients of their respective roles in each patient s care. (Detail) The program must demonstrate that the appropriate level of supervision is in place for all fellows who care for patients. (Core) Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty member. For many aspects of patient care, the supervising physician may be a more advanced fellow. Other portions of care provided by the fellow can be adequately supervised by the immediate availability of the supervising faculty member or fellow physician, either in the institution, or by means of telephonic and/or electronic modalities. In some circumstances, supervision may include post-hoc review of fellow-delivered care with feedback as to the appropriateness of that care. (Detail) VI.D.3. Levels of Supervision To ensure oversight of fellow supervision and graded authority and responsibility, the program must use the following classification of supervision: (Core) VI.D.3.a) VI.D.3.b) VI.D.3.b).(1) Direct Supervision the supervising physician is physically present with the fellow and patient. (Core) Indirect Supervision: with direct supervision immediately available the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision. (Core) Emergency Medical Services 20

22 VI.D.3.b).(2) VI.D.3.c) VI.D.4. VI.D.4.a) VI.D.4.b) VI.D.4.c) VI.D.5. VI.D.5.a) VI.D.6. VI.E. with direct supervision available the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision. (Core) Oversight the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. (Core) The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each fellow must be assigned by the program director and faculty members. (Core) The program director must evaluate each fellow s abilities based on specific criteria. When available, evaluation should be guided by specific national standards-based criteria. (Core) Faculty members functioning as supervising physicians should delegate portions of care to fellows, based on the needs of the patient and the skills of the fellows. (Detail) Fellows should serve in a supervisory role of residents or junior fellows in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual fellow. (Detail) Programs must set guidelines for circumstances and events in which fellows must communicate with appropriate supervising faculty members, such as the transfer of a patient to an intensive care unit, or end-of-life decisions. (Core) Each fellow must know the limits of his/her scope of authority, and the circumstances under which he/she is permitted to act with conditional independence. (Outcome) Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of each fellow and delegate to him/her the appropriate level of patient care authority and responsibility. (Detail) Clinical Responsibilities The clinical responsibilities for each fellow must be based on PGY-level, patient safety, fellow education, severity and complexity of patient illness/condition and available support services. (Core) VI.F. Teamwork Emergency Medical Services 21

23 Fellows must care for patients in an environment that maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care in the specialty. (Core) VI.F.1. VI.G. VI.G.1. Contributors to effective interprofessional teams may include consulting physicians, paramedics, emergency medical technicians, nurses, firefighters, police officers, and other professional and paraprofessional personnel involved in the assessment and treatment of patients. (Detail) Fellow Duty Hours Maximum Hours of Work per Week Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. (Core) VI.G.1.a) Duty Hour Exceptions A Review Committee may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale. (Detail) The Review Committee for Emergency Medicine will not consider requests for exceptions to the 80-hour limit to the fellows work week. VI.G.1.a).(1) VI.G.1.a).(2) In preparing a request for an exception the program director must follow the duty hour exception policy from the ACGME Manual on Policies and Procedures. (Detail) Prior to submitting the request to the Review Committee, the program director must obtain approval of the institution s GMEC and DIO. (Detail) VI.G.2. VI.G.2.a) VI.G.2.b) VI.G.3. Moonlighting Moonlighting must not interfere with the ability of the fellow to achieve the goals and objectives of the educational program. (Core) Time spent by fellows in Internal and External Moonlighting (as defined in the ACGME Glossary of Terms) must be counted towards the 80-hour Maximum Weekly Hour Limit. (Core) Mandatory Time Free of Duty Emergency Medical Services 22

24 Fellows must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days. (Core) VI.G.4. Maximum Duty Period Length Duty periods of fellows may be scheduled to a maximum of 24 hours of continuous duty in the hospital. (Core) VI.G.4.a) VI.G.4.b) VI.G.4.c) VI.G.4.d) VI.G.4.d).(1) VI.G.4.d).(1).(a) VI.G.4.d).(1).(b) VI.G.4.d).(2) VI.G.5. VI.G.5.a) Programs must encourage fellows to use alertness management strategies in the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested. (Detail) It is essential for patient safety and fellow education that effective transitions in care occur. Fellows may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours. (Core) Fellows must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty. (Core) In unusual circumstances, fellows, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. (Detail) Under those circumstances, the fellow must: appropriately hand over the care of all other patients to the team responsible for their continuing care; and, (Detail) document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director. (Detail) The program director must review each submission of additional service, and track both individual fellow and program-wide episodes of additional duty. (Detail) Minimum Time Off between Scheduled Duty Periods Fellows must be prepared to enter the unsupervised practice Emergency Medical Services 23

25 of medicine and care for patients over irregular or extended periods. (Outcome) Emergency medical services fellows are considered to be in the final years of education. VI.G.5.a).(1) VI.G.5.a).(1).(a) VI.G.6. This preparation must occur within the context of the 80-hour, maximum duty period length, and one-dayoff-in-seven standards. While it is desirable that fellows have eight hours free of duty between scheduled duty periods, there may be circumstances when these fellows must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty. (Detail) Circumstances of return-to-hospital activities with fewer than eight hours away from the hospital by fellows must be monitored by the program director. (Detail) Maximum Frequency of In-House Night Float Fellows must not be scheduled for more than six consecutive nights of night float. (Core) VI.G.7. Maximum In-House On-Call Frequency Fellows must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period). (Core) VI.G.8. VI.G.8.a) VI.G.8.a).(1) VI.G.8.b) At-Home Call Time spent in the hospital by fellows on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every-thirdnight limitation, but must satisfy the requirement for one-dayin-seven free of duty, when averaged over four weeks. (Core) At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each fellow. (Core) Fellows are permitted to return to the hospital while on athome call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new off-duty period. (Detail) *** Emergency Medical Services 24

26 *Core Requirements: Statements that define structure, resource, or process elements essential to every graduate medical educational program. Detail Requirements: Statements that describe a specific structure, resource, or process, for achieving compliance with a Core Requirement. Programs and sponsoring institutions in substantial compliance with the Outcome Requirements may utilize alternative or innovative approaches to meet Core Requirements. Outcome Requirements: Statements that specify expected measurable or observable attributes (knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medical education. Osteopathic Principles Recognition For programs seeking Osteopathic Principles Recognition for the entire program, or for a track within the program, the Osteopathic Recognition Requirements are also applicable. ( Requirements.pdf) Emergency Medical Services 25