ACGME Program Requirements for Graduate Medical Education in Child and Adolescent Psychiatry

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1 ACGME Program Requirements for Graduate Medical Education in Child and Adolescent Psychiatry ACGME-approved: February 9, 2015; effective: July 1, 2015 Revised Common Program Requirements effective: July 1, 2016

2 ACGME Program Requirements for Graduate Medical Education in Child and Adolescent Psychiatry Common Program Requirements are in BOLD Introduction Int.A. Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education. It is physically, emotionally, and intellectually demanding, and requires longitudinally-concentrated effort on the part of the resident. 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 physician to assume personal responsibility for the care of individual patients. For the resident, 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 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 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. Child and adolescent psychiatry is a medical specialty focused on the prevention, diagnosis, and treatment of disorders of thinking, feeling, and behavior affecting children, adolescents, and their families. The educational program in child and adolescent psychiatry must be 24 months in length. (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 educational and administrative responsibilities to the program. (Core) I.A.1. The sponsoring institution must also sponsor an Accreditation Council for Graduate Medical Education (ACGME)-accredited program in psychiatry. Child and Adolescent Psychiatry 2

3 (Core) I.A.2. The sponsoring institution must provide at least 50 percent salary support, and protected time of 50 percent FTE (at least 20 hours per week) for the program director dedicated to program administration, education, and supervision. (Core) I.A.3. Programs with an approved fellow complement of 20 or more require 30 hours per week effort and/or the appointment of an associate program director. (Core) I.A.4. I.B. I.B.1. There must be a designated program coordinator to support the fellowship. (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. 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 number of and distance between participating sites must allow for full participation by the fellows in all organized educational aspects of the program. (Core) II. II.A. II.A.1. Program Personnel and Resources Program Director There must be a single program director with authority and accountability for the operation of the program. The sponsoring Child and Adolescent Psychiatry 3

4 institution s GMEC must approve a change in program director. (Core) II.A.1.a) II.A.2. II.A.3. II.A.3.a) II.A.3.b) II.A.3.c) II.A.4. The program director must submit this change to the ACGME via the ADS. (Core) The program director should continue in his or her position for a length of time adequate to maintain continuity of leadership and program stability. (Detail) 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 Psychiatry and Neurology (ABPN), or subspecialty qualifications that are acceptable to the Review Committee; and, (Core) current medical licensure and appropriate medical staff appointment. (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: II.A.4.a) II.A.4.b) II.A.4.c) II.A.4.d) II.A.4.e) II.A.4.f) II.A.4.g) II.A.4.g).(1) oversee and ensure the quality of didactic and clinical education in all sites that participate in the program; (Core) approve a local director at each participating site who is accountable for fellow education; (Core) approve the selection of program faculty as appropriate; (Core) evaluate program faculty; (Core) approve the continued participation of program faculty based on evaluation; (Core) monitor fellow supervision at all participating sites; (Core) prepare and submit all information required and requested by the ACGME; (Core) This includes but is not limited to the program application forms and annual program updates to the ADS, and ensure that the information submitted is accurate and complete. (Core) Child and Adolescent Psychiatry 4

5 II.A.4.h) II.A.4.i) II.A.4.j) ensure compliance with grievance and due process procedures as set forth in the Institutional Requirements and implemented by the sponsoring institution; (Detail) provide verification of fellowship education for all fellows, including those who leave the program prior to completion; (Detail) implement policies and procedures consistent with the institutional and program requirements for fellow duty hours and the working environment, including moonlighting, (Core) and, to that end, must: II.A.4.j).(1) II.A.4.j).(2) II.A.4.j).(3) II.A.4.j).(4) II.A.4.k) II.A.4.l) II.A.4.m) II.A.4.n) II.A.4.n).(1) II.A.4.n).(2) distribute these policies and procedures to the fellows and faculty; (Detail) monitor fellow duty hours, according to sponsoring institutional policies, with a frequency sufficient to ensure compliance with ACGME requirements; (Core) adjust schedules as necessary to mitigate excessive service demands and/or fatigue; and, (Detail) if applicable, monitor the demands of at-home call and adjust schedules as necessary to mitigate excessive service demands and/or fatigue. (Detail) monitor the need for and ensure the provision of back up support systems when patient care responsibilities are unusually difficult or prolonged; (Detail) comply with the sponsoring institution s written policies and procedures, including those specified in the Institutional Requirements, for selection, evaluation and promotion of fellows, disciplinary action, and supervision of fellows; (Detail) be familiar with and comply 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) Child and Adolescent Psychiatry 5

6 II.A.4.n).(3) II.A.4.n).(4) II.A.4.n).(5) II.A.4.n).(6) II.A.4.n).(7) II.A.4.n).(8) II.A.4.o) II.A.4.o).(1) II.A.4.o).(2) II.A.4.p) II.A.4.p).(1) II.A.4.q) 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) monitor fellow stress, including mental or emotional conditions inhibiting performance, or learning, and drug- or alcohol-related dysfunction; and, (Core) Educational situations that consistently produce undesirable stress on fellows must be evaluated and modified. (Core) dedicate at least 20 hours per week directly to the administrative and educational activities of the fellowship. (Core) II.B. II.B.1. Faculty At each participating site, there must be a sufficient number of faculty with documented qualifications to instruct and supervise all fellows at that location. (Core) The faculty must: II.B.1.a) devote sufficient time to the educational program to fulfill their supervisory and teaching responsibilities; and to demonstrate a strong interest in the education of fellows, and (Core) Child and Adolescent Psychiatry 6

7 II.B.1.b) II.B.2. II.B.3. II.B.4. II.B.5. II.B.5.a) II.B.5.b) II.B.5.b).(1) II.B.5.b).(2) II.B.5.b).(3) II.B.5.b).(4) II.B.5.c) II.B.6. II.C. administer and maintain an educational environment conducive to educating fellows in each of the ACGME competency areas. (Core) The physician faculty must have current certification in the subspecialty by the American Board of Psychiatry and Neurology, or possess qualifications judged acceptable to the Review Committee. (Core) The physician faculty must possess current medical licensure and appropriate medical staff appointment. (Core) The nonphysician faculty must have appropriate qualifications in their field and hold appropriate institutional appointments. (Core) The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. (Core) The faculty must regularly participate in organized clinical discussions, rounds, journal clubs, and conferences. (Detail) Some members of the faculty should also demonstrate scholarship by one or more of the following: peer-reviewed funding; (Detail) publication of original research or review articles in peer-reviewed journals, or chapters in textbooks; (Detail) publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; or, (Detail) participation in national committees or educational organizations. (Detail) Faculty should encourage and support fellows in scholarly activities. (Core) In addition to the program director, there must be two FTE core faculty members with current ABPN certification in child and adolescent psychiatry. (Core) Other Program Personnel 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.D. Resources Child and Adolescent Psychiatry 7

8 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.3. II.D.4. II.D.5. II.E. There must be office space available for each fellow to see patients. (Core) There must be space for physical and neurological examinations and access to laboratory testing. (Core) There must be equipment with the capacity for recording and viewing clinical encounters available to fellows. (Core) The number of patients for whom fellows have primary responsibility at any one time must permit them to provide each patient with appropriate treatment, as well as to have sufficient time for other aspects of their educational program. (Core) There should be space and equipment specifically designated for seminars, lectures, and other educational 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 The program director must comply with the criteria for resident eligibility as specified in the Institutional Requirements. (Core) III.A.1. III.A.1.a) III.A.1.b) Eligibility Requirements Residency Programs All prerequisite post-graduate clinical education required for initial entry or transfer into ACGME-accredited residency programs must be completed in ACGME-accredited residency programs, or in Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency programs located in Canada. Residency programs must receive verification of each applicant s level of competency in the required clinical field using ACGME or CanMEDS Milestones assessments from the prior training program. (Core) A physician who has completed a residency program that was not accredited by ACGME, RCPSC, or CFPC may enter an ACGME-accredited residency program in the same specialty at the PGY-1 level and, at the discretion of the program director at the ACGME-accredited program may be Child and Adolescent Psychiatry 8

9 advanced to the PGY-2 level based on ACGME Milestones assessments at the ACGME-accredited program. This provision applies only to entry into residency in those specialties for which an initial clinical year is not required for entry. (Core) III.A.1.c) III.A.1.d) III.A.2. A Review Committee may grant the exception to the eligibility requirements specified in Section III.A.2.b) for residency programs that require completion of a prerequisite residency program prior to admission. (Core) Review Committees will grant no other exceptions to these eligibility requirements for residency education. (Core) Eligibility Requirements Fellowship Programs All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, or in an RCPSC-accredited or CFPC- accredited residency program located in Canada. (Core) To be eligible for appointment, applicants should have completed the first year of an ACGME- or RCPSC-accredited psychiatry residency or such a program in another primary care specialty. (Core) III.A.2.a) III.A.2.b) Fellowship programs must receive verification of each entering fellow s level of competency in the required field using ACGME or CanMEDS Milestones assessments from the core residency program. (Core) Fellow Eligibility Exception A Review Committee may grant the following exception to the fellowship eligibility requirements: An ACGME-accredited fellowship program may accept an exceptionally qualified applicant**, who does not satisfy the eligibility requirements listed in Sections III.A.2. and III.A.2.a), but who does meet all of the following additional qualifications and conditions: (Core) III.A.2.b).(1) III.A.2.b).(2) Assessment by the program director and fellowship selection committee of the applicant s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty; and (Core) Review and approval of the applicant s exceptional qualifications by the GMEC or a subcommittee of the GMEC; and (Core) Child and Adolescent Psychiatry 9

10 III.A.2.b).(3) III.A.2.b).(4) III.A.2.b).(5) III.A.2.b).(5).(a) Satisfactory completion of the United States Medical Licensing Examination (USMLE) Steps 1, 2, and, if the applicant is eligible, 3, and; (Core) For an international graduate, verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification; and, (Core) Applicants accepted by this exception must complete fellowship Milestones evaluation (for the purposes of establishment of baseline performance by the Clinical Competency Committee), conducted by the receiving fellowship program within six weeks of matriculation. This evaluation may be waived for an applicant who has completed an ACGME International-accredited residency based on the applicant s Milestones evaluation conducted at the conclusion of the residency program. (Core) If the trainee does not meet the expected level of Milestones competency following entry into the fellowship program, the trainee must undergo a period of remediation, overseen by the Clinical Competency Committee and monitored by the GMEC or a subcommittee of the GMEC. This period of remediation must not count toward time in fellowship training. (Core) ** An exceptionally qualified applicant has (1) completed a non-acgme-accredited residency program in the core specialty, and (2) demonstrated clinical excellence, in comparison to peers, throughout training. Additional evidence of exceptional qualifications is required, which may include one of the following: (a) participation in additional clinical or research training in the specialty or subspecialty; (b) demonstrated scholarship in the specialty or subspecialty; (c) demonstrated leadership during or after residency training; (d) completion of an ACGME-Internationalaccredited residency program. III.A.2.c) III.A.2.d) III.A.2.e) The Review Committee for Psychiatry does not allow exceptions to the Eligibility Requirements for Fellowship Programs in Section III.A.2. (Core) Prior to appointment, applicants must demonstrate sufficient command of English to permit accurate and unimpeded communication. (Core) Prior to appointment into the program, each fellow must be notified, in writing, of the required length of the program for his or her education. (Core) Child and Adolescent Psychiatry 10

11 III.B. Number of Fellows The program s educational resources must be adequate to support the number of fellows appointed to the program. (Core) III.B.1. III.B.2. III.C. III.C.1. III.C.2. III.D. The program director may not appoint more fellows than approved by the Review Committee, unless otherwise stated in the specialtyspecific requirements. (Core) There should be at least two fellows appointed at each level of education at all times in the two-year FTE program. (Detail) Fellow Transfers Before accepting a fellow who is transferring from another program, the program director must obtain written or electronic verification of previous educational experiences and a summative competencybased performance evaluation of the transferring fellow. (Detail) A program director must provide timely verification of fellowship education and summative performance evaluations for fellows who may leave the program prior to completion. (Detail) Appointment of Fellows and Other Learners The presence of other learners (including, but not limited to, residents from other specialties, subspecialty fellows, PhD students, and nurse practitioners) in the program must not interfere with the appointed fellows education. (Core) III.D.1. IV. IV.A. IV.A.1. IV.A.2. IV.A.3. Educational Program The program director must report the presence of other learners to the DIO and GMEC in accordance with sponsoring institution guidelines. (Detail) The curriculum must contain the following educational components: Overall educational goals for the program, which the program must make available to fellows and faculty; (Core) Competency-based goals and objectives for each assignment at each educational level, which the program must distribute to fellows and faculty at least annually, in either written or electronic form; (Core) Regularly scheduled didactic sessions; (Core) IV.A.3.a) Didactic instruction should include lectures, seminars, and assigned readings that are coordinated with concurrent clinical experiences and that are specific to each fellow s level of Child and Adolescent Psychiatry 11

12 education. (Detail) IV.A.3.b) IV.A.3.c) IV.A.4. IV.A.5. Each fellow should attend a minimum of 70 percent of regularly scheduled didactic sessions. (Detail) There must be interdisciplinary clinical conferences and didactic seminars for fellows, at which faculty psychiatrists collaborate in teaching with colleagues from other medical specialties and mental health disciplines. (Core) Delineation of fellow responsibilities for patient care, progressive responsibility for patient management, and supervision of fellows over the continuum of the program; and, (Core) ACGME Competencies The program must integrate the following ACGME competencies into the curriculum: (Core) IV.A.5.a) IV.A.5.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: IV.A.5.a).(1).(a) IV.A.5.a).(1).(b) IV.A.5.a).(1).(c) IV.A.5.a).(1).(d) evaluation and treatment of patients representing the full spectrum of psychiatric illnesses in children and adolescents, including developmental and substance use disorders; (Outcome) treatment of children and adolescents for the development of conceptual understanding and beginning clinical skills in major treatment modalities, including brief and long-term individual therapy, family therapy, group therapy, crisis intervention, supportive therapy, psychodynamic psychotherapy, cognitive-behavioral therapy, and pharmacotherapy; (Outcome) evaluation and treatment of patients from diverse cultural backgrounds and varied socioeconomic levels; and, (Outcome) performance and documentation of an adequate individual and family history; mental status; physical and neurological examinations when appropriate; supplementary medical and psychological data, and integration of these data into a formulation; Child and Adolescent Psychiatry 12

13 differential diagnosis; and a comprehensive treatment plan. (Outcome) IV.A.5.a).(2) IV.A.5.b) Fellows must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. (Outcome) Medical Knowledge 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 knowledge of: IV.A.5.b).(1) IV.A.5.b).(2) IV.A.5.b).(3) IV.A.5.b).(4) IV.A.5.b).(5) IV.A.5.c) basic neurobiological, psychological, and clinical sciences relevant to psychiatry and the application of developmental, psychological, and sociocultural theories relevant to the understanding of psychopathology; (Outcome) the full range of psychopathology in children and adolescents, including the etiology, epidemiology, diagnosis, treatment, and prevention of the major psychiatric conditions that affect children and adolescents; (Outcome) recognition and management of domestic and community violence, including physical and sexual abuse, as well as neglect, as it affects children and adolescents; (Outcome) diversity and cultural issues pertinent to children, adolescents, and their families; and, (Outcome) the appropriate uses and limitations of psychological tests. (Outcome) Practice-based Learning and Improvement Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. (Outcome) Fellows are expected to develop skills and habits to be able to meet the following goals: IV.A.5.c).(1) identify strengths, deficiencies, and limits in one s knowledge and expertise; (Outcome) Child and Adolescent Psychiatry 13

14 IV.A.5.c).(2) IV.A.5.c).(3) IV.A.5.c).(4) IV.A.5.c).(5) IV.A.5.c).(6) IV.A.5.c).(7) IV.A.5.c).(8) IV.A.5.d) set learning and improvement goals; (Outcome) identify and perform appropriate learning activities; (Outcome) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; (Outcome) incorporate formative evaluation feedback into daily practice; (Outcome) locate, appraise, and assimilate evidence from scientific studies related to their patients health problems; (Outcome) use information technology to optimize learning; and, (Outcome) participate in the education of patients, families, students, fellows and other health professionals. (Outcome) Interpersonal and Communication Skills Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (Outcome) Fellows are expected to: IV.A.5.d).(1) IV.A.5.d).(2) IV.A.5.d).(3) IV.A.5.d).(4) IV.A.5.d).(5) IV.A.5.d).(6) communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; (Outcome) communicate effectively with physicians, other health professionals, and health related agencies; (Outcome) work effectively as a member or leader of a health care team or other professional group; (Outcome) act in a consultative role to other physicians and health professionals; (Outcome) maintain comprehensive, timely, and legible medical records, if applicable; and, (Outcome) collaborate with other professional mental health personnel, pediatricians, teachers, and other school personnel in the evaluation and treatment of patients. Child and Adolescent Psychiatry 14

15 (Outcome) IV.A.5.e) Professionalism Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (Outcome) Fellows are expected to demonstrate: IV.A.5.e).(1) IV.A.5.e).(2) IV.A.5.e).(3) IV.A.5.e).(4) IV.A.5.e).(5) IV.A.5.e).(6) IV.A.5.e).(6).(a) IV.A.5.f) compassion, integrity, and respect for others; (Outcome) responsiveness to patient needs that supersedes selfinterest; (Outcome) respect for patient privacy and autonomy; (Outcome) accountability to patients, society and the profession; (Outcome) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation; and, (Outcome) the ability to maintain appropriate professional boundaries, including those specific to psychiatric practice. (Outcome) Systems-based Practice Programs must distribute to fellows and operate in accordance with the American Medical Association (AMA) Principles of Ethics, with Special Annotations for Psychiatry, as developed by the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry (AACAP) code of ethics to ensure that the application and teaching of these principles are integral parts of the educational process. (Outcome) 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 are expected to: IV.A.5.f).(1) work effectively in various health care delivery settings and systems relevant to their clinical specialty; (Outcome) Child and Adolescent Psychiatry 15

16 IV.A.5.f).(2) IV.A.5.f).(3) IV.A.5.f).(4) IV.A.5.f).(5) IV.A.5.f).(6) IV.A.5.f).(7) IV.A.5.f).(8) IV.A.5.f).(9) IV.A.5.f).(10) IV.A.6. IV.A.6.a) IV.A.6.b) IV.A.6.c) coordinate patient care within the health care system relevant to their clinical specialty; (Outcome) incorporate considerations of cost awareness and risk-benefit analysis in patient and/or populationbased care as appropriate; (Outcome) advocate for quality patient care and optimal patient care systems; (Outcome) work in interprofessional teams to enhance patient safety and improve patient care quality; (Outcome) participate in identifying system errors and implementing potential systems solutions; (Outcome) know how types of medical practice and delivery systems differ from one another, including methods of controlling health care cost, assuring quality, and allocating resources; (Outcome) advocate for quality patient care and assist patients in dealing with system complexities, including disparities in mental health care for children and adolescents; (Outcome) know how to advocate for the promotion of health and the prevention of disease and injury in populations; and, (Outcome) participate in the practices of utilization review, quality assurance, and performance improvement. (Outcome) Curriculum Organization and Fellow Experiences Didactic and clinical experiences must be of sufficient breadth and depth to provide fellows with a thorough, well-balanced presentation of the generally-accepted observations and theories, as well as the major diagnostic, therapeutic, and preventive procedures in child and adolescent psychiatry. (Core) In addition to the PGY-1 required for eligibility, a minimum of two additional years of accredited education in general psychiatry and two additional years of accredited education in a child and adolescent psychiatry program must be provided within an ACGME-accredited program. (Core) In general, education in child and adolescent psychiatry obtained as part of the curriculum for general psychiatry may not count toward education in child and adolescent psychiatry. However, certain clinical experiences with children, adolescents, and families taken during the period when he/she is designated as a Child and Adolescent Psychiatry 16

17 child and adolescent psychiatry fellow may be counted toward a fourth year in general psychiatry, as well as toward the child and adolescent psychiatry program requirements, thereby fulfilling program requirements in general psychiatry and child and adolescent psychiatry at the same time. For these experiences to be given credit for both child and adolescent psychiatry and general psychiatry, the experiences must: (Core) IV.A.6.c).(1) IV.A.6.c).(2) IV.A.6.c).(3) IV.A.6.c).(4) IV.A.6.c).(5) IV.A.6.c).(5).(a) IV.A.6.c).(5).(b) IV.A.6.c).(5).(c) IV.A.6.c).(5).(d) IV.A.6.c).(5).(e) IV.A.6.c).(5).(f) IV.A.6.d) IV.A.6.d).(1) IV.A.6.e) IV.A.6.e).(1) be limited to child and adolescent psychiatry patients; (Core) be limited to a maximum of 12 months that can be doublecounted; (Core) be documented by the program director in all areas for which credit is given in both programs; (Core) result in no reduction in total length of time devoted to education in child and adolescent psychiatry, which must remain at two years FTE; and, (Core) be limited to the following experiences: (Core) one month FTE of child neurology; (Core) one month FTE of pediatric consultation/liaison; (Core) one month FTE of addiction psychiatry; (Core) forensic psychiatry experience; (Core) community psychiatry experience; and, (Core) no more than 20 percent of outpatient experience, as described in the ACGME Program Requirements for Graduate Medical Education in Psychiatry. (Core) Electives must have written goals and objectives, be well constructed and supervised, and lead to effective learning experiences. (Core) The choice of electives must be made with the advice and approval of the program director and the appropriate preceptor. (Core) Fellows must have an organized educational clinical experience in each of the following: pediatric neurology; (Core) Child and Adolescent Psychiatry 17

18 IV.A.6.e).(2) IV.A.6.e).(3) IV.A.6.e).(4) IV.A.6.e).(4).(a) IV.A.6.e).(4).(b) IV.A.6.e).(5) IV.A.6.e).(5).(a) IV.A.6.e).(5).(a).(i) IV.A.6.e).(5).(a).(ii) IV.A.6.e).(5).(a).(iii) IV.A.6.f) IV.A.6.g) IV.A.6.h) intellectual disability (intellectual development disorder), and other developmental disorders; (Core) initial management of psychiatric emergencies in children and adolescents; (Core) caring for acutely- and severely-disturbed children and adolescents, with the fellows actively involved in diagnostic assessment and treatment planning; and, (Core) This experience must occur in settings with an organized treatment program, such as inpatient units, residential treatment facilities, partial hospitalization programs, and/or day treatment programs. (Core) This experience must be the FTE of no fewer than four months and no more than 10 months. (Core) consultation experiences during which fellows do not primarily engage in treatment, but use their specialized knowledge and skills to assist others to function better in their roles. (Core) Exposure and experience in consultation to facilities serving children, adolescents, and their families must include supervised: (Core) consultation experience with an adequate number of pediatric patients in outpatient and/or inpatient non-psychiatric medical facilities; (Core) formal observation and/or consultation experiences in schools; and, (Core) experience in legal issues relevant to child and adolescent psychiatry, which may include forensic consultation, court testimony, and/or interaction with a juvenile justice system. (Core) Fellows should have experience consulting to community systems of care. (Detail) Fellows must be provided sufficient supervision from child and adolescent psychiatrists to enable each fellow to establish working relationships that foster identification in the role of a child and adolescent psychiatrist. (Core) Fellows must have at least two hours of faculty preceptorship Child and Adolescent Psychiatry 18

19 weekly, one hour of which must be individual. (Core) IV.A.6.i) IV.A.6.j) IV.A.6.k) IV.B. IV.B.1. IV.B.2. IV.B.2.a) IV.B.2.b) IV.B.2.c) IV.B.2.d) IV.B.3. Fellows must have instruction in normal development, including observation of and interaction with normal preschoolers, schoolaged children, and adolescents. (Core) Fellows must have instruction in the integration of neurobiological, phenomenological, psychological, and sociocultural issues into a comprehensive formulation of clinical problems. (Core) Care for outpatients must include work with some child and adolescent patients from each developmental age group, continuously over time, and whenever possible, for one year s duration or more. (Core) 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 should participate in scholarly activity. (Core) All fellows must be educated in research literacy and in the concepts and process of evidenced-based clinical practice to develop skills in question formulation, information searching, critical appraisal, and medical decision-making. (Core) The program must provide opportunities for research and development of research skills for fellows interested in conducting research in psychiatry or related fields. (Core) The program must provide interested fellows access to and the opportunity to participate actively in ongoing research under a mentor. (Core) The program must ensure the participation of fellows and faculty members in journal clubs, research conferences, didactics, and/or other activities that address critical appraisal of the literature and understanding of the research process. (Core) The sponsoring institution and program should allocate adequate educational resources to facilitate fellow involvement in scholarly activities. (Detail) V. Evaluation V.A. V.A.1. Fellow Evaluation The program director must appoint the Clinical Competency Committee. (Core) Child and Adolescent Psychiatry 19

20 V.A.1.a) V.A.1.a).(1) V.A.1.a).(1).(a) 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.b) V.A.2.b).(1) 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. These additional members must be physician faculty members from the same program or 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) 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 assure 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 during each rotation or similar educational assignment, and document this evaluation at completion of the assignment. (Core) 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) Child and Adolescent Psychiatry 20

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