ACGME Program Requirements for Graduate Medical Education in Hematology and Medical Oncology (Internal Medicine)

Transcription

1 ACGME Program Requirements for Graduate Medical Education in Hematology and Medical Oncology (Internal Medicine) ACGME approved: February 5, 2011; effective: July 1, 2012 ACGME approved categorization: September 30, 2012; effective: July 1, 2013 Revised Common Program Requirements effective: July 1, 2015 Revised Common Program Requirements effective: July 1, 2016

2 ACGME Program Requirements for Graduate Medical Education in Hematology and Medical Oncology (Internal Medicine) 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. Hematology and medical oncology fellowships provide advanced education to allow the fellow to acquire competency in the subspecialty with sufficient expertise to act as an independent consultant. Int.C. The educational program in hematology and medical oncology must be 36 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) Hematology and Medical Oncology 1

3 I.A.1. I.A.2. I.A.2.a) I.A.2.b) I.A.2.b).(1) I.A.2.b).(2) I.A.3. I.B. I.B.1. The hematology and medical oncology fellowship must function as an integral part of an ACGME-accredited educational program in internal medicine. (Core) The sponsoring institution must: establish the hematology and medical oncology fellowship within a department of internal medicine or an administrative unit whose primary mission is the advancement of internal medicine subspecialty education and patient care; and, (Detail) provide the program director with adequate support for the administrative activities of the fellowship. (Core) The program director must not be required to generate clinical or other income to provide this administrative support. (Core) This support should be 25-50% of the program director s salary, or protected time, depending on the size of the program. (Detail) The sponsoring institution and participating sites must share appropriate inpatient and outpatient faculty performance data with the program director. (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. 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 Hematology and Medical Oncology 2

4 more through the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System (ADS). (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 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.a).(1) II.A.3.b) II.A.3.b).(1) II.A.3.b).(2) 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) The program director must have at least five years of participation as an active faculty member in an ACGMEaccredited internal medicine residency, or hematology or medical oncology fellowship. (Detail) current certification in the subspecialty by the American Board of Internal Medicine (ABIM), or subspecialty qualifications that are acceptable to the Review Committee; and, (Core) The Review Committee only accepts current ABIM certification in hematology or medical oncology. (Core) If the program director does not have appropriate credentials in both subspecialties, an appropriatelycredentialed and full-time Key Clinical Faculty (KCF) member must be identified as responsible for the education program in the second specific area. (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) Hematology and Medical Oncology 3

5 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) II.A.4.h) II.A.4.i) II.A.4.j) 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) 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) 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) Hematology and Medical Oncology 4

6 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) 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) 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) 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) Hematology and Medical Oncology 5

7 II.A.4.o).(2) II.A.4.p) II.A.4.p).(1) II.A.4.p).(2) II.A.4.q) II.A.4.r) II.A.4.s) II.A.4.t) II.A.4.u) request for changes in the program that would have significant impact, including financial, on the program or institution. (Detail) be responsible for monitoring fellow stress, including mental or emotional conditions inhibiting performance or learning, and drugor alcohol-related dysfunction; (Core) The program director should provide access to timely confidential counseling and psychological support services to fellows. (Detail) Situations that demand excessive service or that consistently produce undesirable stress on fellows must be evaluated and modified. (Detail) ensure that fellows service responsibilities are limited to patients for whom the teaching service has diagnostic and therapeutic responsibility. (Core) dedicate an average of 20 hours per week of his or her professional effort to the fellowship, including time for administration of the program; (Detail) participate in academic societies and in educational programs designed to enhance his or her educational and administrative skills; (Detail) have a reporting relationship with the program director of the internal medicine residency program to ensure compliance with ACGME accreditation standards; and, (Core) be available at the primary clinical site. (Detail) 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) II.B.1.b) 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) administer and maintain an educational environment conducive to educating fellows in each of the ACGME Hematology and Medical Oncology 6

8 competency areas. (Core) 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.B.7. II.B.7.a) II.B.7.b) II.B.7.c) The physician faculty must have current certification in the subspecialty by the American Board of Internal 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) 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) The physician faculty must meet professional standards of ethical behavior. (Core) Key Clinical Faculty In addition to the program director, each program must have at least five Key Clinical Faculty (KCF). (Core) KCF are attending physicians who dedicate, on average, 10 hours per week throughout the year to the program. (Core) For programs with more than nine fellows, there must be at least Hematology and Medical Oncology 7

9 one KCF for every 1.5 fellows. (Core) II.B.7.d) II.B.7.d).(1) II.B.7.d).(1).(a) II.B.7.d).(1).(b) II.B.7.d).(2) II.B.7.e) II.B.7.e).(1) II.B.7.e).(2) II.B.7.e).(3) II.B.7.e).(3).(a) II.B.7.e).(3).(b) II.B.7.e).(4) II.B.8. Key Clinical Faculty Qualifications KCF must have current ABIM certification in hematology or medical oncology. (Core) At least three KCF must have current ABIM certification in hematology. (Core) At least three KCF have current ABIM certification in medical oncology. (Core) KCF must be active clinicians with knowledge of, experience with, and commitment to hematology or medical oncology as a discipline. (Core) Key Clinical Faculty Responsibilities In addition to the responsibilities of all individual faculty members, the KCF and the program director are responsible for the planning, implementation, monitoring and evaluation of the fellows clinical and research education. (Core) At least 50% of the KCF must demonstrate evidence of productivity in scholarship, specifically, peer-reviewed funding; publication of original research, review articles, editorials, or case reports in peer-reviewed journals; or chapters in textbooks. (Detail) At least one KCF must: be knowledgeable in the evaluation and assessment of the ACGME competencies; and, (Detail) spend significant time in the evaluation of fellows, including the direct observation of fellows with patients. (Detail) Appointment of one KCF to be an associate program director is suggested. (Detail) Faculty members who are ABIM-certified in endocrinology, gastroenterology, infectious disease, nephrology, and pulmonary disease should be available to participate in the education of fellows. (Core) II.C. Other Program Personnel Hematology and Medical Oncology 8

10 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.C.2. II.C.3. II.C.4. II.C.5. II.C.5.a) II.C.5.b) II.C.5.c) II.C.5.d) II.C.5.e) II.C.5.f) II.D. Resources There must be services available from other health care professionals, including dietitians, language interpreters, nurses, occupational therapists, physical therapists, and social workers. (Detail) The fellowship must have access to surgeons in general surgery and surgical specialties, including those with special interest in oncology. (Detail) The fellowship must have access to other clinical specialists, including those in dermatology, obstetrics and gynecology, neurology, neurological surgery, orthopaedics, otolaryngology, and urology. (Detail) There must be appropriate and timely consultation from other specialties. (Detail) Expertise in the following disciplines should be available to the program to provide multidisciplinary patient care and fellow education: genetic counseling; (Detail) hospice and palliative care; (Detail) oncologic nursing; (Detail) pain management; (Detail) psychiatry; and, (Detail) rehabilitation medicine. (Detail) 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. Space and Equipment There must be space and equipment for the program, including meeting rooms, examination rooms, computers, visual and other educational aids, and work/study space. (Core) II.D.2. II.D.2.a) Facilities Inpatient and outpatient systems must be in place to prevent fellows from performing routine clerical functions, such as scheduling tests and appointments, and retrieving records and Hematology and Medical Oncology 9

11 letters. (Detail) II.D.2.b) II.D.2.c) II.D.2.d) II.D.2.e) II.D.3. II.D.3.a) II.D.3.b) II.D.3.b).(1) II.D.3.b).(2) II.D.3.b).(3) II.D.3.b).(4) II.D.4. The sponsoring institution must provide the broad range of facilities and clinical support services required to provide comprehensive care of adult patients. (Core) Fellows must have access to a lounge facility during assigned duty hours. (Detail) When fellows are in the hospital, assigned night duty, or called in from home, they must be provided with a secure space for their belongings. (Detail) Radiation oncology facilities must be available. (Core) Laboratory and Imaging Services A hematology laboratory must be located at the primary clinical site. (Core) Each of the following must be present at the primary clinical or participating site(s): Other Support Services specialized coagulation laboratory; (Core) nuclear medicine imaging; (Core) cross-sectional imaging, including coaxial tomography (CT) and magnetic resonance imaging (MRI); and, (Core) positron emission tomography (PET) scan imaging. (Core) There must be advanced pathology services, including: II.D.4.a) II.D.4.b) II.D.4.c) II.D.5. immunopathology; (Core) blood banking; and, (Core) transfusion and apheresis services. (Core) Medical Records Access to an electronic health record should be provided. In the absence of an existing electronic health record, institutions must demonstrate institutional commitment to its development, and progress towards its implementation. (Core) II.D.6. Patient Population Hematology and Medical Oncology 10

12 II.D.6.a) II.D.6.b) II.D.6.c) II.E. The patient population must have a variety of clinical problems and stages of diseases. (Core) There must be patients of each gender, with a broad age range, including geriatric patients. (Core) A sufficient number of patients must be available to enable each fellow to achieve the required educational outcomes. (Core) 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) III.A.1.c) 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 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) A Review Committee may grant the exception to the eligibility Hematology and Medical Oncology 11

13 requirements specified in Section III.A.2.b) for residency programs that require completion of a prerequisite residency program prior to admission. (Core) III.A.1.d) III.A.2. 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) Prior to appointment in the fellowship, fellows should have completed an ACGME- or RCPSC-accredited internal medicine program. (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) III.A.2.b).(3) 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) Satisfactory completion of the United States Medical Licensing Examination (USMLE) Steps 1, 2, and, if the applicant is eligible, 3; and, (Core) Hematology and Medical Oncology 12

14 III.A.2.b).(4) III.A.2.b).(5) III.A.2.b).(5).(a) 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; and, (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- International-accredited residency program. III.A.2.b).(6) III.A.2.b).(6).(a) Fellows from non-acgme- or RCPSC-accredited internal medicine programs must have completed at least three years of internal medicine education prior to starting the fellowship. (Core) The program director must inform applicants from non-acgme-accredited programs, prior to appointment, and in writing, of the ABIM policies and procedures that will affect their eligibility for ABIM certification. (Detail) Hematology and Medical Oncology 13

15 III.A.2.c) III.B. Number of Fellows The Review Committee for Internal Medicine does allow exceptions to the Eligibility Requirements for Fellowship Programs in Section III.A.2. (Core) 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) The number of available fellow positions in the program must be at least one per year. (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. 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) Hematology and Medical Oncology 14

16 IV.A.3. IV.A.3.a) IV.A.3.a).(1) IV.A.3.a).(2) IV.A.3.a).(3) IV.A.3.b) Regularly scheduled didactic sessions; (Core) The core curriculum must include a didactic program based on the core knowledge content in the subspecialty area. (Core) The program must afford each fellow an opportunity to review topics covered in conferences that he or she was unable to attend. (Detail) Fellows must participate in clinical case conferences, journal clubs, research conferences, and morbidity and mortality or quality improvement conferences. (Detail) All core conferences must have at least one faculty member present, and must be scheduled as to ensure peer-peer and peer-faculty interaction. (Detail) Patient-based teaching must include direct interaction between fellows and faculty members, bedside teaching, discussion of pathophysiology, and the use of current evidence in diagnostic and therapeutic decisions. (Core) The teaching must be: IV.A.3.b).(1) IV.A.3.b).(2) IV.A.3.c) IV.A.4. IV.A.5. formally conducted on all inpatient, outpatient and consultative services; and, (Detail) conducted with a frequency and duration that ensures a meaningful and continuous teaching relationship between the assigned supervising faculty member(s) and fellows. (Detail) Fellows must receive instruction in practice management relevant to hematology and medical oncology. (Detail) 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) Hematology and Medical Oncology 15

17 IV.A.5.a).(1).(a) IV.A.5.a).(1).(b) IV.A.5.a).(1).(c) IV.A.5.a).(1).(c).(i) IV.A.5.a).(1).(c).(i).(a) IV.A.5.a).(1).(c).(i).(b) IV.A.5.a).(1).(c).(i).(c) IV.A.5.a).(1).(c).(i).(d) IV.A.5.a).(1).(c).(i).(e) IV.A.5.a).(1).(c).(i).(f) IV.A.5.a).(1).(c).(i).(g) IV.A.5.a).(1).(c).(i).(h) IV.A.5.a).(1).(c).(i).(i) IV.A.5.a).(1).(c).(i).(j) IV.A.5.a).(1).(c).(i).(k) IV.A.5.a).(1).(c).(i).(l) IV.A.5.a).(1).(c).(i).(m) IV.A.5.a).(1).(c).(i).(n) must demonstrate competence in the practice of health promotion, disease prevention, diagnosis, care, and treatment of patients of each gender, from adolescence to old age, during health and all stages of illness; (Outcome) must demonstrate competency as a consultant; and, (Outcome) must demonstrate competence in the: prevention, evaluation, diagnosis, cancer staging, and management of patients with hematologic and neoplastic disorders of the: lung; (Outcome) gastrointestinal tract (esophagus, stomach, colon, rectum, anus); (Outcome) breast; (Outcome) pancreas; (Outcome) liver; (Outcome) testes; (Outcome) lymphoid organs; (Outcome) hematopoietic system; (Outcome) central nervous system; (Outcome) head and neck; (Outcome) thyroid and other endocrine organs, including multiple endocrine neoplasia (MEN) syndromes; (Outcome) skin, including melanoma; (Outcome) genitourinary tract; (Outcome) cancer family syndromes; and, (Outcome) Hematology and Medical Oncology 16

18 IV.A.5.a).(1).(c).(i).(o) IV.A.5.a).(1).(c).(ii) IV.A.5.a).(1).(c).(iii) IV.A.5.a).(1).(c).(iv) IV.A.5.a).(1).(c).(v) IV.A.5.a).(1).(c).(vi) IV.A.5.a).(1).(c).(vii) IV.A.5.a).(1).(c).(viii) IV.A.5.a).(2) gynecologic malignancies. (Outcome) care and management of the geriatric patient with malignancy and hematologic disorders; (Outcome) care of patients with HIV-related malignancies; (Outcome) management of the neutropenic and the immunocompromised patient; (Outcome) management of pain, anxiety, and depression in patients with cancer and hematologic disorders; (Outcome) palliative care, including hospice and home care; (Outcome) rehabilitation and psychosocial care of patients with cancer and hematologic disorders; and, (Outcome) treatment and diagnosis of paraneoplastic disorders; (Outcome) Fellows must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. Fellows: (Outcome) must demonstrate competence in the: IV.A.5.a).(2).(a) IV.A.5.a).(2).(b) IV.A.5.a).(2).(c) IV.A.5.a).(2).(d) indications for and application of imaging techniques in patients with neoplastic and blood disorders; (Outcome) use of chemotherapeutic drugs, biologic products, and growth factors; their mechanisms of action, pharmacokinetics, clinical indications, and limitations, including their effects, toxicity, and interactions; (Outcome) use of multiagent chemotherapeutic protocols and combined modality therapy of neoplastic disorders; (Outcome) management and care of indwelling access catheters; (Outcome) Hematology and Medical Oncology 17

19 IV.A.5.a).(2).(e) IV.A.5.a).(2).(f) IV.A.5.a).(2).(g) IV.A.5.a).(2).(h) IV.A.5.a).(2).(i) IV.A.5.a).(2).(j) IV.A.5.a).(2).(k) IV.A.5.a).(2).(l) IV.A.5.a).(2).(m) IV.A.5.a).(2).(n) IV.A.5.a).(2).(o) IV.A.5.a).(2).(p) IV.A.5.a).(2).(q) IV.A.5.b) Medical Knowledge use of hematologic, infection, and nutrition support; (Outcome) specific cancer prevention and screening, including competency in genetic testing for high-risk individuals; (Outcome) correlation of clinical information with cytology, histology, and immunodiagnostic imaging techniques; (Outcome) tests of hemostasis and thrombosis for both congenital and acquired disorders and regulation of antithrombotic therapy; (Outcome) use of chemotherapeutic agents and biological products through all therapeutic routes; (Outcome) assessment of tumor burden and response as measured by physical and radiologic exam, and tumor markers; (Outcome) assessment of hematologic disorders by computed tomography, MRI, PET scanning, and nuclear imaging techniques; (Outcome) assessment and interpretation of complete blood count, including platelets and white cell differential, by means of automated or manual techniques, with appropriate quality control; (Outcome) preparation staining and interpretation of blood smears, bone marrow aspirates, and touch preparations, as well as interpretation of bone marrow biopsies; (Outcome) performance of lumbar puncture and interpretation of cerebrospinal fluid evaluation; (Outcome) access and care of Ommaya reservoir; (Outcome) intrathecal administration of chemotherapeutic agents; and, (Outcome) care and management of venous access devices. (Outcome) Fellows must demonstrate knowledge of established and Hematology and Medical Oncology 18

20 evolving biomedical, clinical, epidemiological and socialbehavioral sciences, as well as the application of this knowledge to patient care. Fellows: (Outcome) IV.A.5.b).(1) IV.A.5.b).(2) IV.A.5.b).(3) IV.A.5.b).(3).(a) IV.A.5.b).(3).(b) IV.A.5.b).(4) IV.A.5.b).(4).(a) IV.A.5.b).(4).(b) IV.A.5.b).(4).(c) IV.A.5.b).(4).(d) IV.A.5.b).(5) IV.A.5.b).(5).(a) IV.A.5.b).(5).(b) IV.A.5.b).(5).(c) must demonstrate knowledge of the scientific method of problem solving and evidence-based decision making; (Outcome) must demonstrate knowledge of indications, contraindications, limitations, complications, techniques, and interpretation of results of those diagnostic and therapeutic procedures integral to the discipline, including the appropriate indications for and use of screening tests/procedures; (Outcome) must demonstrate knowledge of pathogenesis, diagnosis, and treatment of disease, including: basic molecular and pathophysiologic mechanisms, diagnosis, and therapy of diseases of the blood, including anemias, diseases of white blood cells and stem cells, and disorders of hemostasis and thrombosis; and, (Outcome) etiology, epidemiology, natural history, diagnosis, pathology, staging, and management of neoplastic diseases of the blood, blood-forming organs, and lymphatic tissues. (Outcome) must demonstrate knowledge of genetics and developmental biology, including: molecular genetics; (Outcome) prenatal diagnosis; (Outcome) the nature of oncogenes and their products; and, (Outcome) cytogenetics. (Outcome) must demonstrate knowledge of physiology and pathophysiology, including: cell and molecular biology; (Outcome) hematopiesis; (Outcome) principles of oncogenesis; (Outcome) Hematology and Medical Oncology 19

21 IV.A.5.b).(5).(d) IV.A.5.b).(5).(e) IV.A.5.b).(5).(f) IV.A.5.b).(5).(g) IV.A.5.b).(6) IV.A.5.b).(7) IV.A.5.b).(7).(a) IV.A.5.b).(7).(b) IV.A.5.b).(7).(c) IV.A.5.b).(7).(d) IV.A.5.b).(7).(e) IV.A.5.b).(7).(f) IV.A.5.b).(7).(g) IV.A.5.b).(7).(h) IV.A.5.b).(7).(i) IV.A.5.b).(7).(j) tumor immunology; (Outcome) molecular mechanisms of hematopoietic and lymphopoietic malignancies; (Outcome) basic and clinical pharmacology, pharmacokinetics, and toxicity; and, (Outcome) pathophysiology and patterns of tumor metastases. (Outcome) must demonstrate knowledge of clinical epidemiology and biostatistics, including clinical study and experimental protocol design, data collection, and analysis; (Outcome) must demonstrate knowledge of: basic principles of laboratory and clinical testing, quality control, quality assurance, and proficiency standards; (Outcome) immune markers, immunophenotyping, flow cytometry, cytochemical studies, and cytogenetic and DNA analysis of neoplastic disorders; (Outcome) malignant and hematologic complications of organ transplantation; (Outcome) gene therapy; (Outcome) effects of systemic disorders and drugs on the blood, blood-forming organs, and lymphatic tissues; (Outcome) transfusion medicine, including the evaluation of antibodies, blood compatibility, and the indications for and complications of blood component therapy and apheresis procedures; (Outcome) acquired and congenital disorders of red cells, white cells, platelets and stem cells; (Outcome) hematopoietic and lymphopoietic malignancies, including disorders of plasma cells; (Outcome) principles of multidisciplinary management of organ-specific cancers; and, (Outcome) the mechanisms of action, pharmacokinetics, clinical indications, and limitations of Hematology and Medical Oncology 20

22 chemotherapeutic drugs, biologic products, and growth factors, including their effects, toxicity, and interactions. (Outcome) IV.A.5.b).(8) IV.A.5.b).(8).(a) IV.A.5.b).(8).(b) IV.A.5.b).(9) IV.A.5.b).(10) IV.A.5.b).(11) IV.A.5.b).(12) IV.A.5.b).(12).(a) IV.A.5.b).(12).(b) IV.A.5.b).(12).(c) IV.A.5.b).(12).(d) IV.A.5.c) must demonstrate knowledge of, principles of, indications for, and limitations of: surgery in the treatment of cancer; and, (Outcome) radiation therapy in the treatment of cancer. (Outcome) must demonstrate knowledge of principles of, indications for, and complications of autologous and allogeneic bone marrow or peripheral blood stem cell transplantation; (Outcome) must demonstrate knowledge of principles, indications for, and complications of peripheral stem cell harvests; (Outcome) must demonstrate knowledge of the management of posttransplant complications; and, (Outcome) must demonstrate knowledge of the indications, complications, and risks and limitations associated with: thoracentesis; (Outcome) paracentesis; (Outcome) skin biopsies; and, (Outcome) lesion biopsies. (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) IV.A.5.c).(2) IV.A.5.c).(3) identify strengths, deficiencies, and limits in one s knowledge and expertise; (Outcome) set learning and improvement goals; (Outcome) identify and perform appropriate learning activities; Hematology and Medical Oncology 21

23 (Outcome) 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.c).(9) IV.A.5.d) 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; (Outcome) participate in the education of patients, families, students, fellows and other health professionals; (Outcome) obtain procedure-specific informed consent by competently educating patients about rationale, technique, and complications of procedures. (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) 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) Hematology and Medical Oncology 22

24 IV.A.5.d).(6) IV.A.5.d).(6).(a) IV.A.5.d).(6).(b) IV.A.5.d).(6).(c) IV.A.5.e) demonstrate team leadership skills and ability to work with an interdisciplinary team by: Professionalism identifying essential team members; (Outcome) defining the roles of team members; and, (Outcome) evaluating the role of the interdisciplinary team. (Outcome) 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).(7) 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; (Outcome) high standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians and other health care team members, and avoiding conflicts of interest; and, (Outcome) personal development, attitudes, and coping skills of physicians who care for critically-ill patients. (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) Hematology and Medical Oncology 23

25 Fellows are expected to: IV.A.5.f).(1) 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.6. IV.A.6.a) IV.A.6.a).(1) IV.A.6.a).(2) IV.A.6.a).(3) IV.A.6.b) IV.A.6.c) IV.A.6.d) IV.A.6.e) work effectively in various health care delivery settings and systems relevant to their clinical specialty; (Outcome) 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; and, (Outcome) participate in identifying system errors and implementing potential systems solutions. (Outcome) Curriculum Organization and Fellow Experiences A minimum of 18 months must be devoted to clinical experience. (Core) Of this time, nine months must be in hematology and nine months must be in medical oncology. (Core) At least 50% of the medical oncology clinical experience must occur in the outpatient setting. (Core) The program must provide at least one month of clinical experience in autologous and allogeneic bone marrow transplantation. (Core) Fellows must participate in training using simulation. (Detail) Inpatient assignments should be of sufficient duration to permit continuing care of a majority of the patients throughout their hospitalization. (Detail) Fellows must participate in multidisciplinary case management or tumor board conferences, and in protocol studies. (Core) Fellows must assume continuing responsibility for acutely- and chronically-ill patients in order to observe and manage both inpatients and outpatients with a wide variety of blood and neoplastic disorders, and the benefits and adverse effects of Hematology and Medical Oncology 24

26 therapy. (Core) IV.A.6.f) IV.A.6.g) IV.A.6.g).(1) IV.A.6.g).(2) IV.A.6.h) IV.A.6.h).(1) IV.A.6.h).(2) IV.A.6.i) Fellows must participate in a multidisciplinary case management conference or discussion. (Core) Fellows should participate in the care of patients undergoing: apheresis procedures; and (Core) bone marrow or peripheral stem cell harvest for transplantation. (Core) Fellows must be educated about, and should have experience with: performance and interpretation of partial thromboplastin time, prothrombin time, platelet aggregation, and bleeding time, as well as other standard and specialized coagulation assays; and, (Core) test of hemostasis. (Core) Experience with Continuity Ambulatory Patients Fellows must have continuity ambulatory clinic experience that exposes them to the breadth and depth of the subspecialty. (Core) IV.A.6.i).(1) IV.A.6.i).(2) This experience should average one half-day each week. (Detail) This experience must include an appropriate distribution of patients of each gender and a diversity of ages, (Core) This should be accomplished through either: IV.A.6.i).(2).(a) IV.A.6.i).(2).(b) IV.A.6.i).(3) IV.A.6.i).(4) IV.A.6.i).(5) a continuity clinic which provides fellows the opportunity to learn the course of disease; or, (Detail) selected blocks of at least six months which address specific areas of blood and neoplastic disorders. (Detail) Each fellow should, on average, be responsible for four to eight patients during each half-day session. (Detail) The continuity patient care experience should not be interrupted by more than one month, excluding a fellow s vacation. (Detail) Fellows should be informed of the status of their continuity Hematology and Medical Oncology 25

27 patients when such patients are hospitalized, as clinically appropriate. (Detail) IV.A.6.j) IV.A.6.j).(1) IV.A.6.j).(2) IV.A.6.j).(3) IV.B. IV.B.1. IV.B.2. IV.B.2.a) Procedures and Technical Skills Fellows Scholarly Activities Direct supervision of procedures performed by each fellow must occur until proficiency has been acquired and documented by the program director. (Core) Faculty members must teach and supervise the fellows in the performance and interpretation of procedures, which must be documented in each fellow s record, including indications, outcomes, diagnoses, and supervisor(s). (Core) It is suggested that fellows have the opportunity to develop competence in performing thoracentesis, paracentesis, skin biopsies, and lesion biopsies. (Detail) 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) The majority of fellows must demonstrate evidence of scholarship conducted during the fellowship. (Outcome) This should be achieved through one or more of the following: IV.B.2.a).(1) IV.B.2.a).(2) IV.B.2.a).(3) IV.B.2.a).(4) IV.B.3. publication of articles, book chapters, abstracts, or case reports in peer-reviewed journals; (Detail) publication of peer-reviewed performance improvement or education research; (Detail) peer-reviewed funding; or, (Detail) peer-reviewed abstracts presented at regional, state, or national specialty meetings. (Detail) The sponsoring institution and program should allocate adequate educational resources to facilitate fellow involvement in scholarly activities. (Detail) V. Evaluation V.A. Fellow Evaluation Hematology and Medical Oncology 26

28 V.A.1. 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.a).(1) V.A.2.a).(2) 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. 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 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 during each rotation or similar educational assignment, and document this evaluation at completion of the assignment. (Core) The faculty must discuss this evaluation with each fellow at the completion of each assignment. (Core) Assessment of procedural competence should include a formal evaluation process and not be based solely on a Hematology and Medical Oncology 27

29 minimum number of procedures performed. (Detail) V.A.2.b) V.A.2.b).(1) V.A.2.b).(1).(a) 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) Patient Care The program must assess the fellow in data gathering, clinical reasoning, patient management, and procedures in both the inpatient and outpatient setting. (Core) V.A.2.b).(1).(a).(i) V.A.2.b).(1).(a).(ii) V.A.2.b).(1).(a).(iii) V.A.2.b).(1).(b) This assessment must involve direct observation of fellow-patient encounters. (Detail) Each program must define criteria for competence for all required and elective procedures. (Detail) The record of evaluation must include the fellow s logbook or an equivalent method to demonstrate that each fellow has achieved competence in the performance of required procedures. (Detail) Medical Knowledge The program must use an objective formative assessment method. The same formative assessment method must be administered at least twice during the program. (Detail) V.A.2.b).(1).(c) Practice-based Learning and Improvement The program must use performance data to assess the fellow in: V.A.2.b).(1).(c).(i) V.A.2.b).(1).(c).(ii) V.A.2.b).(1).(c).(iii) application of evidence to patient care; (Detail) practice improvement; (Detail) teaching skills involving peers and patients; and, (Detail) Hematology and Medical Oncology 28