ACGME Program Requirements for Graduate Medical Education in Family Medicine

Transcription

1 ACGME Program Requirements for Graduate Medical Education in Family Medicine Visit the Review Committee specialty page on the ACGME website for any related Frequently Asked Questions (FAQs) ACGME approved: September 29, 2013; effective: July 1, 2014

2 ACGME Program Requirements for Graduate Medical Education in Family 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. Int.C. Family medicine is a primary care specialty which demonstrates high quality care within the context of a personal doctor-patient relationship and with an appreciation for the individual, family, and community connections. Continuity of comprehensive care for the diverse patient population family physicians serve is foundational to the specialty. Access, accountability, effectiveness, and efficiency are essential elements of the discipline. The coordination of patient care and leadership of advanced primary care practices and evolving health care systems are additional vital roles for family physicians. (Core) The educational program in family medicine 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 resident assignments at all participating sites. (Core) * The sponsoring institution and the program must ensure that the program Family Medicine 1

3 director has sufficient protected time and financial support for his or her educational and administrative responsibilities to the program. (Core) I.A.1. I.A.2. I.A.3. I.A.4. I.A.4.a) I.A.4.b) I.A.5. I.A.5.a) I.B. I.B.1. Since family medicine programs are dependent in part on other specialties for the education of residents, the ability and commitment of the institution to fulfill these requirements must be documented. (Core) Instruction in the other specialties must be conducted by faculty members with appropriate expertise.(core) There must be agreement with specialists in other areas/services regarding the requirement (II.D.2) that residents maintain concurrent commitment to their patients in the Family Medicine Practice (FMP) site during these rotations. (Core) The sponsoring institution and participating sites must: provide at least 70 percent salary support (at least 28 hours per week) for the program director as protected time for administration, evaluation, teaching, resident precepting, and scholarship; and, (Core) provide support for a full-time residency coordinator and other support personnel required for the operation of the program. (Detail) The sponsoring institution should provide access to an electronic health record system. (Detail) Participating Sites In the absence of an existing electronic health record system, the sponsoring institution must demonstrate institutional commitment to its development, and progress towards its implementation. (Detail) 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. (Detail) The PLA should: I.B.1.a) I.B.1.b) I.B.1.c) identify the faculty who will assume both educational and supervisory responsibilities for residents; (Detail) specify their responsibilities for teaching, supervision, and formal evaluation of residents, as specified later in this document; (Detail) specify the duration and content of the educational experience; and, (Detail) Family Medicine 2

4 I.B.1.d) I.B.2. I.B.3. state the policies and procedures that will govern resident 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 residents, of one month full time equivalent (FTE) or more through the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System (ADS). (Core) Participating sites should not be at such a distance from the primary clinical site that they require excessive travel time or otherwise fragment the educational experience for residents. (Detail) 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.b) II.A.3.b).(1) II.A.3.c) II.A.3.d) 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 specialty by the American Board of Family Medicine, or specialty qualifications that are acceptable to the Review Committee; (Core) The Review Committee accepts no other qualifications. (Core) current medical licensure and appropriate medical staff appointment; and, (Core) a minimum of five years of clinical experience in family medicine, with two years as a core faculty member in an ACGME-accredited family medicine residency program. (Core) The program director must administer and maintain an educational environment conducive to educating the residents in each of the ACGME competency areas. (Core) Family Medicine 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 resident 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 resident 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 resident 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 residency education for all residents, including those who leave the program prior to completion; (Detail) implement policies and procedures consistent with the institutional and program requirements for resident 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 residents and faculty; (Detail) monitor resident 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) Family Medicine 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.n).(9) II.A.4.n).(10) II.A.4.n).(11) 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 residents, disciplinary action, and supervision of residents; (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 resident complement; (Detail) major changes in program structure or length of training; (Detail) progress reports requested by the Review Committee; (Detail) responses to all proposed adverse actions; (Detail) requests for increases or any change to resident duty hours; (Detail) voluntary withdrawals of ACGME-accredited programs; (Detail) requests for appeal of an adverse action; (Detail) appeal presentations to a Board of Appeal or the ACGME; (Detail) proposals to ACGME for approval of innovative educational approaches; and, (Detail) proposals for new or significantly remodeled FMPs. (Detail) Family Medicine 5

7 II.A.4.n).(11).(a) 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) Prior approval of the Review Committee must be obtained before residents may rotate to these sites. (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 at least 70 percent of his or her time, (at least 28 hours per week or 1400 hours per year) to program administration, evaluation, teaching, resident precepting, and scholarship; and, (Core) Time spent in direct patient care without the presence of residents must not be included in the 1400 hours per year total. (Detail) maintain clinical skills by providing direct patient care. (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 residents at that location. (Core) The faculty must: II.B.1.a) II.B.1.b) II.B.2. II.B.2.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 residents; and, (Core) administer and maintain an educational environment conducive to educating residents in each of the ACGME competency areas. (Core) The physician faculty must have current certification in the specialty by the American Board of Family Medicine, or possess qualifications judged acceptable to the Review Committee. (Core) Family medicine physician faculty members who are not certified by the American Board of Family Medicine (ABFM) must demonstrate ongoing learning activities equivalent to the ABFM Maintenance of Certification process, including demonstration of professionalism, cognitive expertise, self-assessment and life-long Family Medicine 6

8 learning, and assessment of performance in practice. (Core) II.B.2.b) II.B.3. II.B.3.a) II.B.3.b) II.B.4. II.B.4.a) 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. Physician faculty members from other specialties must have current certification in their specialties by a member board of the American Board of Medical Specialties, or possess qualifications acceptable to the Review Committee. (Core) The physician faculty must possess current medical licensure and appropriate medical staff appointment. (Core) All family medicine physician faculty members must maintain clinical skills by providing direct patient care. (Core) Some family medicine physician faculty members must have admitting privileges in the hospital(s) where FMP patients are hospitalized. (Core) The nonphysician faculty must have appropriate qualifications in their field and hold appropriate institutional appointments. (Core) Faculty members in other professional disciplines should possess certification as appropriate for their disciplines. (Detail) 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 residents in scholarly activities. (Core) There must be at least one core family medicine physician faculty member, in addition to the program director, for every six residents in the program. (Core) Family Medicine 7

9 II.B.6.a) II.B.6.a).(1) II.B.6.a).(2) II.B.7. II.B.8. II.B.9. II.B.10. II.B.11. II.C. Core physician faculty members must: dedicate at least 60 percent time (at least 24 hours per week, or 1200 hours per year), to the program, exclusive of patient care without residents; and, (Detail) devote the majority of their professional effort to teaching, administration, scholarly activity, and patient care within the program. (Detail) All programs must have family medicine physician faculty members providing and teaching care for each of the following: maternity care, including deliveries; inpatient adults; and inpatient children. (Core) Family medicine physician faculty members should have a specific time commitment to patient care. (Detail) Some family medicine physician faculty members must see patients in each of the FMPs used by the program. (Detail) There must be faculty members dedicated to the integration of behavioral health into the educational program. (Detail) There must be a structured program of faculty development that involves regularly scheduled faculty development activities designed to enhance the effectiveness of teaching, administration, leadership, scholarship, clinical, and behavioral components of faculty members performance. (Detail) 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.C.1. II.D. Resources The program must have a program coordinator. (Core) The institution and the program must jointly ensure the availability of adequate resources for resident education, as defined in the specialty program requirements. (Core) II.D.1. II.D.1.a) II.D.1.b) Patient Population The patient population must include a volume and variety of clinical problems and diseases sufficient to enable all residents to learn and demonstrate competence for all required patient care outcomes. (Core) The patient population must include a sufficient number of patients Family Medicine 8

10 of both genders, with a broad range of ages, from newborns to the aged. (Core) II.D.2. II.D.2.a) II.D.2.b) II.D.2.c) II.D.2.d) II.D.2.e) II.D.2.f) II.D.2.g) II.D.2.g).(1) II.D.2.h) II.D.2.i) II.D.2.j) II.D.2.k) There must be at least one FMP site to serve as the foundation for educating residents and to provide family medicine physician role models. (Core) This space must support continuous, comprehensive, convenient, accessible, and coordinated patient care. (Detail) If multiple FMP sites are used for resident education, each must meet the criteria for the primary practice and be approved by the Review Committee prior to use. (Detail) Each FMP must have a mission statement describing dedication to education and the care of patients within the practice as it relates to the greater community and the community served by the residency program. (Detail) Each FMP site must provide contiguous space for residents clinical work and education. (Detail) Each FMP site should provide space for meetings, group visits, or small group counseling. (Detail) Each FMP site should use an electronic health record. (Detail) There must be a ratio of residents-to-faculty preceptors in the FMP not to exceed 4:1. (Detail) If only one resident is seeing patients in the FMP, a single faculty member must devote at least 50 percent of his or her time to teaching and supervising that resident. (Detail) Each FMP site should provide, on average, two examination rooms for each faculty member and resident when they are providing patient care. (Detail) The FMP site must be sufficiently staffed to ensure efficiency of operation and adequate support for patient care and fulfillment of educational requirements. (Detail) Other physician specialists should not see patients in the FMP site unless their presence enhances the experiences and learning of the residents. (Detail) Each FMP site must involve all members of the practice in ongoing performance improvement, and must demonstrate use of outcomes in improving clinical quality, patient satisfaction, patient safety, and financial performance. (Detail) Family Medicine 9

11 II.D.3. II.D.4. II.E. The inpatient facilities must have occupied teaching beds to ensure a patient load and variety of problems sufficient to support the education of the number of residents and other learners on the services. (Core) Inpatient facilities must also provide physical, human, and educational resources for education in family medicine. (Core) Medical Information Access Residents 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. Resident Appointments Eligibility Criteria The program director must comply with the criteria for resident eligibility as specified in the Institutional Requirements. (Core) III.B. Number of Residents The program s educational resources must be adequate to support the number of residents appointed to the program. (Core) III.B.1. III.B.2. III.B.3. III.C. III.C.1. III.C.2. III.D. The program director may not appoint more residents than approved by the Review Committee, unless otherwise stated in the specialty-specific requirements. (Core) The program must offer at least four resident positions at each educational level. (Detail) The program should have at least 12 on-duty residents. (Detail) Resident Transfers Before accepting a resident who is transferring from another program, the program director must obtain written or electronic verification of previous educational experiences and a summative competency-based performance evaluation of the transferring resident. (Detail) A program director must provide timely verification of residency education and summative performance evaluations for residents 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 Family Medicine 10

12 practitioners) in the program must not interfere with the appointed residents 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 residents and faculty; (Core) Competency-based goals and objectives for each assignment at each educational level, which the program must distribute to residents and faculty at least annually, in either written or electronic form; (Core) Regularly scheduled didactic sessions; (Core) IV.A.3.a) IV.A.4. IV.A.5. The program must provide a regularly scheduled forum for residents to explore and analyze evidence pertinent to the practice of family medicine. (Core) Delineation of resident responsibilities for patient care, progressive responsibility for patient management, and supervision of residents 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) IV.A.5.a).(1).(a) IV.A.5.a).(1).(a).(i) IV.A.5.a).(1).(a).(ii) Patient Care and Procedural Skills Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents: (Outcome) must demonstrate competence to independently: diagnose, manage, and integrate the care of patients of all ages in various outpatient settings, including the FMP site and home environment; (Outcome) diagnose, manage, and integrate the care of patients of all ages in various inpatient settings, including hospitals, long-term care Family Medicine 11

13 facilities, and rehabilitation facilities; (Outcome) IV.A.5.a).(1).(a).(iii) IV.A.5.a).(1).(a).(iv) IV.A.5.a).(1).(a).(v) IV.A.5.a).(1).(a).(vi) IV.A.5.a).(1).(b) IV.A.5.a).(1).(b).(i) IV.A.5.a).(1).(b).(ii) IV.A.5.a).(1).(b).(iii) IV.A.5.a).(1).(b).(iv) IV.A.5.a).(1).(b).(v) IV.A.5.a).(1).(b).(vi) IV.A.5.a).(1).(c) IV.A.5.a).(1).(c).(i) IV.A.5.a).(1).(c).(ii) IV.A.5.a).(1).(c).(iii) IV.A.5.a).(1).(c).(iv) diagnose, manage, and coordinate care for common mental illness and behavioral issues in patients of all ages; (Outcome) assess community, environmental, and family influences on the health of patients; (Outcome) use multiple information sources to develop a patient care plan based on current medical evidence; and, (Outcome) provide end-of-life care. (Outcome) must demonstrate proficiency in their ability to: evaluate patients of all ages with undiagnosed and undifferentiated presentations; (Outcome) treat medical conditions commonly managed by family physicians; (Outcome) provide preventive care; (Outcome) interpret basic clinical tests and images; (Outcome) recognize and provide initial management of emergency medical problems; and, (Outcome) use pharmacotherapy. (Outcome) must demonstrate competence in their ability to provide maternity care, including: (Outcome) distinguishing abnormal and normal pregnancies; (Outcome) caring for common medical problems arising from pregnancy or coexisting with pregnancy; (Outcome) performing a spontaneous vaginal delivery; and, (Outcome) demonstrating basic skills in managing obstetrical emergencies. (Outcome) Family Medicine 12

14 IV.A.5.a).(1).(d) IV.A.5.a).(2) IV.A.5.a).(2).(a) IV.A.5.b) should demonstrate competence in providing basic pre- and post-operative care, recognizing patients requiring acute surgical intervention, diagnosing surgical problems, and using sterile technique. (Outcome) Residents must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. Residents: (Outcome) Medical Knowledge must appropriately use and perform diagnostic and therapeutic procedures. (Outcome) Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socialbehavioral sciences, as well as the application of this knowledge to patient care. Residents: (Outcome) IV.A.5.b).(1) IV.A.5.b).(2) IV.A.5.c) must demonstrate proficiency in their knowledge of the broad spectrum of clinical disorders seen in the practice of family medicine; and, (Outcome) must demonstrate proficiency in their ability to evaluate evolving medical knowledge and incorporate it into meaningful clinical practice. (Outcome) Practice-based Learning and Improvement Residents 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) Residents 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) IV.A.5.c).(4) identify strengths, deficiencies, and limits in one s knowledge and expertise; (Outcome) 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) Family Medicine 13

15 IV.A.5.c).(5) IV.A.5.c).(6) IV.A.5.c).(7) IV.A.5.c).(8) IV.A.5.d) 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, residents and other health professionals. (Outcome) Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (Outcome) Residents 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.e) 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; and, (Outcome) maintain comprehensive, timely, and legible medical records, if applicable. (Outcome) Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (Outcome) Residents are expected to demonstrate: IV.A.5.e).(1) IV.A.5.e).(2) compassion, integrity, and respect for others; (Outcome) responsiveness to patient needs that supersedes self- Family Medicine 14

16 interest; (Outcome) IV.A.5.e).(3) IV.A.5.e).(4) IV.A.5.e).(5) IV.A.5.e).(6) IV.A.5.f) 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) adherence to the sponsoring institution s professionalism standards and code of conduct, and to citizenship and other responsibilities. (Outcome) Systems-based Practice Residents 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) Residents 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) 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 Resident Experiences Each resident must be assigned to a primary FMP site. (Outcome) Residents must be scheduled to see patients in the FMP Family Medicine 15

17 site for a minimum of 40 weeks during each year of the program. (Detail) IV.A.6.a).(1).(a) IV.A.6.a).(1).(b) IV.A.6.a).(2) IV.A.6.a).(3) IV.A.6.a).(3).(a) IV.A.6.a).(4) IV.A.6.a).(5) IV.A.6.a).(5).(a) IV.A.6.a).(5).(b) IV.A.6.a).(5).(c) IV.A.6.a).(6) Residents other assignments must not interrupt continuity for more than eight weeks at any given time or in any one year. (Detail) The periods between interruptions in continuity must be at least four weeks in length. (Detail) Experiences in the FMP must include acute care, chronic care, and wellness care for patients of all ages. (Core) Residents must be primarily responsible for a panel of continuity patients, integrating each patient s care across all settings, including the home, long-term care facilities, the FMP site, specialty care facilities, and inpatient care facilities. (Core) Long-term care experiences must occur over a minimum of 24 months. (Detail) Residents should participate in and assume progressive leadership of appropriate care teams to coordinate and optimize care for a panel of continuity patients. (Detail) Residents must provide care for a minimum of 1650 inperson patient encounters in the FMP site. (Core) The majority of these visits must occur in the resident s primary FMP site. (Detail) One hundred sixty-five of the FMP site patient encounters must be with patients younger than 10 years of age. (Detail) One hundred sixty-five of the FMP site patient encounters must be with patients 60 years of age or older. (Detail) Residents patient encounters should include telephone visits, e-visits, group visits, and patient-peer education sessions. (Detail) IV.A.6.b) Residents must have at least 600 hours (or six months) and 750 patient encounters dedicated to the care of hospitalized adult patients with a broad range of ages and medical conditions. (Core) IV.A.6.b).(1) Residents must have at least 100 hours (or one month) or 15 encounters dedicated to the care of ICU patients. (Detail) Family Medicine 16

18 IV.A.6.b).(2) IV.A.6.c) IV.A.6.c).(1) Residents must provide care to hospitalized adults during all years of the program. (Detail) Residents must have emergency department experience. (Core) Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of acutely ill or injured adults in an emergency department setting. (Detail) IV.A.6.d) Residents must have at least 100 hours (or one month) or 125 patient encounters dedicated to the care of the older patient. (Core) IV.A.6.d).(1) IV.A.6.d).(2) The experience must include functional assessment, disease prevention and health promotion, and management of patients with multiple chronic diseases. (Detail) The experience should incorporate care of older patients across a continuum of sites. (Detail) IV.A.6.e) Residents must have at least 200 hours (or two months) and 250 patient encounters dedicated to the care of ill child patients in the hospital and/or emergency setting. (Core) IV.A.6.e).(1) This experience should include a minimum of 75 inpatient encounters with children. (Detail) IV.A.6.e).(2) This experience should include a minimum of 75 emergency department patient encounters with children. (Detail) IV.A.6.f) Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of children and adolescents in an ambulatory setting. (Core) IV.A.6.f).(1) IV.A.6.g) IV.A.6.h) IV.A.6.h).(1) IV.A.6.i) This care must include well-child care, acute care, and chronic care. (Detail) Residents must have at least 40 newborn patient encounters, including well and ill newborns. (Core) Residents must have at least 100 hours (or one month) dedicated to the care of surgical patients, including hospitalized surgical patients. (Core) This experience must include operating room experience. (Detail) Residents must have at least 200 hours (or two months) dedicated to the care of patients with a breadth of musculoskeletal problems. (Core) Family Medicine 17

19 IV.A.6.i).(1) This experience must include a structured sports medicine experience. (Detail) IV.A.6.j) Residents must have at least 100 hours (or one month) or 125 patient encounters dedicated to the care of women with gynecologic issues, including well-woman care, family planning, contraception, and options counseling for unintended pregnancy. (Core) IV.A.6.k) IV.A.6.k).(1) IV.A.6.l) IV.A.6.l).(1) IV.A.6.m) IV.A.6.n) IV.A.6.o) IV.A.6.p) IV.A.6.q) IV.A.6.q).(1) IV.A.6.r) IV.A.6.r).(1) Residents must document 200 hours (or two months) dedicated to participating in deliveries and providing prenatal and post-partum care. (Core) This experience must include a structured curriculum in prenatal, intra-partum, and post-partum care. (Core) Programs should provide an experience in prenatal care, labor management, and delivery management. (Detail) Some of the maternity experience should include the prenatal, intra-partum, and post-partum care of the same patient in a continuity care relationship. (Detail) Residents must have experience in diagnosing and managing common dermatologic conditions. (Core) The curriculum must be structured so behavioral health is integrated into the residents total educational experience, to include the physical aspects of patient care. (Detail) There must be a structured curriculum in which residents are educated in the diagnosis and management of common mental illnesses. (Detail) There must be a structured curriculum in which residents address population health, including the evaluation of health problems of the community. (Detail) There must be specific subspecialty curricula to address the breadth of patients seen in family medicine. (Core) The program must ensure that every resident has exposure to a variety of medical and surgical subspecialties throughout the educational program. (Detail) Residents must receive training to perform clinical procedures required for their future practices in ambulatory and hospital environments. (Core) The program director and family medicine faculty should Family Medicine 18

20 develop a list of procedural competencies required for completion by all residents in the program prior to graduation. (Core) IV.A.6.r).(1).(a) IV.A.6.r).(1).(b) IV.A.6.s) IV.A.6.s).(1) IV.A.6.s).(2) IV.A.6.s).(3) IV.A.6.s).(4) IV.A.6.t) IV.A.6.u) This list must be based on the anticipated practice needs of all family medicine residents. (Core) In creating this list, the faculty should consider the current practices of program graduates, national data regarding procedural care in family medicine, and the needs of the community to be served. (Core) Residents must have at least 100 hours (or one month) dedicated to health system management experiences. (Core)) This curriculum should prepare residents to be active participants and leaders in their practices, their communities, and the profession of medicine. (Detail) Each resident should be a member of a health system or professional group committee. (Detail) Residents must receive regular reports of individual and practice productivity, financial performance, and clinical quality, as well as the training needed to analyze these reports. (Detail) Residents must attend regular FMP business meetings with staff and faculty members to discuss practice-related policies and procedures, business and service goals, and practice efficiency and quality. (Detail) The curriculum should include diagnostic imaging interpretation and nuclear medicine therapy pertinent to family medicine. (Detail) Residents must have at least 300 hours (or three months) dedicated to elective experiences. (Core) IV.B. IV.B.1. IV.B.2. IV.B.2.a) IV.B.3. Residents Scholarly Activities The curriculum must advance residents knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. (Core) Residents should participate in scholarly activity. (Core) Residents should complete two scholarly activities, at least one of which should be a quality improvement project. (Outcome) The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly Family Medicine 19