Frequently Asked Questions: Complex General Surgical Oncology Review Committee for Surgery ACGME

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1 Frequently Asked Questions: Complex General Surgical Oncology Review Committee for Surgery ACGME Question Institutions What kind of affiliation must the fellowship have with a surgery residency program? [Program Requirement: I.A.1.] What kind of affiliation must the fellowship have with a medical oncology residency program? The program must be sponsored by an institution that 1) also sponsors an ACGMEaccredited surgery residency program; or 2) is an integrated site for an ACGMEaccredited surgery residency program. The program must be sponsored by an institution that 1) also sponsors an ACGMEaccredited medical oncology residency program; or 2) is an integrated site for an ACGME-accredited medical oncology residency program. [Program Requirement: I.A.2.] Are fellows required to return to the primary site for weekly didactics and conferences when they are on rotation at a site that is not geographically proximate? [Program Requirement: I.B.4.] Program Personnel and Resources Why are there required qualifications for new program directors? [Program Requirement: II.A.2.] When a site is not geographically proximate and a fellow cannot return to the primary site, and joint conferences cannot be held, an equivalent educational program of lectures and conferences at that participating site must be provided and fully documented. When a program or institution adds a participating site that is geographically remote, the program or institution must describe how this requirement will be met and monitored. In the past, young faculty members were frequently appointed as program directors with the expectation of learning on the job in a role that was often limited to custodian and contact person. Today, a surgical residency is multi-faceted, and the accreditation requirements are extensive, so it is important that individuals are already prepared to take on the role, are already respected, senior members of the faculty, and have reached a stage in their academic practices that enables them to truly devote the time and effort required to oversee a high quality residency program Accreditation Council for Graduate Medical Education (ACGME) Page 1 of 6

2 Question What type of educational and administrative experience is required before an individual can be appointed as a new program director? [Program Requirement: II.A.2.a)] Why must a program director be boardcertified in the specialty/subspecialty of the program? In order to be prepared to function as a new program director, an individual must already have a comprehensive understanding of and ability in educational and evaluation methods, active experience in managing and administering a complex organization, and leadership and communication skills. An individual who is appointed as a new program director should have served for at least five years as a GME faculty member, with at least two years at the institution at which he or she is being appointed as program director. Such an individual should, as applicable, have been promoted or be eligible for promotion to the position of associate professor, and should already have served as an associate residency program director for at least one year. As a senior leader and role model, the program director is expected to be an expert in the specific field of the program. Current board certification is the minimum benchmark of expertise. [Program Requirement: II.A.2.b)] Why must a new program director have an active, unrestricted license to practice medicine in the state in which the program is located and unrestricted credentials at the primary clinical site? [Program Requirement: II.A.2.c)] Why must the program director have documented scholarly activity, and what types of scholarly activity are sufficient? [Program Requirement: II.A.2.e)] As a senior role model and respected clinical leader, a program director must be recognized as an expert in the practice of surgery, must be fully cognizant of the requirements for licensure and credentialing, and should be actively engaged in the practice of surgery in the clinical site where the program is located. The program director sets the tone for the scholarly environment of the residency program. In order to be effective in this capacity, the program director must be recognized and respected by faculty members and residents as having demonstrated success in scholarship. It is highly recommended that the program director have documented scholarly activity in all three areas described in the Program Requirements. Because it is expected that both faculty members and residents are involved in research and publication, the program director should have evidence of peer-reviewed publication during the most recent five-year period. In addition, the program director should have contributed to the field of surgery by analyzing or reviewing clinical practice. It is highly desirable that a program director has actively participated in national or regional surgical meetings and served on committees of national or regional surgical organizations. Although there are other ways to demonstrate scholarship, the Review Committee recommends these guidelines for 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 2 of 6

3 Question What qualifications are acceptable to the Review Committee in lieu of American Board of Medical Specialties (ABMS) certification for faculty members? [Program Requirement: II.B.3.] What qualifications are acceptable to the Review Committee for faculty members who have not competed an ACGMEaccredited complex general surgical oncology fellowship? demonstration of scholarly activity by program directors. The determination of whether qualifications are equivalent to certification by an ABMS board is a peer judgment decision on the part of the Review Committee. The Common Program Requirement language, included in every set of ACGME specialty and subspecialty Program Requirements, allows for consideration by the Review Committee for those individuals who might have achieved certification in a comparable system. For complex general surgical oncology, current practitioners are not considered for certification by the American Board of Surgery (ABS). Therefore, the Review Committee will consider as faculty members surgeons who trained under other systems of program accreditation and individual certification. In evaluating a surgeon as a faculty member in a complex general surgical oncology fellowship program, several qualifications will be considered. These include: contributions to the field in the form of publications in peer-reviewed journals, ongoing research programs, and presentations at national meetings; peer-selected leadership positions in regional or national organizations; participation in national specialty organizations, including fellowship in the American College of Surgeons (ACS); current certification by the ABS; and current practice of complex general surgical oncology, as defined in the Program Requirements. Neither the ABS nor the Review Committee accepts the phrase "board eligible." The burden of proof for documentation of qualifications of faculty members is on the program director, who is also responsible for ensuring that the curriculum vitae of proposed faculty members are accurate and complete. Until there is an adequate number of graduates who have completed ACGMEaccredited complex general surgical oncology fellowships to be able to serve as these faculty members, ABS certification in general surgery is acceptable. [Program Requirement: II.B.3.a)] 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 3 of 6

4 Question What specialty areas must be represented among the members of the program faculty? [Program Requirement: II.B.5.b)] What qualifications must non-physician faculty members possess? [Program Requirement: II.B.8.] Fellow Appointments Will osteopathic residents who graduate from ACGME-accredited complex general surgical oncology programs be eligible for ABS certification? [Program Requirement: III.A.] Educational Program What are the minimum case requirements for fellows? [Program Requirement: IV.A.2.a.)] What must a program do to establish an alternate rotation schedule that does not include the minimum one-month rotations in medical oncology, pathology, and radiation oncology? [Program Requirement: IV.A.3.b)] Faculty members from other disciplines are crucial to the education of fellows. Institutional resources must include faculty members who participate in the education of fellows in the care of cancer patients. Faculty members from medical oncology and radiation oncology must be involved in the didactic and clinical education of the program s fellows. Non-physician faculty members may include other doctoral-level faculty members, nurses, and nurse practitioners. The Committee expects that any identified nonphysician faculty members will have required licensure to provide clinical care. Nonclinical faculty members should hold a faculty appointment. The ABS requires that graduates of programs in complex general surgical oncology first be certified in general surgery by the ABS to be eligible for ABS certification in this specialty. The ABS Policy for Entry of Osteopathic Trainees into ABS Certification Process may be found on the ABS website: Contact Review Committee Executive Director Donna Lamb with questions ). Case minimum requirements for fellows can be found in the Surgery section of the ACGME website, on the Documents and Resources page, under Case Log Information, or directly, at this link: Complex_General_Surgical_Oncology.pdf. Programs must seek prior approval from the Review Committee for rotation schedules that do not include one month each in medical oncology, pathology, and radiation oncology. Documentation of experience in these areas must be demonstrated through the goals and objectives throughout the program. If requesting consideration for such a schedule from the Review Committee, the program director should provide a cover letter detailing the goals and objectives for each rotation of the program that would incorporate the areas listed above Accreditation Council for Graduate Medical Education (ACGME) Page 4 of 6

5 The Learning and Working Environment Who can supervise residents and fellows in the clinical environment? [Program Requirement: VI.A.2.a).(1)] What skills should members of the caregiver team have and how should these be ensured across the team? [Program Requirement: VI.E.2.] Appropriately-credentialed and privileged attending physicians in the surgical clinical environment include ABMS appropriately-credentialed surgeons (e.g., thoracic surgeries would be supervised by thoracic surgeons, etc.). In the critical care clinical environment, procedures must be supervised by appropriately credentialed ABMScertified critical care physicians (e.g., anesthesia critical care physicians, critical care medicine physicians, critical care pediatric physicians, etc.). All members of the caregiver team should be provided instruction in: 1. recognition of and sensitivity to the experience and competency of other team members; 2. time management; 3. prioritization of tasks as the dynamics of a patient s needs change; 4. recognizing when an individual becomes overburdened with responsibilities that cannot be accomplished within an allotted time period; 5. communication, so that if all required tasks cannot be accomplished in a timely fashion, appropriate methods are established to hand off the remaining task(s) to another team member as necessary; 6. recognizing signs and symptoms of fatigue not only in oneself, but in other team members; 7. compliance with work hours limits; and, 8. team development Accreditation Council for Graduate Medical Education (ACGME) Page 5 of 6

6 Are there any circumstances under which residents may stay on duty to care for their patients or return to the hospital with fewer than eight hours free of clinical and educational work? [Program Requirements: VI.F.2.b).(1), VI.F.4.a)] Yes. Such circumstances include: 1. continuity of care for patients, such as for: a) a patient on whom a resident operated/intervened that day who needs return to the operating room (OR); b) a patient on whom a resident operated/intervened that day who requires transfer to the intensive care unit (ICU) from a lower level of care; c) a patient on whom a resident operated/intervened that day who is in the ICU and is critically unstable; or, d) a patient on whom a resident operated/intervened during that hospital admission, and who needs to return to the OR for a reason related to the procedure previously performed by resident; or, a patient or patient s family with whom a resident needs to discuss limitation of treatment/dnr/dni orders for critically-ill patient on whom the resident operated. 2. a declared emergency or disaster, for which the residents are included in the disaster plan; or, to perform high profile, low frequency procedures necessary for competence in the field Accreditation Council for Graduate Medical Education (ACGME) Page 6 of 6

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