The Academic Pediatric The Academic Pediatric Association (APA) Association (APA)

AGP Fellowship ProjectAGP Fellowship Project

An UpdateAn Update

The AGP Fellowship Project CommitteeThe AGP Fellowship Project Committee

PAS Meeting, May 2008PAS Meeting, May 2008

Committee MembersCommittee Members

Lou BellLou Bell (Chair) (Chair) Steve Ludwig (past-chair)Steve Ludwig (past-chair) Connie BaldwinConnie Baldwin Tina ChengTina Cheng Dan CouryDan Coury Paul Darden Paul Darden Tom DeWittTom DeWitt Benard DreyerBenard Dreyer Peter SzilagyiPeter Szilagyi Marge DegnonMarge Degnon

QuestionQuestion

Why does a pediatric resident Why does a pediatric resident have a more difficult time have a more difficult time choosing a career in general choosing a career in general pediatrics than a career in a pediatrics than a career in a pediatric subspecialty?pediatric subspecialty?

Resident AResident A

Going into a pediatric subspecialtyGoing into a pediatric subspecialty Finds the listing of all the programsFinds the listing of all the programs Knows all programs are accredited Knows all programs are accredited

by ACGMEby ACGME Can easily set up interviewsCan easily set up interviews Enters an organized matchEnters an organized match Completes his/her fellowship and Completes his/her fellowship and

becomes ABP Certifiedbecomes ABP Certified

Resident BResident B

Wants- Academic General PediatricsWants- Academic General Pediatrics Cannot find which programs are availableCannot find which programs are available Not sure of uniformity and quality of Not sure of uniformity and quality of

programsprograms Has variable timelines for application / Has variable timelines for application /

selectionselection Will receive no certificate for his/her Will receive no certificate for his/her

trainingtraining

Background-1Background-1

Survey of AGP programs in US Survey of AGP programs in US (119/199 responded - 60%)(119/199 responded - 60%)

Have AGP fellowship program:Have AGP fellowship program: 28%28%Plan to start one:Plan to start one: 13%13%

Program durationProgram duration 3 yrs (32%)3 yrs (32%) 2 yrs (64%) 2 yrs (64%)

Masters degreeMasters degree 76%76%

Clinical timeClinical time 31% mean (range 10-90%)31% mean (range 10-90%)

Major challengeMajor challenge FundingFunding

Cheng, Markakis, DeWitt, Pediatrics. 2007

Background-2Background-2

AGP programs typically suffer fromAGP programs typically suffer from::– a lack of a unifying structurea lack of a unifying structure

– variability in the level of “academics”variability in the level of “academics”

– lack of any fixed curricular requirements lack of any fixed curricular requirements

– uncertain fundinguncertain funding

– no methods for advertising and promoting no methods for advertising and promoting programsprograms

Background-3Background-3AGP fellowships include programs that may AGP fellowships include programs that may focus onfocus on::

General pediatricsGeneral pediatrics Health services researchHealth services research Clinical effectivenessClinical effectiveness Quality and safetyQuality and safety Community pediatric researchCommunity pediatric research Environmental healthEnvironmental health Hospital medicineHospital medicine Health policy researchHealth policy research

ProposalProposal APA becomes the accrediting body for APA becomes the accrediting body for

Academic General Pediatric Fellowship Academic General Pediatric Fellowship programsprograms

APA set standards for programsAPA set standards for programs

APA provides a consultation service for APA provides a consultation service for developing programsdeveloping programs

APA implements a system to support and APA implements a system to support and enrich existing programs and encourages enrich existing programs and encourages new programs to developnew programs to develop

Key PointKey Point

This is about ACADEMICSThis is about ACADEMICS

It is not about the clinical trainingIt is not about the clinical training

The goal is to improve the academics of The goal is to improve the academics of fellowship training programs fellowship training programs

A goal is to prepare the next generation of A goal is to prepare the next generation of academic leaders as educators and clinical academic leaders as educators and clinical researchers to improve child healthresearchers to improve child health

Strengthening the Academic Strengthening the Academic Base of General Pediatrics Base of General Pediatrics

Fellowship Programs: Fellowship Programs: A National Program and A National Program and

Curriculum Development ProjectCurriculum Development Project

Constance Baldwin, PhDConstance Baldwin, PhD Peter Szilagyi, MD, Peter Szilagyi, MD, MPHMPHLouis M. Bell, MDLouis M. Bell, MD Bernard Dreyer, MDBernard Dreyer, MDTina L. Cheng, MD, MPHTina L. Cheng, MD, MPH Dan Coury, MDDan Coury, MDTom DeWitt, MDTom DeWitt, MD Paul Darden, MDPaul Darden, MD

Stephen Ludwig, MDStephen Ludwig, MD

Ambulatory Pediatrics. 2007;Volume 7 (2 articles)

Description of program and pilot: 340-347

Curriculum design, goals, objectives: 328-339

ObjectivesObjectives

1)1) Developing curriculum guidelines and program Developing curriculum guidelines and program standards standards

2)2) Creating a process for program review and Creating a process for program review and consultation that might later be used for consultation that might later be used for accreditation of AGP fellowship programs accreditation of AGP fellowship programs

3)3) Pilot test an accreditation processPilot test an accreditation process

(Funding from DHHS, Bureau of Health Professions)(Funding from DHHS, Bureau of Health Professions)

To strengthen academic general pediatrics To strengthen academic general pediatrics (AGP) fellowship programs by (AGP) fellowship programs by

Accomplishments to Date - 1Accomplishments to Date - 1

√ Developed Curriculum and Developed Curriculum and Educational Goals and ObjectivesEducational Goals and Objectives

(Ambulatory Pediatrics 2007;7:328-339)(Ambulatory Pediatrics 2007;7:328-339)

AGP FellowshipAGP Fellowship

Five Core Curriculum RequirementsFive Core Curriculum Requirements Goals and Objectives Goals and Objectives for Academic for Academic CompetenceCompetence

3 required domains of competence:3 required domains of competence:– Research, Education, Career Research, Education, Career

DevelopmentDevelopment

Learner Needs Learner Needs Assessments / Assessments / Tracking Tracking

Annually re-assessmentAnnually re-assessmentAnnual evaluationAnnual evaluation

Learning activitiesLearning activities Written individualized plan per Written individualized plan per objectiveobjective

Diversity of activitiesDiversity of activities

Fellow Evaluation Fellow Evaluation MethodsMethods

Focused evaluation of objectivesFocused evaluation of objectivesSound and informative methods Sound and informative methods Multiple assessment and feedbackMultiple assessment and feedback

Program Evaluation Program Evaluation Annual evaluation of faculty; sound Annual evaluation of faculty; sound methodsmethods

Educational Goals & ObjectivesEducational Goals & Objectivesfor Academic Competencefor Academic Competence

DomainsDomains GoalsGoals

ResearchResearch Research design Research design Responsible conduct ..Responsible conduct ..Clinical Epidemiology Clinical Epidemiology Scientific communicationsScientific communicationsStatistical analysisStatistical analysisSeveral optional goals (qualitative, educational, Several optional goals (qualitative, educational, ↑↑ stats) stats)

Education Education TeachingTeachingEvaluation of learnersEvaluation of learnersOptional- curriculum development; Program develop.Optional- curriculum development; Program develop.

Career Career DevelopmenDevelopment & t & LeadershipLeadership

ProfessionalismProfessionalism Career planningCareer planning Academic leadershipAcademic leadership Healthcare organization and deliveryHealthcare organization and delivery AdvocacyAdvocacy Optional-career management,Optional-career management, QI,QI, finance,finance, health policyhealth policy

Accomplishments to Date - 2Accomplishments to Date - 2

√ Developed program requirementsDeveloped program requirements

√ Developed a standardized program Developed a standardized program description formdescription form

√ Site visited 7 programs and summarized Site visited 7 programs and summarized lessons learnedlessons learned

(Ambulatory Pediatrics 2007;7:340-347)(Ambulatory Pediatrics 2007;7:340-347)

Site Visit Pilot Project Site Visit Pilot Project SelectionSelection

43 AGP Fellowship programs identified43 AGP Fellowship programs identified

18 programs volunteered18 programs volunteered

8 selected for diversity of content, location8 selected for diversity of content, location

1 withdrew1 withdrew

7 programs were visited by a pair of 7 programs were visited by a pair of evaluators/consultantsevaluators/consultants

Site Visit Pilot ProjectSite Visit Pilot ProjectProcessProcess

A pre-visit program description form is completedA pre-visit program description form is completed

A post-visit assessing report on compliance with program A post-visit assessing report on compliance with program requirements sent to each programrequirements sent to each program

Site visit team consists of a physician and an educatorSite visit team consists of a physician and an educator

Site Visit Pilot Project Site Visit Pilot Project Results - 1Results - 1

All programs found process useful All programs found process useful

Core curriculum requirement and Core curriculum requirement and education of goals were usefuleducation of goals were useful

Programs liked the increased visibility Programs liked the increased visibility within their institutions as a result of the within their institutions as a result of the site visitsite visit

Preparation for the visit was laboriousPreparation for the visit was laborious

Site Visit Pilot Project Site Visit Pilot Project Results - 2Results - 2

Five of 7 programs would participate in a Five of 7 programs would participate in a future formal accreditation processfuture formal accreditation process

1 felt did not have enough academic 1 felt did not have enough academic resources to participateresources to participate

1 felt that the accreditation process was 1 felt that the accreditation process was not needed given already a strong not needed given already a strong academic program in placeacademic program in place

Site Visit Pilot Project Site Visit Pilot Project Results - 3Results - 3

Common areas needing improvement:Common areas needing improvement:

AGP Fellowship poorly integrated into AGP Fellowship poorly integrated into DepartmentDepartment

Lack of key research faculty Lack of key research faculty (biostatisticians)(biostatisticians)

Failure to adequately evaluate trainees, Failure to adequately evaluate trainees, faculty, and programs as a wholefaculty, and programs as a whole

Major Activities in Prior YearMajor Activities in Prior Year

Drafted policies and proceduresDrafted policies and procedures Developed budgetDeveloped budget Solicited adviceSolicited advice Communicated with some programs, Communicated with some programs,

ACGME, ABP, AAPACGME, ABP, AAP Published 2 manuscripts in Published 2 manuscripts in Ambulatory Ambulatory

PediatricsPediatrics Reconstituted AGP Fellowship committee Reconstituted AGP Fellowship committee

(Lou Bell as chair)(Lou Bell as chair)

Key Issues and Next StepsKey Issues and Next Steps

APA boards consideration as a “core activity”APA boards consideration as a “core activity”

Formation of The Academic General Pediatric Formation of The Academic General Pediatric Accreditation Committee (AGPAC)Accreditation Committee (AGPAC)

Final approval of AGPAC polices and procedures Final approval of AGPAC polices and procedures and review of document with ACGMEand review of document with ACGME

Continue to develop relationships/endorsement Continue to develop relationships/endorsement with the ABP, the AMPSDC, and the AAPwith the ABP, the AMPSDC, and the AAP

Proceed with program rolloutProceed with program rollout

Academic General Pediatric FellowshipAcademic General Pediatric FellowshipAccreditation CommitteeAccreditation Committee

Proposed BudgetProposed Budget

Year 1Year 1 Year 2Year 2 Year 3Year 3 Year 4Year 4

IncomeIncome $26,000 $44,000 $61,500 $58,000$26,000 $44,000 $61,500 $58,000

ExpensesExpenses $44,000$44,000 $52,600$52,600 $53,218$53,218 $53,855$53,855

Surplus/(Deficit) ($18,000) ($8,600) $ 8,282 $ 4,145 Surplus/(Deficit) ($18,000) ($8,600) $ 8,282 $ 4,145

AssumptionsAssumptions20 Programs enrolling over initial 3 years20 Programs enrolling over initial 3 years$3,000 Initial application fee$3,000 Initial application fee$2,500 Annual registration fee$2,500 Annual registration fee4 Site visits per year4 Site visits per year2 Consultation visits per year2 Consultation visits per year

Roll Out Plan For Program If ApprovedRoll Out Plan For Program If Approved

May 2008May 2008 Hire administrative assistantHire administrative assistant

JuneJune Communication strategies finalizedCommunication strategies finalized

and implementedand implemented

July 1July 1 The APA’s fellowship accreditation The APA’s fellowship accreditation program begins with announcementprogram begins with announcement

JulyJuly Selected AGP programs from the pilot Selected AGP programs from the pilot project are invited to participateproject are invited to participate

SeptembeSeptemberr

AGPAC membership reviewed; new AGPAC membership reviewed; new members invited following policy members invited following policy guidelines guidelines

Communication strategies continueCommunication strategies continueSite visits and consultations beginSite visits and consultations begin

NovemberNovember Report to the APA BoardReport to the APA Board

It’s

All

About

Pipeline