Microsoft Word - PedsENT Goals 2018-19.docx

____________________________________________________________________________________________

NIVERSITY OF /MINNESOTA

RADUATE MEDICAL EDUCATION

EDUCATIONAL

PROGRAM/CURRICULUM

Department of Otolaryngology

Pediatric Otolaryngology Fellowship

This Pediatric Otolaryngology Fellowship Educational Program/Curriculum is intended for use

together with the Graduate Medical Education Institution Policy Manual, available online at

http://z.umn.edu/gmeim. The Institution Policy Manual contains information about benefits,

policies and procedures that apply to all residents and fellows in a training program at the

University of Minnesota. Should information in the Program Manual conflict with the Institution

Manual, the Institution Manual takes precedence.

It is also intended for use with the Department of Otolaryngology Program Policy and Procedure

Manual, available online at: http://www.ent.umn.edu/education/fellowships. The Department

Policy Manual contains information about policies and procedures that apply to all residents and

fellows in a training program in the Department of Otolaryngology at the University of

Minnesota.

UNIVE

RSITY OF MINNESOTA OTOLARYNGOLOGY DEPARTMENT

PEDIATRIC OTOLARYNGOLOGY FELLOWSHIP EDUCATIONAL PROGRAM/CURRICULUM

Pediatric Otolaryngology Fellowship Program Mission Statement

______________________________________________________________________

The mission

of the Pediatric Otolaryngology Fellowship is to develop expertise in the diagnosis

and medical/surgical management of complex pediatric patients in the tertiary healthcare

setting.

Table of Contents

Pediatric Otolaryngology Fellowship

Mission Statement i

EDUCATIONAL PROGRAM/

CURRICULUM

Accreditation 1

ACGME Case Log 1

American Board of Otolaryngology 1

Educational Goals and Objectives 2

Patient Care 2

Medical Knowledge 3

Practice Based Learning & Improvement 5

Interpersonal and Communication Skills 5

Professionalism 5

Systems Based Practice 5

Cleft Palate & Craniofacial Clinic 6

Conferences/Courses 7

Research/Scholarly Activity 7

Evaluation 8

Written Evaluations 8

Semiannual Review 8

Components/Principles of Review 8

Possible Outcomes 8

Fellow Evaluation of Faculty and

Rotations 9

APPENDICES

1. Accreditation Status 10

2. ACGME Requirements, Pediatric ENT 12

Direct corrections to:

Program Coordinator

Phone: 612-625-7692

Fax: 612-625-2101

Email: [email protected]

Mailing address:

Otolaryngology

Mayo Mail Code 396

420 Delaware St SE

Minneapolis, MN 55455

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

A. EDUCATIONAL PROGRAM/CURRICULUM

ACCREDITATION

The Pediatric Otolaryngology Fellowship Program at University of Minnesota is accredited by

the Accreditation Council for Graduate Medical Education (ACGME. Accreditation status is

included in Appendix 1. Current requirements for accreditation are included in Appendix 2. For

the most up-to-date information visit ACGME's web site, www.acgme.org.

ACGME Case Log

Pediatric ENT fellows must maintain a record of their surgical procedures on the Resident Case

Log System provided by the Accreditation Council for Graduate Medical Education (ACMGE at

www.acgme.org. Contact Faith Courchane, 612-625-7692 or [email protected] if you have

not received initial login and password from ACGME.

Include procedures performed in clinic as well as in the operating room.

ACGME’s Otolaryngology Residency Review Committee highly recommends that

residents/fellows log their cases on a weekly, or more frequent, basis, so that procedures don’t

become lost or forgotten. Residents/fellows are able to view their case logs at any time, and

can correct entries as needed. The Program Director is able to, at any time, review the

operative data submitted by the fellows. A number of statistics regarding operative data are

available on the ACGME web site (password protected for access by residents/fellows and

program directors, including cumulative national medians, means and standard deviations for

each procedure category, subdivided by year of otolaryngology training. Program Directors are

able to scan the case logs of each of their residents/fellows, tagged for procedure experiences 1

standard deviation or more below the national norms per fellow year of training, so they can

tailor rotations accordingly.

Residents/fellows will be able to print out their cumulative operative experiences.

Resident/fellow logging of procedures relies solely on the AMA’s CPT coding system. The

opportunity to use the CPT codes prepares the residents/fellows for coding procedures after the

completion of training.

The one, and significant, deviation from CPT coding rules allows for “unbundling” so that all

procedures or significant segments of such done by each resident/fellow can be captured.

Ample samples of “unbundling” acceptable for resident/fellow reporting purposes have been

placed as a link on the Resident Case Log web site.

Categories of resident/fellow involvement in a surgical procedure include “resident surgeon,”

“assistant surgeon” and “resident supervisor.” Definitions of these categories are available on

the resident case log web site.

AMERICAN BOARD OF OTOLARYNGOLOGY

Board certification, Otolaryngology: Fellows are expected to take the Otolaryngology

certification exam during their fellowship. Fellows will be given time for preparation for and

participation in this examination. Visit the American Board of Otolaryngology web site at

www.aboto.org for the most up-to-date information on requirements and deadlines.

____________________________________________________________________________________________

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

Board certification, Pediatric Otolaryngology: Board certification is not currently available in the

subspecialty of pediatric otolaryngology.

EDUCATIONAL GOALS AND OBJECTIVES

The Pediatric Otolaryngology Fellow will develop their surgical and practice skills to the level

where they will be able to practice independently as a high level specialist in pediatric

otolaryngology. Fellowship goals and objectives are based on achieving competencies in

patient care, medical knowledge, practice based learning and improvement, communication

skills with patients and the rest of the health care team, professionalism and the ability to train

and practice within a complex pediatric health care system. They will demonstrate this primarily

by managing patients in the operating room, clinic and hospital wards. In addition to teaching

residents and medical students and preparing conferences, the Fellow will make certain that the

service runs smoothly, and will delegate responsibility appropriately to junior residents. The

Fellow will meet informally with the Program Director for Pediatric Otolaryngology weekly to

discuss any issues or problems they see developing in the direction of the service. The fellow

will be evaluated quarterly by the pediatric otolaryngology faculty on the written goals and

objectives as listed below. The goals and objectives below apply to both sites (Children’s

Hospitals and Clinics of Minnesota and Masonic Children’s-University of Minnesota Pediatric

patients with the listed disorders are seen and cared for at both sites. The fellow reviews the

surgical schedule at both sites one week ahead of time and than will plan their future schedule

accordingly to obtain and complete their goals and objectives. Outpatient clinic is performed

only at Children’s ENT and Facial Plastic Surgery which is within and attached to Children’s

Hospital of Minnesota. Children’s Hospitals and Clinics of Minnesota and the University of

Minnesota Masonic Children’s Hospital are approximately three miles apart.

Patient Care: The Fellow must:

Demonstrate ability to manage the Pediatric Otolaryngology Service, including:

 Direct residents and coordinate nursing, social services and administration to optimize

patient care.

 Care for patients in the pediatric, cleft, craniofacial, tumor board, Velocardiofacial, and

vascular anomalies clinics.

 Develop the treatment plan for all patients undergoing medical or surgical care on the

Service.

 Direct the presentation of appropriate patients to the Pediatric Head and Neck Tumor

Board.

 Demonstrate practice based learning by evaluating and effectively critiquing the current

medical literature related to patient care

 Demonstrate effective communication with the health care team and the patient and the

patient’s care givers.

 Demonstrate professional behavior at all times through communication and knowledge

with the patient and their family.

 Demonstrate and be aware of cost effective management for a particular patient’s care

as well as possible ethical or medical-legal issues.

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

____________________________________________________________________________________________

Medical Knowledge: The Fellow must:



Demonstrate superior medical knowledge, equal to the faculty, regarding all aspects o

pediatric otolaryngology (otology, head & neck, bronchoesophagology, craniofacial &

cleft palate /

lip, facial plastics, laryngology and rhinology), including the following:



Ear



Pathophysiology in children of: otitis media, otitis externa, otorrhea, hearing loss, vert

igo,

tinnitus, Eustachian tube dysfunction, mastoiditis, intracranial suppurative complications,

temporal bone tumors



Nose, paranasal sinuses, face and or

bit



Pathophysiology in children of: nasal obstruction, rhinorrhea,

epistaxis, associated

orbital infe

ction, cosmetic nasal deformity, allergies, sinusitis,

tumors of the paranasal

sinuses



Mouth, Pharynx and Eso

phagus

 Pathophysiology in children of: pharyngitis, tonsillitis, dysphagia, congenital

malformatio

ns, cleft lip and palate, inflammatory

disorders, salivary gland disorders,

tumors of the mouth and pharynx, trauma to pharynx and esophagus, foreign bodies of

the mouth and pharynx.



Larynx, Trac

hea, Bronchi and Lungs



Pathophysiology in children of: cough, aspiration, hoarseness, stridor, airw

obstruction, congenital malformations of the airway, infections of the airway, neurologic

disorders of

the airway, tumors of the respiratory tract, trauma to the

airway, foreign

bodies, airway reconstruction



Neck



Pathophysiology in children of: neck masses, developmental anomalies,

adenopathy,

injuries and

trauma, tumors (benign

and malignant)



Communication Disorder

 Pathophysiology in children of: language and speech disorders, cleft lip and palate,

velopharyng

eal insufficie

ncy.

The Fellow must demon

strate ability to perform:

 Laryngobronchoesophagology in premature neonates, neonates, infants and childr

en.



Head and neck surgery including salivary, endocrine, lymphovascular an

d neck

dissections in children as well as demonstrate capabilities in the latest endoscopic

techniques

in head and neck surger

 Care for patients with co-morbidities, including cardiac, hematology-oncology and both

solid organ and bone marrow transplants ,



Laryngotracheal surgery both open and endoscopic techniqu

es,



Otologic surgery including cochlear implants, and reconstruction for cong

enital

malformatio

 Surgery of the nose and

paranasal sinuses,



Surgery for congenital abnormalities of the head

and neck,

 Surgery for benign and malignant head and neck disorders.

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

____________________________________________________________________________________________

 Pediatric facial plastics including cleft lip and palate, mandibular advancement and

rhinoplasty

Although the majority of the Fellow’s time is spent at Children’s Hospital and Clinics of

Minnesota, the addition of University of Minnesota Masonic Children’s Hospital provides access

to an expanded patient base, especially in the area of otology, thus broadening the educational

opportunities available to the fellow. Masonic Children’s Hospital includes the Lions Children’s

Ear Clinic where approximately 50 pediatric cochlear implants are done per year by the pediatric

otolaryngology service in addition to numerous complex pediatric otologic cases located at this

site. Additional patients include children with airway reconstructive needs, cystic fibrosis, bone

marrow transplantation and patients with complex pediatric head and neck tumors. The fellow

averages about 2 cases per week at this site.

At Masonic Children’s Hospital, the fellow will have additional opportunities to demonstrate

superior medical knowledge in the areas of:

 Pathophysiology in children of: otitis media, otitis externa, otorrhea, hearing loss, vertigo,

tinnitus, Eustachian tube dysfunction, mastoiditis, intracranial suppurative complications,

temporal bone tumors

And to demonstrate the ability to perform:

 Otologic surgery including cochlear implants, and reconstruction for congenital

malformations

Benchmarks for the Maturation of the Pediatric Otolaryngology Fellow

At both sites, the Fellow should show increasing skill and knowledge in the care of patients, in

the doctor-patient relationship, in the use of diagnostic and therapeutic aids and methods, in the

ability to form accurate diagnoses and institute appropriate treatment, in the use of medical

literature, in the desire and ability to research problems areas and in teaching.

Specific and in-depth knowledge of the following subjects, as related to the entire body, with

emphasis on the head and neck, bronchopulmonary, otologic and esophageal areas should

increase during the training period:

Allergy

Anatomy

Anesthesia-both local and general

Audiology

Biochemistry

Clinical pathology

Embryology and developmental defects

Histology

Histopathology

Microbiology and microbiopathology

Physiology

Oncology

Radiographic anatomy and diagnosis

Surgical development ultimately should satisfy these critical performance requirements:

1. Eliciting historical information

2. Obtaining information by physical examination

3. Obtaining and interpreting x-rays

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

____________________________________________________________________________________________

4. Obtaining additional information by other means

5. Approaching diagnosis objectively

6. Recognizing condition

7. Adapting treatment to the individual case

8. Determining extent and immediacy of therapy needs

9. Obtaining consultation on proposed treatment

10. Planning the operation

11. Making necessary preparations for operating

12. Performing the operation

13. Modifying operative plans according to situation

14. Handling operative complications

15. Instituting a non-operative therapy program

16. Handling patient

17. Performing emergency treatment

18. Paying attention post-operatively

19. Monitoring patient's progress

20. Providing long-term care

21. Showing concern and consideration

Practice Based Learning and Improvement: The Fellow should demonstrate the ability to:



Evaluate and effectively critique published literature in critically acclaimed journals a

texts.



Apply clinical trials data t

o patient management.



Lead acade

mic and clinical discussions.



Attend and actively participate and direct teachin

g conferences.

Interpersonal and Communication Skills: The Fellow should:



Establish and maintain professional and therapeutic relationships with p

atients and

healthcare team members.



Manage and maintain efficiency of the team (O.R. team, ward team, clinic team).

 Teach residents, medical students, nurses, and physician assistant students.

Professionalism: The Fellow should:



Demonstrate behaviors that reflect an ongoing commitment to continuous profession

development, ethical practice, sensitivity to diversity and responsible attitudes.

 Actively seek and be receptive to feedback on pe

rformance.



Be attentive to ethical

issues.



Be involved in end-of-life discussions and decisio

ns.



Be sensitive to gender, age, race, and cultural

issues.



Demonstrate leadership.

Systems Based Practice: The Fellow should:



Be aware of cost-effective care issu

es.

 Be sensitive to medical-legal issues.



Use information technology/comput

er resources.

____________________________________________________________________________________________

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

Sample of Goals and Objectives For One Assignment

CLEFT PALATE AND CRANIOFACIAL CLINIC

Patient Care



Direct residents and coordinate nursing, social services an

d administration to optimize

patient care.



Care for patients in the pediatric, cleft, craniofacial clin

ics.



Develop the treatment plan for all patients undergoing medical or surgical

care on the

Service.



Direct the presentation of appropriate patients to the multidisciplinary board during t

clinic.



Demonstrate practice based learning by evaluating and effectively critiquing the curr

ent

medical literature related to patient care



Demonstrate effective communication with the health care team and the patient and

the

patient’s

car

e givers.



Demonstrate professional behavior at all times through communication and knowle

dge

with the patient and their

family.

 Demonstrate and be aware of cost effective management for a particular patient’s car

as well as p

ossible ethical or medical-legal issues

Medical Knowledge



Demonstrate superior medical knowledge, equal to the faculty, regarding all aspects o

pediatric cra

niofacial & cleft palate / lip, and facial plastics.

 Demonstrate the ability to present above knowledge to the multidisciplinar

y board.



Translate such knowledge in layman terms to the patient’s family.

 Demonstrate staff level of knowledge of involved genetics and associated syndromes.



Demonstrate staff level of knowledge regarding associated embryogene

sis of

craniofacial disorders.

Practice Based Learning and Improvement



Evaluate and effectively critique published literature in critically acclaimed journals a

texts regarding cleft lip /

palate and craniofacial disorders and

apply that knowledge

during the weekly multidisciplinary conference.



Apply clinical trials data t

o patient management.

 Lead academic and clinical discussions during the weekly multidisciplinary conference.



Attend and actively participate in the multidiscipl

inary conference.

Interperson

al and Communication Skills



Establish and maintain professional and therapeutic relationships with p

atients and

healthcare t

eam members of the clef

t / craniofacial team.



Manage and maintain efficiency of th

e team.



Teach residents, medical students, nurses, and physician assistant students.

 Translate difficult terminology into layman’s terms for the patient and care

giver.

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

____________________________________________________________________________________________

Professionalism



Demonstrate behaviors that reflect an ongoing commitment to continuous profession

development, ethical practice, sensitivity to diversity and responsible attitudes.

 Actively seek and be receptive to feedback on performance from the cleft / craniofacia

team.



Be attentive to ethical

issues.



Be involved in decision making to avoid potentially serious

or poor outcomes.

 Be sensitive to gender, age, race, and cultural issues.



Demonstrate leadership within the clinic and team.

Systems Based Practice



Be aware of cost-effective care issues regarding cleft / craniofacial care.

 Be sensitive to medical-legal issues



Use information technology/computer resources extensively

and effectively.

CONF

ERENCES/COURSES

Orientation: New fellows are required to attend University of Minnesota Medical School

Resident/Fellow Orientation.

Pediatric ENT Conference /Resident Case Presentation, Fridays, 6:30 a.m., Childrens

The pediatric ENT fello

w presents one to three interesting cases at the weekly pediatric

otolaryngology resident conference. Each week, the core otolaryngology resident on the

pediatric ENT rotation formally presents a case and related literature to the fellow and staff. The

fellow provides feedback to the ENT resident.

Pediatric ENT Pre-op Conference, Wednesdays, 6:30 a.m., Childrens

ENT Resident Core Conference - weekly, Tuesd

ay, 6:30 a.m., University

The pediatric ENT fellow participates when these conferences are devoted to pediatric

topics.

Morbidity and Mortality Conference, monthly, first Tuesday, 6:30 a.m., University

Web-based

Learning, provided by the American Society for Pediatric Otolaryngology (ASPO)

monthly.

Visiting Professors, 6:00 p.m., University, four to six times per year

Resident/Fe

llow Graduation Scientific Program, annually, June

RESE

ARCH/SCHOLARLY ACTIVITY

A research project is required during the fellowship program, and must be approved by Program

Director, Brianne Roby, M.D.

____________________________________________________________________________________________

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

EVALUATION

See Also Institution Policy Manual, http://z.umn.edu/gmeim, Evaluation Policy.

Written Evaluations

Evaluations of the fellow are done quarterly by the pediatric otolaryngology faculty through the

online system, where they are available to the director of the pediatric otolaryngology fellowship

for review. The director then meets with the fellow quarterly on an informal basis to discuss the

fellow’s progress and review the case logs.

Semi-Annual Performance Review

The fellowship director meets with the fellow semiannually for a formal review and documents

this meeting in writing. The fellowship director’s summary of the semi-annual review is signed

by both the director and the fellow. The written notes are kept the fellow’s file.

Components/Principles of the Review

All relevant aspects of fellow progress are considered by the faculty/program director at the time

of the review. Review will consider progress toward the goals listed on pages 2 through 7, and

will include:

Clinical and surgical performance and progress: Faculty submit written evaluations

quarterly using the online system.

Research/publication progress

Administrative skill and experience

Teaching skill and experience: Residents submit written evaluations of fellow teaching

using the online system.

Attitude

Punctuality

Conference attendance, participation and presentation

The faculty assume a fellow's performance will mature as the fellow gains greater education and

experience. Therefore, expectations for the fourth-quarter fellow are different from those for the

first-quarter fellow.

Possible Outcomes

Positive outcomes of the Fellow Review include:

Affirmation of good clinical progress

Recommendation for graduation from the program

Information becomes part of the fellows’ permanent file

Negative outcomes of the Fellow Review include:

A reprimand related to concern about performance

Meetings at six-week intervals to evaluate improved performance until the next

scheduled evaluation

Probation for a period of months to allow performance to improve

Expulsion, conducted according to the University of MN appeals process

Information becomes part of the fellows’ permanent file

____________________________________________________________________________________________

Pediatric Otolaryngology Fellowship Educational Program/Curriculum

Fellow Evaluation of Faculty and Rotations/Training Program

At the end of each clinical rotation, fellows have the opportunity to evaluate the rotation and the

faculty using the confidential, online evaluation system. Residents/fellows will receive email

reminders when evaluations are due. This information is valuable to improving our program and

residents/fellows are encouraged to complete it.

Fellows can also review evaluations of their own progress submitted by faculty and ancillary

personnel through the evaluation system.

New Innovations Residency Management Suite (RMS is located at www.new-innov.com.

If you don't know your user name or password, contact Faith Courchane, 612-625-7692 or

[email protected]. Institution is “mmcgme.” You may use the "NET" (not enough time

feature to delete evaluations that have been inappropriately assigned to you.

2882631016 - UNIVERSITY OF MINNESOTA PROGRAM

Pediatric Otolaryngology - Minneapolis, MN



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Children's ENT and Facial Plastic Surgery

Children's Specialty Center, Suite 450

2530 Chicago Ave S

Minneapolis, MN 55404

http://www.ent.umn.edu/education/pediatric-otolaryngology/index.htm 

Specialty:

Pediatric otolaryngology

Sponsoring Institution:

[ 269501 ] University of Minnesota Medical School

Core Programs:

[ 2802631055 ] University of Minnesota Program (Otolaryngology)

Phone:

(612) 874-1292

Fax:

(612) 874-0985

Email:

[email protected]

Brianne B Roby, MD

Program Director

Director First Appointed:

July 27, 2016

Sacha Brueggemann

Phone:

(612) 625-7692

Email:

[email protected]

Original Accreditation Date:

July 01, 2012

Accreditation Status:

Continued Accreditation

Effective Date:

January 26, 2018

Accredited Length of T raining:

Accreditation Council for Graduate Medical Education (ACGME) - Public



Legend



Clinical Site



Primary Clinical Site

Director Information

Coordinator Information

Accreditation And General Information

1 years

Osteopathic Recognition:

No Information Currently Present

Osteopathic Recognition Effective Date:

No Information Currently Present

Director of Osteopathic-Focused Education:

No Information Currently Present

Last Site V isit Date:

April 16, 2014

Date of Next Site V isit (Approximate):

No Information Currently Present

Self Study Due Date (Approximate):

August 01, 2020

10 Year Site V isit (Approximate):

February 01, 2022

Total Approved Resident Positions:

Total Filled Resident Positions*:

Complement Breakdown: Approved

Years: 1 Total

Approved: 1.0 1.0

Complement Breakdown: Filled

Years: 1 Total

Filled: 1.0 1.0

*Total filled will reflect the previous academic year until the annual update is completed for the

current academic year. Totals may vary from year to year due to off cycle residents.

Participating Site Information

Showing 1 to 2 of 2 entries

# ID Site Name

Required

Rotation

Months

1 260740

Children's Hospitals and Clinics of

Minnesota - Minneapolis

Yes 12

2 268128

University of Minnesota Masonic Children's

Hospital

Yes 0.1

Positions

ACGME Program Requirements for

Graduate Medical Education

in Pediatric Otolaryngology

ACGME-approved: June 10, 2012; effective: July 1, 2013

ACGME approved categorization: June 9, 2013; effective: July 1, 2014

ACGME approved focused revision: February 3, 2014; effective: July 1, 2014

Revised Common Program Requirements effective: July 1, 2015

Revised Common Program Requirements effective: July 1, 2016

Revised Common Program Requirements effective: July 1, 2017

Pediatric Otolaryngology

ACGME Program Requirements for Graduate Medical Education

in Pediatric Otolaryngology

One-year Common Program Requirements are in BOLD

Where applicable, text in italics describes the underlying philosophy of the requirements in that

section. These philosophic statements are not program requirements and are therefore not

citable.

Introduction

Int.A. Residency and fellowship programs are essential dimensions of the

transformation of the medical student to the independent practitioner along

the continuum of medical education. They are physically, emotionally, and

intellectually demanding, and require longitudinally-concentrated effort on

the part of the resident or fellow.

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

and fellow physician to assume personal responsibility for the care of

individual patients. For the resident and fellow, 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 and fellows 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 and

fellow’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. Pediatric otolaryngologists specialize in the medical and surgical management of

neonates, infants, children, and adolescents 18 years or younger, particularly

those with complex otolaryngologic problems and significant co-morbidities,

generally cared for in tertiary care pediatric institutions.

Int.C. The educational program in pediatric otolaryngology must be 12 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)

Pediatric Otolaryngology

The sponsoring institution and the program must ensure that the program

director has sufficient protected time and financial support for his or her

educational and administrative responsibilities to the program.

(Core)

I.A.1. The program must be based in a tertiary care pediatric institution where

the care of neonates and children can be readily coordinated with other

subspecialists.

(Core)

I.A.2. The sponsoring institution must also sponsor an Accreditation Council for

Graduate Medical Education (ACGME)-accredited otolaryngology

program.

(Core)

I.B. Participating Sites

I.B.1. 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) identify the faculty who will assume both educational and

supervisory responsibilities for fellows;

(Detail)

I.B.1.b) specify their responsibilities for teaching, supervision, and

formal evaluation of fellows, as specified later in this

document;

(Detail)

I.B.1.c) specify the duration and content of the educational

experience; and,

(Detail)

I.B.1.d) state the policies and procedures that will govern fellow

education during the assignment.

(Detail)

I.B.2. The program director must submit any additions or deletions of

participating sites routinely providing an educational experience,

required for all fellows, of one month full time equivalent (FTE) or

more through the Accreditation Council for Graduate Medical

Education (ACGME) Accreditation Data System (ADS).

(Core)

II. Program Personnel and Resources

II.A. Program Director

II.A.1. 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) The program director must submit this change to the ACGME

via the ADS.

(Core)

Pediatric Otolaryngology

II.A.2. Qualifications of the program director must include:

II.A.2.a) requisite specialty expertise and documented educational

and administrative experience acceptable to the Review

Committee;

(Core)

II.A.2.b) current certification in the subspecialty by the American

Board of Otolaryngology (ABOto), or subspecialty

qualifications that are acceptable to the Review Committee;

and,

(Core)

II.A.2.b).(1) The Review Committee only accepts ABOto certification in

otolaryngology.

(Core)

II.A.2.b).(2) The program director should have also completed a

pediatric otolaryngology fellowship.

(Core)

II.A.2.c) current medical licensure and appropriate medical staff

appointment.

(Core)

II.A.3. The program director must administer and maintain an educational

environment conducive to educating the fellows in each of the

ACGME competency areas.

(Core)

The program director must:

II.A.3.a) prepare and submit all information required and requested by

the ACGME;

(Core)

II.A.3.b) be familiar with and oversee compliance with ACGME and

Review Committee policies and procedures as outlined in the

ACGME Manual of Policies and Procedures;

(Detail)

II.A.3.c) obtain review and approval of the sponsoring institution’s

GMEC/DIO before submitting information or requests to the

ACGME, including:

(Core)

II.A.3.c).(1) all applications for ACGME accreditation of new

programs;

(Detail)

II.A.3.c).(2) changes in fellow complement;

(Detail)

II.A.3.c).(3) major changes in program structure or length of

training;

(Detail)

II.A.3.c).(4) progress reports requested by the Review Committee;

(Detail)

II.A.3.c).(5) requests for increases or any change to fellow duty

hours;

(Detail)

Pediatric Otolaryngology

II.A.3.c).(6) voluntary withdrawals of ACGME-accredited

programs;

(Detail)

II.A.3.c).(7) requests for appeal of an adverse action; and,

(Detail)

II.A.3.c).(8) appeal presentations to a Board of Appeal or the

ACGME.

(Detail)

II.A.3.d) 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)

II.A.3.d).(1) program citations, and/or,

(Detail)

II.A.3.d).(2) request for changes in the program that would have

significant impact, including financial, on the program

or institution.

(Detail)

II.A.3.e) prepare and implement a supervision policy that specifies lines of

responsibility for fellows and faculty members, as well as for

residents and other learners.

(Core)

II.B. Faculty

II.B.1. There must be a sufficient number of faculty with documented

qualifications to instruct and supervise all fellows.

(Core)

II.B.2. The faculty must devote sufficient time to the educational program

to fulfill their supervisory and teaching responsibilities and

demonstrate a strong interest in the education of fellows.

(Core)

II.B.3. The physician faculty must have current certification in the

subspecialty by the American Board of Otolaryngology, or possess

qualifications judged acceptable to the Review Committee.

(Core)

II.B.3.a) The Review Committee only accepts ABOto certification in

otolaryngology.

(Core)

II.B.4. The physician faculty must possess current medical licensure and

appropriate medical staff appointment.

(Core)

II.B.5. The faculty must establish and maintain an environment of inquiry and

scholarship with an active research component.

(Core)

II.B.6. Scholarly activity of each core physician faculty member must include at

least one of the following

(Core)

II.B.6.a) funded research grants;

(Detail)

II.B.6.b) peer-reviewed publications; or,

(Detail)

Pediatric Otolaryngology

II.B.6.c) presentations in regional or national conferences.

(Detail)

II.B.7. To enhance fellows’ educational experience, there must be participation

from appropriately-qualified faculty members from other related pediatric

disciplines, including:

(Core)

II.B.7.a) anesthesiology;

(Core)

II.B.7.b) audiology and speech pathology;

(Core)

II.B.7.c) child and adolescent psychiatry;

(Core)

II.B.7.d) gastroenterology;

(Core)

II.B.7.e) medical genetics;

(Core)

II.B.7.f) neonatology;

(Core)

II.B.7.g) neurology;

(Core)

II.B.7.h) pathology;

(Core)

II.B.7.i) plastic surgery;

(Core)

II.B.7.j) prenatal and fetal medicine;

(Core)

II.B.7.k) pulmonology;

(Core)

II.B.7.l) radiology; and,

(Core)

II.B.7.m) sleep medicine.

(Core)

II.C. Other Program Personnel

The institution and the program must jointly ensure the availability of all

necessary professional, technical, and clerical personnel for the effective

administration of the program.

(Core)

II.D. Resources

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. Program resources must include:

II.D.1.a) inpatient and outpatient facilities.

(Core)

II.D.1.b) an emergency department;

(Core)

II.D.1.c) neonatal and pediatric intensive care units;

(Core)

Pediatric Otolaryngology

II.D.1.d) facilities for the diagnostic assessment of infants and children with

otolaryngologic disorders, including audiologic, voice, speech,

language and developmental assessments; and,

(Core)

II.D.1.e) facilities to support clinical research.

(Core)

II.D.2. Fellows must be provided with prompt reliable systems for communication

and interaction with supervising physicians.

(Core)

II.E. 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. Fellow Appointments

III.A. 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 program, fellows must have successfully completed

an otolaryngology residency accredited by the ACGME, or an otolaryngology

residency located in Canada and accredited by the RCPSC.

(Core)

III.A.1. 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)

III.A.2. 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. and III.A.1., but who

does meet all of the following additional qualifications and

conditions:

(Core)

III.A.2.a) 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)

III.A.2.b) Review and approval of the applicant’s exceptional

Pediatric Otolaryngology

qualifications by the GMEC or a subcommittee of the GMEC;

and

(Core)

III.A.2.c) Satisfactory completion of the United States Medical

Licensing Examination (USMLE) Steps 1, 2, and, if the

applicant is eligible, 3, and;

(Core)

III.A.2.d) For an international graduate, verification of Educational

Commission for Foreign Medical Graduates (ECFMG)

certification; and,

(Core)

III.A.2.e) Applicants accepted by this exception must complete

fellowship Milestones evaluation (for the purposes of

establishment of baseline performance by the Clinical

Competency Committee), conducted by the receiving

fellowship program within six weeks of matriculation. This

evaluation may be waived for an applicant who has

completed an ACGME International-accredited residency

based on the applicant’s Milestones evaluation conducted at

the conclusion of the residency program.

(Core)

III.A.2.e).(1) 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.3. The Review Committee for Otolaryngology does not allow exceptions

to the Eligibility Requirements for Fellowship Programs in Section

III.A.

(Core)

III.B. Number of Fellows

The program’s educational resources must be adequate to support the

number of fellows appointed to the program.

(Core)

III.B.1. The program director may not appoint more fellows than approved

by the Review Committee, unless otherwise stated in the specialty-

Pediatric Otolaryngology

specific requirements.

(Core)

III.C. Other Learners

The presence of other learners, including otolaryngology residents, residents

from other specialties, unaccredited pediatric otolaryngology fellows, other

subspecialty fellows, PhD students, and nurse practitioners, must not interfere

with the appointed fellows’ education.

(Core)

IV. Educational Program

IV.A. The curriculum must contain the following educational components:

IV.A.1. Skills and competencies the fellow will be able to demonstrate at the

conclusion of the program. The program must distribute these skills

and competencies to fellows and faculty at least annually, in either

written or electronic form.

(Core)

IV.A.2. ACGME Competencies

The program must integrate the following ACGME competencies

into the curriculum:

(Core)

IV.A.2.a) Patient Care and Procedural Skills

IV.A.2.a).(1) 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.

(Outcome)

IV.A.2.a).(2) 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:

IV.A.2.a).(2).(a) evaluating neonates, infants, children, and

adolescents 18 years and younger with congenital

abnormalities, infectious and inflammatory

disorders, and inherited and acquired conditions of

the head and neck, including hearing loss and other

communication impairments;

(Outcome)

IV.A.2.a).(2).(b) diagnosing and managing the medical and surgical

treatment of the aerodigestive tract, ear, nose,

sinus, throat, voice and speech, and head and neck

and disorders of neonates, infants, children, and

adolescents 18 years and younger; and,

(Outcome)

IV.A.2.a).(2).(c) performing procedures in the following domains

Pediatric Otolaryngology

with an emphasis on neonates, infants, children

younger than three years of age, and children and

adolescents with significant co-morbidities as

defined by American Society of Anesthesiology

(ASA) status:

(Outcome)

IV.A.2.a).(2).(c).(i) closed and open airways;

(Outcome)

IV.A.2.a).(2).(c).(ii) congenital anomalies;

(Outcome)

IV.A.2.a).(2).(c).(iii) endoscopic airways;

(Outcome)

IV.A.2.a).(2).(c).(iv) facial plastics;

(Outcome)

IV.A.2.a).(2).(c).(v) facial trauma;

(Outcome)

IV.A.2.a).(2).(c).(vi) head and neck surgery;

(Outcome)

IV.A.2.a).(2).(c).(vii) otology;

(Outcome)

IV.A.2.a).(2).(c).(viii) rhinology; and,

(Outcome)

IV.A.2.a).(2).(c).(ix) complex and uncommon pediatric

procedures infrequently encountered in the

general practice of otolaryngology.

(Outcome)

IV.A.2.a).(3) Fellows must document surgical experience as assistant

surgeon, surgeon, and resident supervisor in the ACGME

Case Log System, recording patient age and ASA

classification for each documented case.

(Core)

IV.A.2.b) Medical Knowledge

Fellows must demonstrate knowledge of established and

evolving biomedical, clinical, epidemiological and social-

behavioral sciences, as well as the application of this

knowledge to patient care. Fellows:

(Outcome)

IV.A.2.b).(1) must demonstrate proficiency in their knowledge of

medical and surgical management of neonatal, infant,

childhood, and adolescent diseases of the head and neck

to a level appropriate for unsupervised practice as defined

by the didactic curriculum.

(Outcome)

IV.A.2.c) Practice-based Learning and Improvement

Fellows are expected to develop skills and habits to be able

to meet the following goals:

IV.A.2.c).(1) systematically analyze practice using quality

improvement methods, and implement changes with

Pediatric Otolaryngology

the goal of practice improvement; and,

(Outcome)

IV.A.2.c).(2) locate, appraise, and assimilate evidence from

scientific studies related to their patients’ health

problems.

(Outcome)

IV.A.2.d) 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)

IV.A.2.e) Professionalism

Fellows must demonstrate a commitment to carrying out

professional responsibilities and an adherence to ethical

principles.

(Outcome)

IV.A.2.e).(1) Fellows must demonstrate competence in advocating for

quality patient care when facilitating patient management

in the home, school, or institutional setting.

(Outcome)

IV.A.2.f) 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)

IV.A.3. Curriculum Organization and Fellow Experiences

IV.A.3.a) The didactic curriculum must include basic science, clinical, and

research conferences and seminars, as well as journal club

activities pertaining to pediatric otolaryngology.

(Core)

IV.A.3.a).(1) Didactic topics must include:

IV.A.3.a).(1).(a) developmental anatomy and physiology,

embryology, microbiology, oncology, and

psychology of the infant and child as related to the

head and neck;

(Detail)

IV.A.3.a).(1).(b) diagnosis and care of uncommon and complex

congenital and acquired conditions involving the

aerodigestive tract, nose and paranasal sinuses,

and ear, as well as diseases and disorders of the

laryngotracheal complex and the head and neck;

(Detail)

IV.A.3.a).(1).(c) diagnosis, treatment, and management of

Pediatric Otolaryngology

childhood disorders of hearing, language, speech,

and voice; and,

(Detail)

IV.A.3.a).(1).(d) genetics.

(Detail)

IV.A.3.a).(2) Quality improvement conferences must take place at least

quarterly.

(Detail)

IV.A.3.a).(3) Fellows must participate in planning and conducting

conferences.

(Detail)

IV.A.3.a).(4) Both faculty members and fellows must attend and

participate in multidisciplinary conferences.

(Detail)

IV.A.3.a).(5) Faculty and fellow attendance at conferences must be

documented.

(Detail)

IV.A.3.b) Fellows’ clinical experiences must include:

IV.A.3.b).(1) participation in a multispecialty, interdisciplinary team to

manage and treat conditions for at least three of the

following: cochlear implant, craniofacial disorders, tumors,

or vascular anomalies; and,

(Core)

IV.A.3.b).(2) attendance at a minimum of four clinic sessions per month.

(Detail)

IV.B. Fellows’ Scholarly Activities

IV.B.1. Fellows’ scholarly activity initiated or completed during the program,

including scientific study, production of review articles or chapters, or

creation of online educational activities, must be documented.

(Outcome)

V. Evaluation

V.A. Fellow Evaluation

V.A.1. The program director must appoint the Clinical Competency

Committee.

(Core)

V.A.1.a) At a minimum the Clinical Competency Committee must be

composed of three members of the program faculty.

(Core)

V.A.1.a).(1) The program director may appoint additional members

of the Clinical Competency Committee.

V.A.1.a).(1).(a) 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

Pediatric Otolaryngology

with the program’s fellows in patient care and

other health care settings.

(Core)

V.A.1.a).(1).(b) 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)

V.A.1.b) There must be a written description of the responsibilities of

the Clinical Competency Committee.

(Core)

V.A.1.b).(1) The Clinical Competency Committee should:

V.A.1.b).(1).(a) review all fellow evaluations semi-annually;

(Core)

V.A.1.b).(1).(b) prepare and ensure the reporting of Milestones

evaluations of each fellow semi-annually to

ACGME; and,

(Core)

V.A.1.b).(1).(c) advise the program director regarding fellow

progress, including promotion, remediation,

and dismissal.

(Detail)

V.A.2. Formative Evaluation

V.A.2.a) The faculty must evaluate fellow performance in a timely

manner.

(Core)

V.A.2.b) The program must:

V.A.2.b).(1) 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)

V.A.2.b).(2) use multiple evaluators (e.g., faculty, peers, patients,

self, and other professional staff); and,

(Detail)

V.A.2.b).(3) provide each fellow with documented semiannual

evaluation of performance with feedback.

(Core)

V.A.2.c) The evaluations of fellow performance must be accessible for

review by the fellow, in accordance with institutional policy.

(Detail)

V.A.2.d) The program director must meet with each fellow in person to

review his or her cumulative operative experience and Case Log

data at least semiannually to ensure balanced progress towards

Pediatric Otolaryngology

achieving experience with a variety and complexity of surgical

procedures.

(Core)

V.A.3. Summative Evaluation

V.A.3.a) The specialty-specific Milestones must be used as one of the

tools to ensure fellows are able to practice core professional

activities without supervision upon completion of the

program.

(Core)

V.A.3.b) The program director must provide a summative evaluation

for each fellow upon completion of the program.

(Core)

This evaluation must:

V.A.3.b).(1) become part of the fellow’s permanent record

maintained by the institution, and must be accessible

for review by the fellow in accordance with

institutional policy;

(Detail)

V.A.3.b).(2) document the fellow’s performance during their

education; and,

(Detail)

V.A.3.b).(3) verify that the fellow has demonstrated sufficient

competence to enter practice without direct

supervision.

(Detail)

V.B. Faculty Evaluation

V.B.1. At least annually, the program must evaluate faculty performance as

it relates to the educational program.

(Core)

V.B.2. These evaluations should include a review of the faculty’s clinical

teaching abilities, commitment to the educational program, clinical

knowledge, professionalism, and scholarly activities.

(Detail)

V.C. Program Evaluation and Improvement

V.C.1. The program director must appoint the Program Evaluation

Committee (PEC).

(Core)

V.C.1.a) The Program Evaluation Committee:

V.C.1.a).(1) must be composed of at least two program faculty

members and should include at least one fellow;

(Core)

V.C.1.a).(2) must have a written description of its responsibilities;

and,

(Core)

V.C.1.a).(3) should participate actively in:

Pediatric Otolaryngology

V.C.1.a).(3).(a) planning, developing, implementing, and

evaluating educational activities of the

program;

(Detail)

V.C.1.a).(3).(b) reviewing and making recommendations for

revision of competency-based curriculum goals

and objectives;

(Detail)

V.C.1.a).(3).(c) addressing areas of non-compliance with

ACGME standards; and,

(Detail)

V.C.1.a).(3).(d) reviewing the program annually using

evaluations of faculty, fellows, and others, as

specified below.

(Detail)

V.C.2. The program, through the PEC, must document formal, systematic

evaluation of the curriculum at least annually, and is responsible for

rendering a written, annual program evaluation.

(Core)

The program must monitor and track each of the following areas:

V.C.2.a) fellow performance;

(Core)

V.C.2.b) faculty development; and,

(Core)

V.C.2.c) progress on the previous year’s action plan(s).

(Core)

V.C.3. The PEC must prepare a written plan of action to document

initiatives to improve performance in one or more of the areas listed

in section V.C.2., as well as delineate how they will be measured and

monitored.

(Core)

V.C.3.a) The action plan should be reviewed and approved by the

teaching faculty and documented in meeting minutes.

(Detail)

V.C.4. The faculty must meet at least annually to review program goals and

objectives and program effectiveness in achieving them. At least one

fellow should participate in these reviews.

(Detail)

VI. The Learning and Working Environment

Fellowship education must occur in the context of a learning and working

environment that emphasizes the following principles:

 Excellence in the safety and quality of care rendered to patients by fellows

today

 Excellence in the safety and quality of care rendered to patients by today’s

fellows in their future practice

 Excellence in professionalism through faculty modeling of:

Pediatric Otolaryngology

o the effacement of self-interest in a humanistic environment that supports

the professional development of physicians

o the joy of curiosity, problem-solving, intellectual rigor, and discovery

 Commitment to the well-being of the students, residents/fellows, faculty

members, and all members of the health care team

VI.A. Patient Safety, Quality Improvement, Supervision, and Accountability

VI.A.1. Patient Safety and Quality Improvement

All physicians share responsibility for promoting patient safety and

enhancing quality of patient care. Graduate medical education must

prepare fellows to provide the highest level of clinical care with

continuous focus on the safety, individual needs, and humanity of

their patients. It is the right of each patient to be cared for by fellows

who are appropriately supervised; possess the requisite knowledge,

skills, and abilities; understand the limits of their knowledge and

experience; and seek assistance as required to provide optimal

patient care.

Fellows must demonstrate the ability to analyze the care they

provide, understand their roles within health care teams, and play an

active role in system improvement processes. Graduating fellows

will apply these skills to critique their future unsupervised practice

and effect quality improvement measures.

It is necessary for fellows and faculty members to consistently work

in a well-coordinated manner with other health care professionals to

achieve organizational patient safety goals.

VI.A.1.a) Patient Safety

VI.A.1.a).(1) Culture of Safety

A culture of safety requires continuous identification

of vulnerabilities and a willingness to transparently

deal with them. An effective organization has formal

mechanisms to assess the knowledge, skills, and

attitudes of its personnel toward safety in order to

identify areas for improvement.

VI.A.1.a).(1).(a) The program, its faculty, residents, and fellows

must actively participate in patient safety

systems and contribute to a culture of safety.

(Core)

VI.A.1.a).(1).(b) The program must have a structure that

promotes safe, interprofessional, team-based

Pediatric Otolaryngology

care.

(Core)

VI.A.1.a).(2) Education on Patient Safety

Programs must provide formal educational activities

that promote patient safety-related goals, tools, and

techniques.

(Core)

VI.A.1.a).(3) Patient Safety Events

Reporting, investigation, and follow-up of adverse

events, near misses, and unsafe conditions are pivotal

mechanisms for improving patient safety, and are

essential for the success of any patient safety

program. Feedback and experiential learning are

essential to developing true competence in the ability

to identify causes and institute sustainable systems-

based changes to ameliorate patient safety

vulnerabilities.

VI.A.1.a).(3).(a) Residents, fellows, faculty members, and other

clinical staff members must:

VI.A.1.a).(3).(a).(i) know their responsibilities in reporting

patient safety events at the clinical site;

(Core)

VI.A.1.a).(3).(a).(ii) know how to report patient safety

events, including near misses, at the

clinical site; and,

(Core)

VI.A.1.a).(3).(a).(iii) be provided with summary information

of their institution’s patient safety

reports.

(Core)

VI.A.1.a).(3).(b) Fellows must participate as team members in

real and/or simulated interprofessional clinical

patient safety activities, such as root cause

analyses or other activities that include

analysis, as well as formulation and

implementation of actions.

(Core)

VI.A.1.a).(4) Fellow Education and Experience in Disclosure of

Adverse Events

Patient-centered care requires patients, and when

appropriate families, to be apprised of clinical

situations that affect them, including adverse events.

This is an important skill for faculty physicians to

model, and for fellows to develop and apply.

Pediatric Otolaryngology

VI.A.1.a).(4).(a) All fellows must receive training in how to

disclose adverse events to patients and

families.

(Core)

VI.A.1.a).(4).(b) Fellows should have the opportunity to

participate in the disclosure of patient safety

events, real or simulated.

(Detail)

VI.A.1.b) Quality Improvement

VI.A.1.b).(1) Education in Quality Improvement

A cohesive model of health care includes quality-

related goals, tools, and techniques that are necessary

in order for health care professionals to achieve

quality improvement goals.

VI.A.1.b).(1).(a) Fellows must receive training and experience in

quality improvement processes, including an

understanding of health care disparities.

(Core)

VI.A.1.b).(2) Quality Metrics

Access to data is essential to prioritizing activities for

care improvement and evaluating success of

improvement efforts.

VI.A.1.b).(2).(a) Fellows and faculty members must receive data

on quality metrics and benchmarks related to

their patient populations.

(Core)

VI.A.1.b).(3) Engagement in Quality Improvement Activities

Experiential learning is essential to developing the

ability to identify and institute sustainable systems-

based changes to improve patient care.

VI.A.1.b).(3).(a) Fellows must have the opportunity to

participate in interprofessional quality

improvement activities.

(Core)

VI.A.1.b).(3).(a).(i) This should include activities aimed at

reducing health care disparities.

(Detail)

VI.A.2. Supervision and Accountability

VI.A.2.a) Although the attending physician is ultimately responsible for

the care of the patient, every physician shares in the

responsibility and accountability for their efforts in the

provision of care. Effective programs, in partnership with

their Sponsoring Institutions, define, widely communicate,

Pediatric Otolaryngology

and monitor a structured chain of responsibility and

accountability as it relates to the supervision of all patient

care.

Supervision in the setting of graduate medical education

provides safe and effective care to patients; ensures each

fellow’s development of the skills, knowledge, and attitudes

required to enter the unsupervised practice of medicine; and

establishes a foundation for continued professional growth.

VI.A.2.a).(1) Each patient must have an identifiable and

appropriately-credentialed and privileged attending

physician (or licensed independent practitioner as

specified by the applicable Review Committee) who is

responsible and accountable for the patient’s care.

(Core)

VI.A.2.a).(1).(a) This information must be available to fellows,

faculty members, other members of the health

care team, and patients.

(Core)

VI.A.2.a).(1).(b) Fellows and faculty members must inform each

patient of their respective roles in that patient’s

care when providing direct patient care.

(Core)

VI.A.2.b) Supervision may be exercised through a variety of methods.

For many aspects of patient care, the supervising physician

may be a more advanced fellow. Other portions of care

provided by the fellow can be adequately supervised by the

immediate availability of the supervising faculty member or

fellow physician, either on site or by means of telephonic

and/or electronic modalities. Some activities require the

physical presence of the supervising faculty member. In

some circumstances, supervision may include post-hoc

review of fellow-delivered care with feedback.

VI.A.2.b).(1) The program must demonstrate that the appropriate

level of supervision in place for all fellows is based on

each fellow’s level of training and ability, as well as

patient complexity and acuity. Supervision may be

exercised through a variety of methods, as appropriate

to the situation.

(Core)

VI.A.2.c) Levels of Supervision

To promote oversight of fellow supervision while providing

for graded authority and responsibility, the program must use

the following classification of supervision:

(Core)

VI.A.2.c).(1) Direct Supervision – the supervising physician is

physically present with the fellow and patient.

(Core)

Pediatric Otolaryngology

VI.A.2.c).(2) Indirect Supervision:

VI.A.2.c).(2).(a) with Direct Supervision immediately available –

the supervising physician is physically within

the hospital or other site of patient care, and is

immediately available to provide Direct

Supervision.

(Core)

VI.A.2.c).(2).(b) with Direct Supervision available – the

supervising physician is not physically present

within the hospital or other site of patient care,

but is immediately available by means of

telephonic and/or electronic modalities, and is

available to provide Direct Supervision.

(Core)

VI.A.2.c).(3) Oversight – the supervising physician is available to

provide review of procedures/encounters with

feedback provided after care is delivered.

(Core)

VI.A.2.d) The privilege of progressive authority and responsibility,

conditional independence, and a supervisory role in patient

care delegated to each fellow must be assigned by the

program director and faculty members.

(Core)

VI.A.2.d).(1) The program director must evaluate each fellow’s

abilities based on specific criteria, guided by the

Milestones.

(Core)

VI.A.2.d).(2) Faculty members functioning as supervising

physicians must delegate portions of care to fellows

based on the needs of the patient and the skills of

each fellow.

(Core)

VI.A.2.d).(3) Fellows should serve in a supervisory role to residents

or junior fellows in recognition of their progress

toward independence, based on the needs of each

patient and the skills of the individual resident or

fellow.

(Detail)

VI.A.2.e) Programs must set guidelines for circumstances and events

in which fellows must communicate with the supervising

faculty member(s).

(Core)

VI.A.2.e).(1) Each fellow must know the limits of their scope of

authority, and the circumstances under which the

fellow is permitted to act with conditional

independence.

(Outcome)

VI.A.2.f) Faculty supervision assignments must be of sufficient

duration to assess the knowledge and skills of each fellow

Pediatric Otolaryngology

and to delegate to the fellow the appropriate level of patient

care authority and responsibility.

(Core)

VI.B. Professionalism

VI.B.1. Programs, in partnership with their Sponsoring Institutions, must

educate fellows and faculty members concerning the professional

responsibilities of physicians, including their obligation to be

appropriately rested and fit to provide the care required by their

patients.

(Core)

VI.B.2. The learning objectives of the program must:

VI.B.2.a) be accomplished through an appropriate blend of supervised

patient care responsibilities, clinical teaching, and didactic

educational events;

(Core)

VI.B.2.b) be accomplished without excessive reliance on fellows to

fulfill non-physician obligations; and,

(Core)

VI.B.2.c) ensure manageable patient care responsibilities.

(Core)

VI.B.3. The program director, in partnership with the Sponsoring Institution,

must provide a culture of professionalism that supports patient

safety and personal responsibility.

(Core)

VI.B.4. Fellows and faculty members must demonstrate an understanding

of their personal role in the:

VI.B.4.a) provision of patient- and family-centered care;

(Outcome)

VI.B.4.b) safety and welfare of patients entrusted to their care,

including the ability to report unsafe conditions and adverse

events;

(Outcome)

VI.B.4.c) assurance of their fitness for work, including:

(Outcome)

VI.B.4.c).(1) management of their time before, during, and after

clinical assignments; and,

(Outcome)

VI.B.4.c).(2) recognition of impairment, including from illness,

fatigue, and substance use, in themselves, their peers,

and other members of the health care team.

(Outcome)

VI.B.4.d) commitment to lifelong learning;

(Outcome)

VI.B.4.e) monitoring of their patient care performance improvement

indicators; and,

(Outcome)

VI.B.4.f) accurate reporting of clinical and educational work hours,

patient outcomes, and clinical experience data.

(Outcome)

Pediatric Otolaryngology

VI.B.5. All fellows and faculty members must demonstrate responsiveness

to patient needs that supersedes self-interest. This includes the

recognition that under certain circumstances, the best interests of

the patient may be served by transitioning that patient’s care to

another qualified and rested provider.

(Outcome)

VI.B.6. Programs must provide a professional, respectful, and civil

environment that is free from mistreatment, abuse, or coercion of

students, residents/fellows, faculty, and staff. Programs, in

partnership with their Sponsoring Institutions, should have a

process for education of fellows and faculty regarding

unprofessional behavior and a confidential process for reporting,

investigating, and addressing such concerns.

(Core)

VI.C. Well-Being

In the current health care environment, fellows and faculty members are at

increased risk for burnout and depression. Psychological, emotional, and

physical well-being are critical in the development of the competent,

caring, and resilient physician. Self-care is an important component of

professionalism; it is also a skill that must be learned and nurtured in the

context of other aspects of fellowship training. Programs, in partnership

with their Sponsoring Institutions, have the same responsibility to address

well-being as they do to evaluate other aspects of fellow competence.

VI.C.1. This responsibility must include:

VI.C.1.a) efforts to enhance the meaning that each fellow finds in the

experience of being a physician, including protecting time

with patients, minimizing non-physician obligations,

providing administrative support, promoting progressive

autonomy and flexibility, and enhancing professional

relationships;

(Core)

VI.C.1.b) attention to scheduling, work intensity, and work

compression that impacts fellow well-being;

(Core)

VI.C.1.c) evaluating workplace safety data and addressing the safety of

fellows and faculty members;

(Core)

VI.C.1.d) policies and programs that encourage optimal fellow and

faculty member well-being; and,

(Core)

VI.C.1.d).(1) Fellows must be given the opportunity to attend

medical, mental health, and dental care appointments,

including those scheduled during their working hours.

(Core)

VI.C.1.e) attention to fellow and faculty member burnout, depression,

and substance abuse. The program, in partnership with its

Pediatric Otolaryngology

Sponsoring Institution, must educate faculty members and

fellows in identification of the symptoms of burnout,

depression, and substance abuse, including means to assist

those who experience these conditions. Fellows and faculty

members must also be educated to recognize those

symptoms in themselves and how to seek appropriate care.

The program, in partnership with its Sponsoring Institution,

must:

(Core)

VI.C.1.e).(1) encourage fellows and faculty members to alert the

program director or other designated personnel or

programs when they are concerned that another

resident, fellow, or faculty member may be displaying

signs of burnout, depression, substance abuse,

suicidal ideation, or potential for violence;

(Core)

VI.C.1.e).(2) provide access to appropriate tools for self-screening;

and,

(Core)

VI.C.1.e).(3) provide access to confidential, affordable mental

health assessment, counseling, and treatment,

including access to urgent and emergent care 24

hours a day, seven days a week.

(Core)

VI.C.2. There are circumstances in which fellows may be unable to attend

work, including but not limited to fatigue, illness, and family

emergencies. Each program must have policies and procedures in

place that ensure coverage of patient care in the event that a fellow

may be unable to perform their patient care responsibilities. These

policies must be implemented without fear of negative

consequences for the fellow who is unable to provide the clinical

work.

(Core)

VI.D. Fatigue Mitigation

VI.D.1. Programs must:

VI.D.1.a) educate all faculty members and fellows to recognize the

signs of fatigue and sleep deprivation;

(Core)

VI.D.1.b) educate all faculty members and fellows in alertness

management and fatigue mitigation processes; and,

(Core)

VI.D.1.c) encourage fellows to use fatigue mitigation processes to

manage the potential negative effects of fatigue on patient

care and learning.

(Detail)

VI.D.2. Each program must ensure continuity of patient care, consistent

with the program’s policies and procedures referenced in VI.C.2, in

the event that a fellow may be unable to perform their patient care

responsibilities due to excessive fatigue.

(Core)

Pediatric Otolaryngology

VI.D.3. The program, in partnership with its Sponsoring Institution, must

ensure adequate sleep facilities and safe transportation options for

fellows who may be too fatigued to safely return home.

(Core)

VI.E. Clinical Responsibilities, Teamwork, and Transitions of Care

VI.E.1. Clinical Responsibilities

The clinical responsibilities for each fellow must be based on PGY

level, patient safety, fellow ability, severity and complexity of patient

illness/condition, and available support services.

(Core)

VI.E.1.a) The workload associated with optimal clinical care of surgical

patients is a continuum from the moment of admission to the point

of discharge.

(Detail)

VI.E.1.b) During the fellowship education process, surgical teams should be

made up of attending surgeons, fellows, residents at various PGY

levels, medical students (when appropriate), and other health care

providers.

(Detail)

VI.E.1.c) The work of the caregiver team should be assigned to team

members based on each individual’s level of education,

experience, and competence.

(Detail)

VI.E.2. Teamwork

Fellows must care for patients in an environment that maximizes

communication. This must include the opportunity to work as a

member of effective interprofessional teams that are appropriate to

the delivery of care in the specialty and larger health system.

(Core)

VI.E.2.a) Effective surgical practices entail the involvement of members with

a mix of complementary skills and attributes (physicians, nurses,

and other staff). Success requires both an unwavering mutual

respect for those skills and contributions, and a shared

commitment to the process of patient care.

(Detail)

VI.E.2.b) Fellows must collaborate with fellow surgical residents, and with

especially faculty, other physicians outside of their specialty, and

non-traditional health care providers to best formulate treatment

plans for an increasingly diverse patient population.

(Detail)

VI.E.2.c) Fellows must assume personal responsibility to complete all tasks

to which they are assigned (or which they voluntarily assume) in a

timely fashion. These tasks must be completed within the hours

assigned, or, if that is not possible, fellows must learn and utilize

the established methods for handing off remaining tasks to

another member of the fellow team so that patient care is not

compromised.

(Detail)

Pediatric Otolaryngology

VI.E.2.d) Lines of authority should be defined by programs, and all fellows

must have a working knowledge of expected reporting

relationships to maximize quality care and patient safety.

(Detail)

VI.E.3. Transitions of Care

VI.E.3.a) Programs must design clinical assignments to optimize

transitions in patient care, including their safety, frequency,

and structure.

(Core)

VI.E.3.b) Programs, in partnership with their Sponsoring Institutions,

must ensure and monitor effective, structured hand-over

processes to facilitate both continuity of care and patient

safety.

(Core)

VI.E.3.c) Programs must ensure that fellows are competent in

communicating with team members in the hand-over process.

(Outcome)

VI.E.3.d) Programs and clinical sites must maintain and communicate

schedules of attending physicians and fellows currently

responsible for care.

(Core)

VI.E.3.e) Each program must ensure continuity of patient care,

consistent with the program’s policies and procedures

referenced in VI.C.2, in the event that a fellow may be unable

to perform their patient care responsibilities due to excessive

fatigue or illness, or family emergency.

(Core)

VI.F. Clinical Experience and Education

Programs, in partnership with their Sponsoring Institutions, must design

an effective program structure that is configured to provide fellows with

educational and clinical experience opportunities, as well as reasonable

opportunities for rest and personal activities.

VI.F.1. Maximum Hours of Clinical and Educational Work per Week

Clinical and educational work hours must be limited to no more than

80 hours per week, averaged over a four-week period, inclusive of all

in-house clinical and educational activities, clinical work done from

home, and all moonlighting.

(Core)

VI.F.2. Mandatory Time Free of Clinical Work and Education

VI.F.2.a) The program must design an effective program structure that

is configured to provide fellows with educational

opportunities, as well as reasonable opportunities for rest

and personal well-being.

(Core)

Pediatric Otolaryngology

VI.F.2.b) Fellows should have eight hours off between scheduled

clinical work and education periods.

(Detail)

VI.F.2.b).(1) There may be circumstances when fellows choose to

stay to care for their patients or return to the hospital

with fewer than eight hours free of clinical experience

and education. This must occur within the context of

the 80-hour and the one-day-off-in-seven

requirements.

(Detail)

VI.F.2.c) Fellows must have at least 14 hours free of clinical work and

education after 24 hours of in-house call.

(Core)

VI.F.2.d) Fellows must be scheduled for a minimum of one day in

seven free of clinical work and required education (when

averaged over four weeks). At-home call cannot be assigned

on these free days.

(Core)

VI.F.3. Maximum Clinical Work and Education Period Length

VI.F.3.a) Clinical and educational work periods for fellows must not

exceed 24 hours of continuous scheduled clinical

assignments.

(Core)

VI.F.3.a).(1) Up to four hours of additional time may be used for

activities related to patient safety, such as providing

effective transitions of care, and/or fellow education.

(Core)

VI.F.3.a).(1).(a) Additional patient care responsibilities must not

be assigned to a fellow during this time.

(Core)

VI.F.4. Clinical and Educational Work Hour Exceptions

VI.F.4.a) In rare circumstances, after handing off all other

responsibilities, a fellow, on their own initiative, may elect to

remain or return to the clinical site in the following

circumstances:

VI.F.4.a).(1) to continue to provide care to a single severely ill or

unstable patient;

(Detail)

VI.F.4.a).(2) humanistic attention to the needs of a patient or

family; or,

(Detail)

VI.F.4.a).(3) to attend unique educational events.

(Detail)

VI.F.4.b) These additional hours of care or education will be counted

toward the 80-hour weekly limit.

(Detail)

VI.F.4.c) A Review Committee may grant rotation-specific exceptions

Pediatric Otolaryngology

for up to 10 percent or a maximum of 88 clinical and

educational work hours to individual programs based on a

sound educational rationale.

The Review Committee for Otolaryngology will not consider

requests for exceptions to the 80-hour limit to the fellows’ work

week.

VI.F.4.c).(1) In preparing a request for an exception, the program

director must follow the clinical and educational work

hour exception policy from the ACGME Manual of

Policies and Procedures.

(Core)

VI.F.4.c).(2) Prior to submitting the request to the Review

Committee, the program director must obtain approval

from the Sponsoring Institution’s GMEC and DIO.

(Core)

VI.F.5. Moonlighting

VI.F.5.a) Moonlighting must not interfere with the ability of the fellow

to achieve the goals and objectives of the educational

program, and must not interfere with the fellow’s fitness for

work nor compromise patient safety.

(Core)

VI.F.5.b) Time spent by fellows in internal and external moonlighting

(as defined in the ACGME Glossary of Terms) must be

counted toward the 80-hour maximum weekly limit.

(Core)

VI.F.6. In-House Night Float

Night float must occur within the context of the 80-hour and one-

day-off-in-seven requirements.

(Core)

VI.F.6.a) The Review Committee for Otolaryngology will not permit night

float.

VI.F.7. Maximum In-House On-Call Frequency

Fellows must be scheduled for in-house call no more frequently than

every third night (when averaged over a four-week period).

(Core)

VI.F.8. At-Home Call

VI.F.8.a) Time spent on patient care activities by fellows on at-home

call must count toward the 80-hour maximum weekly limit.

The frequency of at-home call is not subject to the every-

third-night limitation, but must satisfy the requirement for one

day in seven free of clinical work and education, when

averaged over four weeks.

(Core)

VI.F.8.a).(1) At-home call must not be so frequent or taxing as to

Pediatric Otolaryngology

preclude rest or reasonable personal time for each

fellow.

(Core)

VI.F.8.b) Fellows are permitted to return to the hospital while on at-

home call to provide direct care for new or established

patients. These hours of inpatient patient care must be

included in the 80-hour maximum weekly limit.

(Detail)

***

*Core Requirements: Statements that define structure, resource, or process elements essential to every

graduate medical educational program.

Detail Requirements: Statements that describe a specific structure, resource, or process, for achieving

compliance with a Core Requirement. Programs and sponsoring institutions in substantial compliance

with the Outcome Requirements may utilize alternative or innovative approaches to meet Core

Requirements.

Outcome Requirements: Statements that specify expected measurable or observable attributes

(knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medical

education.

Osteopathic Recognition

For programs seeking Osteopathic Recognition for the entire program, or for a track within the

program, the Osteopathic Recognition Requirements are also applicable.

(http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/Osteopathic_Recogniton_Requirements.pdf)