GENERAL AND SPECIAL REQUIREMENTS
FOR GRADUATE MEDICAL EDUCATION IN THE
SUBSPECIALTY OF FEMALE PELVIC MEDICINE
AND RECONSTRUCTIVE SURGERY
Jointly Sponsored by:
THE AMERICAN BOARD OF
OBSTETRICS AND GYNECOLOGY, INC.
First in Women’s Health
THE AMERICAN BOARD OF UROLOGY, INC.
Revised April 2011
TABLE OF CONTENTS
I.
GENERAL REQUIREMENTS
A. Introduction……….………………………………………………..
B. Fellows
1. Enrollment Requirement………….…………………………
2. Fellow Registration…………………………………………..
3. Certification Eligibility………………………………………..
4. Certification……………………………………………………
5. Allocation of Time in a Fellowship………………………….
C. Programs
1. Application Process………………………………………….
2. Educational Objectives………………………………………
3. Residency and Department Affiliations………..…………..
4. New Program Application……………………………………
5. Reaccreditation Process………….…………………………
6. Changes in the Program…………………………………….
7. Annual Report and Fee ……………………………………
8. Specialist Site Visit…………………………………………..
9. Fellow Complement………………………………………….
10. Requirements for an Increase in Complement……………
11. Permanent Increase in Complement………………………
12. Temporary Increase in Complement ………………………
13. Guidelines to Request an Increase in Complement …….
14. Program Evaluation………………………………………….
15. Research Training…………………………………………...
16. Research Rotations………………………………………….
17. Graduate Degrees …………………………………………
18. Research Credit for Advanced Degree ……………………
19. Additional Research Time…………………………………..
20 Programs Without Fellows for Three Years ………………
21. Fellowship Match…………………………………………….
22. ERAS……….…………………………………………………
23. Probation ……………………………………………………..
D. Program Director
1. Program Director Requirements……………………………
2. Duties …………………………………………………………
3. Fellow Registration…………………………………………..
4. Fellow Research Program…………………………………..
5. Fellow Evaluation…………………………………………….
6. Annual Report and Fee ……………………………………
7. Loss of a Program Director …………………………………
E. Other Program Faculty
1. Program Faculty Requirements ……………………………
2. Research Faculty…………………………………………….
F. Curriculum
1. Didactic Conferences………………………………………..
2. Clinical ……………………………………………………….
3. Supervision of Fellows………………………………………
4. Research………………………………………………………
5. Research Mentor and Strategy …………………………….
6. Thesis …………………………………………………………
7. Graduate Courses ..…………………………………………
G. Duty Hours and Work Environment
1. Overview ..……………………………………………………
2. Exceptions ……………………………………………………
3. Activities ………………………………………………………
4. On-Call Activities …………………………………………….
5. Moonlighting ………………………………………………….
6. Oversight ……………………………………………………..
H. Evaluation
1. Fellow Evaluation ……………………………………………
2. Final Evaluation………………………………………………
3. Thesis Defense ………………………………………………
4. Faculty Evaluation …………………………………………..
5. Program Evaluation………………………………………….
I. Vacation and Leave Policy……………………………………….
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J.
K.
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II.
Experimentation and Innovation…………………………………
ACGME Competencies …………………………………………..
Facilities
1. Agreements with Additional Sites ………………………….
2. Supervision at Outside Sites ……………………………….
3. Available Services……………………………………………
4. Medical Records……………………………………………..
5. Medical Library……………………………………………….
6. Laboratories ………………………………………………….
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SPECIAL REQUIREMENTS: FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
A. Introduction…………………………………………………………
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B. Fellows ……………………………………………………………..
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C. Program
1. Goals ………………………………………………………….
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2. Faculty………………………………………………………...
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3. Duration of Fellowships ……………………………………..
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D. Faculty………………………………………………………………
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E. Curriculum
1. Clinical Experience ………………………………………….
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2. Educational Program ………………………………………..
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3. Residency Program………………………………………….
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4. Patient Care ………………………………………………….
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5. Obstetrical Knowledge………………………………………
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6. Fellow Case Lists and Experience Logs…………………..
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7. Research and Thesis ……………………………………….
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F. Facilities ……………………………………………………………
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Addendum A: Thesis Requirements………………………………………
Addendum B: Glossary of Terms …………………………………………
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ALL CORRESPONDENCE SHOULD BE SENT IN WRITING TO:
LARRY C. GILSTRAP, III, M.D.
EXECUTIVE DIRECTOR
THE AMERICAN BOARD OF OBSTETRICS AND GYNECOLOGY
2915 VINE STREET
DALLAS, TX 75204
Subspecialty Coordinator:
Cathy A. Cash
214.871.1619 (Main Line)
214.721.7526 (Fellowship Dept.)
214.871.1943 (Fax)
www.abog.org
E-mail: ccash@abog.org
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General and Special Requirements
for Graduate Medical Education
in the Subspecialty Area of
Female Pelvic Medicine and Reconstructive Surgery
Jointly Sponsored by:
The American Board of Obstetrics
And Gynecology, Inc. and
The American Board of Urology, Inc.
I.
GENERAL REQUIREMENTS
A. INTRODUCTION
1.
Subspecialty fellowship training programs must be designed to ensure the education and training of
physicians who can improve the health care of women and provide leadership for the specialties of
obstetrics and gynecology and urology and the subspecialty of female pelvic medicine and
reconstructive surgery. Each program must have facilities and faculty sufficient to provide its
fellows with the requisite investigative and scholarly skills to prepare candidates for a career in
academic medicine, in addition to the clinical requirements. A subspecialty program must have
special facilities, services, and personnel. Program faculty of such programs also must provide
opportunities for fellows to gain, in graduated fashion, increasing knowledge, skills, and
responsibility in the subspecialty field sufficient to permit them to function as independent
consultants.
2.
Within an institution, the activities of the subspecialty fellows and residents in obstetrics and
gynecology and/or urology must be identified clearly and separately. Subspecialty programs and
the residency program must complement and enrich one another and must not exist in competition
with each other.
B. FELLOWS
1.
Enrollment Requirement - Fellows must be enrolled full-time for the minimum requirement of the
program. A fellow beginning a program must have satisfactorily completed an obstetrics and
gynecology or urology residency that is accredited by the American Council for Graduate Medical
Education (ACGME) or the Council of the Royal College of Physicians and Surgeons of Canada
(CRCPSC) and have acquired basic knowledge and skills in obstetrics and gynecology or urology.
2.
Fellow Registration - A candidate entering an approved subspecialty fellowship must make
application to the American Board of Obstetrics and Gynecology, Inc., and the American Board of
Urology, Inc. (hereinafter called ABOG-ABU), at least ninety (90) days prior to starting the
fellowship using a current form.
3.
Certification Eligibility - When, and if, certification is offered and after a suitable period of
“grandfathering”, if offered, eligible candidates will be accepted for the written examination only if
they have been registered with the ABOG-ABU throughout the period of fellowship training, have
completed or be in their final year of fellowship training and provide documentation of satisfactory
completion of the two required graduate courses.
4.
Certification - When, and if, certification is offered and after a suitable period of “grandfathering”, if
offered, eligible candidates must have passed both the written and oral examinations for
certification in obstetrics and gynecology or urology which are given by their respective Boards.
5.
Allocation of Time in a Fellowship - It is recommended that contact with the broad aspects of
obstetrics and gynecology or urology be continued throughout the fellowship, including such
mechanisms as participation in lectures, conferences, or night and weekend call. No more than
10% of the fellow's time, however, may be spent performing duties unrelated to the subspecialty of
female pelvic medicine and reconstructive surgery (no more than eight hours).
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C. PROGRAMS
1.
Application Process - Institutions must apply for approval of a fellowship program which meets the
jointly sponsored ABOG-ABU requirements. Urology fellows must complete two years of fellowship
training. This must include one year of research. Obstetrics and Gynecology fellows must
complete three years of fellowship training. This must include one year of research.
2.
Educational Objectives - In order to be approved, every subspecialty program must have a written
statement of the educational objectives for the fellows in that program. Examples of such
objectives are set forth in the Guide to Learning in Female Pelvic Medicine and Reconstructive
Surgery. Moreover, educational objectives should be described in enough detail to identify the
unique characteristics of the program. Availability of programs, such as a Masters in Public Health,
a Clinical Research Training Program, special experiences in genetics, intensive care, etc., should
be cited.
3.
Residency and Department Affiliations - An educational program in Female Pelvic Medicine and
Reconstructive Surgery must be affiliated with a medical school and be an integral part of a
Department of Obstetrics and Gynecology or a Department of Urology. This department must also
contain an ACGME-accredited residency program in obstetrics and gynecology or urology. The
program must function with the approval, but not necessarily under the direction of, the Chairman of
the affiliated department.
4.
New Program Application - To establish a new fellowship program, an application and a site
survey must be completed before approval may be given. The application must be signed by the
fellowship Program Director, the Chairs of the Departments of Obstetrics and Gynecology and
Urology, and the Designated Institutional Officer of the institution. The application must be made
on a current form obtained from the office of American Board of Obstetrics and Gynecology, Inc.,
and the form must be submitted to the American Board of Obstetrics and Gynecology, Inc., at least
one year in advance to the proposed start of the new program. (Please Note: When submitting an
application it is imperative that the block diagram match the information provided in the narrative.)
5.
Reaccreditation Process - Approved programs will be reviewed periodically, but not less
frequently than every five years. Review for continued approval requires a new application and an
on-site survey. The deadline date for the reapplication and the date for the program site survey will
be sent to the program director at least 90 days in advance. Notification of action by the ABOGABU Subspecialty Committee (hereinafter called the “Committee”) will include an anticipated
duration of approval; however, based upon the receipt of new information obtained by the
Committee, an earlier survey may be scheduled. (Please Note: When submitting an application it
is imperative that the block diagram match the information provided in the narrative.)
6.
Changes in the Program - If there are any significant changes in the program (i.e., change in the
number of fellowship positions, Program Director, Division Director, key faculty members, patient
volumes and procedures, closure of major research programs, or changes in clinical sites), the
Board must be notified within 60 days of the change. Such changes could result in the request for
a new application and review.
7.
Annual Report and Fee - Every program is required to submit an annual fee and a report which
includes a list of current faculty and enrolled fellows. This report is the responsibility of the Program
Director and is usually due at the end of May. If the fee and report are not received within 30 days
of the due date, accreditation for the program will be withdrawn. These notices and reports may
serve as the basis for modification of the date of the required reaccreditation application and
review.
8.
Specialist Site Visit - If during the review of the application for reaccreditation or the program’s
Annual Report the Committee requests a specialist site visit, the travel expenses and per diem of
the site visitors must be paid by the institution having the site visit.
9.
Fellow Complement - A program will be approved for a specific number of fellows at each level.
Any individual in an institution assigned to a position in a fellowship that has clinical or research
duties similar to fellows must be included in the number of fellows for that institution, and this
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number shall not exceed the approved number without specific prior written approval from the
Committee. A Program Director, however, may change the complement of fellows by one in any
year as long as the total number of fellows approved for a specific program does not change. The
minimum number of fellows in a program requires consideration. Fellowship programs with a
planned complement of only one fellow in total during a two or three year program cannot sustain
the critical mass necessary to keep the program vital. There must be at least a total of two fellows
during a two or three year program. The education of fellows must permit progressively greater
clinical responsibility and must not vary significantly from one fellow to another in the same program
without prior written approval of the Committee.
10.
Requirements for an Increase in Complement - Programs must be fully accredited to be
considered for an increase in fellow complement, whether temporary or permanent. Programs with
a status of probation are not eligible for an increase. A site visit may be required for a complement
change request depending on the details of the request. A request for a change in the number of
fellows must describe the predicted impact on the total experience of the other fellows under the
new circumstances.
11.
Permanent Increase in Complement – All requests for a permanent change in the number of
fellows must demonstrate a distinct and substantial improvement in the educational opportunities
for all fellows in the program. Such requests must be based not only on the availability of an
adequate patient population, but also on adequate resources for supervision, education, and
research.
A request for a permanent increase will be considered incomplete if it lists only expansion in beds,
hospitals, or overall clinical experience and does not address the question of expansion of faculty
and research support necessary for teaching, supervising, and research mentorship for the
additional fellow(s). Programs requesting such an increase must write to the Executive Director of
the American Board of Obstetrics and Gynecology and submit the information requested in
paragraph #13 below.
12.
Temporary Increase in Complement - Programs requesting a one-time, temporary increase in
addition to their approved number of fellows must write to the Executive Director of the American
Board of Obstetrics and Gynecology and submit the information requested in paragraph #13 below.
13.
Guidelines to Request an Increase in Complement - Programs requesting a one-time temporary
increase or a permanent increase of fellows must provide the following information:
a.
b.
c.
d.
approval by the Designated Institutional Officer (DIO);
an educational justification for the increase;
a description of major changes in the program since its last review;
a description of the predicted impact on the total experience of the other fellows under the new
circumstances; and
e. a block diagram of all fellows’ schedules incorporating the additional fellow(s).
14.
Program Evaluation - Performance of a fellowship program is evaluated on the basis of (a) the
performance of the fellows on the written certification examination (when and if one is given), (b)
completion of a thesis by each fellow, and (c) the continued academic productivity of the current
faculty members. To this end, there must be evidence that the fellowship program has on-going
strong scholarly activity and productivity in clinical and laboratory research. Such evidence must be
provided in each year's Annual Report by listing the publications and presentations by faculty and
fellows at regional, national, or international scientific meetings.
15.
Research Training - Graduate education programs must be designed to provide research
experience for the fellow while satisfying the basic training objectives outlined in the curriculum. A
detailed curriculum that describes both the clinical and research training will require approval by the
Committee prior to implementation. The overall research goals and objectives must be defined in
the institutional application submitted by the fellowship program. These must include the:
a. opportunity for structured basic laboratory and/or clinical research and the development of
additional clinical skills;
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b. enhancement of the fellow's understanding of the latest scientific techniques and
encouragement of interaction with other scientists;
c. promotion of the fellow's academic contributions to the subspecialty;
d. enhancement of the opportunities for the fellows to obtain research funding and academic
positions; and
e. furthering of the ability of the fellow to be an independent investigator.
16.
Research Rotations - Fellow research rotations must be in monthly blocks and no more than 10%
of a fellow’s time can be devoted to non-research clinical activities during research block rotations.
Additionally, a specific faculty member (mentor) must be assigned or chosen by a fellow to direct
the fellow’s research efforts.
17.
Graduate Degrees - The Committee encourages the combination of fellowships with graduate
degrees, such as a Masters of Public Health, or a fellowship with a focused interest in genetics,
infectious disease, etc. The design and implementation of these programs, however, must be
approved by the Committee in advance.
18.
Research Credit for Advanced Degree - Coursework which leads to an advanced degree (e.g.,
Master’s or doctorate level) may be counted towards the minimum time required in
research/didactic training. Programs may request a reduction of the fellowship for a candidate with
a Master’s Degree or Ph.D. in a closely related field who can document having had extensive
research experience. Their fellowship still must provide sufficient clinical experience to allow
certification, if and when this is offered. The request must be submitted by the Program Director to
the Executive Director of the American Board of Obstetrics and Gynecology, Inc., prior to starting
the fellowship.
Other unique or special requests will be considered on a case-by-case basis.
Requests made after starting a fellowship will NOT be considered. Such candidates must also
complete a thesis during the fellowship program.
19.
Additional Research Time - Fellows may remain in their institution for longer periods of time to
pursue additional research. This does not require Committee approval; however, the Committee
must be notified of this decision. This option must not detract from the experience of the fellows in
the core program.
20.
Programs Without Fellows for Three Years - Programs with no active fellows for three
consecutive years will not be reviewed. Moreover, accreditation for such programs will be
withdrawn automatically if no ACGME or CRCPSC graduate fellows have been enrolled in the
program for three consecutive years.
21.
Fellowship Match - In selecting from among qualified fellowship applicants, it is required that the
fellowship programs participate in an organized matching program administered by the National
Resident Matching Program (NRMP) for obstetrics and gynecology or through the American
Urological Association (AUA) for urology. Participating fellowship programs should comply with all
terms and conditions of the match agreement. Additional information on these matches can be
found at www.nrmp.org or www.auanet.org.
22.
ERAS – Beginning in 2009, the accredited programs in Female Pelvic Medicine and Reconstructive
Surgery will participate in ERAS (Electronic Residency Application Service). More information on
this electronic application system can be found at www.aamc.org.
23.
Probation – If a program is placed on probation, the Program Director is required to notify all
faculty, enrolled fellows, and applicants of the probationary status. If the program is also restricted
from accepting fellows, the program may not participate in the Match or in ERAS.
D. PROGRAM DIRECTOR
1.
Program Director Requirements - The Program Director must:
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a. be certified/recertified in their specialty (Ob/Gyn or Urology) by the American Board of
Obstetrics and Gynecology, Inc., or the American Board of Urology, Inc., and certified in the
subspecialty of Female Pelvic Medicine and Reconstructive Surgery, when and if it is offered;
b. have a minimum of five years’ experience after completion of fellowship training;
c. show evidence of scholarly accomplishments;
d. demonstrate evidence of continued academic productivity, such as publications in refereed
journals, receipt of national or international honors, and membership and participation in
scientific societies, national committees, editorial boards, etc.;
e. have a full-time faculty appointment or be "geographically" full-time in the primary institution
offering the fellowship program;
f. have direct responsibility for the appropriate education of fellows enrolled in the program;
g. be actively engaged in the care of patients in the subspecialty; and
h. have completed an ABOG-ABU accredited fellowship training program if their basic urology or
obstetrics and gynecology residency training program was completed after June 30, 2010.
2.
Duties - The Program Director must oversee and organize the activities of the educational program
in all institutions that participate in the program. This includes participation in selecting and
supervising the subspecialty faculty and other program personnel at each participating institution,
appointing a local site director, selecting fellows for appointment to the program in accordance with
institutional and departmental policies and procedures, and monitoring appropriate fellow
supervision at all participating institutions.
The Program Director also must ensure the
implementation of fair policies, grievance procedures, and due process for fellows as established by
the sponsoring institution.
3.
Fellow Registration - The Program Director is responsible for ensuring that each fellow in the
program completes an application for registration in that fellowship 90 days prior to commencing
their fellowship.
4.
Fellow Research Program - The Program Director also is responsible for assuring that each fellow
in the program is actively pursuing a research program which will result in the completion of a thesis
which may be utilized in the certification process, if and when it is offered, and that the fellow
selects or is assigned a research mentor.
5.
Fellow Evaluation - The Program Director and division faculty are responsible for the written
evaluation of the fellows’ progress as described in Section I.H.1.
6.
Annual Report and Fee – Every year the Program Director must file an Annual Report with the
American Board of Obstetrics and Gynecology, Inc, and pay an annual fee. This report is usually
due at the end of May. If the fee and report are not received within 30 days of the due date,
accreditation for the program will be withdrawn.
7.
Loss of a Program Director - If the Program Director leaves and the only Board-certified faculty
members remaining do not meet the requirements for assuming the directorship, a two-year time
limit will apply for program continuation. Programs that do not have a faculty member who is
acceptable to the Committee to be the Program Director will be placed on probation at the end of
the first year. At that time, the program is required to notify faculty, enrolled fellows, and applicants
of the program’s probationary status. If the program fails to appoint a Program Director acceptable
to the Committee by the end of the second year, accreditation of the program will be withdrawn
automatically.
E. OTHER PROGRAM FACULTY
1.
Program Faculty Requirements - In addition to the Program Director, there must be at least one
other full-time program faculty member who is certified by either the American Board of Obstetrics
and Gynecology, Inc., or the American Board of Urology, Inc. At this time, there are no Boardcertified individuals in Female Pelvic Medicine and Reconstructive Surgery, so programs must have
a minimum of two Board-certified obstetrician-gynecologists, two Board-certified urologists, or a
combination of one Board-certified urologist and one Board-certified obstetrician-gynecologist.
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Programs may continue for a maximum of two years with only the Program Director, and the
program may be allowed to continue to enroll fellows. If at the end of one year there is not a
second Board-certified faculty recruited, the program will be placed on probation. At that time, the
Program Director is required to notify faculty, enrolled fellows, and applicants of the program’s
probationary status. If the program fails to recruit a second Board-certified faculty by the end of the
second year, accreditation for the program will be withdrawn automatically.
2.
Research Faculty - Some of the faculty must be actively engaged in clinical and/or basic research.
The numbers of clinical and basic science faculty may vary among institutions. It is expected,
however, that some program faculty who are clinicians will have special areas of active clinical
and/or basic science investigation. Such evidence must be provided in each year's Annual Report
by listing the publications and presentations by faculty and fellows at regional, national, or
international meetings. The number of Ph.D. investigators with primary or secondary involvement
in the fellowship program may vary among institutions and may change periodically within
institutions depending upon the research interest of the faculty and fellows. The sequence of
integration of research and clinical training in fellowship programs may vary among different
programs.
F. CURRICULUM
1.
Didactic Conferences - Education of fellows must be accomplished through clinical experiences
and regularly scheduled teaching conferences, seminars, and didactic instruction in both basic
science and clinical aspects of the subspecialty. The fellow's schedule and responsibilities must be
structured to allow regular attendance at these conferences. These conferences must be directed
at the fellows and conducted at a fellowship level. Attendance at other conferences devoted to
medical students and residents, as well as the department’s Grand Round topics is encouraged,
but such conferences are not a substitute for fellow-specific conferences. The fellows’ schedules
and responsibilities must be structured to allow regular attendance at these conferences.
2.
Clinical - A sufficient number of teaching rounds, including reviews of patient care, must be
organized and conducted by qualified faculty at regular intervals. These subspecialty fellows’
teaching rounds should occur at least weekly. The clinical experience of inpatient and outpatient
care must include a sufficient number and variety of cases to fulfill the educational objectives of the
Guide to Learning. There must be a rotation schedule which conforms to the block diagram in the
application submitted for program approval. Outpatient experience is particularly important and
must be carefully organized and closely supervised by the clinical faculty. The fellow must be
capable of performing all appropriate diagnostic and therapeutic procedures relevant to the clinical
practice of the subspecialty. The fellow must play a major role in decisions affecting patient
management and participate in a program constructed to allow continuity of patient care. During
the course of the educational program, the fellow should be supervised in clinical activities and
faculty consultation should be available to the fellow at all times.
3.
Supervision of Fellows - During the course of the educational program, the fellow must be
supervised in clinical activities and faculty consultation must be available to the fellow at all times.
Outpatient experiences must be supervised by on-site clinical faculty. The level of supervision
should be commensurate with the amount of independent function that is designated at each fellow
level. Faculty schedules must be constructed to provide fellows with continuous supervision and
consultation.
4.
Research - The Program Director must provide evidence of strong scholarly activity and
productivity by faculty and fellows in clinical and/or laboratory research. Within the fellowship
curriculum, there must be time allocated for research objectives. Additionally, time must be
reserved for clinical activities, including surgery. Research projects can be developed either within
the department or in collaboration with other academic departments. There also should be
progressive involvement by the fellow in research so that the fellow develops the skills to continue
to conduct independent research.
5.
Research Mentor and Strategy - Familiarity and experience in clinical and laboratory research is
an important part of fellowship training. The ability to carry out a research plan, to interpret the
results, and to demonstrate facility with the scientific method is critical. The structure of the
research program will require a faculty research training director, or mentor, whose role will be
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different from that of the Program Director (although this may be the same individual). There must
be appropriate supervision by the mentor and sufficient opportunity to develop a research project.
The fellow is expected to conceptualize a question or hypothesis and to formulate a strategy to
answer the question. This step must be followed by appropriately supervised experiments and a
statistical analysis as outlined in the thesis instructions (See Addendum A).
6.
Thesis - The portion of each fellow's education devoted to research must ultimately result in a
thesis worthy of publication in a peer-reviewed journal. It is expected that each fellow will acquire a
thorough knowledge and understanding of the methodologies and analyses used in research
protocols that relate to research in their subspecialty. An in-depth understanding of the statistical
analysis of research projects is mandatory.
All fellows must produce a thesis as first author. The thesis need NOT have been published or
accepted for publication. In fact, acceptance of the thesis for publication by a refereed journal does
not guarantee acceptance of the thesis by the Committee if and when an oral examination is given.
It is the Program Director's responsibility to provide the conditions for fulfilling this requirement and
to assist the fellow in reaching this objective by the end of the fellowship. It is required that the
fellow actually perform the research (See Addendum A). The fellow is expected to submit a written
copy of their thesis and to defend the thesis to their division faculty and peers prior to graduation
from the fellowship program (See I.H.3.).
7.
Graduate Courses - A fellowship program must include two university graduate-level courses.
One is in quantitative techniques including biostatistics and other areas such as epidemiology and
research design and implementation. The second course must be relevant to the specific
subspecialty. Both courses must be approved by the Committee. If either course is listed in a
university catalogue, the description in the catalogue may be submitted for approval. If a course is
not listed in a university catalogue, the entire curriculum and the credentials of the instructor must
be submitted. These courses must be completed satisfactorily, concluding with an examination and
documentation of a passing grade. This grade can be a “Pass/Fail” or a letter grade. Attendance
at continuing education courses or short, single-topic courses sponsored by various organizations
is not sufficient to meet the requirement of a university graduate-level course.
G. Duty Hours and Work Environment
1.
Overview - Providing fellows with a sound didactic, research, and clinical education must be
carefully planned and balanced with concerns for patient safety and fellow well-being. Fellows
must adhere to the existing resident duty hour requirement set forth by the ACGME. Each program
must ensure that the learning objectives of the program are not compromised by excessive reliance
on fellows to fulfill service obligations. Didactic and clinical education and research must have
priority in the allotment of the fellows’ time and energy. Duty hour assignments must be consistent
with the fact that faculty and fellows collectively have responsibility for the safety and welfare of
patients.
2.
Exceptions - Fellowship training programs are expected to be in compliance with the current
ACGME Resident Duty Hours requirements and local Graduate Medical Education duty hour
requirements. A Committee may grant exceptions for up to 10% of the 80-hour limit in duty hours
to individual programs based on a sound educational rationale. Prior permission of the institution’s
Graduate Medical Education Committee is required before such a request will be considered by the
Committee. Any such request must be made to the Committee in writing.
3.
Activities - Duty hours include all clinical and academic activities related to the fellowship program
(i.e., inpatient and outpatient care), administrative duties related to patient care, the provision for
transfer of patient care, time spent in-house during call activities, and scheduled academic activities
such as conferences. Duty hours do not include reading and preparation time spent away from the
duty site.
a. Duty hours must be limited to 80 hours per week, averaged over a four-week period, including
all in-house call activities.
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b. Fellows must be provided with one day in seven free from all educational and clinical
responsibilities, averaged over a four-week period, inclusive of call. One day is defined as one
continuous 24-hour period free from all clinical, educational, and administrative activities.
c.
4.
Adequate time for rest and personal activities must be provided. This should consist of a 10hour time period provided between all daily duty periods and after in-house call.
On Call Activities - On-call activities are to provide fellows with continuity of patient care
experiences. In-house call is defined as those duty hours beyond the normal work day when
fellows are required to be immediately available in the assigned institution.
a. In-house call must occur no more frequently than every third night, averaged over a four-week
period.
b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours.
Fellows may remain on duty for up to six additional hours to participate in didactic activities,
transfer care of patients, conduct outpatient clinics, and maintain continuity of medical, surgical,
or obstetrical care.
c.
No new patients may be accepted after 24-hours of continuous duty, except in outpatient
clinics. A new patient is defined as any patient for whom the fellowship service or department
has not previously provided care.
d. At-home call (or pager call) is defined as call taken from outside the assigned institution.
e. The frequency of at-home call is not subject to the every third-night-limitation. At-home call,
however, must not be so frequent as to preclude rest and reasonable personal time for each
fellow. Fellows taking at-home call must be provided with one day in seven completely free
from all educational and clinical responsibilities, averaged over a four-week period.
f.
When fellows are called into the hospital from home, the hours spent in-house are counted
toward the 80-hour limit.
g. The Program Director and the faculty must monitor the demands of at-home call in their
programs and make scheduling adjustments as necessary to mitigate excessive service
demands and/or fatigue.
5.
Moonlighting
a. Because fellowships are full-time endeavors, the fellowship Program Director must ensure that
moonlighting does not interfere with the ability of the fellows to achieve the goals and objectives
of the program.
b. The Program Director also must comply with the sponsoring institution’s written policies and
procedures regarding moonlighting, in compliance with the ACGME Institutional Requirements.
c.
6.
Moonlighting that occurs within the fellowship and/or the sponsoring institution’s primary clinical
site(s), i.e., internal moonlighting, must be counted toward the 80-hour weekly limit on duty
hours.
Oversight
a. Each program must have written policies and procedures consistent with these program
requirements for fellow duty hours and the working environment. These policies must be
distributed to the fellows and the faculty.
b. Duty hours must be monitored with a frequency sufficient to ensure an appropriate balance
between education and service. The fellows’ hours must be monitored by the program director
or faculty via a tracking system (i.e., an online system where the fellows enter their weekly duty
hours).
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c.
Back-up support systems must be provided when patient care responsibilities are unusually
difficult or prolonged or if unexpected circumstances create fellow fatigue sufficient to
jeopardize patient care.
H. EVALUATION
1.
Fellow Evaluation - The faculty must evaluate each fellow in a timely manner; however, the
Program Director must perform a formal written evaluation of each fellow at an interval of no less
than every six months. In addition, the program must have an effective mechanism for assessing
fellow performance and for utilizing the results to improve performance.
a. Assessment should include the use of methods that accurately assess the fellows’ competence
in patient care, medical knowledge, practice-based learning and improvement, interpersonal
and communication skills, professionalism, and systems-based practice.
b. Assessment should include the regular and timely feedback to the fellow that includes the
evaluations of knowledge, skills, research, and professional growth using appropriate criteria
and procedures. Such evaluations are to be communicated to each fellow in a timely manner
and maintained in a record that is accessible to each fellow.
c.
Assessment should include the use of the results of evaluation by faculty and others to achieve
progressive improvements in fellows’ competence and performance.
2.
Final Evaluation - The Program Director must provide a final evaluation for each fellow who
completes the program. It should verify that the fellow has demonstrated sufficient ability to
practice competently and independently. It should verify that the fellow completed two graduate
level courses and provide their titles and grades. This final evaluation must be part of the fellow’s
permanent record maintained by the institution.
3.
Thesis Defense – Each fellow must submit a written copy of their thesis and is expected to defend
the thesis to their division faculty and to their peers prior to graduation. Documentation of this
thesis defense must be part of the fellow’s permanent record maintained by the institution.
4.
Faculty Evaluation - The performance of the fellowship faculty must be evaluated by the program
no less frequently than at the midpoint of the accreditation cycle and again prior to the next site
visit. The evaluations should include a review of their teaching abilities, commitment to the
educational program, clinical knowledge, research mentoring, and scholarly activities. This
evaluation must include annual written confidential evaluations by the fellows.
5.
Program Evaluation - The educational and research mentoring effectiveness of a program must
be evaluated at least annually in a systematic manner.
a. Representative program personnel (the Program Director, representative faculty, and at least
one fellow) must be organized to review program goals and objectives and the effectiveness
with which they are achieved. This group must conduct a formal documented meeting at least
annually for this purpose. In the evaluation process, the group must take into consideration
written comments by faculty, the most recent GMEC report of the sponsoring institution, and the
fellows’ confidential written evaluations. If deficiencies are found, the group should prepare an
explicit plan of action, which should be approved by the faculty and documented in the minutes
of the meeting.
b. The program should use fellow performance and outcome assessment in its evaluation of the
educational effectiveness of the fellowship program. The program should maintain a process
for using assessment results together with other program evaluation results to improve the
fellowship program.
I.
VACATION AND LEAVE POLICY
Leaves of absence and vacation may be granted to fellows at the discretion of the Program Director in
accordance with local policy, but the Board has determined that the maximum amount of all leaves of
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absence for any reason (e.g., vacation, sick leave, maternity or paternity leave, or personal leave) consist
of the following.
Two-Year Fellowship - If the fellowship training program is two years in duration, the total of such leaves
of absence must not exceed eight (8) weeks in the first year, six (6) weeks in the second and final year, or
a total of ten (10) weeks over the entire two years of fellowship. If a fellow’s leaves exceed the required
maximums in the two years of fellowship, then the fellowship must be extended for the duration of time
the individual was absent in excess of the maximum.
Three-Year Fellowship - If the fellowship training program is three years in duration, the total of such
leaves of absence must not exceed eight (8) weeks in each of the first two years, six (6) weeks in the
third and final year, or a total of fifteen (15) weeks over the entire three years of fellowship. If a fellow’s
leaves exceed the required maximums in the three years of fellowship, then the fellowship must be
extended for the duration of time the individual was absent in excess of the maximum.
J. EXPERIMENTATION AND INNOVATION
Since responsible innovation and experimentation are essential to improving subspecialty education,
experimental projects along sound educational principles are encouraged. Requests for such innovative
projects that may deviate from the program requirements must be approved by the Committee and they
must include the educational rationale and method of evaluation. The sponsoring institution(s) and
program(s) are jointly responsible for the quality of education offered to fellows for the duration of such a
project.
K. ACGME COMPETENCIES
The fellowship program must require its fellows to obtain competence in the six areas listed below to the
level expected of a new practitioner. Programs must integrate the following competencies into the
curriculum.
1. PATIENT CARE that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health.
2. MEDICAL KNOWLEDGE about established and evolving biomedical, clinical, and cognate sciences,
as well as the application of this knowledge to patient care.
3. PRACTICE-BASED LEARNING AND IMPROVEMENT that involves the investigation and evaluation
of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in
patient care.
4. INTERPERSONAL AND COMMUNICATION SKILLS that result in the effective exchange of
information and collaboration with patients, their families, and other health professionals.
5. PROFESSIONALISM, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.
6. SYSTEMS-BASED PRACTICE, as manifested by actions that 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.
L. FACILITIES
1. Agreements with Additional Sites - In addition to patient volume and patient diversity, facilities are
critical in order to meet the objectives of the educational program. Assignment of fellows to other
institutions or hospitals can be approved on an individual basis. For this to occur, the fellowship
program must have a formal agreement with each institution or hospital. Such formal agreements
must include stated responsibility of each institution, the anticipated experience of the fellow, and the
evaluation process which will be used to measure the fellows’ progress.
2. Supervision at Outside Sites - A fellowship program may utilize more than one patient facility. If
more than one site is used, there must be at least one physician qualified in the subspecialty at each
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site or a similarly qualified faculty of the program must be assigned for on-site supervision of fellows
during their training at these sites.
3. Available Services - Operating rooms, labor and delivery, and ambulatory care facilities must be
available for the care of patients on a regularly scheduled basis and must always be available on an
emergency basis for the management of complications. The complexity of care required for these
patients makes it necessary that there be available recovery rooms, intensive care units, blood banks,
diagnostic laboratories, and imaging services.
4. Medical Records - The medical records systems must be designed so that individual records are
readily available for patient care and clinical research. Periodic summaries of Department and
Subspecialty Division statistics are essential for the evaluation of results and may be requested at the
time of review.
5. Medical Library - The institution must have a comprehensive medical library. Fellows should have
access to computerized literature searches. Such libraries should contain a wide variety of current
textbooks and clinical and basic science journals, including those relevant to the subspecialty.
6. Laboratories - The program must have access to clinical and laboratory research facilities which are
adequate in size and appropriately equipped to conduct the research training of the fellows.
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II. SPECIAL REQUIREMENTS:
FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE
SURGERY
A. INTRODUCTION
A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in obstetrics and
gynecology or urology who, by virtue of education and training, is prepared to provide consultation and
comprehensive management of women with complex benign pelvic conditions, lower urinary tract
disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and
therapeutic procedures necessary for the total care of the patient with these conditions and complications
resulting from them.
B. FELLOWS
By virtue of satisfactory completion of a fellowship program in this discipline, the individual should be a
specialist in obstetrics and gynecology or urology capable of functioning independently as a physician
defined in Section A. The fellow should be capable of independent scientific inquiry and critical
evaluation. Following the completion of the fellowship program, the candidate must be able to function as
a consultant to other physicians and is expected to continue to demonstrate dedication to the
management of urogynecologic and pelvic floor dysfunction and to academic pursuits.
C. PROGRAM
1.
Goals - Graduate educational programs should provide fellows with advanced training in the care
of women with such disorders. The objectives of such programs are to improve the health care of
women by:
a.
b.
c.
d.
elevating standards of education and training relating to female pelvic medicine and
reconstructive surgery;
enhancing the recruitment of qualified physicians to this subspecialty and encouraging the
development of academicians;
increasing basic science and clinical knowledge regarding complex benign pelvic conditions,
lower urinary tract disorders, and pelvic floor dysfunction; and
improving the organization, distribution, and cost effectiveness of patient care.
2.
Faculty - It is strongly recommended that obstetric and gynecology-based fellowships have a
designated faculty member who is an urologist, and that urology-based fellowships have a
designated faculty member who is a gynecologist.
3.
Duration of Fellowships – The duration of all female-pelvic medicine and reconstructive
fellowships is listed below.
Three-Year Fellowships - Fellowship programs for a gynecologist must consist of at least 36
months of clinical and research work, with a minimum of 18 months in clinical work within the parent
program and department and 12 months in research with blocks of time devoted exclusively to
basic research to the exclusion of clinical care. The remaining six months of fellowship may be
tailored to the specific research and/or clinical goals of the individual fellow. The length of
fellowship must be the same for each fellow.
Two-Year Fellowships - Fellowship programs for a urologist must consist of at least 24 months of
clinical and research work, 12 months in clinical work within the parent program and department
and 12 months in research with blocks of time devoted exclusively to basic research to the
exclusion of clinical care. The length of fellowship must be the same for each fellow.
D. FACULTY
In addition to the Program Director, there must be at least one additional faculty member who has
demonstrated contributions to education in female pelvic medicine and reconstructive surgery. Such an
individual must be a Board-certified obstetrician gynecologist or urologist. Consultative services must be
available from general surgeons, colorectal surgeons, gynecologists, urologists, plastic surgeons,
15
vascular surgeons, geriatricians, gastroenterologists, physical therapists and/or rehabilitation specialists,
neurologists, imaging specialists, and pain management specialists.
E. CURRICULUM
The Program Director should utilize the Guide to Learning in Female in Pelvic Medicine and
Reconstructive Surgery as the basis for curriculum development and is responsible for ensuring that the
terminal objectives are realized by each fellow at the completion of the fellowship.
1. Clinical Experience - The clinical experience of the fellows must be of sufficient volume and variety
to provide an adequate education. Both inpatient and outpatient experiences are important. There
must be sufficient diagnostic and operative experiences with a variety of procedures to develop the
fellow’s skills in the complex surgical treatment of any pelvic organ prolapse and other problems of
pelvic floor dysfunction which involve any and all gynecological and/or urological conditions. Included
in these skills must be the ability to perform urodynamics and pelvic floor testing, cystoscopy,
laparoscopy, reconstructive surgery for urinary and fecal incontinence, and pelvic organ prolapse in
addition to other benign conditions occurring in the female pelvis. Programs will be critically reviewed
for educational content and volume of both operative and non-operative management of these
disorders.
2. Educational Program - The educational program also must include instruction in the following areas:
anatomy, physiology and pathophysiology of the pelvic floor (including lower urinary tract, colorectalanal, and vaginal function), diagnostic evaluation of urinary and anal incontinence, pelvic floor
dysfunction and prolapse. It also must include behavioral, pharmacological, functional and surgical
treatment of urinary and anal incontinence, pelvic floor dysfunction (including micturition and
defecation disorders) and pelvic organ prolapse, diagnosis and management of genito-urinary and
rectovaginal fistulae, urethral diverticula, injuries to the genitourinary tract, congenital anomalies,
infectious and non-infectious irritative conditions of the lower urinary tract and pelvic floor, and the
management of genitourinary complications of spinal cord injuries.
The educational program must include both the basic science and the clinical aspects of the
discipline. The basic science educational program must be based on an organized curriculum which
provides a knowledge of clinically-relevant basic science, physiology, and microbiology. Fellows
must participate in the diagnosis and management of clinically pertinent areas of pathology, infectious
disease, geriatric medicine, colorectal dysfunction, electrodiagnostic testing, physical therapy, pain
management, sexual dysfunction, psychosocial aspects of pelvic floor disorders, general surgery,
colon and rectal surgery, vascular surgery, urologic surgery, and plastic surgery.
3. Residency Program - The fellow should have an active role in the residency education program.
4. Patient Care - The fellow must examine and evaluate a sufficient number of women who have
received all methods of treatment. The fellow is expected to develop the ability to assess the effects
of treatment and to recognize and manage the complications of therapy. The fellow must be able to
evaluate the lower urinary tract for abnormalities including neoplasms; thus, training should include
the development of knowledge concerning the appropriate use of urinary tract cytology and biopsy.
The population of patients in the follow-up care facility must be sufficient in number for the fellow to
become experienced in the continuing follow-up phase of patient care.
5. Obstetrical Knowledge - It is imperative that the trainee have a firm foundation in obstetrics. For
urologists enrolled in these ABOG-ABU fellowships, it is essential that they have an understanding of
obstetrical issues that are related to the pathophysiology of female pelvic dysfunction.
6. Fellow Case Lists and Experience Logs - Case lists and experience logs of each fellow’s hospital
experience are required to be kept on forms provided by the Board office. In order to maintain
program approval, these must be submitted every year as part of the program’s Annual Report. The
Program Director must ensure that case lists and experience logs are submitted each July as part of
the Annual Report (See I.C.6. for more information on the Annual Report).
7. Research and Thesis - A designated segment of time within the educational program must be
devoted to research. Trainees will be expected to gain a thorough understanding of the
methodologies necessary to conduct a scientific investigation. This component of the program
16
requires that the trainee design a research project, test the results statistically, and interpret them
critically. Under appropriate supervision, the trainee is expected to produce a thesis which is an
original clinical or basic research project whose results may be worthy of publication in a peerreviewed journal.
F. FACILITIES
Appropriate education can be provided only in institutions which have appropriate facilities and in which
an educational environment is maintained. There must be well-equipped diagnostic/therapeutic facilities
available that will ensure the fulfillment of all educational requirements related to the fellowship program.
This should include laparoscopic, endoscopic, and urogynecologic and pelvic floor testing equipment.
Sufficient inpatient and outpatient facilities must be available, preferably in one geographic area, to
accommodate the number of patients necessary for appropriate clinical training of all the fellows in the
program. Operating rooms must be available for the care of relevant patients on a regularly scheduled
basis, and operating rooms must always be available on an emergency basis for the management of
complications.
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ADDENDUM A: THESIS REQUIREMENTS
A thesis is required to be completed during fellowship. The thesis requirements are below.
1.
The thesis must meet the instructions for authors for any one of the following journals: (1) American
Journal of Obstetrics and Gynecology; (2) The New England Journal of Medicine; (3) Fertility and
Sterility; (4) Obstetrics and Gynecology, (5) Journal of Urology, (6) Urology, or (7) Neurourology and
Urodynamics. The format chosen must be clearly identified on the cover page of the manuscript, and
as a rule, the total pages of the manuscript should not exceed thirty (30). The thesis must be in typewritten form, single-spaced, double-sided on standard 8½x11 paper. (THIS INCLUDES PUBLISHED
MANUSCRIPTS - REPRINTS ARE NOT ACCEPTABLE.) The applicant must be the sole or principal
investigator and should be the only author listed on the manuscript (Do not list co-authors, institutions,
or acknowledgments). The pages must be numbered.
2.
The subject should be clearly in the area of female pelvic dysfunction.
3.
The thesis must be on clinical or basic research and NOT a review of work by others. The work must
have been performed during the fellowship period.
4.
All research involving humans and animals must be reviewed and approved by the human or animal
Institutional Review Boards (IRBs).
5.
The thesis must be a scholarly effort that most often should consist of:
a.
b.
c.
d.
e.
f.
g.
6.
The fellow must complete their thesis prior to completion of their fellowship. Moreover, the Program
Director must attest that each graduating fellow has:
a.
b.
7.
an abstract (200-300 word concise statement of the work performed);
an introduction outlining the pertinent background and reasons for doing the work, as well as,
when appropriate, a testable hypothesis and a rationale for the hypothesis;
a methodology section, including quality control of the methods used (for assays this should also
include precision, accuracy, sensitivity, and specificity) and a well-defined control group, as well
as a reasonable number of observations, as demonstrated by a power analysis, when
appropriate;
an analysis of results with valid statistical methods;
pertinent discussion and significance of the study including an appropriate review of the literature
and justifications reached;
a summary; and
references.
submitted a written copy of the thesis; and
defended the thesis to their division faculty and peers.
The following are not acceptable for a fellow’s thesis:
a.
b.
c.
d.
book chapters;
clinical case reports;
descriptive series; or
systematic reviews and meta-analyses.
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ADDENDUM B: GLOSSARY OF TERMS
Accreditation: A voluntary process of evaluation and review performed by a non-governmental agency of peers.
At-Home Call (also see Pager Call): A call taken from outside the assigned institution.
Certification: A process to provide assurance to the public that a certified medical specialist or subspecialist has
successfully completed an approved educational program and an evaluation, including an examination process
designed to assess the knowledge, experience, and skills requisite to the provision of high quality care in that
specialty or subspecialty.
Competencies: Specific knowledge, skills, behaviors, and attitudes and the appropriate educational experiences
required of residents and fellows to complete graduate and post-graduate educational programs.
Designated Institutional Officer (DIO): The individual in a sponsoring institution who has the authority and
responsibility for the graduate and post-graduate medical education programs.
Didactic: A kind of systematic instruction by means of planned learning experiences, such as conferences, Grand
Rounds, etc.
Duty-Hours: All clinical, academic, and research activities related to the fellowship program, i.e., patient care
(both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient
care, time spent in-house during call activities, scheduled academic assignments such as conferences and
clinical or basic science research.
Elective: An educational experience approved for inclusion in the program curriculum and selected by the fellow
in consultation with the Program Director.
ERAS: Electronic Residency Application Service. Used for applying for a fellowship position in Female Pelvic
Medicine and Reconstructive Surgery Fellowship Programs.
Essential: (See "Must").
Faculty: Any individuals who have received a formal assignment to teach fellows.
appointment to the medical staff of the hospital constitutes appointment to the faculty.
In some institutions
Fellow: A physician in a program of postgraduate medical education accredited by the ABOG-ABU who has first
completed the requirements for eligibility for board certification in the specialty of obstetrics and gynecology or
urology. Other uses of the term "fellow" require modifiers for precision and clarity, e.g., research fellow.
Graduate Medical Education: The period of didactic and clinical education in a medical specialty which follows
the completion of a recognized undergraduate medical education and which prepares physicians for the
independent practice of medicine, also referred to as residency education.
In-House Call: Duty hours beyond the normal work day when fellows are required to be immediately available in
the assigned institution.
Institution: An organization having the primary purpose of providing educational programs and/or health care
services (e.g., a university, a medical school, a hospital, an organized health care delivery system, a consortium,
an educational foundation).
Sponsoring Institution: The institution (or entity) that assumes the ultimate financial and academic responsibility
for a program of GME.
Major Participating Institution: A Committee-approved participating institution to which the fellows rotate for a
required educational experience.
Other Participating Institutions: Those institutions to which fellows rotate for a specific educational experience
for at least one month, but which do not require prior Committee approval. Subsections of institutions, such as
departments, clinics, or units in a hospital do not qualify as participating institutions.
19
Institutional Review: The process undertaken by the ACGME to determine whether a sponsoring institution
offering GME programs is in substantial compliance with the Institutional Requirements.
Medical School Affiliation: A formal relationship between a medical school and a sponsoring institution.
Must: A term used to identify a requirement which is mandatory or done without fail. This term indicates an
absolute requirement.
National Resident Matching Program (NRMP): A private, not-for-profit corporation established in 1952 to
provide a uniform date of appointment to positions in graduate medical education in the United States. Five
organizations sponsor the NRMP: American Board of Medical Specialties, American Medical Association,
Association of American Medical Colleges, American Hospital Association, and Council of Medical Specialty
Societies.
New Patient: A new patient is defined as any patient for whom the fellow has not previously provided care.
One Day Off: One (1) continuous 24-hour period free from all administrative, clinical, educational, and research
activities.
Pager Call: A call taken from outside the assigned institution.
Primary Teaching Institution: If the sponsoring institution is a hospital, it is by definition the principal or primary
teaching hospital for the fellowship program. If the sponsoring institution is a medical school, university, or
consortium of hospitals, the hospital that is used most commonly in the fellowship program is recognized as the
primary teaching institution.
Program: A structured educational experience in postgraduate medical education designed to conform to the
program requirements of a particular subspecialty, the satisfactory completion of which may result in eligibility for
subspecialty board certification.
Program Director: The one physician designated to oversee and organize the activities for the fellowship
program. The Program Director is responsible for the implementation of the program requirements for a specific
subspecialty. (See specific program requirements for Program Director responsibilities and qualifications.)
Required: Educational experiences within a fellowship program designated for completion by all fellows.
Rotation: An educational experience of planned activities in selected settings developed to meet the goals and
objectives of the program.
Scholarly Activity: An opportunity for fellows and faculty to participate in research and the scholarship of
discovery, dissemination, application, and active participation in clinical discussions and conferences. This is
primarily accomplished through presentations at subspecialty meetings and publications in peer-reviewed
journals.
Shall: (See “Must”).
Should: A term used to designate requirements so important that their absence must be justified.
Sponsoring Institution: If the sponsoring institution is a hospital, it is by definition the principal or primary
teaching hospital for the fellowship program. If the sponsoring institution is a medical school, university, or
consortium of hospitals, the hospital that is used most commonly in the fellowship program is recognized as the
primary teaching institution.
Suggested: A term along with its companion “strongly suggested,” used to indicate that something is distinctly
urged rather than required. An institution or program will not be cited for failing to do something that is suggested
or strongly suggested.
Supervision: A required faculty activity involving the oversight and direction of patient care activities that are
provided by fellows.
20