PIFmanship 101
(or how to survive writing/reviewing
program information forms)
Department of Graduate Medical Education
Stanford University Medical Center
Session Objectives
By the end of this session, you will be able
to…
 Understand the basics of putting together a
program information form (PIF)
 Improve outcomes by avoiding many of the
PIFmanship “pitfalls” that lead to RRC
citations
 Save time when preparing/ reviewing PIFs
for internal reviews and site visits
 Decrease the fear and stress associated with
completing a PIF
“I see a Site
Visit coming in
your future…”
Gentle words of wisdom…
Your PIF is the site visitor’s first impression of
your program, so...
 Be accurate
 Answer the question that’s asked
 Be terse/tight
 Have documentation to back up your
answers
 Start early – it takes months to write a good
PIF
 This is not something your mother, spouse,
best friend, or admin asst. can do for you!
Common vs. Specialty
There are actually 2 PIFs to complete:
 The Common PIF
 Addresses the program’s compliance with the
Common Program Requirements (common
to all GME programs)
 The common PIF is completed online via the
ACGME Web Accreditation Data System
(WebADS)
 The Specialty PIF
 Addresses compliance with the specialty-
specific program requirements
 Depending on specialty, may be a Word
document downloaded from the ACGME Site
to be completed offline, or may be completed
online via the ACGME Web Accreditation
Data System (WebADS).
Common PIF
 The common PIF contains questions
regarding participating sites, faculty CVs,
evaluation, and duty hours.
 Most of the data should be updated annually
by your coordinator.
 To update the Common PIF:
 Go to: www.acgme.org/ads
 Use your ACGME assigned User ID &
Password
 Go to the PIF preparation section (left-side
menu)
 Once all of the data is entered and
VALIDATED
 Print as PDF
Common PIF – Page 1
Common PIF – Page 1
 Data is auto-populated based on entries
elsewhere in WebADS
 Original signatures required:
 Program Director
 Core Program Director (subspecialty
programs only)
 DIO
Common PIF – Page 2
Common PIF – Page 2
 Previous citations are auto-populated
 Remember, your citations and corrective
actions live forever – respond with care.
Common PIF – Page 2
 “Major Changes” include:
 Changes in program format
 e.g., Have you gone from 3 to 4 years?
 Changes in resident complement?
 Changes in program leadership?
 Changes in participating sites?
 Only include changes since the last site visit!
Common PIF – Page 3
Common PIF – Page 4
Common PIF – Page 3-4
 Sponsoring Institution
 Auto-populates from WebADS
 Single/Limited Site Sponsor - only sponsors
one program
 Participating Sites
 Only list sites that provide a required one
month full-time equivalent educational
experience
 Required means all residents rotate to that site
 Make sure rotation lengths add up to 12
months per year across all sites
Common PIF – Page 3-4
 Participating Sites
 Brief Educational Rationale
 Residents are exposed to a wide array of patients with advanced
diseases, larger indigent population, and many minority groups
not as well represented in the other participating sites.There is
an excellent exposure to the primary components of general
surgery especially trauma and surgical critical care.
Common PIF – Page 3-4
 Participating Sites
 Program Letter of Agreement (PLA) is required
unless under governance of sponsor!
 We’ve posted a PLA template to our GME web site
 Note that the PLA is an agreement between the
Program Director and the individual at the
participating site charged with oversight of the
residency program. As such, the PLA may be
between you and yourself…
 e.g., at Stanford, the PM&R Program Director is also
the site director at the VA hospital
Common PIF – Page 5
Common PIF – Page 5
 Program Director MUST be able to approve the
selection of teaching faculty
 The Program Director MUST evaluate and
approve continuation of teaching faculty
 Program Director MUST comply with the
university’s or medical center’s policies on
selection, evaluation, promotion, disciplinary
action and supervision
 Refer to the House Staff Policies and Procedures
document posted on our GME web site:
http://med.stanford.edu/gme/policy/
 Program Director MUST comply with ACGME
and RC policies and procedures
 Institutional
 Common
 Specialty-Specific
Common PIF – Page 5
Common PIF – Page 5
 Physician Faculty Roster
 List Alphabetically and by Site
 Faculty who spend at least 10 hrs per week in
resident education
 Hours/week devoted to education should be
realistic!
 Board certification
 If double boarded include both boards
 If sub-specialty program director or faculty, ensure
primary boards are included
 Make sure the roster data matches CV data
Common PIF – Page 6
Common PIF – Page 6
 Faculty CVs
 Great potential for a HUGE number of
citations
 All fields must be completed (NO BLANKS)
 Accurately list training history including GME
 Ensure certification is valid
 Ensure licensure is current and has not lapsed
Common PIF – Page 6
 Faculty CVs
 Selected Bibliography, Review Articles, &
Activities
 Strict limit of 10
 “…from the last 5 years” excludes any before 2006!
 Publications should not be “in press” if submitted
many years ago…
 If not ABMS certified, explain…
Common PIF – Page 6
 Be concise, but not THAT concise. Try instead:
 <Program Director> oversees the operations of the
entire program; supervises trainees during patient-care
activities; mentors trainees’ research projects; leads
lectures and seminars; monitors duty hour compliance;
and coordinates evaluation of courses, rotations, trainees
and faculty.
Common PIF – Page 7
Common PIF – Page 7
 Non-Physician Roster and CVs
 Again, accurately complete all fields and
 Observe the 10 item / 5 year limit
Common PIF – Page 8
Common PIF – Page 8
 Number of Positions
 Note: If you have a resident making up a
maternity leave, you must ask ACGME for an
extra slot if you are over your quota
 Actively Enrolled Residents
 Other than interns, everyone should have
prior years of GME
 Program Director MUST obtain summative
evaluation of previous experience for transfers
Common PIF – Page 9
Common PIF – Page 10
Common PIF – Page 10
 Transferred, Withdrawn or Dismissed
Residents
 Residents who resign are NOT dismissed
 Must provide competency-based summative
evaluation to new program for transfers
 Evaluation
 YES, residents are evaluated following each
learning experience (i.e. rotation)
 YES, evaluations are documented (state how)
 Electronically
 Resident Files
Common PIF – Page 10
 Methods of Evaluation
 Assessment Method
 Direct Observation
 Simulation
 OSCE
 Etc
 Evaluator(s)
 Program Director
 Faculty
 “360” (required as of 2007)
 Nurses
 Ancillary Staff
 Patients
 Other
Common PIF – Page 11
Common PIF – Page 11
 Answer the question that’s asked!
Common PIF – Page 11
 Describe how evaluators are educated to use
the assessment methods listed above so that
residents are evaluated fairly and
consistently.
 The Program Director meets with evaluators
annually before new trainees start the program to
review and discuss the core competencies,
competency-based performance evaluations, and
assessment methods to be used. The electronic
assessment system and the rating scales are also
reviewed and discussed during faculty meetings in
order to ensure that evaluators are fully educated
and up to date with the assessment methods and
processes.
Common PIF – Page 11
 Describe how residents are informed of the
performance criteria on which they will be
evaluated.
 At the beginning of each academic year, the
Program Director conducts an orientation to address
several key issues related to the residency including
the performance criteria on which the residents will
be evaluated. During this orientation session, the
Program Director carefully details the specific
evaluation methods to be used. Both the criteria and
methods are also documented in the residency
handbook. Additionally, at the beginning of each
block rotation, the rotation director meets with the
resident and carefully delineates the expectations
and performance criteria on which the resident will
be evaluated for that specific rotation.
Common PIF – Page 11
 Describe the system to ensure that faculty
complete written evaluations of residents in
a timely manner following each rotation or
educational experience.
 At the end of each block rotation, our online
resident data collection and tracking system sends
an automated reminder to the service attending(s) to
evaluate the resident(s) on that particular rotation.
Using this online system, the Program Coordinator
tracks pending evaluations and follows up with
faculty as needed to urge them to complete their
evaluations on time. In the unlikely event that a
faculty member is unresponsive to the coordinator's
requests to complete evaluations, the Program
Director contacts the faculty member and requests
him/her to complete the evaluations.
Common PIF – Page 11
 Describe the process used to complete and
document written semiannual resident
evaluations, including the mechanism for
reviewing results (e.g., who meets with the
residents and how the results are documented in
resident files).
 Resident performance is evaluated by the teaching
faculty at the conclusion of each rotation using an
electronic evaluation form. Additionally, each faculty
mentor meets with their resident advisee quarterly and
documents a summary of the meeting to be placed in the
resident’s file.The Program Director meets with each
resident on an individual basis semiannually to review
the accumulated performance evaluations and mentor
notes, provide feedback, and update the resident’s
learning plan as appropriate. A summary of these
meetings is documented and placed in the resident’s file.
The residents are free to review the contents of their
records at any time.
Common PIF – Page 11
 Describe the system used by the residents to
provide annual confidential written
evaluations of the teaching faculty (have
examples and forms available for review by
site visitor).
 Residents annually confidentially evaluate the
teaching faculty using <system>.The
electronically submitted evaluation forms are
anonymous. Residents are sent e-mail reminders
about completing evaluations in a timely manner by
the Fellowship Coordinator. Paper copies of
completed evaluations without personal identifiers
are printed by the Program Coordinator, reviewed by
the Program Director, and presented to individual
faculty members for review and consideration.
Common PIF – Page 11
 Describe the program's (or Department's, if
applicable) system for evaluating and providing
feedback to the teaching faculty.
 Residents annually confidentially evaluate the teaching
faculty using <system>.The electronically submitted
evaluation forms are anonymous. Residents are sent email reminders about completing evaluations in a timely
manner by the Fellowship Coordinator. Paper copies of
completed evaluations without personal identifiers are
printed by the Program Coordinator, reviewed by the
Program Director, and presented to individual faculty
members for review and consideration. If and when an
evaluation reveals an issue with a particular member of
the teaching faculty, the Program Director (and/or the
Department Chair) meets with that faculty member more
urgently to address the issue. Additionally, the Program
Director meets with all faculty on an annual basis to
review resident feedback and implement any necessary
changes.
Common PIF – Page 11
 Describe the approach used for program
evaluation.
 Residents and faculty annually evaluate the
program using the <system>.The electronically
submitted evaluation forms are anonymous.
Residents and faculty are also encouraged to provide
feedback to the Program Director whenever any issue
arises or as they see opportunities for improvement.
Additionally, residents and faculty participate in an
Annual Program Review Meeting led by the Program
Director. Aggregated data including the most recent
ACGME survey results and the resident/faculty
program evaluation results are reviewed and used at
this meeting to improve the program.The Program
Coordinator keeps minutes during this annual
meeting and documents any plans to address areas
requiring improvement. Action plan progress is
monitored and documented by the Program Director.
Common PIF – Page 11
 Describe one example how the program used the
aggregated results of residents' performance and/or
other program evaluation results to improve the
program (have the written plan of action available for
review by the site visitor).
 Over the past two years, the evaluations by the faculty, as well
as the results of the didactic EMG examinations, and resident
performance on the SAE examination have all reflected an
average to less than average performance by the residents in the
area of electrodiagnosis.The educational committee discussed
this area of concern, going over all of the evaluations,
reviewing the examinations, and determined an action plan.
Each of the participating sites exposing the residents to EMG
increased the number of didactic sessions in this area,
especially for the first-year residents. Noon conferences were
instituted atValley Medical Center and the VA emphasizing
EMG education, which included hands-on sessions conducted
by the faculty, with senior resident contribution.The EMG
portion of the didactic curriculum was moved forward toward
the beginning of the academic year (September) to expose the
junior residents to the electrodiagnostic educational material
earlier in their residency.The anatomy lab was also
restructured to supplement the functional anatomy and EMG
correlative didactics.
Common PIF – Page 11
 Describe the improvement efforts currently
undertaken based on feedback from the
ACGME Resident Survey.
 Program Director MUST:
 review the results of the ACGME Resident Survey
each year
 discuss the results at your Annual Program Review
Meeting
 address each area of concern (more than 20%) or
any negative Duty Hour response
 While smaller programs do not receive their results
annually, results aggregated over several years may
be accessible – check in WebADS and/or with your
DIO
Common PIF – Page 12
Common PIF – Page 12
 Resident Duty Hours
 Use the summary report generated by your
tracking system
Common PIF – Page 12
 Briefly describe how the faculty provides appropriate
supervision of residents in patient care activities.
 While the supervision of residents in the program is designed to
provide gradually increased responsibility and maturity in the
performance of the skills, all residents are supervised at all times.
The required Level of Supervision for specific tasks is assigned
based on level of training unless by exception, the Program
Director indicates that further training is required before such
approval is granted for a given resident.The Levels of Supervision
provided by faculty are defined as follows:
 Level-1: Direct Supervision - The supervising physician is physically
present with the resident and patient
 Level-2: Indirect Supervision  A: Direct supervision immediately available – The supervising
physician is physically within the confines of the site of patient care,
and immediately available to provide Direct Supervision
 B: Direct supervision available – The supervising physician is not
physically present within the confines of the site of patient care, is
immediately available via phone, and is available to provide Direct
Supervision
 Level-3: Oversight – The supervising physician is available to provide
review of procedures/encounters with feedback provided after care is
delivered
 Residents are responsible for knowing the limits of their scope of
authority.Whenever a question arises about resident competency to
perform a procedure independently, the attending physician is
consulted.
Specialty PIF
 The specialty PIF is generally a Word
document* and found on the ACGME web
site:
http://www.acgme.org/acWebsite/navPage
s/nav_comPIF.asp
 The specialty PIF contains questions
regarding the ACGME general competencies
and may request a block diagram for your
program, a narrative description of your
program, documentation of scholarly
activity, and/or case logs.
* For some programs, such as Medicine Specialties and
Ophthalmology, the Specialty PIF is accessed and completed via
WebADS, just like the Common PIF.
Specialty PIF – PBLI
 Describe one learning activity in which
residents engage to identify strengths,
deficiencies, and limits in their knowledge
and expertise (self-reflection and selfassessment); set learning and improvement
goals; identify and perform appropriate
learning activities to achieve self-identified
goals (life-long learning).
 Describe one learning activity.
 e.g., programs may use a structured process
for reflection in which a faculty advisor guides
the resident in using feedback , evaluations,
and/or in-training exam scores to inform the
self-assessment process.
 Documentation of the semi-annual evaluation
meetings in which this process is
demonstrated would provide evidence that
this requirement is being addressed.
Specialty PIF – PBLI
 Describe one example of a learning activity in
which residents engage to develop the skills
needed to use information technology to locate,
appraise, and assimilate evidence from scientific
studies and apply it to their patients’ health
problems. The description should include: a)
locating information, b) using information
technology, c) appraising information, d)
assimilating evidence information (from
scientific studies), e) applying information to
patient care.
 Describe one example.
 An appropriate learning activity could be a
structured activity such as a journal club
presentation, critical appraisal of a topic, or
educational prescription with appropriate faculty
oversight and formal assessment of skills.
 Additional documentation would be the written
goals and objectives for this learning activity and
how residents are assessed.
Specialty PIF – Professionalism
 Describe at least one learning activity, other than
lecture, by which residents develop a commitment to
carrying out professional responsibilities and an
adherence to ethical principles.
 At intern retreat we devote an afternoon to discussing the role
of a pediatrician in the long term care of a chronically ill and
ultimately terminally ill child. We use the film “Cameron’s Arc”
to initiate a discussion of the crucial role the pediatrician
played in the care of a child with Tay Sachs disease. Focusing
not on the disease per se, but on the role of the pediatrician, we
identify the important character traits that made the
pediatrician so very crucial to this family and to this child: we
discuss the sense of ownership, the process of bringing a family
to an understanding of the disease they face, the essential
simultaneous expression of empathy and control, the style of
communication that adapted to each parent’s needs, the choice
of timing of various conversations as the condition and
circumstances change for this child and her family, and the
holistic approach to a disease process that requires direction of
difficult decisions and participation adjusted to the needs of a
family at various points in the journey a disease may dictate.
At the end of the exercise, we share and reflect as a group on
what we each found so essential to the “meaning of being a
doctor” that was so well portrayed by the pediatrician in this
film.
Specialty PIF –
Systems-Based Practice
 Describe an activity that fulfills the requirement
for experiential learning in identifying system
errors.
 Important elements may include identified faculty
to guide the activity, mechanism to ensure active
engagement by each resident, and evidence of
experiential learning (not just passive presence at
conferences and meetings) in which residents
participate in identifying a system problem or
error and contribute to a potential solution.
 Additional documentation could include written
goals and objectives for this learning activity and
how residents are assessed. Aggregated resident
outcomes may be in the form of percentage of
residents that completed a patient safety or other
Systems-Based Practice project by the end of
training, annual list of improvements that resulted
from such projects, etc.
Other PIF Questions
 Describe how residents are informed about
their assignments and duties during the
residency.
 This should be in writing and verbal. For
example:
 All residents are given the program training manual
which describes their assignments and duties during
orientation to the program. Each resident signs an
attestation that they have received and read the
manual.The manual is discussed during orientation
with the residents as a group.
Other PIF Questions
 Describe how the program handles
complaints or concerns the residents raise.
 The House Staff Policies & Procedures document
(posted on our GME web site) includes
documentation of “Dispute Resolution”
(grievance) procedures. Simply cut and paste
into the PIF.
Other PIF Questions
 How are identified resident duty hour
violations addressed?
 Residents are required to enter their duty hours into
our electronic tracking system weekly. Duty hours
are closely monitored each week for compliance with
the 80 hour, 1 day in 7, and 30/10 duty hour
standards by the Program Coordinator. Any
potential violations are reported to the Program
Director for review and follow-up action if required.
If a resident has reached the limit, his or her
schedule is then adjusted if required and closely
monitored to ensure that no violations occur over a
four week period. The program takes duty hour
monitoring and compliance very seriously.
Other PIF Questions
 Describe how the program monitors for excessive
service and modifies the program accordingly.
 The residency has several methods to monitor for excessive
service and modify the program if required:
 Formal rotation evaluations with alerts: Residents complete monthly





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evaluations that are reviewed and communicated with the rotation
directors.
Committee on Residency Training and Clinical Services: Each class
has resident representatives meet with the Program Director monthly
for a formal agenda to review and address issues in the residency
program.
The rotation directors are sent the residents’ monthly feedback on a
quarterly basis (to ensure confidentiality for the residents’ feedback)
Yearly, the residents have a retreat in which each aspect of the
program is reviewed. Areas of concern are brought back to the
Committee on Residency Training.The ACGME resident survey
questions with respect to excessive service are reviewed.
Informal feedback: the residents are encouraged to let the Chief
Residents, the Faculty, and the Program Director know immediately
when either the service load or the educational activities are
compromised.
Weekly meetings of the program director and chief residents to discuss
the residents and experiences on individual rotations.
Computerized entry and monitoring of all duty hours.
Patient Care Data
Block Diagrams
General Information
 Glossary of ACGME terms :
 http://www.acgme.org/acWebsite/about/ab_A
CGMEglossary.pdf
 PIF sometimes asks for…
 Hospital Statistics
 613 Licensed Beds at SHC
 272 Beds at LPCH
 Library Resources
 http://lane.stanford.edu/about/physical-res.html
 http://lane.stanford.edu/about/digital-res.html
General Information
 Major Participating Institutions (Affiliates):
 Children's Health Council [058191]
 Kaiser Permanente Medical Center (Santa Clara)
[050571]
 Kaiser Santa Teresa [058092]
 Lucile Salter Packard Children's Hospital at
Stanford [050572]
 San Mateo Medical Center [050585]
 Santa Clara Valley Medical Center [050438]
 Veterans Affairs Palo Alto Health Care System
[050273]
Table of Contents
Common Errors
 Table of Contents Inaccurate
 Pages not numbered or not numbered





correctly
Document not spell-checked
Response does not answer the question asked
Statistics not added correctly
% of time for faculty inconsistent within the
PIF
Type font does not match
The Land Mines
As you write your PIF, remember to read the
questions carefully...
 One example does NOT mean several
 “How” does not mean “we do”
 No “the program will…” or “we plan to…”
 No “see attached” or “see below”
Putting It All Together
 One complete PIF (common and specialty)
is due to the site visitor at least 14 days
before the site visit.
 The DIO (Ann) must sign the PIF before it
goes out …and will want to read it first!
 Submit your completed PIF 14-30 days before
it’s sent to the site visitor.
 The DIO and GME staff will review the PIF
and return to you with suggested revisions.
 You really cannot have too many eyes look at
one PIF!!
Have the following documents
available for the site visitor:
 Policy for supervision of residents
(addressing resident responsibilities for
patient care, progressive responsibilities for
patient management, and faculty
responsibility for supervision) (CPR IV.A.4)
 Program policies and procedures for
residents’ duty hours and work environment
(CPR II.A.j.4.; CPR VI.C.; IR II.D.4.i.; IR
III.B. 3.)
 Moonlighting policy (CPR II.A.4.j; CPR
VI.F)
Have the following documents
available for the site visitor:
 Documentation of internal review (date,
participants’ titles, type of data collected,
and date of review by the GMEC)
 Overall educational goals for the program
(CPR IV.A.1)
 Competency-based goals and objectives for
each assignment at each educational level
(CPR IV.A.2)
 Current Program Letters of Agreement
(PLAs) (CPR I.B.1)
Have the following documents
available for the site visitor:
 Files of current residents who have
transferred into the program, if applicable
(including documentation of previous
experiences and summative competencybased performance evaluations) (CPR
III.C.1)
 Evaluations of residents at the completion of
each assignment (CPR V.A.1.a)
 Evaluations showing use of multiple
evaluators (faculty, peers, patients, self, and
other professional staff) (CPR V.A.1.b.(2))
Have the following documents
available for the site visitor:
 Documentation of residents’ semiannual
evaluations of performance with feedback
(CPR II.A.4.g; V.A.1.b.(4))
 Final (summative) evaluation of residents,
documenting performance during the final
period of education and verifying that the
resident has demonstrated sufficient
competence to enter practice without direct
supervision (CPR V.A.2)
 Completed annual written confidential
evaluations of faculty by the residents (CPR
V.B. 3)
Have the following documents
available for the site visitor:
 Completed annual written confidential




evaluations of the program by the residents
(CPR V.C.1.d.(1))
Completed annual written confidential
evaluations of the program by the faculty
(CPR V.C.1.d.(1))
Documentation of program evaluation and
written improvement plan (CPR V.C)
Documentation of resident duty hours (CPR
II.A.4.j; VI.D.1-3)
Files of current residents and most recent
program graduates
PIFmanship 101