New Application: Pediatric Infectious Disease
Review Committee for Pediatrics
ACGME
515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000  www.acgme.org
COMMON SUBSPECIALTY SECTION
FACULTY RESEARCH
1. Complete the table below regarding the involvement of faculty in research. Add rows as necessary.
[PR II.B.5.b)]
# of current
IRB approved
research
Name
projects
Program Director:
Total # of
current
funded
research
projects
# of current
research
projects with
peer review
funding
(subset of
total # in
previous
column)
#
presentations
at national
scientific
# publications
meetings in in peer review
the last 5
journals in the
years
last 5 years
Key Faculty:
Research Mentors Who Are Not Key Faculty:
2. List active research projects in the subspecialty. Add additional rows as necessary.
Project title
Funding
source
Put an “X” for
funding
awarded by
peer review
process
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Years of
funding
(dates)
Faculty investigator and
role in grant (i.e. PI, Co-PI,
Co-investigator)
Updated 4/2015
Page 1 of 13
RESEARCH RESOURCES
1. Does the program provide research laboratory space and equipment? (if appropriate) [PR II.D.]
.................................................................................................................................... ☐ YES ☐ NO
2. Does the program provide financial support for research? ........................................... ☐ YES ☐ NO
3. Does the program provide computer and statistical consultation services? .................. ☐ YES ☐ NO
PROGRAM CURRICULUM
Goals and Objectives
Place an ‘X” in the box before the applicable response. [PR IV.A.2.]
Are there goals and objectives for all training
☐ YES ☐ NO
experiences?
Are they rotation and level specific?
☐ YES ☐ NO
How are they distributed?
☐ Hard Copy ☐ Electronic or web-based
If not web-based, when are they distributed to
☐ Prior to Each Rotation
☐ Annually
fellows?
☐ Once in Handbook
☐ Other
If not web-based, when are they distributed to
☐ Prior to Each Rotation
faculty?
☐ Annually
☐ Other
If web-based, do you send out reminders to access ☐ YES ☐ NO
them?
If yes, when do you send them?
Click here to enter text.
Collaboration between Programs
Are there meetings among the core Program
Director and subspecialty Program Directors?
How often do these meetings occur?
Who is typically involved in these meetings?
(check all that apply)
☐ YES ☐ NO
Click here to enter text.
☐ Core program director
☐ Subspecialty program director for this specialty
☐ Program directors from other subspecialties
General Subspecialty Curriculum
Topic
e.g., Biostatistics
Basic science as
related to the
Participants (place and X in the
appropriate column)
Where Taught in
Number of
Fellows in
Curriculum?
Structured
this
All
Residents &
(Name should Teaching Hours Discipline Subspecialty Subspecialty
match name in
Dedicated to
Will
Fellows
Fellows
conference list)
Topic Area?
Attend
Attend
Attend
Research
Course
14
X
Click here to
#
☐
☐
☐
enter text.
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 2 of 13
Participants (place and X in the
appropriate column)
Where Taught in
Number of
Fellows in
Curriculum?
Structured
this
All
Residents &
(Name should Teaching Hours Discipline Subspecialty Subspecialty
match name in
Dedicated to
Will
Fellows
Fellows
conference list)
Topic Area?
Attend
Attend
Attend
Topic
application in clinical
subspecialty practice
Clinical subspecialty
Click here to
#
☐
☐
☐
content
enter text.
For the topics below, if the topic is not appropriate for your discipline (i.e., lab research for
fellows in developmental and behavioral pediatrics), enter N/A into column 1.
Biostatistics
Click here to
#
☐
☐
☐
enter text.
Lab research
Click here to
#
☐
☐
☐
methodology (if
enter text.
appropriate)
Clinical research
Click here to
#
☐
☐
☐
methodology
enter text.
Study design
Click here to
#
☐
☐
☐
enter text.
Grant preparation
Click here to
#
☐
☐
☐
enter text.
Preparation of
Click here to
#
☐
☐
☐
protocols for
enter text.
institutional review
board
Principles of evidenceClick here to
#
☐
☐
☐
based medicine/
enter text.
Critical literature
review
Quality Improvement
Click here to
#
☐
☐
☐
enter text.
Teaching skills
Click here to
#
☐
☐
☐
enter text.
Professionalism/Ethics
Click here to
#
☐
☐
☐
enter text.
Cultural Diversity
Click here to
#
☐
☐
☐
enter text.
Systems-based
Click here to
#
☐
☐
☐
practice (economics of
enter text.
healthcare, practice
management, clinical
outcomes, etc.)
Conferences
1. List regular subspecialty and interdepartmental conferences, rounds, etc., that are a part of the
subspecialty training program. Identify the "SITE" by using the corresponding number as appears
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 3 of 13
on the first and second pages of this form. Indicate the frequency, e.g., weekly, monthly, etc., and
whether conference attendance is required (R) or optional (0). List the planned role of the fellow in
this activity (e.g., conducts conference, presents case and participates in discussion, case
presentation only, participation limited to Q&A component, etc.). Add rows as necessary.
Conference
Site #
Frequency
R/O
Role of the Fellow
2. Describe the mechanism that will be used to ensure fellow attendance at required conferences.
State the degree to which faculty attendance is expected, and how this will be monitored.
Limit the response to 50 words
Click here to enter text.
Scholarship Oversight Committee
1. Will there be a scholarship oversight committee for every fellow? ................................ ☐ YES ☐ NO
2. How often will the committee meet with the fellow? ................................................... # times per year
Fellow Research Activities
1. Describe how the program will ensure a meaningful supervised research experience for the fellows,
beginning in their first year and extending throughout their training.
Click here to enter text.
2. If faculty outside the division will be actively involved in mentoring the fellows, identify the mentors
and describe how liaisons will be created between these mentors and the fellows that allows for
meaningful accomplishment of research.
Click here to enter text.
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 4 of 13
SPECIALTY-SPECIFIC SECTION
PROGRAM PERSONNEL AND RESOURCES
Facilities and Services
1. Indicate the availability of the following (for inpatient services, indicate the number of available
beds):
Facility/Service
Space in an ambulatory setting for evaluation
and care of patients from newborn to early
adulthood
[PR VII.B.1.a)]
PICU (indicate number of beds)
[PR VII.B.1.b).(2)]
NICU (indicate number of beds)
[PR VII.B.1.b).(2)]
Diagnostic clinical microbiology laboratory
[PR VII.B.2.]
Capabilities for identification and susceptibility
testing of bacteria
[PR VII.B.2.a)]
Capabilities for isolation and identification of
fungi
[PR VII.B.2.a)]
Capabilities for identification of parasites
[PR VII.B.2.a)]
Diagnostic clinical virology laboratory
Capabilities for cell culture for primary isolation
Rapid diagnostic tests
Site #1
Choose an
item.
Site #2
Choose an
item.
Site #3
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
2. Provide an explanation if “NO” is indicated for any of the above facilities and/or services across all
sites:
Click here to enter text.
Infection Control Program [PR VII.B.3.]
1. Is there an infection control program? .......................................................................... ☐ YES ☐ NO
2. Is the program located at the primary site? .................................................................. ☐ YES ☐ NO
3. Is there a physician leader with knowledge of epidemiology of pediatric infectious diseases?
[PR VII.B.3.a)] .............................................................................................................. ☐ YES ☐ NO
4. Does the program include written protocols for prevention of infection and its spread? ☐ YES ☐ NO
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 5 of 13
5. Does the program include an active surveillance system? ........................................... ☐ YES ☐ NO
6. Does the program include an interventional plan for outbreak control? ........................ ☐ YES ☐ NO
7. If you answered “no” to any of the above questions, explain how fellows are educated in that aspect
of infection control.
Click here to enter text.
8. Identify the director of the infection control program who has knowledge of pediatric infectious
diseases and describe his/her involvement with the program. Include highest educational degree
and Board certification.
Click here to enter text.
9. Describe the planned involvement of the pediatric infectious diseases fellows with this program.
Click here to enter text.
Antibiotic Utilization
Describe the planned fellows’ involvement with a hospital antimicrobial utilization program:
Click here to enter text.
Microbiology and Immunology Program
Name of Director and Degree
Laboratory
Bacteriology
Mycology [PR VII.A.3.]
Parasitology [PR VII.A.3.]
Virology [PR VII.A.3.]
Serology/Immunology
Certification
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Fellow Involvement
Hours/wks and wks/year by
level of training
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Describe the planned fellows’ involvement in the above laboratories and their interaction with the
laboratory personnel
Click here to enter text.
PATIENT POPULATION [PR VII.B.4.]
Inpatient
Provide the following information for the most recent 12-month academic or calendar year. Note the
same timeframe should be used throughout the forms.
Inclusive dates:
FROM: Click here to enter a date.
TO: Click here to enter a date.
Site #1
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Site #2
Site #3
Updated 4/2015
Page 6 of 13
Total number of admissions to the pediatric
infectious diseases service
Number of new patients admitted each year (“new”
refers to those who are seen by members of the
pediatric infectious diseases service for the first
time.)
Average length of stay of patients on the pediatric
infectious diseases service
Total number of consultations by pediatric infectious
disease specialists on other inpatients
Number of consultations provided to the NICU
Number of consultations provided to the PICU
Average daily census of patients on the pediatric
infectious diseases service, including consultations
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
Outpatient
Provide the following information for the most recent 12-month academic or calendar year.
Inclusive dates:
FROM: Click here to enter a date.
Is there a separate pediatric infectious
diseases clinic?
Number of pediatric infectious diseases
clinic/or office sessions per week during
12-month period reported:
Number of ambulatory pediatric
infectious diseases visits during 12month period reported:
Of the visits reported in the question
above, how many are new patients?
("new" refers to those who are being
seen by members of the infectious
diseases service for the first time)
How many patients were initially seen
on the inpatient service?
Estimate the number of pediatric
infectious diseases clinics or sessions
office a fellow attends (will attend)
during the entire training period:
TO: Click here to enter a date.
Site #1
Choose
an item.
#
Site #2
Choose
an item.
#
Site #3
Choose
an item.
#
Other
Site #1*
Choose
an item.
#
Other
Site #2*
Choose
an item.
#
Other
Site #3*
Choose
an item.
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
*For each of the other outpatient sites (identify by site number) where patients with infectious diseases
will be seen by fellows provide full details including name and credentials of supervisor, numbers and
types of patients, degree of fellow responsibility for their care, frequency of attendance at office, how
director will monitor the experience and fellow performance.
Click here to enter text.
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 7 of 13
12- Month Summary: Inpatient Services/Outpatient Clinics
For the most recent 12-month academic or calendar year, identify how many pediatric patients with the
following conditions were: a) seen in the ambulatory settings; b) were admitted to and/or consulted on
by the pediatric infectious diseases specialists at the primary site? (A patient can be counted only once
in any diagnostic category) The full academic or calendar year must be identical to the period used in
other sections.
Site Name:
Inclusive dates:
Click here to enter text.
FROM: Click here to enter a date.
Diagnoses of Clinical Population
Primary and acquired immunodeficiency
[PR VII.B.4.c).(1)]
Immunosuppression secondary to malignancies
and to chemotherapeutic or immunosuppressive
agents [PR VII.B.4.c).(2)]
Prematurity, low birth weight [PR VII.B.4.c).(3)]
Infections associated with surgery
[PR VII.B.4.c).(4)]
TO: Click here to enter a date.
Inpatients
# new patients seen by
ID service
#
Outpatients
# of new patients
#
#
#
#
#
#
#
12- Month Summary: Inpatient Services/Outpatient Clinics - Infectious Diseases
For the most recent 12-month academic or calendar year, how many pediatric patients with the
following diseases were: a) seen in the ambulatory settings; b) were admitted to and/or consulted on by
the pediatric infectious diseases at the primary site? Count only patients or new encounters and only
one organ system/infection per encounter. The full academic or calendar year must be identical to the
period used in other sections. Programs making new application should complete only the columns
marked by an asterisk (*).
Site Name:
Inclusive dates:
Click here to enter text.
FROM: Click here to enter a date.
Infectious Diseases**
Upper respiratory tract infections [PR VIII.A.1.a)]
Lower respiratory tract infections [PR VIII.A.1.b)]
Central nervous system infections [PR VIII.A.1.c)]
Urinary tract infections [PR VIII.A.1.d)]
Cardiovascular infections [PR VIII.A.1.e)]
Bone and joint infections [PR VIII.A.1.f)]
Skin/soft tissue/muscle infections [PR VIII.A.1.g)]
Gastrointestinal tract/intra-abdominal infections
[PR VIII.A.1.h)]
Hepatic/biliary infections [PR VIII.A.1.i)]
Ocular infections [PR VIII.A.1.j)]
TO: Click here to enter a date.
Inpatients
# new patients seen by
ID service
#
#
#
#
#
#
#
#
# of new patients
#
#
#
#
#
#
#
#
#
#
#
#
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Outpatients
Updated 4/2015
Page 8 of 13
Infectious Diseases**
Reproductive tract infections [PR VIII.A.1.k)]
Sexually transmitted infections [PR VIII.A.1.l)]
Foreign-body and catheter-related infections
[PR VIII.A.1.m)]
HIV infection [PR VIII.A.1.n)]
Healthcare-associated infections [PR VIII.A.1.o)]
Surgical and traumatic wound infections
[PR VIII.A.1.p)]
Congenital and neonatal infections [PR VIII.A.1.q)]
Infections in transplant patients [PR VIII.A.1.r)]
Prolonged and recurrent fever [PR VIII.A.1.s)]
Bloodstream infections and sepsis [PR VIII.A.1.t)]
Inpatients
# new patients seen by
ID service
#
#
#
Outpatients
# of new patients
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
**If an opportunity to see patients with any of these conditions is limited, describe how fellows will learn
to provide clinical consultations for this group of patients.
Click here to enter text.
List of Diagnoses
List 150 CONSECUTIVE admissions and/or consultations to the infectious diseases inpatient service.
Identify the time period during which these admissions/consultations occurred. The date range should
occur within the same 12-month period used in the previous sections. The dates must begin on the
date the first patient on the list was admitted and end with the date the 150th patient was admitted (e.g.,
July 1, 2014 through October 20, 2014). Submit a separate list for each site that provides required
rotations. Duplicate tables as necessary.
Site Name:
Click here to enter text.
Give inclusive dates
during which these
FROM: Click here to enter a date.
admissions/consultations
occurred:
Patient ID
Number
Age
TO: Click here to enter a date.
Infectious Diseases Diagnosis
(may include secondary diagnosis if relevant)
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 9 of 13
Patient ID
Number
Age
Infectious Diseases Diagnosis
(may include secondary diagnosis if relevant)
EDUCATIONAL PROGRAM [PR VIII.]
Core Curriculum: Specialty Experiences
Identify the learning activities (clinical experience, conference series, journal club, etc.) and training
sites (Site #) which will be used to address the required core knowledge area.
List in Bulleted Format the
List the Corresponding
Learning Activities Used to
Setting in Which These
Address the Core
Learning Activities Take
Knowledge/Skills
Place
Click here to enter text.
Click here to enter text.
Core Knowledge Area
Information necessary to
diagnose and manage
pediatric patients with a wide
variety of acute and chronic
infectious diseases, including
disorders of host defense.
[PR VIII.B.1.a)]
Principles of disease control, Click here to enter text.
prevention of healthcareassociated infections,
emerging pathogens,
immunization programs
and/or vaccine-preventable
diseases.
[PR VIII.B.1.b)]
Basic epidemiologic and
Click here to enter text.
biostatistical methods and
their application to clinical
research and patient care.
[PR VIII.B.2.a)]
The functions and appropriate Click here to enter text.
utilization of diagnostic
microbiology, immunology,
virology, mycology, and
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Year(s) of
Training
#
Click here to enter text.
#
Click here to enter text.
#
Click here to enter text.
#
Updated 4/2015
Page 10 of 13
Core Knowledge Area
parasitology laboratories.
[PR VIII.B.2.b)]
The appropriate use of
antimicrobial agents in a
variety of clinical settings,
their mechanisms of action,
pharmacokinetics and
potential adverse reactions.
[PR VIII.B.2.c)]
Diagnosing and managing
microbiological and
immunologic factors that
determine the outcome of the
interaction between host and
microbe (i.e., the hostparasite relationship).
[PR VIII.B.2.d)]
Training in microbiology
laboratory techniques,
including culture techniques,
rapid diagnostic methods,
and molecular methods for
identification of bacteria,
mycobacteria, fungi, viruses,
rickettsiae, chlamydiae, and
parasites in clinical
specimens.
[PR VIII.B.2.e)]
The effects of underlying
disease states and
immunosuppressive therapies
on host response to infectious
agents.
[PR VIII.B.2.f)]
Mechanisms of protection
against infection (e.g., active
or passive immunization and
immunomodulating agents).
[PR VIII.B.2.g)]
Clinical pharmacology of
antimicrobial agents including
drug interactions, adverse
reactions, dose adjustments
for abnormal physiology, and
principles of
pharmacokinetics and
pharmacodynamics.
[PR VIII.B.2.h)]
List in Bulleted Format the
Learning Activities Used to
Address the Core
Knowledge/Skills
List the Corresponding
Setting in Which These
Learning Activities Take
Place
Year(s) of
Training
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 11 of 13
Core Knowledge Area
Methods of determining
activity of antimicrobial
agents and techniques to
determine their
concentrations in blood and
other body fluids.
[PR VIII.B.2.i)]
Indications for diagnostic
procedures and the
interpretation of results,
including but not limited to
bronchoscopy, thoracentesis,
arthrocentesis, lumbar
puncture, and aspiration of
abscess cavities and soft
tissues.
[PR VIII.B.2.j)]
The sensitivity, specificity,
efficacy, benefits, and risks of
contemporary technologies,
such as those for rapid
microbiologic diagnosis and
for diagnostic imaging.
[PR VIII.B.2.k)]
The principles and practice of
hospital epidemiology and
infection control and
prevention.
[PR VIII.B.2.l)]
The currently recommended
immunization schedules,
knowledge of protective
efficacy, risks, and benefits of
routinely administered
vaccines.
[PR VIII.B.2.m)]
Understanding of adverse
events attributed to
immunomodulators.
[PR VIII.B.2.n)]
Understanding of emerging
infectious diseases and public
health issues pertinent to
pediatric infectious diseases.
[PR VIII.B.2.o)]
List in Bulleted Format the
List the Corresponding
Learning Activities Used to
Setting in Which These
Address the Core
Learning Activities Take
Knowledge/Skills
Place
Click here to enter text.
Click here to enter text.
Year(s) of
Training
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Click here to enter text.
Click here to enter text.
#
Inpatient Experiences
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 12 of 13
What responsibilities will the fellows have for inpatients and how and by whom will they be
supervised when assigned to inpatient services?
Click here to enter text.
Outpatient Experiences
1. What responsibilities will the fellows have for outpatients and how and by whom will they be
supervised during the provision of outpatient care?
Click here to enter text.
2. Describe the experience the fellows will have in providing longitudinal care in an outpatient setting.
Include opportunities that fellows will have to provide outpatient care for patients whom they have
treated on the inpatient service.
Click here to enter text.
IF THERE ARE ANY UNIQUE SCENARIOS OCCURRING IN THE PROGRAM THAT DO NOT FIT WITHIN THE CONFINES
OF THIS FORM, PLEASE EXPLAIN.
Click here to enter text.
Pediatric Infectious Disease
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 13 of 13