New Application: Pediatric Rheumatology
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 Rheumatology
©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
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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?
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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
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☐ 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 Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 2 of 11
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 Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 3 of 11
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 Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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SPECIALTY-SPECIFIC SECTION
PROGRAM PERSONNEL AND RESOURCES
Other Professional Personnel [PR: VII.B.]
1. Indicate with a check mark the personnel who will interact regularly with fellows at each
participating site.
Team Members
Physical therapists
Occupational therapists
Nurse specialists
Social workers
Nutritionists
Other (specify)
Site #1
☐
☐
☐
☐
☐
☐
Site #2
☐
☐
☐
☐
☐
☐
Site #3
☐
☐
☐
☐
☐
☐
2. For categories of personnel that are unavailable, describe how that function will be addressed in the
program.
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Facilities and Services [PR VII.C.1.]
1. Indicate the availability of the following by checking the appropriate box. For inpatient services,
indicate the number of available beds.
Facility/Service
Space in an ambulatory setting for optimal
evaluation and care of patients
An inpatient area with pediatric and related
services staffed by pediatric residents and
faculty
PICU (indicate number of beds)
NICU (indicate number of beds)
Access to comprehensive diagnostic imaging
facilities
Access to pediatric physical therapy and
rehabilitation services
Access to pediatric occupational therapy
services
Access to clinical immunology laboratory
Site #1
(Yes/No)
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item.
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item.
Site #2
(Yes/No)
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item.
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item.
Site #3
(Yes/No)
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item.
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2. For every facility/service that is not available at any of the sites, provide an explanation below.
Pediatric Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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PATIENT POPULATION [PR: VII.C.2.]
Patient Data
Provide the following information for the most recent 12-month period.
Inclusive dates:
FROM:
Click here to enter a date.
Are consultations available to the NICU? (Yes/No)
Click here to enter a date.
Site #1
Site #2
#
Site #3
#
#
#
#
#
#
#
Choose an
item.
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item.
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item.
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item.
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item.
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item.
Inpatient
Total number of patients admitted to the
rheumatology service:
Total number of consultations by pediatric
rheumatologists on other inpatients
Number of new patients (admits or consults) ("new"
refers to those who are being seen by the
rheumatologists for the first time)
Are consultations provided to the PICU? (Yes/No)
TO:
#
12-Month Summary: Outpatient Clinics/Inpatient Services
During the same 12-month period, how many pediatric patients with the following rheumatology
problems were admitted and/or consulted on by the pediatric rheumatologists? The date range should
occur within the same 12-month period used in previous sections. Duplicate table as necessary.
Name of Site or
Other Setting
Inclusive dates:
Click here to enter text.
FROM: Click here to enter a date.
Outpatients
Rheumatology Problems
Number of Patients
Acute rheumatic fever/post strep
#
arthritis and reactive arthritis
[PR VII.C.2.a).(1)]
Juvenile rheumatoid arthritis and/or
#
uveitis
[PR VII.C.2.a).(2)]
Dermatomyositis/polymyositis
#
[PR VII.C.2.a).(3)]
Systemic vasculitis (HSP, Wegner’s,
#
PAN, Kawasaki disease, etc.)
[PR VII.C.2.a).(4)]
Systemic lupus erythematosus
#
[PR VII.C.2.a).(5)]
Pediatric Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
TO:
Click here to enter a date.
Inpatient service
Number on
Rheumatology
Service
#
Consultations
#
#
#
#
#
#
#
#
Number of
Consults
#
Updated 4/2015
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Outpatients
Rheumatology Problems
Scleroderma, local and systemic
[PR VII.C.2.a).(6)]
Spondyloarthropathies, including
enthesitis
[PR VII.C.2.a).(7)]
Psoriatic arthritis
[PR VII.C.2.a).(8)]
Infections of bones and joints,
including Lyme Disease
[PR VII.C.2.a).(9)]
Musculoskeletal pain syndromes
(including reflex neurovascular
dystrophy, fibromyalgia, etc)
[PR VII.C.2.a).(10)]
Hypermobility syndromes (including
Ehlers-Danlos ’ and Marfan’s
syndromes)
[PR VII.C.2.a).(11)]
Rheumatic aspects of systemic and
genetic diseases (endocrine,
metabolic, pulmonary &
gastrointestinal diseases, periodic
fever syndromes, and skeletal
dysplasias, etc)
[PR VII.C.2.a).(12)]
Rheumatic aspect of malignancy
[PR VII.C.2.a).(13)]
Other musculoskeletal complaints,
undifferentiated rheumatic diseases
and abnormal laboratory tests as
they relate to rheumatic diseases
[PR VII.C.2.a).(14)]
Consultations
Number of Patients
#
Inpatient service
Number on
Rheumatology
Service
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
Number of
Consults
#
List of Diagnoses
List 75 consecutive admissions and consultations by the Pediatric Rheumatology service. Identify the
time period during which these admissions/consultations occurred. The date range should occur within
the same 12-month period used in previous sections. The dates must begin on the date the first patient
on the list was admitted and end with the date the 75th patient was admitted, (e.g., July 1, 2012 through
October 20, 2012). Submit a separate list for each site that provides required rotations. Duplicate tables
as necessary.
Site Name
Inclusive dates:
Click here to enter text.
FROM: Click here to enter a date.
Patient ID
Number
Age
# of Days in Hospital
TO:
Click here to enter a date.
Diagnosis
(may include secondary diagnosis, if relevant)
Pediatric Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 7 of 11
Patient ID
Number
Age
# of Days in Hospital
Diagnosis
(may include secondary diagnosis, if relevant)
Ambulatory Rheumatology Training Sites
Add rows as necessary. Include all ambulatory sites as well as sites for the fellows’ continuity
experience. Designate continuity clinic sites with an asterisk (*).
Name of setting used to address core
knowledge areas. Use Site/other
setting identifier.
Planned
Number of
Duration of sessions
experience per week
(in wks/yr) per fellow
Pediatric Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Planned Role of
fellow in care of
patients –
Annual
designate as:
number of Primary Provider
patient
(PP)
visits
Consultant (C)
Updated 4/2015
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Name of setting used to address core
knowledge areas. Use Site/other
setting identifier.
Planned
Number of
Duration of sessions
experience per week
(in wks/yr) per fellow
Planned Role of
fellow in care of
patients –
Annual
designate as:
number of Primary Provider
patient
(PP)
visits
Consultant (C)
Skill Objectives
Complete the table below. The date range should occur within the same 12-month period used in
previous sections.
Inclusive dates:
FROM: Click here to enter a date.
Procedures
Diagnostic aspiration of joints and/or
intra-articular administration of
glucocorticoids (Count joints individually)
[PR VIII.A.4.a), c)]
TO: Click here to enter a date.
# performed on subspecialty service(s)
Site/Clinical
Site/Clinical
Site #1
Setting #2
Setting #3
#
#
#
EDUCATIONAL PROGRAM [PR VIII.)
Core Curriculum
Identify the training sites (e.g., sites, clinics, offices, community agencies) and learning activities
(clinical experience, conference series, self-directed learning modules, small group discussions, journal
club, workshops, etc) which will be used to address the required core knowledge areas.
List the learning activities
used to address the core
Core Knowledge Area
knowledge area
Interpretation of synovial fluid Click here to enter text.
studies
[PR VIII.A.4.a)]
Nailfold capillary microscopy Click here to enter text.
[PR VIII.A.4.b)]
Intraarticular administration of Click here to enter text.
glucocorticoids
[PR VIII.A.4.c)]
Use of non-steroidal antiClick here to enter text.
Pediatric Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
List the corresponding
setting in which these
learning activities take
place
Click here to enter text.
Year(s)
of
Training
#
Click here to enter text.
#
Click here to enter text.
#
Click here to enter text.
#
Updated 4/2015
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Core Knowledge Area
inflammatory drugs, diseasemodifying anti-rheumatic
drugs, glucocorticoid drugs,
cytotoxic agents, biologic
therapies, plasmapheresis
and infectious/antimicrobial
therapy
[PR VIII.A.4.d)]
Prescription of physical
therapy and/or occupational
therapy
[PR VIII.A.4.e)]
Utilization and interpretation
of bone and joint imaging
studies
[PR VIII.A.4.e)]
Utilization and interpretation
of laboratory tests as they
relate to rheumatic disorders
[PR VIII.A.4.f)]
Knowledge of the indications
for EMG and nerve
conduction studies
[PR VIII.A.4.g)]
Indications and interpretations
of slit lamp examination of the
eye [PR VIII.A.4.h)]
Principles of pharmacologic
and non-pharmacologic
management of pain
[PR VIII.A.4.i)]
Knowledge of the anatomy,
biochemistry, embryology,
genetic, immunology,
molecular biology and
pathology relevant to the
rheumatic diseases
[PR VIII.B.2.a).(2)]
Experience in counseling
chronically ill patients and
their families
[PR VIII.B.2.a).(5)]
Evaluation for surgical
intervention, including
participation in both
preoperative and
List the learning activities
used to address the core
knowledge area
List the corresponding
setting in which these
learning activities take
place
Year(s)
of
Training
Principles of Rehabilitation
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#
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#
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#
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#
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#
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#
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#
Pediatric Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
Page 10 of 11
Core Knowledge Area
postoperative patient
management
[PR VIII.B.2.a).(3)]
List the learning activities
used to address the core
knowledge area
List the corresponding
setting in which these
learning activities take
place
Year(s)
of
Training
Outpatient Experiences
1. What degree of responsibility will fellows have for required outpatient care?
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2. Describe the continuity of care experience fellows will receive during their period of assignment to
the outpatient clinic throughout their three-year training. [PR VIII.A.5.c)]
Click here to enter text.
3. Explain how fellows will have the opportunity to provide outpatient care for patients whom they
treated on the inpatient service.
Click here to enter text.
Inpatient Experiences
1. What responsibilities will fellows have when assigned to inpatient services?
Click here to enter text.
2. How and by whom will fellows be supervised? [PR VI.D.]
Click here to enter text.
3. How many hours per week will fellows participate in rounds with faculty?
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 Rheumatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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