New Application: Pediatric Transplant Hepatology
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 Transplant Hepatology
©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 2/2015
Page 1 of 15
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
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
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 2 of 15
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
Click here to
#
☐
☐
☐
enter text.
Topic
Basic science as
related to the
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
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 3 of 15
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
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 Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 4 of 15
SPECIALTY-SPECIFIC SECTION
PROGRAM PERSONNEL AND RESOURCES [PR II.)
Program Director Responsibilities
Are there meetings among the core Program
Director and subspecialty Program Directors?
[PR II.A.3.f)]
How often do these meetings occur?
[PR II.A.3.f).(1)]
Who is typically involved in these meetings?
(check all that apply) [PR II.A.3.f)]
☐ YES ☐ NO
Click here to enter text.
☐ Core program director
☐ Subspecialty program director for this specialty
☐ Program directors from other subspecialties
Other Professional Personnel [PR II.C.1)
1. Indicate with a check mark the personnel who will interact regularly with fellows at each
participating site. [PR II.C.1)
Team Members
Social Workers
Nutritionists
Clinical Nurse Coordinators
Child Life Therapists
Pharmacist
Site #1
☐
☐
☐
☐
☐
Site #2
☐
☐
☐
☐
☐
Site #3
☐
☐
☐
☐
☐
For categories of personnel that are unavailable, describe how that function will be addressed in the
program.
Click here to enter text.
2. Describe the process in which a multidisciplinary team approach is used in donor and recipient
selection and evaluation.
Click here to enter text.
Outpatient and Inpatient [PR II.D.2.b)]
1. Indicate the availability of the following. 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 (including surgery and psychiatry)
staffed by pediatric residents and faculty
Total number of beds in PICU
Site #1
Yes/No
Choose an
item.
Choose an
item.
Site #2
Yes/No
Choose an
item.
Choose an
item.
Site #3
Yes/No
Choose an
item.
Choose an
item.
#
#
#
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 5 of 15
Facility/Service
Interventional radiology services with staff
experienced in the invasive procedures required
in liver transplant candidates and recipients.
Is this a United Network of Organ Sharing
(UNOS) approved transplant program?
Site #1
Yes/No
Choose an
item.
Site #2
Yes/No
Choose an
item.
Site #3
Yes/No
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
2. For every facility/service that is not available at any of the sites, provide an explanation below.
Explain how the service is provided for patients.
Click here to enter text.
Patient Data [PR II.D.2.)
1. Inpatient Experiences
Provide the following information for the most recent 12-month academic or calendar year.
Inclusive dates:
FROM: Click here to enter a date.
TO: Click here to enter a date.
Number of pediatric (<18 years) liver transplants over the previous
three years
Total number of surviving patients in long-term follow-up (> 1 year)
who are actively managed by the transplant team.
Average daily census of patients on the transplant hepatology service
Number of consultations by pediatric hepatologists on other
inpatients:
Number of patients with liver disease seen on the inpatient service
who are pre- transplant (or do not require transplantation)
Number of patients seen on the inpatient service who are posttransplant (recent or remote)
#
#
#
#
#
#
#
#
a) What responsibilities will the fellows have for patients in; 1) non-intensive care inpatient settings
and, 2) intensive care inpatient settings when assigned to inpatient services?
Click here to enter text.
b) How and by whom will they be supervised?
Click here to enter text.
c) How many hours per week will they participate in rounds with faculty? Describe the role of the
fellow.
Click here to enter text.
d) Describe how the program provides co-management responsibility of patients with the
transplant surgeons, including the structure of rounds, order entry and weekly meetings.
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 6 of 15
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2. Outpatient Experiences
a) Describe the responsibilities that fellows will have for outpatients and how and by whom fellows
will be supervised.
Click here to enter text.
b) Describe the continuity of care experience fellows will receive during their period of assignment
to the outpatient clinic. To what extent will they have the opportunity to provide outpatient care
for patients whom they treated on the inpatient service?
Click here to enter text.
c) How and by whom will they be supervised during the provision of outpatient care?
Click here to enter text.
EDUCATIONAL PROGRAM [PR IV.)
Skills and Competencies
Submit the complete set of goals and objectives to the application. [PR IV.A.1.)
Are there goals and objectives for all training
experiences?
Are they rotation specific?
How will they be distributed?
If not web-based, when will they be distributed to
fellows?
If not web-based, when will they be distributed to
faculty?
If web-based, will you send out reminders to
access them?
If yes, when will you send them?
☐ YES ☐ NO
☐ YES ☐ NO
☐ Hard Copy ☐ Electronic or web-based
☐ Prior to Each Rotation
☐ Annually
☐ Once in Handbook
☐ Other
☐ Prior to Each Rotation
☐ Annually
☐ Other
☐ YES ☐ NO
Click here to enter text.
Curriculum Organization and Fellow Experiences
1. General Subspecialty Curriculum [PR IV.A.3.e)]
Topic
e.g., Biostatistics
Participants
Where Taught
Number of
(place
and
X
in
the appropriate column)
in Curriculum? Structured
(Name should
Teaching
Fellows in
All
Residents &
match name in
Hours
this
Subspecialty Subspecialty
conference
Dedicated to Discipline
Fellows
Fellows
list)
Topic Area?
Attend
Attend
Attend
Research
14
X
Course
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 7 of 15
Topic
Basic science as
related to the
application in clinical
subspecialty practice
Clinical subspecialty
content
Participants
Where Taught
Number of
(place
and
X
in
the appropriate column)
in Curriculum? Structured
(Name should
Teaching
Fellows in
All
Residents &
match name in
Hours
this
Subspecialty Subspecialty
conference
Dedicated to Discipline
Fellows
Fellows
list)
Topic Area?
Attend
Attend
Attend
#
☐
☐
☐
Click here to
enter text.
Click here to
enter text.
☐
#
☐
☐
2. 12-Month Summary: Outpatient Clinics/Inpatient Services
During the same 12-month period as used for the list of consecutive diagnoses, how many pediatric
patients with the following LIVER DISEASES [PRe- and post-transplant) were: a) seen in the
ambulatory settings; b) were admitted to and/or consulted on by the pediatric hepatologists at the
primary site?
Inclusive dates:
FROM: Click here to enter a date.
Outpatients
Diagnosis/Disorder
chronic cholestasis
[PR IV.A.2.a).(1).(d).(i)]
biliary atresia
intrahepatic cholestasis
cirrhosis/end-stage liver
disease
[PR IV.A.2.a).(1).(d).(i)]
acute liver failure
[PR IV.A.2.a).(1).(d).(ii)]
metabolic liver disease
[PR IV.A.2.a).(1).(d).(iii)]
viral hepatitis
[PR IV.A.2.a).(1).(d).(iv)]
autoimmune hepatitis
[PR IV.A.2.a).(1).(d).(v)]
Sclerosing cholangitis
[PR IV.A.2.a).(1).(d).(v)]
drug hepatotoxicities
[PR IV.A.2.a).(1).(d).(vi)]
infection in the transplant
recipient:
[PRIV.A.2.a).(1).(d).(xv)]
Cytomegalovirus
Adenovirus
Number of Patients
#
TO: Click here to enter a date.
Inpatients
Number on Gastro
Service
Number of Consults
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 8 of 15
Outpatients
Diagnosis/Disorder
Number of Patients
fungal infection
#
Epstein-Barr virus related
#
disease including post
transplant
lymphoproliferative
disease (PTLD)
recurrent viral hepatitis in the
#
allograft
[PR IV.A.2.a).(1).(d).(xvi)]
acute allograft rejection
#
[PR IV.A.2.a).(1).(d).(xviii)]
chronic allograft rejection
#
[PR IV.A.2.a).(1).(d).(xviii)]
Inpatients
Number on Gastro
Service
Number of Consults
#
#
#
#
#
#
#
#
#
#
3. List of Diagnoses
List admissions and/or consultations to the hepatology service over a 12 month period. Identify the
time period during which these admissions/consultations occurred. The date range should occur
within the same 12-month period used in the 12 month summary of diagnoses. Submit a separate
list for each site that provides required rotations. Duplicate table and add rows as necessary.
Site Name:
Inclusive dates during which
these admissions/
consultations occurred:
Patient ID
Number
Age
FROM: Click here to enter a
date.
Number of
Days in
Hospital
TO: Click here to enter a date.
Diagnosis
(may include secondary diagnosis if relevant)
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 9 of 15
Patient ID
Number
Age
Number of
Days in
Hospital
Diagnosis
(may include secondary diagnosis if relevant)
4. Skill Objectives
Indicate whether or not the program provides experience in the following procedure. Use the same
12-month period as indicated on the previous pages.
Inclusive dates:
Number performed on
service(s)
Percutaneous liver biopsies
[PR IV.A.2.a).(2).(c).(i)]
FROM: Click here to enter a
date.
Site #1
Choose an item.
TO: Click here to enter a date.
Site #2
Choose an item.
Site #3
Choose an item.
For procedures not performed at any of the participating sites, provide an explanation on a
separate page.
Click here to enter text.
5. Provide a description of the method by which fellows will acquire skills and how their
competence will be ensured for the required procedure listed above.
Click here to enter text.
6. For the learning activities listed in the table below identify the learning activities in which fellows will
engage to ensure that they understand the principles, indications, risks and interpretation of results.
Core Curriculum
Core Medical Knowledge
Management of children with
chronic cholestasis, cirrhosis,
and end-stage liver disease
[PR IV.A.2.a).(1).(d).(i)]
Management of acute liver
failure including critical care
management
[PR IV.A.2.a).(1).(d).(ii)]
Diagnosis and management of
Metabolic Liver Disease
[PR IV.A.2.a).(1).(d).(iii)]
List the Learning Activities
Used to Address the Core
Knowledge Area
List the Corresponding
Setting in Which These
Learning Activities Take Place
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Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 10 of 15
Core Curriculum
Diagnosis and management of
viral hepatitis
[PR IV.A.2.a).(1).(d).(iv)]
Diagnosis and management of
autoimmune hepatitis and
Sclerosing Cholangitis
[PR IV.A.2.a).(1).(d).(v)]
Diagnosis and management of
drug hepatotoxicities
[PR IV.A.2.a).(1).(d).(vi)]
Understanding the impact of
chronic liver disease on growth
and development in children
[PR IV.A.2.a).(1).(d).(vii)]
Nutritional support of patients
with chronic liver disease
[PR IV.A.2.a).(1).(d).(viii)]
Knowledge of indications and
strategies for liver
transplantation
[PR IV.A.2.a).(1).(d).(ix)]
Recognition of absolute and
relative contraindications for
liver transplantation
[PR IV.A.2.a).(1).(d).(x)]
Psychosocial evaluation of
candidates and recipients and
their families
[PR IV.A.2.a).(1).(d).(xi)]
Primary evaluation, presentation
and discussion of potential liver
transplant candidates for
consideration by a multidisciplinary board
[PR IV.A.2.a).(1).(d).(xii)]
Ethical considerations relating to
liver transplant donors, including
questions related to living
donors, donation after cardiac
death, criteria for brain death,
and appropriate recipients
[PR IV.A.2.a).(1).(d).(xiii)]
Evaluation of indications for
emergent re-operation or retransplantation
[PR IV.A.2.a).(1).(d).(xiv)]
Prevention and management of
opportunistic infection in the
List the Learning Activities
Used to Address the Core
Knowledge Area
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List the Corresponding
Setting in Which These
Learning Activities Take Place
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Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 11 of 15
Core Curriculum
transplant recipient including
cytomegalovirus, adenovirus,
fungal infection, and the
spectrum of Epstein-Barr virus
related disease including post
transplant lymphoproliferative
disease (PTLD)
[PR IV.A.2.a).(1).(d).(xv)]
Prevention and management of
recurrent viral hepatitis in the
allograft
[PR IV.A.2.a).(1).(d).(xvi)]
Development of a knowledge
base in transplant immunology,
including blood group matching,
histocompatibility and tissue
typing
[PR IV.A.2.a).(1).(d).(xvii)]
Recognition, evaluation,
diagnosis and treatment of
acute and chronic allograft
rejection
[PR IV.A.2.a).(1).(d).(xviii)]
Recognition and intervention for
complications of
immunosuppressive therapy
[PR IV.A.2.a).(1).(d).(xix)]
Recognition, evaluation and
management of long-term
complications of liver
transplantation
[PR IV.A.2.a).(1).(d).(xx)]
The indications,
contraindications, complications
and interpretation of allograft
biopsies. (Fellows must also
perform at least 15
percutaneous liver biopsies
during training; familiarity with
the appropriate indications for
ultrasound guided biopsies.)
[PR IV.A.2.a).(2).(c); (c).(i)]
Liver transplantation including
the management of pediatric
patients with end-stage liver
disease and management of
major complications, such as
nutritional complications of
cholestasis and chronic liver
List the Learning Activities
Used to Address the Core
Knowledge Area
List the Corresponding
Setting in Which These
Learning Activities Take Place
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Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 12 of 15
Core Curriculum
disease, upper gastrointestinal
hemorrhage, refractory ascites,
hepatorenal syndrome, and
hepatic encephalopathy
[PR IV.A.2.b).(1)]
Knowledge of the different
methods of vascular and biliary
reconstruction and the
outcomes of prolonged warm
and cold ischemia times and be
familiar with the risks and
associated complications of the
different operative phases
including the anhepatic phase
and reperfusion by observing at
least three liver transplant
procedures
[PR IV.A.2.b).(2)]
Understanding of the
organizational principles of a
multi-disciplinary transplant
program, including the training
and responsibilities of nurse
coordinators, procurement
coordinators and other support
staff
[PR IV.A.2.b).(3)]
Knowledge of the current UNOS
organ allocation policies and the
history of the evolution of the
process
[PR IV.A.2.b).(4)]
Principles of donor selection
and management (e.g.,
hemodynamic management,
indications for donor biopsy and
donor factors that increase the
risk of poor graft function)
through observation of at least
three deceased donor liver
procurements; evaluation of
LRD candidates and
observe/participate in LRD
donor/recipient procedures
[PR IV.A.2.a).(2).(d)-(d).(i)]
List the Learning Activities
Used to Address the Core
Knowledge Area
List the Corresponding
Setting in Which These
Learning Activities Take Place
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7. Identify the methods and tools that will be used to assess competence in key patient care
elements of the core curriculum as outlined in the table above.
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 13 of 15
Click here to enter text.
Ambulatory Pediatric Transplant Hepatology Experience
Complete the following table for all sites to which fellows rotate. Designate continuity clinic sites with an
asterisk (*).Add rows as necessary.
Location of
# of
Experience
Duration of Sessions
Use Site/Other Setting Experience per week
Identifier
(in wks/yr) per fellow
Estimate
d
Estimated Average #
Average # of followof new
up
patients
patients
per fellow per fellow
per
per
session
session
Role of
Fellow in
Care of
Patients List the 5
Designate
most
as:
common
Primary
patient
Provider
diagnoses
(PP)
encountered
Consultant
in this
(C)
setting
Conferences
1. List regular subspecialty and interdepartmental conferences, rounds, etc., that will be a part of the
subspecialty training program. Identify the "SITE" by using the corresponding number as appears
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 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 response to 50 words
Click here to enter text.
Pediatric Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 14 of 15
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 Transplant Hepatology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
Page 15 of 15