New Application: Pediatric Pulmonology
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 Pulmonology
©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
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 Pulmonology
©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 Pulmonology
©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
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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 Pulmonology
©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
1. Indicate with a check mark the personnel who will interact regularly with fellows at each
participating site. [PR II.C.1; VII.B.]
Team Members
Nutritionist/ Registered Dietician
Psychology
Social Workers
Relevant healthcare providers (e.g. nurse
specialists, PAs)
Clinical Pharmacologist
Physical & Occupational Therapist
Child Life Therapist
Speech Therapist
Respiratory Therapist
Site #1
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☐
☐
Site #2
☐
☐
☐
☐
Site #3
☐
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☐
☐
☐
☐
☐
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☐
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☐
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.]
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
PICU (indicate total number of beds)
NICU (indicate total number of beds)
Pediatric pulmonary function laboratory capable of
measuring flows, gas exchange and lung volumes
including use of body plethysmography, and
performing bronchoprovocation studies
Flexible bronchoscopy capability
Pediatric polysomnography capability
Inpatient services capable of meeting the needs of
adolescents/young adults with pulmonary disease
Pathologists with experience/training in pediatric
pulmonary pathology
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.
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.
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Pediatric Pulmonology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Facility/Service
Faculty with expertise in sleep medicine
Adult medicine pulmonary consultants for transition
care of young adults
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.
Patient Population [PR VII.C.2.]
1. 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.
Total number of admissions to the pediatric
pulmonology service
Number of new patients admitted each year
(“new” refers to those who are seen by members
of the pulmonology service for the first time.)
Average length of stay of patients on the
pediatric pulmonology service
Total number of consultations by pediatric
pulmonologists 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
pulmonology service, including consultations
Number of patients requiring follow-up care by
pulmonology service as outpatients during 12month period reported
To: Click here to enter a date.
Site #1
#
Site #2
#
Site #3
#
#
#
#
Length
Length
Length
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
2. Provide the following information for the most recent 12-month academic or calendar year for each
site used to provide a specific required experience, such as transplant, cardiology, intensive care,
etc. Duplicate this table as necessary. 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
Site #2
Site #3
Name of service:
Total number of fellows and residents on the
service
Total number of admissions to the service
Number of new patients admitted each year
(“new” refers to those who are seen by members
of the service for the first time.)
Pediatric Pulmonology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Site #1
Site #2
Site #3
Average length of stay of patients on the service
Average daily census of patients on the service,
including consultations
3. Ambulatory Pediatric Pulmonology Experience for all Years of Training:
Add rows as necessary.
Name of Experience
Site/Other Setting
Identifier
Estimated # Estimated # Estimated
Planned # of
of New
of Return
Average #
Duration of
Sessions Patients Per Patients Per Teaching
Experience Per Week
Fellow Per Fellow Per Attendings
(in wks/yr) Per Fellow
Session
Session
Per Session
If the experience is in a private office, 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.
12-Month Summary - Outpatient Clinics/Inpatient Services
During the same 12-month period as used in previous sections, how many pediatric patients with the
following pulmonology problems were: a) seen in the ambulatory settings; b) were admitted to and/or
consulted on by the pediatric pulmonologists at the primary site?
Inclusive dates:
From: Click here to enter a date.
Pulmonology Diagnosis/Disorder
Asthma and allergic disorders affecting the
respiratory system
Chronic lung disease of infancy
Cystic fibrosis
Lower respiratory tract infections
Newborn respiratory diseases
Sleep disordered breathing, such as apnea
To: Click here to enter a date.
Outpatients
Number of
Patients
#
Pediatric Pulmonology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
#
#
#
#
#
Inpatients
Number on
Number of
Pulm Service
Consults
#
#
#
#
#
#
#
#
#
#
#
#
Updated 4/2015
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Pulmonology Diagnosis/Disorder
Chronic ventilatory assistance, including home
mechanical ventilation such as, bi-level positive
airway pressure ventilation, and tracheostomy
management
Aspiration syndromes
Congenital anomalies of the respiratory system
Acquired upper airway obstruction
Chronic suppurative lung disease
Respiratory infections in the immunocompromised
host
Other diseases such as pulmonary hypertension,
interstitial lung disease, hemosiderosis and acute
lung injuries
Pre-operative and post-operative management of
children with respiratory disorders
Outpatients
Number of
Patients
#
Inpatients
Number on
Number of
Pulm Service
Consults
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
List of Diagnoses
List 150 consecutive inpatient admissions and/or consultations by the PEDIATRIC PULMONOLOGY
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 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 and add rows as necessary.
Site Name:
Give inclusive dates during
which these
From: Click here to enter a date.
admissions/consultations
occurred:
Patient ID
Number
Age
Number
of days in
hospital
To: Click here to enter a date.
Pulmonary diagnosis
(may include secondary diagnosis if relevant)
Pediatric Pulmonology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Patient ID
Number
Age
Number
of days in
hospital
Pulmonary diagnosis
(may include secondary diagnosis if relevant)
EDUCATIONAL PROGRAM [PR VIII.]
Skill Objectives
Will the program provide experience in the following:
Pulmonary Function Testing/Procedures
Simple spirometry (volume-time or flow-volume)
Whole body plethysmography [PR VII.C.1.b).(1).(b)]
Bronchoprovocation studies [PR VII.C.1.b).(1).(b)]
Pre-post bronchodilator study
Evaluation of respiration during sleep [PR VIII.A.3.b)]
Bronchoscopy [PR VIII.A.3.c)]
Number Per Year
#
#
#
#
#
#
Core Curriculum - Specialty Experiences
Identify the activities (clinical experience, conference series, journal club, etc.) and training sites (Site #)
learning which will be used to address the required core knowledge area.
Core Knowledge Area
Asthma and allergic disorders
affecting the respiratory system
[PR VIII.A.2.a)]
Chronic lung disease of infancy
[PR VIII.A.2.b)]
Cystic fibrosis
[PR VIII.A.2.c)]
Lower respiratory tract infections
[PR VIII.A.2.d)]
Newborn respiratory diseases
[PR VIII.A.2.e)]
Sleep disordered breathing, such
as apnea
[PR VIII.A.2.f)]
Chronic ventilatory assistance,
including home mechanical
ventilation, bi-level positive airway
List the Learning
Activities Used to
Address the Core
Knowledge/Skills
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List the Corresponding
Setting in Which These
Learning Activities Take Year(s) of
Place
Training
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#
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#
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#
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#
Pediatric Pulmonology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Core Knowledge Area
pressure ventilation, and
tracheostomy management.
[PR VIII.A.2.g)]
Aspiration syndromes
[PR VIII.A.2.h)]
Congenital anomalies of the
respiratory system
[PR VIII.A.2.i)]
Acquired upper airway obstruction
[PR VIII.A.2.j)]
Chronic suppurative lung disease
[PR VIII.A.2.k)]
Respiratory infections in the
immunocompromised host
[PR VIII.A.2.l)]
Other diseases such as pulmonary
hypertension, interstitial lung
disease, hemosiderosis and acute
lung injuries
[PR VIII.A.2.m)]
Pre-operative and post-operative
management of children with
respiratory disorders
[PR VIII.A.2.n)]
Environmental influences on
respiratory disease.
[PR VIII.B.1)
Indication and interpretation of
pulmonary function tests
Evaluation of respiration during
sleep
[PR VIII.A.3.b)]
List the Learning
Activities Used to
Address the Core
Knowledge/Skills
List the Corresponding
Setting in Which These
Learning Activities Take Year(s) of
Place
Training
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Inpatient Experiences
What responsibilities do the fellows have for inpatients and how and by whom will they be
supervised when assigned to inpatient services?
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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?
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Pediatric Pulmonology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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2. Describe how the program will ensure that fellows provide continuity of care for a panel of patients
throughout training? 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.
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 Pulmonology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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