New Application: Addiction Psychiatry Review Committee for Psychiatry ACGME 515 North State Street, Suite 2000 Chicago, Illinois 60654 312.755.5000 www.acgme.org INSTITUTIONS - PARTICIPATING SITES Indicate whether ACGME-accredited programs in the following specialties are available at each participating site. [PR I.B.4.] Family medicine Internal medicine Neurology Physical medicine and rehabilitation Site #1 ☐ ☐ ☐ ☐ Site #2 ☐ ☐ ☐ ☐ Site #3 ☐ ☐ ☐ ☐ Site #4 ☐ ☐ ☐ ☐ PROGRAM PERSONNEL AND RESOURCES Faculty 1. List the designated site director at each participating site who is responsible for the day-to-day activities of the program at that site, with overall coordination by the program director. [PR II.B.1.b)] Site #1 #2 #3 #4 Designated Site Director Name Name Name Name 2. Describe faculty members’ participation in organized clinical discussions, rounds, journal clubs, and conferences. [PR II.B.6.] Click here to enter text. Other Program Personnel 1. List the professional personnel that will be available to the program from those clinical disciplines necessary for the accomplishment of clinical training and the educational goals of the program. [PR II.C.1.] Click here to enter text. 2. Will substance abuse counselors and, where appropriate, teachers, be available to the program? [PR II.C.3.] ................................................................................................................... ☐ YES ☐ NO If “NO,” explain. Click here to enter text. 3. Will there be a designated program coordinator? [PR II.C.4.] ....................................... ☐ YES ☐ NO Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 1 of 10 Resources 1. Describe the inpatient facilities available to the program. [PR II.D.1.; PR II.D.1.a)] Click here to enter text. 2. Describe the partial hospitalization and/or day treatment programs that will be used for fellow education. [PR II.D.2.-II.D.2.b)] Click here to enter text. 3. Will there be a multidisciplinary ambulatory care facility? [PR II.D.3.] ........................... ☐ YES ☐ NO 4. Describe the patient population and how the program director will ensure that fellows achieve competence in the required patient care outcomes. [PR II.D.4.; II.D.4.a)] Click here to enter text. NUMBER OF FELLOWS Describe how the program director will ensure that the presence of other learners will not interfere with the appointed fellows’ education. [PR III.B.2.] Click here to enter text. EDUCATIONAL PROGRAM Patient Care Indicate the settings and activities in which fellows will demonstrate proficiency in evaluating and treating patients in each of the categories listed below. Also indicate the method(s) that will be used to assess proficiency. Patient Categories Patients with primary substancerelated disorders, and their families [PR IV.A.2.a).(1).(a)] Medical and surgical patients in the emergency department, intensive care units, and general wards of the hospital with acute and chronic substance-related disorders, including acute intoxication and overdose [PR IV.A.2.a).(1).(a)] Psychiatric inpatients and outpatients with chemical dependencies and co-morbid psychopathology to include affective disorders, psychotic disorders, organic disorders, Settings/Activities Click here to enter text. Assessment Method(s) 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. Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 2 of 10 Patient Categories Settings/Activities personality disorders, and anxiety disorders, as well as patients suffering from medical conditions commonly associated with substance-related disorders including hepatitis and HIV/AIDS [PR IV.A.2.a).(1).(c)] Medication-dependent patients Click here to enter text. with chronic medical disorders/conditions, including patients with chronic pain [PR IV.A.2.a).(1).(d)] Assessment Method(s) Click here to enter text. Medical Knowledge Indicate the activities (lectures, conferences, journal clubs, clinical teaching rounds, etc.) in which fellows will demonstrate proficiency in their knowledge in each of the following areas. Also indicate the method(s) that will be used to assess proficiency. Proficiency Area The use of all of the major categories of substances, as well as knowledge of the types of treatment required for each [PR IV.A.2.b).(1)] Signs of withdrawal from these major categories of substances, knowledge, and experience with the range of options for treatment of the withdrawal syndromes, and knowledge of the complications commonly associated with such withdrawal [PR IV.A.2.b).(1).(a)] Signs and symptoms of overdose, including the medical and psychiatric sequelae of overdose, and treatment of overdose [PR IV.A.2.b).(2)] The social and psychological problems and the medical and psychiatric disorders which often accompany the chronic use of the major categories of substances [PR IV.A.2.b).(3)] The special problems of the pregnant woman with substancerelated disorders and of the babies born to these women Settings/Activities Click here to enter text. Assessment Method(s) Click here to enter text. Click here to enter text. Click here to enter text. 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Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 3 of 10 Proficiency Area [PR IV.A.2.b).(4)] Family systems and dynamics relevant to the etiology, diagnosis, and treatment of substance-related disorders [PR IV.A.2.b).(5)] American culture and subcultures, including immigrant populations, particularly those found in the patient community associated with the educational program, with specific focus on the cultural elements of the relationship between the fellow and the patient including the dynamics of differences in cultural identity, values and preferences, and power [PR IV.A.2.b).(6)] The genetic vulnerabilities, risk and protective factors, epidemiology, and prevention of substance-related disorders [PR IV.A.2.b).(7)] Settings/Activities Assessment Method(s) 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. Practice-based Learning and Improvement 1. Briefly describe one planned quality improvement activity or project that will allow fellows to demonstrate the ability to analyze, improve, and change practice or patient care. Describe planning, implementation, evaluation, and provisions of faculty member support and supervision that will guide this process. [PR IV.A.2.c).(1)] (Limit response to 400 words) Click here to enter text. 2. Briefly describe one example of a learning activity in which fellows engage to develop the skills needed to locate, appraise, and assimilate evidence from scientific studies, including major medical journals and professional-scientific organizations dealing with research on the understanding and treatment of substance-related disorders, and apply it to their patients' health problems. [PR IV.A.2.c).(2)-(2).(a)] (Limit response to 400 words) The description should include: Locating information Appraising information Assimilating evidence information (from scientific studies) Applying information to patient care Click here to enter text. 3. Briefly describe one example of a learning activity in which fellows critically analyze research reports as presented in journal clubs and seminars. [PR IV.A.2.c).(3)] Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 4 of 10 Click here to enter text. 4. Briefly describe one learning activity in which fellows demonstrate administrative and teaching skills in the subspecialty, including teaching and supervising residents, medical students, and/or other allied health professionals, in the care of patients with substance-related disorders. [PR IV.A.2.c).(4)] (Limit response to 400 words) Click here to enter text. Interpersonal and Communication Skills 1. Briefly describe one learning activity in which fellows demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. [PR IV.A.2.d)] (Limit response to 400 words) Click here to enter text. 2. Briefly describe one learning activity in which fellows work collaboratively with specialists in the treatment of addiction in the emergency department and intensive care units in the diagnosis and management of acute overdose symptoms. [PR IV.A.2.d).(1)] (Limit response to 400 words) Click here to enter text. 3. Briefly describe one learning activity in which fellows work collaboratively with other mental health providers and allied health professionals, including nurses, social workers, psychologists, nurse practitioners, counselors, pharmacists, and others who participate in the care of patients with substance-related disorders. [PR IV.A.2.d).(2)] (Limit response to 400 words) Click here to enter text. 4. Briefly describe one learning activity in which fellows work effectively with multidisciplinary teams as consultants and team leaders, including integrating recommendations and decisions from consulting medical specialists and other professionals in related health disciplines. [PR IV.A.2.d).(3)] (Limit response to 400 words) Click here to enter text. 5. Briefly describe one learning activity in which fellows demonstrate competence in effectively interviewing socioculturally-diverse patients and families, which may include those with limited English proficiency, health literacy, vision/sight, and hearing. [PR IV.A.2.d).(4)] (Limit response to 400 words) Click here to enter text. Professionalism 1. Briefly describe the learning activity(ies), other than lecture, by which fellows demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. [PR IV.A.2.e)] (Limit response to 400 words) Click here to enter text. Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 5 of 10 2. Briefly describe one learning activity in which fellows demonstrate sensitivity and responsiveness to diverse patients, including to sex, age, culture, race, religion, disabilities, and sexual orientation. [PR IV.A.2.e).(1)] (Limit response to 400 words) Click here to enter text. 3. Briefly describe one learning activity in which fellows demonstrate competence in recognizing and appropriately addressing biases in themselves, others, and the health care delivery system. [PR IV.A.2.e).(2)] (Limit response to 400 words) Click here to enter text. Systems-based Practice 1. Briefly describe the learning activity(ies) through which fellows demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. [PR IV.A.2.f)] (Limit response to 400 words) Click here to enter text. 2. Briefly describe the learning activity(ies) through which fellows incorporate considerations of cost awareness and risk-benefit analysis in providing psychiatric and other health care services to patients with substance-related disorder. [PR IV.A.2.f).(1)] (Limit response to 400 words) Click here to enter text. 3. Briefly describe the learning activity(ies) through which fellows incorporate quality assurance measures when treating substance-related disorders. [PR IV.A.2.f).(2)] (Limit response to 400 words) Click here to enter text. Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 6 of 10 Curriculum Organization and Fellow Experiences 1. List all planned seminars and didactic courses to be attended by fellows. Provide the name of the session, whether it is required or elective, the name(s) of instructor(s), and length, frequency, and total number of sessions. Insert additional rows as necessary. [PR IV.A.3.b); IV.A.3.b).(1); IV.A.3.b).(3)] Title Required or elective Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Instructor(s) Length of session Frequency Total number of sessions Updated 3/2015 Page 7 of 10 2. Describe how clinical experience and didactics will be integrated to provide appropriate progressive learning. [PR IV.A.3.b).(4)] Click here to enter text. 3. Briefly describe fellow experiences with: a) Evaluating acute and chronic patients in inpatient and outpatient, and/or residential, settings [PR IV.A.3.c).(1)] Click here to enter text. b) Performing assessments, including community and environmental assessments, family and care giver assessments, medical assessments, and physical assessments [PR IV.A.3.c).(2)] Click here to enter text. c) Managing opiate replacement therapy [PR IV.A.3.c).(3)] Click here to enter text. d) Using psychoactive medications in the treatment of psychiatric disorders often accompanying the major categories of substance-related disorders [PR IV.A.3.c).(4)] Click here to enter text. e) Using techniques required for the intervention with chronic substance users, and dealing with the defense mechanisms that cause such patients to resist treatment [PR IV.A.3.c).(5)] Click here to enter text. f) Using the various psychotherapeutic modalities involved in the ongoing management of the chronic substance using patient, including individual psychotherapies, couples therapy, family therapy, group therapy, motivational enhancement therapy, and relapse prevention therapy [PR IV.A.3.c).(6)] Click here to enter text. g) Working with patients who are participating in self-help programs [PR IV.A.3.c).(7)] Click here to enter text. h) Assessing and treating patients with substance-related disorders related to: (1) Alcohol [PR IV.A.3.c).(8).(a)] Click here to enter text. (2) Benzodiazepines [PR IV.A.3.c).(8).(b)] Click here to enter text. Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 8 of 10 (3) Cannabis and hallucinogens [PR IV.A.3.c).(8).(c)] Click here to enter text. (4) Cocaine and other stimulants [PR IV.A.3.c).(8).(d)] Click here to enter text. (5) Opioids [PR IV.A.3.c).(8).(e)] Click here to enter text. (6) Other substances of abuse, including sedatives, hypnotics, or anxiolytics [PR IV.A.3.c).(8).(f)] Click here to enter text. (7) Nicotine [PR IV.A.3.c).(8).(g)] Click here to enter text. (8) Miscellaneous or unusual substances [PR IV.A.3.c).(8).(h)] Click here to enter text. i) Providing consultation to acute and chronic medically-ill patients with substance-related disorders who are being treated on emergency, intensive care, medical, and/or surgical services of a general hospital. [PR IV.A.3.c).(9)] Click here to enter text. (1) Will fellows function at the level of a specialist consultant to primary care physicians and to intensive care specialists? [PR IV.A.3.c).(9).(a)] ............................................... ☐ YES ☐ NO If “NO,” explain. Click here to enter text. 4. How many hours will each fellow have of faculty preceptorship weekly? [PR IV.A.3.d)] ................. (#) a) How much time will be dedicated to one-on-one preceptorship? .................................... (#) hours b) How much time will be dedicated to group preceptorship? ............................................ (#) hours 5. Describe how the program director will ensure that each fellow will maintain a patient log documenting all clinical experiences. [PR IV.A.3.e)] Click here to enter text. Fellows’ Scholarly Activities Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 9 of 10 Will fellows participate in developing new knowledge or evaluating research findings? [PR IV.B.1.] .......................................................................................................................................... ☐ YES ☐ NO If “NO”, explain. Click here to enter text. FELLOW FORMATIVE EVALUATION Will assessment include quarterly written evaluations of all fellows by all supervisors and directors of clinical components of the program? [PR V.A.2.d)] ........................................................... ☐ YES ☐ NO If “NO”, explain. Click here to enter text. Addiction Psychiatry ©2015 Accreditation Council for Graduate Medical Education (ACGME) Updated 3/2015 Page 10 of 10