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Program Information for GMEC Review: non-ACGME Training/Program
Program name:
Program director (attach a copy of your
CV or biosketch):
Associate program director (if any):
Sponsoring Hospital and Department:
Division chief:
Program coordinator:
How long has the program been recruiting/training fellows?
Length of program (if there is an option
to extend beyond standard length,
please explain):
Total number of current fellow/s (by program year, if more than one year):
Prerequisite training: e.g., has completed 2 years of a core residency program
in…; is a graduate of a U.S. program
in….., post-fellowship in…., etc.
Hospital (not HMS) appointment given:
(standard appointment is “Clinical Fellow”; additional “Graduate Assistant” title
may be given.)
*Are fellows paid according to Partners
Resident Salary Scale?
If yes, state PGY level(s):
If no, indicate amount, by program year:
List the funding source(s) (e.g., department, grant from industry, foundation,
NIH, other hospital):
*Do you use the standard Partners contract for non-ACGME fellows?
If no, attach a copy of the contract you
issue to the fellow/s.
Date of application submission:
Yes
No
Yes
No
N/A
Attached
$
*The Partners Resident Salary Scale and the contract template for non-ACGME fellows can be found on
the Partners GME website.
General Notes:

Please spell out any acronyms that may not be familiar to those outside your specialty.

You may “cut and paste” from available resources (i.e. brochures, websites, accreditation applications) to provide answers to the questions below. Please edit as needed to provide succinct, specific
responses to each of the questions.
ACCREDITATION:
Is national accreditation currently available for the program?
1. If yes, name of accrediting body:
2. If yes, is the program currently accredited?
a. Date of the last accreditation site visit:
Yes
No
Yes
No
b. Approximate date of the next site visit:
3. If no, do you intend to apply for accreditation?
Yes
No
If yes to #2, please send a copy of the application or most recent progress report submitted to the accrediting body, and any correspondence/results from the most recent site visit.
If yes to #3, please note that the application should be reviewed by the Office of Graduate Medical
Education prior to submission.
If no to #3, please explain your reasons for not applying for accreditation:
Not applying for accreditation for the following reason(s):
CURRICULUM:
Summarize the content of the training program and the specific educational goals and objectives,
as well as the overall plan to accomplish these (ideally to include overarching goals/objectives and
goals/objectives described by rotation).
Goals and objectives:
Describe the schedule, length, format and content of lectures, conferences and other didactic program components specifically designed for your fellow/s.
Didactics:
List other didactics the fellow/s may attend (describe the schedule, length, format and content).
Other Didactics:
Describe any research requirements and/or opportunities; note whether (and how much) protected
time is provided for research.
Research:
List the rotations and/or major educational activities and assignments and estimate fellow time
spent in each (as days/week, months/year or % effort, as applicable). For example, inpatient care
– 5 ½ days/week x 9 months, ambulatory clinic – ½ day/week x 11 months, performing procedures
– two ½ days/week x 9 months, attending conferences – 4hrs/week x 11 months, research – 1
mo/year, elective rotations – 1 mo/year, vacation 1mo/year.
Description of rotation/s:
If elective time is provided, describe how it may be used.
Electives:
If you offer an option to extend training beyond standard program length, please provide a detailed
explanation why the extension may be necessary and provide a curriculum for the optional training.
Program length:
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Is the program integrated across the Partners Hospitals?
Yes
No
If yes, describe the level of integration (e.g., fully integrated; reciprocal rotations; shared didactics,
etc.).
Integration:
If external rotations are required, indicated the institution(s), duration and goals.
Affiliates:
PROGRAM PERSONNEL:
Do you have adequate time, resources and support staff to manage the program?
Yes
No
If no, please explain:
List the faculty involved in the program; and indicate how much time each devotes to teaching.
Faculty; time commitment (hours per week):
Describe the fellow recruitment procedures (e.g., national advertisement, NRMP or other specialty
matching program) and describe the program’s selection process and timetable.
Fellow selection process, criteria and timetable:
Describe how the fellows are supervised by the faculty in all patient care settings, and throughout
the program.
Supervision:
List the names of current trainees. Indicated each fellow’s year in program, if the program is longer than
one year.
Trainee name:
Program year:
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
3
3
3
3
3
3
3
3
List the names for the most recent graduates (min 3, max 6). For each, describe his/her immediate postfellowship position.
Graduate's name
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Post-fellowship position
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Did all graduates over the past two years secure positions where they utilize this subspecialty
training?
Yes
No
If no, please comment:
Please indicate the (i) number and (ii) percent of fellows over the past 2-5 years who are:
Women:
(#)
(%)
Underrepresented minorities:
(#)
(%)
Discuss the careers for which this program prepares trainees, and how mentoring (in terms of career development) is provided.
Career preparation:
Describe the interactions between your fellows and other trainees; describe any impact your program has on the core residency program and other fellowship/s: e.g., how are clinical opportunities allocated among fellows and residents?; are fellows involved in teaching and/or supervising
residents?; are joint conferences open to trainees in other programs?
Interactions/impact w/core residency, other GME programs:
PROGRAM SPECIFICS:
Does the program have an explicit duty hours policy?
If yes, does the policy adhere to the ACGME duty hours requirements?
Yes
Yes
No
No
Discuss assigned coverage responsibilities (how often do fellow/s take call?; is call in-house or
taken from home?; do fellows cover for attending physicians?).
Patient coverage:
How much vacation time is provided?
Vacation:
Is moonlighting permitted?
Yes
No
Is any type of internal moonlighting (i.e. extra work for additional pay) required?
No
Yes
Describe the process for evaluating fellows and providing feedback on their performance. Please
indicate frequency of written evaluations, verbal feedback, and who participates.)
Fellow assessment and feedback:
Describe the process by which fellow/s evaluate the faculty, the program director and the program
overall. If possible, please cite an example of a program improvement initiated based on fellow
suggestions.
Evaluation by the fellows; program improvement process:
Do the fellows maintain procedure/case logs?
If yes, do you review these with the fellow/s?
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If yes, indicate frequency:
Frequency:
Discuss the strengths and weaknesses of the program, and how you address the latter.
Strengths and weaknesses:
REQUIRED ATTACHMENTS:

Attach a copy of your CV.

Please submit a statement from the Residency Program Director confirming that the proposed
program will have no negative impact on the core residency program.

Please attach the program curriculum as a separate document (or insert link, if web-based).
If you are working to develop or update a curriculum, please review the documents in the Start a
Program section of the GME website titled “Program Standards” and “Curriculum Development”
for more information. Sample curricula are also provided on this site.

Provide as separate attachments the forms used for: (i) faculty evaluations of the fellow/s; (ii)
fellow evaluations of the faculty, and (iii) fellow evaluations of the program.
Please return the completed application and all requested documents via email to Irina Knyshevski
(iknyshevski@partners.org).
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