The Academic Pediatric Association (APA) AGP Fellowship Project An Update The AGP Fellowship Project Committee PAS Meeting, May 2008

Committee Members  Lou Bell (Chair)  Steve Ludwig (past-chair)  Connie Baldwin  Tina Cheng  Dan Coury  Paul Darden  Tom DeWitt  Benard Dreyer  Peter Szilagyi  Marge Degnon

Question Why does a pediatric resident have a more difficult time choosing a career in general pediatrics than a career in a pediatric subspecialty?

Resident A  Going into a pediatric subspecialty  Finds the listing of all the programs  Knows all programs are accredited by ACGME  Can easily set up interviews  Enters an organized match  Completes his/her fellowship and becomes ABP Certified

Resident B  Wants- Academic General Pediatrics  Cannot find which programs are available  Not sure of uniformity and quality of programs  Has variable timelines for application / selection  Will receive no certificate for his/her training

Background-1 Survey of AGP programs in US (119/199 responded - 60%) Have AGP fellowship program:28% Plan to start one:13% Program duration3 yrs (32%) 2 yrs (64%) Masters degree76% Clinical time31% mean (range 10-90%) Major challengeFunding Cheng, Markakis, DeWitt, Pediatrics. 2007

Background-2 AGP programs typically suffer from : –a lack of a unifying structure –variability in the level of “academics” –lack of any fixed curricular requirements –uncertain funding –no methods for advertising and promoting programs

Background-3 AGP fellowships include programs that may focus on :  General pediatrics  Health services research  Clinical effectiveness  Quality and safety  Community pediatric research  Environmental health  Hospital medicine  Health policy research

Proposal  APA becomes the accrediting body for Academic General Pediatric Fellowship programs  APA set standards for programs  APA provides a consultation service for developing programs  APA implements a system to support and enrich existing programs and encourages new programs to develop

Key Point  This is about ACADEMICS  It is not about the clinical training  The goal is to improve the academics of fellowship training programs  A goal is to prepare the next generation of academic leaders as educators and clinical researchers to improve child health

Strengthening the Academic Base of General Pediatrics Fellowship Programs: A National Program and Curriculum Development Project Constance Baldwin, PhDPeter Szilagyi, MD, MPH Louis M. Bell, MDBernard Dreyer, MD Tina L. Cheng, MD, MPHDan Coury, MD Tom DeWitt, MDPaul Darden, MD Stephen Ludwig, MD Ambulatory Pediatrics. 2007;Volume 7 (2 articles) Description of program and pilot: Curriculum design, goals, objectives:

Objectives 1)Developing curriculum guidelines and program standards 2)Creating a process for program review and consultation that might later be used for accreditation of AGP fellowship programs 3)Pilot test an accreditation process (Funding from DHHS, Bureau of Health Professions) To strengthen academic general pediatrics (AGP) fellowship programs by

Accomplishments to Date - 1 √ Developed Curriculum and Educational Goals and Objectives (Ambulatory Pediatrics 2007;7: )

AGP Fellowship Five Core Curriculum Requirements Goals and Objectives for Academic Competence  3 required domains of competence: –Research, Education, Career Development Learner Needs Assessments / Tracking  Annually re-assessment  Annual evaluation Learning activities  Written individualized plan per objective  Diversity of activities Fellow Evaluation Methods  Focused evaluation of objectives  Sound and informative methods  Multiple assessment and feedback Program Evaluation  Annual evaluation of faculty; sound methods

Educational Goals & Objectives for Academic Competence DomainsGoals Research  Research design  Responsible conduct..  Clinical Epidemiology  Scientific communications  Statistical analysis  Several optional goals (qualitative, educational, ↑ stats) Education  Teaching  Evaluation of learners  Optional- curriculum development; Program develop. Career Development & Leadership  Professionalism  Career planning  Academic leadership  Healthcare organization and delivery  Advocacy  Optional-career management, QI, finance, health policy

Accomplishments to Date - 2 √ Developed program requirements √ Developed a standardized program description form √ Site visited 7 programs and summarized lessons learned (Ambulatory Pediatrics 2007;7: )

Site Visit Pilot Project Selection  43 AGP Fellowship programs identified  18 programs volunteered  8 selected for diversity of content, location  1 withdrew  7 programs were visited by a pair of evaluators/consultants

Site Visit Pilot Project Process  A pre-visit program description form is completed  A post-visit assessing report on compliance with program requirements sent to each program  Site visit team consists of a physician and an educator

Site Visit Pilot Project Results - 1  All programs found process useful  Core curriculum requirement and education of goals were useful  Programs liked the increased visibility within their institutions as a result of the site visit  Preparation for the visit was laborious

Site Visit Pilot Project Results - 2  Five of 7 programs would participate in a future formal accreditation process  1 felt did not have enough academic resources to participate  1 felt that the accreditation process was not needed given already a strong academic program in place

Site Visit Pilot Project Results - 3 Common areas needing improvement:  AGP Fellowship poorly integrated into Department  Lack of key research faculty (biostatisticians)  Failure to adequately evaluate trainees, faculty, and programs as a whole

Major Activities in Prior Year  Drafted policies and procedures  Developed budget  Solicited advice  Communicated with some programs, ACGME, ABP, AAP  Published 2 manuscripts in Ambulatory Pediatrics  Reconstituted AGP Fellowship committee (Lou Bell as chair)

Key Issues and Next Steps  APA boards consideration as a “core activity”  Formation of The Academic General Pediatric Accreditation Committee (AGPAC)  Final approval of AGPAC polices and procedures and review of document with ACGME  Continue to develop relationships/endorsement with the ABP, the AMPSDC, and the AAP  Proceed with program rollout

Academic General Pediatric Fellowship Accreditation Committee Proposed Budget Year 1 Year 2 Year 3 Year 4 Income$26,000 $44,000 $61,500 $58,000 Expenses$44,000 $52,600 $53,218 $53,855 Surplus/(Deficit) ($18,000) ($8,600) $ 8,282 $ 4,145 Assumptions  20 Programs enrolling over initial 3 years  $3,000 Initial application fee  $2,500 Annual registration fee  4 Site visits per year  2 Consultation visits per year

Roll Out Plan For Program If Approved May 2008  Hire administrative assistant June  Communication strategies finalized and implemented and implemented July 1  The APA’s fellowship accreditation program begins with announcement July  Selected AGP programs from the pilot project are invited to participate September  AGPAC membership reviewed; new members invited following policy guidelines  Communication strategies continue  Site visits and consultations begin November  Report to the APA Board

It’s All About Pipeline