1. The ACGME Transitional Year Application Process
Cheryl Gross, MA, CAE, Executive Director
Transitional Year Review Committee
March 2018

2. Disclosure
No disclosures to report

3. Discussion Topics Overview – role of transitional year
Review – application process
Block diagram
Application actions
Letters of notification
Common Program Requirements – proposed revisions

4. Transitional Year Goal
To provide a well-balanced program of GME in multiple clinical disciplines designed to facilitate the choice of and preparation for a specific specialty, including specialties requiring a year of fundamental clinical education as a prerequisite

5. Transitional Year Goal
Broad spectrum of clinical experience
Robust and healthy learning environment
Enhance team skills and function as a team leader
Meets twice per year

6. Transitional Year Goal
Focused opportunity to fully develop basic clinical skills
Obtaining comprehensive medical history
Performing comprehensive medical exam
Assessing patient’s problems/chief complaint
Appropriately using diagnostic studies and tests
Integrating information to develop differential diagnosis
Developing and implementing a treatment plan

7. Similarities – AOA TRI and ACGME TY Programs
Different types of preliminary / transitional year programs
Applicants need to determine which type of program they need
Overseen by institutional GMEC
Minimum of 4 positions
Focus on “fundamental clinical skills” education
Flexible curriculum within parameters of TY program requirements

8. Single Accreditation System
AOA traditional rotating internships
121 official TRIs as of 6/30/2015
Current
Applications (being reviewed 4/2018)
9 programs
Initial Accreditation
10 programs
Osteopathic Recognition – 3 initial, 2 application

9. Minimum Requirements
Sponsoring Institution – ACGME accredited or pre-accredited
(1) Sponsoring Program – ACGME accredited or pre-accredited
Must be at the same institution as the TY program
Must be in a Fundamental Clinical Skills specialty

10. Fundamental Clinical Skills
Emergency medicine
Family medicine
General surgery
Internal medicine
Obstetrics and gynecology
Pediatrics

11. Specialties Requiring a Preliminary Year
Anesthesiology Dermatology Diagnostic radiology Nuclear medicine Ophthalmology
Osteopathic neuromusculoskeletal medicine Physical medicine and rehabilitation Preventive medicine Radiation oncology

12. Curriculum Requirements
At least 24 weeks must include rotations in which residents from other ACGME- accredited programs rotate
Must have 28 weeks of FCS rotations
ICU, general acute care surgery, trauma surgery and critical care unit experiences DO count
Any other subspecialty experiences DO NOT count

13. Curriculum Requirements
140 hours in emergency medicine
Continuous 4-week block
No vacation permitted during EM rotation
140 hours in ambulatory care
Time may be divided through the training year
Minimum – ½-day sessions

14. Curriculum Requirements
Must be 8 weeks of elective rotations
Maximum of 8 weeks of non-patient care experience
Ex. research, administration, clinical informatics

15. Curriculum Requirements
Night float
Residents must not be scheduled for more than 4 consecutive weeks of night float
Scheduled night float must not exceed 8 weeks during the training year

16. Milestones, CCC, PEC Program director guides for each on ACGME website
Final summative evaluation SHOULD NOT state that the resident has demonstrated sufficient competence to practice without direct supervision

17. Program Evaluation Committee
Members
Program director
Program directors of sponsoring program(s)
Program directors of disciplines regularly included in the curriculum
DIO
Peer-selected residents – 1 must be a TY resident
May include designees, but need to represent

18. Program Evaluation Committee
Must be a separate committee or subcommittee of the GMEC
MUST MEET AT LEAST QUARTERLY!
May include designees, but need to represent

19. Submitting Applications
Review Committee meets in December and April
Possible late summer / early fall meeting, NOT guaranteed
Submit application NO LATER than 4-5 months before the scheduled meeting

20. Your Application Two parts Cannot be changed after submitting
General information for all programs (ADS)
TY-specific application (Word document)
Cannot be changed after submitting
Describe plan to meet each requirement
Reference program requirements while completing application
Use ACGME language – policies, etc.

21. Application Review Concerns
Faculty and resident scholarly activity
Block diagram formatting
Use of AOA terminology and forms
Inaccurate info – faculty roster
CONTACT ME WITH ANY QUESTIONS!

22. Block Diagram Program snapshot Follow ADS instructions and format!
Don’t make the TYRC assume anything

23. RC Uses for Block Diagram
Ensure program requirements are being met by the program
Determining best practices
Other Review Committee activities
Quality improvement
Review of standards

24. What is a Block Diagram? Block Diagram IS Block Diagram IS NOT
Representation of sample rotation schedule
Single table
Rotations in a given year
Information related to
FCS
Outpatient
Research
Vacation
Specific trainees’ rotation schedules
Multiple tables
Representative of the order in which rotations occur
Duty hours listing

25. Sample IS

26. Sample IS NOT

27. Parts of the Block Diagram
Guide to Construction of a Block Diagram
Program name and number
All participating sites (group rotations by site)
Name of rotation at each site

28. Parts of the Block Diagram (cont’d)
Legend – Key
Identify abbreviations
Identify sites
Provide any information as Notes that will help RC understand the diagram
Electives
% of time – Outpatient
% of time – Research
TY – if FCS
Vacation time

29. Additional Info
If FCS (and counting toward 24 weeks), the categorical program shouldbe noted
Example: if a general surgery rotation occurs in an ACGME-accredited family medicine program, should be listed in block diagram as “GS/FM”

30. Abbreviations List any participating site abbreviations used
EM – emergency medicine
FM – family medicine
GS – general surgery
IM – general internal medicine
OB/GYN – obstetrics and gynecology
PEDS - pediatrics

31. Process Models: Create PDF Upload to ADS Use samples as a guide
12 blocks (monthly)
13 blocks (4 weeks – 28 days)
Create PDF
Upload to ADS
Use samples as a guide
Upload new one if substantive changes made

33. Fundamental Clinical Skills Transitional Year
Rotations that count
Emergency Medicine
Family Medicine
General Surgery, Trauma Surgery, Acute Care Surgery
Internal Medicine (incl. Night Float)
Obstetrics & Gynecology
Pediatrics
ICU / Critical Care Units

34. Fundamental Clinical Skills Transitional Year (cont’d)
Rotations that DON’T count
Highly specialized experiences - Subspecialty rotations
Dermatology
Cardiology
Endocrinology
Otolaryngology
Urology
NICU
Cardiac Care Units

35. TYRC Actions Initial Accreditation – 1 or 2 years
Site visit scheduled at the end of the period
Continued Pre-Accreditation
Resubmit application
Must respond to citations
Possible site visit

36. Letter of Notification
Areas for Improvement (AFIs)
Concerns not reaching level of citation
No written response required
Review with PEC

37. Letter of Notification
Citations
More serious concerns than AFI
Linked to 1 or more program requirements
Require written response in ADS
TYRC will review again

38. Common Program Requirements
Proposed – Sections I-V
Review & Comment Period open until 3/22
Encourage community to reply

39. Common Program Requirements
Transitional year potential concerns
A number of CPRs which apply to full residency programs, but not to transitional year
Resident scholarly activity
Ability to enter practice without supervision
Pass rates
PEC membership – request to include institutional leadership

40. Resources ADS ACGME Website Email for technical questions
Program Requirements
Frequently Asked Questions by Specialty (FAQs)
Block Diagram Samples

41. Thank you!! Contact ACGME Staff – We want to help!
Cheryl Gross, MA, CAE, Executive Director
Aimee Morales, Accreditation Administrator