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ARTICLE I - INTRODUCTION

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  • 1. BASIC STANDARDS FOR SUBSPECIALTY RESIDENCY TRAINING IN CRITICAL CARE MEDICINE American Osteopathic Association and the American College of Osteopathic Internists Adopted, 3/1990 Revised, BOT 3/1999 Revised, BOT 7/2003
  • 2. Basic Standards for Subspecialty Residency Training in Critical Care Medicine TABLE OF CONTENTS ARTICLE I: Introduction...........................................................................................................1 ARTICLE II: Purpose..................................................................................................................1 ARTICLE III: Institutional Requirements....................................................................................1 ARTICLE IV: Program Requirements..........................................................................................2 ARTICLE V: Qualifications and Responsibilities of the Program Director ............................................................................................4 ARTICLE Vl: Resident Requirements .........................................................................................4 APPENDIX A: Resident Work Hours and Supervision Policies............................................................................................................6 APPENDIX B: Model Hospital Policy on Academic and Disciplinary Dismissals ..................................................................................8
  • 3. ARTICLE I - INTRODUCTION These are the Basic Standards for Subspecialty Residency Training in Critical Care Medicine as approved by the American Osteopathic Association (AOA) and the American College of Osteopathic Internists (ACOI). These standards are designed to provide the osteopathic internal medicine resident with advanced and concentrated training in critical care medicine and to prepare the resident for certification in critical care medicine. ARTICLE II - PURPOSE The subspecialty of critical care medicine in internal medicine involves the diagnosis, treatment and management of patients with life threatening illness. The purpose of this residency program is to: A. Provide the resident with a properly organized program with progressively more responsibility in the care of the critically ill patient. B. Provide adequate training to enable the resident to provide definitive diagnosis and institute appropriate treatment for the critically ill patient and to demonstrate the application of osteopathic principles and practice as it relates to critical care medicine. C. Provide training in critical care medicine that may be taken as a two (2) year program following completion of a two (2) year internal medicine residency, or as a additional year to supplemental residency training in the subspecialty areas of cardiology, pulmonary medicine, or nephrology, or finally as a two (2) year program following training in any internal medicine subspecialty, other than cardiology, pulmonary medicine, or nephrology. ARTICLE III - INSTITUTIONAL REQUIREMENTS A. To be approved by the AOA for residency training in critical care medicine, an institution1 must meet all the requirements as formulated in the Residency Training Requirements of the AOA. B. The institution must provide sufficient patient load to properly train a resident in critical care medicine. C. The institution shall maintain an adequate medical library containing carefully selected texts, the latest editions of medical journals and other appropriate publications, in various branches pertaining to training in critical care medicine. The library shall be in the charge of a qualified person who shall act as custodian of its contents and arrange for the proper cataloging and indexing that will facilitate 1 Indicates a hospital, college, organization or other training facility Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 1
  • 4. investigative work by the residents. D. The institution shall provide the following equipment for its residency program in critical care medicine: 1. State-of-the-art monitoring equipment for patients with heart disease, i.e., myocardial infarction, congestive heart failure, and cariogenic shock. 2. A fluoroscopic room for catheter placement. 3. State-of-the-art ventilators for patients requiring them. Ventilators must be equipped with appropriate monitoring equipment for the regulation of minute ventilation, tidal volume or airway pressure, and respiratory rate. Equipment for the rapid analysis of arterial blood gases is also required. 4. Adequate equipment for performance of bedside right heart catheterization, intravascular pressure measurement, and thermodilution cardiac output determination is also required. E. The institution shall provide an intensive care unit that meets the current standards for architectural structure and design of such units. F. The institution shall provide adequate staff to provide for patient care, resident training and directorship of the unit. G. The institution shall provide a written policy and procedure for the selection of residents. This policy should be incorporated into the resident's manual presented to the resident at the beginning of the training program. H. The institution shall execute a contract with each resident, in accordance with the Residency Training Requirements of the AOA. I. Upon satisfactory completion of the training program, the institution shall award the resident an appropriate certificate. The certificate shall confirm the fulfillment of the program requirements, starting and completion dates of the program and the name(s) of the training institution(s) and the program director(s). ARTICLE IV - PROGRAM REQUIREMENTS A. The residency training program shall only commence after it has received the recommendation of the Committee on Postdoctoral Training and the approval of the AOA Board of Trustees. B. Residents who have successfully completed AOA approved residency training in cardiology, pulmonary medicine, or nephrology may participate in a special one-year critical care medicine residency to supplement previous training. Residents who have successfully completed two or more years of an AOA-approved residency in general internal medicine may participate in a two (2) year critical care medicine residency. Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 2
  • 5. C. The program shall: 1. Teach medical, clinical laboratory and surgical skills required for proper diagnosis and treatment of critical diseases or conditions to allow the resident to establish a treatment plan and prophylactic therapy for the critically ill patient. 2. Teach the appropriate skills required to establish effective communication between the resident, patient and the patient's family to adequately maintain the health of the patient and properly plan his/her discharge from the unit. 3. Integrate osteopathic principles and practice appropriately throughout the training program. 4. Integrate clinical and basic science research in critical care medicine and publish the results of this research in the appropriate scientific journals. 5. Arrange for elective training to improve scope of the critical care residency program. 6. The one-year critical care medicine program for residents who have completed training in pulmonary, cardiology or nephrology must include at least six (6) months of training in an intensive care unit under the direct supervision of the program director, or his designate. Additional training must be provided in dialysis techniques, medical emergencies as they relate to endocrinology, gastroenterology, hematology and oncology, infectious diseases, and neurology. A specific rotation in the medical and surgical aspects of treatment of the acute coronary insufficiency syndromes, as well as, valvular heart disease must be included. The specific rotation schedules will be modified based on the resident's prior training. 7. Residents who have completed two (2) years of training in internal medicine will require two additional years of training in critical care medicine. At least six (6) months of each year must be spent in an intensive care unit under the direct supervision of the program director, or his designate. During the first year of training specific rotations in endotracheal intubation techniques, mechanical ventilatory support, central venous access techniques, hemodynamic monitoring and support, and acute renal failure are required. The program content for the second year is as outlined for the one year program as outlined above. 8. The sponsoring institution’s primary training site should sponsor AOA- approved subspecialty training programs in cardiovascular disease, infectious diseases and pulmonary diseases and must have an approved residency program in general surgery. The presence of training programs in these disciplines ensures the extensive educational patient care and research resources that are essential to the learning environment for residents in the critical care medicine program. Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 3
  • 6. ARTICLE V - QUALIFICATIONS AND RESPONSIBILITIES OF THE PROGRAM DIRECTOR A. Qualifications 1. The program director must be certified in internal medicine by the AOA through the American Osteopathic Board of Internal Medicine (AOBIM) and passed an examination and have received certification of added qualification in critical care medicine through the AOBIM. 2. The program director must meet the standards of the position as formulated in the Residency Training Requirements of the AOA. B. Responsibilities 1. The program director's authority in directing the residency program must be defined in the program documents of the institution. 2. The program director shall establish reciprocal arrangements with the appropriate departments and divisions within the training institution to ensure cooperation in the training of critical care residents. 3. The program director shall establish affiliations to meet the program objectives. 4. The program director shall, in cooperation with the AOA Department of Education, prepare required materials for inspections. 5. The program director will provide the resident with all documents pertaining to the training program as well as the requirements for the satisfactory completion of the program. 6. The program director shall be required to submit quarterly program reports to the director of medical education and administrator of the institution. Annual reports shall be submitted to the American College of Osteopathic Internists at the completion of each training year. ARTICLE Vl - RESIDENT REQUIREMENTS A. Applicants participating in critical care medicine residency programs must: 1. have graduated from an AOA accredited college of osteopathic medicine. 2. be and remain a member in good standing of the AOA during the residency program. B. Several pathways exist for subspecialty training in critical care medicine: 1. Residents who have successfully completed an AOA-approved internship, and two (2) years of general internal medicine residency may enroll in a two (2) year subspecialty training program in critical care medicine. Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 4
  • 7. 2. Residents who have successfully completed an AOA-approved internship, internal medicine residency, and internal medicine subspecialty, other than cardiology, pulmonary medicine, or nephrology may be enrolled into a two (2) year subspecialty program in critical care medicine. 3. Residents who have completed an AOA-approved internship, two (2) years of general internal medicine, and two (2) years of subspecialty training in either cardiology, pulmonary medicine, or nephrology may be enrolled in a one-year subspecialty training program in critical care medicine. C. Applicants must be appropriately licensed in the state in which training is being conducted. D. During the training program, the resident must: 1. Submit annual reports to the American College of Osteopathic Internists at the completion of each year of training 2. Submit a scientific paper on a topic pertinent to the area of critical care medicine that is suitable for publication to the ACOI within thirty (30) days of completion their training program. 3. Attend meeting, professional staff activities and conferences that are pertinent to critical care medicine. Attendance at such meetings must have prior approval of the program director. Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 5
  • 8. APPENDIX A RESIDENT WORK HOURS AND SUPERVISION POLICIES It is recognized that excessive numbers of hours worked by resident physicians can lead to errors in judgment and clinical decision-making. These can impact on patient safety through medical errors, as well as the safety of the physician trainees through increased motor vehicle accidents, stress, depression and illness related complications. The training institution, director of medical education (DME) and residency program director must maintain a high degree of sensitivity to the physical and mental well being of residents and make every attempt to avoid scheduling excessive work hours leading to sleep deprivation, fatigue or inability to conduct personal activities. A. Work Hours 1. The following work hour policy will apply to all residents in all specialties. a. The resident shall not be assigned to work physically on duty in excess of eighty hours (80) per week averaged over a four (4) week period, inclusive of in-house night call. b. The resident shall not work in excess of twenty-four (24) consecutive hours inclusive of morning and noon educational programs. Allowance for, but not to exceed up to six (6) hours for inpatient and outpatient continuity, transfer of care, educational debriefing and formal didactic activities may occur. Residents may not assume responsibility for a new patient after twenty-four (24) hours. c. If moonlighting is permitted, all moonlighting will be inclusive of the eighty (80) hour per week maximum work limit and must be reported. (See Moonlighting Policy.) d. The resident shall have alternate week forty-eight (48) hour periods off or at least one (1) twenty-four (24) hour period off each week. e. Upon conclusion of a twenty-four (24) hour duty shift, residents shall have a minimum of twelve (12) hours off before being required to be on duty again. Upon completing a lesser hour duty period, adequate time for rest and personal activity must be provided. f. All off-duty time must be totally free from assignment to clinical or educational activity. g. Those rotations requiring the resident to be assigned to Emergency Department duty shall not be assigned longer than twelve (12) hour shifts. h. The resident and training institution must always remember the patient care responsibility is not precluded by this policy. In the case where a resident is engaged in patient responsibility which cannot be interrupted, additional coverage should be provided to relieve the resident involved as soon as possible. Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 6
  • 9. i. The resident may not be assigned to call more often than every third night averaged over any consecutive four (4) week period. 2. The training institution shall provide an on-call room for residents, which is clean, quiet, safe and comfortable, so to permit rest during call. A telephone shall be present in the on-call room. Toilet and shower facilities should be present in or convenient to the room. Nourishment shall be available during the on-call hours of the night. B. Moonlighting Policy Any professional clinical activity (moonlighting) performed outside of the official residency program may only be conducted with the permission of the program administration (DME/Program Director). A written request by the resident must be approved or disapproved by the Program Director and DME and be filed in the institution’s resident file. All approved hours are included in the total allowed work hours under AOA policy and are monitored by the institution’s graduate medical education committee. This policy must be published in the institution’s housestaff manual. Failure to report and receive approval by the program may be grounds for terminating a resident’s contract. Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 7
  • 10. APPENDIX B Model Hospital Policy on Academic and Disciplinary Dismissals In July 1993, the Board of Trustees of the American Osteopathic Association adopted the following policy: The hospital and department have clearly defined procedures for academic and disciplinary action. Academic dismissals result from a failure to attain a proper level of scholarship or non-cognitive skills, including clinical abilities, interpersonal relations, and/or personal and professional characteristics. Institutional standards of conduct include such issues as cheating, plagiarism, falsifying records, stealing, alcohol and/or substance abuse, or any other inappropriate actions or activities. In cases of academic dismissal, the hospital and department will inform trainees, orally and in writing, of inadequacies and their effects on academic standing. The trainee will be provided a specified period in which to implement specified actions required to resolve academic deficiencies. Following this period, if academic deficiencies persist, the trainee may be placed on probation for a period of three (3) to six (6) months. The trainee may be dismissed following this period, if deficiencies remain and are judged to be unremediable. In accordance with institutional policy, the trainee will be provided an opportunity to meet with evaluators to appeal decisions regarding probation or dismissal. Legal counsel at hearings concerning academic issues will not be allowed. In cases of disciplinary infractions that are judged unremediable, the hospital and department will provide the trainee with adequate notice, in writing, of specific ground(s) and the nature of the evidence on which the disciplinary action is based. The trainee will be given an opportunity for a hearing in which the disciplinary authority will provide a fair opportunity for the trainee's position, explanations and evidence. Finally, no disciplinary action will be taken on grounds that are not supported by substantial evidence. The department and/or hospital intern training committee, or house staff education committee, or other appropriate committees will act as the disciplinary authority. Trainees may be allowed counsel at hearings concerning disciplinary issues. Pending proceedings on such disciplinary action, the hospital in its sole discretion may suspend the trainee, when it is believed that such suspension is in the best interests of the hospital or of patient care. Basic Standards for Subspecialty Residency Training in Critical Care Medicine, Revised BOT 7/2003 8

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