Basic Standards - Reproductive Endocrinology

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Basic Standards - Reproductive Endocrinology

  1. 1. Basic Standards for Fellowship Training in Reproductive Endocrinology AMERICAN OSTEOPATHIC ASSOCIATION AND THE AMERICAN COLLEGE OF OSTEOPATHIC OBSTETRICIANS AND GYNECOLOGISTS Adopted 3/1991 Revised BOT 2/2003 Revised BOT 2/2004 Revised BOT 7/2007, Effective 7/2008
  2. 2. BASIC STANDARDS FOR FELLOWSHIP TRAINING IN REPRODUCTIVE ENDOCRINOLOGY TABLE OF CONTENTS ARTICLE I INTRODUCTION ......................................................................................................p. 3 ARTICLE II PURPOSE.......................................................................................................................p. 3 ARTICLE III COMPETENCIES .......................................................................................................p. 3 ARTICLE IV INSTITUTION REQUIREMENTS ........................................................................p. 5 ARTICLE V INSTITUTION RESPONSIBILITIES ....................................................................p. 6 ARTICLE VI EDUCATIONAL PROGRAM...................................................................................p. 6 ARTICLE VII CURRICULUM ............................................................................................................p. 7 ARTICLE VIII PROGRAM DIRECTOR REQUIREMENT..........................................................p. 8 ARTICLE IX FACULTY.......................................................................................................................p. 9 ARTICLE X CANDIDATE REQUIREMENTS................................... .......................................p. 9 ARTICLE XI FELLOW RESPONSIBILITIES...............................................................................p. 9 APPENDIX I FELLOW WORK HOURS AND SUPERVISION POLICIES ..............................................................p. 11 APPENDIX II MODEL OSTEOPATHIC GME POLICY ON ACADEMIC AND DISCIPLINARY DISMISSALS .......................................................p. 13 Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 2
  3. 3. ARTICLE I – INTRODUCTION A reproductive endocrinologist is a sub specialist in obstetrics and gynecology who is capable of managing complex problems relating to reproductive endocrinology and infertility, and whose current professional activity involves the practice of reproductive endocrinology and infertility in a setting wherein essential diagnostic and therapeutic resources are available and being used appropriately. ARTICLE II – FELLOWS At the completion of a fellowship program in reproductive endocrinology and infertility, the physician will be able to manage complex problems related to function of the reproductive system and to select and conduct appropriate therapies for the infertile couple. The fellow must understand endocrine assay methodology and principles of molecular biology and be skilled in laboratory techniques, clinical research design and statistical analysis. The fellow is expected to be proficient in the clinical diagnosis and in the surgical management of structural problems related to fertility and developmental abnormalities of the reproductive tract, as well as contemporary techniques involved in assisted reproductive technology. Having conducted investigative work leading to the production of a thesis, it is anticipated that the fellow will be capable of continued research endeavors. By completion of a fellowship program, a fellow will have demonstrated progressive professional and intellectual growth. ARTICLE III - COMPETENCIES The fellowship program is required to provide a curriculum that promotes and assesses competencies in the following seven areas: A. Interpersonal and Communication Skills Fellows are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams. 1. Demonstrate effectiveness in developing appropriate doctor- patient relationships. 2. Exhibit effective listening, written, and oral communication skills in professional interactions with patients and health professionals. B. Systems-Based Practice Fellows are expected to demonstrate an understanding of health care delivery systems, provide effective and qualitative patient care within the system, and practice cost-effective medicine. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 3
  4. 4. 1. Understand national and local health care delivery systems and how they impact on patient care and professional practice. 2. Advocate for quality health care on behalf of patients and assist them in their interactions with the complexities of the medical system. C. Medical Knowledge Fellows are expected to demonstrate and apply knowledge of accepted standards of clinical medicine, remain current with new developments in medicine, and participate in life-long learning activities, including research. 1. Demonstrate competency in the understanding and application of clinical medicine to patient care. 2. Know and apply the foundations of clinical and behavioral medicine appropriate to their discipline. D. Osteopathic Philosophy and Osteopathic Manipulative Treatment Fellows are expected to demonstrate and apply knowledge of accepted standards in Osteopathic Manipulative Therapy (OMT) appropriate to their specialty. The educational goal is to train a skilled and competent osteopathic practitioner who remains dedicated to life-long learning. 1. Demonstrate competency in the understanding and application of OMT appropriate to obstetrics and gynecology. 2. Integrate osteopathic concepts and OMT into the medical care provided to patients as appropriate. 3. Understand and integrate osteopathic principles and philosophy into all clinical and patient care activities. E. Practice-Based Learning and Improvement Fellows must demonstrate the ability to critically evaluate their methods of clinical practice, integrate evidence-based medicine into patient care, show an understanding of research methods, and improve patient care practices. Treat patients in a manner consistent with the most up-to-date information on diagnostic and therapeutic effectiveness. 1. Perform self-evaluations of clinical practice patterns and practice-based improvement activities using a systematic methodology. 2. Understand research methods, medical informatics, and the application of technology as applied to medicine. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 4
  5. 5. F. Professionalism Fellows are expected to uphold the osteopathic oath in the conduct of their professional activities that promote advocacy of patient welfare, adherence to ethical principles, collaboration with health professionals, life-long learning, and sensitivity to a diverse patient population. Fellows should be cognizant of their own physical and mental health in order to effectively care for patients. 1. Demonstrate respect for patients and families and advocate for the primacy of patient’s welfare and autonomy. 2. Adhere to the ethical principles in the practice of medicine. 3. Demonstrate awareness and proper attention to issues of culture, religion, age, gender, sexual orientation, and mental and physical disabilities. G. Patient Care Fellows must demonstrate the ability to effectively treat patients, provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive medicine and health promotion. Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records, and diagnostic/therapeutic plans and treatments. 1. Validate competency in the performance of diagnosis, treatment and procedures appropriate to reproductive endocrinology. 2. Provide health care services consistent with osteopathic philosophy, including preventive medicine and health promotion that are based on current scientific evidence and understanding of behavioral medicine. ARTICLE IV - INSTITUTION REQUIREMENTS A. The training institution shall be accredited by the American Osteopathic Association (AOA) or Joint Commission. B. The department must have an adequately organized division in reproductive endocrinology. C. The fellow shall have available a medical library to include carefully selected texts, the latest editions of current medical journals and particularly those relating to reproductive endocrinology and other appropriate publications. D. Institutions that meet all of the training requirements and provide an adequate volume of major reproductive gynecologic surgery and admissions of sufficient scope and volume may qualify for this program. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 5
  6. 6. E. The program may commence at any time of the year. It is the responsibility of the institution to forward the completed fellowship contract to the American Osteopathic Association within thirty (30) days of commencement of the fellowship. F. The institution shall have outpatient clinics or provide for rotations at affiliated outpatient facilities. These clinics shall be under the supervision of the teaching staff of the division of reproductive endocrinology of the base institution. G. The objectives of the educational program are facilitated by the presence of adequate facilities and adequate numbers of patients with a variety of reproductive disorders. Ambulatory facilities, including ultrasound imaging, must be available to ensure the presence of high quality care for women. The operating rooms must be equipped for endoscopic and microsurgical procedures. Laboratories equipped to conduct hormone assays, andrology testing, and embryo culture must be available. The facilities also should be able to perform hysterosalpingography, computerized axial tomography, bone densitometry, and magnetic resonance imaging. ARTICLE V - INSTITUTION RESPONSIBILITIES A. The professional staff shall assume collective responsibility to provide the proper training of the fellows. B. All organized departments and services shall be coordinated to provide fellows with the benefits of cooperation from all professional areas. C. The institution shall immediately report any change in a fellow's status to the AOA Office of Education. D. Contract violations by fellows shall be reported in writing to the Office of Education immediately following the incident. E. Upon completion of training, the institution shall provide fellows with certificates attesting that they have satisfactorily fulfilled all requirements of the program. F. It is the responsibility of the institution, exercised through the director of medical education and program director, to see that fellows shall receive the training outlined in the program. ARTICLE VI – EDUCATIONAL PROGRAM Graduate educational programs in reproductive endocrinology and infertility should be developed along the following guidelines to ensure a clinical and research experience consistent with the educational objectives of the Guide to Learning in Reproductive Endocrinology and Infertility. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 6
  7. 7. A. All reproductive endocrinology and infertility fellowship programs must be at least thirty-six (36) months in duration. Within a fellowship program, the length of fellowship must be the same for each fellow. A minimum of eighteen (18) months is required for research/didactic efforts and a minimum of twelve (12) months in clinical reproductive endocrinology/ infertility. The remaining six (6) months may be tailored to electives or be focused in a specific clinical or research area at the discretion of the program director. B. The apportionment of time must be constructed to achieve four (4) major objectives including: 1. Experience in the management of a wide variety of clinical problems affecting the development, the function, and the aging of the human reproductive system. This experience should include disorders related to both men and women, as detailed in the Guide to Learning in Reproductive Endocrinology and Infertility. 2. Adequate and diverse medical and surgical experience related to infertility and reproductive disorders (including management of ovulation defects and techniques of assisted reproduction, which must include an adequate number and success rate), contraception, aging, and the surgical management of acquired and developmental abnormalities of the reproductive tract. 3. Knowledge of the techniques and limitations of various diagnostic, surgical, and laboratory procedures utilized in clinical reproductive endocrinology and infertility. 4. A research experience centered on an intensive specific area of investigation that will provide a thesis for the fellow and also stimulate future independent study. 5. Osteopathic philosophy, principles and practices as they relate to reproductive endocrinology and infertility shall be integrated into the training program. ARTICLE VII – CURRICULUM A. Education in the basic science aspects of reproductive endocrinology and infertility is of singular importance and specifically must include the study of anatomy, biochemistry, pathology, physiology, molecular biology, cell biology, experimental designs and statistics. Didactic instruction separate from the two required university graduate courses should be provided in both basic science and clinical learning aspects of reproductive endocrinology and infertility. The Guide to Learning in Reproductive Endocrinology and Infertility should be used to provide the foundation and scope of this instruction. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 7
  8. 8. B. Training in specialized surgical techniques including, but not limited to, endoscopy, microsurgery, oocyte retrieval and embryo transfer is a prerequisite to the development and enhancement of surgical skills. Direct hands-on experience with transvaginal ultrasound imaging techniques is considered to be an integral part of the training experience. The fellow must have direct experience in the interpretation of all imaging procedures and histological material available from the surgical specimens. C. In order to develop an appreciation for the scope and limitations of laboratory techniques, the fellow must become familiar with the relevant laboratory procedures in reproductive endocrinology and infertility. The fellow should acquire a thorough understanding of the theory and special methodology utilized to perform hormonal assays, tissue culture techniques, receptor assays, molecular biological procedures, chromosomal analyses, and gamete manipulation. D. The fellowship program director must provide evidence of strong scholarly activity and productivity by faculty and fellows in clinical and/or laboratory research. Research projects can be developed either within the department or in collaboration with other academic departments. The portion of each fellow’s education devoted to research must ultimately result in a thesis that may be worthy of publication in a peer-reviewed journal. It is expected that fellows will acquire a thorough knowledge and understanding of the methodologies and analyses used in research protocols that relate to research in their area of study. An in-depth understanding of the statistical analysis of research projects is mandatory. ARTICLE VIII - PROGRAM DIRECTOR REQUIREMENT A. The program director shall be a diplomat of the American Osteopathic Board of Obstetrics and Gynecology (AOBOG) and certified in reproductive endocrinology, and by training experience and teaching ability shall qualify to implement and conduct the program in reproductive endocrinology. B. The program director shall be a member in good standing of the American College of Osteopathic Obstetricians and Gynecologists. The program director shall endeavor at all times to set a benchmark of professional behavior consistent with, or exceeding, the code of ethics of the ACOOG and the AOA. C. The program director shall insure that osteopathic theory and practice and its application to the specialty are emphasized. D. The program director shall be required to submit annual progress reports on the fellows to the director of medical education of the hospital, and the American College of Osteopathic Obstetricians and Gynecologists (ACOOG) along with an annual administrative fee. These reports shall cover the fellow's progress, acceptability as a prospective specialist, and other factors pertinent to the continuation of training. In addition, any reports received more than thirty (30) Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 8
  9. 9. days after the end of year training will not be reviewed by the REC of the ACOOG until a $150.00 late fee has been paid. E. The program director shall annually retrieve his/her evaluation of the program director and the program faculty summary as performed by the fellows within sixty (60) days of the end of each training year and assure that these evaluations are reviewed annually with the director of medical education. F. The program director shall keep the ACOOG advised at all times of a working e-mail address. ARTICLE IX– FACULTY Consultative services must be available in the areas of medical endocrinology, pediatric endocrinology, and genetics. The presence of institutional training program in these areas is beneficial, but not required. There also must be evidence of mutually complementary active and continuing interaction between these groups and the program’s fellow. It is essential that another individual with special interest and expertise in the management of male infertility be associated with the program, and this person must provide formal education for the fellows and consultative care for male infertility. ARTICLE X - CANDIDATE REQUIREMENTS A. The candidate shall be a graduate of an AOA accredited college of osteopathic medicine. B. The candidate must have completed an AOA approved residency in obstetrics and gynecology. C. The candidate shall be a member of the AOA and shall maintain that membership throughout specialty training. D. The candidate shall have applied for the AOBOG general OB/GYN certification exam and shall have taken the written portion of the exam prior to matriculating the fellowship. ARTICLE XI - FELLOW RESPONSIBILITIES A. All fellows shall maintain satisfactory records of work performed. These shall be submitted monthly to the program director for review and verification. These records shall be filed with the hospital administrator or the director of medical education. B. Fellows shall participate in the teaching of house staff and interns. C. The fellow shall not be permitted to act as a consultant; however, fellows may render services to affiliated clinics with the approval of the program director. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 9
  10. 10. D. The fellow shall submit annually, verified by the signature of the program director, a training program report to the ACOOG within thirty (30) days of the end of each year’s training. The fellow must also complete an annual evaluation of the program director and faculty in a format as required by the ACOOG. If either of these annual reports is received after the thirty (30) day deadline, a late fee of $150.00 must be paid before the REC will review them. E. All fellows must produce a thesis as first author. It is required that the fellow actually performs the research. F. All fellows must register as a candidate member of the ACOOG within sixty (60) days of matriculating to the fellowship and must keep the ACOOG informed of a working e-mail address at all times. Failure to do so will result in a late fee of $50.00 which will be paid prior to the rec review of the end-of-year training reports. The fellow will maintain a standard of professionalism that meets or exceeds the code of ethics of the ACOOG and the AOA. Candidate members do not pay dues to ACOOG. G. The fellow will attend appropriate conferences relating to reproductive endocrinology. H. The fellow will be encouraged to attend appropriate meetings including the annual meeting of the ACOOG, and any additional meetings that the program director may deem appropriate. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 10
  11. 11. APPENDIX I – FELLOW WORK HOURS AND SUPERVISION POLICIES It is recognized that excessive numbers of hours worked by fellow 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 fellowship program director must maintain a high degree of sensitivity to the physical and mental well being of fellows and make every attempt to avoid scheduling excessive work hours leading to sleep deprivation, fatigue or inability to conduct personal activities. A. Work Hours The following work hours policy will apply to all fellows. 1. The fellow shall not be assigned to work physically on duty in excess of eighty (80) hours per week averaged over a four (4) week period, inclusive of in-house night call. 2. The fellow 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. Fellows may not assume responsibility for a new patient after twenty-four (24) hours. 3. 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 below.) 4. The fellow shall have alternate week forty-eight (48) hour periods off or at least one (1) twenty-four (24) hour period off each week. 5. Upon conclusion of a twenty-four (24) hour duty shift, fellows 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. 6. All off-duty time must be totally free from assignment to clinical or educational activity. 7. Those rotations requiring the fellow to be assigned to Emergency Department duty shall not be assigned longer than twelve (12) hour shifts. 8. The fellow and training institution must always remember the patient care responsibility is not precluded by this policy. In the case where a fellow is engaged in patient responsibility which cannot be interrupted, additional coverage should be provided to relieve the fellow involved as soon as possible. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 11
  12. 12. 9. The fellow may not be assigned to call more often than every third night averaged over any consecutive four (4) week period. B. On-Call Room The training institution shall provide an on-call room for fellows, 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. C. Moonlighting Policy Any professional clinical activity (moonlighting) performed outside of the official fellowship program may only be conducted with the permission of the program administration (DME/Program Director). A written request by the fellow must be approved or disapproved by the Program Director and DME and be filed in the institution’s fellow 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 house staff manual. Failure to report and receive approval by the program may be grounds for terminating a fellow’s contract. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 12
  13. 13. APPENDIX II - MODEL OSTEOPATHIC GME POLICY ON ACADEMIC AND DISCIPLINARY DISMISSALS 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 fellows, orally and in writing, of inadequacies and their effects on academic standing. The fellow 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 fellow may be placed on probation for a period of three (3) to six (6) months. The fellow may be dismissed following this period, if deficiencies remain and are judged to be irremediable. In accordance with institutional policy, the fellow 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 irremediable, the hospital and department will provide the fellow with adequate notice, in writing, of specific ground(s) and the nature of the evidence on which the disciplinary action is based. The fellow will be given an opportunity for hearing in which the disciplinary authority will provide a fair opportunity for the fellow's position, explanations and evidence. Finally, no disciplinary action will be taken on grounds which 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. Fellows may be allowed counsel at hearings concerning disciplinary issues. Pending proceedings on such disciplinary action, the hospital in its sole discretion may suspend the fellow, when it is believed that such suspension is in the best interests of the hospital or of patient care. Basic Standards for Fellowship Training in Reproductive Endocrinology, Revised BOT 7/2007, Effective 7/2008 13

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