香港六合彩

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一惊,将近八点,忙掏手机,果然有家里的好几通未接来电,估计刚才冷得直抖外加慌得直颤才没意识到。糟了,心里这样想,电话里还保持着谈笑自如,过度几句话才说,不早了,我要回家了。啊,你不是在家打的电话?周晨晨顿然不安。子允想不到香港六合彩为这事反应如此之大,一股甜蜜蜜的滋味灌满整个肠胃,闹事的胃酸立即消失。香港六合彩经不住周晨晨关心,把为什么在这里打电话的原因说了一遍,描述的时候差点把自己感动得要哭。周晨晨不在话下,直说,笨,笨笨,我怎会不接你电话呐,快回家吧,家人等急了可不好。才罢,又娇嗔的口吻道,瞧你愣头愣脑的,什么事都想得那么简单,路上小心噢。子允依依不舍挂掉电话,跨上车子并不急着走,深深吸了一口冷气,冷气窜到肺里后立马变暖。《Y滋味》寒冷相逼回家后自然逃不过一顿责备,子允心中有无限暖意在呵护,不在乎眼前暂时的寒冷相逼,所以一反常态地不加任何解释,由着父母传承严谨的家风。其实这个过程不长,在父亲接过母亲说教的重任时,母亲已动用所有加热设备热来菜饭。子允感动无限,态度更加好地向父母认错。没见过儿子如此乖顺的父母大为激动,后悔刚才言语过于严重。子允顾不得品味好菜好饭,只把嘴巴当成肠胃进口通道,脑瓜子复读机一样仔细回味着刚才跟周晨晨的一字一句,尤其最后香港六合彩为自己着急的口气和香港六合彩对自己不加掩饰的关心。子允从没吃过这种滋味的饭菜,放下碗就蹿到楼上自己的房间赶作业。香港六合彩家三百多平方米住房,大得可以踢足球,可惜只香港六合彩一个小孩,玩不起比赛。其实,有几个兄弟又怎样,高二下学期才开始,家庭作业就呼啸地填满整个晚上。子允得抓紧时间赶写,不然交不出作业的待遇可没几个人受得了。也没什么啦,上有政策下有对策,古已有之。老师要求每天第一堂下课交作业,没做的同学就起早赶到学校或向住校同学借着抄,或相互之间互通有无。老师没这些同学勤奋,哪有香港六合彩起得早。等老师来时,这些同学早已收拾好作案工具,有潇洒者还会去食堂补吃早饭。这样情况也会被左派分子打小报告,但老师有心抓贼,却无力回天,精力耗不过更加年轻的学生们,加之于学校政策是教育为主,惩罚为辅,老师再狠心权力也有限,而众多学生的游击战术却无限,抄袭之风自然无法根治。十一点多,子允还有一块大骨头没啃

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  • 香港六合彩

    1. 1. Updates from the Residency Review Committee for Pediatrics Jerry Vasilias, PhD, Executive Director Caroline Fischer, Associate Executive Director
    2. 2. RRC Composition <ul><li>3 appointing organizations - AAP, ABP, AMA </li></ul><ul><li>10 voting members; due to workload increase to 13 </li></ul><ul><li>members serve a term of 6 years -- except resident </li></ul><ul><li>Generalists and subspecialists </li></ul><ul><ul><li>Critical Care Medicine, Hematology/Oncology, Pediatric Emergency Medicine, Gastroenterology, Neurology, Nephrology, Rheumatology </li></ul></ul><ul><li>Geographic Distribution – CA, CT, DC, GA, MI, MD, OH, PA, WA </li></ul><ul><li>Ex-officio members from each appointing organization (non-voting) </li></ul>
    3. 3. RRC Review of Programs <ul><li>Peer Review – 2 reviewers </li></ul><ul><li>Reviewers use the following information to determine whether program is in compliance with the requirements: </li></ul><ul><ul><ul><li>Program Information Forms (PIF) </li></ul></ul></ul><ul><ul><ul><li>Site visitor’s report </li></ul></ul></ul><ul><ul><ul><li>Board scores </li></ul></ul></ul><ul><li>Program Directors: this is an open book test </li></ul><ul><ul><ul><li>Questions in PIF correspond to program requirements </li></ul></ul></ul><ul><li>Reviewers present program to Committee </li></ul><ul><li>Committee assigns accreditation status along with review cycle, range of 1-5 years </li></ul>
    4. 4. Review Cycle of Cores and Subs <ul><li>Historically : Review cycle of sub was aligned with core. </li></ul><ul><ul><ul><li>If core has a three year cycle, sub had a three year cycle. </li></ul></ul></ul><ul><ul><ul><li>- The cycle of the sub did not exceed that of the core </li></ul></ul></ul><ul><li>Now : ACGME has allowed RRC to un-couple subs cycle from core. </li></ul><ul><ul><ul><li>Subs are still considered dependent, but the cycle of the sub can exceed that of the core. </li></ul></ul></ul><ul><li>Continued with warning status </li></ul><ul><ul><ul><li>If receive a 2 year cycle warning language is included in letter </li></ul></ul></ul><ul><li>New subspecialty applications: </li></ul><ul><ul><ul><li>Do not require a site visit </li></ul></ul></ul><ul><ul><ul><li>Maximum of a three year cycle </li></ul></ul></ul>
    5. 5. Citation <ul><li>Citation = the program has not documented/provided evidence of substantial compliance with the minimum requirements, or, an area identified by the site visitor as non-compliant </li></ul>
    6. 6. Summary of Activities in 2006 <ul><li>The RRC meets twice a year – Spring and Fall </li></ul><ul><ul><li>Workload per meeting in 2006: </li></ul></ul><ul><ul><li>approximately </li></ul></ul><ul><ul><ul><li>30 core programs </li></ul></ul></ul><ul><ul><ul><li>120 subs pecialty programs </li></ul></ul></ul><ul><ul><ul><li>15 progress reports </li></ul></ul></ul>
    7. 7. Accreditation Decisions in 2006 --Subspecialties of Pediatrics 15 Proposed Adverse Actions 236 Total 7 Accreditation Withheld 9 Voluntarily Withdrawal 182 Continued Accreditation 22 Accreditation Types of Status Decisions in 2006
    8. 8. Most Frequent Citations in 2006 – Subspecialties of Pediatrics 26 12. Evaluation of Faculty – not being done; not confidential 34 11. Goals and Objectives – not being rotation and level specific 43 10. Institutional Support – internal review; facilities issues; personnel issues 48 9. Responsibilities of the PD – providing accurate info; sufficient time to the prog 52 8. Qualifications of Faculty – not ABP certified; no evidence of on-going scholarship 53 7. Didactic Components – conference attendance; particular curriculum lacking 61 6. Procedural Experience – lack required # of procedures; lack logging of procedures 71 5. Evaluation of Fellows – semi-annually; not written; competent and independent 85 4. Curricular Development – general curriculum issues; research methodology, etc 100 3. Evaluation of the Program – no documentation (minutes); don’t include fellows 119 2. Patient Care Experience – lacking adequate patient population 133 1. Research and Scholarly Activity – faculty and fellow lacking <ul><li>Programs Reviewed for a Status Decision </li></ul><ul><li>Total of 963 citations -- about 5 citations/program </li></ul>
    9. 9. New General Subspecialty Requirements <ul><li>Went into effect January 1, 2007 </li></ul><ul><ul><li>Competencies! </li></ul></ul><ul><ul><ul><li>“ Companion document” </li></ul></ul></ul><ul><ul><li>Collaboration between programs </li></ul></ul><ul><ul><ul><li>Documented semi-annual meetings b/w subs and core </li></ul></ul></ul><ul><ul><ul><li>Departmental approach to common educational issues (core curriculum, competencies, evaluation, SOC etc). </li></ul></ul></ul><ul><ul><ul><li>Message: Don’t reinvent the wheel! </li></ul></ul></ul><ul><ul><li>New language for administering and managing a subspecialty program </li></ul></ul>
    10. 10. General Subspecialty Requirements (cont) <ul><ul><li>Research and scholarly activity </li></ul></ul><ul><ul><ul><li>Faculty: </li></ul></ul></ul><ul><ul><ul><ul><li>must have ongoing scholarship – peer reviewed funding and pubs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>scholarly environment outside of the training program can supplement, but does not replace within program </li></ul></ul></ul></ul><ul><ul><ul><li>Fellow: </li></ul></ul></ul><ul><ul><ul><ul><li>must design + conduct a scholarly project in sub w/ guidance of PD and mentor </li></ul></ul></ul></ul><ul><ul><ul><li>Program: </li></ul></ul></ul><ul><ul><ul><ul><li>must identify a mentor and scholarship oversight committee to oversee fellow’s progress related to scholarly activities </li></ul></ul></ul></ul><ul><ul><li>Board Score Information </li></ul></ul><ul><ul><ul><li>Deficient if over 6 yrs LT 75% take, of those who take LT 75% pass it. </li></ul></ul></ul><ul><ul><ul><li>Exceptions will made for programs with small # of fellows </li></ul></ul></ul>
    11. 11. <ul><li>Revised Common Program Requirements go into effect July 1, 2007 </li></ul><ul><ul><li>Review language for PD duties and responsibilities; appointment of PD; participating sites; competencies </li></ul></ul><ul><li>Changes to the PIF </li></ul><ul><ul><li>Common requirements questions will migrate to ADS -- Electronic PIF </li></ul></ul><ul><ul><li>More information will be provided from ACGME on this in the near future </li></ul></ul>Common Requirements
    12. 12. www.acgme.org <ul><li>www.acgme.org </li></ul><ul><li>Staff contact information </li></ul><ul><li>ACGME Policies & Procedures </li></ul><ul><li>Competencies/Outcomes Project </li></ul><ul><li>ADS/List of accredited programs </li></ul><ul><li>Duty hours Information/FAQ </li></ul><ul><li>Affiliation Agreements FAQ </li></ul><ul><li>General information on site visit process and your site visitor </li></ul><ul><li>Pediatrics Webpage </li></ul><ul><li>Resident complement increase </li></ul><ul><li>Application timeline </li></ul><ul><li>Frequent citations </li></ul><ul><li>Program Requirements </li></ul><ul><li>PIFs </li></ul><ul><li>Archive of RRC Updates/Email Communications </li></ul>
    13. 13. Resident Survey <ul><li>New survey </li></ul><ul><ul><li>Heavily vetted – residents, RRCs </li></ul></ul><ul><ul><li>implemented in waves starting in January - May </li></ul></ul><ul><ul><li>contains elements of the common requirements, not just duty hours </li></ul></ul><ul><li>Who participates: </li></ul><ul><ul><li>All core programs and subspecialty programs with 4 or more residents/fellows </li></ul></ul><ul><li>Survey programs every other year </li></ul><ul><li>Programs are notified directly – not residents </li></ul><ul><li>70% compliance required </li></ul>
    14. 14. ACGME’s Strategic Plan <ul><li>In November 2005, ACGME endorsed 4 strategic priorities. </li></ul><ul><ul><li>1) Foster innovation and improvement in the learning environment </li></ul></ul><ul><ul><li>2) increase the accreditation emphasis on educational outcomes </li></ul></ul><ul><ul><li>3) Increase efficiency and reduce burden from accreditation </li></ul></ul><ul><ul><li>4) Improve communication and collaboration with key internal and external stakeholders </li></ul></ul><ul><li>Many of the changes ACGME has implemented in the recent past and will continue to roll out in the future can be seen from the vantage point of the 4 strategic priorities. </li></ul>
    15. 15. Innovations and Improvements to the Learning Environment <ul><li>Conference on Educational Re-Design </li></ul><ul><li>ACGME focus on innovation </li></ul><ul><li>Portfolios </li></ul><ul><li>Innovation within the RRC </li></ul><ul><ul><li>R3P </li></ul></ul><ul><ul><li>“ Companion Documents” </li></ul></ul>
    16. 16. Increase Emphasis on Outcomes <ul><li>RRC has been front-runner with competencies </li></ul><ul><ul><li>Core requirements – January 1, 2006 </li></ul></ul><ul><ul><li>Subspecialty requirements -- January 1, 2007 </li></ul></ul><ul><ul><li>Competency PIF questions </li></ul></ul><ul><ul><li>“Companion documents” </li></ul></ul><ul><ul><li>Competency citations </li></ul></ul><ul><li>New common requirements </li></ul><ul><li>Competencies modules are available on outcome webpage </li></ul>
    17. 17. Increase Efficiency and Reduce Burden -- ACGME <ul><li>E-mail status of programs on RRC agenda </li></ul><ul><ul><ul><li>Within 3-5 days of RRC meeting will receive an email with the accreditation status and review cycle. </li></ul></ul></ul><ul><li>E-mail to notify you that your notification letter is posted on ADS. </li></ul><ul><ul><ul><li>Will no longer send notification letters. </li></ul></ul></ul><ul><li>Standard letters of notification </li></ul><ul><li>New ADS features </li></ul><ul><ul><ul><li>Field to response to citations </li></ul></ul></ul><ul><ul><ul><li>Making complement, PD, VW and participating institutions </li></ul></ul></ul><ul><ul><ul><li>This will feed directly into part 1 of the PIF </li></ul></ul></ul>
    18. 18. Increase Efficiency and Reduce Burden -- RRC <ul><li>New PIF for core and subs </li></ul><ul><ul><ul><li>Streamlining the document and making it less onerous to complete </li></ul></ul></ul><ul><ul><ul><li>More checkboxes and forced choice responses </li></ul></ul></ul><ul><ul><ul><li>Narrative sections remain, but there is a limit on amount allowed   </li></ul></ul></ul><ul><li>No Competencies Assessment Form </li></ul><ul><li>Collaboration stressed in requirements </li></ul><ul><li>Collaboration with CoPS for PIF </li></ul>
    19. 19. Improve Communication and Collaboration <ul><li>Email updates from RRC are posted on website </li></ul><ul><li>Collaboration in the requirements </li></ul><ul><li>Engaging CoPS on PIF construction for new requirements </li></ul><ul><li>[email_address] </li></ul><ul><li>[email_address] </li></ul><ul><li>[email_address] </li></ul>
    20. 20. Requirements <ul><li>Effective July 1, 2006 </li></ul><ul><li>Combined Training in Internal Medicine/Pediatrics </li></ul><ul><li>Effective July 1, 2007 Requirements to be Revised </li></ul><ul><li>Adolescent Medicine Developmental-Behavioral </li></ul><ul><li>Critical Care Medicine Endocrinology </li></ul><ul><li>Pediatric Cardiology Gastroenterology Pediatric Emergency Medicine Infectious Diseases </li></ul><ul><li>Pediatric Hematology-Oncology Nephrology </li></ul><ul><li>Neonatal-Perinatal Medicine Pulmonology </li></ul><ul><li>Pediatric Rheumatology Sports Medicine </li></ul>

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