The Academic Pediatric Association APA AGP Fellowship Project An Update

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The Academic Pediatric Association (APA) AGP
Fellowship ProjectAn Update

• The AGP Fellowship Project Committee
• PAS Meeting, May 2008

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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

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Question

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

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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

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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

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Background-1

• Survey of AGP programs in US (119/199 responded
  - 60)
• Have AGP fellowship program 28
• Plan to start one 13
• Program duration 3 yrs (32) 2 yrs (64)
• Masters degree 76
• Clinical time 31 mean (range 10-90)
• Major challenge Funding

Cheng, Markakis, DeWitt, Pediatrics. 2007
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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

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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

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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

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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

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Strengthening the Academic Base of General
Pediatrics Fellowship Programs A National
Program and Curriculum Development Project
Ambulatory Pediatrics. 2007Volume 7 (2
articles) Description of program and pilot
340-347 Curriculum design, goals, objectives
328-339

• Constance Baldwin, PhD Peter Szilagyi, MD, MPH
• Louis M. Bell, MD Bernard Dreyer, MD
• Tina L. Cheng, MD, MPH Dan Coury, MD
• Tom DeWitt, MD Paul Darden, MD
• Stephen Ludwig, MD

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Objectives

• To strengthen academic general pediatrics (AGP)
  fellowship programs by

• Developing curriculum guidelines and program
  standards
• Creating a process for program review and
  consultation that might later be used for
  accreditation of AGP fellowship programs
• Pilot test an accreditation process
• (Funding from DHHS, Bureau of Health Professions)

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Accomplishments to Date - 1

• Developed Curriculum and Educational Goals and
  Objectives
• (Ambulatory Pediatrics 20077328-339)

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AGP FellowshipFive Core Curriculum Requirements
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Educational Goals Objectivesfor Academic
Competence
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Accomplishments to Date - 2

• Developed program requirements
• Developed a standardized program description form
• Site visited 7 programs and summarized lessons
  learned
• (Ambulatory Pediatrics 20077340-347)

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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

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Site Visit Pilot ProjectProcess

• 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

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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

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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

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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

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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)

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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

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Academic General Pediatric FellowshipAccreditatio
n 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

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Roll Out Plan For Program If Approved
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Its All About Pipeline