ACGME Releases Draft Clinical Informatics Fellowship Program Requirements For Public Comment

As with all medical subspecialties, the new clinical informatics (CI) subspecialty will need to develop fellowship training programs for those seeking to enter the field. After the first five years of the subspecialty (which starts in 2013), during which the training requirements to be eligible to sit for the certification exam can be met by the "practice pathway" or a “non-traditional fellowship" (i.e., "grandfathering"), starting in 2018 the only way to become certified will be through a fellowship accredited by the Accreditation Council for Graduate Medical Education (ACGME).

On July 29, 2013, the ACGME released a draft program requirements document and opened up a 45-day comment period for public feedback (with comments due September 11, 2013). This posting provides a summary of the 26-page document. In a subsequent post, I will provide the comments that the Oregon Health & Science University (OHSU) biomedical informatics program submits to ACGME.

As with most training requirements documents, there is boilerplate (required of all specialties, in bold text style) and specialty-specific text (plain text style).

All CI programs will need to be administratively integrated with one of six specialties: Anesthesiology, Emergency Medicine, Medical Genetics, Pathology, Pediatrics, or Preventive Medicine. This does not mean that a program needs to be focused in one of these specialties; it only means that it must be administered by one of them. CI programs will not have their own residency review committees (RRCs), but instead will be reviewed by RRCs from these six specialties. Physicians from other specialties can enroll in any of these programs.

Programs will be required to be of 24 months duration, with the fellow having completed the program within 48 months.

There must be a single program director who is board-certified in CI or a subspecialty acceptable to the RRC. There are substantial administrative responsibilities for the director. He or she must also have five years experience working in CI. There must be two additional faculty members, with the three faculty collectively devoting at least two FTE to administration, supervision, and teaching. There must also be a program coordinator to provide administrative support.

In addition to resources for education, the program must have a "clinical information system" that contains health and wellness data, includes clinical decision support, and is accessible in all (inpatient and outpatient) healthcare settings.

The program must of course have an educational program that has clear competency-based goals that are distributed to faculty and fellows at least annually. There must be regularly scheduled didactic sessions. The document is not specific as to the content of the educational program, but of course the content must as a minimum prepare the student to pass the CI subspecialty board exam.

The educational competencies that the program must follow are based on the six ACGME core competencies, with some additional learning objectives specific to CI. The ACGME competencies and some of CI extensions include:

1. Patient care and procedural skills – leverage information and communication technology across the dimensions of healthcare to improve processes and outcomes
2. Medical knowledge – demonstrate knowledge of informatics theory and practice
3. Practice-based learning and improvement – develop skills and habits for self-evaluation and life-long learning
4. Interpersonal and communication skills – communicate effectively, including serving as a liaison between information technology professionals, administrators, and clinicians
5. Professionalism – demonstrate all aspects of professionalism, including the ability to recognize the causes and consequences of security breaches and to show sensitivity to the impact of information system changes
6. Systems-based practice – in addition to understanding the operations of the healthcare system, be able to recognize and disclose the role of oneself and systems in medical error as well as identify and improve the impact of systems on clinical care

Programs must be evaluated at the level of the fellow, the faculty, and the whole program, to be done via:

• Clinical Competency Committee of three program faculty to evaluate fellows semi-annually
• Faculty evaluations to be done at least annually
• Program Evaluation Committee of two faculty and one fellow for ongoing evaluation of program

In addition, the document states standard requirements for duty hours, supervision, moonlighting, mandatory time free of duty, and maximum duty period length. Clinical work may be performed in the fellow’s primary specialty.

(Thanks to Ben Munger of University of Arizona for reviewing this summary and providing feedback. All errors, however, are my responsibility.)