Alternate Training Tracks or Sites (e.g., Rural, Urban)
2006

The RRC is receptive to proposals for the use of alternate tracks/sites. If you plan a track within an existing program the residents in the track must have 20 months of training in common with the other residents. If that is not the case, perhaps the proposed track can qualify as a separate program, as is the case with those that operate in the 1-2 format. You are encouraged to contact the Executive Director of the RRC to discuss your plans prior to formal submission of a proposal. Residents should not be assigned to new sites until RRC approval is achieved.

The procedures vary depending on the nature of the proposal, i.e., whether it involves only a few months or an extensive period of time at the alternate site. A proposed arrangement may be considered as part of an accredited residency, as the equivalent of a separate program that should be accredited independently, or as an entity accreditable as a separate 1-2 program. In the latter two cases a site visit will be required and the full Program Information Form (PIF) must be completed . Generally, if less than 20 months of training is in common with the core program, the proposal will be considered a separate program rather than as a track within an accredited program.

In all cases the RRC will expect documentation that:

1. residents will have the required experiences during their three years of training
2. there will be at least two residents at the rural site, i.e., 1 PGY-2, 1 PGY-3, and that some degree of interaction with the parent program is maintained
3. there are an adequate volume and mix of patients
4. there is adequate and stable financial support for the proposal
5. appropriate supervision is ensured, i.e., if 1 resident is present, the supervising physician may engage in other activities to a maximum of 50%; the presence of 2 residents requires a full time physician preceptor
6. residents’ experience in the provision of continuity of care is satisfactorily addressed
7. the program director will have appropriate authority over the educational activities in the additional facilities.

If you are uncertain whether your proposed plans will be acceptable, you may submit an abbreviated proposal for the RRC’s review and comment. Such proposals * for alternate training tracks/sites should include the following either in a separate narrative or as part of the information provided in the full PIF:

1. the rationale for the alternate track/site and how it will relate organizationally to the parent program;
2. a description of the alternate location, its distance from the parent program and the degree of liaison that will be maintained between these residents and those in the main program;
3. the number of residents at each level who will participate, whether these will be in addition to the regular complement and how they will be selected and assigned;
4. a block diagram/longitudinal chart, excerpted from the PIF, for each of the three years of training with indication of which years or parts of years will be at the alternate site;
5. a description of each of the components of the curriculum *** that will be handled at this site, including the content, duration, estimated patient numbers and age distribution (refer to questions asked on PIF);
6. a list of participating faculty with their credentials and amount of time contributed to the teaching program; provide information on specialty faculty as needed, using the appropriate pages from the PIF;
7. staffing information/hospital statistics (PIF) for hospitals at the proposed site including a statement regarding how many of the patients will be available to the residents;
8. a description of the conferences available at this site, their frequency and who will conduct them (PIF);
9. a description of the model unit or other facility that will be used for the continuity experience (PIF - note that a DRAWING, not a blueprint, is requested);
10. details of the funding arrangements;
11. letters of support/concurrence from participating institutions or agencies.

Proposals that involve a departure from the regulations of the American Board of Family Medicine should be discussed with the Executive Director of the Board to avoid jeopardizing residents’ eligibility.

The Program Requirements and the Program information Form (PIF) may be downloaded from the ACGME Website: www.acgme.org. Guidelines for describing a program in a 1-2 format are included in the instructions on the PIF.

Send proposals to:

Jerry Vasilias, PhD, Exec. Dir.
RRC for Family Medicine
515 N. State Street, Suite #2000
Chicago, IL 60654
(312) 755-7477
jvasilias@acgme.org

PROGRAMS IN 1-2 FORMAT

Be sure you have the current PIF that was obtained from the RRC office recently. The instructions that are attached to the PIF provide some guidelines for describing a proposed program that will operate in the 1-2 format, with the first year taking place in an accredited program and years 2 and 3 being at a different site. Note that both the ABFM and the RRC require that the last two years (24 months) involve continuity of care for a panel of patients. In some 1-2 programs year one is not identical to the year 1 for residents remaining at that site for the three years. Some additional tertiary care experiences are offered in year 1 to the residents in the 1-2 program. Such arrangements should be clearly described in the PIF for the 1-2 program.

The PIF instructions state:

* Check with the staff in the RRC office regarding deadlines for submission of proposals in relation to scheduled RRC meetings. For those requiring a site visit, count on one year for processing and evaluating the proposal.

*** If the proposal involves the suspension of a program requirement, explain how an alternate arrangement will be used to accomplish the goals of that requirement.