What’s New at ACOFP

1. What’s New at ACOFP What you as residents need to know

2. Updates in the 7/2011 Basic Standards include changes in the following: • Internal Medicine • Ambulatory Care Continuity • Geriatrics • Sports Medicine • Procedural Training • Community Medicine • Safety and Quality Improvement • Practice Management • Diagnostic Imaging • Women’s Health

3. The Program Itself… • Must utilize at least one hospital where FP’s have admitting privileges • Must utilize at least one extended care facility where family practice residents can care for patients under supervision by residency faculty. • Must provide a minimum of one osteopathic family practice training site • multiple sites may be utilized as long as they meet standards

4. General Internal Medicine • At least 32 weeks of clinical training in internal medicine disciplines • At least 8 weeks of general internal medicine experiences during the OGME-1 year • Can be met by either inpatient internal medicine or inpatient family practice service • 24 weeks of inpatient experience • 4 weeks of training in critical care medicine • This is part of inpatient experience

5. Continuity of Care Clinic • 1650 patient visits during residency • minimum of 150 during OGME-1 year • Minimum of 40 weeks per year in Continuity of care site • Note: “Sessions” may still be used for OGME-3 residents as they began prior to the new standards • 312 total “sessions” over 3 years

6. Geriatrics • The program must provide at least 100 hours or 1 month of training in the care of the geriatric patient. • This is in addition to training that occurs in the continuity of care site or general internal medicine rotations

7. Sports Medicine • The program must provide at least 50 hours or two weeks of training in Sports Medicine • This is in addition to time spent in the continuity of care ambulatory site • At a minimum this must include: • Pre-participation assessment • Didactic and clinical experiences • Management of uncomplicated sports related injuries • Rehabilitation of athletic related injuries • Injury prevention/training

8. Procedural Training** • The program must have defined mechanisms to train residents to competency in the 16 procedures: • Joint injections • Biopsy of dermal lesions, excision of subcutaneous lesions, incision and drainage of abscess • Cryosurgery of skin, curettage of skin lesion • Laceration repair, endometrial biopsy • Office microscopy, splinting, EKG interpretation • Office spirometry, toenail removal, removal of cerumen from ear • Defibrillation and endotracheal intubation

9. Community Medicine • The program must provide 50 hours or two weeks of documented training in community medicine

10. Community Medicine • The time can be spent in any/some/all of the following experience: • Occupational health • Mental health agencies • Community based screening programs • Public health agencies • Community health centers • Free clinics • Drug and alcohol treatment centers • School health programs • Homeless shelters

11. Safety and Quality Improvement • The program must provide training in patient safety and quality improvement. • At a minimum this shall include: • Identification and analysis of inpatient and ambulatory measures of quality. • Utilization of quality measurements to improve patient care. • Participation in at least one national or regional quality improvement registry. • Training in the principles of the Patient Centered Medical Home (PCMH).

12. Practice Management • At least 20 hours of structured educational experiences • Training shall include: • Debt management, retirement planning • Financial planning, disability insurance • Medical liability insurance, risk management • Coding, HIPAA requirements in office setting • OSHA for private practice • Payer mix, practice overhead management • Personnel management

13. Diagnostic Imaging • Must be a structured curriculum • At a minimum: • Didactic and clinical experience • Utilization of appropriate radiographic studies

14. Women’s Health • At least 12 weeks in women’s health • At least 4 weeks during OGME-1 • Gynecologic training to include both in- hospital and ambulatory care • Obstetrical portion to include both in- hospital and ambulatory care

15. Surgery • At least 20 weeks • At least 4 weeks general surgery in OGME-1 • Other surgical rotations can be in general or surgical subspecialty (urology, orthopedic, ophthalmology, ENT, etc.) • Ambulatory and/or inpatient management

16. Pediatrics • 16 weeks total (4 weeks in 1st year) • Must include care of the newborn and inpatient pediatrics

17. Electives • Each resident shall have a minimum of 20 weeks to a maximum of 28 weeks • Basic standards of 7-1-11 are flexible as to when electives utilized

18. Scholarly Activity • Each resident must participate in an active research activity: • Resident research project within family medicine department or at the Institution level, or in a Multi- Center project involving family medicine • Original paper on health care topic • Presentation at state, regional or national level • Author a grant

19. During Residency Inspection What is automatic 1 year probation regardless of the rest of the inspection

20. Automatic Probation • Program Requirements: • The program must provide didactics for an average of at least five hours per week • Curriculum Requirements: • Three year continuity of care site experience must include at least 1,650 patient visits, with a minimum of 150 in OGME-1 year • Responsibilities: • Program Director must have sole responsibility and authority for educational content and conduct of the residency • Family Physician Faculty: • There must be at least one time full time equivalent faculty (FTE) for each six residents in the program

21. Automatic Probation • Program Requirements: • The program must provide didactics for an average of at least five hours per week • Curriculum Requirements: • Three year continuity of care site experience must include at least 1,650 patient visits, with a minimum of 150 in OGME-1 year • Responsibilities: • Program Director must have sole responsibility and authority for educational content and conduct of the residency • Family Physician Faculty: • There must be at least one time full time equivalent faculty (FTE) for each six residents in the program

22. Immediate Closure • Institutional Requirements • Ambulatory Continuity of Care Site • The institution must provide a minimum of one Osteopathic Family Medicine Training Site • Program Director/Faculty • Program Director • Each program must have a single Program Director who is compensated by the institution

23. Preparing for ABOFP Sitting for your specialty (FP) boards

24. Two separate sections… • Electronic Testing (Cognitive) • Offered twice annually • April and October • Performance Evaluation (OMT) • Offered twice annually • During ACOFP spring convention • During AOA (OMED) Fall convention • Can be done in any order

25. When is the earliestI can take the exam? • If you are scheduled to complete the residency by June 30, you are eligible to take the ABOFP exams during the Spring prior to graduation • You have to attend an ACOFP meeting during either your 2nd or 3rd year anyway. Avoids cost of 2 trips. • If you are off cycle by a month (e.g., maternity leave), program can petition to allow you to take test in spring as well.

26. For the NEXT cycle…

27. Performance Evaluation (OMT) Fee includes both the performance and cognitive exams

28. Cognitive Exam (computer) Test dates for Spring, 2014 can be found at http://www.aobfp.org/exam/index.html Cognitive given April 5th, 2014; Performance given at ACOFP – March 11&12

29. Application to take exam • http://www.aobfp.org/cert-req/cert-app.pdf • Once you have completed application, you will receive notice from ABOFP and can schedule your cognitive exam through Pearson VUE • Similar to prometrics for COMLEX, however fewer test sites available • http://www.pearsonvue.com/aobfp/

30. …From the website… • You will be provided with detailed information from Pearson VUE for the selection of your test site only after your completed application and supporting documents have been received by the AOBFP, fully processed/verified, and your eligibility is confirmed in writing. • AOBFP requires at least four weeks after receipt for the processing of your materials. • Once you have received your verification from the AOBFP that you are approved for examination, it is to your benefit to contact Pearson VUE in a timely manner to select your preferred test sites, as confirmations will be provided on a first come, first served basis.

31. Eligibility to take exam • Graduate of an approved osteopathic college • Current full, unrestricted license • it is understood that residents may be practicing with a temporary license or under a hospital license • Member in good standing of the AOA for at least two consecutive years immediately prior to application, examination and presentation for certification AND . . . • Completion within the immediate past six years of a one-year AOA-approved internship and a two-year AOA-approved family medicine residency program OR currently in a three-year AOA- or ACGME-approved approved family medicine residency program to be completed no later than December 31, 2013.

32. The Practical Exam • You will be randomly assigned a day and time for the exam by the ABOFP • Based on first come/first served application completion • You will be randomly assigned a partner for the exam by the ABOFP • You will be handed 3 clinical scenarios, and given 20 minutes to review all of them, selecting a diagnosis for each

33. Practical Exam • You will receive 1 case from each of the following categories: spine, extremities, and systemic diseases (i.e. asthma). • You will have 20 minutes to review and choose the 1 best answer from the 4 choices listed on the front side of each sheet. • After you have selected the diagnosis for each case, you should spend the remainder of the 20 minutes planning your treatment strategy for each case. • This is all the data that will be given.

34. Practical Exam • After 20 minutes each pair of candidates will be directed to their first of three separate exam stations. • The examiner will review your diagnosis for the first case and indicate whether or not the correct diagnosis has been given. • If the wrong diagnosis is given, you will be informed of the correct diagnosis. • An incorrect diagnosis will result in no points awarded for that portion of that case evaluation. • You will be given 4 minutes in which to demonstrate and discuss appropriate OMT for your first case, based on the correct diagnosis.

35. Practical Exam • You will have 4 minutes to describe your treatment • DO NOT explain how you made the diagnosis • Your partner will also have 4 minutes to describe his/her treatment (having received 3 different scenarios) • After 8 minutes you will be directed to the next station for the next case.

36. Practical Exam • A candidate must receive a passing score on 2 of the 3 cases in order to pass the performance exam. • In the event a candidate does not receive a passing score on two of the three cases, that candidate shall be given another opportunity to retake the performance exam later that same day. • The candidate will be retested in all three categories.

37. Practical Recommendations • Although there is a cost to this (rooming), fly in the day before your exam, and leave, at the earliest, the day after your exam • This allows for weather delays, possible retake of the practical, etc. • ACOFP would LOVE to have you stay for the conference as long as you are there (if you are taking this exam in Spring of your 3rd year)

38. Cognitive Exam • 400 questions initially • 200 for recertification • General Medicine • Allergy/Immunology inc. Rheumatology 5% • Cardiology 5% • Dermatology 5% • Endocrinology 5% • Gastroenterology 5% • Hematology 4% • Nephrology/Urology 4% • Neurology 5% • OPP 5% • Pulmonology 5%

39. Cognitive Exam • Geriatrics 5% • Surgery • EENT 5% • General Surgery 3% • Orthopedics 5% • Obstetrics/Gynecology 4% • Pediatrics 4% • Sports Medicine 3% • Women’s Issues 4% • Addiction Medicine 3% • Adolescent Medicine 4% • Behavioral Sciences • Preventive Medicine 5% • Psychiatry 4% • Medical Jurisprudence 3%

40. Pearson Vue test centers…

41. Questions?