RESIDENCY REVIEW COMMITTEE FOR PEDIATRICS

PEDIATRIC GASTROENTEROLOGY 9/03

RESIDENCY REVIEW COMMITTEE FOR PEDIATRICS515 N. State St., Suite 2000

Chicago, IL 60610

INSTRUCTIONS FOR COMPLETING PROGRAM INFORMATION FORMS FOR PROGRAMS IN PEDIATRIC GASTROENTEROLOGY

The same program information form (PIF) is used for those making initial application and those undergoing periodic re-review.

Applications: The RRC will evaluate an application for a new program without a prior site visit. Contact the RRC office for deadlines. Note that a subspecialty program must function in conjunction with a fully accredited program in pediatrics that is in good standing.

Title: The title of a subspecialty program should correspond to the title of the affiliated pediatrics program to facilitate cross referencing.

Sponsor: Identify as the SPONSORING INSTITUTION that entity which has final administrative responsibility for the program, as evidenced by the fact that it monitors the quality of the education and coordinates the accreditation activity. This must be the same sponsor as the core pediatrics residency. If the SPONSORING INSTITUTION and the PRIMARY HOSPITAL are one and the same, the hospital's name should be entered in both sections.

Before work is begun on this form, the Program Requirements for Subspecialties of Pediatrics and the Program Requirements for Residency Education in Pediatric Gastroenterology should be thoroughly reviewed. Copies of these documents may be obtained from the ACGME website (www.acgme.org).

If more than one hospital participates in the program, information on each hospital should be given as requested. The program director is responsible for gathering the requested data from the participating institutions and consolidating the information on one form.

The total length of time subspecialty residents are assigned to each participating hospital should be filled in as requested on Pages 1 and 2.

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If the subspecialty residents in your program rotate for a period of time to another accredited pediatric gastroenterology program, the written agreement should include: 1) the scope of the affiliation; 2) the resources in the affiliated program which will be available to the subspecialty residents; 3) the duties and responsibilities the subspecialty residents will have in the affiliated program; 4) the relationship which will exist between subspecialty residents and staff of the affiliate and primary programs.

For those sections where additional pages are needed to answer the questions, retype each question using a small bold type font and answer in a larger font. It is important that the original pagination remain the same. If necessary, paginate the forms by hand in the upper right corner.

All sections of the form must be completed. If any requested information is not available, an explanation should be given in the appropriate place on the form. The completed form should be prepared as a single document with all added pages numbered in sequence as requested. INCLUDE ONLY THE REQUESTED INFORMATION.

The program director is responsible for the accuracy of the information supplied in this form and must sign it. It must also be signed by the Department Chair/Chief of Service and the Designated Institutional Official of the sponsoring institution.

ALL PAGES INCLUDED IN THE FORM SHOULD BE 8 1/2" BY 11". DO NOT USE UNDERSIZED OR OVERSIZED SHEETS. Each copy of the completed form may be secured with a rubber band, a clip, or it may be loosely enclosed in protective materials. DO NOT punch holes in the form. Remove all staples within the form, e.g., from the CV's. DO NOT use any kind of process to bind the form or attach it to anything. DO NOT insert section dividers. The number of copies to be submitted will vary as follows:

New application: Send four complete copies to the Executive Director of the Residency Review Committee for Pediatrics at the above address.

Resurvey: See letter announcing the site visit.

If you have questions about the form, contact the Accreditation Administrator (Phone: 312-755-5044). For word processing questions/problems, contact the ACGME Help Desk (Phone: 312-755-7464). For questions regarding a site visit, contact the writer of the letter announcing the survey.

H:\peds\pif-pd\332pif02.doc

9/03 RESIDENCY REVIEW COMMITTEE FOR PEDIATRICS

515 North State Street, Suite 2000, Chicago, Illinois 60610

PROGRAM INFORMATION FORMPEDIATRIC GASTROENTEROLOGY

DATE OF APPLICATION:

TITLE OF PROGRAM:(Use first line of program listing on the ACGME Website for core Pediatrics program to which this program is attached.

New Application: ( ) Accredited Program: ( )

Pediatric Gastroenterology Program DirectorNAME:

Full Time: YES NO

Title:

Address:

E-mail Address:

Telephone: Fax:

The signatures of the director of the program and the chief of the department attest to the completeness and accuracy of the information provided on these forms.

Signature - Pediatric Gastroenterology Program Director Signature - Chief of Pediatrics/Department Chairman

SPONSORING INSTITUTION: (Name the entity, i.e., the university, hospital, or foundation that has administrative responsibility for this program.)

Name of Sponsor:

Address:

Name of Designated Institutional Offiicial (Typed):

Signature:

If this is not a medical school program, is there an affiliation with a medical school: YES NO

If yes, name the medical school and append a document that specifically describes the effects of these arrangements on this program. Label this Appendix C.

Name of Medical School:

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PRIMARY HOSPITAL (Hospital 1)

Name:

Address: City/State/ZIP:

Total number of months pediatric gastroenterology trainee is assigned to this institution in each year of training:

1st year 2nd year 3rd year

Chief/Chair, Department of Pediatrics:

For each participating institution provide letters of agreement specifying the administrative and organizational relationships which bear upon the educational program. Attach as Appendix C.

OTHER PARTICIPATING INSTITUTION (Hospital 2)

Name:




Distance between 2 and 1 in Miles: In Minutes:

Is this hospital used for: (check appropriate box)

Required rotations?

Electiverotations?

Other?


OTHER PARTICIPATING INSTITUTION (Hospital 3)

Name:




Distance between 3 and 1 in Miles: In Minutes:

Is this hospital used for: (check appropriate box)

Required Rotations?

Electiverotations?

Other?


3DURATION OF TRAINING

The program requirements which were approved by the ACGME on February 16, 1993, contain the following paragraph regarding the duration of training:

Two years of progressive educational experience is required, which includes the development of procedural skills, responsibility for patient care and participation in research. Any program that extends training beyond the minimum requirements must present clear educational rationale consonant with the Program requirements and objectives for residency training. The program director must obtain approval of the Residency Review Committee prior to implementation and at each subsequent review of the program. Prior to entry in the program, each resident must be notified in writing of the required length of training.

If you propose or offer a program of three years duration, please provide the educational rationale below. In doing so, make reference to both the Program requirements for Pediatric Gastroenterology and the Program Requirements for Subspecialties of Pediatric Programs.

4SUBSPECIALTY RESIDENTS

Programs making initial application should provide ONLY THE INFORMATION marked by an asterisk (*) in the top section of the of this page:

*Number of positions offered: Year 1 Year 2 Year 3

Number of positions filled: Year 1 Year 2 Year 3

*Source of salary support for subspecialty residents: (Add the salaries of all subspecialty residents and indicate what percent of the total is supplied by each of the following services:)

% from NIH:

% from other non-federal programs:

% from hospital:

% from other federal programs:

% from practice-generated income:

% from other:

*Does the program have a funded training grant? *If yes, supply the following:

YES*If yes, supply the following:

NO

*Grant: *Amount *Project Director:

CURRENT SUBSPECIALTY RESIDENTSProvide the following information regarding the current subspecialty residents in the program:

NameDate began

gastroenterology program

Name of ACGME-accredited pediatric residency program

completed

Date of completion Name of medical

school

Date of graduation

GRADUATES OF THE PROGRAM

Total number of graduates of the program in the last five years:

Provide the following information regarding the subspecialty residents who have completed the program in the last five years. Use additional pages as necessary, numbered 4a, 4b, etc. Include name, present location, present position, type of practice, if sub-board certification in pediatric gastroenterology has been achieved.

PROGRAM FACULTYProgram Requirements for Subspecialties of Pediatrics, IV

Program Requirements Pediatric Gastroenterology, V

A. PROGRAM DIRECTORExplain how the program director meets the Program requirements with regard to: a) Board and Sub-board certification; b) demonstrated competence as a teacher and researcher; and, c) Adequate administrative experience to direct the program.

If not certified by the American Board of Pediatrics' Sub-board of Pediatric Gastroenterology, provide evidence of equivalent qualifications. Use an additional page numbered as page 5a to include your answer. Do not exceed one page.

B. FACULTYList below the faculty members who are direct contributors to the program, including the program director. List the gastroenterologists first. Time on gastroenterology teaching service should include the total of time spent providing instruction, supervising inpatient and outpatient experiences and supervising consultation experiences. Also include and identify any research mentors who participate in training. Duplicate this page if necessary.

Name Primary specialty

Time on gastroenterology teaching service

Location:Hospital 1,

2, 3

Certification

Hrs. per week Wks. per year Pediatrics (yr.)

Recertification (yr.)

Specify other board & year

For each of those listed above, provide details of the individual's role in the pediatric gastroenterology training program. If not certified in pediatric gastroenterology, provide evidence of equivalent qualifications. Specify the type of contact with the subspecialty residents, e.g., lectures, group discussions, ward rounds, laboratory supervision, patient care activities, consultations. Indicate clearly how the reported time is distributed. Include research mentors. Use additional pages as needed, numbered as 5b, 5c, etc.C. CURRICULUM VITAE

1. Attach as Appendix A the program director's full curriculum vitae and complete bibliography of articles in peer-reviewed journals.

2. For faculty members listed on the chart above, other than the program director, attach curriculum vitae using the CV format contained onthe page identified as Appendix B at the end of this form and follow its instructions.

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4

PROGRAM FACULTY (Continued)

D. PROGRAM STAFF: RELATED SPECIALISTS (working with pediatric gastroenterology) at participating hospitals:

Complete the following chart using the name of the primary staff member involved. It is understood that certification is not available in all of the disciplines listed below. Faculty hours reported should be only for hours CONTRIBUTED TO THIS PROGRAM. Use 40 hours per week as the full time equivalent. Numbers of additional faculty in each field should be entered in the last column. (If adult specialists cover pediatric subspecialties, enclose name or number in parentheses.)

Discipline NameSub-certification/

RecertificationFaculty participation in training program Hospital 1, 2 or 3 No. of other faculty

Name of Sub-board

Year of certification/

recertification

Hours per

week

Weeks per year

Neonatology

Pediatric Hematology/Oncology

Pediatric Allergy/Immunology

Genetics

Pediatric Infectious Diseases

Pediatric Surgery

Pediatric Anesthesiology

Pediatric Pathology

Pediatric Radiology

Child Psychiatry and/or Psychology

Nutrition

Other: (specify)

If any of the above are not housed predominantly in the primary hospital, provide specific details of their availability to the program. Include on a page numbered 6a.

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7

PROGRAM FACULTY (Continued)

D. PROGRAM STAFF: OTHER ANCILLARY STAFF

List only the numbers of those who work in the pediatric gastroenterology training program:

Hospital 1 Hospital 2 Hospital 3

Nurse specialists and/or physician extenders in gastroenterology

Pediatric social workers

Pediatric nutritionists

Other (specify):

Describe the involvement of the staff in each of these categories in the pediatric gastroenterology program:

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FACILITIES AND SERVICESProgram Requirements Pediatric Gastroenterology, IV

Indicate the availability of the following:

Facility/ServiceHospital 1 Hospital 2 Hospital 3

Yes No Yes No Yes No

Space in an ambulatory setting for optimal evaluation and care of patients

An inpatient area with pediatric and related services (including surgery and psychiatry) staffed by pediatric residents and faculty

Support services including radiology laboratory, nuclear medicine and pathology

Pediatric intensive care unit

Number of beds in PICU

Neonatal intensive care unit

Number of beds in NICU

Access to gastrointestinal function laboratory capable of measuring intestinal absorptive function, esophageal physiology and pancreatic function and nutritional parameters in pediatrics patients

Flexible endoscopy facilities

Provide an explanation if NO is indicated for any of the above facilities and/or services across all hospitals:

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PATIENT DATA

Provide the following information for the most recent 12-month period.

Inclusive dates: FROM (mm/dd/yy): TO (mm/dd/yy):

INPATIENT

1. Total number of admissions for whom the pediatric gastroenterology service assumed major clinical responsibility:

a. Average daily census of patients on the pediatric gastroenterology service

If ADC is less than six, please explain how residents have an adequate exposure to inpatients on a page numbered 8a.

b. Number of new patients admitted each year ("new" refers to those who are being seen by the gastroenterologists for the first time):

c. Average length of stay of patients on the pediatric gastroenterology service:

2. Number of consultations by pediatric gastroenterologists on other inpatients:

a. Are consultations provided to the NICU? YES NO

If yes, how many?

b. Are consultations provided to the PICU? YES NO

If yes, how many?

AMBULATORY PEDIATRIC GASTROENTEROLOGY EXPERIENCEFOR ALL YEARS OF TRAINING

Name of ExperienceHospital/Other Setting Identifier

Duration ofExperience(in wks/yr)

Number ofSessions Per

Week PerResident

Number ofNew Patients

PerResident

Per Session

Number ofReturn

Patients Perresident

Per Session

AverageNumber

Other TraineesPer Session

AverageNumberTeaching

AttendingsPer Session

FacultySupervision

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

1. If the experience is in a private office, provide full details, including name and credentials of supervisor, numbers and types of patients, degree of residentresponsibility for their care, frequency of attendance at office, how director monitors the experience and resident performance. Include as pages 10a,

10b, etc.

2. Explain how the residents have the opportunity to provide outpatient care for patients whom they treated on the inpatient service.

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12-MONTH SUMMARY: OUTPATIENT CLINICS/INPATIENT SERVICES

During the same 12-month period as used on page 9, how many pediatric patients with the following gastroenterology problems were: a) seen in the ambulatory settings; b) were admitted to and/or consulted on by the pediatric gastroenterologists at the primary hospital? PROGRAMS MAKING NEW APPLICATION SHOULD COMPLETE ONLY THE COLUMNS MARKED BY AN ASTERISK ( * ).

Inclusive Dates: FROM (mm/dd/yy): TO (mm/dd/yy):

Gastroenterologyproblems

Outpatients Inpatients

Number of patients*

Number seen bysubspecialty

residents

Inpatient service Consultations

No. on gastro

service*

No. seen bysubspecialty

residents

No. of consults*

No. seen by sub-specialty

residents

1. Growth failure and malnutrition

2. Malabsorption (celiac disease, cystic fibrosis, pancreatic insufficiency, etc.)

3. Gastrointestinal allergy

4. Peptic ulcer disease

5. Jaundice

6. Liver failure (including evaluation and follow-up care of patient requiring liver transplantation)

7. Digestive tract anomalies

8. Chronic inflammatory bowel disease

9. Functional bowel disorders

10. Gastrointestinal problems in the immune-compromised host

11. Vomiting (including gastroesophageal reflux)

12. Acute and chronic abdominal pain

13. Acute and chronic diarrhea

14. Constipation (including Hirshsprung disease)

15. Gastrointestinal bleeding

16. Gastrointestinal infections

17. Motility disorders

18. Infectious and metabolic liver diseases

19. Pancreatitis

12LIST OF DIAGNOSES

List 150 CONSECUTIVE admissions and/or consultations from the general pediatric service to the gastroenterology service during the same 12-month period as used on the previous pages. Use additional pages as necessary. Submit a separate list for each hospital that provides required rotations. Number all additional pages in sequence as 12a, 12b, etc.

Hospital:

Inclusive dates during which these admissions/consultations occurred:

FROM (mm/dd/yy): TO (mm/dd/yy):

PATIENT ID NUMBER OF DAYS IN HOSPITAL GASTROENTEROLOGIC DIAGNOSIS

NUMBER AGE

SKILL OBJECTIVESProgram Requirements Pediatric Gastroenterology, II.C

Indicate whether or not the program provides experience in each of the following procedures. Use the same 12-month period as indicated on the previous pages. For procedures not performed at any of the participating hospitals, provide an explanation on a page numbered 13a. PROGRAMS MAKING NEW APPLICATION COMPLETE ONLY THE COLUMN MARKED "NUMBER PERFORMED ON SERVICE(S)" FOR EACH HOSPITAL.

Inclusive Dates: FROM (mm/dd/yy): TO (mm/dd/yy):

Hospital 1 Hospital 2 Hospital 3

Number performed

on service(s)

Total # performed by sub-specialty

residents

Number performed

on service(s)


residents

Number performed

on service(s)


residents

1. Colonoscopy

2. Diagnostic upper panendoscopy

3. Establishment and maintenance of patients on enteral/parenteral nutrition (including nutritional assessment)

4. Sigmoidoscopy (rigid and flexible)

5. Paracentesis

6. Percutaneous liver biopsy

7. Rectal biopsy

8. Small bowel biopsy

9. Anorectal manometry

10. Breath hydrogen analysis

11. Dilatation of esophagus

12. Endoscopic retrograde cholangiopancreoscopy (ERCP)

13.Therapeutic upper pandendoscopy (sclerosis of esophageal varices)

14. Esophageal manometry

15. Pancreatic stimulation test

16. Esophageal pH monitoring

17. Placement of percutaneous gastrostomy

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CONTENT OF TRAINING PROGRAM

Complete the following chart by providing the duration of the activities specified below for each year of the training program. Answers should be provided as indicated, i.e., in months, in weeks, or in other appropriate time periods.

First Year Second Year Third Year(if offered)

1. Clinical training months months months

Frequency of night call

Number of clinical rounds per week per week per week

2. Research training and experience months months months

Frequency of night call

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CONFERENCESProgram Requirements Pediatric Gastroenterology, II.D

List regular subspecialty and interdepartmental conferences, rounds, etc., that are a part of the pediatric gastroenterology training program. Identify the INSTITUTION by using the corresponding number as it appears on the first and second pages of this form. Indicate the frequency, e.g., weekly, monthly, etc., and whether conference attendance is required (R) or optional (O).

Conference R, O FrequencyPerson(s) responsible for conducting

conferenceHospital 1,

2, or 3

Describe how subspecialty residents participate in these activities:

What are the attendance requirements for subspecialty residents? What mechanisms are (will be) used to ensure trainee attendance at required conferences? To what degree is faculty attendance expected? Is this monitored?

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NARRATIVE DESCRIPTION

Provide a narrative description of this subspecialty program. The points listed below should be covered in the narrative.

A. PROGRAM GOALS AND OBJECTIVES (Program Requirements for Subspecialties of Pediatrics)

1. Describe the educational goals and objectives of the program.

2. Are the goals and objectives documented in writing and available for review? Are they provided to the resident?

3. Describe how the goals and objectives are reviewed and revised. Describe the role of the resident and the faculty in this process.

B. RELATIONSHIP TO OTHER PROGRAMS

1. What are the differences in responsibilities for the subspecialty residents at each level of training from those of the pediatric residents?

2. How are patients assigned or apportioned between the pediatric residents and those in this subspecialty program?

3. How are those in this subspecialty program involved with other pediatric subspecialty residents, other clinics, departments and accredited residency programs?

4. How are the subspecialty residents involved in the education of pediatric residents and medical students?

C. SPECIALTY EXPERIENCES (Refer to the requirements and describe how they are covered in the program)

1. Provide a general description of each year of training.

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2. Inpatient experiences

a. What responsibilities do the subspecialty residents have for inpatients requiring acute and chronic care in appropriate facilities when assigned to inpatient services?

b. How and by whom are they supervised?

c. How many hours per week do they participate in rounds with faculty? Describe this experience.

3. Outpatient experiences

a. What degree of responsibility do the residents have for required outpatient care?

b. Describe the continuity of care experience they receive during their period of assignment to the outpatient clinic. To what extent

do they have the opportunity to provide outpatient care for patients whom they treated on the inpatient service?

c. How and by whom are they supervised during the provision of outpatient care?

d. How do subspecialty residents have the opportunity to provide outpatient care for patients whom they treated on the inpatient service?

4. Other

a. Describe any special sessions/coursework/special laboratory experiences in which the residents participate.

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b. How are psycho-social aspects of medicine and ethical issues related to this subspecialty taught to the residents?

c. Describe the residents' instruction and experience in the administration of a pediatric gastroenterology facility.

D. RESEARCH PROGRAM (Program Requirements for Subspecialties of Pediatrics, V)

1. Is the program director directly involved in a research program?

2. Are other faculty in this subspecialty actively engaged in a research program?

3. How does the program ensure a meaningful supervised research experience for the residents, beginning in their first year and extending throughout their training? Include a description of how they learn experimental design, data collection and analysis, and laboratory techniques used in this subspecialty research. Include the plans for frequency and duration of these sessions and the year of training in which they occur. Identify the teacher/supervisor in each case.

4. How do they receive support and guidance in the preparation of manuscripts and presentations?

5. Describe research facilities, space and equipment directly related to this subspecialty program and the residents' research activity.

6. List active research projects in this subspecialty. Include the title of the project, the principal investigator(s), and the amount, dates and source(s) of financial support.

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7. Provide a list of scholarly publications and presentations at regional, national and international meetings by faculty and residents within the program for the last five years only. Do not duplicate citations. Underline the names of subspecialty residents. List journal articles, presentations and abstracts separately under those headings.

E. SERVICE DUTIES (Program Requirements for Subspecialties of Pediatrics, III)

Describe the call schedule including whether it is on-site or from home. Demonstrate how the schedule allows the subspecialty residents a monthly average of one day in seven away from program duties.

F. LIBRARY FACILITIES (Program Requirements for Subspecialties of Pediatrics, VII)

Describe the library facilities and their availability to the residents. How is the library equipped to handle the particular needs of pediatric subspecialists? Are there computerized literature search facilities available?

G. EVALUATION (Program Requirements for Subspecialties of Pediatrics, VIII)Do not attach evaluation forms but have them available for inspection by the site visitor.

1. Evaluation of subspecialty residents

a. How often and by whom are the residents in this program formally evaluated? Are written records of the evaluations maintained

by the program?

b. Describe the process, frequency and by whom these evaluations are discussed with the residents.

c. Do they have an opportunity to read and respond to their evaluations? Describe the process.

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d. Describe the mechanisms for monitoring each resident's acquisition of skills in the performance of the procedures utilized in this subspecialty.

2. Evaluation of faculty

a. Describe the mechanism, frequency and by whom faculty are evaluated on their teaching ability, clinical knowledge and scholarly activity.

b. How do the residents in this training program participate formally in the process?

3. Evaluation of program by staff and residents?

a. Is the training program periodically evaluated by the staff and the residents?

b. How often does this evaluation take place and what is the mechanism by which it is accomplished?

c. How are these evaluations used in program planning and development?

Appendix BCURRICULUM VITAE

CV should be condensed to fit this page. Do not addadditional pages except as directed below.

Append bibliography for the past FIVE YEARS ONLY, limited to articles published or in press and abstracts presented.

Name

Position:

Address:

Professional education (including dates and degrees obtained):

Hospital training (including dates of internships, residencies, fellowships, etc.)

Current professional appointments:

Primary certification (including date):

Subspecialty certification (including date):

Recertification (including date):

Professional activities/committees:

RESIDENCY REVIEW COMMITTEE FOR PEDIATRICS

PEDIATRIC GASTROENTEROLOGYProgram Information Form Checklist

Use this checklist before submitting the forms to the RRC office. The RRC considers it the responsibility of the program director to ensure that the application materials are complete and are submitted in accordance with the instructions. The signature of the program director on the forms indicates his/her approval of the content. A review of the instructions provided at the beginning of the form and on individual pages is suggested.

_______ Have the appropriate person(s) signed page 1 of the forms where requested?

_______ Is the form free of unrequested schedules, printouts, reprints, catalogues, brochures, etc?

_______ Do the CVs attached as Appendix A follow appropriate instructions regarding their length?

_______ Are all requested official letters of agreement/affiliation appended as requested on pages 1 and 2?

_______ Has the final copy been carefully proofread and has it been checked to see that every question has been answered, every chart completed, etc.?

_______ Has the ACGME letter of report regarding the Institutional Review of the Sponsoring Institution been appended?

Once the preparer is satisfied that the form has been completed and assembled correctly, make the appropriate number of copies. After the copies have been made, review the individual sets to be sure that all of the copied pages are legible and that each set of forms contains all of the pages in the original. ALL PAGES INCLUDED IN THE FORM SHOULD BE 8-1/2” BY 11.” DO NOT USE UNDERSIZED OR OVERSIZED SHEETS. The completed copies of the form may be secured with one large clip or enclosed in a folder. DO NOT STAPLE. Holes should not be punched in the form and it should not be attached to the folder.

C O N T E N T S

PROGRAM NAME:PROGRAM #:

Retain our pagination followed through the form, e.g., 8, 8a, 8b, etc. When you finish, go through the form, number each page sequentially with black ink or typed in upper right hand corner. Report this pagination on this page. Place this page at the front of the form.

SECTION IN PROGRAM INFORMATION FORM Page Number(s)

1. Training Sites

Sponsoring Institution

Participating Institutions

2. Pediatric Gastroenterology Residents

3. Program Faculty

A. Program Director

B. Faculty

C. Curriculum Vitae (Appendices A & B)

D. Program Staff

4. Facilities and Services

5. Patient Data

Inpatient Service

Ambulatory Experience

6. 12 Month Summary: Outpatient Clinics/Inpatient Services

7. List of Diagnoses

8. Skill Objectives

9. Content of Training Program

10. Conferences

11. Narrative Description of the Pediatric Gastroenterology

Program

A. Program Goals and Objectives

B. Relationship to Other Programs

C. Specialty Experiences

D. Research Program

E. Service Duties

F. Library Facilities

G. Evaluation

12. Appendices

Appendix A (Program Director’s Full CV)

Appendix B (Teaching Staff CV’s)

SECTION IN PROGRAM INFORMATION FORM Page Number(s)

Appendix C (Letters of Agreement)

Documents

RESIDENCY REVIEW COMMITTEE FOR PEDIATRICS