§ 57.3105 - Project requirements.

(a) For each residency program, a proj-ect must:

(1) Have a residency program director.

(2) Employ an individual with relevant experience or training who is responsible for curriculum development and evaluation.

(3) Employ faculty members experienced in the practice of general internal medicine and/or general pediatrics who participate as instructors at principal training settings.

(4) Employ individual(s) with formal education in behavioral sciences who participate in the preparation and implementation of the curriculum and in clinical consultation.

(5) Use a resident recruitment and selection process which assures that residents in the program have applied specifically for training in a program that emphasizes the practice of general internal medicine and/or general pediatrics.

(6) Provide financial assistance from grant funds only to residents who have signed statements of their intention to specialize or work in the practice of general internal medicine and/or general pediatrics.

(7) Have, in each program of a school of medicine, at least four residents in training by the beginning of the second year of Federal support, and at least 12 residents in training by the beginning of the fourth year of Federal support. By the beginning of the fourth year of Federal support, a program may meet this requirement with less than 12 residents in training if the number of internal medicine or pediatric residents in primary care training is at least 50 percent of the total number of internal medicine or pediatric residents at the institution. The Secretary may suspend this requirement for a period which he or she finds appropriate if the Secretary determines that a grantee has made a good faith effort to comply with the requirement and has met the other requirements of this Subpart and the Act, but is unable to have the required number of residents in the program due to circumstances beyond its control.

(8) Have, in each program of a school of osteopathic medicine, at least two residents in training by the beginning of the second year of Federal support; and at least six residents in training in 3-year programs and at least four residents in training in 2-year programs by the beginning of the fourth year of Federal support. The Secretary may suspend any of these requirements for a period which he or she finds appropriate if the Secretary determines a grantee has made a good faith effort to comply with the requirement and has met the other requirements of this Subpart and the Act, but is unable to have the required number of residents in the program due to circumstances beyond its control.

(9) Plan to have residents distributed so that there is no decrease in numbers of residents in successive levels of training by the time the program is fully operational.

(10) Use one or more ambulatory care training settings which actively promote the practice of general internal medicine and/or general pediatrics, and which:

(i) Attract patients for primarily longitudinal and comprehensive (including psychosocial and preventive) health care;

(ii) Organize personnel, including residents, into functional units providing comprehensive health services and provide residents with experience working with various types of health personnel;

(iii) Have systems for referring patients to other specialists, and subspecialists, which assure coordination with the patients’ own practitioners of general internal medicine and/or general pediatrics;

(iv) Use an appointment system which facilitates the assignment of patients to their practitioner of general internal medicine and/or general pediatrics or to a particluar team of practitioners; and

(v) Use a medical record system which:

(A) Gives practitioners of general internal medicine and/or general pediatrics ready access to a patient's medical records including data relating to members of the patient's family which is pertinent to the patient's care;

(B) Is suitable for audit by organizations or individuals who perform this work with adequate safeguards against unauthorized disclosures; and

(C) Assures systematic review of the records.

(11) Make provision for each resident to serve a panel of patients and/or families who recognize him or her as their provider of longitudinal and comprehensive (including preventive and psychosocial) health care. The panel must be sufficiently numerous and varied to provide the resident with broad clinical experience. The clinical experience must be scheduled principally in ambulatory care settings as described in paragraph (a)(10) of this section.

(12) Offer ambulatory care training relevant to general internal medicine and/or general pediatrics in settings such as emergency rooms and specialty clinics.

(13) Have a planned curriculum which:

(i) Supplements the residents’ inpatient and ambulatory patient care experiences with related educational activities such as courses, presentations, discussions, and reading assignments;

(ii) Emphasizes subjects pertaining to:

(A) Ambulatory care;

(B) Psychosocial skills and topics; and

(C) Non-clinical areas relevant to the practitioner of general internal medicine and/or general pediatrics; and

(iii) Is annually evaluated, using previously established criteria and objectives in a manner which includes the participation of residents.

(14) Develop and use systematic procedures to assess the individual resident's needs and to assist in educational planning and evaluation of the resident's competence.

(b) For each faculty development program, a project must:

(1) Have a project director who is employed by the grantee or training institution, has relevant training and experience, and has been approved by the Secretary to direct the project;

(2) Have an appropriate administrative and organizational plan and appropriate faculty, staff and facility resources to achieve the stated objectives;

(3) Have a curriculum which:

(i) Directly applies to general internal medicine and/or general pediatrics,

(ii) Emphasizes improvement of pedagogical skills and techniques for clinical teaching in classroom and ambulatory health care settings, and

(iii) Uses structured didactic and experiential teaching strategies.

(iv) With respect to training programs of 9 or more months duration, the curriculum must also include:

(A) A research component, with a research project to be completed by each trainee, and

(B) An administrative component which addresses the non-teaching roles and functions of faculty;

(4) Systematically evaluate the educational program, including trainees and faculty, the administration of the program, and the degree to which the program and educational objectives are met;

(5) Have as trainees only physicians who teach or plan teaching careers in general internal medicine and/or general pediatrics;

(6) To be eligible for stipend support from grant funds, a trainee must:

(i) Be a general internist or a general pediatrician,

(ii) Intend to teach in a general internal medicine and/or general pediatrics program on a full-time basis,

(iii) Be a full-time participant in the training project for at least 3 months, and

(iv) Receive less than full institutional salary during the period of Federal support of stipends; and

(7) Stipend support from grant funds may be no longer than 24 cumulative months for any trainee.