[Federal Register Volume 59, Number 190 (Monday, October 3, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24340]
[[Page Unknown]]
[Federal Register: October 3, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
RIN 0905-ZA45
Proposed Review Criterion and Indicators for Grants for Family
Medicine Training and Grants for General Internal Medicine and General
Pediatrics Training
Grants for Family Medicine Training and Grants for General Internal
Medicine and General Pediatrics Training are authorized by sections 747
(a) and (b) and 748, title VII of the Public Health Service Act, as
amended by the Health Professions Education Extension Amendments of
1992, Pub. L. 102-408, dated October 13, 1992. These grant programs
include:
Grants for Predoctoral Training in Family Medicine
Grants for Graduate Training in Family Medicine
Grants for Faculty Development in Family Medicine
Grants for Establishment of Departments of Family Medicine
Grants for Residency Training in General Internal Medicine and
General Pediatrics
Grants for Faculty Development in General Internal Medicine and
General Pediatrics
Competing applications for grants authorized under sections 747 and
748 are reviewed by chartered review committees. It is proposed that
the following review criteria and weighted indicators be used by the
chartered review committees for the FY 1995 grant cycles. Public
comments are invited on the one proposed review criterion and the
weighted indicators associated with all four review criteria.
This review criterion and weighted indicators are proposed in this
combined notice, rather than in individual program announcements, to
provide consistent review of all primary care medical education grant
applications. A funding notice for Grants for Family Medicine Training
for FY 1995 has been published elsewhere in today's Federal Register. A
funding notice for Grants for General Internal Medicine and General
Pediatrics will be published should funds become available for
competitive cycles in FY 1995. Deadline dates and other specific
information regarding these grant programs are included in funding
notices.
General Purposes
Grants provided in support of primary care medical education are
intended to produce, over time, a training infrastructure capable of
meeting the nation's needs for generalist health care practitioners by
the year 2000 and beyond.
The Division of Medicine (DM), Bureau of Health Professions (BHPr),
has developed the following Strategic Directions for fiscal year 1995:
Generalism--increasing the number of generalist
physicians, including the coordination and integration of training
opportunities designed to produce generalists;
Workforce diversity, particularly the training of
minorities;
Strategies to improve health care for the underserved;
Improve primary care quality;
Increase primary care faculty and researchers; and
Emphasize public health and interdisciplinary training.
Applicants are encouraged to consider each application as part of
an integrated institutional plan that considers these strategic
directions in providing education and training that encourages the
selection and future practice of generalist physicians in the
disciplines of family medicine, general internal medicine and general
pediatrics.
Review Criteria
Considering charter review committee recommendations, the Secretary
will approve projects which best promote the purposes of sections 747
and 748 of the PHS Act, taking into consideration the following review
criteria established in 42 CFR part 57, subparts Q, R, and FF.
1. The administrative and management ability of the applicant to
carry out the proposed project in a cost-effective manner.
2. The potential of the project to continue on a self-sustaining
basis after the period of grant support.
3. The degree to which the proposed project adequately provides for
the project requirements.
In addition, the following review criterion is proposed for FY
1995:
4. Potential effectiveness of the proposed project in carrying out
the training purposes of sections 747 or 748 of the PHS Act.
For the above review criteria, weighted indicators have been
identified. These indicators, which are listed below, will measure,
among other things, the qualifications of the proposed staff and
faculty, the institution's commitment to preparing generalist
physicians, and the recruitment and retention of underrepresented
minority and disadvantaged faculty, students, trainees and/or
residents. These issues have been addressed in previous grant cycles as
review criteria or funding factors. The review criteria and indicators
were developed for the FY 1995 grant cycle with input from potential
applicants for these grant programs.
Merit Score Point Potential
----------------------------------------------------------------------------------------------------------------
Potential Administrative Economic Project
Type of project effectiveness and management viability requirements
(points) ability (points) (points) (points)
----------------------------------------------------------------------------------------------------------------
Department of Family Medicine....... 130 145 20 75
Family Medicine Residencies......... 100 145 20 40
Family Medicine Faculty Development. 110 145 20 65
Family Medicine Predoctoral Training 130 145 20 80
General Internal Medicine/General
Pediatrics Residencies............. 130 145 20 120
General Internal Medicine/General
Pediatrics Faculty Development..... 110 145 20 65
----------------------------------------------------------------------------------------------------------------
The points available for the various grant programs in the
``Potential Effectiveness'' criterion vary slightly. This is a result
of a small number of indicators that are specific to individual grant
programs. In general, this category relates to the overall
institutional environment in which the program is located and the
manner of support for establishing or enhancing the training of
generalist physicians at the institution.
The ``Administrative and Management Ability'' review criterion has
the highest number of points and is consistent across all grant
programs because this area of the application will describe the
proposed project for which the grant funds are being requested. The
proposal needs to clearly detail the proposed project as well as relate
the proposed project to the institution's overall goal of establishing
or enhancing its training infrastructure in order to produce more
generalist physicians to meet the needs of the Nation.
The ``Economic Viability'' points are consistent across all grant
programs.
The ``Project Requirements'' points vary considerably for some
programs. This is related to the differing number of project
requirements specific to each grant program as well as the significance
of some of the indicators. For example, for Family Medicine
Residencies, the points are lower to reflect the fact that residency
programs that are accredited or approved by the appropriate accrediting
body, have already met the project requirements.
Weighted Indicators
Criterion 1: Potential Effectiveness of the Proposed Project in
Carrying Out the Training Purposes of Sections 747 and 748 of the PHS
Act
Indicator 1--Institutional Environment--20 points
Proposal describes the actions taken by the institution (i.e.,
department, medical school, or other sponsoring health care delivery
institution) that demonstrate a high level of support for and promotion
of generalist training and practice in community-based settings within
underserved urban and rural communities and populations. Examples
include organizational mission statements describing support for
training and graduating generalists in the primary care disciplines,
institutional financial support for such programs, institutional
support for rural practices such as locum tenens, 1-800 numbers for
consultations, visiting faculty status for rural practitioners,
complementary institutional and other resources to support such
programs, and adequate representation of generalist faculty on key
academic committees such as Admissions, Selection, Tenure, and Faculty
Recruitment.
Indicator 2--Strategic Outcomes--20 Points
Proposal describes a strategy for the institution's training
program that will lead to or sustain a high level of graduates entering
generalist residencies and/or practice.
Indicator 3--Generalist Faculty--10 points
Proposal includes strong, clinically-oriented generalist faculty
who practice in community-based settings that include underserved
populations.
Indicator 4--Promotion of Workforce Diversity--20 Points
Proposal includes a strategy and plan for recruiting and retaining
underrepresented minority and disadvantaged faculty, students, trainees
and/or residents. Proposal describes the current and projected levels
of participation of these underrepresented groups in the program.
Applicants are expected to reflect the diversity of the populations
within their states.
Indicator 5--Critical Training Emphasis--10 Points
Proposal includes reference to a curriculum that incorporates
Healthy People 2000 objectives in one or more of the following content
areas: HIV/AIDS epidemiology, prevention, diagnosis and treatment;
substance abuse; or clinical preventive services. Wherever necessary,
curriculum is appropriate to the needs of the patient population
(culturally competent regarding ethnicity, gender, and sexual
orientation) whether that population is urban, rural or underserved.
Indicator 6--Interdisciplinary Training--10 Points
Except for Faculty Development projects, proposal provides for
interdisciplinary clinical training opportunities, i.e., a training
environment in which students, interns and/or residents learn to work
in teams including varied health care professionals and/or primary care
disciplines. The environment is such that the important contributions
by each member of the health care team are recognized and utilized in
the primary care setting.
Indicator 7--Clinical Training Settings--10 Points
Except for Faculty Development projects, proposal provides for
clinical training in community-based settings within underserved areas
or populations.
Indicator 8--Primary Care Preceptorship--10 Points
For Departments of Family Medicine and Predoctoral Training
Programs Only: Training includes a primary care preceptorship that: 1)
occurs in the first or second year and is at least four weeks in
duration; or 2) is a longitudinal experience of at least five days per
semester in both the first and second years.
Indicator 9--Third-Year Clerkship--20 Points
For Departments of Family Medicine and Predoctoral Training
Programs Only: Training includes a required third-year clerkship in
family medicine of at least four-weeks duration.
Indicator 10--Faculty Expertise--30 Points
For Faculty Development Programs Only: Proposal includes adequate
balance in faculty expertise to teach the proposed curriculum, e.g.,
teaching skills, administrative and management skills, or primary care
research.
Indicator 11--Generalism Outcomes/Continuity of Care--30 Points
For General Internal Medicine and/or General Pediatrics Residency
Training Program Only: Competing continuation General Internal Medicine
and/or General Pediatrics program demonstrates a consecutive 3-year
track record of 80% or more graduates entering primary care careers. IN
ADDITION, by the beginning of the second year of grant support the
competing continuation OR NEW General Internal Medicine and/or General
Pediatrics program will provide ALL PGY-1 residents (primary care and
traditional) entering the Internal Medicine and/or Pediatrics residency
with continuity of care training experience comprising a total of 20%
(average) over the 3-year training period, scheduled in at least 9
months of each year of training.
Criterion 2: Administration & Management Ability of the Applicant to
Carry Out the Proposed Project in a Cost-Effective Manner
Indicator 1--Project Rationale--30 Points
Project plan includes a background statement, a statement of need
for the project, and a specific rationale justifying the proposed
project. Project plan also describes the links between this proposed
project and an effective larger institutional program, i.e., the
department, division, residency, etc. This section of the project plan
will define the larger purposes of the project, i.e., in what way the
project will cause an improvement or expansion in the capability of the
larger educational institution or program to deliver quality primary
care training.
For competing continuation proposals, a progress report is
provided. At a minimum, the report includes a summary of the funded
objectives and the accomplishments made during the project period.
Progress report includes evaluation data related to each of the project
objectives. For applicants who are not currently funded, but who have
received funding within the last four years, a discussion is included
in the application describing the previously funded objectives,
accomplishments and evaluation data relative to those objectives.
Indicator 2--Project Objectives--40 Points
Project plan contains a detailed description of the project's
objectives with measurement indicators for each objective. The plan
also includes a description of the methods that will be used to
implement the project, e.g., educational strategy, timetable and a
resource plan that outlines the faculty, staff, facilities and
equipment that will be used, including identification of those
resources that already exist or that will be made available by the
institution.
Indicator 3--Budget Justification--30 Points
Project plan indicates the degree to which the proposed objectives
relate to the budget narrative and justifies the budget items
requested.
Indicator 4--Evaluation Plan--10 Points
Project plan includes an evaluation strategy for the proposed
project to determine achievements in relation to project objectives.
Indicator 5--Anticipated Problems--10 Points
Project plan defines the problems anticipated in implementing the
project and the proposed approaches to resolving such problems as may
arise.
Indicator 6--Institutional Collaboration--15 Points
Project plan includes documentation of the support of individuals
or organizations who will collaborate in implementation of this
proposed project. Letters of support for the project from the
institution, department, faculty, etc., are included. For Faculty
Development projects, letters from potential/actual trainees are
included.
Indicator 7--Trainee Grid--10 Points
Except for Departments of Family Medicine, project plan includes a
``trainee grid'' that defines the type of individuals being trained,
how many will be trained, and when they will be trained.
For General Internal Medicine and General Pediatrics Residencies,
the grid should also reflect actual and projected numbers of primary
care and traditional residents.
Criterion 3: Economic Viability--The Potential of the Project to
Continue on a Self-Sustaining Basis After the Period of the Project
Grant
Indicator 1--Continuation Support--10 Points
Proposed projects demonstrate how their support will be continued
after cessation of Federal funding. If other projects have been funded
under this grant program within the past five years, a financial report
discusses how terminated Federal funds have been replaced.
Indicator 2--Non-Federal Support--10 Points
Financial and in-kind support is or will be provided by state or
local government, institution, medical school, department, patient
fees, or other private funding sources to supplement the Federal grant.
Criterion 4: Degree to Which the Proposed Project Adequately Provides
for the Project Requirements
These indicators (project requirements) have been established in 42
CFR part 57, subparts Q, R, and FF and are summarized below.
Establishing Departments of Family Medicine
Indicator 1--Project Director--10 points
Indicator 2--Administrative Autonomy--15 points
Indicator 3--Control Over Residency Program--10 points
Indicator 4--Evaluation Plans--10 points
Indicator 5--Family Medicine Instruction--10 points
Indicator 6--Full-Time Faculty--10 points
Indicator 7--Academic Status--10 points
Family Medicine Residencies
Indicator 1--Accreditation Status--40 points
Proposal includes a letter of accreditation from the ACGME/RRC
or a letter of approval from the AOA verifying that the residency
meets all requirements. All such projects are considered to have
satisfied the Project Requirements. To the extent that problems are
noted by the accrediting body, the project plan addresses the
problems and has a plausible plan for their correction.
Family Medicine Faculty Development
Indicator 1--Project Director--10 points
Indicator 2--Administrative & Organizational Plan--10 points
Indicator 3--Evaluation Plans--10 points
Indicator 4--Curriculum--25 points
Indicator 5--Eligible Trainees--10 points
Indicator 6--Number of Trainees--0 points
Indicator 7--Length of Training--0 points
Indicator 8--Trainee Support--0 points
Family Medicine Predoctoral Training
Indicator 1--Project Director--10 points
Indicator 2--Administrative & Organizational Plan--10 points
Indicator 3--Evaluation Plans--10 points
Indicator 4--Ambulatory Care Training Settings--20 points
Indicator 5--Curriculum--10 points
Indicator 6--Sponsoring Unit--10 points
Indicator 7--Institutional Strategy--10 points
General Internal Medicine & General Pediatrics Residencies
Indicator 1--Project Director--10 points
Indicator 2--Administrative & Organizational Plan--10 points
Indicator 3--Curriculum Development and Evaluation Coordinator--10
points
Indicator 4--Faculty and Training Personnel--10 points
Indicator 5--Behavioral Science Faculty--10 points
Indicator 6--Resident Recruitment and Selection--10 points
Indicator 7--Requirement for Stipend Support--0 points
Indicator 8--Number and Distribution of Residents--10 points
Indicator 9--Ambulatory Care Training Setting--10 points
Indicator 10--Continuity of Care Experience--0 points
Indicator 11--Other Ambulatory Patient Care Experiences--10 points
Indicator 12--Curriculum Content and Evaluation of Educational
Offerings--20 points
Indicator 13--Evaluation of Residents--10 points
General Internal Medicine & General Pediatrics Faculty Development
Indicator 1--Project Director--10 points
Indicator 2--Administrative & Organizational Plan--10 points
Indicator 3--Curriculum--25 points
Indicator 4--Evaluation Plans--10 points
Indicator 5--Eligible Trainees--10 points
Indicator 6--Eligibility for Trainee Stipend Support--0 points
Indicator 7--Length of Training for Stipend Support--0 points
Additional Information
Interested persons are invited to comment on the one proposed
review criterion and the weighted indicators associated with all four
review criteria. The comment period is 30 days. All comments received
on or before November 2, 1994 will be considered before the final
review criterion and weighted indicators are established. Written
comments should be addressed to: Marc Rivo, M.D., M.P.H., Director,
Division of Medicine, Bureau of Health Professions, Health Resources
and Services Administration, Parklawn Building, Room 9A-27, 5600
Fishers Lane, Rockville, Maryland 20857.
All comments received will be available for public inspection and
copying at the Division of Medicine, Bureau of Health Professions, at
the above address, weekdays (Federal holidays excepted) between the
hours of 8:30 a.m. and 5:00 p.m.
If additional information is needed, please contact: Enrique
Fernandez, M.D., Division of Medicine, Bureau of Health Professions,
Health Resources and Services Administration, Parklawn Building, Room
9A-20, 5600 Fishers Lane, Rockville, Maryland 20857, Telephone : (301)
443-1467, FAX: (301) 443-8890.
Dated: August 29, 1994.
Ciro V. Sumaya,
Administrator.
[FR Doc. 94-24340 Filed 9-30-94; 8:45 am]
BILLING CODE 4160-15-P
