POSNA Fellowship Program Accreditation Application Form

Pediatric Fellowship Program Accreditation

New applications must be submitted by March 1 for the upcoming match cycle which begins in August of that year. Final decisions will be made by May 1.
Program Name*
Institution Name*
Program Director*
Director Email*
Is your program currently ACGME accredited?*

YESNO
If yes, please provide letter of accreditation, go to the end of the form and hit submit. Your program application is complete.
Attach Letter of Accreditation here:

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PART A
Does your program include an experience at a pediatric trauma center?

YESNO
Does your program include an experience at a pediatric trauma center?

YESNO
Please describe the nature and extent of this experience including frequency and nature of trauma call responsibilities:
For programs with existing fellows, please submit a list of qualifying orthopaedic cases (patients ≤ 18 years of age ) performed during the prior academic year by the fellows (separate log per fellow) with a verification letter from OR administration, medical records officer, or other similar officiate. For programs without current fellows, please submit a list of qualifying orthopaedic cases (patients ≤ 18 years of age ) performed during the prior academic year by pediatric orthopaedic faculty with a verification letter from OR administration, medical records officer, or other similar officiate.

At minimum this list should include the date of procedure, age of the patient, and procedure performed (including CPT codes for US programs).

For renewal applications, previous case logs submitted online will be reviewed for case volume.

Program requirement: 250 operative cases (not CPT codes) per fellow matched at your program. Example: If your program has 3 fellows, you must submit 750 cases.
Attach case log here

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Does your program provide malpractice coverage (occurence coverage or claims-made with tail coverage) for each fellow?

YESNO

PART B
Number of fellowship positions offered?
Number of additional trainees on service at any given time (i.e. number of residents)
Attach a list of all full-time faculty, starting with the Program Director*. For each faculty member, please indicate the following infromation:
- POSNA Membership: Yes or No?
- If Yes, what membership category?
- Board Certification: Yes, No or board eligible?
- AAOS Member: Yes or No?
- COA Member: Yes or No?
- Active Licensure: Yes or No?
*Please NOTE that the Program Director must be an ACTIVE, not Candidate, member of POSNA.
Attached faculty list with information here

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PART C

Educational Requirements
Please describe in detail the educational curriculum for your pediatric orthopaedic fellows (1-2 pages). At a minimum, each program must include information on the following components:
- Indications or pre/post-operative conferences
- Morbidity and mortality conferences
- Journal club
- Pediatric core curriculum conferences (i.e. didactic or case-based lectures)
If any of these conferences are not provided, please document in your report. Also, please comment on the frequency of these conferences (i.e. weekly, monthly, etc.) and describe the level of involvement of the fellow at each conference. Any additional conferences that are provided, or attended regularly by fellows, should be documented. Outline and define any expected changes, additions, or deletions from the program anticipated for the upcoming year.
Attach educational requirements here:

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PART D

Research Requirements
Upload a detailed description of the research component of the fellowship program including training in research methodology, mentorship, research support, and opportunities to present data (1 page). For established fellowships, please list projects in which each fellow was involved during the previous academic year.
Attach research requirements here

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PART E

Surgical Clinical Responsibilities of the Fellows

(to be completed by the program director)
I agree to require my program's fellows to log cases through the POSNA fellowship case log and will monitor compliance with this periodically throughout the year.

YESNO
I understand that completion of the case log is necessary for fellows to receive a diploma from POSNA.

YESNO

PART G

Evaluations

(to be completed by the program director)
I agree to administer evaluations of the fellows, the faculty, and the program, and understand that fellowship graduation and receipt of the POSNA fellowship program diploma is pending completion of evaluations. I agree to store these evaluations onsite for a period of at least 5 years and produce them if requested by the POSNA fellowship committee.

By checking this box I agree to the above statement.
I understand that a confidential evaluation of the program by the fellow will be solicited by POSNA directly and the results of this evaluation will be made available to our program after review by the fellowship committee.

By checking this box I understand the above statement.
I agree to complete and sign a letter near the completion of the fellowship certifying proper completion of the fellowship program and readiness for graduation.

By checking this box I agree to the above statement.
By typing your name in this field, you are authorizing an eSignature.
Thank you!
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Pediatric Fellowship Program Accreditation