[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]


-----------------------------------------------------------------------

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