Hi, Dr. Johnson. Hi, Anita, how are you? I'm good. Hi, Dr. Garland, and it's 1150, it's 1059. There are four different time zones probably. So for everyone, I'm going to be referring an Eastern time zone. Moving forward, we will have the breaks in four different time zones. It's 1059 Eastern time. Dr. Johnson, do you want to just give it another minute? We have about 24 people who have joined so far. Yeah, we can give, I think we can afford another minute or so. Okay, great, thank you. Thank you. Hi, Dr. Hadlock. Morning. How are you? Good. Hi, Dr. Mann. Morning. Nice to see everybody this year. At least we see faces, right? It'd be nice if people took off their, put on their videos just to say hi. Yeah, please use the networking and wait leave the video on. Let's pretend we're at a real meeting. This is the advantage of Zoom. Hi, Dari. Dr. Johnson, it's 11.02. Do you want to get started? Yes, let's go ahead and get started. Well, hello, everyone. Welcome to the 2021 Residency Directors Workshop, our second virtual workshop, and it's nice to see those of you that are on camera so that we can pretend that we're in person. My name is Dr. Tisha Johnson. I am the program director for the University of Kentucky, and I will be moderating the session today. A bit of housekeeping. Please put yourself on mute. If needed, ACPM will place all attendees except the speaker on mute. The virtual workshop is being recorded and will be shared with the program directors along with slides from the presenters. No CME or mock credits are available for this workshop. If you have any questions, please type them in the chat box, and we will address them after each presentation. If there's time, you can also raise your hand, and the moderator will ask you to unmute yourself to ask a question after all the questions in the chat box have been answered. We do have a packed agenda today. The most up-to-date agenda has been emailed to the PMR listserv and has been uploaded to the chat. We will aim to stay on time and adjourn by 5 15 p.m. eastern time today. Feel free to network during the breaks. We would like to begin with the workshop with welcoming remarks from the ACPM president. I am pleased to introduce Dr. Tannette Carlisle-Wood. Dr. Carlisle-Wood is the professor, associate provost, senior associate dean at Tulane University School of Medicine, and associate dean at Tulane University School of Medicine and School of Public Health and Tropical Medicine. She is the past chair of the American Board of Preventive Medicine. Her research interests are focused on clinical outcomes and health care processes for patients with chronic diseases such as hypertension and diabetes. She's a fellow of ACPM and the American Heart Association. Welcome, Dr. Carlisle-Wood. Dr. Carlisle-Wood Sorry, that darn mute button. Thank you so much. Thank you so much, Dr. John, for a very kind introduction, and it's so wonderful to be here. I'm pleased also to welcome you to the residency director's workshop. I had the pleasure of Zooming with several of you earlier this week at the HRSA preventive medicine stakeholder meeting, which was held for non-grantees, and it was great to hear your insights and your perceptions and perspectives on the funding situation. As a former program director, I've had the opportunity to attend many of these workshops in the past and found them very helpful. I've also presented at this workshop as a former board member of the American Board of Preventive Medicine, and now I'm so pleased to be here as president of the college to welcome you to this virtual meeting. It has certainly been an unprecedented year for all of us, and I certainly want to take a moment right now to thank each and every one of you for all the work that you've done supporting your residents, supporting the specialty, not only with the trials and tribulations of being a director, but also in light of the pandemic. You adapted quickly to remote monitoring and mentoring, but you also made time to prepare for other aspects of the challenges that we had to face collectively. Also, it was good to see that many of you were able to accept residents through the college's standardized acceptance process, and that that worked well in fostering our pipeline to our future leaders. Needless to say, you all are an integral part of the college and the specialty because you are training the future of our workforce, and this is so important if we are to lead and to thrive in various practice settings that are relevant to our specialty. I know as program directors and our board of directors recognize the many challenges that each and every one of you face. Of course, importantly, the lack of sufficient funding to allow you to support your residents, the competition that we experience with other specialties and non-physician groups for the jobs for which our residents are uniquely trained, the constant battle that we have to continuously engage with various stakeholders to raise awareness of the field of preventive medicine and the value that we add. The challenges of this past year that we've experienced with the pandemic and the issues around health equity that were revealed certainly presented the college and our specialty with opportunities to position preventive medicine residents as an indispensable component of this country's public health and healthcare system infrastructure. So later today, you'll hear a little bit more about what we're doing to advocate for Congress, with Congress, for sufficient funding with HRSA and other sources to secure funding for our residents and for the future of our field. The CM 2021 conference was also a tremendous success. I hope many of you all attended. At the closing session, I did share three priorities for my presidential term and outlined as a visible presence and purpose of the preventive medicine specialty, a pledge for evidence-based data-driven strategies to improve the health and well-being as we look at social determinants of health as well as equity, diversity, and inclusion. And last but not least and foremost on my mind is the pipeline for our future leaders. If you were not able to attend the session, we have outstanding topics from climate change, resiliency, justice, vaccine confidence. All of these would be available to you through purchasing of the recordings if you were not able to attend the meeting and would still like to be a part of it. Later today, I'll give you a very high level overview of what the ACPM is doing in the field of EDI and what the efforts we're employing to actually address health disparities as a college. I'm very pleased to see a significant portion of your residents as well as medical students attending the meeting and we do hope that you will continue to encourage your residents to attend because it gives them not only networking opportunities but also an opportunity to learn about volunteer and leadership experiences that they can have. We are absolutely looking forward to the in-person meeting at p.m. 22 in Denver in June 15th through the 19th. If you haven't already marked your calendar, please do and you can also reach out to Dr. Angela Micheline. She's our vice president for programs in education if you have any questions. Our recent graduates should be aware that ACPM is gearing up for for an ask the expert Q&A session in September which is just ahead of the board exam so please keep on the lookout for communications from the college and in the newsletter as well as our journal about information on that opportunity. Your voice and our charge to actually step up to our our place and and up to the plate for our field is so critical especially in these next coming years. You heard for those who are on the HRSA meeting we have a unique opportunity on the tales of COVID as well as other opportunities that have been unveiled to really demonstrate where preventive medicine can fill critical gaps in our health care system but we need you. If you're not a member or haven't renewed your membership please reach out, join the college, renew your membership, volunteer with our committees, participate in the webinars and the conferences, engage in our advocacy efforts. It is going to take all of us. If you have any questions please don't hesitate to reach out to our outstanding staff Anita Ballin and always know that we're welcome feedback from you all on how we can improve. I hope you have a wonderful meeting today. Thank you for the opportunity to be here and I'll turn it back over to you Dr. Johnson. Thank you. Thank you Dr. Carlisle-Wood. She will also be back in the afternoon when we have a session on diversity equity inclusion and we look forward to hearing from you then. Thank you. Now we have Dr. Elizabeth Garland to present updates from the Organization of Program Directors Associations and on the GME Subcommittee. Dr. Garland is a professor in the Department of Environmental Medicine and Public Health and the Department of Pediatrics at the Icahn School of Medicine at Mount Sinai. She has served as the director of their general preventive medicine residency since 1995. She continues her clinical practice at Mount Sinai Student Health Center where she served as a director from 1997 to 2010. She's a fellow of ACPM and is the current vice chair of the college's graduate medical education subcommittee within the education committee. Welcome Dr. Garland. Great. Good morning. Thank you. Welcome everybody and it's really nice to see all your faces now that we're on Zoom and I like it better than the webinar last year. I'm going to review maybe my first slide, Anita. So the GME committee meets quarterly and we've actually met a few extra times this year. First up was really our staff and this is our fifth year. It was very successful. We initiated a new program of first choices and then second first choices. It worked very well but later today Jim Tachi is going to present our new improved version that we hope is going to align ourselves better with other residency programs to utilize the match system. I think it's been a strong feeling of the committee that we should align ourselves as best we can so we look as familiar to the face of medical students and interns from other programs who might want to enter our really special field. A couple of months ago, Turnette actually presented to ACGME on trying to protect our protected time. We will find out from ACGME in the end of June, I believe, what the policy is going to be about exactly how much protected time we're supposed to get. Of course that means that our institutions have to align themselves with our protected time but at least it will be in the regulations. This might be a little bit of a hammer to our DIOs and chairs. We did talk a lot about funding. We had the HRSA meeting, as Turnette said, a couple of days ago. PJ also had a fantastic presentation during the conference and I'm happy to talk to anybody offline about the different ways that we can get funded through HRSA, not just through the PM funding through HRSA but also to stress the fact that we tend to think, preventive medicine, that we are not allowed to use CMS funding and we are allowed. I mean my program has two lines through CMS and there is no prohibition. Nothing prohibits us from getting money through CMS as long as, I mean we know about the cap, as long as your cap and your DIO agree. So there were various other ways. We have the next HRSA funding is going to, I think he said 2023 is when it will start. So 2022 will be the RFP will be released. So look for that next year and get on the HRSA email list so you can get alerts to that. I think Turnette really talked about membership. We're going to have a presentation about how we as program directors should promote ourselves being members as well as our residents and there are different ways that the college has facilitated our new incoming residents getting a prorated membership starting in July for their first year since the memberships are now. I'm sorry Dr. Garland, I'm sorry could you unmute yourself? Sorry about that. Okay, I hope you all, so meet me whenever you want. We trying to obviously promote some advocacy and we're going to have a presentation by Pat Remington from Wisconsin later about some of the efforts and our trainings that we did which were really awesome. At least my residents participated and tried to be in touch with members of Congress and also was raised at the committee that we haven't really addressed D.I.E. in our committee and as a residency program. So we're going to have a presentation as Turnette said, a high level one on what we're doing at the college. So by all means get involved with the committee. I really want to thank all the committee members. You're a great group. I love seeing you. Special thanks to Anita for Ballin for really organizing it and another special thanks to Jim Tachi working with me and working out some of these things and presenting it to the board. And he will go through all of what the process that we dealt with. Next slide. The other thing I do as the GME chair is I go to OCTA, the Organization of Program Directors Associations and that meets twice a year but it's also had some extra meetings. And this is just some highlights from the last meeting which was in May that again we believe it's all going to be virtual interviews again this year. I don't think we're surprised by that. I think we're going to have to think not as a specialty but as a whole group of program directors across the country what we'll do for the year after if we want to keep it virtual. They are not going to re-institute Step 2 clinical skills and they are committed to in-person exams. They did go to self-monitored at home for Step 1, 2, and 3 but didn't work so well so we're going back to in-person. ERIS is open late last year. It opened up the end of October so we had kind of a scrunch season. They're going back to the regular which is in September. There was some talk and I did reach out to the head of ERIS about changing the preventive medicine open time to more align with the fellowships which is July because the fellowships like the IM fellowships open in July and then they match in early December and we didn't know if we wanted to try to align ourselves with that but alas they said no we're we are not part of that group we're part of the other group and so we kind of have to stick with the 9-29 start date. They're trying to improve the application process, trying to kind of standardize the letters that we get from from all the their professors and doctors and try to have more letters of recommendation maybe with some check boxes and some open text so that we can get similar information from all of the advisors and evaluators and then the last thing was which it's interesting that they don't have if you've ever tried to apply to a residency program and again I went through this with my oldest daughter who's going to be starting fellowship soon so I've gone through medical school residency and fellowship matches there's really no way to look at a residency program or a fellowship and get statistics how many people apply what you know I'm not saying it's important but average scores how many people they interview how far down the list they may go to to get their applicants there's there's really nothing so they're going to try to create a database to actually help students apply better and mostly to apply to targeted programs that may accept them better and because one of the huge issues which we don't really hear about in our day is about the escalating growing snowballing number of applications per person actually for our program it's somewhere about eight or nine applications per applicant that's not so bad but in other specialties it could be it's about 60 and it's gone up to 70 or 80 applications per person which means that programs are getting thousands and thousands of applications so OPTA has been trying to since we are you know we have all the programs they're trying to see how we can address that issue and if you go to the next slide my last is how they talk about how to redesign the application process and they had we OPTA has now become like a letter writing organization we were just kind of a group of people who got together but now more and more other organizations are coming to us us OPTA to ask how do our specialties feel about these things so they drafted three letters this year the first one was this development of a preference ranking system so this is really very interesting ENT started it they gave every applicant who they who was interested who was going to apply for the ENT match five you know signals or tokens and these tokens are through error so you signify it on your application five programs that you think are your best match that you really want to go to and you might apply to 70 programs but five are your top choices the programs look at the people who say I really like you and I really want to come to your program and from looking at ENT's evaluation of the process they found that you know most programs want obviously want to interview people who really want to come to their program and they found it really worked and when they asked the applicants if you could have picked a sixth program and what would that have been and did you get an interview there and most of the applicants did not get an interview at their sixth choice which was not one of their signal choice so again we can just we're going to discuss later we have some polling whether we might want to adopt something like that for our specialty I don't think it would be five maybe maybe four signals three or four signals so that we can better target our interview process another one was the second thing that we wrote a letter to was separating the rank order list from the program deadlines now this is a maybe not as important to us but for the match with they want the programs to put their rank order in and then a week or two later have the the applicants put their rank order in so that they can visit in person some of the programs so they can get a feel for the atmosphere and some of those tangibles that you get when you actually step foot in the hospital and meet residents and program directors in person. And to see if that might help so that we could still stay virtual but the applicants could still have an opportunity to visit. And the last thing was broad program director support. And this is from something that was sent out to all of us to have a centralized process to facilitate evidence-based, specialty-specific limits on the number of interviews that each applicant can attend. Again, I'm not sure if this is an issue with our program as much, but for those who are highly desirable applicants, they may get 10, 15 interviews, and maybe that's not quite right. And for this, I believe was ortho, and they did limit it to 20 interviews. No one even got 20, so 18 was the most anybody got. Again, something for us to discuss, do we want to limit the number of interviews our applicants go on? If so, what would that number be? I do know that a lot of the top applicants do get interviewed all around the country, especially now that it's virtual. And that makes that first round match a little bit more difficult, but maybe if we did the token, so you would actually know exactly who really wants to come to your program, that might facilitate things. So that's what OCTA is up to, and I'm happy to answer any questions about any of that, but we will have presentations on most of this later this afternoon. I don't think I saw any questions in the chat, just comments. Agree with eliminating CS? Yeah, that seems to be a popular one, especially because it was only offered a couple... Oh, this is just, this is maybe hard to read, and I asked Anita, maybe she can put it in the chat as well. This is the last five years of our applications, and if you can look over on the top, that's the total. We have about 300 applicants. American grads, or UMGs, are about half, and international grads are a little less than half. It's like 160, 140, and it's about 50-50 men, and we have gone up a little bit in the last few years, and as you, if you look at the bottom, in terms of diversity, we actually do have a very diverse applicant pool, and so, but this, I know it's hard to read, but I want, you know, I did not know this, ERIS hosts this, and if you go on their website, and you can, you can just go to our specialty, and what kind of table you want, and they can create a table like that, so you can have it, but I think Anita can either email it, or stick it in the chat, so people can look at it better. This doesn't talk about the number of spots we have. We have 42 or 43 programs, but we'll be talking about that later in the afternoon, and I see, well, someone said they like the idea of the tokens. I thought it sounded like a kind of a cool idea. Personally, for me, well, when I, I'm a New York program, when I get applications from the Midwest, or something, I say, well, why, who wants to, you know, they're going to move to New York City, so I maybe discount it, but because it's a unique place to live. I'm sure some of you, others feel the same way about where your programs are, and this may be a way of, you know, interviewing those who you might not have because of geography. Anyway, that's, that's what all I have today, and put, put it, email that, yeah, email the chart. Anita will email it, don't worry. Thank you all, and it's really nice to see you. Thank you, Dr. Garland. We now move on to updates from ACGME. Katie Hatlick joined ACGME in 2015, and is the Executive Director for the Review Committees for Medical Genetics and Genomics, Pathology, and Preventive Medicine at ACGME. She was previously the Associate Executive Director of the Review Committees for Emergency Medicine, Medical Genetics and Genomics, Nuclear Medicine, and Radiology, working especially closely with the interventional radiology community in the onboarding of the new interventional radiology residency programs. Welcome, Ms. Hatlick. Dr. Judith McKenzie is the Program Director for the Occupational Medicine Residency at the University of Pennsylvania Perlman School of Medicine. Her research focuses on occupational environmental medicine outcomes and employee health, especially in the areas of graduate residency education, occupational exposures and injuries, the cost of work, disability, and resiliency, wellness, and prevention. Trained in both internal medicine and occupational medicine, she's an appointee to the Accreditation Council for Graduate Medical Education Residency Review Committee for Preventive Medicine. Ms. Hatlick, we're ready for your presentation. Thank you. All right, thank you so much, Dr. Johnson. Morning, everyone. It's great to see you. Hopefully next year I actually get to meet some of you guys in Denver. As some of you recall, I took over from Dr. Lori Lewis just as COVID was taking over. So I've interacted with a lot of you, but haven't had a chance to meet you yet, which is one of the favorite parts of my job. So Denver 2022, I'm looking forward to it. Thank you so much, everybody, for being here. I'm going to take us through some updates from the ACGME. And as mentioned, Dr. McKenzie, who is the Chair for the Review Committee, is here as well. We'll have some time hopefully for questions at the end, and she and I can hopefully answer whatever everybody wants to know. Next slide. Just disclosures. I'm a full-time employee of the ACGME. No disclosures. Next slide. So just a quick overview of what we're going to talk about today. I always like to give some updates on the annual program review cycle and the statistics. You know, what did the Review Committee's year look like? I want to talk a little bit about accreditation statuses, citations, areas for improvement. I think there's maybe a couple myths or misunderstandings out there that maybe we can bust today. Some newer frequently asked questions that have been popping up. A couple other updates from the ACGME. And then, like I said, hopefully at the end, some time for questions. Next slide. So this is the membership of the Review Committee. You can find this listing on the Preventive Medicine section of the ACGME website as well. As I already mentioned, Dr. McKenzie is our chair. Dr. Carl Wurz from the AOA is our vice chair. I always like to point out to people that every Review Committee has a public member. Marie Dotseth is our public member. And every Review Committee has at least one resident member, to bring the resident perspective. Right now, that is Rachel Thies. And actually, her term will be ending in just a couple of weeks here. So we'll have a new person coming in. Next slide. There are also two ex officios. Chris Andrula comes to us from the American Board of Preventive Medicine, serves as a liaison to the committee. And Dr. Howard Teitelbaum from the American Osteopathic Board of Preventive Medicine also serves as an ex officio. Next slide. Okay, so we're about at the turn of the academic year, which means we have some members whose terms are ending, and we have some who are coming in. So I always like to say a warm welcome to our incoming members, who will start on July 1. Tim LeVan comes to us from the Naval Aerospace Medical Institute. He'll be replacing Dr. Tara Castleberry, whose term will be ending in a couple of weeks. And as I mentioned, our current resident member, Dr. Thies will be ending her term on the committee. And so Dr. Erin Winkler from the National Capital Consortium will be joining us as the next resident member. Next slide. This is probably one of the most important slides in the whole presentation. This is the contact information for the review committee staff. You can also find this on the website. But if you take anything away from this presentation, it's that you can call us with questions. Please don't hesitate. I think there used to be sort of a myth out there that if you called the ACGME, we were going to send in a site visit. That is not true at all. We would rather talk with you, answer questions, you know, maybe troubleshoot issues before they become big problems. So it's in your best interest to give us a call if you have questions on program requirements, you know, not sure how to proceed with something, if you're looking to apply for a program. You've already met me. Natasha Lewis is our Associate Executive Director. She joined the ACGME in January and is super eager to get to know people. So feel free to reach out to her. And some of you may have already interacted with Catherine McHugh, who's our Accreditation Administrator. She's been with us for about two years. So email us, call us with questions. We are here to help you. Next slide. A couple of statistics. Currently, there are 72 accredited residency programs. You can see five in aerospace medicine, 24 in occupational medicine, and 43 in public health and general preventive medicine. Those numbers have stayed pretty static over the last couple of years. We've had a little bit of movement with occupational and GPM in terms of the number of programs, but nothing huge. And for this current academic year, 2020 to 2021, there's been a total of 355 residents enrolled. Next slide. Okay, so like I said, we're going to talk a little bit about the program review cycle, which starts kind of in November and goes through the next April. So as a reminder for how this works, or if you're new, to give you a little bit of an update. So looking at this past year, you submitted your annual updates around August of 2020. So a little under a year ago. And most of those updates are going to reflect what happened in your program in the 2019 to 2020 academic year. So in August 2020, you were reporting on what had just happened in what had happened in the year that kind of just ended. So a lot of that, again, a lot of what you put into ADS is what the review committee is looking at. The review committee also gets the exam certifying exam data from the ABPM. So last year, the committee was looking at results from 2016 to 2018. So those those three years of exam results. I do want to note, some of you might have seen this noted in your letters of notification from us. ACGME did not get the 2019 exam results from the ABPM in time for the annual review when it started kind of an early fall. And that was due to COVID-19. ABPM had to shift their focus and try to get ready to do exams virtually. And so they just didn't have the bandwidth. That's not unique to ABPM. There were a number of other specialties who encountered similar challenges. So the committee did not issue any new citations on board pass rates in the last cycle. And they also did not resolve any existing citations on board pass rates because there was no new data. And again, those of you that may have gotten some of that feedback would have seen that reflected in your letter to say, there was no data, the committee couldn't resolve the citation because there's nothing to look at. For the next cycle, that's going to start in a couple of months, we anticipate. In fact, I think we may already have some of the data that we need. So this should just be a one time thing as a result of COVID. Other things the committee looked at was scholarly activity. Again, it's always behind by an academic year. And that's done by design because of how scholarly activity gets reported. You need time for you know, scholarly activity to be published. So looking at the 1617 1718 and 1819 academic years for scholarly activity. And then always the committee looks at the results of the resident fellow and faculty surveys. And for this cycle, those were completed in January and February of 2020. And as you may recall, I mentioned last year that some specialties had an extended survey window because of COVID-19. This group was not affected because the surveys were all completed. The deadline was before the pandemic kind of had really exploded in GME. So these, these specialties were not affected. Next slide. Okay, so the committee meets twice a year, typically in November and in April to do program review. So we're going to talk about the November 2020 meeting for a minute here. The bulk of preventive medicine programs are always reviewed at the November meeting. That's just the busier meeting for most review committees is that sort of winter meeting. So there were a number of programs that were on a consent agenda because they didn't really have programs that were on a consent agenda because they didn't really have any issues. So they didn't require what we call like an in-depth review. There were nine programs that the committee did that in-depth review on because they had either existing citations, multiple data indicators, like surveys, scholarly activity, clinical experience, they flagged in our system, or they might have had a combination of both. So out of the November 2020 meeting, there were 65 programs that received continued accreditation, which is the best status you can get. It says you're, you're doing good, keep doing what you're doing. There were three preventive medicine programs that were not reviewed. And that's because they were on initial accreditation, which means their newer programs there, they applied and were approved within the past two to three years. And we always give those programs a two to three year window to get up and running before we review them. So they just weren't reviewed because they're still in their ramp up period. And then there were three programs that requested site visits. And so those were deferred until the April meeting. Now, if you're doing some fast math in your head, you'll see that that adds up to 71, not 72 that I told you a minute ago. And that's because we had one application get approved at the April meeting. And so that's, that's where that missing program is, it's not missing, it's just an application. So it wasn't reviewed as part of the annual program review. But that's where we get to 72 programs. Next slide. I'm not going to spend too much time here. But we always like to give just a little report on the citation situation. So at the November meeting, the committee issued eight new citations, extended three and resolved seven. And that's, that's a pretty good mix. That's, you know, about what we see in other specialties. So not going to go into each of these in depth, you can kind of see the different categories. Some of these come from the survey or may have come from some of the program data. The program director administrative time is on there. It's already been mentioned today. And I'm going to come back to it in a few slides. So I won't dwell on it now. As I mentioned, under the extended citations, there were two citations extended for board pass rate. Again, that's because the committee had no new data to determine if it was resolved or not. Next slide, please. Giving you a workout, Anita. And then areas for improvements. A lot of these come from the resident survey, you can see these categories sort of line up. Faculty scholarly activity also mentioned significant attrition. That's usually faculty attrition, clinical experience. So that's the survey is one of the more common areas where the areas for improvement come from. Next slide. Okay, so talking about the April meeting, it's the the less busy meeting agenda of the two. So there were those again, those three programs I told you about that were deferred from November, they were reviewed in April due to site visits. One was a data prompted site visit, meaning the committee said, hey, there's something looking a little funny here with some of the data, let's go talk to the program and see what's going on. And then there were two 10 year accreditation site visits. And they were actually kind of combined with some data elements in the 10 year. So of that review, there were five new citations. And again, not going to dive into them too deeply. But I am going to highlight the first one because you're going to hear me talk about this a couple times throughout accurate and complete information. The committee knows usually, most of the time, the committee knows what's going on in your program because of what you put into ADS. So if what you put into ADS isn't accurate, isn't complete, isn't clear, isn't consistent, the committee's not mind readers, and they're not going to really know what's going on in your program. And that likely will result in some sort of feedback from the review committee. So I know it's a lot. There's a lot to put into ADS. I used to work on the program side. So I remember the days of the annual updates. But we implore you guys as program directors, work with your program coordinators, make sure everything is as accurate and complete as possible. It's better for everybody, I promise you. Next slide. Again, not going to spend much time here. These were the areas for improvement issued at the April meeting. You can see a number were issued in the evaluations area, board passage rates. Again, a lot of these were born out of surveys. And then again, because these were site visits, some of these would have come out of the site visit reports. Next slide. Okay. So this is a really good slide. And it's good news for a couple of reasons. The first being is that there are no preventive medicine programs on continued accreditation with warning or probation. That's great. That's what we like to see. 68 of your programs are on continued accreditation, which again, that's what we like to see. Keep doing what you're doing. The other good news on this slide is that there are four programs on initial accreditation, which as I mentioned earlier, means these are new programs that have recently applied and are in that kind of two to three year foundational period. So we have four programs that have applied in the last few years, which indicates a little bit of growth, which is always good news. Next slide. Okay. Speaking of program statuses, this is another maybe one of the myth busters sections of the presentation. I just want to take a few minutes to talk about program status and citations and maybe clear up some misunderstandings. And I'll talk in a minute about what a citation and what an area for improvement is. But for now, I just want to remind everybody, the ACGME and therefore the review committees focus on substantial compliance with the program requirements, not absolute compliance. The idea is not that you have to check every box and demonstrate compliance with absolutely every program requirement in order to be accredited. You've got to check most of the boxes and in all the right areas. There are some program requirements that the review committee may weight more heavily. You know, some of the competency areas, the curricular requirements are important. Are you treating your residents well? Are you giving them a balanced education? Those are going to hold a little bit more weight, but it's always substantial compliance. A few minor issues will not cause the review committee to withdraw accreditation. I will promise you, per ACGME policy, you have to have a site visit before we can withdraw accreditation. So it's not like you're going to get a letter from us one day that just all of a sudden says you don't have a program anymore. That's not how it works. And the review committee really is here to help programs, you know, succeed and improve. They don't want to withdraw programs either. They want to see everybody succeed. So if you've got, you know, when I say minor issues, there's a lot of paperwork to keep up. And we know that, you know, so if you're having issues with getting your evaluation forms with the right terminology, getting your block diagram in order, you know, maybe some of your policies, you know, don't cover all the right boxes, things like that, still important to need to be addressed, but certainly not going to close your program. It's not just about the number of citations. It's about quality. So quantity and quality together. I've seen some programs with upwards of 20 citations, not necessarily in preventive medicine, but in other specialties, upwards of 20 citations, and they're still accredited. They got some things to work on, but they're still an accredited program. I've seen some programs that maybe only have a couple of citations, but because they're such fundamental issues, again, curricular, treatment of the residents, you know, balance of education, that maybe programs with only a couple of citations may be in trouble. So it's a balance. A citation is not the end of the world. It may feel like it when you get your letter. I promise that it's not. It's meant to help you improve. On that same note, the committee understands that some things take time to fix. You know, paperwork sometimes is easier to fix. If you're looking at curricular issues, if there's some culture issues in your program, that's not going to get fixed overnight. And again, the review committee is made up of program directors or former program directors who know what it's like to run a program and know that sometimes these things take time, and we're here to help you. And I will just note in terms of accreditation statuses, they typically go in a stepwise fashion, you know, going from continued accreditation to continued accreditation with warning, which the warning is meant to say, if you don't shape up, it's a warning that you could go on probation. I mean, that's what that means. And then move to probation. And then, you know, possibly move to withdraw. In my six years at the ACGME, I personally have never seen a program's accreditation get withdrawn. It's rare. So I won't say that you may, the review committee may jump over some of these statuses, but it would have to be a really egregious situation. Because again, the committee is here to help you guys, and they want to see you succeed. Next slide, please. So what is a citation? Maybe if you're a new program director, you just want a refresher, it's an area of non-compliance with a program requirement, or maybe a couple of related program requirements. It's going to be something the program doesn't have, doesn't do, or didn't clearly describe. And I'm going to focus on that didn't clearly describe for a moment, because again, that's where this accurate and complete information comes in. A lot of the citations are that the review committee couldn't determine if the program was doing something. It is unclear whether the program is doing this evaluation. It is unclear whether residents are getting the required didactics, because it, the program didn't clearly describe it. So again, that's where that sort of accurate, complete, consistent information comes in. All citations must be responded to in ADS. You can respond to citations at any point of the year. You can go in and do an update, and a response. You will have to as part of the annual update window, but you don't have to wait. If you have things you want to respond to as soon as you get the letter, go ahead and put it in there. Then it's captured, and you don't have to think, you know, six, eight, ten months later, and think, okay, what did I want to say about this? You can do that for any part of ADS, actually. We give you a dedicated window to make sure you go in and update, but if you are adding and subtracting faculty members, if you're changing your block diagram, go ahead and make the changes as they happen, and you don't have to sit there and think, what all has happened in my program in the last year, and try to capture it all at one time. Specifically for those citations, they do get reviewed by the review committee every year until they've determined that the issue is resolved. Next slide. So areas for improvements, a little less serious than a citation. We like to think of them as like a professional heads up, or a little tap on the shoulder, just to say, the review committee notices that maybe this is a, you know, a concerning area. It's a trend. We want to make sure you as the program are aware, so you can work on it before it rises to the level of a citation. So AFIs may be tied to program requirements, they don't have to be like citations do. You don't have to respond to AFIs in ADS. However, the committee loves information. So if you have an update you'd like to give the committee, if you got an AFI last year, and at the time of your annual update, if you want to update the committee on what you're doing, you can put something in the major changes section in ADS and just say, I got this AFI on evaluations. Here's what we're doing to fix it. The committee's, you know, you don't have to do that, but it just gives the committee context and helps them better understand what you're doing to address issues. And of course, repeat AFIs could become citations. If you keep getting that heads up, and the issue is not getting any better, that's when it might rise to the level of a citation. Next slide. So how to respond to citations. The first thing is make sure you understand the citation and the non-compliance. We try to be as clear as possible when writing the letters to say what was wrong and kind of where did we find that it was wrong. But if you don't understand, feel free to give me a call. I'm happy to chat with you. That's, again, that's, I'm here to help. This isn't meant to be a mystery. We're, you know, we're trying to make it as easy as possible for you to know what's wrong and how to fix it. Be sure your response is concise, but thorough, and that it addresses all areas. Sometimes there may be a couple of program requirements lumped together. Make sure your response addresses everything that was mentioned in the citation. It's also important to watch tone. This isn't really as much of a problem in preventive medicine as maybe some of the other specialties I've worked with. But anytime you're communicating through written means, you know, tone of voice, those sorts of things don't always communicate very well. So best to just, again, kind of be concise, stick to the facts, and that's, you know, really going to be your best approach. Again, if you ever have questions, feel free to reach out. And here we go. Accurate, complete, consistent information. Again, make sure everything matches. If you got a citation about your block diagram, say that, you know, the committee didn't see the required direct patient care experiences in your block diagram. And so in your response to the citation, you say, we updated our block diagram to clearly denote those required direct patient care experiences. Make sure your block diagram and ADS is updated. You'd be surprised that programs say that they updated something, but then they didn't actually upload the updated documentation. Again, the review committee are not mind readers, so in that situation, they're going to say, they said they updated the block diagram, but we don't see it. What do we do with that information? And in many cases, what's likely going to happen is you're going to get that citation extended to say the committee didn't have enough evidence to resolve that you're, you know, it's going to get extended for another year. So make sure things are consistent throughout. Next slide. Okay, just going to spend a few minutes on the resident fellow survey, because we do get some questions on this. And I just, again, wanted to clear up any misconceptions. So you will get results of the resident fellow survey. This actually applies to the faculty survey as well, but we're going to hone in on the resident fellow survey. You will get those results if there are at least four respondents, and the response rate is at least 70%. And I know for some of the smaller programs here, that may not always be the case. If that's true, then you're going to get multi-year survey results that are aggregated over, I think, three years once enough data is collected. And the reason for that is anonymity. If you've only got two residents responding to a survey, it's probably a lot easier for you to determine who said what. And of course, you know, the ACGME takes, you know, anonymity issues of, you know, fear and intimidation very seriously, and this is one way to protect that. Next slide. So how should you use your resident survey results? You want to make sure you're reviewing them annually with your program evaluation committee. That's actually a program requirement. One of the things the PEC has to do is review the ACGME survey results. If there are areas of concern, talk to your residents and fellows. Ask them. You can't coach them on the survey ahead of time, but once you get the survey results, you can say to them, why did, you know, why did you respond like this? What's the concern? Try to identify the source or sources of the problem and then solicit specific improvement suggestions. It's also a good idea to communicate what changes are being made. Again, it's not required, but you can use that major changes section to say, hey, review committee, we know that, you know, our survey was low in these areas last year. We've identified the problems. Here's what we're doing to work on fixing it. Doesn't mean you won't get feedback from the review committee, but I guarantee you that if you've already proactively said, yes, we know our survey didn't look great. Here's what we're doing to try to fix it. You're likely going to get a little bit of leniency from the review committee and they'll say, okay, we've already got some plans in place. Let's maybe give them a year, look at the next survey and see if they were able to address it on their own. And this is another myth buster moment that I've heard throughout the years. Poor resident fellow survey results alone will not cause the review committee to withdraw your accreditation. I've heard that some programs tell their residents that, which is not something we want programs telling their residents, but it is not going to happen. A poor resident survey could result in a site visit, which if the program was really, truly in that rough of shape, it could lead to withdrawing accreditation. But again, that's very rare, very rare. And it's again, not like you're going to have one bad survey and then all of a sudden we won't have a program. So I just wanted to clear that up in case that was a misconception out there. Next slide. Okay. Anita, there's some animation here, so I'm going to put you to work. So just bear with me. So this is just kind of a screenshot of the survey and I've kind of sandwiched some elements together. So it's a little compressed, but go ahead and click Anita. So up in the upper right, you're always going to see the number of residents surveyed and the number of residents responded and the response rate. We always like to see a hundred percent. You've got to hit at least 70% for the resident survey. So if you've got, you know, maybe one resident or two that didn't respond, you might still be okay, but you really want you to get all your residents to respond. Go ahead and click. Then at the top, you'll see kind of the overall evaluation and opinion of the program ranging from, you know, a very negative to a very positive experience. And then in terms of the opinion, residents definitely would not choose the program again, or they definitely would. Go ahead and click twice. So you can see then on the very left there, you'll see the different sections. And again, I kind of took out some of the sections, but resources is one of the sections of the survey. And then the next thing that's highlighted, that's one survey element. It doesn't say what the actual question is, but that's what's being evaluated. And so this one would be education compromised by known physician obligations. Click again. So then here you'll see the program percent compliance. And what that means is that's the percentage of people that responded that gave a compliant response. Each survey item will have most, because some are yes, no, but most survey responses, they'll have five response options. And typically the top two are going to be what's considered a compliant response. So anybody that picked one of the top two would be in that percentage. So you can see for this category, except for one area, all of the respondents picked compliant responses, which is great. Click again. And so the next to that is the mean, and each response gets a numeric weight one through five. And so that's the mean of all the responses. So you can see for the top one, education compromised by non-physician obligations, not only did everybody pick a compliant response, everybody picked the highest response, because the mean for that question is five. You can see the next one down, everybody still gave compliant responses, but there was a little bit of waffling between either the highest response or the second highest response. So that's what those two things mean, and that's how they're calculated. You can see next to it, that it also calculates for the specialty. So that would be all preventive medicine programs, and then nationally, which would be all residency programs at the ACGME. Then at the bottom, you can see, and again, this would be at the very bottom of your survey, but I smushed it. You get trend data, and that's something that the review committee will look at as well, is if you're looking across, is there a big dip in one of those blue bars at the bottom? Because if there's a dip, they're going to say, well, what happened? The program is doing well, and there's a big dip. That's an indication there could be a problem. Then at the very bottom, again, you'll see those means against the national means. Next slide. I promised I'd come back to protected time, and I know that this is still newer for you guys as program directors, and so as a reminder, it's a minimum of 20% FTE for you as program directors, bottom line. There's also a requirement that there's an additional 10% FTE for a total of 30% that either you can take as the program director, or you can split that between yourself as a program director and an associate program director, and that's up to you. Program director has to have 20, that additional 10, you can decide, working with your department and your institution, you can decide how you want to manage that. Then it's a minimum of 50% FTE for the program coordinator, and that's just pretty straightforward, 50% time for your program coordinator. Now, I will say, and you heard Dr. Garland talk earlier a little bit about presenting to the ACGME about this, the review committee presented as well, there are some changes being made to the common program requirements, which are common across all residency programs. They're not specific to preventive medicine. There's some changes being made in how the protected time requirements are reflected there. That may result in some minor changes to these protected time requirements in preventive medicine. The committee is actually meeting next week to discuss this. Same 50% for coordinator regardless of program size. Yes. As of right now, yes. That was a direct question. I wanted to just knock it out while we were on this slide. As of right now, yes. Again, there may be some minor modifications. As always, revisions to program requirements will be posted for public comment. We always share with these groups as we can when changes are being made, but I don't anticipate that the committee is going to make any really drastic changes and all of a sudden say that program directors need 100% time or anything like that. Stay tuned for more updates. Again, I just want to reiterate, we hear this from a few programs. Well, I'm not going to get enough protected time, so we have to close. Not from a review committee standpoint. Again, you have to work with your institution, but lack of protected time for the program director or for the program coordinator alone will not cause the review committee to withdraw accreditation. Combined with other issues, that's a different story. But if you say, well, I'm not recruiting to my full complement or I don't have any residents this year, I'm not going to get enough protected time because my institution doesn't have the funding, we're going to close. Again, from a review committee standpoint, you're okay. You may get some feedback from the committee, but it's not going to close your program. Actually, if it's a temporary blip, I would recommend staying accredited because financially, it's much more expensive to close a program and then have to reapply and also a lot more effort than to perhaps just escape by one or two years, maybe where you're a little bit under or not recruiting and then coming back. This is an area where if you've got specific questions, we can certainly talk via email or phone and chat about specific circumstances. But I wanted to put that proclamation out there, that lack of protected time, again, from an ACGME standpoint, that alone isn't going to close your program. Next slide. I see more questions coming in. I think we're going to hold them for the end at this point. But that one question was very on the nose to what I was talking about. So I'm not going to read these slides in detail. You'll have the slides made available to you. And these will be posted pretty soon here as FAQs on the website. But so I'm just going to kind of talk through the issues. So if you're appointing a resident at the PM2 level, as a refresher, that means if you've got a resident who's completed an ACGME residency program, full program, and has done at least 50% of the MPH, the master's degree requirements, you can take them into the PM2 level and then they only have to do one year of preventive medicine education. So the question is, are they still held to that requirement that they have to do the 10 months of direct patient care before entering? The answer is yes. So they don't just get to skirt around the clinical year requirements, even if you're appointing them at the PM2. This can be accomplished in one of two ways. If they're coming to you from an ACGME, if they've completed an ACGME accredited residency that does direct patient care, pediatrics, internal medicine, family medicine, then they're good. You can roll it up into their experience. It doesn't have to be 10 months separate from the residency, they just have to make sure they've had that 10 months of direct patient care before they start in your program regardless of year. The other way this could be fulfilled is even if the residency itself isn't a direct patient care residency, if that residency had a requirement for a clinical year that they did, then you're good. I know for example, that's medical genetics and genomics isn't direct patient care, but they have a clinical year requirement. Not sure if you would have anybody going from genetics to preventive medicine. I mean, who knows, but that's an example where even though they didn't complete a direct patient care residency, they did the clinical year requirement for that residency and so it counts. Next slide. A couple of questions about the 36 month residency program option, which was a new option added as of last July, so just under a year. And that's where you take the clinical year and roll it into your program. And so instead of being 24 months just of preventive medicine education, now you're doing the clinical year and the 24 months all in one. So you're a 36 month program. So how do you do that? That's the question. If you'd like to do that, you're going to have to submit a block diagram all three years and either like an attestation or a program letter of agreement outlining who's going to provide the clinical year experience and confirming there are adequate resources. And you can send that right to myself or anybody on the team. Essentially what the committee is looking for is are you partnering like with internal medicine at your institution? Are you building your own clinical year? How are you doing this? And of course the committee wants to make sure that it's going to be an equivalent experience to if they did the clinical year and then came to you. So again, reach out if you have questions on that. Next slide. A follow-up to that, if my program switches to the 36 month format, can I only take people into the 36 month format? The answer is no. If you have a resident or an applicant who's already done the clinical year or maybe they've already done a full direct patient care residency, you still are a 36 month program. You're not changing the format of your program, but you're just recruiting them then into the PM1 year instead of the PGY1. So you can just internally within ADS, let them skip. It's the same concept as if you appoint someone at the PM2 level. You're still a two-year program. You're just letting them skip the first year. So if you switch to 36 months, you stay a 36 month program and you still have to demonstrate that you're meeting all those program requirements for 36 months, but you can recruit residents at whatever level you want. You're not stuck to only taking residents for the full three years. Next slide. This is another fairly common question. If I want to become program director, do I have to have ABPM certification in the same specialty concentration as the program? So do I have to have aerospace certification for aerospace, occupational for occupation, et cetera? The answer is not always. Obviously that's desirable by the review committee that you have certification in the specialty concentration, but if you have ABPM certification in one of the other specialty concentrations and you've got some other good qualifications, maybe you've been working as an APD in that program. So you're familiar with the education. If you've done some research or other scholarly pursuits in that area, that would probably be okay. The committee evaluates each program director candidate on the whole of their qualifications. So you can't really say yes or no based on just one snippet of qualifications, but if you can make a case that you don't have certification in that specialty concentration, but a different ABPM certificate and you've got some good other experience, the review committee will probably find that acceptable. Next slide. Okay, just a couple more slides. And I know I'm trying to watch time here because I know we have some questions. So I'll go quickly through these last slides. Most of these are just kind of reminders, nothing new from what I said last year. So you'll have these slides and you can reach out. All site visits at the ACGME are being conducted virtually through at least January. Likely once we start moving back to in-person site visits, we'll see a hybrid model. That some site visits will continue to be virtual even after that, some will be in-person. You'll always get plenty of notice if you're scheduled for a site visit. So again, nobody's just gonna show up one day and say, oh, we're here for our site visit. So don't worry, you'll get plenty of communication. We're just still figuring out what that hybrid model is going to look like. Self-studies are postponed through at least July, 2022. So if you were a program that had kind of been on tap to start your self-study and then it was postponed, you're not gonna start it at least until a year from now. And again, you'll get plenty of communication on what to do as that gets closer. But if you're kind of in that limbo period, you can stay in that limbo period for a little bit longer. We are going to be delinking the 10-year accreditation site visits from the self-studies. Now, as it was now, you completed your self-study and then about two years later, we would come and do the 10-year site visit and also talk about your self-study. It's no longer gonna be the case. It just wasn't a sustainable model for the ACGME and we're looking into how best to proceed. So again, we're kind of in a transition period there, so stay tuned. If you have any questions about your self-study, you can email as you see self-study at acgme.org. Next slide. This is a reminder, hopefully we are coming out of COVID-19, but it's still here. So I just like to remind everybody as we get to the end of the academic year, it's ultimately up to you as program directors to determine if somebody is ready for autonomous practice. That may mean that you have residents that need a little bit extra time if they didn't get all the experiences they needed. If they're not quite, if you don't think they're ready, you may need a little bit more time in the program and that's up to you. We do have some guidance posted on our website about competency-based medical education and how to evaluate residents. You can check that out. You can always contact us with questions and of course, always get ABPM involved because you probably don't wanna be making a decision that could negatively affect a resident's eligibility for certification. We will ask again during the annual update, programs should, again, if you did have any disruptions or modifications to curricular experiences, just report those in major changes. We know that there's gonna be some of those same COVID-19 questions in the annual update. They're not really specific to preventive medicine. So the committee thinks, even if it's just a couple sentence narrative in that major changes section to give some context to what went on in the program, it's gonna be super helpful as they're reviewing again this fall. Next slide. So just a quick reminder on COVID-19 guidance. And this letter was posted over a year ago now, but it's still out there and that the review committee will continue for a little while longer to allow some flexibility in what can be counted as those direct patient care experiences. The letter will give you some examples. They're also allowing some flexibility in experience at a governmental health agency for the GPM residents, that there is not flexibility in completion of a master's or those graduate level courses. This is tied to COVID-19. So this will not be indefinite. This is just to give you guys flexibility because we know things have been very crazy in the last year. I will say with the master's, I've had a couple of questions from individuals saying that their residents are ready to graduate from a program. And for whatever reason, the master's degree is a little delayed. Maybe they're finishing up like a capstone project and they won't quite get the master's degree by the time they would graduate from the program. And I've had some program directors saying, does that mean I have to keep them for another year? I would say no. If they're gonna get that actual degree in a couple of months and it's just sort of a timing issue, you as program director think that they've checked all the other boxes. That alone, I don't think should hold them up. Again, check with ABPM. You don't wanna set up a situation here, but we know that the timing doesn't always line up. And if they're super close to being done and it's just a matter of waiting for the degree, you don't have to keep them for another year or whatever. Next slide. Okay, that was it. And I would say any questions, but I've seen quite a few popping up in the chat. So I think we will take, again, Dr. McKenzie is with me. So we will take whatever questions we can get to. I thank you, Dr. Hatlick. We will, so we have a list of questions that I've been trying to jot them down. Does anyone know what the current average median time for PD, APD time is? So is there a breakdown that you're aware of of what most other programs are doing? Not off the top of my head. That's a good question. And I could get that information. I just don't know it off the top of my head. And that could possibly be something we can send through the listserv too. Maybe Anita can send that as a question and people can respond on the listserv. And then they had lack of protected time won't lead to closure, but it could lead to a citation. Is that correct for the program director and APD? Yes. The next question was, do you have any thoughts on what the direction of the changes with in regards to the common program requirements will lead to? Do you feel that it's gonna be more protected time or less protected time? I'll give a quick answer and then I'd love to have Dr. McKenzie weigh in a little bit. The changes in the common program requirements are taking out any baseline numeric requirements. Right now, the common program requirements say a minimum of 20% and committees can build on that. Same with the coordinator. It's a minimum of 50% and then committees can build. The changes are gonna take those numeric baselines out to allow committees to have more flexibility to go either under that or over that because there are no numbers anymore. So there's a little bit more flexibility being afforded. Judith, would you like to chime in with some more insight? Yeah, so there was a Congress last year discussed this issue because it's kept coming up and there was so much variability. So as Kate said, the new requirement is to allow PDs more flexibility. But I think the RC also has to decide for their programs what would work best. And then we sort of have to stick with that. So for example, preventive medicine overall, if I'm thinking correctly, it was 30% divided between the PD and APD or the PDLO and whatever you wanted to do. And so now, and the coordinator is 50%. As a group, we wanted to keep that and not change that in any way. I'm not sure if that's gonna change. Kate, I think you and I were talking about why can't we keep it that way? And so I don't know if you wanna take it away from here, but it's supposed to give us more flexibility, but I don't think it's gonna make everybody 100% happy. I think that's true of any specialty is that whatever protected time requirements you put into place won't work and won't please everybody. And so it's a tough job for the committee to come up with a one size fits most model. I will say that for the most part, the committee could stick with what is in place now. And those were just done as part of a major revision again, just about a year ago. So the committee just put these into place. We don't wanna cause whiplash. One option the committee may be exploring, and I don't know if they will go this route or not because we meet next week, but there is an option to scale up based on program size and complexity. I mean, by complexity, looking at the number of sites because we know for coordinators, that's a lot to manage. I don't know if the committee will go that model or we'll really just kind of stick with what they have. But whatever, well, I should say, if there are changes made, again, they will be posted for public review and comments. And we can get an announcement out in the listserv when that happens. So you guys will have absolutely an opportunity to comment and say, this is great, or this is not great. And the committee gets to look at that feedback and take that into account. Yeah, I think what we're discussing, I'm looking at the chat as well, is if we keep that as a minimum, then we need to maintain that even if there's no one in your program that year, on the one hand. On the other hand, for bigger programs, it will be nice if we can actually add that stepwise increase that Kate was talking about to protect the program director in terms of having that support to say to leadership, hey, we have this many more residents or sites or whatever it might be, and this is what is recommended. But it won't be required in that if you don't get it, it doesn't mean you have to go stepwise, but the option is there as a guide to support us, MAPD as well, in saying this is what we need. Thank you. And there's some comments in the chat there that it sounds like at least those are commenting or saying that we like at least the 30 and 15% protected time that we currently are afforded. But we appreciate having the opportunity to do feedback when you all make your recommendations. The next question is a 10% additional time, is that just for the PD or APD, or can that be split between the PD and other core faculty that are not necessarily the APD? The way it is designed right now is that it's either the PD or the PD and the APD, because it's meant to be program leadership. And ACGME defines program leadership as program director and associate program director, assistant or associate program director as applicable. So core faculty would not be included in that. At the Congress, we did discuss some core faculty protected time and our RC recommendation, and Josh is on the call here as well, was that we would have a minimum amount of time for a core faculty, which was really very minimal. It was like half a day a year or something, but that has not been a part of what came out of the decision-making. So as Kate said, it's 30% PD, APD. And the next question, it's on self-studies. The next couple, if we already did a self-study, will this be delinked from the site visit, or is it just those who haven't yet done the self-study? This is still in conversation with our Department of Field Activities, but I believe going forward, the delinking starts now. So if you're kind of between submission of self-study and then waiting for your 10-year site visit, I believe your 10-year site visit will be delinked. They're looking at ways to still give feedback if you've already done your self-study, because that's part of what we're doing is giving programs feedback. But I believe 10-year site visits from here on out are gonna be delinked. Thank you. This is from a new program director, just wanting a brief sentence or two, if we can do it. What is a self-study? In a brief sentence or two, essentially a self-study is meant to be a way for the program to do a comprehensive retrospective and prospective view of the program. Looking at your annual program evaluations, reviews, and coming up with a SWOT analysis of where have we come and where are we going? That's probably the best cliff notes I can give. If you have more questions, there's a section on the website or email me and I can give you a more in-depth. Wonderful, thank you for the additional resources. And I added the brief part. I know that's difficult because we're running short on time. So this is the final question that I have in the chat. So if residents are completing MPH requirements but missed the May graduation, but will technically graduate this summer, can we certify completion? Do we need official documentation from the School of Public Health of impending graduation or is email communication sufficient? And I'll defer again to Dr. McKenzie if she has any additional, but I would think if you're just looking at a matter of a couple of months before official graduation, that seems close enough to me. I think we discussed that as well. And we decided what Kate just said. I mean, it would be nice if everything were perfect. And to the documentation parts, I think in the interim, an email in the residence file would be okay. Again, since the official documentation will be forthcoming within a month or so. If you're looking at a longer time span, that may be different, but I think an email would be okay. Wonderful, thank you. I believe that is the last of the questions. Thank you everyone for your thoughtful questions.

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