I'm gonna go ahead and get started. So I'd like to thank everybody for for taking their time out of their evening and I appreciate the fact that it's late summer and you probably have many better things to do but for those for those of us who are running fellowships this is an important call. The you know the board and the fellowship committee have been poring over this for frankly for a couple of years and basically I'll let Jim give the history leading up to how this evolved but in several different instances it's it's come to our attention somewhat abruptly and I won't say painfully but but it could go that direction. We are the last standing subspecialty society to not have any kind of formal accreditation for our fellows and as such it puts us in a precarious position because we're one specialty or subspecialty that really has a very active competitor or competitors in the space in which we work. So you know for podiatry and now frankly for you know depending on what part of the country you're in for physical therapy, nurse practitioning, physician assistance, there's a lot of reasons that we need to have our fellows leave their fellowships with some level of accreditation that suggests that their training isn't just some sort of pass-through or other you know other form of just a gratis extra year that it actually means something that it provides them with education that supports the mission of the AOFAS to be the premier provider of foot and ankle care worldwide. So that's where this all came from and quite frankly it's been sort of a little bit of a burden to really get this up and off the ground because we really just haven't had a whole lot of direction. You know other societies have done different things but I think the fellowship committee has really pulled together. Jim started it off and and got everybody together the last year or two prior to his stepping down and then Aaron has taken the ball and run with it. And so what we've arrived at from a board standpoint is not really a suggestion. This is what we're what we really feel that we need to do as far as accreditation for our fellows coming out of fellowship training if they are to be trained by AOFAS trained foot and ankle specialists. And so Jim's going to give a little history and then Aaron's going to run it down but what we're going to ask you to do is keep an open mind. There will be some time for discussion after this and if you have any rebuttals concerns I mean this is a time for open discussion. There's no judgment here and I'm going to just lay it out that probably four years ago or so Dan Farber was actually leading this committee and I personally stood up at one of the early morning fellowship committee meetings and was a naysayer for this whole process. Maybe not accreditation but parts of what we're going to discuss tonight I felt pretty strongly at the time were really just not appropriate for all fellowships to have to comply with. But I think as with many things times change and we're in a circumstance now where we really need to band together as a group and if we're going to quality plan the community we really need to have something with teeth that supports what kind of training they had that if somebody comes back and says well you know these guys they don't they don't have any metrics they don't have any any real support or oomph to their training that we can say no no that's not true here's documentation here's what we look at here's what we feel is necessary to to meet the bare minimum standards. Admittedly we're still all trying to work this out it is not something that is set in stone right now but we need to move toward that and that's where we are that's why we've called you all together and and again that's why I certainly appreciate the fact that you're participating. So with that I'm going to turn it over to Jim and and then we'll hear from Aaron but please please feel free let us let us give you the actual presentation but at the end please feel free to say whatever is on your mind this is a non-judgmental meeting and we really need to we need the feedback we encourage the feedback we have to have it to make this work well. So Jim I'm going to turn it over to you. Thanks Bill. I just have Bill and the group asked me to sort of put a couple slides together and and let people know. I can share my screen too if that's easier Guadalupe. There we go. Kind of how we got here sort of thing. Let's go down to slide five please. Next. Anyway this all started about one more yeah in about 2016 when Jerry Williams was president of the academy he gathered some people and and anointed Alan Hillbrand as a sort of the person to lead the charge for this alternative what was then called an alternative accreditation initiative and Dr. Williams. Can you hear me? Dr. Williams said that that many of the societies came to him and and wanted this and and and and so each of the subspecialties were asked to have some folks on that on that task force. Dan Farber and I were asked to be on it and so we we went to several meetings and at some point all the subspecialties were asked to put together a draft. Now this was all all very all very preliminary and and non-binding and some of the specialties went a little bit faster than others and then we started to vet that with various societies and as Bill said I guess maybe three years ago this was rolled out at one of the fellowship directors meeting and there was understandably a great deal of of indifference or indifference to resistance in that spectrum and certainly no support for it and understandably so it wasn't clear whether whether we really had a need you know why do we need to do this who owns the data where does the data live who accesses the data who can get to the data transparency there was concern about inequity with regard to winners and losers if we go through this and and by and large it certainly died a slow attritional death in AOFAS but even at AAOS it died not many people went through with it and like everything else I don't know what the question is but the answer is always money and part of the part of the problem at AAOS was that that this was going to take one or two FTEs and where was the money going to come from and so it really it really died from an academy standpoint in 2018 well while all that was going on a lot of the subspecialties a lot of the subspecialties took off and decided they want to do it why don't we go to the next slide please my last slide and so that over that two year period people in their individual subspecialties for various reasons started to look at this and really took the ball and ran with it now understand that the that OTA has been around for seven or eight years the the the origin of their accreditation really was inconsistent fellowships low case numbers sometimes absent case numbers they had some programs that didn't do any pelvic surgery and so on and so forth so they sort of led this and you can see where things are at now and I put up here where as Bill said we're really pretty conspicuous by our absence virtually everybody else arguably spine hasn't gotten everything together and and the various and sundry lower extremity arthroplasty groups aren't quite all on the same page but everybody else by and large has a document that that governs or guides to varying degrees their fellowships and you can see them here and I talked to Elaine earlier today the the the language is conspicuous and and specific and as you might well imagine then through legal vetting so accredited and recognized and so on so forth mean different things but at any rate each of these societies already has some some document that governs their expectations for each of their fellowship programs so we're really and you know I've as on the fellowship committee going to the BOS meetings every year another you know another group would be closer to accreditation so this has been a it wasn't a groundswell but slowly each of the other groups have done that so that's where we're at virtually not not universally but virtually everybody else is either there or almost there and so we're sort of conspicuous by our absence as I said before so that's really a reader's digest excuse me reader's digest version of of of how we got here and I'll turn it over to Aaron to let people know where things stand now thank you thank you Bill so first thing I'm going to do I'm going to run through why we're doing this so Jim touched on some of this but there's a couple things that the fellowship committee board directors felt were benefits of having an AOFAS accreditation for our fellowships the first is the benefit to the applicants to the the orthopedic surgeons that are applying to foot and ankle fellowships having an accreditation process provides them a consistent some consistent elements across programs so they can be sure that no matter what fellowship they go to their they are getting training in certain things that AOFAS you know the the society for foot and ankle surgeons feels important in their training and with that we have some curriculum requirements and that we're going to have our the accredited fellowships comply with that we thought are important we also have for the applicants requirements for the program faculty so that they know whatever fellowship they go to those faculty at that at that fellowship are doing the things and are certified in the way that AOFAS feels is important we also as you'll see have some case requirements and we i'm going to go over this as to what types of cases what specific cases that we feel are important for anybody doing a foot and ankle fellowship to be proficient or at least be exposed to this would be very broad but we'll i'll go over some of those categories and requirements that we've come up with and we modeled it after some of the other such as OTA and other societies for benefits programs for the fellowship programs by having an accreditation this would provide them resources that might not otherwise be available from AOFAS and also a program gets recognition if a program is AOFAS accredited that tells not only fellows and other medical providers that they've been recognized as a program that complies with a lot of the things that are felt to be important by our society but also to the public which you can see as the next bullet here public recognition that some they're going to for care has been trained at a fellowship that is accredited by an accrediting body and in this case our society is i think important for the public and that's one of the things that some of our biggest competitors podiatrists have that we have not had there's also some interprofessional benefits where care provider knows that you that a fellow has been trained in a credited program it gives them some idea that this that this person does meet certain minimum requirements for training so i'm going to run through the framework of of the accreditation program that we've come up with and these are just some of the bullet points of the basically the the major bullet points of what we feel is important for again what we're going to i'm going to do is just run through the framework of this program here and these again are some of the requirements we came up with that we think are going to be important for programs to be AOFAS accredited so first first thing all programs must participate in the AOFAS match and we felt it was important that every fellowship has a standard fellowship calendar from august 1st to july 31st so this is accredited it must be a one-year minimum length fellowship and that's to be standardized across the board all current fellowships that are participating in the AOFAS san francisco match will be offered provisional accreditation during the trial data collection period and what i mean by that this trial data collection period is going to be 2020 to 2021 and there are some things that you'll see a little bit later on that we want to collect this data regarding case numbers case types things like that from the different programs because as we go forward we're going to want to come up with some minimum requirements for a of things like that such as cases and case types for a program to be accredited we've determined a three-year cycle is probably the most appropriate to have for a fellowship to be accredited and then re-reviewed through an evaluation process that we're working on next slide requirements are we have a minimum of we have some faculty requirements first of all the first is we want a one-to-one faculty to fell ratio and the fellowship director must be board certified or and other faculty need to be board certified or board eligible the faculty must be md do or international equivalents aos and aofas members and they also must have unrestricted medical licenses in the states they practice podiatrists can participate in the non-operative education both clinical and research of fellows but we want the primary fellowships directors and faculty bmds and dos research we want at least one authorship of a scholarly work during the the year per fellow and i think that's also important clinical experience we want to require at least two days a week in the operative setting with a graduated responsibility according to the fellow's ability and at least one day a week equivalent seeing patients in clinic we also want some dedicated teaching time outside of the or in the clinic of at least an hour a week average and this can include things like teaching conferences indications m&m other conferences and journal club there also needs to be a curriculum that's in place that guides the teaching goals of the fellowship which we which is updated annually and submitted to ao that's when we when there is a reaccreditation evaluation the evaluation where there is has to be an evaluation system for each fellowship for evaluating the fellows and then also the faculty and the program that is that's a something that's being worked on also at the fellowship committee level for the reaccreditation and accreditation process the data that's collected is going to be confidential and used only by the fellowship committee and the board of directors in this reaccreditation and accreditation process next slide like i mentioned before we thought it would be important to have surgical case requirements other societies such as ota um posna any a lot of the other ones have uh certain requirements of certain minimum numbers and types of cases that they feel are important uh in the training of their fellows and we thought that would be good on our part as well um we tried to break this down into um categories and make them kind of broad so that we're not kind of nitpicking at each specific surgery we know that every fellowship has a different kind of flavor where you do where some do more types of cases than others but we did feel that there had to be some guidance on the most uh most common surgeries and the any fellow that's coming out of a foot and ankle fellowship should have exposure to and be participating in um and as you can see here we've broken it down into achilles disorders arthritis deformity trauma diabetic foot sports nerves and then we do have a miscellaneous um category that other things can be placed in next slide and so for these case requirements the fellows will have to record this we have a um already uh worked out a system at aofs where we have a platform that is provided to the fellows to the fellowships from aofs for the fellows to enter the case data the fellows will only record cases in which they are the primary surgeon um you go back one yeah um they are the primary surgeon or first assist and when uh supervisions are deemed appropriate um it will be performed by the certain member of the surgical faculty but they have to not just be an observer they have to be the primary or surgeon or first assist the um the the logs like i said aofs keeps that log the this will be kept confidential the data will be used to set program requirements and that's one of the reasons we want to do this trial program we don't really have a great idea of course of how many cases that fellows do in each fellowship and so we wanted this trial period for a year to collect the cases uh the case types and numbers as well as cpt data from the programs to try to come up with some minimum requirements as we go forward with the fellowship accreditation process um we have also we have come up with a preliminary cpt code list as well that's going to be uh be part of this um in the future once we collect this data we will want to come up with a total minimum number of cases with a minimum number of fulfilling requirements of essential what we consider essential foot and ankle cases and that's from the cpt code list and also a total minimum number of cpt codes but we don't have those numbers yet because we want to see where everybody's at and that's why we have this trial period and other programs would do that like for example ota uses cpt codes as their their only um requirement for cases we didn't we wanted to bring that to number of cases as well cpt codes as well um next slide so the timeline here is this is august and so this is where we're announcing the new program and providing the overview from october of 2020 to june 21 this is when we're going to uh want to try to have programs collect that trial case log data um and then we so that we can use that for creating some of these minimum numbers in january of 21 applications open for the program approval and then march of 21 application deadline for the 2022 mesh cycle in april to june we're we're planning on having the fellowship committee review these applications and um and by june 30th have program decision notifications july through august programs would enroll with sf match for the match um next time our next steps um essentially want to share um this this presentation with all the program directors and provide their information to them send instructions for the current fellows to log cases using the platform and then uh programs uh we're going to look at programs forwarding their current curricula to afs to the committee so we can review that and uh the application forms for the accreditation um program are going to be posted by 20 december of this year uh for moving forward next slide so i know that was very um quick and that was a very bare bones outline of of what we're thinking here with the program um the details of which um we do have and we will continue to work on this is a work in progress but this is a basically the program we have come up with that we think would do well as a as the accreditation process

formal accreditation

foot and ankle fellowship programs

American Orthopaedic Foot & Ankle Society

high-quality education and training

standardized fellowship calendar

faculty requirements