HARMONIZED

ACCREDITATION GUIDELINES

Faculty of Internal Medicine

National Postgraduate Medical College of Nigeria

Table of Contents

Preface

Chapter 1: Introduction and General Principles

Chapter 2: Table of Requirements for accreditation in General Medicine

Chapter 3: Table of Requirements for accreditation in Sub-Specialties

Preface

CHAPTER 1

INTRODUCTION AND GENERAL PRINCIPLES OF ACCREDITATION

The Senate of National Postgraduate Medical College of Nigeria at its meeting of 3rd December 2015

approved Uniform Criteria /Guidelines for Accreditation of Training Institutions as follows:

BASIS

The College recognizes that the training of specialist requires:

1. Qualified and experienced personnel

2. Appropriate infrastructure

3. A well-structured training programme that recognizes modern trends of training and

assessments

4. Opportunities and evidence of acquisition of skills

5. Access to up-to-date information

6. Regular feedback and evaluation from trainers and trainees

PHILOSOPHY

The process must be:

1. Fair: Done when the institution is ready

2. Transparent: What is being assessed and persons assessing is known to all

3. Objective: Minimal bias in the choice of the accreditors – usually not from the institution of

affiliates

4. Instructive: Feedback given to heads of Institutions

5. Monitored: Reaccreditation done after a clearly defined period – 5 years (Full), 2years

(Partial)

DEFINITIONS AND WEIGHTING

1. MANDATORY REQUIREMENT.

a) Qualified personnel:

The College approved that the basic qualification for training is the Fellowship of College (by

examination or election but not honorary). The individual must have had at least 5 years’ experience

working in a training institution and must be financially up-to-date. It is also expedient that departments

in Institutions should have a good mix of the College training in the country so that trainees will have the

maximum benefits of current rules and regulations governing their training.

Weighting should be 15%of total accreditation score

b) Appropriate Infrastructure:

This is a major pillar without which training cannot take place. What is appropriate will be defined by

faculties. But facilities must be well constructed and maintained with the basic amenities available such

as:

i. Light

ii. Water

iii. Waste disposal

In addition the following facilities should be available with adequate backup:

i. wards

ii. out patients clinic

iii. laboratories

iv. theaters

v. radiological suites

The weighting shall be a minimum of 10% of total accreditation scores. This can be sub-divided into core

infrastructure (5%) and support infrastructure (5%)

c) Equipment:

The College noted that equipment is an essential component in the acquisition of skills and competence.

The minimum equipment needs will be determined by faculties and the procedure/log book will be

necessary in assessing this component.

The weighting shall be a minimum of 20% of total accreditation score.

d) Structured training programme:

The College has approved curricula and required competencies that trainees are expected to acquire. It

is expected that institutions have a well-publicized (every trainee should have it in writing) structured

programme which faithfully implemented and evaluated by a departmental residency committee. This

programme must be seen by the accreditation team.

Weighting should be 15% of total accreditation score.

e) Opportunities/ Evidence of skill acquisition

In recognition that our profession is an apprenticeship, all trainees must be provided with the

opportunities of acquiring the necessary skills to be competent as a specialist. Records of such must be

seen. This includes a procedure registrar, theater list and log book.

Weighting should be 15% of total accreditation score.

2. DESIRABLE REQUIREMENT

a) Access to new information

This is a crucial element in making our trainees lifelong learners. It is therefore expected that there

should be institutional support for trainees to attended updates, revisions, conference and seminars. It

is also expedient that trainees acquire the skills at making presentation at departmental meetings and

other scientific of professional. The library and the internet are veritable sources of information and it is

expected that training institutions have such facilities accessible to the trainees. Evidence of all these

must be seen.

Weighting should be 15% of total accreditation score

b) Regular feedback and evaluation:

Evaluation is an important aspect of training. It is recognize that assessment can be formative

/continues or summative. The College traditionally have carried out summative examinations at the end

of each part. However, training requires regular feedback from trainers to trainees and vice versa.

Mentorship builds on the concept of regular evaluation, feedback, appropriate guidance and counseling

of trainees. A good training programme must have these inbuilt and faithfully carried out.

Weighting should be 10% of total accreditation score.

Maximum total score shall be 100% or 100 points

CHAPTER 2

TABLE OF REQUIREMENTS FOR ACCREDITATION IN GENERAL MEDICINE

No Requirement Inadequate 0

Partially Adequate 7.5

Fully Adequate 15

1. Qualified and Experienced Personnel: A. Prescribed Number (Full-time/Part-Time) B. Prescribed Trainers/Trainees ratio C. Support Personnel

(MAX: 15 Points)

2. Appropriate Infrastructure:

A. Basic: Water, Light, Sewage etc. B. Core Departments Present C. Support Departments Present

(MAX: 10 Points)

3 Equipment:

A. Core Equipment B. Support Equipment

(MAX: 20 Points)

4 Well-structured Training Programme:

A. Seen by all B. Content (lectures, tutorial, bedside sessions)

(MAX: 15 Points)

5 Opportunities/ Evidence of Skill Acquisition:

A. Procedure Registrar B. Theater List C. Logbook

(MAX: 15 Points)

6 Access to New Information: A. Library B. b. Internet

(MAX: 15 Points)

7 Regular feedback and evaluation

(MAX: 10 Point)

TOTAL

Interpretation

0 – 49 (Scores less than 50%) - Accreditation Denied

50 – 74 (Scores equals to 50% and Less than 75%) - Partial Accreditation for 2 years

75 – 100 (Scores equals or greater than 75% and above) - Full Accreditation for 5 years

Duration of Accreditation Recommended/ Accreditation Status- a. Full

b. Partial

c. Denied

Name & Signature of Panel Members Faculty Secretary:…………………………………............

1…………………………………………………………………………. Signature & Date

2……………………………………………………………………….. Faculty Chairman:…………………………………………….

3………………………………………………………………………… Signature & Date

4………………………………………………………………………..

CHAPTER 3

TABLE OF REQUIREMENTS FOR ACCREDITATION IN SUB-SPECIALTIES

No Requirement Inadequate Partially Adequate

Full adequate

1. Qualified and Experienced Personnel (Max 15 points)

a. Prescribed number (Full time) (7pts) [M]

- Minimum of 2 full time Consultants

- Not less than 5 years post-fellowship qualification, - At least one should be a Fellow of the

National Postgraduate Medical College

< 2 Consultants

(0 points) 2 Consultants

(3 points ) ≥3 Consultants (5 points )

b. Prescribed Trainer: Trainees Ratio (Max 2 points) > 1: 3 (0 points)

1:3 (1 points)

1:2 (2 points)

c. Support Personnel (Max 8 points) < 4 points 4 – 7points 8 points

1. Physicians in other relevant subspecialties

(Max 2 points) [Mandatory] 2. Pathologists (Max 2points) 3. Radiologists (Max 0.25points) 4. Nurses (Max 1point) 5. Lab. Scientist (Max 0.25points) 6. Pharmacist (Max 0.25points) 7. Nutritionist/Dietician (Max 0.25points) 8. Social worker (Max 0.25points) 9. Medical Records officers (Max 0.25points) 10. Physiotherapist (Max 0.25points) 11. Secretarial staff (Max 0.25points) 12. Others as applicable to the subspecialty

(Max 1point)

2.

Appropriate Infrastructure (10 points)

a) Basic: (Max 2 points) 1. Power 2. Water 3. Environmental Safety/ Waste disposal 4. Communication (If adequate, award 0.5points for each)

<1.5points 1.5points 2points

b) Core Departments present (Max 4 points) 1. Cardiology 2. Dermatology and GUM 3. Endocrinology and DM 4. Gastroenterology 5. Nephrology 6. Neurology 7. Pulmonology 8. Infectious Diseases 9. Rheumatology 10. Clinical Hematology 11. Clinical Pharmacology 12. Geriatrics 13. Others as applicable to the sub specialty

The 4 relevant sub-specialties as specified in the sub-specialty curriculum are scored 0.5points each. Others are scored 0.25points each

< 2 points 2–3 points 4 points

c) Support Department (4pts) < 2 points 2–3 points 4 points

1. Wards (at least 10beds per sub-specialty) (Max 1 point) [Mandatory]

2. Outpatients clinic (1pt) [M]

3. Accident and Emergency ( 0.5pts)[M)

4. ICU ( 0.5pts)(M)

5. Laboratories ( 0.5pts)(M)

6. Imaging ( 0.5pts)

7. Surgery/O & G/Pediatrics/Psychiatry (as applicable to the sub specialty) (Max 0.5pts)

3. Equipment (Subspecialty specific) [Max 20 points]

a) Core Equipment (Max 15points)

Refer to attached list of core equipment for the individual specialties

< 10 points 10 – 14 points

15 points

b) Support Equipment (5points) Refer to attached list of core equipment for the individual specialties

< 1 point 1 - 3 points 4 - 5points

4. Structured Training Program (Max 15 points)

a) Must be seen by all (Max 5points) 1. Training Curriculum 2. Attendance Registers 3. Rosters 4. Periodic Assessments 5. Training Co-Ordinator

(If seen score 1 point for each)

< 3 points

3-4points 5points

b) Contents (Max 10points) < 6points 6-8points >8points

1. Seminars 2points

2. Journal club 2points

3. Bedside sessions 2points

4. Grand round 2points

5. Clinico-pathological Meetings 1point

6. Clinico Radiological/ Other Inter-departmental meetings 1point

5. Opportunities/Evidence of Skills Acquisition Subspecialty specific (Max 15 points)

1. Procedure registers

<4points 4-6points 7-8points

2. Log book

<4points 4-5points 6-7points

6. Access to new information (15 points)

a) Library (Max 5points) 1. Adequacy in number of books 2. Currency of books 3. Adequacy in number of journals 4. Currency of journals 5. Infrastructure

(If adequate score 1 point each)

<2points 2-4points 5points

b) Internet (Max 10points) 1. Adequacy in subscription/number of e-books 2. Currency of e-books

3. Adequacy in subscription/number of e-journals 4. Currency of e-journals 5. Infrastructure

(If adequate, score 2 points each)

<5 points 5-8points >8points

7. Regular feedback and Evaluation (Max 10 points)

a) Sub-specialty-based assessments (Max 5points) 1. MCQs 2. Essay 3. OSCE/Viva Voce

<3points

3-4points 5points

b) Departmental/Institutional based assessments (Max 3points)

1point

2points

3points

c. NPMCN based assessments (2points) 0point 1point 2points

Total

Interpretation

0 – 49 (Scores less than 50%) - Accreditation Denied

50 – 74 (Scores equals to 50% and Less than 75%) - Partial Accreditation for 2 years

75 – 100 (Scores equals or greater than 75% and above) - Full Accreditation for 5 years

Duration of Accreditation Recommended/ Accreditation Status- a. Full

b. Partial

c. Denied

Name & Signature of Panel Members Faculty Secretary:…………………………………............

1…………………………………………………………………………. Signature & Date

2……………………………………………………………………….. Faculty Chairman:…………………………………………….

3………………………………………………………………………… Signature & Date

4………………………………………………………………………..

LIST OF CORE AND SUPPORT EQUIPMENT FOR INDIVIDUAL SUBSPECIALITIES

1. Cardiology Sub-specialty

a) Core Equipment: i. Electrocardiogram

ii. Echocardiogram iii. Sphygmomanometer iv. Cardiac monitors v. Pulse oximeter

vi. Exercise ECG vii. Holter ECG

viii. Ambulatory Blood pressure monitors ix. Defibrillator x. CVP monitors

xi. Cardiac Catheterization Laboratory

b) Support Equipment i. Neubulizer

ii. Weighing scale iii. Standometer iv. Arterial Blood Gas machine

2. Clinical Pharmacology

a) Core Equipment:

i. At least one of the following: - HPLC and/or - GC and/or - LC-MS/MS)

b) Support Equipment

i. Spectrometer, ii. pH meter,

iii. Water-bath, iv. Freezers - 20oC and/or -80oC, Centrifuge

3. Clinical Haematology

a) Core equipment i. At least 2 Binocular microscopes

ii. Teaching microscope for trainees iii. Haematology analyser iv. Bone marrow needles v. Electrophoretic tank and power pack

vi. Coagulometer

b) Support equipment i. Microhaematocrit

ii. Bench centrifuge iii. Point of Care Machines

4. Dermatology

a) Core Equipment i. Microscope,

ii. Woods lamp, iii. Cryotherapy devices iv. Electrocautery v. Punch biopsy

vi. Dermatoscope vii. Ultraviolet Lamp

viii. Patch Test kits ix. Prick Test kits x. Curette

xi. Lasers xii. Chemical peels

b) Support Equipment i. Autoclave

ii. Minor surgical pack iii. Biopsy kits

5. Endocrinology Diabetes and Metabolism

a) Core Equipment

i. Functioning Endocrine Laboratory

ii. Autoanalyser,

iii. Spectrophotometer,

iv. Eliza reader

b) Support Equipment i. Facilities for basic biochemical tests

ii. Ophthalmoscope iii. Monofilaments

6. Gastroenterology

a) Core Equipment

i. Two gastroscopes ii. Two colonoscopes

iii. Duodenoscope iv. Proctoscopes v. Rectal biopsy forceps

vi. Endoscopy biopsy forceps, vii. Accessories for endoscopic variceal ligation

viii. Sclerotherapy ix. Esophageal dilators x. Appropriate manual and digital record storage & reporting formats.

xi. Fluoroscopy xii. Patient monitoring and resuscitation (including pulse oximeter, ambu bags, emergency

IV drugs, oxygen.

b) Support Equipment i. Biopsy needles for

- Liver biopsy, - Peritoneal biopsy

7. Infectious Disease and Immunology

a) Core equipment i. Culture facility (Automated/Conventional

ii. Mycobacterium culture (Liquid/Solid) iii. Equipment for ZN stain, Gram stain, Fungal stain, Giemsa stain iv. ELISA Test: For Bacterial ,Fungal and Viral Diagnosis v. Equipment for HIV viral load, CD4 Count

vi. Basic radiological (Chest X-ray Ultrasonography)

b) Support Equipment i. PCR: For Hepatitis B Virus and other Viruses

ii. Viral culture facilities iii. Advanced radiological equipment: CT-Scan, MRI, Nuclear imaging Scan iv. Immunological technique equipment: Agglutination test, Hem agglutination test

Precipitation test, electron microscopy

8. NEPHROLOGY

a) Core Equipment i. Facilities for heamodialysis

ii. Facilities for at least one of the following - Peritoneal dialysis - Kidney transplant

iii. Facilities and Equipment for active renal biopsy

b) Support Departments i. Functional chemical Pathology laboratory

ii. Functional anatomic pathology laboratory iii. Functional Haematology laboratory

iv. Equipment for tunneled catheter insertion

9. Neurology

a) Core Equipment i. EEG

ii. EMG

iii. NCS iv. CT v. MRI

vi. Doppler ultrasonography vii. plain radiography

viii. Sleep laboratory/PSG ix. spinal needles x. monitored beds (may be in the ICU or neurology wards)

b) Support Equipment i. Electrocardiography

ii. echocardiography iii. transcranial Doppler USS iv. any of carotid angiography/CT angiography/MR angiography v. arterial blood gasses (ABG)

vi. point of care assessments (glucometers, pulse oximeters)

10. Pulmonology

a) Core Equipment i. Spirometry

ii. Peak flow meters iii. Body plethysmography iv. Transfer factor for carbon monoxide v. At least two functional fiberoptic bronchoscope

vi. Nebulizers vii. Sphygmomanometers

viii. Abram’s needle ix. Electrocardiograph Pulse oxymeters X 6 including one in the emergency department x. Oxygen cylinders with a functioning delivery system

xi. Tthread mill and bicycle ergometer xii. Arterial blood gas analysis

xiii. Radiology services including: - Plain X-rays - Fluoroscopy, - ultrasonography, - computer tomography including high resolution type, - Magnetic resonance imaging and angiography. - Mobile X-ray machine

b) Support Equipment i. Laboratory services for the following:

- Haematology and immunology - Morbid anatomy - Chemical pathology - Microbiology and parasitology

11. Rheumatology

a) Core Equipment i. Serology Laboratory facilities for:

- R rheumatoid factor, - Antinuclear antibody(ANA), - ds DNA, - Extractable Nuclear Antigen(ENA), - AntiCardiolipin Antibody(ACA), - Antineutrophil Cytoplasmic Antibody(ANCA), - Immunoglobulin assays

b) Support Equipment i. Cardiac Monitors/Pulse Oximeters

ii. Radiology/Ancillary Services - Plain x-ray - Ultrasonography services to all parts of the body - Contrast studies of the gastro-intestinal tract and genitor-urinary system - Fluoroscopy, - Angiography, Computerized tomography - MRI

iii. Arthroscope iv. Arthrography v. Nerve Conduction Tests

vi. EMG vii. EEG

viii. Radio-Isotope Scan ix. Bone Densitometry [DEXA]