CLINICAL PRIVILEGE WHITE PAPER

Transcription

1 Practice area 112 CLINICAL PRIVILEGE WHITE PAPER Background Gynecologic oncology Gynecologic oncology is the medical subspecialty of obstetrics and gynecology that is concerned with the study and treatment of cancers of the female reproductive organs such as ovarian, cervical, or uterine cancer. The obstetricians/gynecologists (OB/GYNs) who practice this subspecialty are called gynecologic oncologists. They are the practitioners who by virtue of education and training are prepared to provide consultation on and comprehensive management of women with gynecologic cancer. They practice their subspecialty in an institutional setting where all the effective forms of cancer therapy are available. Gynecologic oncologists receive their specialized training in fellowship programs approved by the American Board of Obstetrics and Gynecology (ABOG). The threeyear training program should include clinical experience that provides a sufficient variety of inpatient and outpatient cases so fellows will become capable of performing all appropriate diagnostic and therapeutic procedures relevant to the subspecialty. Gynecologic oncology training programs must include the following: Experience in radical pelvic surgery, including bowel resections and anastomoses, intestinal diversions, gastrostomies, urinary diversions, ureteral implantations, urinary bladder removal, abdominal and pelvic lymphadenectomies, and various other surgeries such as splenectomies, pelvic reconstruction, and plastic surgery Experience in administering chemotherapeutic agents and their attendant modes of delivery as well as managing severe life-threatening chemotoxicity Knowledge of radiation physics, dosimetry, and treatment techniques, including experience with external beam therapy, brachytherapy, radioactive needles, seeds, and colloidal solutions, and the specific indications for use in each of these modalities Gynecological oncologists are trained to perform surgery on the female reproductive system as well as on all the organs of the pelvic and abdominal tissues and organs that may be involved if cancer has spread. They are also extensively trained in the vital techniques of surgical staging and cytoreductive surgery. Surgical staging is important because finding the exact stage of a cancer is vital to planning the best treatment. In regard to cytoreductive surgery, gynecological oncologists have the required skills A supplement to Briefings on Credentialing 781/ /04 1

2 to find and remove tumors that have spread in the pelvic and abdominal areas. Patients who see gynecologic oncologists have the advantage of needing only one doctor. These practitioners are trained both as surgeons and specialty oncologists and can prescribe and oversee all aspects of a woman s treatment. They are also most likely to be well versed in the latest treatments in gynecologic oncology, including the experimental ones. Involved specialties Gynecologic oncologists and medical oncologists Positions of societies and academies SGO The Society of Gynecologic Oncologists (SGO) is a national surgical specialty society of physicians who are trained in the comprehensive management of women with malignancies of the reproductive tract. Its purpose is to improve the care of women with gynecologic cancer by encouraging research; disseminating knowledge, which will raise the standards of practice in the prevention and treatment of gynecologic malignancies; and cooperating with other organizations interested in women s health care, oncology, and related fields. SGO s members make it the leading organization of gynecologic oncologists in the United States. Primarily gynecologic oncologists, the members are women s cancer specialists who have received an additional three to four years of intensive medical training in the study and treatment of malignancies arising in the female reproductive tract the ovaries, endometrium, cervix, vulva, and vagina. SGO members also include gynecologic oncologists from the international community and related medical specialists such as medical oncologists and radiation oncologists. SGO members provide unified, comprehensive medical and surgical care to women with reproductive tract cancers from diagnosis to completion of treatment, such as radiation therapy, supportive care, and surgery. Full members of the SGO must meet the following requirements: Be a diplomate of the ABOG, or its equivalent Have completed an ABOG-approved postresidency fellowship training program in gynecologic oncology Be certified in special competence in gynecologic oncology Positions of other interested parties The ABOG examines and certifies subspecialists in gynecologic 2 A supplement to Briefings on Credentialing 781/ /04

3 ABOG oncology. Candidates for certification must have passed both the written and oral examinations for ABOG certification in obstetrics and gynecology. In addition, candidates must pass a written and oral examination in gynecologic oncology. Gynecologic oncology written examination requirements Candidates must have an unrestricted license to practice medicine in the state or territory of the United States or a province of Canada in which the candidate practices. completed an ABOG-approved gynecologic oncology fellowship program. satisfactorily completed two university graduate-level courses. One course should be in quantitative techniques that includes biostatistics and other areas such as epidemiology and research design and implementation. The second course must be relevant to gynecologic oncology. Gynecologic oncology oral examination requirements Candidates must be certified diplomates of the ABOG have passed the gynecologic oncology written examination have an unrestricted license to practice medicine in the state or territory of the United States or a province of Canada in which the candidate practices have full and unrestricted hospital privileges have gained and can document not less than 12 months of experience in practice as a subspecialist in a center or centers providing or having ready access to essential diagnostic and therapeutic facilities submit an approved thesis AOA The American Osteopathic Association (AOA) grants certification in the subspecialty of gynecologic oncology through the American Osteopathic Board of Obstetrics and Gynecology (AOBOG). Candidates for certification must hold certification in obstetrics and gynecology through the AOBOG complete an AOA approved gynecologic training program prepare logs reflecting a minimum of 24 months of the most recent clinical activity begun after completion of the A supplement to Briefings on Credentialing 781/ /04 3

4 subspecialty-training program author a paper that s published or accepted for publication in a peer review journal JCAHO The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has no formal position on the delineation of privileges in gynecologic oncology. However, in its 2004 Comprehensive Accreditation Manual for Hospitals, the JCAHO states (MS.4.10), The organized medical staff has a credentialing process that is defined in the medical staff bylaws. In the rationale for MS.4.10, the JCAHO says credentials review is the process of obtaining, verifying, and assessing the qualifications of an applicant to provide patient care, treatment, and services for a healthcare organization. The credentials review process is the basis for making appointments to membership of the medical staff; it also provides information for granting clinical privileges to licensed independent practitioners (LIPs) and other practitioners credentialed and privileged through the hospital s medical staff process. The JCAHO further states (MS.4.20), There is a process for granting, renewing, or revising setting-specific privileges. In the rationale for standard MS.4.20, the JCAHO says essential information needs to be gathered in the process of granting, renewing, or revising clinical privileges. The information will dictate the type(s) of care, treatments, and services or procedures that a practitioner will be authorized to perform. Privileges are setting-specific because they require consideration of setting characteristics, such as adequate facilities, equipment, number, and type of qualified support personnel and resources. Setting-specific decisions mean that privileges granted to an applicant are based not only on the applicant s qualifications, but also on consideration of the procedures and types of care, treatment, and services that can be performed within the proposed setting. All LIPs are privileged through the medical staff process. The JCAHO further states (MS.4.40), At the time of renewal of privileges, the organized staff evaluates individuals for their continued ability to provide quality care, treatment, and services for the privileges requested as defined in the medical staff bylaws. In the rationale for MS.4.40, the JCAHO says the process for renewal of privileges involves the same steps as those outlined 4 A supplement to Briefings on Credentialing 781/ /04

5 under standard MS.4.20 for granting initial privileges, and it additionally requires the medical staff to evaluate a practitioner s ability to perform the privileges requested based on his or her performance during the period of time he or she has been practicing at the organization. A hospital reviews the performance of each practitioner for every setting under the control of the hospital where the individual practices. Current competence is determined by the results of performance improvement activities and peer recommendations. Evidence of current ability to perform privileges requested is required of all applicants for renewal of clinical privileges. CRC draft criteria Minimum threshold criteria for requesting core privileges in gynecologic oncology References Core privileges in gynecologic oncology Basic education: MD or DO Minimum formal training: Applicants must have successfully completed an ABOG/AOA-approved training program in gynecologic oncology. Required previous experience: Applicants must be able to demonstrate that they have provided inpatient and consultative gynecologic oncology services for at least 50 patients in the past 12 months. A letter of reference must come from the director of the applicant s gynecologic oncology training program. Alternatively, a letter of reference regarding competence should come from the chief of gynecologic oncology at the institution where the applicant most recently practiced. Core privileges in gynecologic oncology include but are not limited to the following: Evaluate, screen, and diagnose cancers of the female reproductive system Select the appropriate treatment to recommend to patients, based on the nuances of the specific disease Perform surgical treatment including radical pelvic procedures Manage gastrointestinal, urologic, and vascular problems caused by gynecologic cancer or its treatment Plan and implement outpatient and inpatient chemotherapy treatment Place radioactive delivery systems Manage radiation complications such as genitourinary and intestinal fistulae and ureteral and intestinal obstructions Provide posttreatment surveillance A supplement to Briefings on Credentialing 781/ /04 5

6 Reappointment Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided inpatient and consultative gynecologic oncology services for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to gynecologic oncology should be required. For more information For more information regarding this practice area, contact: American Board of Obstetrics and Gynecology 2915 Vine Street Dallas, TX Telephone: 214/ Fax: 214/ Web site: American Osteopathic Association 142 East Ontario Street Chicago, IL Telephone: 312/ Fax: 312/ Web site: Society of Gynecologic Oncologists 401 North Michigan Avenue Chicago, IL Telephone: 312/ Fax: 312/ Web site: Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL Telephone: 630/ Fax: 630/ Web site: 6 A supplement to Briefings on Credentialing 781/ /04

7 Privilege request form Gynecologic oncology In order to be eligible to request clinical privileges in gynecologic oncology, an applicant must meet the following minimum threshold criteria: Basic education: MD or DO Minimum formal training: Applicants must have successfully completed an ABOG/AOA-approved training program in gynecologic oncology. Required previous experience: Applicants must be able to demonstrate that they have provided inpatient and consultative gynecologic oncology services for at least 50 patients in the past 12 months. References: A letter of reference must come from the director of the applicant s gynecologic oncology training program. Alternatively, a letter of reference regarding competence should come from the chief of gynecologic oncology at the institution where the applicant most recently practiced. Core privileges: Core privileges in gynecologic oncology include but are not limited to the following: - Evaluate, screen, and diagnose cancers of the female reproductive system - Select the appropriate treatment to recommend to patients, based on the nuances of the specific disease - Perform surgical treatment including radical pelvic procedures - Manage gastrointestinal, urologic, and vascular problems caused by gynecologic cancer or its treatment - Plan and implement outpatient and inpatient chemotherapy treatment - Place radioactive delivery systems - Manage radiation complications such as genitourinary and intestinal fistulae and ureteral and intestinal obstructions - Provide posttreatment surveillance Reappointment: Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided inpatient and consultative gynecologic oncology services for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to gynecologic oncology should be required. I understand that by making this request I am bound by the applicable bylaws or policies of the hospital, and hereby stipulate that I meet the minimum threshold criteria for this request. Physician s signature: Typed or printed name: Date: A supplement to Briefings on Credentialing 781/ /04 7

8 Clinical Privilege White Papers Advisory Board James F. Callahan, DPA Executive vice president and CEO American Society of Addiction Medicine Chevy Chase, MD Sharon Fujikawa, PhD Clinical professor, Dept. of Neurology University of California, Irvine Medical Center Orange, CA John N. Kabalin, MD, FACS Urologist/Laser surgeon Scottsbluff Urology Associates Scottsbluff, NE Publisher/Vice President: Suzanne Perney Executive Editor: Dale Seamans John E. Krettek Jr., MD, PhD Neurological surgeon Vice president for medical affairs Missouri Baptist Medical Center St. Louis, MO Michael R. Milner, MMS, PA-C Senior physician assistant consultant Phoenix Indian Medical Center Phoenix, AZ Senior Managing Editor: Edwin B. Niemeyer Beverly Pybus Senior consultant The Greeley Company Marblehead, MA Richard Sheff, MD Chair and Executive Director The Greeley Company, a division of HCPro, Inc. Marblehead, MA The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 2004 HCPro, Inc., Marblehead, MA A supplement to Briefings on Credentialing 781/ /04