Alternate Entry Path (AEP) program guidelines

PROGRAM OBJECTIVE
The Alternate Entry Path (AEP) program allows international medical graduates who are certified by the national anesthesiology organization in the country where they trained and practicing anesthesiology in the U.S. to qualify for entrance into the ABA examination system for initial certification in anesthesiology. The objective of the program is to encourage outstanding internationally trained and certified anesthesiologists to become members of anesthesiology programs located in the United States and accredited by the Accreditation Council for Graduate Medical Education (ACGME). Documented achievement in teaching and/or scholarship, rather than the potential for future success, is required for acceptance into the AEP program. The application must also describe the ability of the sponsoring department to provide an outstanding academic environment.

AEP program participants will spend four years in an anesthesiology program located in the United States and accredited by the ACGME as fellows, researchers or faculty members. Participants are expected to actively participate in departmental educational activities and to otherwise retain or gain basic anesthesiology knowledge and experience that would help them to attain ABA certification.

QUALIFICATIONS
When the anesthesiology department enrolls the international medical graduate in the AEP program through either the clinician educator pathway, exceptional clinician pathway or the research and fellowship pathway described below, the department must have an anesthesiology residency or fellowship training program with “continued full” ACGME accreditation status. Anesthesiology departments may have as many as eight international medical graduates enrolled in the AEP program at one time. A letter of justification from the department chair is required and will be reviewed for approval for any amount over four (effective Jan. 1, 2024).

CLINICIAN EDUCATOR PATHWAY
Documented achievement in teaching and/or scholarship in the United States, rather than the potential for future success, is required for acceptance into the AEP program.

To be considered for entry into the AEP Clinician Educator Pathway, physicians must:

• Be internationally trained with 4+ years (3+ years of anesthesiology-specific training) of post-graduate medical education.
• Have a letter of support from the sponsoring program’s chair and program director.
• Be board certified in anesthesiology from an ABA-approved certifying body.
• Have an active clinical appointment for a minimum period of four years after enrolling in the AEP program.
• Have an academic appointment in a department of anesthesiology with an ACGME-approved residency and should be an outstanding clinician educator in the field of anesthesiology.
• Have the sponsoring program’s department chair and program director submit a four-year mentoring plan for future academic development as a clinician educator, co-signed by the physician, for prospective approval by our Credentialing Committee. We must receive the four-year plan no later than four months before the department enrolls the internationally certified anesthesiologist in the AEP program and the four-year period of continuous experience commences.
• Demonstrate excellence in teaching and excellence in clinical anesthesiology during the four-year period specifically designed and identified for the physician.

Documented achievement in teaching requires:

• Recognition by peers and students as an excellent teacher (evaluations, invitations to teach at conferences, authorship of teaching materials (book chapters, guidelines, review articles)).
• Documented participation in faculty development programs AND application of principles of education from those programs (include previously attended courses and courses to which the faculty has applied).

Mentoring plans for candidates must demonstrate a trajectory of scholarship in education over four years.

Examples of evidence of scholarship for a mid-career faculty include:

1. Development of educational materials, including new curricular offerings, educational programs, textbook chapters, syllabi, computer programs, videotapes or simulation technology that make a unique contribution to the quality and methods of education.
2. Regional or national recognition of educational expertise demonstrated by participation and/or leadership in educational societies, invited lectureships, publications related to education, membership on editorial boards of education focused journals.

Examples of evidence of scholarship for a senior faculty include

1. Publications of literature related to education.
2. Development of innovative methodologies on materials which have influence and impact both regionally, nationally or internationally.
3. Leadership in organizations focused on educational guidelines, policy and practice.
4. Visiting lectureships on educational theory or practice.

RESEARCH & FELLOWSHIP PATHWAY
Documented achievement in teaching and/or scholarship in the United States, rather than the potential for future success, is required for acceptance into the AEP program.

To be considered for entry into the AEP research or fellowship pathway, physicians must:

• Be internationally trained and certified anesthesiologists practicing in the U.S.
  Be internationally trained with 4+ years (3+ years of anesthesiology-specific training) of post-graduate medical education.
• Have a pre-existing track record of scholarship as represented by the scholarship of discovery, dissemination and application. The scholarship of discovery is accomplished by obtaining peer-reviewed funding or by publication of original research in peer-reviewed journals. The scholarship of dissemination is accomplished by publication of review articles in peer-reviewed journals or chapters in textbooks. The scholarship of application is accomplished by publication of case reports or clinical series at local, regional, or national professional and scientific society meetings. High-quality ongoing scholarship is critical to acceptance into the AEP program.
• Have an active clinical appointment for a minimum period of four years after enrolling in the AEP program.
• Have the chair of the anesthesiology department that sponsors them submit a four-year plan, co-signed by the physician, for prospective approval by our Credentialing Committee. We must receive the four-year plan no later than four months before the department enrolls the physician in the AEP program and the four-year period of continuous experience commences.
• Demonstrate discovery of new knowledge in the specialty, excellence in teaching and excellence in clinical anesthesiology during the four-year period specifically designed and identified for the physician.

EXCEPTIONAL CLINICIAN PATHWAY
Documented achievement in clinical excellence in the United States, rather than the potential for future success, is required for acceptance into the AEP program. Also, the application must describe the ability of the sponsoring department to provide an outstanding academic environment.

Documented achievement in clinical practice requires:

1. Recognition by peers and learners as an excellent clinician (evaluations, invitations to teach at conferences, authorship of guidelines and practice parameters).
2. The expectation for faculty concentrating on this area of focus is superb performance as clinicians or public health practitioners to improve patient care.
3. Documented participation in faculty development programs (e.g., leadership training, ultrasound workshops) AND application of principles of leadership and/or clinical skills from those programs (include previously attended courses and courses to which the faculty has applied).
4. Greater than 80% of time spent taking care of patients in the clinical setting.

Mentoring plans for candidates must demonstrate a trajectory of scholarship in leadership and or clinical practice over four years.

Examples of clinical excellence for a mid-career faculty may include:

1. Important contributions to quality assurance programs, clinical or public health practice guideline development or policy panels.
2. Membership on editorial boards of clinical or public health specialty journals.
3. Development of guidelines/patient care or public health protocols which are used locally, regionally or nationally.
4. Recognition by peers and learners as a health care professional delivering quality patient care or related patient service or direct public health interventions if applicable. Expertise within the faculty member’s discipline should be evident, though leadership may not be predominant.
5. Academic citizenship demonstrated by service on departmental, local, national organization committees and leadership in university/national professional organizations.

Examples of clinical excellence for a senior faculty may include:

1. Publication of reviews and book chapters related to the clinical or public health discipline.
2. National or international recognition as an expert in the clinical or public health discipline.
3. Service as a consultant to federal agencies charged with assessing clinical treatments or public health intervention programs.
4. Invited lectureships or teaching related to the discipline on a national or international level.
5. Prominent role on national organizations/committees defining treatment methodologies, care guidelines, technologies or public health interventions that change practice.
6. Recognition by peers and learners as a health care professional delivering quality patient care, related patient service or direct public health service interventions if applicable. Expertise within the faculty member’s discipline should be evident, though leadership may not be predominant.
7. Academic citizenship demonstrated by service on departmental, university, local, national organization committees and/or leadership in university/national professional organizations.

PERIODIC EVALUATION REPORTS

• At six-month intervals, the program must attest that the AEP physician is still a fellow or faculty member with a full-time primary appointment in an ACGME-accredited program or is still actively engaged in research. At the same time, the department chair will provide an assessment of the physician’s performance during the preceding six months relative to the American Board of Medical Specialties- and ACGME-approved six general physician competencies.
• All AEP participants must annually take the In-Training Exam (ITE). Once participants achieve a score of 40 or higher, they no longer need to take the ITE.

CERTIFICATION ENTRANCE REQUIREMENTS

• AEP participants must complete the planned and approved four-year program in one anesthesiology department before we will accept them as candidates for primary certification. Our policy book lists the registration eligibility requirements all physicians must fulfill to be accepted as a candidate.