accreditation council for graduate medical education © 2015 accreditation council for graduate...

Accreditation Council for Graduate Medical Education

© 2015 Accreditation Council for Graduate Medical Education (ACGME)

Update from theInternal Medicine (RC-IM)

Andrew Dentino, MD, FACP, AGSF, FAPA, FAAHPMUniversity of Oklahoma HSC


Plan for Session • Brief review of NAS• NAS Y2 • Targeted Update • New Approach for Self-Study• Update on SAS• Q&A


Continuous Improvement

Y1

Y2

Y3

Y4

Y5

Y6

Y7

Y8

Y9

SE

LF

ST

UD

Y

●

Annual Data Submission

● Annual A

CGME Feedback

● Annual P

rogram Evaluations

● Annual Writte

n Action Plans

Y10

© 2015 Accreditation Council for Graduate Medical Education

• Delivers on promise of outcomes-based accreditation

• Provides annual RRC review to identify “problem programs” and help them improve

• Changes the workflow of the process of accreditation • Site visits only every 10 years

• (or as needed)• Internal Reviews are no longer *required*• Annual ADS data entry replaces PIFs

• “Detail” PRs allow for innovation

NAS: Why?


Detail

Core

Outcome

0 10 20 30 40 50 60 70

IM PRs Common PRs

NAS: Innovation + Accreditation

IM PRs vs. Common PRs (% Outcome, % Core, % Detail)

INNOVATE!!INNOVATE!!


• Some see that NAS allows for experimentation….• e.g., Continuity experience

• But…there is concern: is it really OK?

• If programs can demonstrate compliance with Core and Outcome PRs, they will not be asked to demonstrate compliance with Detail PRs.

Program must:• be in good standing CA (without warning)• not have issues with the PR(s) to be innovated around• have an educational rationale (noncompliance ≠ innovation)

• No waiver requests necessary

NAS: Innovation & Detail PRs


Detail

Core

Outcome

0 10 20 30 40 50 60 70

IM PRs Common PRs

NAS: Innovation + Accreditation

IM PRs vs. Common PRs (% Outcome, % Core, % Detail)

INNOVATE!!INNOVATE!!


NAS: Program* Review

Is program on Warning

or Probation?

NO

Does program

have NAS citations** ?

Do annual data indicate

potential issues?

Continued Accreditation

NO NO

Further Review

YES

Further Review

YES

Further Review

YES

* = applies to established programs (not on Initial Accreditation)** = citations given after July 1, 2013


NAS Revisited: Primary Data Elements


ADS: Annual Update

• Update can begin after the ADS rollover (late June), but cannot be submitted until the window is open

• email will be sent with window open/close dates• Core IM Residency: August 4-September 4, 2014• Subspecialty programs: September 8-October 9, 2014

• Required Information:• Duty Hour/Learning Environment/Evaluation Responses• Major Changes• Responses to Citations• Resident/Faculty Rosters • Resident/Faculty Scholarship (for previous year)• Sites (and Block Diagram)

• “Omission of Data” is a data point.


ADS: Scholarly Activity

• Data entry can begin after the ADS rollover (late June), but update cannot be submitted until the window is open

• Data entry is for current faculty roster, but for last year’s productivity. 2013-2014 presentations and publications are entered now (during 2014-2015).

• Definitions for scholarly activity are included in ADS and on a downloadable template

• General Scholarly Activity FAQs are available in ADS

• Internal Medicine FAQs are available on the IM page.• http://www.acgme.org/acgmeweb/portals/0/pdfs/faq/140_internal_medicine_faqs.pdf


Milestones: (Future) Data Element

• All IM reported during last reporting window (Nov – early Jan)

• Not a data element yet…(Cannot be fully used for several years)

• Important to remember:Will be one aspect of accreditation

• Initially, ascertain that programs are reporting

• Next, check for completeness of data

• Ultimately, patterns or trends will be important


Specific Curriculum

EPAs

Curricular (“Developmental”) Milestones

Reporting Milestones

Curricular (“Developmental”) Milestones

Milestones: Reporting vs. “Other”

X

Reporting Milestones X

X

X

EPAs

Specific Curriculum


New language effective 7/1/2015

• Broad flexibility for PD to appoint “health professionals” to CCC beyond the minimum 3 faculty

• Typical IM chief residents (not R3’s) will be allowed

• No rules on who may attend the CCC meeting, participate in discussion, etc.

• Program coordinators are not called out specifically in the PRs

Milestones: CCC


NEW: CCC Guidebook

Milestones: CCC


• Obtain feedback, learn what works

• Boundaries, common elements• Especially for the “common” competencies SBP, PBLI, IC, P• Subspecialties?

• Implementation, logistics, resource utilization

• Validation• Emergency medicine example

• Milestones Version 2

Milestones v1.0: A Work-in-Progress


Reporting Clinical Experience

• Along with the common ACGME survey items, there are IM specific questions that get at clinical experience

• They are broad and brief

• Resident (Core IM) questions include questions about all major subspecialty areas and also “general questions”

• Fellow questions includes only general questions plus general questions about competency in subspecialty


• identify areas of non-compliance• are linked to specific requirements• require response in ADS • are given (and removed) by RRC (not by staff)

Citations received in NAS (after July 1, 2013) – will require an RRC member to review annually; – can be given from annual review of data – that is, with or

without a site visit

Citations received pre-NAS (prior to July 1, 2013) have been either:

– systematically removed after two cycles of “clean screens” (no issues identified through data review)

– removed or extended following a recent RC review (extended citations are now NAS citations)

Citations…


• are new in NAS

• represent “general concerns”

• may be given (or removed) by RRC or by staff

• might not be specifically linked to a requirement

• do not require written response in ADS, but…• will be monitored locally• will be tracked by RRC• will likely be used more frequently than citations

Areas for Improvement (AFIs)…


NAS “Intermittent” Site Visits

Full• Application for a new core program• At the end of the initial accreditation period• RC identifies broad issues/concerns• Serious conditions or situations identified by the RC

Focused• Potential problems identified during annual review• To diagnose reason for deterioration in performance• To evaluate complaint

Both• One month notification• Minimal document preparation expected• Team of site visitors


NAS Ten-Year Site Visits


Self-Study/10-year Site Visits How described in the past…

• Scheduled to begin in the late spring of 2015 for IM

• Departmental – core + subs together

• Scheduled every 10 years

• TWO purposes (‘elements’), ONE visit: • Self-study element: to assess continuous

improvement within department/program; analyze strengths, weaknesses, opportunities and threats

• Full site visit element: to asses compliance with “core” + “outcome” PRs

• Elements may have not been clearly stated in the past


Self-Study/10-year Site VisitNEW APPROACH – Feb, 19, 2015


Self-Study/10-year Site VisitNEW APPROACH

• The two purposes (elements) are now more fully demarcated

• Programs will be notified that they will need to complete a self study document, and then, 12-18 months later, will undergo a full site visit - now called the 10-year site visit.

• The time lag between completing the self-study and the 10 year site visit is intentional to give programs time to make improvements


• A small number of programs initially informed by RC that

their self-study will be between April 2015 and July 2016 are eligible to be in a pilot study:

• Programs will be asked if they want to volunteer for a self-study site visit after completing the self-study document.

• Participation in the self-study visit is strictly voluntary • Self study visit is not an accreditation visit. • Strengths and areas for improvement identified during the visit will

not be shared with the RC.• If there are subs, they can opt in or out of the visit• Field staff with added training will offer feedback on program

strengths and areas for improvement, both verbally and in writing.

Self-Study/10-year Site Visit Pilot Study


• All other programs with tentative self-study/10-year visit

dates between April 2015 and July 2016 will receive a 5-7 month delay

• Will be asked to begin self study document in the month/year RC indicated the self study/10-year visit would take place – date that appears in ADS

• Punchline: All programs will do a self study and have a 10 year visit 12-18 months later.

Self-Study/10-year Site Visit Non-Pilot Study Programs


Accredited ProgramContinued Accreditation

CA w/Warning

Site Visit

Probationary Accreditation

Withdrawal of Accreditation

CA w/Warning

Continued Accreditation

Accreditation Status Schema


• Core always receives LON• Either after Jan/Feb meeting, or, after May meeting

• Sub always copied/listed on core’s LON• Every Sub is Dependent on Core (or “Parent”)

• 10 year/self-study involves the entire department• Probation for core = “administrative probation” for subs• Subs’ annual review data affect core’s review• Most subs will not receive individual LONs

• Sub sometimes receive individual LON• Probation for sub, separate letter

LON (RC Communication to Program)


To: core PDCc: sub PDs, DIO

Sub 1: Continued Accreditation

Sub 2: Probation. Program will receive separate letter : LTR designation

Sub 3: Program not reviewed at meeting because it received initial in 2012, and has no/limited NAS data. ** designation

The “Departmental LON”


• Data Reported – what information programs submit in ADS

• Data Reviewed – what information RC reviews

NAS: Data Reported vs. Data Reviewed


2014 2014 2014 2014 2014 2014 - 2015 2015 2015 2015 2015 2015

jul aug sep oct nov dec jan feb mar apr may jun

Data Review by RC staff

RC Meeting 1 ●

2013 2013 2013 2013 2013 2013 - 2014 2014 2014 2014 2014 2014


RC Meeting 2 ●

2013-2014 Milestones Reporting 1

2011-2013 ABIM pass rate data (reported by ABIM) ●

2012-2013 Faculty and Resident Scholarly Activity Reporting – updated until ADS Rollover

2013-2014 Faculty/Resident Roster Reporting (Attrition) - updated until ADS Rollover

2013-2014 Resident Survey (including Clinical Experience)

2013-2014 Faculty Survey

2013-2014 Milestones Reporting 2

2014 ADS Rollover●

RC Review

RC1 LONs

RC2 LONs

Site Visits/Clarifying Information

SVs/CI

RC Review

Data Analysis

2014 Annual UpdateResponses to Citations ■

Major Changes ■Sites/Block Diagram ■

“Common” Questions ■Evaluations □Duty Hours □

Patient Safety □Learning Environment □

NAS: Data Reported vs. Data Reviewed


2014 2014 2014 2014 2014 2014 - 2015 2015 2015 2015 2015 2015


RC Meeting 1 ●

RC Meeting 2 ●

RC1 LONs

RC2 LONs

“Annual Accreditation”reported via the Letter of Notification

NAS: Communication of Status Decision

• Core programs will receive results of RC’s annual review after either the RC’s 1st or 2nd meeting • This year, either after the Feb or the May meeting• Vast majority will receive status decision after 1st meeting


(Single Accreditation System)

ACGME + AOA = SAS


ACGME + AOA = SASWhat does this mean for IM?

Numbers • # of AOA accredited IM programs 129 • # of dually accredited IM programs 27 • # of AOA accredited IM subs 118• # of dually accredited IM subs 2

RC-IM can likely see ~100 core applications from AOA• Core applications will require a site visit• All apps will receive “Pre-Accreditation” upon submission• Subs will not be reviewed until core receives Initial Accreditation• Subs will not require a site visit• Spring 2016 meetings will likely expand by 1 day


• MOU provides exceptions of two ACGME CPRs for AOA-approved programs with matriculated residents as of July 1, 2015 that apply for ACGME accreditation:

1) programs can have co-PDs, one certified by a member Board of the ABMS; and,

2) AOA Board certification will be considered acceptable for faculty members

• Although the MOU allows for co-PD, the RC-IM decided that either

ABIM or AOBIM certification is acceptable for an AOA program seeking ACGME accreditation.

• What does this mean for these AOA programs applying??• No need to identify co-program directors• AOA faculty are acceptable

ACGME + AOA = SASProvisions of MOU


ACGME + AOA = SASTimeline

• Institutions can start applying April 1, 2015• AOA-approved programs - July 1, 2015

• Both will receive ‘Pre-Accreditation Status” – Core will get a site visit before reviewed by RC– Sub will not be reviewed until receives Initial Accreditation

• AOA Application window closes June 30, 2020• New applications will be treated like any new application• No ‘Pre-Accreditation” status

• AOA ceases accreditation June 30, 2020


• New status for any AOA approved programs applying to ACGME• AOA approved before July 1, 2015 = get Pre-Accreditation• AOA approved after July 1, 2015 = do NOT get Pre-Accreditation

• Includes institutions• Core app can be submitted only if sponsor has Pre-Accreditation,

Initial or Continued Accreditation• Granted upon receipt of completed application• Will not require RC review • Status will be acknowledged on ACGME website• Not synonymous with Initial Accreditation

ACGME + AOA = SAS“Pre-Accreditation”: What?


• Biggest + : AOA applications that do not receive Initial Accreditation will not have withhold of accreditation (WH)

– Pre-Accreditation remains in effect– No re-application fee – b/c application will not be WH– Pre-Accreditation goes away when receive Initial Accreditation,

or application is withdrawn, or, June 30, 2020

• Allows use of either 2013 or 2016 eligibility PRs, whichever less restrictive

– Not an issue for IM: AOA grads are allowed in subs now under the “75% over 5 years” PR

• Important to ACGME: program will be in ADS – Will participate in annual update, RS, FS, Milestones

ACGME + AOA = SAS“Pre-Accreditation”: Why?


AOA-Approved

7/1/2015

Yes No

Matriculated Residents7/1/2015

Yes 1 3

No 2 3

Can have Pre-Accreditation

Status

Can have AOA-certified

Co-PD

AOA-certified faculty systematically“acceptable”

1 + + +2 + - -3 - - -

ACGME + AOA = SASApplications—Who gets what?


• RC-IM will have 3 new members• Approved by ACGME Board last month; RC observers in May

• ACGME Board • By 2020, 4 from AACOM and 4 from AOA

• AACOM and AOA will each seat 2 members in 2015; • Then one additional form each in 2018, and again in 2020

• Osteopathic Neuromusculoskeletal Medicine RC • New RC - Delegated authority for accreditation of Neuromusculoskeletal

and Osteopathic Manipulative Medicine residency programs; Eight members

• Chair will sit on CRC

• Osteopathic Principles Committee• Not an RC. Recognition committee. • Responsible for review of the osteopathic principles dimension of

programs that seek ongoing Osteopathic Recognition; 17 Members• Chair will sit on CRC

ACGME + AOA = SASChanges to ACGME


• What could this mean for geriatrics?

• Currently are 9 AOA-approved Internal Medicine-Geriatric Medicine Fellowships nationally

• FL (2), IL, MI (2), NJ, NY, PA (2)



• Currently are 15 AOA-approved Family Medicine-Geriatric Medicine Fellowships nationally

• CA, FL (2), MI (4), NJ, NY, PA (3), VA, WV (2)



• Therefore, up to 24 currently AOA-approved Geriatric Medicine Fellowships may possibly apply to join the geriatric fellowship program community

• CA, FL (4), IL, MI (6), NJ (2), NY (2), PA (5), VA, WV (2)



Jerry Vasilias [email protected]

Karen Lambert [email protected]

William (billy) Hart [email protected]

Lauren Johnson [email protected]

? ? ? Questions ? ? ?

accreditation council for graduate medical education © 2015 accreditation council for graduate...

Documents

outcome prs

graduate medical education4nas

graduate medical education6nas

based accreditation

initial accreditation

common prs

innovation nas

annual ads data entry