Welcome to…..
The Single Accreditation System:AOA/ACGME Integration At Last!
Judith Pauwels, MDAAFP Residency Program Solutions Consultant
Disclosures
• I have no conflicts of interest to report regarding this presentation.
Disclosures
• And I DO represent two organizations actively collaborating to assist AOA programs with the SAS:• Association of Family Medicine Residency
Directors (AFMRD)• American College of Osteopathic Family
Physicians (ACOFP)
Polling Question #1
Goals
• Describe the Single Accreditation System process for Sponsoring Institutions and Programs.• Discuss Institutional Accreditation and CLER
requirements.• Discuss common questions related to
Program Accreditation in Family Medicine.• Identify resources to help!
The ultimate goal:
Preserving and enhancingthe primary care workforce
critical to health care system reform
SAS Process and Timelines
• What has changed in the pathways that our students and residents will follow?• What is the process for achieving ACGME
accreditation for both the Sponsoring Institution, and for the sponsored program?• What are the key timelines and dates for
doing this?
Medical School
Medical School
US MLE COMLEX
NRMP Match NMS Match
Residency Residency
Specialty Boards
Specialty Boards
LCM
EN
BM E
NBO
ME
AOA
AAM
C
AOA
ACG
ME AO
A
ABF
M
AOB
FP
Initial Accreditation
ResidencyACG
ME
SOAPMatch
OPTI
Accreditation Status, 2014
Sponsoring Institution: Hospital, CHC
MD StudentsDO Students
MD DO
Updated 8/6/2015
ACG
ME Pre-
accredited Residency
Medical School
Medical School
US MLE COMLEX
NRMP Match NMS Match
Residency
Specialty Boards
Specialty Boards
LCM
EN
BM E
NBO
ME
AOA
AAM
C
AOA
ACG
ME
ABF
M
AOB
FP
Initial Accreditation
ResidencyACG
ME
SOAPMatch
Sponsoring Institution: Hospital, CHC, OPTI*
Moving to the Unified Accreditation Process:2015-2020
Residency
AOA
OPTI
MD StudentsDO Students
Osteopathic Recognition
DO only
OPTI(?)
Unknown
MD DO
Updated 8/6/2015 *may apply
Medical School
Medical School
US MLE COMLEX
NRMP Match
NMSMatch
Residency
Specialty Boards
Specialty Boards
LCM
EN
BM E
NBO
ME
AOA
AAM
C
AOA
ACG
ME
ABF
M
AOB
FP
MD StudentsDO Students
Initial AccreditationResidency
SOAPMatch
Accredited Sponsoring Institution: Hospital, CHC
Fully Implemented Unified Pathway:2020
Osteopathic Recognition OPTI (?)
Unknown
DO only
MD DO
Updated 8/6/2015
SAS Process
• Note several issues yet to be fully resolved:• The Match systems are still separate.• Board certification systems are still
separate.• Separate ACGME requirements for
resident pass rates for residency (ABFM) and Osteopathic Recognition (AOA).
SAS Process and Timelines
• The Sponsoring Institution (SI) must receive Institutional Accreditation before a Program can receive initial accreditation.• However, both can be in “pre-
accreditation” status and application work move forward simultaneously.
SAS Process and Timelines
• All AOA-only residents must be graduated by 2020.• Family Medicine programs must achieve
Initial Accreditation by June 30, 2020.• Although this is almost 5 years away, the
accreditation process will take significant time and resources, with many complex questions still be be answered….
Polling Question #2
Sponsoring Institutions
•Who can be a Sponsoring Institution (SI)?
Or…•What are the responsibilities and authorities of the SI?
SI Responsibilities
• Institution must demonstrate assumption of ultimate financial and academic responsibility for the programs that it sponsors, and be in substantial compliance with other relevant ACGME Institutional Requirements. •No distance requirement.
SI Responsibilities
•Oversight of resident/ fellow assignments and of the quality of the learning and working environment, extending to all participating sites.• Financial support for administrative,
educational, and clinical resources, including personnel.
Institutional Accreditation
•ACGME institutional objectives:• SI resources in support of GME.• SI oversight of learning and working
environment.• Structure for SI oversight of
programs.• SI policies and procedures for GME.
Structure for SI oversight of programs
•Critical elements:• Institutional commitment to GME.• Designated Institutional Official (DIO):• May be the Program Director in single-
program SI (SPSI).• An engaged Graduate Medical Education
Committee (GMEC).
Structure for SI oversight of programs
• GMEC structure:• DIO, program directors.• Must include residents/fellows (at least two).• Must include patient safety/quality officer (or
designee).• For SPSI: must include at least one person
from outside the program who’s involved with GME.• Must meet at least quarterly, and keep
minutes of these meetings.
Structure for SI oversight of programs
•GMEC responsibilities:• Oversight of learning
environment• Oversight of sponsored
programs accreditation status, and annual evaluation activities• Compliance with policies
SI GME policies and procedures• Resident/fellow recruitment and selection• Resident/fellow contract, including specific list
of what must be in the contract• Promotion, appointment renewal, and
dismissal• Grievances• Resident services (behavioral health, policies
on harassment, disabilities, impairment)• Supervision, duty hours• Vendor interactions• Non-competition• Closures and reductions, disasters
SI oversight of learning and working environment: CLER
What is CLER?
“The Clinical Learning Environment Review (CLER) is a mechanism by which the ACGME assesses a Sponsoring Institution (SI) to evaluate its commitment to developing a culture of quality, patient safety, and performance improvement for both resident education and patient care.”
CLER Focus Areas
Professionalism
Supervision
Healthcare QualityHealthcare Disparities
Transitions of Care
Duty HoursFatigue
Management
Patient Safety
Sponsoring Institutions
•Who can be a Sponsoring Institution (SI)?
Polling Question #3
PROGRAM requirements
• Common Requirements:• Apply to ALL programs, regardless of
specialty.• Specialty-specific Requirements:• Define each specialty.
Common Program Requirements
• Affiliation of Sponsoring and Participating Institutions, and “PLAs”• Specifications about program director and
faculty• General information about resident
appointments, educational program, and the competencies• Expectations of resident scholarly activity• Evaluation systems• Resident supervision• Resident duty hours
Family Medicine Program Requirements: potential issues
• Program size (minimum 4-4-4)• Specifications for the “Family Medical
Practice”• Program director qualifications and time
allocated to program• Core faculty ratio and time allocated to
program• Faculty roles; scholarly activity• Rotation / experience requirements
Family Medicine Program Requirements: potential issues
• Supervision requirements• Evaluation system complexities:• Incorporating the Milestones• Direct observations• CCC (Clinical Competency Committee)• Administrative complexities:• PEC (Program Evaluation Committee)• ADS (Accreditation Data System) reports
Financial Considerations• Federal and state GME funding streams:• CMS rules only relate to accreditation in
that either AOA or ACGME accreditation is required to claim residents.• Program must maintain AOA accreditation
until Initial Accreditation by ACGME is received.
• Sponsoring Institution costs• Program costs for meeting ACGME
requirements…
Program Pre-accreditation
• Process:• Writing the PIF (Program Information Form)• Submitting the PIF and attachments in
ACGME ADS (Accreditation Data System)• Site visit• Deadlines for submission on ACGME
website for the specialty (note: includes site visit!)
Program Pre-accreditation
• Process:• Initial accreditation will
be for two years.• If not approved the first
time, the program can continue to revise its plans and then reapply, until June 2020.
Program Pre-accreditation
• Programs must start reporting all required ACGME annual information:• ADS annual update• Resident survey• Faculty survey• Milestone assessment and reporting• Can simultaneously start application for
Osteopathic Recognition
Polling Question #4
Networking for Strength
• Fundamental belief in the need for primary care, and specifically family medicine, for our patients and communities.• Core value that all of us working together
are stronger than working in isolation.• NO program has found all of this “easy.”• But ALL programs have found this
rewarding!
Resources• Accreditation Navigation – Attend an intensive
two-session program to cover all aspects of the transition to ACGME accreditation and to provide a networking opportunity with fellow directors and experienced faculty. See details at www.afmrd.org/an• Association of Family Medicine Residency
Directors (AFMRD) – Become a member and have access to the members only toolbox and discussion list.• Residency Program Solutions – When a program
consultation is called for, AAFP’s RPS has experienced consultants to meet your needs.
