review committee update + acgme self-study

Review Committee Update + ACGME Self-Study

ACC.16 - 65th Annual Scientific Session & Expo Training Program Directors’ Symposium I Session #301 Friday, April 1, 2016, 12:30 pm Hyatt McCormick, Jackson Park Room

James A. Arrighi, MD, FACC Associate Professor of Medicine, Warren Alpert Medical School of Brown University Director of Graduate Medical Education, Lifespan Chair, Review Committee for Internal Medicine

Jerry Vasilias, PhD

Executive Director, Review Committee for Internal Medicine Accreditation Council for Graduate Medical Education

Disclosure

• No conflicts to disclose

Session Outline

• Review of NAS process

• Review of NAS objectives

• Update on Self-Study/10-year visit

• Report on the Single Accreditation System

• Update on Common Program Requirements

• Two New Initiatives

• Reflection and Discussion

A Brief History of Everything

1889

First

Residency

1939

First

“RC”

1981

ACGME

established

2000

ACGME

incorporated

Outcomes

Duty Hours

JGME

Milestones

ACGME-I

NAS

CLER

SAS 1971

CCME/LCGME

established

1898

AHA

Founded

1847

AMA

Founded

1876

AAMC

Founded

1933

ABMS

Founded

1965

CMSS

Founded

2001-2016

1987

Cardiology

Accreditation

1949

ACC

Founded

1941

Cardiology

Certification

Trending Now

Professional expectations Public expectations

Expert-based Evidence-based

Process-based Outcomes-based

ACGME control Local control

Focus on Accreditation Focus on Improvement

Periodic review Annual review

Paper (PIFs) Electronic (ADS)

ACGME focus Collaborative focus

#ACGME

NAS: Continuous Accreditation

Y1

Y2

Y3

Y4

Y5

Y6

Y7

Y8

Y9

Self-Study/10-year visit

NAS: Continuous Improvement

Y1

Y2

Y3

Y4

Y5

Y6

Y7

Y8

Y9

SELF

STU

DY

● Annual Submission to ACGME

● Annual ACGME Review

● Annual ACGME Feedback

● Annual Program Evaluations

Y10

NAS: Updated Information

Additional ▼ Requirements

Duty Hours/Learning Environment

Overall Evaluation Methods

Citations and Major Changes

Good practice for annual ADS update…

• Proactively use the “major changes” field in ADS • If you are see high non-compliance rates on survey and

you start implementing corrections, inform the RC via “major changes”

• Provides RC context if program is flagged

• Reminder: RC reviews data from previous AY

Best Practice: Review ADS at end of academic year Update as needed Program changes after APE Changes planned based on AFI’s Confirm citation responses

NAS: Annual Data

• Resident/Fellow Survey

• Clinical Experience

NAS: Annual Data – Clinical Experience

Rate how strongly you agree or disagree with the following statements:

• I have had clinical experiences with patients with a variety of clinical problems and stages of disease

• I have had clinical experiences with patients of both genders and a broad age range

• My continuity ambulatory clinic experience provided me sufficient exposure to the breadth and depth of the sub-specialty

• At the completion of training, I will be able to competently perform all of the medical and/or diagnostic procedures considered essential for a sub-specialist in this area

• At the completion of training, I will be able to manage patients in the practice of health promotion, disease prevention, diagnosis, and care and treatment of diseases/disorders appropriate of a sub-specialist in this area

NAS: Annual Data



• ABIM Pass Rate

• Faculty Survey

• Scholarly Activity

NAS: Annual Data – Scholarly Activity

NAS: Annual Data



• ABIM Pass Rate

• Faculty Survey

• Scholarly Activity

• Attrition/Changes/Ratio

• Subspecialty Performance

• Omission of Data

NAS: Annual Submission to ACGME

NAS: Screening → “Further Review”

Warning or Probation?

NO Citations? Annual Data

issues?

PASS (Continued

Accreditation)

NO NO

NAS: Reported vs. Reviewed

2015 2015 2015 2015 2015 2015 - 2016 2016 2016 2016 2016 2016

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

Data Review by RC staff

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


2014-2015 Milestones* Reporting 1

2012-2014 ABIM pass rate data (reported by ABIM) ●

2013-2014 Faculty and Resident Scholarly Activity Reporting – updated until ADS Rollover

2014-2015 Faculty/Resident Roster Reporting (Attrition/Changes) - updated until ADS Rollover

2015 Resident Survey (including Clinical Experience)

2015 Faculty Survey


2015 ADS Rollover●

Site Visits/Clarifying Information

Data Analysis

2015 Annual Update Responses to Citations ■

Major Changes ■ Sites/Block Diagram ■

“Common” Questions ■ Evaluations □ Duty Hours □

Patient Safety □ Learning Environment □

* Milestones data are not reviewed by RC

NAS - Site Visits

we’re from

the acgme,

and we’re

here to help!

NAS: Reported vs. Reviewed

2015 2015 2015 2015 2015 2015 - 2016 2016 2016 2016 2016 2016


Data Review by RC staff

RC Meeting 1 ●

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


RC Meeting 2 ●


2012-2014 ABIM pass rate data (reported by ABIM) ●

2013-2014 Faculty and Resident Scholarly Activity Reporting – updated until ADS Rollover

2014-2015 Faculty/Resident Roster Reporting (Attrition/Changes) - updated until ADS Rollover

2015 Resident Survey (including Clinical Experience)

2015 Faculty Survey


2015 ADS Rollover●

RC Review

RC1 LONs

RC2 LONs

Site Visits/Clarifying Information

SVs/CI

RC Review

Data Analysis

2015 Annual Update Responses to Citations ■

Major Changes ■ Sites/Block Diagram ■

“Common” Questions ■ Evaluations □ Duty Hours □

Patient Safety □ Learning Environment □

* Milestones data are not reviewed by RC

“Annual Accreditation” reported via the Letter of Notification

Based on the information available to it at its recent meeting, the Review Committee accredited the program as follows: Status: Continued Accreditation Maximum Number of Residents: 48 Effective Date: 05/29/2015 Subspecialty Programs The following is a list of subspecialty programs associated with your program. Subspecialty programs with ** preceding the program number were not reviewed at the most recent RC meeting. Subspecialty programs with LTR preceding the program number will be issued a separate Letter of Notification.

LTR - 141XXXXXXX – Cardiovascular disease Probationary Accreditation – Effective 02/20/2015 150XXXXXXX – Rheumatology Continued Accreditation – Effective 05/29/2015

** - 155XXXXXXX – Hematology and oncology Initial Accreditation – Effective 7/1/2015

To: core PD Cc: sub PDs, DIO

Sub 1

Program will receive

separate letter.

LTR designation

Sub 2

Continued Accreditation

(no separate letter)

Sub 3

Program not reviewed at meeting because it received initial in 2013, and has no/limited NAS data.

** designation

Letter of Notification

RC Activity, NAS Y2 (Core IM)

- - - - - -

- - - - - - -

- - - - - - -

▼ - - - - - -

- - ▲ - - - -

- - ▲ ▲ - - -

- ▲ ▲ ▲ - - -

- ▲ ▲ ▲ - - -

- ▲ ▲ ▲ - - -

- ▲ ▲ ▲ ▼ - -

377 core programs in the annual review cycle

other “further review”

- site visits ▼ continued accreditation

ca with warning

probationary accreditation ▲ -

positive change

negative change

No change

NAS Objective – Rapid Improvement

P

P W W

P W W

P W W

P W W

P W W

W W

W W

W W

P W W

P W W

P W W

P W W

P W W

P W W

P W W

P W W

W W

W W

W W

P W W

P W W

W W

NAS Y1 NAS Y2

NAS Objective – Reduction of Burden

A Decade of Cardiology Citations

130

202

141

191

139

101

81

44

14 0

0

50

100

150

200

250

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

NAS Objective – Focus on issues

June 2015 July 2015

NAS Objective - Innovation

Self-Study Process

© 2016 Accreditation Council for Graduate Medical Education (ACGME)

Elements of the Self-Study

• What is our mission? What are our aims?

• Systematic/thorough evaluation of program

• Need input from those involved in the program

• Review (since last accreditation review):

• Improvement activities (from prior APE’s)

• Successes achieved

• Areas for improvement (citations, etc)

• Plan-Do-Study-Act…

• Important to “do” not just “plan”

• Be realistic

Longitudinal


APE to Self Study Tracking Action Plans Longitudinally

ACGME Template

Example* Self-Study/10-year Timeline

N D J F M A M J J A S O N D J F M A M J J A S O

2016 2017 2018

ACGME DFA

November 2016

Announces Self-Study

~ May 2018 (+/- 3 months)

Announces 10-year compliance visit

~ August 2018 (+/- 3 months)

Conducts 10-year compliance visit

Program

May 2017

Uploads Self-Study Summary

~ August 2018 (+/- 3 months)

Updates ADS

Uploads Summary of Achievements

12-18 months between Self-Study and 10-year compliance visit

* as displayed in ADS:

Self Study Date (Approximate): May 1, 2017

The 10-Year Site Visit

• 18-20 months after the self-study visit

• allows programs time to implement improvements

• Different team of site visitors

• A “PIF-Less” Visit

• Programs update self-study summary - provide info ONLY on the improvements realized from their self-study

• Site Visit team provides verbal feedback on key strengths and suggestions for improvement

• Team prepares a written report for the Review Committee

Review Committee 10-Year Visit (All Programs)

• What is available to the Review Committee:

• ADS data

• The self-study summary (successful items only)

• The site visitors’ report from the full accreditation site visit + info on improvements made on areas identified during the self-study

• Allows the RC to assess the self-study effectiveness


• Findings highlight the need for a different model for the self-study for subs

• Intent

• Reduce burden to subs

• Focus evaluation on areas most useful for subs

• Enhance coordination of activities among subs and between the subs and the core

• Promote joint planning, coordination and shared learning

• ACGME Response:

• A new abbreviated format for the self-study summary for subs is “in production” (stay tuned…)

Self-Study Visits: Findings to Date

Self-Study: Findings to Date

SAS Update

• Dually-accredited

• Applications submitted/pending (“Pre-Accreditation”)

• Reviewed/awarded Initial Accreditation

• Reviewed/awarded Continued Pre-Accreditation

♥ Also sponsors cardiology fellowship

♥ ♥

♥ ♥ ♥ ♥

♥ ♥ ♥ ♥

♥ ♥ ♥ ♥

♥ ♥ ♥ ♥

♥ ♥ ♥ ♥

♥ ♥ ♥ ♥

♥ ♥ ♥ ♥

♥ ♥

SAS Application

AP

CA

RC

SV

IA

RC

SV

RC

SV

IW

WD

CA

RC

SV

IA

RC

SV

RC

SV

IW

WD

AP PA

CPA

Re-AP (sas)

WH

SAS Impact

PD, APD, CF, KCF, SEC…AOA is AOK!

CPR Phase 1 Task Force

J A S O N D J F M A M J J A S O N D

9/2015

Phase 1 Task

Force Approved

12/2015

Position

Statements

Requested

Task Force Meetings

6/2016

TF1 Report

To BoD (16-17)

3/2016

National

Congress

2/2016

Position

Statements

Due

9/2016

TF1 Report

To BoD (17-18)

2015 2016

New Initiatives

Milestones

Growth of Subspecialty

174 177 180 180 183 187 187 191 192 193

2300 2351

2415 2444 2493 2521 2548

2617 2626 2679

06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 15-16

# of cardiology fellows (all levels)

# of ACGME-accredited cardiology programs

RC Composition

ACGME/RC Staff

2 ex officio, non-voting (ABIM, ACP)

24 VOTING MEMBERS

6 ABIM-nominated

6 ACP-nominated

6 AMA-nominated

3 AOA-nominated

2 resident members

1 public member

Program Director

DIO

Subspecialist

Current RC Membership

James Arrighi, MD Chair

Kristin Jacob, MD Resident Member

Robert Benz, MD Betty Lo, MD

Christian Cable, MD Chair-elect

Monica Lypson, MD

Ricardo Correa, MD Resident Member

Brian Mandell, MD Vice-Chair-elect

E. Benjamin Clyburn, MD Vice-Chair

Elaine Muchmore, MD

Alan Dalkin, MD Jill Patton, DO

Andrew Dentino, MD Ilene Rosen, MD

Sanjay Desai, MD Frederick Schaller, DO

Sima Desai, MD Samuel Snyder, DO

John Fisher, MD Jacqueline Stocking, RN Public Member

Oren Fix, MD Heather Yun, MD

Andrea Reid, MD Patrick Alguire, MD ex officio, ACP

Andrew Gersoff, MD Furman McDonald, MD ex officio, ABIM

RC Staff Contacts

Betty Cervantes Accreditation Assistant

[email protected]

Lauren Johnson Senior Accreditation Administrator

[email protected]

billy Hart Associate Executive Director

[email protected]

Karen Lambert Associate Executive Director

[email protected]

Jerry Vasilias Executive Director

[email protected]

Self-Study Process

Self-Study: “An Opportunity, Not a Burden”

Susan Guralnick, Tamika Hernandez, Mark Corapi, Jamie Yedowitz-Freeman, Stanislaw Klek, Jonathan Rodriguez, Nicholas Berbari, Kathryn Bruno, Kara Scalice, and Linda Wade (2015) The ACGME Self-Study—An Opportunity, Not a Burden. Journal of Graduate Medical Education: September 2015, Vol. 7, No. 3, pp. 502-505.

review committee update + acgme self-study

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