Program

Transcription

Program

Update from the Review Committee for
Internal Medicine (RC-IM)
James A. Arrighi, MD, FACC
Chair, RC-IM
Director of Graduate Medical Education, Rhode Island Hospital
Alpert Med School of Brown University
Christian Cable, MD, MHPE
Chair-elect, RC-IM
Program Director, Scott & White Health Care
Jerry Vasilias, PhD
Executive Director, RC-IM
William Hart
Associate Executive Director, RC-IM
© 2016 Accreditation Council for Graduate Medical Education (ACGME)
Disclosures
• No conflicts to disclose
Plan for Session
•
•
•
•
•
•
Review of NAS Process
Summary of RC Actions - NAS Y2
Reminder to Innovate
Update on Self-Study-10 year visit
Report on SAS
Update on Revision to Common
Program Requirements
• New FAQs
• Changes in the future…
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
It’s a new dawn
It’s a new day…
Well…it’s a relatively new…
NAS: Continuous Accreditation
Y3
Y2
Y4
Y1
Y5
Y6
Self-Study/10-year visit
Y9
Y7
Y8
NAS: Continuous Improvement
● Annual Submission to ACGME
● Annual ACGME Review
● Annual ACGME Feedback
● Annual Program Evaluations
Y10
Y8
Y7
Y6
Y5
Y4
Y3
Y2
Y1
SELF STUDY
Y9
Refresher:
Annual Data Elements
•
•
•
•
•
•
•
Resident Survey
Clinical Experience
ABIM Pass Rate
Faculty Survey
Scholarly Activity
Attrition/Changes
Subspecialty Performance
(for cores)
• Omission of Data
Suggestion……
• Proactively use the “major changes” in ADS
• If you see high non-compliance on survey and you start
implementing corrections, inform the RC
• Provides RC context if program is flagged
• Reminder, RC reviews data from previous AY
Reminder:
This year, surveys will be released…
Annual Program Review
Warning
or
Probation?
YES
↓
Further
Review
NO
Previous
Citations?
YES
↓
Further
Review
NO
Annual Data
Issues?
YES
↓
Further
Review
PASS
NO
(Continued
Accreditation)
Annual Data Issues →
QUESTION #1: Are flags real?
• Which data elements were flagged?
• Not all elements have same weight/importance
• How many elements were flagged?
• Are there trends?
• Has issue been cited in the past? How often?
• Are other data elements corroborating?
QUESTION #2: If reviewer believes the signal is real,
needs to decide if more information is necessary prior
to accreditation action.
•
•
Request for clarifying information ?
Site visit ?
Annual Data: Reported vs. Reviewed
2014
2014
2014
2014
jul
aug
sep
oct
2014 - 2015 2015
nov dec jan feb
2014
2015
2015
2015
2015
mar
apr
may
jun
2014-2015 Faculty/Resident Roster Reporting (Attrition/Changes) - updated until ADS Rollover
2013-2014 Faculty and Resident Scholarly Activity Reporting – updated until ADS Rollover
2014-2015 Milestones* Reporting 2
2014-2015 Milestones* Reporting 1
2015 Resident Survey (including Clinical Experience)
2015 Faculty Survey
2012-2014 ABIM pass rate data (reported by ABIM) ●
* Milestones data are not reviewed by RC
2015
2015
2015
2015
jul
aug
sep
oct
2015 - 2016 2016
nov dec jan feb
2015
2015 ADS Rollover●
2016
2016
2016
2016
mar
apr
may
jun
Data Analysis
Data Review by RC staff
2015 Annual Update
Responses to Citations ■
Major Changes ■
Sites/Block Diagram ■
“Common” Questions ■
Site Visits/Clarifying Information
RC Review
RC Meeting 1 ●
Evaluations □
Duty Hours □
Patient Safety □
Learning Environment □
RC1 LONs
SVs/CI
RC Review
RC Meeting 2 ●
RC2 LONs
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
RC Activity, NAS Y2 (AY 2014-15)
Core IM
377 core programs in the annual review cycle
- site visits
other “further review”
continued accreditation
ca with warning
probationary accreditation
-
-
▼
- - - - - - - - - - - - - - - ▼
- ▲▲▲▲▲
▲▲▲▲▲▲
- - ▲▲▲▲
- - - - - -
▼ negative change
▲ positive change
-
No change
RC Activity, NAS Y2 (AY2014-15)
Core IM
▲▲▲▲▲
▲▲▲▲▲▲
continued accreditation
ca with warning
probationary accreditation
RC Activity, NAS Y3 (AY 2015-16)
Core IM
Comparing Pre-NAS to NAS
Core + Subs
100
90
99
98
80
70
60
%
50
40
30
20
10
2
1
0
1
0
CA
CA w warning
Pre-NAS
Probation
NAS
Byrne, Miller, & Nasca, Implementing the NAS: Results of
the 2014-15 Annual Data Review, JGME, Feb 2016
# of CITATIONS by AY
CORE + SUBs
2111
1739
1714
1643
1516
1352
1051
962
467
2004-05
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
379
2013-14
248
2014-15
After July 1, 2015
% of IM CORE + SUBs w ZERO citations…
100
90
95
80
70
60
50
%
40
30
20
10
21
0
Pre-NAS
Byrne, Miller, & Nasca, Implementing the NAS: Results of
the 2014-15 Annual Data Review, JGME, Feb 2016
NAS
AFIs
RC Identified “Areas for Improvement”
• AFI = un-citation. Unlike citations, AFIs do not require
specific response in ADS.
• The RC assumes the program/institution will address
• RC will look closer if the issue continues
CORE
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
AY 2013-14
CIT + AFI
AY 2014-15
Cit
AFI
Neither
SUBs
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
AY 2013-14
CIT + AFI
AY 2014-15
CIT
AFI
Neither
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
NAS: Encourages Innovation
Innovate around “detail” PRs
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
What is a Self-Study?
• Self-Study = Self-Assessment
• Commitment to change for the better
• Not just maintaining status quo (meeting bare minimum of
program requirements to get a pass from the 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
Must be ongoing
Plan-Do-Study-Act…
• Important to “do” not just “plan”
Resources
Guralnick, S, Hernandez, T, Corapi, M, Yedowitz-Freeman, J, Klek, S,
JGME, September 2015
Example* Self-Study/10-year Timeline
ACGME DFA
November 2016
Announces Self-Study
~ August 2018 (+/- 3 months)
Updates ADS
Uploads Summary of Achievements
Program
~ August 2018 (+/- 3 months)
Conducts 10-year compliance visit
May 2017
Uploads Self-Study Summary
~ May 2018 (+/- 3 months)
Announces 10-year compliance visit
N
D
J
F
M
A
2016
M
J
J
A
S
O N
D
2017
J
F
M
A
M
J
J
A
2018
12-18 months between Self-Study and 10-year compliance visit
* as displayed in ADS:
Self Study Date (Approximate): May 1, 2017
S
O
Self-Study: Findings to Date
RC will review self-study/10-year visit reports…
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
ACGME+AOA=SAS: Co-PDs
Under the terms of the Memorandum of Understanding
between the ACGME and the AOA, the program director
must either be ABMS-certified, or the program may have
two co-PDs, one of whom may be AOA-certified.
RC-IM decided that either ABIM- or AOBIM- certification
was acceptable for a PD for an AOA program seeking
ACGME accreditation.
Next Question: Beyond SAS…
What positions can an AOBIM-certified internist hold in
“non-SAS” programs?
RC-IM Decision:
A program director, APD, core faculty member, SEC, or
KCF may be either ABIM- or AOBIM-certified, regardless
of whether the program is an AOA program applying to
ACGME, a new non-SAS application, or an existing
ACGME-accredited program.
Local, program, and institutional leadership need to
select the most appropriately qualified and certified
internist for the leadership position within the
program.
FAQs: Work-in-progress
• FAQs on website are great resources, but they predate SAS (and NAS).
• May not reflect RC’s most recent decisions
• Questions…contact RC staff
SAS: #s for AY2015-16
• 143 programs approved by AOA by July 1, 2015 (eligible to apply under MOU)
• 27 programs dually-accredited (will likely request complement increase)
• 7 applications pending site visit and review (pre-accreditation)
• 11 programs granted Initial Accreditation
•
5 application with Initial Accreditation, Contingent
• 1 application with Continued Pre-Accreditation
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
Revision of Common Requirements: 2 Phases
Phase I Task Force (TF)
September 2015
ACGME Board approved Task Force
• Board Members
• Members of Council of RC Chairs
• Members of Council of RC Residents
J
A
S
December 2015
June 2016
September 2016
• Request for position statements from
GME community
• Statements were due early Feb
TF makes recommendations
to Board for changes to be
implemented AY 2016-2017
TF makes recommendations
to Board for changes to be
implemented AY 2017-2018
O
N
D
March 2016
April 2016
National Congress - invited
speakers present “key or
controversial” positions
Revised Requirements
posted for 45 day
Public comment
J
F
M
AY 2015-2016
A
M
J
J
A
S
O
N
D
AY 2016-17
Task Force Meetings
Nasca, TJ, Letter to GME community, January 7, 2016
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
New FAQ for Residency Programs
New
Can a faculty member board-certified in anesthesia or surgical critical care
medicine supervise medicine house staff in the critical care units?
•
The RC expects that the majority of those educating and supervising
residents in the critical care setting are IM-CCM physician faculty
(certified by either ABIM or AOBIM), and that the majority of each
fellow’s clinical experience be under the supervision of such faculty.
Any non-IM-CCM physician faculty involved in resident education must
be approved as teaching faculty by both the MICU director and the
internal medicine program director. Physicians certified in anesthesia
and surgical critical care may not be subspecialty education
coordinators in internal medicine residency programs.
•
The RC recognizes that cross coverage between different types of
critical care specialists may occur, especially in smaller programs. The
expectation does not preclude evening and weekend cross coverage by
physicians certified in other critical care disciplines.
New
New FAQ for Residency Programs
Can an EM physician certified in CCM by the ABEM supervise medicine
house staff in the critical care units?
•
An EM physician who has completed an ACGME accredited IM-CCM
program and is certified in the subspecialty by the ABEM can teach and
supervise IM residents in the critical care units. This individual can
serve as the attending of record or teaching attending for internal
medicine residents on critical care rotations. The MICU director and
internal medicine program director must approve this individual as
teaching faculty.
Plan for Session
•
•
•
•
•
•
Report on SAS
• New FAQs
• Changes…
A Brief History of Everything
2001-2016
1889
First
Residency
1847
AMA
Founded
1876
AAMC
Founded
1898
AHA
Founded
1939
First
“RC”
1933
ABMS
Founded
SAS
CLER
NAS
ACGME-I
Milestones
JGME
Duty Hours
Outcomes
1971
CCME/LCGME
established
1965
CMSS
Founded
2000
ACGME
incorporated
1981
ACGME
established
ACGME: Trending Now
•
•
•
•
•
•
•
•
Professional expectations  Public expectations
Expert based approach to PRs  Evidence-based
Process  Outcomes-based
Focus on rules  Focus on improvement
ACGME/RC oversight  Local oversight
Episodic review  Annual review
Paper  electronic data collection
ACGME Focus  Collaborate Focus
Courtesy of Ling, L
Current Composition of the RC-IM
James Arrighi, MD
Chair
Kristin Jacob, MD
Robert Benz, MD
Resident Member
Betty Lo, MD
Christian Cable, MD
Chair-elect
Monica Lypson, MD
Ricardo Correa, MD
Resident Member
Brian Mandell, MD
E. Benjamin Clyburn, MD
Vice-Chair
Vice-Chair-elect
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
Oren Fix, MD
Heather Yun, MD
Andrea Reid, MD
Patrick Alguire, MD
Andrew Gersoff, MD
Furman McDonald, MD
Public Member
ex officio, ACP
ex officio, ABIM
ACGME/RC Staff
2 ex oficio, 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
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
New Members
Terms beginning 7/1/2016
Program director
Subspecialist
• Jessica Deslauriers, MD
ABIM-nominated
• Cheryl O’Malley, MD
AMA-nominated
• Kris Patton, MD
• Donna Polk, MD
• David Sweet, MD
Resident member
Please Contact RC Staff
Betty Cervantes [email protected]
Accreditation Assistant
312.755.7470
Lauren Johnson [email protected]
Senior Accreditation Administrator
312.755.5085
billy Hart [email protected]
Associate Executive Director
312.755.5002
Karen Lambert [email protected]
Associate Executive Director
312.755.5785
Jerry Vasilias [email protected]
Executive Director
312.755.7477

Program

Transcription

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