Scholarly Activity Evaluation to Adhere to the ACGME

Scholarly Activity Evaluation to Adhere to the
ACGME Outcome-based Milestones
Dr. Suporn Sukpraprut-Braaten, MSc, MA, PhD
Dr. Dewey McAfee DO, FACOFP, PharmD
Dr. David Covey, MD, FACP
Graduate Medical Education
Unity Health
Searcy, Arkansas
INTRODUCTION
 Unity Health is the largest employer in an eight surrounding county area in with more than 2,000
associates located in Searcy, Newport, and Bradford, Arkansas.
 The facility has a combined total of 438 licensed beds and a medical staff of more than 150
physicians that specialize in various areas of healthcare.
Location of White County, Arkansas
Unity Health – White County Medical Center
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Unity Health – Harris Medical Center
UNITY HEALTH – WHITE COUNTY MEDICAL CENTER
NYIT
ARCOM
104 miles to Memphis
54 miles to Little Rock
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INTRODUCTION
 Dr. Suporn Sukpraprut-Braaten
 Assistant Professor for Research, Unity Health
 Vice Chair on the Scholarly Activity & Faculty Development Committee of Kansas City
University of Medicine and Biosciences (KCUMB) - GME Consortium
 Adjunct Clinical Assistant Professor of Preventive Medicine, Department of Specialty
Medicine, KCUMB
 Adjunct Clinical Assistant Professor in the Department of Academic Affairs, Arkansas
College of Osteopathic Medicine (ARCOM), Fort Smith, AR
 Former Director of Preventive Medicine Research Center and Assistant Professor of
Preventive Medicine and Public Health at Edward Via College of Osteopathic Medicine
(VCOM) – Virginia Campus
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KEY PERSONNEL
Unity Health’s Osteopathic Residency Program
Dr. Dewey McAfee
 Director of Medical Education
 Family Medicine Program Director
Dr. David Covey
 Internal Medicine Program Director
 Arkansas’s White County Health Officer
Dr. John Henderson
 Chief Medical Officer
Dr. Delaney Kinchen
 Institutional Education Officer
Dennis Yecke, MBA
 Operations Director
Dr. James S. Stanley
 Psychiatry Program Director
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RESIDENCY PROGRAM
Unity Health’s Osteopathic Residency Program:
 Unity Health’s Residency Program is affiliated with Kansas City University of
Medicine and Biosciences – Graduate Medical Education Consortium (KCU-GME
Consortium).
 The program is the first osteopathic residency program in the state of Arkansas.
 The program is the second residency program in the state after a residency program at
University of Arkansas Medical Center (UAMS).
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RESIDENCY PROGRAM
Unity Health’s Osteopathic Residency Program:
 The program was started in July, 2015 and approved for three specialty programs
 Family Medicine – 3 PGY1 and 1 PGY2
 Internal Medicine – 5 PGY1 and 2 PGY2
 Psychiatry
– 3 PGY1 and 1 PGY2
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Common Program
AOA Requirements
AOA Basic Documents for Postdoctoral Training – Research &
Scholarly Activity:
ACGME Requirements
ACGME Common Program Requirements – Residents’
Scholarly Activities:
IX.D Research and Scholarly Activity
IV.B
Residents’ Scholarly Activities
9.1 Each OPTI shall require each member institution to establish policies IV.B.1 The curriculum must advance residents’ knowledge of
and guidelines that govern scientific research activities in accordance
the basic principles of research, including how research
with local, state and federal guidelines.
is conducted, evaluated, explained to patients, and
applied to patient care.
9.2 Each OPTI shall facilitate and provide research education, assistance
and resources directly to trainees and institutions to encourage
research and to meeting the Specialty College requirements.
9.3 Each OPTI shall provide in collaboration with its member COM(S),
hospitals and other teaching institutions access to basic science
and/or clinical research mentorship.
IV.B.2 Residents should participated in scholarly activity.
IV.B.3 The sponsoring institution and program shall allocate
adequate educational resources to facilitate resident
involvement in scholarly activities.
9.4 The OPTI shall support and provide a mechanism to recognize
trainees who conduct research activities.
9.5 The OPTI shall provide budgeted funding for OPTI-wide or program
specific research for its trainees.
9.6 The OPTI shall demonstrate its support of trainee scholarly activity.
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Family Medicine Program
AOA Requirements
ACGME Requirements
Family Medicine:
Family Medicine:
VII.B.7.1.e) Attend a minimum of one of the following: National
American College of Osteopathic Family Physicians (ACOFP)
annual convention or the AOA Osteopathic Medical Conference &
Exposition (OMED), registered as an ACOFP Family Physician.
IV.B Residents’ Scholarly Activities
IV.B.1
The curriculum must advance residents’ knowledge of the
basic principles of research, including how research is
conducted, evaluated, explained to patients, and applied to
patient care.*
IV.B.2
Residents should participate in scholarly activity.*
VII.C Research and Scholarly Activity Requirements
VII.C.7.1 The participation of each resident in a scholarly activity
is required. This requirement can be met by participating in or
completion of any of the following:
a. Resident scholarly project within the department of family
medicine
IV.B.2.a) Residents should complete two scholarly activities,
at least one of which should be a quality improvement
project.
IV.B.3
b. Institutional or regional research programs in which family
physicians are actively involve
The sponsoring institution and program should allocate
adequate educational resources to facilitate resident
involvement in scholarly activities. *
c. Authoring an original paper on a health-care related topic
d. Presentation at a state, regional, or national meeting
e. Authoring a grant
*Core
requirement
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Internal Medicine Program
AOA Requirements
Internal Medicine:
ACGME Requirements
Internal Medicine:
VII. Resident Requirements
IV.B Residents’ Scholarly Activities
VII.7.7 The residents must attend the American College of
Osteopathic Internists (ACOI) Annual Convention
and Scientific Sessions or another ACOI
continuing education program once during the
training program.
IV.B.1 The curriculum must advance residents’
knowledge of the basic principles of research,
including how research is conducted, evaluated,
explained to patients, and applied to patient care.*
IV.B.2 Residents should participate in scholarly activity.*
VII.7.8 The resident must complete a scholarly project that IV.B.3 The sponsoring institution and program should
is approved by the program director and submitted
allocate adequate educational resources to
for publication or presented at a scientific meeting,
facilitate resident involvement in scholarly
or participate in two critiqued evidenced-based
activities.*
presentations.
*Core
requirement
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Psychiatry Program
AOA Requirements
ACGME Requirements
Psychiatry:
Psychiatry:
VII. Resident Requirements
IV.B
VII.B.4 Write one (1) professional research project
pertinent to psychiatry which is suitable for
publication.
IV.B.1
The curriculum must advance residents’ knowledge of the basic
principles of research, including how research is conducted, evaluated,
explained to patients, and applied to patient care.*
IV.B.2
Residents should participate in scholarly activity. *
The paper shall be submitted the American
College of Osteopathic Neurologists and
Psychiatrists (ACONP) during the last year of
training prior to completion of the residency
training.
Residents’ Scholarly Activities
IV.B.2.a) The program must provide residents with the opportunities for research
and development of research skills for residents interested in
conducting research in psychiatry or related fields.
IV.B.2.b) The program must provide interested residents access to and the
opportunity to participate actively in ongoing research under a mentor.
IV.B.2.c) All residents must be educated in research literacy and in the concepts
and process of evidence-based clinical practice to develop skills in
question formulation, information searching, critical appraisal, and
medical decision-making.
IV.B.3
The sponsoring institution and program should allocate adequate
educational resources to facilitate resident involvement in scholarly
activities.*
*Core requirement
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SUMMARY
Common Program Requirements:
I. Establish policies and guidelines that govern scientific research activities
II. Provide research education and establish a curriculum to advance residents’ knowledge
of the basic principles of research
III. Provide access to basic science and/or clinical research mentorship
IV. Allocate adequate educational resources to facilitate resident involvement in scholarly
activities and provide budgeted funding for the residents
V. Have the residents participate in scholarly activity
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I. Establish policies and guidelines that govern scientific research activities
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II. Establish a curriculum to advance residents’ knowledge of the basic principles of research
Unity Health’s GME has created a course titled “Principles of Evidence Based Medicine and Research”.
 Unity Health’s GME has created:
 A course titled “Principles of Evidence Based Medicine and Research”.
 The curriculum is designed to advance the residents’ knowledge of basic principles of evidence
based medicine and research.
 Monthly Meeting with Research Mentors
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II. Establish a curriculum to advance residents’ knowledge of the basic principles of research
Course Structure:
 The course is started in January and end June during the noon didactic once a month.
 At the end of each lecture, there is a workshop section to go through some practice questions and
calculations related to the materials in the lecture.
Lecture
1
Description
The Foundation of Evidence Based Clinical Practice and
Hierarchy of Research Evidence and Study Designs
2
Methods and Requirements for using of human subjects for Institutional Review Board (IRB)
3
Validity of Diagnostic Test and Random Error
4
Types of Data, Test Hypothesis, and Statistical Analyses
5
Understand How to Interpret the Results and Translate the Evidence to Patient Care
6
Research Biases: Sources of Bias and Strategies for Minimizing Biases
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III. Provide access to basic science and/or clinical research mentorship
Unity Health’s GME allocates two types of research mentors to provide assistance regarding
research methodology and clinical guidance to facilitate the residents’ involvement in
scholarly activities.
Clinical Research Mentor is an expert in the field of the resident’s research area of interest.
The clinical research mentor will help the resident by:
 Approving the research topic and study design
 Determining an appropriate conference and journal in order to submit the research poster
and/or manuscript
 Approving the final abstract, poster, and/or manuscript
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Study Research Mentor is an expert in study design and research methodology.
The study research mentor will help the resident by:
 Teaching the residents to understand principles of research and become competent in
research skills
 Advising the residents in designing a research study, including providing an assistance in
choosing an appropriate data set, statistical analysis, interpretation of results, conducting a
research poster, and/or writing a manuscript
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IV. Allocate adequate educational resources to facilitate resident involvement in
scholarly activities and provide budgeted funding for the residents
Unity Health’s GME allocates the following educational resources:
For internal medicine and family medicine residents:
1.
Harrison’s Principles of Internal Medicine Textbook
2.
American College of Physicians (ACP) MKSAP 17 Part A and B books
For psychiatry residents:
1.
Kaufman’s Clinical Neurology for Psychiatrists Textbook
2.
Stahl’s Essential Psychopharmacology Textbook
3.
The Human Brain Book
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Unity Health’s GME allocates the following educational resources to all of the residents:
1. Microsoft Surface Pro to allow the residents to access patient’s information and search for
research articles
2. Educational stipend:
 $1,000 for the PGY1 and PGY2
 $1,500 for the PGY3 and PGY4
3.
Scholarship fund to help the residents to pay for conference attendance and presentation
4.
Monthly meeting with the research mentors
5.
High quality noon didactic lectures with the CME credit available for faculty and free lunch
6.
Access to the KCUMB library
7.
Discount rate for an access to the COMBANK to help the residents to prepare for the
COMLEX-3
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8.
Provide a dedicated time for the residents to prepare for their special board exams
V. Have the residents participate in scholarly activity
A.
B.
C.
D.
Scholarly activity productivity
Expectation for graduation
Research timeline
Scholarly activity evaluation:
1. Research Responsibility
2. Research Project or Case Report Progression
3. Scholarly Activity Productivity
4. ACGME – Milestones
5. Overall Competency
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V.A: Scholarly Activity Productivity
Required Scholarly Activity:
Level 1: Literature Review
The residents are required to conduct a literature review for the following activities:
 Research project or case report
 Noon didactic
 Journal club
 Patients support group
Level 2: Attend a regional or national medical conference
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V.A: Scholarly Activity Productivity
Level 2: Attend a regional or national medical conference (required)
Family Medicine Residents:
 Attend the American College of Osteopathic Family Physicians (ACOFP) or AOA OMED
Conference (AOA VII.B.7.1.e)
Internal Medicine Residents:
 Attend the American College of Osteopathic Internists (ACOI) Annual Convention and
Scientific Sessions (AOA VII.7.7)
Psychiatry Residents:
 Attend the American College of Osteopathic Neurologists and Psychiatrists (ACONP)
(AOA VII.7.7)
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V.A: Scholarly Activity Productivity
Optional Scholarly Activity:
Level 3:
Conduct a case report and a poster presentation at a regional or a national conference
Level 4.1†:
Conduct an original research project and a poster presentation at a regional or a
national conference
Level 4.2†:
Publish an original research article in a peer review scientific journal
Level 4.3†:
Submit a grant proposal as a principal investigator or a co-investigator
Level 5.1:
Write a book chapter in a textbook related to medicine
Level 5.2:
Receive a grant award as a as a principal investigator or a co-investigator
†Level
4 is designed as a graduation target.
The residents are not required to be listed as the primary investigator or the first author of the research poster or research article.
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V.A: Expectation for Graduation
1.
Every resident is required to provide noon didactics, conduct literature review for his/her case report
or research project, present/attend journal clubs and patients support group, and attend a medical
conference
2.
Every resident is required to accomplish one of the following four options of scholarly activity
productivities in order to graduate from Unity Health’s residency program
Option 1: Two case reports for poster presentations (Level 3)
Option 2: An original research project for a poster presentation or publication (Level 4†)
Option 3: A grant application (Level 4†) or grant award (Level 5)
Option 4: Accomplish a submission of a text book chapter (Level 5)
†Level
4 is designed as a graduate target.
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V.B Research Project Timeline
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V.B Case Report Timeline
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V.C: Scholarly Activity Evaluation
 Clinical Competency Committees (CCC) of each program evaluate and monitor the residents’
scholarly activity and progression.
 A CCC is the ACGME required body comprising three or more members of the active
teaching faculty who is advisory to the program director and reviews the progress of all
residents in the program1.
 The evaluation is conducted semi-annually.
 The evaluation results are reported to the GME Committee.
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K, Padmore J, Hauer KE, and Holmboe E. “A Guidebook for Programs: Clinical Competency Committees.” Accreditation Council
for Graduate Medical Education, Jan. 2015. Web. 1 April 2016.
1Source: Andolsek
V.C: Scholarly Activity Evaluation
The residents are evaluated according to these sections:
1.
Research Responsibility
2.
Research Project or Case Report Progression
3.
Scholarly Activity Productivity
4.
ACGME – Milestones
5.
Overall Competency
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1. Research Responsibility
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2. Research Project or Case Report Progression
PGY 1
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2. Research Project or Case Report Progression
PGY 2
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2. Research Project or Case Report Progression
PGY 3
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3. Scholarly Activity Productivity
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4. ACGME – Milestones
The ACGME Review Committee will examine milestone performance data for each program’s residents
as one element in the Next Accreditation System (NAS) to determine whether residents overall are
progressing according to the following areas:
PC – Patient Care
PBLI – Practice-Based Learning and Improvement
MK – Medical Knowledge
PROF – Professionalism
SBP – System-Based Practice
C - Communication
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4. ACGME – Milestones
Family Medicine ACGME – Milestones
 PBLI-1: Locates, appraises, and assimilates evidence from scientific studies related to the
patients’ health problems
PBLI-1: Locates, appraises, and assimilates evidence from scientific studies related to the
patients’ health problems
Level
Competency Component
Level 1
Able to describe basic concepts in clinical epidemiology, biostatistics, and clinical
reasoning
Level 1
Know different categories of research study design
Level 2
Able to identify pros and cons of various study designs, associated types of bias, and
patient-centered outcomes
Level 2
Able to formulates a searchable question from a clinical question
Level 2
Able to evaluates evidence-based point-of-care resources
Level 3
Able to apply a set of critical appraisal criteria to different types of research, including
synopses of original research findings, systematic reviews and meta-analyses, and
clinical practice guidelines
Level 3
Able to critically evaluate information from others, including colleagues, experts, and
pharmaceutical representatives, as well as patient-delivered information
Level 4†
Level 5
Able to incorporates principles of evidence-based care and information mastery into
clinical practice
Able to independently teach and assess evidence-based medicine and information
mastery techniques
PBLI = Practice-Based Learning and Improvement
†Level 4 is designed as the graduation target
Milestones Achievement
Month
6
12 18 24 30 36
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Family Medicine ACGME – Milestones
 PBLI-2: Demonstrates Self-Directed Learning
PBLI = Practice-Based Learning and Improvement
†Level 4 is designed as the graduation target
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Internal Medicine ACGME – Milestones
 PROF-4: Exhibits Integrity and Ethical Behavior in Professional Conduct
i. Critical Deficiencies: Dishonest in clinical interactions, documentation, research, or scholarly activity
ii. Professionalism Early Concern Note will be written if the resident is suspected of dishonesty in
reporting his/her scholarly activities or plagiarism on the research abstract, poster, or manuscript
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PROF = Professionalism
PBLI = Practice-Based Learning and Improvement
†Ready for Unsupervised Practice: This level is designed as the graduation target
Internal Medicine ACGME – Milestones
 PBLI-2: Learns and Improves via Performance Audit
PBLI = Practice-Based Learning and Improvement
†Ready for Unsupervised Practice: This level is designed as the graduation target
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Internal Medicine ACGME – Milestones
 PBLI-4: Learns and Improves at the Point of Care
PBLI = Practice-Based Learning and Improvement
†Ready for Unsupervised Practice: This level is designed as the graduation target
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Psychiatry ACGME – Milestones
 PBLI-1: Development and execution of lifelong learning through constant self-evaluation, of
research and clinical evidence
A: Self-Assessment and self-improvement
B: Evidence in the clinical workflow
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PBLI = Practice-Based Learning and Improvement
Psychiatry ACGME – Milestones
 PBLI-1: (Continue)
PBLI = Practice-Based Learning and Improvement
†Level 4: This level is designed as the graduation target
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Psychiatry ACGME – Milestones
 PBLI-3: Teaching
A: Development as a teacher
B: Observable teaching skills
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PBLI = Practice-Based Learning and Improvement
V.E: Overall Competency in Scholarly Activity
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Research Project Team Structure
44
Family Medicine Residents
45
Internal Medicine Residents
46
Psychiatry Residents
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Medical Students (OMS III)
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 Ray Montgomery, FACHE – Unity Health’s President and CEO
 John Henderson, M.D., FACC – Chief Medical Officer
 Dewey McAfee, D.O., FACOFP, PharmD – Director of Medical Education/Family Program Director
 James S. Stanley, M.D., FANP – Psychiatry Program Director
 Delaney Kinchen, D.O., FAEP – Institutional Education Officer
 Dennis Yecke, MBA – Operations Director, Graduate Medical Education Program
 Rachael Sowers, MBA – Program Coordinator , Graduate Medical Education Program
 Leslie Provence, MBA – Program Coordinator , Graduate Medical Education Program
 Kelly Bopp – Administrative Assistant, Graduate Medical Education Program
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THANK YOU
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