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PROGRAM DIRECTOR ’ S ROLE. “ The Next Accreditation System (NAS) ”. Brian L. Cohen, MD, FRCOG, FACOG. Associate Dean of Graduate Medical Education Professor of Obstetrics, Gynecology and Women ’ s Health. Introduction. 1999: ACGME introduced the domains of clinical competency - PowerPoint PPT Presentation
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““The Next Accreditation System The Next Accreditation System (NAS)” (NAS)”
Brian L. Cohen, MD, FRCOG, FACOG
PROGRAM DIRECTOR’S ROLE PROGRAM DIRECTOR’S ROLE
Associate Dean of Graduate Medical Education
Professor of Obstetrics, Gynecology and Women’s Health
1999: ACGME introduced the domains of clinical competency
2009: ACGME began a multiyear process to restructure the
accreditation system to be based on outcomes
2013: Phased implementation of the NAS
IntroductionIntroduction
Aims of NASAims of NAS
Enhance the peer review system to prepare physicians
Accelerate ACGME accreditation based on outcomes
Reduce the burden of the current system which is process based
BasisBasis
Institute of Medicine Report
Public pressure
Congressional pressure
Constrained finances and possible reductions for GME
July 2013 July 2013 Phase I Phase I
Emergency medicine Internal medicine Pediatrics Diagnostic radiology Neurosurgery Orthopedic surgery Urology
NAS will be implemented by 7 of 26 core specialties
All other specialties and preliminary programs implementation - July 2014
GME communities must be prepared for changes
NAS ComplianceNAS Compliance
① Annual ADS consists of: Program statistics Program structure & resources Scholarly activity Teaching responsibilities
Five important data collection areas:
NAS ComplianceNAS Compliance
③ Clinical Experience Case log Case mix Minutes from meetings of program
evaluation
NAS ComplianceNAS Compliance
④ Resident Survey Duty hours Supervision & teaching Teamwork Education vs. service Evaluations Patient safety
Additional InformationAdditional Information
Minutes from annual meetings to be submitted annually
Residents on committees Sample PLA & LOA policy Policies- Supervision
- Handover rounds
- Work hours
- Others
Essential component of NAS are the MILESTONES Basis is to track development in the 6 competencies Dreyfus Model:
- Novice
- Advanced beginner
- Competent
- Proficient
- Expert
- Master
MilestonesMilestones
Develop by December 2012Submission to ACGME 2013 & 2014
Milestones Will Supplement, Not Replace Existing Assessment Tools
Timeline: Timeline:
Milestones Milestones
Clinical Competency Committee (C.C.C.)Clinical Competency Committee (C.C.C.)
Core faculty
Program director- professionalism
Chief resident
IncludeInclude
FunctionFunction
FunctionFunction
Evaluate milestones & early warning
Track progress of residents
Faculty development
Reduce potential bias/subjective
Performance measure
Decision making by multiple people
Evaluate 360° assessments
PurposePurpose
Clinical Learning Environment Clinical Learning Environment Review (CLER)Review (CLER)
On resident learning of patient safety
Institution responsibility for quality and safety of the learning environment
Focus is:
Focus Comprises Six Areas:
1. Patient safety
2. QI by residents
3. Transition of care
4. Supervision
5. Duty hours & fatigue management
6. Professionalism
Clinical Learning Environment Clinical Learning Environment Review (CLER)Review (CLER)
Evaluation by Site VisitsEvaluation by Site Visits
Site visitors CEO of medical institution DIO GMEC chair Residents Safety officer Senior administration
Personnel Involved:
Three weeks advance notice
No advance documentation
Conduct interviews
Work hour reports
Visit learning environment
ProcessProcess
1. NAS itself
2. Milestones
3. Clinical competency committee
4. CLER
SummarySummary
NAS will involve four areas (2013 & 2014):
Begin the process NOW (2013 & 2014)
Structured & standardized protocols Assess resident skills Use of technology
Handoff / Handover ProcessHandoff / Handover Process
Program directors provide:
May be: Verbal Written Written & verbal Electronic
Objective: Accuracy Patient safety
Sick – degree
Identifying data
General hospital course
New events
Overall health status
Upcoming plan
Tasks to complete
Questions
Standardized ToolStandardized Tool