Workshop Overview Optimizing your “PIF-manship”

Day of Reckoning: The visit Itself

Behind the Scenes (ACGME / RRC)

Avoiding the MOST Common Citations

How the GME Office Can Help!

Optimizing Your “PIF-manship” Why it matters

Understanding the rules

Timeline for completion

Attachments and Supporting Documents

Avoiding the most common errors

*****Group Exercise: Common PIF Competency Ideas

The PIF is the KEY! Majority of ultimate citations result directly from

information provided in the PIF (others primarily from resident interview, resident survey, and document review)

A well-written PIF can minimize a multitude of sins!

A platform to prepare all survey day participants (best completed as a group effort for optimal buy-in…)

Ideally functions as a self-study to help ID areas of “opportunity”

Understand the RULES: Review your CURRENT program requirements before

beginning work on your PIF

All PIF questions track DIRECTLY to a program requirement (common or specialty)

There ARE many PIF questions with RIGHT and WRONG answers!

READ (and follow!) THE DIRECTIONS!!!!!!!! (“one” examples means ONE, “describe” means DESCRIBE)

NEVER send extra attachments or unsolicited information with the PIF

Be CLEAR, CONCISE, & CONSISTENT!

Timeline for PIF completion: Many experts recommend beginning formal writing at

the point of Internal Review (response to last citations, etc.)

On-going prep is best (track data, keep files organized, example folders of key requirements, etc.

ALWAYS at least 6-12 months before anticipated review date

Timeline Reminders: Site surveyor must receive PIF and attachments 2

weeks before site visit

DIO must review and sign off before document can be mailed to surveyor

Optimally DIO reviews polished draft 4-6 weeks before survey, recommends changes, and signs final copy 3 weeks before survey date ***

Dept Chair, Chief Residents, Key Faculty should read and edit PIF prior to sending to DIO

SO… Anticipated Date of Next Review: 4/2010

Send to Site surveyor: 3/15/2010

Send draft to DIO: 2/15 - 3/1/2010

Draft for CR/key Faculty review: 2/1 – 3/1/2010

90-120 Day survey date notice:12/15/2009

Best you start writing by: 10 – 11/ 2009

Getting started: Acgme.org

Web-ads sign-in and print out PIF

Part 1 is pre-populated program description; check for accuracy, make changes as needed thru web-ads

Part 2 is questions and narrative specific to your programs

Tackle the PIF in small bites / sections

JUST DO IT!!! (procrastination compromises product!)

Common PIF Errors: Unanswered questions / Missing information

Failure to follow directions

Spelling / Grammar / Structure Structure errors

Including unformatted faculty CV’s, manuscripts, etc.!!!!!!

PIF faculty CV’s with publications from the 70’s & 80’s, (last 5 years ONLY!!!)

Pages incorrectly numbered

Inconsistent data

Inaccurate block diagrams

Failure to fully explain unique approached to satisfying requirements

Failure to TELL the TRUTH!!!

Common “inconsistencies”: # residents in ACGME database = number of names on

resident list = #of residents listed in PIF

Months / FTE’s at each participating site = number of rotations on block diagram

# of resident evaluations in folders = frequency of resident reviews reported

Institution mentioned in narrative is not referenced elsewhere

Faculty List / Faculty Credentials = faculty CV’s attached

Procedures listed for individual residents = numbers of total program procedures

Attachments: May be slightly different for different RRC’s

Usually: Policy for resident supervision Moonlighting policy Duty Hours Policy Competency Assessment Tools Evaluation tools Overall Educational Goals for the Program Sample Goals & Objectives for a rotation Program Letters of Agreement

Supporting Documentation: Policy for Supervision of residents

Program Policies for duty hours and work environment

Moonlighting policy

Documentation of internal review (DIO provides)

Overall Program Goals

Competency Based Goals & Objectives by rotation and level of trainee

Current Program Letters of Agreement

Files of current residents (sample transfer & problems)

File of recent program graduate (final summative eval, “competent to practice independently”)

Supporting Documentation (cont’d): Evaluations of residents at end of rotation

Examples of completed 360* evaluations

Sample of written semi-annual evaluation by PD

Completed confidential evals of faculty by residents

Completed confidential evals of program by residents

Completed confidential evals of program by faculty

Minutes of annual program evaluations and written improvement plan

Resident duty hour tracking

Supporting Documentation (cont’d): Complete Program Curriculum

Examples of scholarly activity (resident and faculty)

Documentation of program improvement projects

Conference schedules with documentation of attendance

Board Exam Results of graduates

Copies of alumni surveys if done

Trainee handbooks

Any other examples of “special” things you do!

Day of Reckoning: The Site Visit The site visitor

Preparation Program Director Prep Program Administrator Prep Faculty / Chair Prep RESIDENT PREP

Last Minute Reminders

The Schedule

The Site Visitor: Professional profile of your surveyor available on

acgme.org

Confirms and clarifies the PIF (Does NOT make accreditation decision!)

Documents the data and the processes

Writes fair, objective, and accurate report

Does NOT make recommendations regarding accreditation action

Will have a specific structure they wish to follow for the day---ACCOMMODATE them!!!!

Survey Day Prep - General Make sure everyone meeting with the surveyor has read the

PIF (and agrees with its content!!!)

Design the day’s schedule as directed by your site surveyor

Communicate any changes or problems directly to your surveyor

Identify and schedule a room for the survey day which can accommodate all interviews

Have three copies of PIF for surveyor

Decide who will hold / answer pagers for participants!

Survey Day Prep – PD/PA Know your Program Requirements inside / out,

forwards & backwards!

Know your PIF/ prep your people

Have all supportive documentation, well-organized and optimally ordered by PIF topics

Have interview room neat and stocked with water

Surveyor may also wish to tour lounge and call rooms (make sure they are clean, too!)

Survey Day Prep - Residents Hold peer election in larger programs to select who will

meet with the surveyor (Surveyor will tell you how many; usually 10-12)

Provide PIF to residents for review 2-4 weeks prior

Meet with residents 1-2 weeks prior and review anticipated surveyor questions

Make sure they understand how previous citations have been addressed

Make certain ALL “non-compliant” issues in ACGME resident surveys have been addressed, and be sure residents feel efforts have been effective for all remedies

Survey Day Prep - Faculty Select faculty per site surveyor directions

Provide PIF to faculty for review 2-4 weeks prior

Meet with faculty 1-2 weeks prior and review anticipated surveyor questions

Make sure they understand how previous citations have been addressed

Pagers must be OFF (or absent) during the meeting

The Typical Schedule PD / PA meeting with review of PIF / Documents

Chair Meeting

DIO Meeting

Key Faculty Meeting

Resident Meeting

Wrap Up meeting with PD

Behind the Scenes: ACGME / RRC Site Surveyor completes a written report- just the facts, designed to verify

PIF information, summarize document review, and clarify issues raised in the ACGME resident survey

Surveyor report is forwarded to designated RRC to be added to next open agenda (agendas usually finalized 2 months in advance of actual meeting)

RRC committee members (1-3) are assigned PIF and surveyor report for review & to present at meeting (actual surveyors do not participate)

Committee discusses and determines status and cycle length

E-mail notice received within 2 weeks of meeting re status decision and cycle length

Full Letter of Report (LOR) with citations received 8-12 weeks after RRC meeting

The Common Problem Areas

Nationally Most Common Citations

UMC Most Common Citations

The Nine Red Flags

Most Common Citations: Duty Hour Violations

Service versus Education Issues

Evaluation problems

Board Pass Rate Citations

Written Curriculum Inadequacies

UMC Most Common Citations: Qualifications and Number of Faculty (14)

Procedural Experience (13)

Patient Care Experience (12)

Institutional Support (10)

Evaluation of Program (9)

Scholarly Activities (9)

Responsibilities of Program Director (9)

Performance on Board Exams (8)

Nine “Red Flags” in Accreditation Surveys

From ACGMe-Bulletin February 2008

Barbara Bush, William Robertson, Ingrid Philibert authors

Key issues to AVOID in program & site surveys

These problems most likely to result in adverse accreditation citations

Red Flag #1: Lack of Program Leadership

PD and Faculty fail to advocate for residents on important education and patient care issues

Lack of response to issues raised by residents/fellows

Too much reliance on communication and preparation PIF by program coordinator or other staff members

Repeat citations on successive reviews

Red Flag #2: Lack of Program Infrastructure for Teaching and

Evaluation Insufficient clinical or didactic curriculum

Insufficient systems for evaluation of residents, faculty or program

Red Flag #3: Lack of Appropriate Volume and Variety of Patients

Insufficient volume or balance of patients (diagnoses, clinical problems, acuity and demographics)

Disputes with other disciplines affecting numbers of patients available to the teaching program

Too many residents, fellows, other learners competing for same patient populations

Red Flag #4: Problems with Resident Recruitment or Retention

High Resident Turn-over

Unfilled resident positions

Poor record for graduates sitting for and passing board exam (reflects poorer quality applicants / trainees?)

May be due to geography, program or institutional reputation, interest in specialty, etc.

Red Flag #5: Lack of Dedicated Teachers

Faculty unwillingness or inability to devote added time required for effective teaching (at the bedside and in operating room, during conferences, rounds, and other didactics)

Problem may present with low numbers of board-certified faculty or not enough key faculty

Too much or too little supervision

Failure to provide meaningful feedback and evaluation

Fellows doing all the teaching

Red Flag #6: Lack of Meaningful Didactics

Didactics don’t cover the essential body of knowledge required by RRC (basic science and clinical)

Frequent cancellation of conferences

Lack of sufficient faculty attendance or participation in conferences

Over-reliance on residents or fellows to organize and present at conferences

Red Flag #7: Lack of Financial and Human Resources

Inadequate or outdated facilities

Excessive clinical demands on faculty / PD

Excessive clinical demands on faculty including PD

Excessive “services needs” / Residents need to “cover” too many hospitals

Inadequate number of administrative and ancillary staff for size of program

Lack of funding for program

Red Flag #8: Service has a Higher Priority than education

Undue reliance on residents to provide service including clinical services that cannot run without the presence of residents

Residents being “pulled” to “cover” services regularly

Duty hour violations affecting a significant percentage of the residents

Residents being required to provide coverage or cross-coverage on inpatient units during their ambulatory, subspecialty, or research rotations.

Red Flag #9: Lack of Preparation for the Accreditation Process

On site survey day, a program leader or faculty member who does not understand, argues about the standards, or lacks “buy-in” for the requirements

Poorly prepared PIF Obvious errors, inconsistencies or failure to follow

instructions Missing documents PIF that arrives late to site visitor

Not Germane to ALL:(BUT Frequent Area of Citation in many specialty areas)

Too MUCH or too LITTLE Scholarly Activity

on the part of Faculty or Residents

How the GME Office Can Help! Many required topics are covered in orientation annually

We provide notification of campus wide activities that offer opportunities to meet program requirements

Evaluation Tools ; Faculty Development Opportunities

Problem Resident / Faculty Intervention

Anonymous Resident Complaint Line

internal reviews/ Annual Survey/ Duty Hours Survey designed to help you maintain compliance and identify problems early

Resident Focus Groups convened as needs identified

PIF REVIEW!!!! (in draft form!)

Mock Surveys on request or consultant visits

Keys to Success: Start early

Review and know Program and Institutional Requirements

Correct ALL previous citations

Have on-going program improvement processes

Good communication and preparation with residents and faculty

Convey the strengths and unique attributes of your program clearly to the surveyor!