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The Next Accreditation System. Aims of the Next Accreditation System. Enhance the ability of the peer-review system to prepare physicians for practice in the 21 st Century To accelerate the movement of the ACGME toward accreditation on the basis of educational outcomes - PowerPoint PPT Presentation
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Accreditation Council for Graduate Medical Education
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
The Next Accreditation System
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Aims of the Next Accreditation System
Enhance the ability of the peer-review system to prepare physicians for practice in the 21st Century
To accelerate the movement of the ACGME toward accreditation on the basis of educational outcomes
Reduce the burden associated with the current structure and process-based approach
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Competencies/MilestonesPast Decade
Competency evaluation stalls at individual programmatic definitions
MedPac, IOM, and others question the process of accreditation preparation of graduates for the “future” health care delivery
system
House of Representatives codifies “New Physician Competencies”
MedPac recommends modulation of IME payments based on competency outcomes
Macy issues two reports (2011) IOM 2012-2013
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
The Next Accreditation System: Background and Rationale
MedPAC
COGME
Robert Wood JohnsonFoundation
Macy Foundation
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Most data elements are in place Standards revised every 10 years No PIFs
Scheduled (Self-Study) visits every 10 years
Site visits may be requested by the Review Committee in-
between the 10-year Self-Study visits
Internal reviews no longer required
How is Burden Reduced?
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
The Next Accreditation System
Instead of biopsies, annual data collection, that may include, but are not limited to: Trends in annual data Milestones, Resident, Fellow and Faculty Surveys Scholarly activity template Operative and Case Log Data Board pass rates
PIF replaced by Self-Study High-quality programs will be free to innovate:
Requirements have been re-categorized (Core, Detail, Outcome)
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
The Conceptual Change from…“Do this or else...”
The Current Accreditation System
Rules
Corresponding Questions
“Correct or Incorrect” Answers
Citations and Accreditation Decision
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
WHAT IS DIFFERENT?
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
The Next Accreditation System
ContinuousObservations
Identify Opportunities for
Improvement
Program Makes
Improvement(s)
AssessProgram
Improvement(s)
PromoteInnovation
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Terminology
Core Requirements:
Statements that define structure, resource, or process
elements essential to every graduate medical
educational program.
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Terminology
Outcome Requirements:
Statements that specify expected measurable or
observable attributes (knowledge, abilities, skills, or
attitudes) of residents or fellows at key stages of their
graduate medical education.
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Terminology
Detail Requirements:
Statements that describe a specific structure, resource,
or process, for achieving compliance with a Core
Requirement.
Programs in substantial compliance with the Outcome
Requirements may utilize alternative or innovative
approaches to meet Core Requirements.
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Terminology
Each requirement labeled:
Core – All programs must adhere
Outcome – All programs must adhere
Detail – Programs with status of “Continued
Accreditation” may innovate
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Decisions on Program Standing in the NAS
STANDARDS
OutcomesCore ProcessDetail Process
STANDARDS
OutcomesCore ProcessDetail Process
ContinuedAccreditationContinued
Accreditation
Withdrawal of AccreditationWithdrawal of Accreditation
Accreditation with Warning
ProbationaryAccreditation
2-4% 10-15% 75-80%
<1%
Application forNew Program
Application forNew Program
1. NAS: No Cycle Length2. All programs with 1-2y cycles in the old system – placed in Continued Accreditation with Warning Status3. Percentages represent approximations based on accreditation status received by programs in the past
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Data Collection in the Next Accreditation System
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Annual Data Review ElementsPolicy 17.61 Review of Annual Data
Continuous Data Collection/Review ADS Annual Update Resident Survey Faculty Survey Milestone data Certification examination performance Case Log data/Clinical experience Hospital accreditation data Faculty member and resident scholarly activity and
productivity Other
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
ACGME complaints Verified public information Historical accreditation decisions/citations Institutional quality and safety metrics
Other Data (Episodic)
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Except for the program director, faculty CVs will no longer be collected
Curriculum Vitae
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Core Faculty
For core programs, only physicians can count as Core Faculty
Only faculty members who spend 15 or more hours per week working on the residency program (including clinic work, didactics, research, and administration) are counted as Core Faculty
Core Faculty complete Scholarly Activity template in ADS
Core Faculty complete Faculty Survey
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Core Faculty
Examples of faculty members that meet the definition of Core Faculty: A physician who works in the ICU with responsibilities that
include clinical supervision of residents, who is a member of the Clinical Competency Committee, runs simulation, who helps write resident curriculum
A physician scientist who spends most of his time conducting clinical outcomes research, with only four weeks per year of clinical time, but in addition, spends 15 hours or more supervising residents in their research projects; and writes and provides didactics related to scholarship; writes the curriculum for scholarship (i.e., statistics), and conducts evidence-based journal club.
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Core Faculty
Examples of faculty members that do not meet the definition of Core Faculty:
A physician who conducts rounds two weeks out of the whole year and has no other program responsibilities (administrative, didactics, research supervision) other than clinical work during those two weeks
A faculty member with a PhD, and who is not a physician, who works in the basic science laboratory
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity Template in ADS
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity
Enter Pub Med ID #’s
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity
Enter a number
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity
Enter a number
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity
Enter a number
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity
Enter a number
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity
Answer Yes or No
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Faculty Scholarly Activity
AnswerYes or No
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Resident Scholarly Activity
Similar toFaculty
Template
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
What Happens in My Program?
Annual data submission Self-Study visit every 10 years Possible actions following Review Committee:
Clarify information Progress reports for potential problems Focused site visit Full site visit Site visit for potential egregious violations
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
What Happens in My Program?
Core and subspecialty programs reviewed together
Existing Independent subspecialty programs that
chose to remain independent are subject to:
Program Requirements and program review
Institutional Requirements and institutional review
CLER visits
No new independent subspecialty programs allowed
after July 2013
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
What Happens after Review of my Program?
Citations will still be issued (if necessary) Programs have to provide response to citations
in ADS annually Areas of non-compliance Citations issued after 7/1/13 (Phase I) and after
7/1/14 (Phase II) will not be considered resolved until the Review Committee determines that they have been corrected
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Areas in need of improvement:
General concern(s) identified from annual review
Written response not required
Will not have to be documented in ADS
PD, DIO/GMEC should act on these areas
What Happens after Review of my Program?
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
No site visits (as we know them)
but…
Focused site visits for an “issue”
Full site visit (no PIF)
Self-Study Visits every 10 years
NAS: What’s Different?
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
What is a Focused Site Visit?
Assesses selected aspects of a program and may be used: to address potential problems
identified during review of annually submitted data
to diagnose factors underlying deterioration in a program’s performance
to evaluate a complaint against a program
30-day notification given
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
What is a Full Site Visit?
Application for a new core program
At the end of the initial accreditation period
Re-applications (withheld or withdrawn)
Review Committee identifies broad issues/concerns
Other serious conditions or situations identified by
the Review Committee
60-day notification given
Minimal document preparation
Team of site visitors
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Ten-Year Self-Study Visit
Not to be confused with a focused or full site
visit requested by the Review Committee after
annual program review
Not a traditional site visit
Implementation:
2015 for Phase I and some Phase II specialties
2016 for most Phase II specialties
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Ten Year Self-Study Visit
Will review core and subspecialty programs together
Review Annual Program Evaluations (PR-V.C.) Response to citations Faculty development
Judge program success at Continuous Quality Improvement (CQI)
Learn future goals of program Will verify compliance with Core requirements
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Self-Study and Self-Study Visit
Self-Study Conducted by the
program Annual Program
Evaluation Review of
program goals and improvement efforts
Self-Study Visit Conducted by ACGME
Field Staff members
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
Ten-Year Self-Study and Self-Study Visit
Self-Studyvisit
Ongoing Improvement
AE
Self-Study
Yr 0 Yr 1 Yr 3 Yr 4 Yr 5 Yr 6 Yr 7 Yr 8 Yr 9 Yr 10Yr 2
AE AE AE AE AE AE AE AE AE
Annual Program Evaluation (PR-V.C.)Resident performanceFaculty developmentGraduate performanceProgram qualityDocumented improvement plan
AE: Annual Program Evaluation
© 2013 Accreditation Council for Graduate Medical Education Information Current as of December 2, 2013
ACGME Webinars and Other Resources
ACGME webinars are available at: http://www.acgme.org/acgmeweb/tabid/431/ProgramandInstitutionalAccreditation/NextAccreditationSystem/Webinars.aspx
CLER Overview of Next Accreditation System Milestones, Evaluation, CCCs Specialty-Specific Webinars (Phase I) Phase I Coordinator Webinars (surgical and non-surgical) Specialty-specific Webinars (Phase II): Nov 2013-Dec 2013
Slide presentations for distribution to the GME community: NAS, CCC, Milestones, Annual Program Evaluation/PEC, Updates on Policy– December 2013
Upcoming Specialty-specific Webinars (Phase II): Jan 2014-May 2014 CLER Self-Study (what programs do) Self-Study Visit (what ACGME site visitors do)