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Neuromuscular Fellowship Program Directors: Neurology Review Committee (NRC)/ACGME Update

Neuromuscular Fellowship Program Directors: Neurology Review Committee (NRC)/ACGME Update. John W. Engstrom, M.D. October 2010. Goals. Know what the ACGME and NRC do Know recent changes/future plans at the NRC Know ACGME plans for the near future (duty hours, milestones)

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Neuromuscular Fellowship Program Directors: Neurology Review Committee (NRC)/ACGME Update

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  1. Neuromuscular Fellowship Program Directors: Neurology Review Committee (NRC)/ACGME Update John W. Engstrom, M.D. October 2010

  2. Goals Know what the ACGME and NRC do Know recent changes/future plans at the NRC Know ACGME plans for the near future (duty hours, milestones) Suggestions for NMM reaccreditation prep Innovations for neuromuscular medicine?

  3. ACGME: Accreditation Council on Graduate Medical Education -Responsible for accreditation of post-MD medical training programs within US. Accreditation is accomplished through a peer review process and is based upon established standards and guidelines. -Common Program Requirements (e.g.-duty hours) set by ACGME -Specialty Program Requirements-29 Review Committees (e.g.-program director support)

  4. ACGME-Scope of Activity In 2008-2009, there were 8,734 ACGME-accredited residency and fellowship programs in 130 specialties/subspecialties. Active full and part-time residents for 2008-2009  was 109,482 . www.acgme.com-- text of all program requirements; (tab Review Committees; Neurology; program requirements; neuromuscular medicine) Does not provide any funding; funding tied to ACGME-sponsored programs through Medicare

  5. Constituent Input to the ACGME AHA Congress AAMC ABMS Lay Public Exam Boards AMA Medical Societies

  6. Who is the Neurology Review Committee and why are they doing all these terrible things to me?

  7. NRC: Structure and CompositionNameTitleInstitution Terry Cascino Member Mayo Clinic Pat Crumrine Vice-Chair/ABPN U Pitt-Child Neuro John Engstrom Chair/CNPD/GES UCSF/AAN Larry Faulkner Ex-Officio ABPN Ralph Jozefowicz Member/ABPN U Rochester Brett Kissela Member U Cincinnati Steven Lewis Member Rush Univ MC Phillip Pearl Member Children’s Nat MC Shannon Kilgore Member Stanford Meredith Runke Member/Resident U Indiana Catherine Rydell Ex-Officio AAN

  8. ACGME: What Does the Neurology Review Committee (NRC) Do? • Council of Review Committee Chairs-29 • Neurology is one Review Committee • Accredits/Reaccredits ACGME-sponsored neurology and subspecialty neurology residency training programs-385 programs • Make recommendations regarding how training needs to innovate or adapt to changing circumstances

  9. NRC-Some Current/Future Goals • Make program director role part of a viable career pathway • Reduce burden of accreditation-incr max time bet program reviews from 5 to 8 years • Encourage innovations so programs can adapt to changing clin/acad environments • Optimize implementation of new duty hours and supervision requirements

  10. Program Directors and Career Pathway • Program director attrition/challenges • 50% turnover every 4 years • Admin work an add-on to other work • Adult neurology program director salary support-20% + 1% per trainee; began 7/1/10 • Prod institutions (not departments!) to reallocate IME resources to GME programs

  11. Program Directors (PDs) and Coordinators-Resource Support • Hardwire support for core and subspecialty program directors? • Coordinators must be adequately supported “How can we possibly demand funds?” • Precedents: • Obstetrics/Gynecology PDs-50% • Psychiatry PD-50% • Internal medicine PDs-similar to neurology

  12. Future: Reduce Admin Burden of Accreditation-Possibilities Extend approvals for programs with 4 and 5 year periods of accreditation to 8 years Require interim updates at 2 and 6 years Use local internal review as update at 4 yrs Encourage programs with long cycles to stay current while decreasing the administrative burden of accreditation Incentivize long accreditation cycles

  13. ACGME Initiatives Milestone Project-The milestones will define the behavioral attributes that are essential to be demonstrated in each competency domain before a resident graduates and at other key points during the resident’s education. Specialty milestone groups are being convened to develop milestones and identify assessment tools. STAY TUNED-First meeting to discuss with Review Committee chairs is in the fall 

  14. NRC-Encourage Innovative Training Program Structures • NEW-Practical innovations need to come from programs or review committees, not the ACGME--Dr. Thomas Nasca • Example: Flex Res at UCSF-research and research training in adult neuro • What changes would most benefit NMM program directors and NMM programs?

  15. For Neuromuscular Medicine Programs in AY 09/10, there were…. 23 accredited programs Specialty Length = 1 year 51 approved resident positions 30 filled positions Average Program Cycle Length = 3.48 14 programs with continuing accreditation 9 programs with initial accreditation No programs with an adverse action

  16. Duty Hours Changes and Neuromuscular Medicine • Modest direct effect on fellows • Appear rested and fit for duty • Report internal and external moonlighting • Circumstances requiring communication with faculty by trainees • 80 hours per week-unchanged • 24 hours/shift for R2s-R4s • More night float in core programs-impact on teaching? • Increased role for web-based learning?

  17. Trainee Supervision Requirements VI.D.3. Levels of Supervision. The program must use the following classification of supervision: .a) Direct Supervision – The supervising physician is physically present with the resident and patient. .b) Indirect Supervision: (1) with direct supervision immediately available – The supervising physician is physically within the confines of the site of patient care, and is immediately available to provide Direct Supervision.

  18. Trainee Supervision Requirements (2) with direct supervision available – The supervising physician is not physically present within the confines of the site of patient care, but is immediately available via phone, + is available to provide Direct Supervision VI.D.3.c) Oversight – The supervising physician is available to provide review of procedures or encounters with feedback provided after care is delivered. VI.D.4. The privilege of progressive responsibility and a supervisory role must be assigned by the program director and faculty members.

  19. Accreditatioon Prep: Site Visit and PIF Review your last Internal Review. Pay special attention to Prior Citations. Emphasize your strengths. Hear the problems before the visit.

  20. Accreditation Prep: The Site Visit The role of the site visitor (SV) is to verify and clarify the contents of the PIF. The SV meets with trainees and faculty and prepares a lengthy report for the RRC. SV does not take part in RRC discussions. The SV cannot tell you how you did. Discuss the site visit and the last resident/fellow survey questions with faculty and trainees before the site visit

  21. Accreditation Prep: Program Citations in the Notification Letter The goal is continued accreditation and maximum cycle length, not fewest citations Do not respond to the NRC unless asked When responding to citations use facts and neutral language, not emotions (examples) Address the citations shortly after receiving the notification letter

  22. Neuromuscular Medicine • Program requirements will be revised in 10-11; your feedback during comment period matters • Support for program directors/coordinators? • Participation in education meetings? • Flexibility for research training and time; spread over 2 years? • 12 months funding from Medicare for clin training • 12 months funding from another source for research

  23. ACGME Staff Contact List Executive Director Incoming Executive Director Louise King, MS 312-755-5498lking@acgme.org Associate Executive Director Susan Mansker 312-755-5028 smansker@acgme.org Neurology ADS Representative Timothy Goldberg 312-755-7111 tgoldberg@acgme.org

  24. For Core Adult Neurology Programs in AY 09/10, there are…. 126 accredited programs Specialty Length = 3 years (77) or 4 years (49) 2108 approved resident positions 1914 filled positions Average Program Cycle Length = 4.08 120 programs with continuing accreditation 1 program with accreditation with warning 4 programs with initial accreditation 1 program with probation

  25. For Clinical Neurophysiology Programs in AY 09/10, there were…. 91 accredited programs Specialty Length = 1 year 292 approved resident positions 230 filled positions Average Program Cycle Length = 4.09 84 programs with continuing accreditation 7 programs with initial accreditation

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