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Trends at the ACGME (where we are going?) Louis Ling, MD Senior VP, Hospital-based accreditation Professor of Emergency Medicine University of Minnesota. Evolution of the ACGME. Single Accreditation. CLER. NAS. ACGME-I. Milestones Project. JGME. 2010. 1890. 1900. 1910. 1920. 1930.

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1890

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  1. Trends at the ACGME(where we are going?)Louis Ling, MDSenior VP, Hospital-based accreditationProfessor of Emergency MedicineUniversity of Minnesota

  2. Evolution of the ACGME Single Accreditation CLER NAS ACGME-I Milestones Project JGME 2010 1890 1900 1910 1920 1930 1940 1950 1970 1980 2020 1960 1990 2000 Outcomes Project ACGME independent ACGME established First RRC First residency Courtesy of John Potts MD

  3. Evolution of the ACGME Single Accreditation CLER NAS ACGME-I 60 yrs Milestones Project JGME 2010 1890 1900 1910 1920 1930 1940 1950 1970 1980 2020 1960 1990 2000 Outcomes Project ACGME independent ACGME established First RRC First residency Courtesy of John Potts MD

  4. Evolution of the ACGME Single Accreditation 91 yrs CLER NAS ACGME-I Milestones Project 2010 1890 1900 1910 1920 1930 1940 1950 1970 1980 2020 1960 1990 2000 JGME Outcomes Project ACGME independent ACGME established First RRC First residency Courtesy of John Potts MD

  5. Evolution of the ACGME 15 yrs Single Accreditation CLER NAS ACGME-I Milestones JGME 2010 1890 1900 1910 1920 1930 1940 1950 1970 1980 2020 1960 1990 2000 Outcomes Project 2003 Duty Hours ACGME independent ACGME established First RRC 2011 Duty Hours First residency 2015 Duty Hours studies in Medicine and Surgery Courtesy of John Potts MD

  6. Megatrends at the ACGME • Change in attitude at the ACGME • Limitation of rules • Need to improve and innovate faster • Need to train physicians for future practice • Partners with programs, institutions and others

  7. Megatrends at the ACGME • Professional expectations to Public expectations • Expert-based to Evidence-based • Process to Outcomes based • Rules based to QI based • ACGME control to Local control • Focus on Accreditation to GME Improvement • Periodic review to Annual review • Paper (PIF) to Computer (ADS) • ACGME focus to Collaborative focus

  8. Trends at the ACGME 1. Professional expectations to Public expectations • Patient safety and competency concerns • Duty hours and IOM reports • Public members added • Congress and GME funding • ACGME Resource accountability

  9. Trends at the ACGME 2. Expert-based to Evidence-based • JGME • Milestones 2.0 • Duty Hours: FIRST and iCOMPARE • Future program requirement changes

  10. Trends at the ACGME 3. Process based to Outcomes based • Outcomes project • Core Competencies • Milestones • NAS screening • Focus from individual citations to overall accreditation status

  11. Trends at the ACGME 4. Rule-based model to QI model: Minimum compliance (just getting by) to encourage excellence (to be the best) • Internal reviews • CLER Pathways to Excellence • Annual Program Review • 10 Year Self-studies/Program Aims

  12. Trends at the ACGME 5. ACGME Control to Local Control • Internal reviews and GMECs • Annual Program Evaluations and PECs • Linking core programs and fellowships • Areas for Improvement (AFIs) • Recognition of programs and institutions • Best practices

  13. Trends at the ACGME 6. Accreditation moving to Improving GME • Feedback at the site visit • More Education • Annual Education Conference larger • New Assessment workshops • Coordinator and chief resident training • Distance learning • Wellness and Learning Environment

  14. Trends at the ACGME 7. Periodic 4.5 year avg to Annual Review • Annual review of data • Annual review to resolve citations • Annual review of surveys • Annual review of case logs • Shift from citations to accreditation

  15. Trends at the ACGME 8. Paper (PIF) to Electronic (ADS) • Overall GME Summary reports • Analysis (and research) is possible • Trends are measurable • More uniformity between specialties • Expect initial bugs and transition woes

  16. Trends at the ACGME 9. ACGME focus to Collaborative focus • Comment period before requirement changes • Milestones process • Wellness efforts • Duty Hours Reassessment • Research efforts

  17. Trends at the ACGME Impact on RCs • Embrace and track outcomes • Let go of reliance on process every year • Not checking on all requirements for CA • More use of annual data and trends • Review of only high risk programs

  18. Trends at the ACGME Impact on programs • Greater importance of annual data • Less oversight of good programs • Earlier detection of programs at risk • Need faster response to citations • AFIs may or may not need attention

  19. Trends at the ACGME Impact on programs • More self-assessment and improvement • More focus on what you do best • More focus on your outcomes • Graduation based on competency

  20. Trends at the ACGME Impact on institutions • Importance of annual program data • More responsible for programs • Know program needs before the ACGME • CLER as a mirror, not as a hammer • Develop a wellness culture (supportive environment for all)

  21. Trends at the ACGME Impact on institutions • Help programs self-assess and improve • Shift focus: compliance to education

  22. Megatrends at the ACGME • Professional expectations to Public expectations • Expert-based to Evidence-based • Process to Outcomes based • Rules based to QI based • ACGME control to Local control • Focus on Accreditation to GME Improvement • Periodic review to Annual review • Paper (PIF) to Computer (ADS) • ACGME focus to Collaborative focus

  23. Program Coordinator Advisory Group • To advise ACGME administration concerning coordinator, GME, learning environment and accreditation matters • One source of insight in improving communications, ACGME process and interactions with the GME community • Responsible to the ACGME • Overall goal is to further ACGME mission

  24. Program Coordinator Advisory Group • Represent coordinators as a whole • Not representative of any specific organization, institution or specialty • Diverse group by location, size of program, specialty

  25. Program Coordinator Advisory Group • September 8-9, 2016 topics • Improving the Next Accreditation System • Input on Sponsoring institution 2025 • Improving communications • Understanding the Coordinator role

  26. Understanding the Coordinator role • Joys • Always learning • Variety • Purpose • Relationships • Career, not just a job

  27. Understanding the Coordinator role • Frustrations • Lost connections with residents • Relationship with PD • Non-responsive faculty • Overwork and overwhelmed • Lack of respect • Lack of communication • Lack of recognition and thanks

  28. Understanding the Coordinator role • Advice • Reminders of seasonal tasks • Tutorials and professional developmen • Accessible training • Learning from others and mentoring • Redundant data entry • GME finance

  29. Program Coordinator Advisory Group • Ongoing conversation • Input considered with other stakeholders

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