The Next Accreditation System

1. The Next Accreditation System

2. 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

3. 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

4. The Next Accreditation System: Background and Rationale Macy Foundation MedPAC COGME Robert Wood Johnson Foundation

5. How is Burden Reduced? • 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

6. 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)

7. The Current Accreditation System The Conceptual Change from…“Do this or else...” Rules Corresponding Questions “Correct or Incorrect” Answers Citations and Accreditation Decision

8. What is Different?

9. The Next Accreditation System Continuous Observations Promote Innovation Assess Program Improvement(s) Identify Opportunities for Improvement Program Makes Improvement(s)

10. Terminology Core Requirements: Statements that define structure, resource, or process elements essential to every graduate medical educational program.

11. 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.

12. 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.

13. Terminology • Each requirement labeled: • Core – All programs must adhere • Outcome – All programs must adhere • Detail – Programs with status of “Continued Accreditation” may innovate

14. Decisions on Program Standing in the NAS Application for New Program Continued Accreditation Accreditation with Warning Probationary Accreditation 10-15% 75-80% 2-4% STANDARDS Outcomes Core Process Detail Process <1% Withdrawal of Accreditation 1. NAS: No Cycle Length 2. All programs with 1-2y cycles in the old system – placed in Continued Accreditation with Warning Status 3. Percentages represent approximations based on accreditation status received by programs in the past

15. Data Collection in the Next Accreditation System

16. 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

17. Other Data (Episodic) • ACGME complaints • Verified public information • Historical accreditation decisions/citations • Institutional quality and safety metrics

18. Curriculum Vitae Except for the program director, faculty CVs will no longer be collected

19. 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

20. 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.

21. 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

22. Faculty Scholarly Activity Template in ADS

23. Faculty Scholarly Activity Enter Pub Med ID #’s

24. Faculty Scholarly Activity Enter a number

25. Faculty Scholarly Activity Enter a number

26. Faculty Scholarly Activity Enter a number

27. Faculty Scholarly Activity Enter a number

28. Faculty Scholarly Activity Answer Yes or No

29. Faculty Scholarly Activity Answer Yes or No

30. Resident Scholarly Activity Similar to Faculty Template

31. 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

32. 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

33. 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

34. What Happens after Review of my Program? • 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

35. NAS: What’s Different? • 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. Ten-Year Self-Study and Self-Study Visit • Annual Program Evaluation (PR-V.C.) • Resident performance • Faculty development • Graduate performance • Program quality • Documented improvement plan Self- Study visit Self- Study Ongoing Improvement Yr 1 Yr 0 Yr 2 Yr 7 Yr 9 Yr 10 Yr 8 Yr 6 Yr 5 Yr 3 Yr 4 AE AE AE AE AE AE AE AE AE AE AE: Annual Program Evaluation

42. 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)