Subspecialty Update from the Residency Review Committee RRC

1. Subspecialty Update from the Residency Review Committee (RRC) Jerry Vasilias, PhD, Executive Director Caroline Fischer, Associate Executive Director

2. Setting the Stage Overviews to ACGME and RRC Citations What�s Available on Website New Changes Requirements Updates PIFs Updates Staff Contact Information

3. ACGME Five member organizations/four board members from each: AAMC, ABMS, AHA, AMA, CMSS Independent accrediting organization Governed by statutes of incorporation Approves program requirements Accredit GME/residency programs 28 review committees 26 RRCs TYRC IRC

4. RRC Composition 3 appointing organizations - AAP, ABP, AMA 10 voting members 3 from each appointing org + 1 resident member Committee approved to increase by three members Members serve a term of 6 years -- except resident Generalists and subspecialists Critical Care Medicine, Hematology/Oncology, Pediatric Emergency Medicine, Gastroenterology, Neurology, Nephrology, Rheumatology Geographic Distribution � CA, CT, DC, GA, MI, MD, OH, PA, WA Ex-officio members from each appointing organization (non-voting)

5. RRC Review of Programs Peer Review Reviewers use the following when they review a program to determine whether it is in compliance with the requirements: Program Information Forms (PIF) prepared by the program The site visitor�s report Program Directors: this is an open book test The questions in the PIF correspond to program requirements Reviewers present program to Committee Committee assigns accreditation status along with review cycle

6. Review Cycle of Subs Historically: Review cycle of sub was aligned with core. If core has a three year cycle, the sub (s) will have a three cycle. - The cycle of the sub did not exceed that of the core Now: ACGME has allowed RRC to un-couple subs� cycle from that of the core. Subs are still considered dependent on the core, but the cycle of the sub can exceed that of the core. New subspecialty applications: No site visit Maximum of a three year cycle

7. Citations Citation = the program has not documented/provided evidence of compliance with the requirements, or an area identified by the site visitor as non-compliant Three Broad Categories of Citations = Don�t Have Don�t Do Didn�t Bother

8. Citations: Don�t Have/Don�t Do/Didn�t Bother Don�t Have Resources -- Patients (# & types); Required faculty; Required educational experience; Facilities/equipment; Time/Support; Other program personnel Don�t Do Research/Scholarly activity; Formally structured curriculum; Development of goals and objectives; Evaluations (fellow, faculty, program); Supervision; Monitor/track fellows procedures; Comply with duty hours. Didn�t Bother Doing Proof/edit PIF; Incomplete or contained inconsistent information; Unclear from PIF that there is compliance with the requirements; Did not fully describe/provide sufficient details.

9. Most Frequent Citations Insufficient patient #/types of patients Lack of required experience/procedures No evidence of productivity in research/scholarly activity Faculty do not demonstrate commitment to� Residents: research must begin in year 1 and continue; protected time; evidence Inappropriate Goals and Objectives rotation and level specific Lack of formal evaluation mechanisms Fellow = written evaluation formally reviewed semi-annually; final written evaluation verifying ability to practice competently and independently Faculty = annual; participation by residents/fellows needs to be confidential; formal feedback provided to faculty Program = regular, documented meeting to review G & O�s�effectiveness in achieving them; written evaluation by residents are used; annual meeting with at least one fellow representative

10. www.acgme.org www.acgme.org Staff contact information ACGME Policies & Procedures Competencies/Outcomes Project List of accredited programs ADS Duty hours Information/FAQ Affiliation Agreements FAQ General information on site visit process and your site visitor Pediatrics Webpage Resident complement increase Application timeline Frequent citations Program Requirements PIFs Archive of RRC Updates/Email Communications

11. New Changes E-mail status of programs on RRC agenda Within two weeks of an RRC meeting programs on the agenda will receive an email notification with the accreditation status and review cycle. Programs that received an adverse action/proposed adverse action will not get such an email E-mail to notify you that your notification letter is posted on ADS. Will no longer send notification letters via mail. You will receive email to check ADS for letter. Inactive status has been eliminated Programs that are without a resident or fellow for 4 years will be asked to voluntarily withdraw their accreditation

12. New General Subspecialty Requirements Approved February, 2006 to go into effect January 1, 2007 Competencies! Collaboration between programs - Documented semi-annual meetings b/w subs and core to address a departmental approach to common educational issues (core curriculum, competencies and evaluation practices). Mentor fellows to develop clinical, educational, admin, and research skills Greater specificity on scholarly activity for faculty and fellows Faculty: activities that are evidence of ongoing commitment to scholarly activity� Fellow: �...must conduct a scholarly project in sub area with guidance of PD and mentor.� Program: must identify a mentor and scholarship oversight committee to oversee fellow�s progress related to scholarly activities Board Score Information Deficient if over 6 yrs LT 75% eligible take, of those who take LT 75% pass it. Exceptions will made for programs with small # of fellows

13. New Administration Language All three years fellowship programs must address the following areas of administration: � 1. An awareness of regional and national access to care, resources, workforce, and financing appropriate to their specialty through guided reading and discussion. 2. Organization and management of a subspecialty service within one�s own delivery system by engaging fellows as active participants in discussions (e.g., through already scheduled division activities/meetings ) that involve: � a) staffing a service or unit, including managing personnel and making and adhering to a schedule; b) drafting policies and procedures, leading interdisciplinary meetings and conferences, providing in-service teaching sessions; c) discussions/proposals for hospital and community resources including clinical, laboratory and research space, equipment and technology necessary for the program to provide state-of-the-art care while advancing knowledge in the field; d) business planning and practice management that includes billing and coding, personnel management policies and professional liability; e) division or program development, organization, and maintenance; and f) necessary collaborations within (e.g., pathology, radiology, surgery) and beyond the institution (e.g., participation in national specialty societies, cooperative care groups, multi-center research collaboratives) as appropriate to their specialty. � This language is much more flexible than what had been vetted.

14. Updates to Subpecialty PIFs So, the new General Requirements for the Subspecialties in Pediatrics go into effect January 1, 2007. Accordingly, all of the subspecialty PIFs have been modified to reflect the changes. All subspecialty programs with site visits after January 1, 2007 will need to use the new updated subspecialty PIFs. The PIFs now have three parts. Part 1: Accreditation Data System (ADS) Section of PIF: Information that is entered in ADS as part of the annual update will need to printed and appended to PIF (e.g., information related to the PD, sponsor, participating institutions, residents, faculty roster, etc.). Part 2: Common Subspecialties Section of PIF: This section will contain common questions that pertain to all subspecialties (e.g., questions on the competencies, research, duty hours, evaluation, etc..). Part 3: Subspecialty Specific Section of PIF: This section will contain subspecialty specific questions.

15. Revised Subspecialty Requirements The followings subspecialty requirements have been approved and have a July 1, 2007 effective date: Adolescent Medicine Critical Care Medicine Pediatric Cardiology Pediatric Hematology-Oncology Neonatal-Perinatal Medicine Pediatric Rheumatology So, Part 3 of the PIF (subspecialty section) will be updated again for all of the aforementioned subspecialty PIFs to be in line with the new requirements. This will be done in spring of 2007. RRC has solicited input on the data collection section of the PIFs. Common Requirements have gone out for review and comment -- yesterday

16. Questions and Answers ?�s about the PIF that are technical Contact ACGME Help Desk: helpdesk@acgme.org or 312/755-7464 For Part I of PIF of WebADS: rsmith@acgme.org ?�s about PIF content/program requirements Call or email the RRC staff For PIF questions: dbraun@acgme.org or (312) 755-5478 For Program Requirements questions: jvasilias@acgme.org or (312) 755-7477; cfischer@acgme.org or (312) 755-5044 Look on Peds website/FAQ

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