RRC Surgery What is New

1. Surgical Education WeekMarch 19-24, 2012San Diego, CaliforniaJames C. Hebert, MD, FACSChair, Surgery RRC RRC Surgery What is New

2. Disclosures • None

3. James C. Hebert, MD, Chair John H. Armstrong, MD Paris Butler, MD, Resident Timothy R. Billiar, MD Ronald Dalman, MD Peter J. Fabri, MD Linda M. Harris, MD G. Whit Holcomb, MD Peggy Simpson, EdD – Executive Director John J. Ricotta, MD Marshall Z. Schwartz, MD Steven Stain, MD Charles W. Van Way III, MD, Vice Chair Marc K. Wallack, MD Frank Lewis, MD, Ex-Officio ABS Patrice Blair, MPH, Ex-Officio ACS RRC—Surgery Members

4. RRC Meeting Activity • 253 programs were surveyed • 164 post-site visit reviews • 89 administrative requests at meetings • 391administrative interim decisions

5. Surgery PR Changes ( 7/1/12) • New expectations for simulation learning • Removal of the distinction between “designated preliminary” (DP) and “non-designated preliminary” positions • 300% limit on Preliminary Positions • Clarification of transplant surgery experience • Flexibility for required chief year • 4 to 6 month maximum.

6. Program Requirements- Simulation II.D.2. Resources must include simulation and skills laboratories. These facilities must address acquisition and maintenance of skills with a competency – based method of evaluation

7. RRC Review- Simulation • Review Simulation G & O’s • Review Evaluation Methods and Tools • Encourage Best Practices (such as ASC-AEI) • FAQs

8. Preliminary Residents • III.B.1. Residency positions must be allocated to one of two groups: categorical or preliminary positions. • III.B.1.b) Preliminary (P) residents are accepted into the program for one or two years before continuing their education. • III.B.1.b).(1) The number of preliminary positions in the PG1 and PG2 years combined must not exceed 300% of the number of approved categorical chief resident positions.

9. Transplant Experience • IV.A.5.a).(3).(d) A formal transplant experience is required. It must include patient management and cover knowledge of the principles of immunology, immunosuppression, and the management of general surgical conditions arising in transplant patients. Clearly documented goals and objectives must be presented for this experience; • Formal rotation may be easiest

10. Chief Year Clinical Rotations • IV.A.5.a).(3).(f).(iv): Clinical assignments during the chief year must be in the essential content areas of general surgery. No more than six months of the chief year may be devoted exclusively to only one essential content area; • Aligns with current ABS requirements; (requires ABS approval)

12. Goals of The “Next Accreditation System” • To begin the realization of the promise of Outcomes • To free good programs to innovate • To assist poor programs to improve • To reduce the burden of accreditation • To provide accountability for outcomes (in tandem with ABMS) to the Public

13. Challenges/Opportunities • Culture Change and Faculty Development • Program Directors, Designated Institutional Officials • Faculty • Review Committee Members • “Retooling” of ACGME Infrastructure and Personnel • The “Community of Educators” in each specialty must come together and agree on: • core elements of the competencies • levels of performance

14. New Administrative Structure • John R. Potts, III, MDSenior Vice President, Surgical Accreditation • Louis J. Ling, MDSenior Vice President, Hospital-Based Accreditation • Mary Lieh-Lai, MDSenior Vice President, Medical Accreditation • Kevin B. Weiss, MD, MPHSenior Vice President, Institutional Accreditation

15. Surgical Accreditation • John R. Potts, III, MDSenior Vice President, Surgical Accreditation • Peggy Simpson, EdDExecutive Director, RRCs for Plastic Surgery, Surgery, Thoracic Surgery • Pamela L. Derstine, PhD, MHPEExecutive Director, RRCs for Colon and Rectal Surgery, Neurological Surgery, Orthopaedic Surgery, Otolaryngology • Patricia Levenberg, PhDExecutive Director, RRCs for Obstetrics & Gynecology, Ophthalmology, Urology

16. The “Next Accreditation System” in a Nutshell • Continuous Accreditation Model – annually updated • Based on annual data submitted, other data requested, and program trends • Scheduled Site Visits replaced by 10 year Self Study Visit • Standards revised every 10 years • Standards Organized by • Structure • Resources • Core Processes • Detailed Processes • Outcomes

17. The Conceptual ChangeFrom… The Current Accreditation System Rules Corresponding Questions “Correct or Incorrect” Answer Citation and Accreditation Decision Rules Corresponding Questions “Correct or Incorrect” Answer Citations and Accreditation Decision

18. “Continuous” Observations Assure that the Program Number of Potential Fixed the Problem Related “Rules” Problems Promote Innovation Diagnose the Problem If there is one! The Conceptual ChangeTo… The “Next Accreditation System”

19. Conceptual Model of Standards Implementation Across the Continuum of Programs in a Specialty Accreditation with Warning New Programs, Accredited Programs with Major Concerns Probationary Accreditation Initial Accreditation New Programs Maintenance of Accreditation Accredited Programs without Major Concerns Maintenance of Accreditation with Commendation 2-4% 15% 75% 6-8% STANDARDS Structure Resources Core Process Detailed Process Outcomes Structure Resources Core Process Detailed Process Outcomes Structure Core Process Resources Detailed Process Outcomes Structure Resources Core Process Detailed Process Outcomes Withhold Accreditation Withdrawal of Accreditation

20. Next Accreditation System • Seven specialties/RRC’s begin training 7/2012 • Pediatrics • Internal Medicine • Diagnostic Radiology • Emergency Medicine • Orthopedic Surgery • Neurological Surgery • Urological Surgery • Sponsor Visit Program begins 9/2012 • The “Next Accreditation System” begins 7/2013 • These seven specialties “go live” 7/2013 • The remaining specialties begin training 7/2013 • All specialties/RRC’s using the “Next Accreditation System” 7/2014 • Visits to IRC and all 7 RRC’s this Spring

21. Thank You ?????????