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PROGRAM DIRECTOR ’ S ROLE. “ The Next Accreditation System (NAS) ”. Brian L. Cohen, MD, FRCOG, FACOG. Associate Dean of Graduate Medical Education Professor of Obstetrics, Gynecology and Women ’ s Health. Introduction. 1999: ACGME introduced the domains of clinical competency
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PROGRAM DIRECTOR’S ROLE “The Next Accreditation System (NAS)” Brian L. Cohen, MD, FRCOG, FACOG Associate Dean of Graduate Medical Education Professor of Obstetrics, Gynecology and Women’s Health
Introduction 1999: ACGME introduced the domains of clinical competency 2009: ACGME began a multiyear process to restructure the accreditation system to be based on outcomes 2013:Phased implementation of the NAS
Aims of NAS • Enhance the peer review system to prepare physicians • Accelerate ACGME accreditation based on outcomes • Reduce the burden of the current system which is process based
Basis • Institute of Medicine Report • Public pressure • Congressional pressure • Constrained finances and possible reductions for GME
July 2013 - Phase I • NAS will be implemented by 7 of 26 core specialties • Emergency medicine • Internal medicine • Pediatrics • Diagnostic radiology • Neurosurgery • Orthopedic surgery • Urology • All other specialties and preliminary programs implementation - July 2014 • GME communities must be prepared for changes
NAS Compliance • Annual ADS consists of: • Program statistics • Program structure & resources • Scholarly activity • Teaching responsibilities Five important data collection areas:
NAS Compliance • Board Pass Rates • Improve curriculum / didactics
NAS Compliance • Clinical Experience • Case log • Case mix • Minutes from meetings of program evaluation
NAS Compliance • Resident Survey • Duty hours • Supervision & teaching • Teamwork • Education vs. service • Evaluations • Patient safety
NAS Compliance • Patient Safety • Resident participation
Additional Information • Minutes from annual meetings to be submitted annually • Residents on committees • Sample PLA & LOA policy • Policies • Supervision • Handover rounds • Work hours • Others
Milestones • Essential component of NAS are the MILESTONES • Basis is to track development in the 6 competencies • Dreyfus Model: • Novice • Advanced beginner • Competent • Proficient • Expert • Master
Milestones • RRC • Boards • P.D.’s • Residents Milestones Developed By
Milestones Develop by December 2012 Submission to ACGME 2013 & 2014 Milestones Will Supplement, Not Replace Existing Assessment Tools Timeline:
Clinical Competency Committee (C.C.C.) Core faculty Program director- professionalism Chief resident Evaluate milestones & early warning Track progress of residents Faculty development Include Function Purpose • Reduce potential bias/subjective • Performance measure • Decision making by multiple people • Evaluate 360° assessments Function
Clinical Learning Environment Review (CLER) • On resident learning of patient safety • Institution responsibility for quality and safety of the learning environment Focus is:
Clinical Learning Environment Review (CLER) Focus Comprises Six Areas: • Patient safety • QI by residents • Transition of care • Supervision • Duty hours & fatigue management • Professionalism
Evaluation by Site Visits Personnel Involved: • Site visitors • CEO of medical institution • DIO • GMEC chair • Residents • Safety officer • Senior administration
Process • Three weeks advance notice • No advance documentation • Conduct interviews • Work hour reports • Visit learning environment
Summary • NAS itself • Milestones • Clinical competency committee • CLER NAS will involve four areas (2013 & 2014): Begin the process NOW (2013 & 2014)
Handoff / Handover Process Program directors provide: • Structured & standardized protocols • Assess resident skills • Use of technology May be: • Verbal • Written • Written & verbal • Electronic Objective: • Accuracy • Patient safety
Standardized Tool Sick – degree Identifying data General hospital course New events Overall health status Upcoming plan Tasks to complete Questions