ACGME Core Competencies New ACGME Duty Hours Standards

1. ACGME Site Visit Residency Program July 26 ACGMECore CompetenciesNew ACGME Duty Hours Standards Effective July 1, 2011

2. The Accreditation Council for Graduate Medical Education (ACGME) is a private, non-profit council that evaluates and accredits medical residency programs in the US. To accomplish this, the ACGME has established a set of standards for all programs, and specific standards by specialty. Accredited programs must demonstrate compliance with these standards through contribution of program data on an ongoing basis, and at the time of scheduled site visits.

3. Our department has eight accredited training programs: The Core AP/CP Residency Program Fellowship Programs: Blood Banking and Transfusion Medicine Cytopathology Dermatopathology Hematopathology Molecular Genetic Pathology Pediatric Pathology Surgical Pathology …and is currently pursuing two additional ACGME-accredited fellowships: Neuropathology Forensic Pathology

4. The ACGME Standards with which we must comply are organized as follows: • Relationships between the sponsoring institution and participating sites • Qualifications and responsibilities of the Program Director and the Faculty • Resident selection, credentialing, and quota • The Educational Program • Including the Six Core Competencies • Resident and Faculty evaluations • Program evaluation • Resident duty hours and the learning environment

5. The ACGME Six Core Competencies are: Patient Care Medical Knowledge Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based Practice

6. Patient Care = What you do Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

7. Medical Knowledge = What You Know Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social/behavioral sciences, as well as the application of this knowledge to patient care.

8. Practice-based Learning and Improvement = How You Get Better Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.

9. Interpersonal and Communication Skills = How You Interact With Others Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.

10. Professionalism = How You Act Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

11. Systems-based Practice = How You Work Within the System Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

12. Why should you know about these six core competencies if you are not a residency or fellowship program director? The newly written curriculum, including all of the rotation goals and objectives are based on them. Resident evaluation forms will ask you to comment on them. Surveys of employers of recent pathology graduates indicate that many are deficient in skills related to those competencies other than Patient Care and Medical Knowledge. An ACGME Site Visitor will expect the faculty to understand them.

13. Since 2003, the ACGME standards for residency programs have included caps on weekly duty hours and rules governing in-house call and days off. 2011 updated Duty Hours standards have added further guidelines, some regarding first year residents.

14. The following duty hours standards are significant to our residency program: Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. PGY-1 residents are not permitted to moonlight. Residents must be scheduled for a minimum of one day free of duty every week, averaged over four weeks. At-home call cannot be assigned on these free days.

15. More duty hours standards that are significant to our residency program: Duty periods of PGY-1 residents must not exceed 16 hours. PGY-1 residents cannot take call, either in-house or at-home. PGY-1 and intermediate level residents (PGY-2 for pathology) should have 10 hours and must have 8 hours between scheduled duty periods. Residents in the final years of training (3rd and 4th years) may have fewer than 8 hours free when patient care needs dictate this need, but these circumstances must be closely monitored by the program director.

16. For which of these duty hours standards does our residency program have violations? 1st year taking call? Autopsy scheduling changes 1st yr moonlighting? Change in policy 80 hour work week? 12 violations since 7/1/10 10 hr. rest between duty periods? 67 violations since 7/1/10

17. 80 hour work week? 12 violations since 7/1/10 These are happening in the services with the highest clinical volumes. 10 hr. rest between duty periods? 67 violations since 7/1/10

18. You will be seeing and considering these as part of resident education ACGMECore CompetenciesNew ACGME Duty Hours Standards More work to be done to address these