Successfully Preparing for an ACMGE Site Visit: A Program Coordinator’s Approach

1. Successfully Preparing for an ACMGE Site Visit:A Program Coordinator’s Approach Tabitha Fineberg Education Coordinator tfineberg@tuftsmedicalcenter.org (617) 636-5846

2. 7 Steps to Success • Notifying & Communicating Information • Preparation • Gathering Necessary Documentation • The Final Countdown • The Visit • Proactive Preparation • Hot Topics Based on the Survey

3. Notifying & Communicating Information • Start immediately and don’t delay • Remind everyone that this visit involves the entire division, not just fellows • Designate time for yourself; this cannot be rushed and requires significant attention to detail • Discuss strategy with the Internal Medicine Coordinators • Meet with your Program Director (PD) early • PD and coordinator meet with fellows as a group to the explain process • Designate one or two fellows to be champions (chief fellows) • Decide who your key faculty will be • Defined as key people who are involved in the training program • e.g. not a two week covering physician • Find out what has changed since your last ACGME site visit • i.e. attending physician numbers, etc • How prior citations were addressed

4. Notifying & Communicating Information(cont.) • Block off Schedules: • Your Schedule • Program Director’s • The Chief’s • A Conference Room • 2 Key Faculty (well-spoken, well-respected, well-versed) • Notify Your Fellows • Sit down with your Program Director to discuss: • Status of your paperwork • What paperwork needs to be updated • What ACGME requirements might you be at risk for non-compliance • What needs to be done in order to become compliant • Ask any questions you may have about the “To Do List” (See Appendix A)

5. Consider sending out weekly emails to all: “ACGME updates”

6. Preparation: The Hardest Part! • Review ACGME annual survey • This is a key document that the ACGME will review during the site visit and many questions will be drawn from this survey • Mock survey your fellows: • Ask them what they think is wrong with the program • Ask them if there is anything you can fix (often there is an easy remedy) • e.g. getting more computers and printers • These are things the site visitor will bring up and it makes a world of difference to be proactive • Email your key faculty in order to: • Obtain concise summaries of their roles in the program • Request the most current CV available • Preferably in word document format; never in NIH-biosketch form

7. Preparation: The Hardest Part! (cont.) • Email fellows requesting their current CV’s • Print ABIM certificates for all fellows and / or letter from their prior internal medicine PD stating that they have successfully completed residency • Print out ABIM certificates for all key faculty members • If someone is not certified, find out the reason • All of this data will have to be entered into the ADS section of the ACGME website and required for documentation • All information collected should be entered into the ADS section of the ACGME website and your PD can then complete the remaining portions of the PIF

8. Create a binder with tabs for each required category (See Appendix A) Everything electronic should be printed Educational goals Competency based goals and objectives Etc. The ABIM printouts will need to be added to your binder It is acceptable to have separate binders for evaluations, conference attendance, etc. Gathering Necessary Paperwork

9. Gathering Necessary Paperwork (cont.) • Don’t forget the necessary hospital policies • Be very familiar with the COCATS III and ACGME requirements for fellowship training • Documentation of procedure logs / complications, in-service exam results, conference attendance, evaluation of research and presentations • For duty hours you will only need to print out: • The exception report • Any communications on why the exceptions occurred • What steps you took to fix the exception

10. The Final Countdown • Review your PIF several times over, specifically looking for: • Spelling errors and typos • Incorrect years and wrong starting years for fellows • Once you have a final draft make 4 copies: • 1 for your records • 1 to mail the auditor • 2 for the auditor on the day of the site visit • Get all of the necessary signatures and mail out the PIF 3 weeks before the due date, making sure to include the itinerary • The Program Director / Chief of Cardiology should review the basics of the site review with staff and fellows during monthly meetings, grand rounds, conferences, etc.

11. The Final Countdown • Have your fellows, as a group, compose a topic list and email it to the auditor two to four weeks prior to the visit • Typically, this should include mostly good features of the program with perhaps one or two minor issues that won’t make the program look bad • Double check all of your binders for the necessary paperwork and that the correct items are on each document • Email everyone to remind them when/where the visit will be taking place • Consider getting an outside facilitator / consultant to perform a mock interview with fellows and to review the PIF

12. The Visit • The night before you should try to have all of your binders in an easily accessible location and ready to go • Arrive by 7:30am to set up the conference room and make sure you know where everything is located • Do not serve food or drink – it’s not needed and may be distracting • Make sure fellows / key faculty arrive on time (beepers off / no distractions) • Pick a conference room that is quiet and private • Confirm that the auditor has all necessary components to perform the site visit • You don’t want to get penalized for not having something you really do have • He/She will be looking for faults: It’s their job, don’t get defensive! Just state the facts.

13. Proactive Preparation • Make sure you can track fellows / attendings back at least 5 years: • Can you reach them? • Did they graduate from an ACGME internal medicine residency? • Are they ABIM certified in Cardiology? • If not, why? • For current fellows, be sure to know where they went to medical school and graduation dates • For graduating fellows make sure they leave you: • Final procedure log • Exit survey • Updated CV • Contact information including a cell phone or email address

14. Hot Topics Based on the Tufts Survey • EMR! It’s very important and the ACGME would like to see it implemented in all hospitals so if you don’t have it, do your homework: • What is your timeline? • Is there a plan in place? • How will you adapt? • Performance improvement: • How are the fellows involved? • What types of improvement plans are set up for them? (Data entry doesn’t count) • Looking for ways to improve daily care • Evaluations • How are they done, frequency, format? • Is there peer evaluation, 360, self evaluation? • Is it Competency-based? • Professionalism: • Do you teach it and how? • Do you practice it? • Are your fellows and attendings professional? • Confidentiality: • for programs with only 1-2 fellows how do you maintain confidentiality during surveys and evaluations

15. Policy for supervision of fellows (addresses fellows’ responsibilities for patient care and progressive responsibility for patient management and faculty responsibilities for supervision) Program policies and procedures for fellows’ duty hours and work environment Moonlighting policy Overall educational goals for the program A sample of competency-based goals and objectives for one assignment at each educational level All Program Letters of Agreement A blank copy of the forms that is used to evaluate fellows at the completion of each assignment Copies of tools the program uses to provide objective assessments of competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice A blank copy of the form that documents the semiannual evaluation of the fellows with feedback Site Visitor Document Checklist (Appendix A)

16. A blank copy of the form that fellows use to evaluate the faculty A blank copy of the form that fellows use to evaluate the program A blank copy of the form that faculty use to evaluate the program. A blank copy of the form that multiple evaluators (faculty, peers, patients, self, and other professional staff) use to evaluate fellows. A blank copy of the final (summative) evaluation of fellows, documenting performance during the final period of education and verifying that the fellow has demonstrated sufficient competence to enter practice without direct supervision For each site, a description of the lines of responsibility among fellows at various stages in training, and attending physicians, on each type of teaching service. Documentation of a program evaluation and written improvement plan. Documentation of fellow duty hours Documentation (one-page, print screen from ABIM website) of Program Director, Associate Program Director (if applicable) and Key Clinical Faculty (minimum required) current ABIM-certification. Site Visitor Document Checklist (Appendix A cont)

17. S.O.P. for Evaluations • Fellow evaluations will be performed by designated attendings at the completion of each 4-week rotation during the first two years of fellowship. • Fellows will evaluate attendings at the completion of each 4-week rotation during the first two years of fellowship. • Fellows will be evaluated quarterly during their third year by the attending in their subspecialty. • Fellows will evaluate attendings quarterly during their third year. • Fellow will be evaluated semi-annually by their ambulatory attending. • Fellows will undergo 360 evaluations semi-annually by non-physician staff familiar with them, including managers, nurses and support staff. • Fellows will obtain written feedback from patients. • Fellows will have a focused observational evaluation annually, which will include an attending observation of a patient encounter or procedure.

18. S.O.P. for Evaluations (cont.) • Fellows will meet semi-annually with the Program Director, Chief or Associate Chief of Cardiology to review the program and their evaluations. Fellows will also be asked to give self-evaluations and will be given an anonymous evaluation form of the program to fill out. In addition, fellows will participate in peer review and attending review during this meeting. • Fellows will meet in a group setting with the Program Director / Chief of Cardiology to discuss topics related to fellowship training. • Fellows will be assessed for ‘competency’ in each domain within fellowship training. • Duty hours will be tracked for fellows. • Fellowship issues will be discussed monthly at attending staff meetings (séance). • Attendings will formally evaluate the program annually. • Graduates of the training program will be asked to review their fellowship training.

19. Initial application & yearly renewal with demographic changes Current and past contracts to your institution Current state license card and application Current CV DEA license Malpractice Facesheet NPI number ACLS card Employee Health clearance forms Procedure log Verification of completion of residency (either diploma, ABIM printout, or final evaluation from residency program) Other necessary paperwork e.g. visa applications, mandatory hospital training, etc Confidential area for notes regarding praises, reprimands, etc Interview documents and letters of letters of recommendation Fellows Folders Each fellow should have a folder containing;

20. New Innovations New Innovations is a great tool to help you monitor the day to day training of your fellows. It can monitor;Most site visit auditors know how to use this program and once you log them in can and will actually look up everything that they need. • Duty hours • Conference Attendance • Evaluations • Demographics • Procedure logs • Curriculum • Schedules

21. Competency-based Everything needs to be competency-based – including curriculum; this is extremely important for site reviews The ACGME has established six general competencies for residency / fellow education. These competencies are the guiding principles for all graduate medical education (and lifelong learning). They include: Medical Knowledge:learn about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care. Patient Care:provide compassionate, appropriate, and effective patient care for the treatment of health problems and the promotion of health. Practice Based Learning and Improvement:investigate and evaluate patient care practices, appraise and assimilate scientific evidence, and improve patient care practices. Systems Based Practice:demonstrate an awareness of and responsiveness to the larger context and system of health care and effectively call on system resources to provide care that is of optimal value. Professionalism:show a commitment to carrying out professional responsibilities, adherence to ethical  principles, and sensitivity to a diverse patient population. Interpersonal and Communication Skills:demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, families, and professional associates.

22. Any Questions?

23. Thank you for your time, please feel free to contact me if you have any questions. Tabitha Fineberg Education Coordinator tfineberg@tuftsmedicalcenter.org (617) 636-5846