nas lisa

Next Accreditation Next Accreditation System For System For

Program CoordinatorsProgram Coordinators

Lisa Thornton, Program CoordinatorLisa Thornton, Program CoordinatorAmy Oxentenko, M.D., Program DirectorAmy Oxentenko, M.D., Program Director

Division of Gastroenterology and HepatologyDivision of Gastroenterology and Hepatology

Mayo Clinic, Rochester, MNMayo Clinic, Rochester, MN

DisclosuresDisclosures

No Relevant No Relevant

Financial RelationshipsFinancial Relationships

Learning ObjectivesLearning ObjectivesParticipants will be able to:Participants will be able to:

• Gain an understanding of the ACGME’s Next Gain an understanding of the ACGME’s Next Accreditation System (NAS) from a Program Accreditation System (NAS) from a Program Coordinator’s (PC) perspective Coordinator’s (PC) perspective

• Begin planning for future requirements Begin planning for future requirements

• Discuss Program Coordinator concernsDiscuss Program Coordinator concerns

Program Coordinator’s Program Coordinator’s PerceptionPerception

Program Coordinator’s Program Coordinator’s PerceptionPerception

What is NAS?What is NAS?

• Named after Dr. Thomas “NAS”ca?Named after Dr. Thomas “NAS”ca?

• No…..No…..

• NAS = Next Accreditation SystemNAS = Next Accreditation System

What is NAS?What is NAS?

• ACGME “Big Picture”ACGME “Big Picture”– Less prescriptive program requirements Less prescriptive program requirements

that promote curricular innovationthat promote curricular innovation– Continuous accreditation modelContinuous accreditation model–Monitoring of programs based on Monitoring of programs based on

performance indicatorsperformance indicators– Continuously holding sponsoring Continuously holding sponsoring

institutions responsible for oversight of institutions responsible for oversight of educational and clinical systems – via educational and clinical systems – via CLERCLER

What is NAS?What is NAS?

Time LineTime Line

• ACGME StatementACGME Statement“In July 2013, the NAS will be “In July 2013, the NAS will be implemented by 7 out of the 26 implemented by 7 out of the 26 ACGME-accredited core ACGME-accredited core specialties. In the remaining specialties. In the remaining specialties and the transitional specialties and the transitional year, the NAS will be year, the NAS will be implemented in July 2014.”implemented in July 2014.”

Next Accreditation SystemNext Accreditation SystemWhat to Expect?What to Expect?

• Annual Data CollectionAnnual Data Collection– ADS, ADS, educational milestoneseducational milestones, resident and , resident and

faculty surveys, operative and case-faculty surveys, operative and case- log log datadata

• A site visit every 10 years, unless concerns of A site visit every 10 years, unless concerns of non-compliance arisenon-compliance arise– ACGME expects that there will be 12 to 15 months ACGME expects that there will be 12 to 15 months

advance notice of a self-study as well as 120-day advance notice of a self-study as well as 120-day advanced notice with the specific date of self-advanced notice with the specific date of self-studystudy

Next Accreditation SystemNext Accreditation System

Educational Milestones: Educational Milestones:

•Developmentally-based, specialty-specific Developmentally-based, specialty-specific achievements that fellows are expected to achievements that fellows are expected to demonstrate at progressive intervals as they demonstrate at progressive intervals as they advance through training advance through training

•Data will be submitted on fellows every 6 Data will be submitted on fellows every 6 months, synchronized with fellows’ semiannual months, synchronized with fellows’ semiannual evaluationsevaluations

Next Accreditation SystemNext Accreditation SystemEducational Milestones: Educational Milestones:

•~20-30 descriptions of competency which are ~20-30 descriptions of competency which are specialty-specificspecialty-specific– Have not been established for GI at this time Have not been established for GI at this time

(development to begin in July 2013)(development to begin in July 2013)

•But we can start to prepare nowBut we can start to prepare now– Educate faculty and fellows of new terms/time Educate faculty and fellows of new terms/time

lines at Divisional meetingslines at Divisional meetings– Form a Form a Clinical Competency Committee Clinical Competency Committee (June 2013)(June 2013)

Next Accreditation SystemNext Accreditation SystemEducational Milestones: Educational Milestones:

•BenefitsBenefits– Shared understanding of expectationsShared understanding of expectations

– Set goals of competenceSet goals of competence

– Allows trainees to progress at various rates Allows trainees to progress at various rates (advanced vs remediation)(advanced vs remediation)

– Provide a framework and language for Provide a framework and language for discussions across the fielddiscussions across the field

– Track the educational outcomes of the programTrack the educational outcomes of the program

Clinical Competency CommitteeClinical Competency CommitteeWho should be members on this committee? Who should be members on this committee?

It varies….It varies….•Core and non-core faculty members who Core and non-core faculty members who observe and have direct observation of observe and have direct observation of traineestrainees

•Representation of core subspecialtiesRepresentation of core subspecialties

•Include assessment specialists and/or Include assessment specialists and/or non MD medical educatorsnon MD medical educators

Clinical Competency CommitteeClinical Competency Committee

Who should be members on this committee? Who should be members on this committee? It varies….It varies….

•Chair may be PD, APD, Dept/Division chair, Chair may be PD, APD, Dept/Division chair, other faculty memberother faculty member

•A group of faculty members A group of faculty members trainedtrained in in looking at milestones using narratives or looking at milestones using narratives or Entrustable Professional Activities (EPA’s)Entrustable Professional Activities (EPA’s)

Clinical Competency CommitteeClinical Competency CommitteeWhat is the role of this committee?What is the role of this committee?

It varies….It varies….•Decides on composition, procedure, data Decides on composition, procedure, data elements elements

•Meets every 6 months to review assessments Meets every 6 months to review assessments in trainee portfolio in trainee portfolio

•Determines milestone levels or progress of Determines milestone levels or progress of each traineeeach trainee

Clinical Competency CommitteeClinical Competency Committee

Benefits/Opportunities: Benefits/Opportunities: •Group versus single decision makerGroup versus single decision maker•Especially helpful to have group decision Especially helpful to have group decision when issues of remediation raisedwhen issues of remediation raised•Narrative comments versus numbers on Narrative comments versus numbers on evaluations with no feedback; more likely to evaluations with no feedback; more likely to uncover deficienciesuncover deficiencies•Offers the trainee the insight and perspective Offers the trainee the insight and perspective of a group of faculty membersof a group of faculty members

Clinical Competency CommitteeClinical Competency Committee

Benefits/Opportunities: Benefits/Opportunities: •Improve quality of faculty observation and Improve quality of faculty observation and documentation; faculty development is documentation; faculty development is essentialessential•Same set of eyes looking at all data and same Same set of eyes looking at all data and same process is appliedprocess is applied•Committee serves as an early warning system Committee serves as an early warning system if a trainee fails to progress in the educational if a trainee fails to progress in the educational programprogram

Clinical Competency CommitteeClinical Competency Committee

Benefits/Opportunities: Benefits/Opportunities: •Multiple tools are available for assessing Multiple tools are available for assessing trainee competencytrainee competency– End of rotation and in-training examsEnd of rotation and in-training exams

– Multi-source evals (faculty, nurses, other allied Multi-source evals (faculty, nurses, other allied staff, patients, peers)staff, patients, peers)

– Procedure documentation (numbers and skill)Procedure documentation (numbers and skill)

– Direct ObservationDirect Observation

Example: IM ResidencyExample: IM Residency

• Monthly meetingsMonthly meetings• Chaired by Associate Program DirectorChaired by Associate Program Director• Annual evaluation of each resident (~168)Annual evaluation of each resident (~168)

- More frequent if concerns raised- More frequent if concerns raised• Handles, remediation, academic warnings, Handles, remediation, academic warnings,

probation, dismissal, annual awardsprobation, dismissal, annual awards

Example: PediatricsExample: Pediatrics

• Quarterly meetingsQuarterly meetings• Chaired by Associate Program DirectorChaired by Associate Program Director

- PD and resident advisors attend- PD and resident advisors attend• Reports to Education CommitteeReports to Education Committee• Determines promotion to next PGY level and Determines promotion to next PGY level and

program completionprogram completion

Clinical Competency CommitteeClinical Competency Committee

ChallengesChallenges: :

•Time constraints of PC and facultyTime constraints of PC and faculty– Expect 1 hour of review per trainee per periodExpect 1 hour of review per trainee per period

•More paperwork to track milestones More paperwork to track milestones •More time needed to:More time needed to:– Arrange meetingsArrange meetings

– Prepare for meetingsPrepare for meetings

– Document group recommendationsDocument group recommendations– Implement changesImplement changes

One Tool For Evaluating One Tool For Evaluating Fellow CompetencyFellow Competency

Direct Observation Direct Observation

of Traineesof Trainees

ACGME Requirement:ACGME Requirement: Direct Observation Direct Observation

• The program must assess the fellow in The program must assess the fellow in data gathering, clinical reasoning, data gathering, clinical reasoning, patient management and procedures in patient management and procedures in both the inpatient and outpatient both the inpatient and outpatient setting. setting.

• This assessment must involve This assessment must involve direct direct observation of fellow-patient observation of fellow-patient encountersencounters..

• Needs to occur Needs to occur inpatientinpatient, , outpatientoutpatient and and during during endoscopyendoscopy– Endoscopy/Inpatient largely happeningEndoscopy/Inpatient largely happening

• Outpatient options:Outpatient options:• Go in room with fellowGo in room with fellow• Use 1-way mirror via an adjacent roomUse 1-way mirror via an adjacent room• Use camera systemUse camera system

• Need to use an assessment tool Need to use an assessment tool • Number of assessments needed not clearNumber of assessments needed not clear– Proposed ≥ 10 by 5 staff q 6 months*Proposed ≥ 10 by 5 staff q 6 months*

Direct Observation by KCFDirect Observation by KCF

Our Mayo Camera System Our Mayo Camera System for Direct Observationfor Direct Observation

• Currently 3 camera systems installedCurrently 3 camera systems installed

– 1 Mayo E 91 Mayo E 9 (IBD, general GI, educ clinic) (IBD, general GI, educ clinic)

– 2 Gonda 92 Gonda 9 (continuity clinics) (continuity clinics)

Assignment of ObservationAssignment of Observation

• Align with continuity clinic scheduleAlign with continuity clinic schedule– 1 camera per 1 staff for 1 fellow 1 camera per 1 staff for 1 fellow

observation on any half dayobservation on any half day

• Always 1st patient of the CC dayAlways 1st patient of the CC day– Longer patient visitLonger patient visit– Allows system to not wait for staffAllows system to not wait for staff

• Secretaries and appt office will avoid Secretaries and appt office will avoid staff meetings/patients during sessionstaff meetings/patients during session

Fellows Identified By HighlightsFellows Identified By Highlights

How You Will Know on OutlookHow You Will Know on Outlook

Order of EventsOrder of Events

• Desk rooms patient; turns on Desk rooms patient; turns on camera switch after patient camera switch after patient reads instructions/agreesreads instructions/agrees

• Desk will page both fellow Desk will page both fellow and staff that observation and staff that observation patient ready; room number patient ready; room number displayed for eachdisplayed for each

• Staff to log on to system to Staff to log on to system to observeobserve

Patient InformationPatient Information

Logging Onto SystemLogging Onto System

• Log onto office sessionLog onto office session• Click desktop icon Click desktop icon – GI Fellow GI Fellow GoGo 9-452 9-452– GI Fellow GI Fellow MaMa 9/35E 9/35E

Logging Onto SystemLogging Onto System

• Log onto office sessionLog onto office session• Click desktop icon Click desktop icon – GI Fellow GI Fellow GoGo 9-452 9-452– GI Fellow GI Fellow MaMa 9/35E 9/35E

• Close any pop up Close any pop up blockers that ariseblockers that arise

Logging Onto SystemLogging Onto System

• Log onto office sessionLog onto office session• Click desktop icon Click desktop icon – GI Fellow GI Fellow GoGo 9-452 9-452– GI Fellow GI Fellow MaMa 9/35E 9/35E

• Close any pop up Close any pop up blockers that ariseblockers that arise

• Log into systemLog into system– Username and password Username and password

CEX EvaluationCEX Evaluation

CEX EvaluationCEX Evaluation

In a staff’s evaluation box by the day of observationIn a staff’s evaluation box by the day of observation

ABIM ABIM Direct Observation ToolDirect Observation Tool

What is in it for Faculty?What is in it for Faculty?• Can get practice improvement points Can get practice improvement points

for ABIM MOCfor ABIM MOC

CostCost

Program CoordinatorProgram CoordinatorConcerns/ChallengesConcerns/Challenges

Open for questions and concerns you all have!Open for questions and concerns you all have!

Program CoordinatorProgram CoordinatorConcerns/ChallengesConcerns/Challenges

ChallengesChallenges: :

•Time constraints of PC and facultyTime constraints of PC and faculty– Expect 1 hour of review per trainee per periodExpect 1 hour of review per trainee per period

•More paperwork to track milestones More paperwork to track milestones •More time needed to:More time needed to:

– Arrange meetingsArrange meetings

– Prepare for meetingsPrepare for meetings

– Document group recommendationsDocument group recommendations– Implement changesImplement changes

SummarySummary

• Reviewed a few of the NAS requirementsReviewed a few of the NAS requirements

• Reviewed examples of how to get startedReviewed examples of how to get started

• Discussed Program Coordinator concernsDiscussed Program Coordinator concerns

Thank you!Thank you!

thornton.lisa@mayo.eduthornton.lisa@mayo.edu