next accreditation system for program coordinators meyer3

AGA 2013 AGA 2013 GI Training DirectorsGI Training Directors

WorkshopWorkshop

Jo Meyer, Education CoordinatorJo Meyer, Education Coordinator

Amy Oxentenko, MD, Program DirectorAmy Oxentenko, MD, Program DirectorDivision of Gastroenterology and HepatologyDivision of Gastroenterology and Hepatology

Mayo Clinic, Rochester, MNMayo Clinic, Rochester, MN

Next Accreditation SystemNext Accreditation System(NAS)(NAS)

for Program Coordinatorsfor Program Coordinators

How Bad Is This Going To Hurt?How Bad Is This Going To Hurt?

Yet – To Be DeterminedYet – To Be Determined

From ACGME FAQs about NAS-December 2012From ACGME FAQs about NAS-December 2012

NAS is a Moving TargetNAS is a Moving Target

What We Will ReviewWhat We Will Review

• Overview of NASOverview of NAS(Background; Core, Detail, (Background; Core, Detail, Outcome; WebAds)Outcome; WebAds)

• CLER Program CLER Program

• Clinical Competency CommitteeClinical Competency Committee

• Direct Observation/Direct Observation/Supervision of FellowsSupervision of Fellows

What We Will ReviewWhat We Will Review

• Overview of NASOverview of NAS(Background; Core, Detail, (Background; Core, Detail, Outcome; WebAds)Outcome; WebAds)

• CLER ProgramCLER Program

• Clinical Competency CommitteeClinical Competency Committee

• Direct Observation/Direct Observation/Supervision of FellowsSupervision of Fellows

DifferencesDifferences

AccreditationAccreditation NASNAS* PIF* PIF * No PIF – Annual Data* No PIF – Annual Data

CollectionCollection

* Site Visits (5 yrs)* Site Visits (5 yrs) * Site Visits (10 yrs)* Site Visits (10 yrs)

Self StudySelf Study

* ACGME Oversight* ACGME Oversight * Local Oversight* Local Oversight

(MSGME/DIO)(MSGME/DIO)

* Internal Reviews* Internal Reviews * Verify Oversight – CLER* Verify Oversight – CLER(midway site visit)(midway site visit) (every 18 mo.)(every 18 mo.)

Other New Aspects of NASOther New Aspects of NAS• Program Requirement Re-categorizationProgram Requirement Re-categorization• Development of MilestonesDevelopment of Milestones• WebAds (Faculty Survey) WebAds (Faculty Survey) • Resident survey with new focusResident survey with new focus– Quality, safety, transitions of care, fatigueQuality, safety, transitions of care, fatigue

• CLER Program (Clinical Learning CLER Program (Clinical Learning Environment Environment Review)Review)

• Clinical Competency CommitteeClinical Competency Committee• Direct Observation/SupervisionDirect Observation/Supervision

Timeline of NASTimeline of NAS

• Phase 1 – Core Programs, (Phase 1 – Core Programs, (Internal Medicine)Internal Medicine)

Specialty Milestones CompleteSpecialty Milestones Complete• Spring 2013 – Final Site VisitSpring 2013 – Final Site Visit• July 2013 – Subspecialty Milestone July 2013 – Subspecialty Milestone

Development BeginsDevelopment Begins• January 2014 – RC Reviews Annual DataJanuary 2014 – RC Reviews Annual Data• May 2014 – Self-Study Visits BeginMay 2014 – Self-Study Visits Begin

(Cores, Subs)(Cores, Subs)

Timeline of NASTimeline of NAS

For GIFor GI

• Late Spring 2012 – Resident/Fellow SurveyLate Spring 2012 – Resident/Fellow Survey• September 2012 – WebAds UpdateSeptember 2012 – WebAds Update• Late Fall 2012 – Faculty SurveyLate Fall 2012 – Faculty Survey• Late Spring 2013 – Resident SurveyLate Spring 2013 – Resident Survey

Annual Data CollectionAnnual Data Collection• ADS UpdateADS Update

– Attrition (PD / core faculty / residents)Attrition (PD / core faculty / residents)– Program Characteristics (block diagram, sites)Program Characteristics (block diagram, sites)– Faculty Scholarly Activity (ACGME populates from Pub Med)Faculty Scholarly Activity (ACGME populates from Pub Med)

• Board Pass Rates (graduates)Board Pass Rates (graduates)• Case Logs / ExperienceCase Logs / Experience• Resident SurveyResident Survey• Faculty SurveyFaculty Survey

• Milestones Report (semi-annual, CCC report)Milestones Report (semi-annual, CCC report)– Program reports on milestonesProgram reports on milestones

– RRC reviews de-identified, aggregated resident dataRRC reviews de-identified, aggregated resident data• Progress of a resident cohort over timeProgress of a resident cohort over time• Are residents progressing?Are residents progressing?• Achieving competency for independent practice?Achieving competency for independent practice?

FAQs of NASFAQs of NAS(updated Dec. 2012)(updated Dec. 2012)

http://www.acgme-nas.org/assets/pdf/NASFAQs.pdfhttp://www.acgme-nas.org/assets/pdf/NASFAQs.pdf

Program Requirements (PR)Program Requirements (PR)

• PRs have been re-categorized “core” & PRs have been re-categorized “core” & “detailed”“detailed”

• NAS – focus is on “outcomes”NAS – focus is on “outcomes”• ““Detail” requirements will be mandatory for Detail” requirements will be mandatory for

new programs or those that have failed to new programs or those that have failed to meet expectations for outcomesmeet expectations for outcomes

• High-performing programs will be allowed the High-performing programs will be allowed the opportunity to innovateopportunity to innovate

““Core,” “Detailed,” & Core,” “Detailed,” & “Outcome”“Outcome”

Examples PR “Core”Examples PR “Core”Taken from 2012 APDIM Fall Meeting – ACGME Taken from 2012 APDIM Fall Meeting – ACGME

•PD Salary SupportPD Salary Support•Inpatient CapsInpatient Caps

•Faculty Qualifications (e.g. certification)Faculty Qualifications (e.g. certification)

Examples PR “Detail”Examples PR “Detail”

Taken from 2012 APDIM Fall Meeting – ACGME Taken from 2012 APDIM Fall Meeting – ACGME

•SimulationSimulation•Minimum 1/3 ambulatory, 1/3 inpatientMinimum 1/3 ambulatory, 1/3 inpatient

•5 year rule for PD’s5 year rule for PD’s

Examples PR “Outcome”Examples PR “Outcome”Taken from 2012 APDIM Fall Meeting – ACGME Taken from 2012 APDIM Fall Meeting – ACGME

•80% / 80% board take / board pass rule80% / 80% board take / board pass rule•PR’s related to principals of professionalismPR’s related to principals of professionalism

(Safety, recognition of fatigue, honesty of (Safety, recognition of fatigue, honesty of reporting, etc.)reporting, etc.)

•Effective handoffsEffective handoffs

MilestonesMilestones

ACGME December 2012 FAQ’s define ACGME December 2012 FAQ’s define Milestones as:Milestones as:– observable developmental steps, observable developmental steps,

organized under the six competency organized under the six competency areas, that describe a trajectory of areas, that describe a trajectory of progress on the competencies from progress on the competencies from novice (entering resident) to proficient novice (entering resident) to proficient (graduating resident) and, ultimately, to (graduating resident) and, ultimately, to expert/master.expert/master.

Development of MilestonesDevelopment of MilestonesRaising a ChildRaising a Child

Grade schoolGrade school•Know how to brush their teethKnow how to brush their teeth

•Know how to make their bedKnow how to make their bed

Middle schoolMiddle school•Know how to do laundryKnow how to do laundry•Know how to make mealsKnow how to make meals

High schoolHigh school•Know how to manage moneyKnow how to manage money•Know how to drive a carKnow how to drive a car•Know how to make decisions/prioritize/be responsibleKnow how to make decisions/prioritize/be responsible

GI MilestonesGI Milestones

• Development of milestones for Development of milestones for subspecialty programs scheduled to subspecialty programs scheduled to begin July 2013begin July 2013

• Subspecialty milestones will also focus Subspecialty milestones will also focus to a much greater extent on medical to a much greater extent on medical knowledge and patient care skillsknowledge and patient care skills

Milestone Questions Answered Milestone Questions Answered by ACGME FAQsby ACGME FAQs

http://www.acgme-nas.org/assets/pdf/NASFAQs.pdfhttp://www.acgme-nas.org/assets/pdf/NASFAQs.pdf

What We Will ReviewWhat We Will Review

• Overview of NASOverview of NAS(Background; Core, Detail, (Background; Core, Detail, Outcome; WebAds)Outcome; WebAds)

• CLER Program CLER Program

• Clinical Competency CommitteeClinical Competency Committee

• Direct Observation/Direct Observation/Supervision of FellowsSupervision of Fellows

Clinical LearningClinical LearningEnvironment ReviewEnvironment Review

(CLER) Program(CLER) Program

Aims of CLERAims of CLER

• Promote safety and quality of carePromote safety and quality of care

• Focus on six areasFocus on six areas

• Care residents give and will provide Care residents give and will provide after residencyafter residency

Six Areas of FocusSix Areas of Focus

• Engaging Residents in Patient SafetyEngaging Residents in Patient Safety• Engaging Residents in Quality ImprovementEngaging Residents in Quality Improvement• Patient Care TransitionsPatient Care Transitions• Resident SupervisionResident Supervision• Duty Hour Oversite/Fatigue ManagementDuty Hour Oversite/Fatigue Management• Professionalism in the Learning EnvironmentProfessionalism in the Learning Environment

CLER VisitsCLER Visits

• Team of dedicated site visitorsTeam of dedicated site visitors• During the first 18-month cycle, SVs will visit During the first 18-month cycle, SVs will visit

only one major participating site for each only one major participating site for each Sponsoring InstitutionSponsoring Institution

• No less than 10 day’s noticeNo less than 10 day’s notice• Not required to complete documentsNot required to complete documents• Will be asked to share existing documentsWill be asked to share existing documents

CLER Visits CLER Visits (cont.)(cont.)

• Will be asked to share existing documents Will be asked to share existing documents – Quality and safety strategiesQuality and safety strategies

– Policies on supervisionPolicies on supervision

– Duty hoursDuty hours

• Site visitors – Combine group meetings and Site visitors – Combine group meetings and walking roundswalking rounds

• Interview faculty, program directors, trainees, Interview faculty, program directors, trainees, MSGME leadershipMSGME leadership

Data From CLER VisitsData From CLER Visits

• Testing phaseTesting phase

• Continue to develop, test, Continue to develop, test, implementimplement

• Gather baseline dataGather baseline data

• Give formative feedbackGive formative feedback

CLER Eval ProcessCLER Eval Process

Provide 3 opportunities for feedbackProvide 3 opportunities for feedback1.1. Oral reportOral report

2.2. Written report to institution before Written report to institution before submission to CLER Evaluation submission to CLER Evaluation Committee – Institution respondCommittee – Institution respond

3.3. Final report to CLER Evaluation Final report to CLER Evaluation CommitteeCommittee

Examples of CLER DataExamples of CLER Data

1) Patient Safety1) Patient Safety

Examples of CLER DataExamples of CLER Data

2) Quality Improvement2) Quality Improvement All fellow are required to complete a QI project during All fellow are required to complete a QI project during

fellowshipfellowship

Examples of CLER DataExamples of CLER Data

3) Patient Care Transitions3) Patient Care Transitions

Examples of CLER DataExamples of CLER Data3) Patient Care Transitions3) Patient Care Transitions

Examples of CLER DataExamples of CLER Data

4) Resident Supervision4) Resident Supervision

Examples of CLER DataExamples of CLER Data

5) Duty Hours5) Duty Hours

- Back-up fellow on call 24/7- Back-up fellow on call 24/7

- Fellows on at-risk rotations monitored weekly- Fellows on at-risk rotations monitored weekly

- Fellows may seek guidance anytime- Fellows may seek guidance anytime

- Fellows complete a module to recognize- Fellows complete a module to recognizeand mitigate fatigueand mitigate fatigue

Examples of CLER DataExamples of CLER Data5) Duty Hours5) Duty Hours

Examples of CLER DataExamples of CLER Data5) Duty Hours5) Duty Hours

Examples of CLER DataExamples of CLER Data5) Duty Hours5) Duty Hours

Examples of CLER Data - DOMExamples of CLER Data - DOM6) Enhancing Professionalism6) Enhancing Professionalism

Examples of CLER - MMSExamples of CLER - MMS6) Enhancing Professionalism6) Enhancing Professionalism

Resources for CLER ProgramResources for CLER Program

1)1) https://www.aamc.org/members/gra/306034/clerwebinar.htmlhttps://www.aamc.org/members/gra/306034/clerwebinar.html

2) 2) http://www.acgme-nas.org/ http://www.acgme-nas.org/

Thank you!Thank you!

Joanna L. Meyer (Jo)Joanna L. Meyer (Jo)

jmeyer@mayo.edujmeyer@mayo.edu