final summit presentation suzanne rose

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Internal Medicine Subspecialty Milestones Summit:

February 11-‐12, 2013, Alexandria, VA

Suzanne Rose, MD, MSEd Senior Associate Dean for Educa2on

Professor of Medicine University of Connec2cut School of Medicine

Milestone

Background

•  New ERA for GME •  Next AccreditaMon System: NAS New Nomenclature, Processes, and Compliance •  Competencies and Milestones •  EPA’s: Entrustable Professional AcMviMes •  CLER Visits

A Key element of the NAS is the measurement and reporMng of outcomes through the educaMonal milestones….

Programs in the NAS will submit composite milestone data on their residents every 6 months, synchronized with residents’ semiannual evaluaMons.

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Components of NAS

•  Program aXriMon •  Program changes •  Resident survey •  Board pass rate •  Clinical experience log •  Core faculty scholarly acMviMe •  Faculty survey •  CLER visit

• Repor&ng of milestones

Where are we now? •  Six specialMes ready for the ACGME Milestones 2013

–  DiagnosMc radiology –  EM –  IM –  Neuro Surg –  Orthopedics –  Pediatrics –  Urology

•  IM has established 22 sub-‐competencies •  Now it is Mme for the IM subspecialMes to create their

competencies/milestones •  Summit organized to bring together the Chairs of the

EducaMon and Training CommiXees in the Sub-‐specialty socieMes

•  Develop subspecialty milestones now •  ImplementaMon in 2014

Before th

e MeeMn

g

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MeeMng Agenda •  Key Stakeholder PerspecMves – AAIM, ABIM, and ACGME

•  Basics of Competency-‐based Medical EducaMon: Concepts of Curricular Milestones, EPAs, and NAS ReporMng Milestones

•  Review of some of the subspecialty work: –  Geriatrics –  Cardiology –  GI-‐Transplant Hepatology (wonderful work of Oren Fix, MD and colleagues!)

•  Small group work •  Large group review of small group work

RepresentaMon from GI at the meeMng: AASLD, ACG, AGA, ASGE

ACGME Competencies

•  PaMent Care •  Medical Knowledge •  Systems-‐Based PracMce •  PracMce-‐Based Learning & Improvement •  Professionalism •  Interpersonal & CommunicaMon Skills

Introduced 1999 Implemented 2001

CBME, NAS, EPA

•  CBME: assessing meaningful outcomes – Work-‐based – AuthenMc

•  NAS: reporMng meaningful outcomes – Developmental progression over Mme (MILESTONES)

•  EPA: strategy to create meaningful, work-‐based assessments of residents/fellows – can generate data for reporMng milestones in NAS

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Entrustable Professional AcMviMes

•  Observed and measurable to an conclusion •  Reflects expected competencies •  EPA’s = Core of the profession •  EPA’s are not mandatory and not reportable to ACGME

•  EPA’s = strategy for meaningful, work-‐based assessment of a resident/fellow

•  EPA’s provide assessment data for reporMng of milestones to the ACGME via NAS

“… idenMfy the criMcal ac2vi2es that consMtute a specialty … the ac2vi2es of which we would all agree should be only carried out by a trained specialist.”

ten Cate et al. Acad Med 2007; 82: 542-‐47

How will we use milestones?

•  Clinical Competency CommiXee (CCC) will review all assessment data (end-‐of-‐rotaMon faculty evaluaMons, peer evals, case logs, simulaMon, self-‐assessments)

•  CCC will review and assess data from these mulMple evaluaMons and apply them to the milestones to note the progress of a resident/fellow

IM Milestones and Sub-‐competencies

•  PC: PaMent Care -‐ 5 •  MK: Medical Knowledge -‐ 2 •  SBP: Systems-‐Based PracMce -‐ 4 •  PBLI: PracMce-‐Based Learning and Improvement -‐ 4 •  PROF: Professionalism -‐ 4 •  ICS: Interpersonal and CommunicaMon Skills – 3

Total of 22 Subcompetencies

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Summit Small Group AcMvity

•  IM reporMng milestones for the 6 ACGME General Competencies are composed of 22 sub-‐competency streams – Do these 22 streams make sense for sub-‐specialMes?

•  Each sub-‐competency stream is composed of a series of milestones that describe developmental competence of learner in behavioral terms – Can these be applied to a fellow?

IM Sub-‐Competencies

PaMent Care 1.  Gathers and synthesizes essenMal and accurate

informaMon to define each paMent’s clinical problem(s). (PC1)

2.  Develops and achieves comprehensive management plan for each paMent. (PC2)

3.  Manages paMents with progressive responsibility and independence. (PC3)

4.  Skill in performing procedures. (PC4) 5.  Requests and provides consultaMve care. (PC5)

Sub-‐Competency

Milestone

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Medical Knowledge 6.  Clinical knowledge. (MK1) 7.  Knowledge of diagnosMc tesMng and procedures.

(MK2)


Systems-‐Based PracMce 8.  Works effecMvely within an interprofessional team

(e.g. peers, consultants, nursing, ancillary professionals and other support personnel. (SBP1)

9.  Recognizes system error and advocates for system improvement. (SBP2)

10.  IdenMfies forces that impact the cost of health care, and advocates for, and pracMces cost-‐effecMve care. (SBP3)

11.  TransiMons paMents effecMvely within and across health delivery systems. (SBP4)


PracMce-‐Based Learning and Improvement 12. Monitors pracMce with a goal for improvement.

(PBLI1) 13. Learns and improves via performance audit.

(PBLI2) 14. Learns and improves via feedback. (PBLI3) 15. Learns and improves at the point of care.

(PBLI4)

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IM Sub-‐Competencies Professionalism

16. Has professional and respecpul interacMons with paMents, caregivers and members of the interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and support personnel. (PROF1)

17. Accepts responsibility and follows through on tasks. (PROF2)

18. Responds to each paMent’s unique characterisMcs and needs. (PROF3)

19.  Exhibits integrity and ethical behavior in professional conduct. (PROF4)


Interpersonal and CommunicaMon Skills 20. Communicates effecMvely with paMents and

caregivers. (ICS1) 21. Communicates effecMvely in interprofessional

teams (e.g. peers, consultants, nursing, ancillary professionals and other support personnel). (ICS2)

22. Appropriate uMlizaMon and compleMon of health records. (ICS3)

Summit Process

•  Small group work by subspecialty •  Our small group had representaMon from – AASLD – ACG – AGA – ASGE

•  The group concluded: –  Sub-‐competencies from medicine could apply to GI/Hepatology with different behavioral milestones

– May require a shiq to the leq in terms of our fellows starMng out at a higher level than a resident in IM

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Summit Discussions

•  Consensus: The IM reporMng subcompetencies seem like a good foundaMon and can apply to the subspecialMes

–  Systems-‐Based PracMce –  PracMce-‐Based Learning and Improvement –  Professionalism –  Interpersonal and CommunicaMon Skills Should be applicable even with the same EPA’s but the levels of competency may shiq if we assume the fellow comes in at the milestone level of a resident

•  Concerns: Not clear if PaMent Care and Medical Knowledge can be the same

The large group reconvened:

Next Steps

•  OWN (Oversight Working Network) will meet at DDW •  The GI SocieMes have made a commitment to work jointly on this endeavor

•  Summit organizers will convene a smaller group of subspecialty educators –  To create a template –  To make a proposal regarding what the subspecialMes can keep from the IM effort

–  To determine what new informaMon needs to be created •  OWN will need to work on the PC and MK areas in parMcular

How can you help? •  Program Directors for all GI/Hepatology programs are key stakeholders in this process

•  Through OWN and this group convening at this Summit, we must work together to: –  Create what makes sense – Develop what is pracMcal – Achieve the goals of the ACGME, ABIM, AAIM – Generate what speaks to the needs of our PD’s and our fellows

•  Must consider a uniform tracking system across all programs to make this pracMcal, transferable, and helpful…

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Final Thoughts

•  We are at a crossroads, advancing towards a new paradigm for GME

•  It will be a lot of work •  But there are opportuniMes: –  Career paths for many of you –  RecogniMon of the great work you do – Dedicated Mme to do what you do in Graduate Medical EducaMon

–  Improved educaMon for our trainees –  CollaboraMve work that will role model the team spirit we are trying to inculcate in our trainees

Contact Info for Suzi Rose: [email protected]

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final summit presentation suzanne rose

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