Transcript Document
This presentation includes the audio recording from the “Introduction to Internal Medicine Subspecialty Reporting Milestones” webinar held on September 4, 2013. Please note the recording will play continuously as you move through the slides. INTERNAL MEDICINE SUBSPECIALTY REPORTABLE MILESTONES Webinar #1 Moderators Scott D. Gitlin, M.D. University of Michigan ASP Past-President John P. Flaherty, M.D. Northwestern University ASP President Milestones • By definition a milestone is a significant point in development. • Milestones should enable the trainee, program and the certification board to know an individuals trajectory of competency acquisition. • The milestones define the floor of competence but do not eliminate the need for aspirational goals! Competency Across the Continuum Professional Career Medical School Residency Fellowship How do milestones facilitate this continuum? Internal Medicine has TWO sets! The original milestones published in 2009 Now the curricular milestones The NAS reporting milestones published in 2013 The Curricular Milestones • Initial draft published in 2009 • The milestones define the abilities (K/S/A) expected of IM residents as they progress through training o Integrate knowledge, skills, values and attitudes o Developmental in nature o Inherently linked within/across core competencies • Framed in behavioral terms o They are observable o Sets the stage for assessment of competence 10 Patient Care ACGME Competency Developmental Milestones Informing ACGME Competencies Clinical skills and reasoning Manages patients using clinical skills of interviewing and physical examination Historical Data Gathering 1. Acquire accurate and relevant history from the patient in an efficiently customized, prioritized, and hypothesis driven fashion 2. Seek and obtain appropriate, verified, and prioritized data from secondary sources (e.g. family, records, pharmacy) 3. Obtain relevant historical subtleties that inform and prioritize both differential diagnoses and diagnostic plans, including sensitive, complicated, and detailed information that may not often be volunteered by the patient RRC sub-bullet Approximate Time Frame Trainee to Achieve Stage 6 months 9 months 18 months Assessment Methods/Tools Standardized patient Direct Observation Simulation ACGME Internal Medicine Reporting Milestones • Define stages of development that provide the framework for making judgment/attestation of competence in each of the six general competencies • Are written in narrative form • The six general competencies are organized in 22 subcompetencies (narrative milestones streams) Internal Medicine Milestones sub-competency Version 12/2012 5. Requests and provides consultative care. (PC5) Ready for unsupervised practice Critical Deficiencies Is unresponsive to questions or concerns of others when acting as a consultant or utilizing consultant services Unwilling to utilize consultant services when appropriate for patient care Inconsistently manages patients as a consultant to other physicians/health care teams Provides consultation services for patients with clinical problems requiring basic risk assessment Inconsistently applies risk assessment principles to patients while acting as a consultant Asks meaningful clinical questions that guide the input of consultants Provides consultation services for patients with basic and complex clinical problems requiring detailed risk assessment Appropriately weighs recommendations from consultants in order to effectively manage patient care Inconsistently formulates a clinical question for a consultant to address Aspirational Switches between the role of consultant and primary physician with ease Provides consultation services for patients with very complex clinical problems requiring extensive risk assessment Manages discordant recommendations from multiple consultants Comments: Milestone Patient Care The resident is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in training. He/she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, timely, equitable, effective and patient-centered care. _____ Yes _____ No _____ Marginal Copyright (c) 2012 The Accreditation Council for Graduate Medical Education and The American Board of Internal Medicine. All rights reserved. The copyright owners grant third parties the right to use the Internal Medicine Milestones on a non-exclusive basis for educational purposes. Milestones and Trajectories Fully Competent A’ A B C Lucey and Boote Start PGY Milestones Finish PGY Clearly, if we are to move forward, two events must take place ……. First, we must agree on the ‘milestones’ of competency development in each discipline……. Second, we must agree on and implement common evaluation tools in each discipline…...” Nasca TJ, ACGME Bulletin. May 2008 The Charge 19 subspecialties of Internal Medicine A common set of milestones or 19? NAS Milestones Can the IM Milestones Guide this work? Reporting in the NAS Internal Medicine Subspecialty Milestones Summits Sponsors/Organizers Internal Medicine Subspecialty Milestones Summit #1 February 11-12, 2013 42 participants representing 22 subspecialty societies joined ABIM, ACGME, AAIM, and ASP representatives to discuss subspecialty milestones development. Participants American Academy of Hospice and Palliative Medicine American Academy of Sleep Medicine American Association for the Study of Liver Diseases American Association of Clinical Endocrinologists American College of Cardiology American College of Chest Physicians American College of Gastroenterology American College of Physicians American College of Rheumatology American Gastroenterological Association American Geriatrics Society American Society of Clinical Oncology American Society of Gastrointestinal Endoscopy American Society of Hematology American Society of Nephrology American Society of Nuclear Cardiology American Thoracic Society Association of Pulmonary and Critical Care Medicine Program Directors Infectious Disease Society of America Society of Cardiac Angiography and Intervention Society of Critical Care Medicine The Endocrine Society Internal Medicine Subspecialty Milestones Summit #1 Summit #1 Goals Make the work of developing subspecialty milestones as meaningful and efficient as possible. Understand how milestones can facilitate improvements in fellowship training. Review the approach and the work that led to the published IM reporting milestones. Highlight the work completed by the Geriatrics, Cardiology and GI/Transplant Hepatology communities and determine how this work could facilitate the work of other subspecialties. Internal Medicine Subspecialty Milestones Summit #1 Summit #1 Goals Determine if the IM reporting milestones could serve as a starting framework and template for this work. Can subspecialties use some portion of the IM reporting milestones for specialty level reporting. Achieve consensus on a strategy for developing subspecialty milestones for use in the ACGME Next Accreditation System (NAS) by 2014. Internal Medicine Subspecialty Milestones Summit #1 Summit # 1 Summary • Agreement that the Internal Medicine Milestones could serve as starting point for developing the subspecialty milestones - Professionalism - Interpersonal & Communication Skills - Systems-Based Practice - Practice-Based Learning and Improvement • Individual subspecialties might need to subsequently customize milestones document to address their specific needs Internal Medicine Subspecialty Milestones Summit #1 Summit # 1 Summary • Agreement that a “universal” subspecialty milestones draft document should be developed by modifying the Internal Medicine core program milestones document • Medical Knowledge and Patient Care milestones would be writte by the subspecialties Internal Medicine Subspecialty Milestones Summit #1 Summit # 1 Summary Specific Modifications discussed: • Develop milestones to capture scholarly activity requirements of fellowship programs • Review and potentially modify the “Critical Deficiency” (left han column of the Milestones document to reflect expected starting competencies for fellowship training • Review and potentially modify the “Aspirational ” (right hand) column of the Milestones document to reflect expectations fo fellowships • Determine if any of the current 22 Internal Medicine reportable milestones can be eliminated for fellowships Internal Medicine Subspecialty Milestones Summit 2 Philadelphia, PA May 15, 2013 Milestones Summit #2 Participants American Board of Internal Medicine (ABIM) Bill Iobst; Lee Berkowitz; Elizabeth Blaylock; Sarah Hood; Sharon Levine; Lynn Lorna; Sandra Yaich; Mary Ann Zaaborowski Alliance of Academic Internal Medicine (AAIM) D. Craig Brater; Margaret Breida; Greg Kane; Polly Parsons; Bergitta Smith Accreditation Council for Graduate Medical Education (ACGME) James Arrighi; Tim Brignam; Susan Swing; Jerry Vasilias Association of Specialty Professors (ASP) Scott Gitlin; John Flaherty; Don Rockey; Joshua Safer IM Milestone Group Kelly Caverzagie American Academy of Hospice and Palliative Care Medicine Laura Morrison American Association for the Study of Liver Diseases Oren Fix American College of Cardiology Jill Foster; Marcia Jackson Milestones Summit #2 Participants American College of Chest Physicians John (Jack) Buckley American College of Gastroenterology Ronald Szyjkowski American College of Rheumatology Calvin Brown American Gastroenterological Association Brijen Shah American Geriatrics Society Lisa Granville American Society of Clinical Oncology Frances Collichio American Society of Hematology Elaine Muchmore American Society of Nephrology Nancy Adams Milestones Summit #2 Participants American Society of Nuclear Cardiology Brian Abbott American Thoracic Society Henry Fessler Association of Program Directors in Endocrinology, Diabetes, and Metabol Geetha Gopalakrishnan Association of Pulmonary & Critical Care Medicine Program Directors Craig Piquette Geriatric Milestones Committee Rosanne Leipzig Infectious Disease Society of America Daniel Havlichek, Jr Society of Cardiac Angiography and Interventions Tarek Helmy Society of Critical Care Medicine Stephen Pastores The Endocrine Society Ailene Cantelmi Summit #2 Goals Make the work of developing subspecialty milestones as meaningful and efficient as possible. Understand how milestones can facilitate improvements in fellowship training. Develop the reportable Milestones for Internal Medicine subspecialties (context free as possible). Critical deficiencies/Aspirational Goals Scholarship Internal Medicine Subspecialty Milestones Summit #2 Small Groups Calibrating Critical Deficiencies and Aspirational categories Scott Gitlin Brian Abbott John (Jack) Buckley Geetha Gopalakrishnan Lisa Granville Tarek Helmy Marcia Jackson Rosanne Leipzig Laura Morrison Craig Piquette Joshua Safer Brijen Shah Ronald Szyjkowski Enriching Scholarly Activity John Flaherty Nancy Adams Calvin Brown Ailene Cantelmi Frances Collichio Henry Fessler Oren Fix Jill Foster Daniel Havlichek, Jr Vishesh Kapur Elaine Muchmore Polly Parsons Stephen Pastores Don Rockey Internal Medicine Subspecialty Milestones Summit #2 Summit # 2 Summary • Subspecialty reportable milestone subcompetencies were identified from the Internal Medicine milestones and were modified for the subspecialties • Context-free language that met all subspecialties’ needs was developed • Scholarship subcompetency was defined and developed for integration into the subspecialty milestones IM Subspecialty Reporting Milestones Development February 11-12, 2013 First IM Subspecialty Milestones Summit Held in Alexandria, VA May 15, 2013 Second IM Subspecialty Milestones Summit Held in Philadelphia, PA May-September 2013 Small Groups worked to alter IM Reporting Milestones to meet the needs of the Subspecialties September 4, 9, 11, 2013 Webinars held with Subspecialty Societies to obtain feedback Reporting Milestones followed by request for society comment September-October 2013 Revision Made to Initial Draft based on feedback from societies November 11, 2013 Third IM Subspecialty Milestones Summit to be held in Chicago, IL December 2013 ACGME to publish Subspecialty Milestones January 2013 April 2013 July 2013 October 2013 ACGME expects programs to implement Subspecialty Reporting Milestones for AY 2014-2015 January 2014 HOW DID WE DO THIS? 1. Reviewed task at hand (i.e. need to develop reporting milestones for the subspecialties of Internal Medicine) 2. Reviewed Internal Medicine Residency (Core program) milestones ● Lessons learned from that process 3. Open discussion of individual goals, biases, concerns 4. Heard from subspecialties that had already been working on the reportable milestones ● Lessons learned from their experiences 5. Came to understanding and agreement of the utility of having one set of “context-free” reportable milestones for the subspecialties 6. Initial review of the Internal Medicine core program milestones led to the identification that the Critical Deficiencies and the Aspirational Goals sections would need focused review and modifications. HOW DID WE DO THIS? 7. Initial review of the Internal Medicine core program milestones led to the identification that a reportable milestone for scholarly activity was needed 8. After initial face-to-face work by the 2 working groups (i.e. Critical Deficiencies and Aspirational Goals & Scholarly Activity), each working group met by conference calls to further their respective work on developing context-free reportable milestones that are appropriate for the IM subspecialties 7. Throughout the process, there has been transparency, open dialogue, respectful disagreements, camaraderie and a sincere effort by everyone to try to find common language that would be satisfactory to, and meet the needs of, all of the IM subspecialties IM Subspecialty Reporting Milestones Development February 11-12, 2013 First IM Subspecialty Milestones Summit Held in Alexandria, VA May 15, 2013 Second IM Subspecialty Milestones Summit Held in Philadelphia, PA May-September 2013 Small Groups worked to alter IM Reporting Milestones to meet the needs of the Subspecialties September 4, 9, 11, 2013 Webinars held with Subspecialty Societies to obtain feedback Reporting Milestones followed by request for society comment September-October 2013 Revision Made to Initial Draft based on feedback from societies November 11, 2013 Third IM Subspecialty Milestones Summit to be held in Chicago, IL December 2013 ACGME to publish Subspecialty Milestones January 2013 April 2013 July 2013 October 2013 ACGME expects programs to implement Subspecialty Reporting Milestones for AY 2014-2015 January 2014 NEXT STEPS • Webinars Introduce the reportable milestone development process to the subspecialty societies Initial review of the subspecialty reportable milestones by t subspecialty societies Allow the working group to receive feedback from the socie • 3rd Summit Meeting on November 11, 2013 in Chicago to addr societies’ “final” comments and to come to group consensus • Submit Internal Medicine Subspecialty Reportable Milestone to ACGME • Identify the need for, and provide, further education about the reportable milestones QUESTIONS AND OPEN DISCUSSION