Transcript Becoming a Mentor in MFM

“The Next Accreditation System
(NAS)”
PROGRAM DIRECTOR’S ROLE
Brian L. Cohen, MD, FRCOG, FACOG
Associate Dean of Graduate Medical Education
Professor of Obstetrics, Gynecology and Women’s Health
Introduction
1999: ACGME introduced the domains
of clinical competency
2009:
ACGME began a multiyear
process to restructure the
accreditation system to be
based on outcomes
2013: Phased implementation of the NAS
Aims of NAS
 Enhance the peer review system to
prepare physicians
 Accelerate ACGME accreditation
based on outcomes
 Reduce the burden of the current
system which is process based
Basis
 Institute of Medicine Report
 Public pressure
 Congressional pressure
 Constrained finances and possible
reductions for GME
July 2013 - Phase I
 NAS will be implemented by 7 of 26 core specialties
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Emergency medicine
Internal medicine
Pediatrics
Diagnostic radiology
Neurosurgery
Orthopedic surgery
Urology
 All other specialties and preliminary programs
implementation - July 2014
 GME communities must be prepared for changes
NAS Compliance
Five important data collection areas:
① Annual ADS consists of:
 Program statistics
 Program structure & resources
 Scholarly activity
 Teaching responsibilities
NAS Compliance
② Board Pass Rates
 Improve curriculum / didactics
NAS Compliance
③ Clinical Experience
 Case log
 Case mix
 Minutes from meetings of program
evaluation
NAS Compliance
④ Resident Survey
 Duty hours
 Supervision & teaching
 Teamwork
 Education vs. service
 Evaluations
 Patient safety
NAS Compliance
⑤ Patient Safety
 Resident participation
Additional Information
 Minutes from annual meetings to be submitted
annually
 Residents on committees
 Sample PLA & LOA policy
 Policies
- Supervision
- Handover rounds
- Work hours
- Others
Milestones
 Essential component of NAS are the MILESTONES
 Basis is to track development in the 6
competencies
 Dreyfus Model:
- Novice
- Advanced beginner
- Competent
- Proficient
- Expert
- Master
Milestones
Milestones Developed By
 RRC
 Boards
 P.D.’s
 Residents
Milestones
Milestones Will Supplement,
Not Replace Existing Assessment Tools
Timeline:
Develop by December 2012
Submission to ACGME 2013 & 2014
Clinical Competency Committee (C.C.C.)
Include
 Core faculty
 Program directorprofessionalism
 Chief resident
Function
 Evaluate
milestones &
early warning
 Track progress
of residents
 Faculty
development
Purpose
 Reduce potential
bias/subjective
 Performance
Function
measure
 Decision making
by multiple people
 Evaluate 360°
assessments
Clinical Learning Environment
Review (CLER)
Focus is:
 On resident learning of patient safety
 Institution responsibility for quality and
safety of the learning environment
Clinical Learning Environment
Review (CLER)
Focus Comprises Six Areas:
1. Patient safety
2. QI by residents
3. Transition of care
4. Supervision
5. Duty hours & fatigue management
6. Professionalism
Evaluation by Site Visits
Personnel Involved:
 Site visitors
 CEO of medical institution
 DIO
 GMEC chair
 Residents
 Safety officer
 Senior administration
Process
 Three weeks advance notice
 No advance documentation
 Conduct interviews
 Work hour reports
 Visit learning environment
Summary
NAS will involve four areas (2013 & 2014):
1. NAS itself
2. Milestones
3. Clinical competency committee
4. CLER
Begin the process NOW (2013 & 2014)
Handoff / Handover Process
Program directors  Structured & standardized protocols
provide:
 Assess resident skills
 Use of technology
May be:
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Objective:
 Accuracy
 Patient safety
Verbal
Written
Written & verbal
Electronic
Standardized Tool
Sick – degree
Identifying data
General hospital course
New events
Overall health status
Upcoming plan
Tasks to complete
Questions
2000
2013