1. Next Accreditation
System For
Program Coordinators
Lisa Thornton, Program Coordinator
Amy Oxentenko, M.D., Program Director
Division of Gastroenterology and Hepatology
Mayo Clinic, Rochester, MN
2. Disclosures
No Relevant
Financial Relationships
3. Learning Objectives
Participants will be able to:
• Gain an understanding of the ACGME’s Next
Accreditation System (NAS) from a Program
Coordinator’s (PC) perspective
• Begin planning for future requirements
• Discuss Program Coordinator concerns
6. What is NAS?
• Named after Dr. Thomas “NAS”ca?
• No…..
• NAS = Next Accreditation System
7. What is NAS?
• ACGME “Big Picture”
– Less prescriptive program requirements
that promote curricular innovation
– Continuous accreditation model
– Monitoring of programs based on
performance indicators
– Continuously holding sponsoring
institutions responsible for oversight of
educational and clinical systems – via
CLER
9. Time Line
• ACGME Statement
“In July 2013, the NAS will be
implemented by 7 out of the 26
ACGME-accredited core
specialties. In the remaining
specialties and the transitional
year, the NAS will be
implemented in July 2014.”
10. Next Accreditation System
What to Expect?
• Annual Data Collection
– ADS, educational milestones, resident and
faculty surveys, operative and case- log
data
• A site visit every 10 years, unless concerns of
non-compliance arise
– ACGME expects that there will be 12 to 15 months
advance notice of a self-study as well as 120-day
advanced notice with the specific date of self-
study
11. Next Accreditation System
Educational Milestones:
•Developmentally-based, specialty-specific
achievements that fellows are expected to
demonstrate at progressive intervals as they
advance through training
•Data will be submitted on fellows every 6
months, synchronized with fellows’ semiannual
evaluations
12. Next Accreditation System
Educational Milestones:
•~20-30 descriptions of competency which are
specialty-specific
– Have not been established for GI at this time
(development to begin in July 2013)
•But we can start to prepare now
– Educate faculty and fellows of new terms/time
lines at Divisional meetings
– Form a Clinical Competency Committee (June 2013)
13. Next Accreditation System
Educational Milestones:
•Benefits
– Shared understanding of expectations
– Set goals of competence
– Allows trainees to progress at various rates
(advanced vs remediation)
– Provide a framework and language for
discussions across the field
– Track the educational outcomes of the program
14. Clinical Competency Committee
Who should be members on this committee?
It varies….
•Core and non-core faculty members who
observe and have direct observation of
trainees
•Representation of core subspecialties
•Include assessment specialists and/or
non MD medical educators
15. Clinical Competency Committee
Who should be members on this committee?
It varies….
•Chair may be PD, APD, Dept/Division chair,
other faculty member
•A group of faculty members trained in
looking at milestones using narratives or
Entrustable Professional Activities (EPA’s)
16. Clinical Competency Committee
What is the role of this committee?
It varies….
•Decides on composition, procedure, data
elements
•Meets every 6 months to review assessments
in trainee portfolio
•Determines milestone levels or progress of
each trainee
17. Clinical Competency Committee
Benefits/Opportunities:
•Group versus single decision maker
•Especially helpful to have group decision
when issues of remediation raised
•Narrative comments versus numbers on
evaluations with no feedback; more likely to
uncover deficiencies
•Offers the trainee the insight and perspective
of a group of faculty members
18. Clinical Competency Committee
Benefits/Opportunities:
•Improve quality of faculty observation and
documentation; faculty development is
essential
•Same set of eyes looking at all data and same
process is applied
•Committee serves as an early warning system
if a trainee fails to progress in the educational
program
19. Clinical Competency Committee
Benefits/Opportunities:
•Multiple tools are available for assessing
trainee competency
– End of rotation and in-training exams
– Multi-source evals (faculty, nurses, other allied
staff, patients, peers)
– Procedure documentation (numbers and skill)
– Direct Observation
20. Example: IM Residency
• Monthly meetings
• Chaired by Associate Program Director
• Annual evaluation of each resident (~168)
- More frequent if concerns raised
• Handles, remediation, academic warnings,
probation, dismissal, annual awards
21. Example: Pediatrics
• Quarterly meetings
• Chaired by Associate Program Director
- PD and resident advisors attend
• Reports to Education Committee
• Determines promotion to next PGY level and
program completion
22. Clinical Competency Committee
Challenges:
•Time constraints of PC and faculty
– Expect 1 hour of review per trainee per period
•More paperwork to track milestones
•More time needed to:
– Arrange meetings
– Prepare for meetings
– Document group recommendations
– Implement changes
23. One Tool For Evaluating
Fellow Competency
Direct Observation
of Trainees
24. ACGME Requirement:
Direct Observation
• The program must assess the fellow in
data gathering, clinical reasoning,
patient management and procedures in
both the inpatient and outpatient
setting.
• This assessment must involve direct
observation of fellow-patient
encounters.
25. Direct Observation by KCF
• Needs to occur inpatient, outpatient and
during endoscopy
– Endoscopy/Inpatient largely happening
• Outpatient options:
• Go in room with fellow
• Use 1-way mirror via an adjacent room
• Use camera system
• Need to use an assessment tool
• Number of assessments needed not clear
– Proposed ≥ 10 by 5 staff q 6 months*
26. Our Mayo Camera System
for Direct Observation
• Currently 3 camera systems installed
– 1 Mayo E 9 (IBD, general GI, educ clinic)
– 2 Gonda 9 (continuity clinics)
27. Assignment of Observation
• Align with continuity clinic schedule
– 1 camera per 1 staff for 1 fellow
observation on any half day
• Always 1st patient of the CC day
– Longer patient visit
– Allows system to not wait for staff
• Secretaries and appt office will avoid
staff meetings/patients during session
30. Order of Events
• Desk rooms patient; turns on
camera switch after patient
reads instructions/agrees
• Desk will page both fellow
and staff that observation
patient ready; room number
displayed for each
• Staff to log on to system to
observe
32. Logging Onto System
• Log onto office session
• Click desktop icon
– GI Fellow Go 9-452
– GI Fellow Ma 9/35E
33. Logging Onto System
• Log onto office session
• Click desktop icon
– GI Fellow Go 9-452
– GI Fellow Ma 9/35E
• Close any pop up
blockers that arise
34. Logging Onto System
• Log onto office session
• Click desktop icon
– GI Fellow Go 9-452
– GI Fellow Ma 9/35E
• Close any pop up
blockers that arise
• Log into system
– Username and password
42. Program Coordinator
Concerns/Challenges
Open for questions and concerns you all have!
43. Program Coordinator
Concerns/Challenges
Challenges:
•Time constraints of PC and faculty
– Expect 1 hour of review per trainee per period
•More paperwork to track milestones
•More time needed to:
– Arrange meetings
– Prepare for meetings
– Document group recommendations
– Implement changes
44. Summary
• Reviewed a few of the NAS requirements
• Reviewed examples of how to get started
• Discussed Program Coordinator concerns
Sent email to epcs at Mayo what their perception of NAS was and here are a few pictures describing their thoughts.
And some thought jumping through hoops would be appropriate, I guess those going to the dolphin next week for the ACGME meeting, will find out more!
We will start off with some real basics, what is the definition of NAS….some thought Dr. Thomas Nasca had something to do with this and wanted to name it after himself, but we all know it stands for …
ACGME has given us some verbiage on the big picture divided into 4 categories
Still confused?
As for now, GI is scheduled to begin implementation in July 2014
What to expect, the final reporting systems for the NAS are still under development, however much of the data used to accredit programs is available now which includes our annual data collection – we are all familiar with Ads, the faculty surveys are new however we just have gone through that cycle. “Site visit” is now a “self study”
What are milestones? They are defined as….
Each program is expected to form a ccc and begin to develop its members by June 2013 (ACGME)
Benefits are…..We ALL will have
We at Mayo are just starting to establish our ccc…who should members be, it can vary.
What is role…that can also vary
We use the AGA in-training exam, have used BB for end of rotation exams.
This is just to name a few, I left a little bit of time at the end for feedback on additional concerns. Change to direct observation
Review one tool of how we evaluate fellow competency by direct observation.