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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
Disclosures


     No Relevant
Financial Relationships
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
Program Coordinator’s
     Perception
Program Coordinator’s
     Perception
What is NAS?
• Named after Dr. Thomas “NAS”ca?

• No…..

• NAS = Next Accreditation System
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
What is NAS?
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.”
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
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
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)
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
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
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)
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
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
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
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
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
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
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
One Tool For Evaluating
  Fellow Competency

    Direct Observation
        of Trainees
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.
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*
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)
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
Fellows Identified By Highlights
How You Will Know on Outlook
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
Patient Information
Logging Onto System
• Log onto office session
• Click desktop icon
  – GI Fellow Go 9-452
  – GI Fellow Ma 9/35E
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
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
Nas lisa
Nas lisa
CEX Evaluation
CEX Evaluation




In a staff’s evaluation box by the day of observation
ABIM
Direct Observation Tool
What is in it for Faculty?
• Can get practice improvement points
  for ABIM MOC
Cost
Program Coordinator
         Concerns/Challenges

Open for questions and concerns you all have!
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
Summary

• Reviewed a few of the NAS requirements

• Reviewed examples of how to get started

• Discussed Program Coordinator concerns
Thank you!

thornton.lisa@mayo.edu

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Nas lisa

  • 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
  • 28. Fellows Identified By Highlights
  • 29. How You Will Know on Outlook
  • 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
  • 38. CEX Evaluation In a staff’s evaluation box by the day of observation
  • 40. What is in it for Faculty? • Can get practice improvement points for ABIM MOC
  • 41. Cost
  • 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

Hinweis der Redaktion

  1. EPC = 20 years
  2. Over the next 30 minutes, we will
  3. Sent email to epcs at Mayo what their perception of NAS was and here are a few pictures describing their thoughts.
  4. 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!
  5. 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 …
  6. ACGME has given us some verbiage on the big picture divided into 4 categories
  7. Still confused?
  8. As for now, GI is scheduled to begin implementation in July 2014
  9. 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”
  10. What are milestones? They are defined as….
  11. Each program is expected to form a ccc and begin to develop its members by June 2013 (ACGME)
  12. Benefits are…..We ALL will have
  13. We at Mayo are just starting to establish our ccc…who should members be, it can vary.
  14. What is role…that can also vary
  15. We use the AGA in-training exam, have used BB for end of rotation exams.
  16. 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
  17. Review one tool of how we evaluate fellow competency by direct observation.
  18. Clinical Evaluation Exercise Evaluation (CEX)
  19. DONE AFTER THIS SLIDE