Family Medicine Milestones & the Next Accreditation System - - PowerPoint PPT Presentation

Accreditation Council for Graduate Medical Education

Family Medicine Milestones & the Next Accreditation System

April 2013

Overview

• Next Accreditation System
• Clinical Learning Environment Review
• Family Medicine Milestones

Why ‘Next Accreditation System’ (NAS)?

“Self-regulation is a fundamental professional responsibility, and the system for educating physicians answers to the public for the graduates it produces.”

“The Next GME Accreditation System – Rationale and Benefits” Nasca T.J., Philibert I., Brigham T., Flynn T.C. N Engl J Med 2012; 366:1051-1056

Why ‘Next Accreditation System’ (NAS)?

• The ACGME's public stakeholders have

heightened expectations of physicians.

• Patients, Payers, and the public demand
• access to proper care and a good physician
• information-technology literacy,
• sensitivity to cost-effectiveness,
• the ability to involve patients in their own care, and
• the use of health information technology to improve

care for individuals and populations.

Why ‘Next Accreditation System’ (NAS)?

• Evaluate programs based on reporting of
• utcomes through educational milestones which

is the next step for the ACGME competencies.

• Patient care
• Medical Knowledge
• Professionalism
• Systems-based practice
• Practice-based learning and improvement
• Interpersonal and communication skills
• Foster innovation and improvement by

programs.

Goals of NAS

• Strengthen resident development in

Professionalism, Interpersonal & Communication Skills, Systems Based Practice, & Practice Based Learning

• Enhance public accountability
• More explicit definition of a good physician

(Milestones)

• Patient safety is paramount (Clinical Learning

Environment Review Program)

• Improve efficiency and reduce burden required

for accreditation

NAS Overview

• Continuous oversight rather than episodic

sampling

• Milestone reports (semi-annual), Resident &

Faculty questionnaires (annually), Case Logs (annually), Program & Institutional Infrastructure (annually) monitored by ACGME Review Committees

• Program Site Visits at ~10 year intervals
• Emphasis on program effectiveness as

evidenced by resident advancement through the milestones

‘Next Accreditation System’ in a Nutshell

• NAS allows accreditation process to advance

from an episodic “biopsy” model to annual data

• collection. RRCs will measure compliance

through the evaluation of annual program data elements.

Annual Program Data (Elements to Include)

• RC receives data ‘continuously’
• RC tracks data on each program/residents
• Milestone Performance
• Resident Survey Results
• Faculty Survey Results
• Case Logs and other parameters of clinical experience
• Scholarly Activity
• Key Quality/Patient Safety Data
• Board Certification Examination Results
• Institutional/Fiscal/Faculty/Leadership, etc..

ACGME Strategy

• De-emphasize the current focus on the PIF and

prescriptive program requirements

• Emphasize evaluation of program’s actual operations

and implementation processes

• Enhance selected elements of visit
• Review of citations
• Resident complaints
• Resident survey (non-compliance)
• Duty hour and learning environment standards
• Changes since last visit
• Annual program evaluation

NAS Timeline

• June 2011 ACGME Board Approved NAS
• July 2012 Clinical Learning Environment Review

(CLER) Visits Initiated

• December 2012 Draft Residency Milestones

Completed

• July 2013 NAS begins in 7 Specialties
• 2013-14 NAS Policies & Procedures Finalized
• 2014 NAS Implemented in all Specialties
• 2015 Subspecialty Milestones Completed

Clinical Learning Environment Review

• Institutional CLER visits ~ every 18 months for

each participating institution

• Entire first cycle of visits are beta testing and

will not change accreditation

• Initial visits will be used for feedback, learning

and to establish baseline information

• Site visits will be done by full-time staff and

volunteer peers

• Six key areas that will be focused on during

the site visits

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Clinical Learning Environment Review Visits

• Integration of residents into institution’s

Patient Safety programs and demonstration

• f impact
• Integration of residents into institution’s

Quality Improvement programs and efforts to reduce Disparity in Health Care Delivery and demonstration of impact

• Establishment, implementation and oversight
• f Supervision policies

Additional information available at: http://www.acgme-nas.org/CLER

Clinical Learning Environment Review Visits

• Oversight of Transitions of Care
• Oversight of Duty Hours Policy, Fatigue

Management and Mitigation

• Education and Monitoring of Professionalism

Additional information available at: http://www.acgme-nas.org/CLER

FM Milestones

• 14-member Committee
• Committee Meetings
• March, July, October 2012
• Conference calls between meetings
• Comment Period
• Late 2012/Early 2013
• Presentation at RPS/PDW
• Final Document – Summer 2013
• Implementation – Summer 2014

FM Milestones

• Milestones are specific benchmarks of skills,

knowledge, and behaviors that each resident is expected to achieve at identified stages of residency training.

• Milestones developed for each of the six ACGME

competencies.

• Stages for the FM Milestones: Has not achieved

level 1, level 1, level 2, level 3, level 4 and level 5.

FM Milestones

• Observable developmental steps describing a

trajectory of progress from level 1 to level 5

• Provide a “roadmap” for learning
• “Intuitively” known by experienced family

medicine educators

FM Milestones

• Designed to allow tracking of discrete and

measurable educational “outcomes”

• Build upon existing evaluation tools and
• bservations of the faculty
• Additional evaluation tools and techniques may be

developed, as needed

• Progress of each resident to be assessed by local

program’s Clinical Competency Committee (CCC)

FM Milestones

• FM Milestones draft document will be on the

ACGME website in February 2013

• Feedback on the milestones encouraged
• Revised document presented at RPS/PDW for

comment

• Final document – Summer 2013
• Living document that will be updated

FM Milestones

• Each residency will have a clinical

competency committee (CCC)

• CCC should include faculty only
• CCC should have at least 3 faculty

members

• CCC should include faculty who are active

in evaluation of the residents

FM Milestones

• CCC will review each resident’s progress

in each competency and enter assessments on the milestones reporting form for each resident twice a year

• The program will provide feedback to each

resident regarding their progress in each milestone

FM Milestones

• Residents do not need to achieve level 4 in

every milestone to graduate but should substantially demonstrate the milestones targeted for this level as it is designed as the graduation target

• Residents do not need to achieve

competency at level 2 in each milestone to advance to their second year of training but should achieve that level in the majority of milestones

FM Milestones

• Residents are not expected to achieve

competency at level 5 during residency

• Residents may achieve a level of

competency in specific milestones sooner than expected

FM Milestones

• Resident data will be de-identified on the

semi-annual milestone form

• ACGME will compile data at program level

and specialty level

• Milestone data will not affect accreditation

cycle at this time

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FM Milestones Feedback

• Common themes from general feedback:
• Too long - too short
• Too vague - too specific
• Hard stops or pass/fail that must be met
• Assessment tools
• Administrative burden

FM Milestones Alpha Testing

• 12 programs
• Recommended:
• 2 residents from each year – total 6 residents
• Variety of residents – top of class, bottom of

class, middle of class

• Clinical Competency Committees
• Survey completed about the process

FM Milestones Alpha Testing

• CCC averaged 6 – 7 members
• Reviewed on average 6 residents
• Averaged time was 60 minutes/resident

with range of 36 – 84 minutes

• 8/12 programs plan to modify their

curriculum because of the experience

• 10/12 programs plan to modify or add new

evaluation tools/methods

FM Milestones

• Revised milestones online:

http://www.acgme-nas.org/assets/pdf/ Milestones/FamilyMedicineMilestones.pdf

• Programs to beta test the FM Milestones
• If interested, please send an email to:

FMMilestones@acgme.org with name of programs, name of program director and contact information

Accreditation Council for Graduate Medical Education

Questions?