AN_AA_11_13_2008AN_AA_11_13_2008
ACGME AnesthesiologyACGME Anesthesiology
RRC UpdateRRC Update
SAAA 2008 Annual Meeting - ...
AN_AA_11_13_2008AN_AA_11_13_2008
What’s NewWhat’s New
 Anesthesiology programsAnesthesiology programs
– New core PRs - ef...
AN_AA_11_13_2008AN_AA_11_13_2008
Executive
Committee
Specialty
Review Committee
Specialty
Review Committee
Specialty
Revie...
AN_AA_11_13_2008AN_AA_11_13_2008
What’s NewWhat’s New
Update onUpdate on Core ProgramsCore Programs
7/07-6/087/07-6/08
 1...
AN_AA_11_13_2008AN_AA_11_13_2008
New AnesthesiologyNew Anesthesiology
Requirements – 7/1/08Requirements – 7/1/08
Increased...
AN_AA_11_13_2008AN_AA_11_13_2008
Additional ComponentsAdditional Components
AllAll PGY-1 residentsPGY-1 residents must hav...
AN_AA_11_13_2008AN_AA_11_13_2008
CA-1 – CA-3 YearsCA-1 – CA-3 Years
 Minimum of 2, 1-month rotations in peds,Minimum of 2...
AN_AA_11_13_2008AN_AA_11_13_2008
Elective ExperiencesElective Experiences
 6 mo of elective time6 mo of elective time
 C...
AN_AA_11_13_2008AN_AA_11_13_2008
Educational ProgramEducational Program
The program must contain:The program must contain:...
AN_AA_11_13_2008AN_AA_11_13_2008
Residents’ Scholarly ActivitiesResidents’ Scholarly Activities
 Curriculum must advance ...
AN_AA_11_13_2008AN_AA_11_13_2008
Resident EvaluationResident Evaluation
 FormativeFormative – faculty must evaluation res...
AN_AA_11_13_2008AN_AA_11_13_2008
Summative EvaluationSummative Evaluation
 Program Director must provide a summativeProgr...
AN_AA_11_13_2008AN_AA_11_13_2008
Faculty EvaluationFaculty Evaluation
 At least annually,At least annually, the programth...
AN_AA_11_13_2008AN_AA_11_13_2008
Program Evaluation & ImprovementProgram Evaluation & Improvement
 Program must document ...
AN_AA_11_13_2008AN_AA_11_13_2008
Resident Duty HoursResident Duty Hours
 Program must be committed to and beProgram must ...
AN_AA_11_13_2008AN_AA_11_13_2008
What’s NewWhat’s New
 Electronic case log – online 7/1/09Electronic case log – online 7/...
AN_AA_11_13_2008AN_AA_11_13_2008
What’s NewWhat’s New
 Outcome Project - Phase 3Outcome Project - Phase 3
– Programs are ...
AN_AA_11_13_2008AN_AA_11_13_2008
What is “experientialWhat is “experiential
learning?”learning?”
 learning through reflec...
AN_AA_11_13_2008AN_AA_11_13_2008
What is “experientialWhat is “experiential
learning?”learning?”
IV.A.5.a).(1)(o)IV.A.5.a)...
AN_AA_11_13_2008AN_AA_11_13_2008
Innovative ProjectsInnovative Projects
Process has
evolved; now
governed by
ACGME Pol &
P...
AN_AA_11_13_2008AN_AA_11_13_2008
Innovative ProposalsInnovative Proposals
Proposal ContentProposal Content
The program dir...
AN_AA_11_13_2008AN_AA_11_13_2008
Innovative ProposalsInnovative Proposals
Approval ProcessApproval Process
 Institutional...
AN_AA_11_13_2008AN_AA_11_13_2008
Innovative ProposalsInnovative Proposals
 StatusStatus
– 14 proposals received by RRC14 ...
AN_AA_11_13_2008AN_AA_11_13_2008
What’s NewWhat’s New
 International rotationsInternational rotations
ABA and RRC support...
AN_AA_11_13_2008AN_AA_11_13_2008
Common CitationsCommon Citations
Core ProgramsCore Programs 7/05-9/087/05-9/08
 Institut...
AN_AA_11_13_2008AN_AA_11_13_2008
Program DirectorProgram Director
 Increasing quantity and quality ofIncreasing quantity ...
AN_AA_11_13_2008AN_AA_11_13_2008
Other ACGME InformationOther ACGME Information
 ACGME Resident SurveyACGME Resident Surv...
AN_AA_11_13_2008AN_AA_11_13_2008
AN_AA_11_13_2008AN_AA_11_13_2008
AN_AA_11_13_2008AN_AA_11_13_2008
What’s NewWhat’s New
 Fellowship programsFellowship programs
– Adult CardiothoracicAdult...
AN_AA_11_13_2008AN_AA_11_13_2008
Adult CardiothoracicAdult Cardiothoracic
AnesthesiologyAnesthesiology
Program requirement...
AN_AA_11_13_2008AN_AA_11_13_2008
Adult CardiothoracicAdult Cardiothoracic
AnesthesiologyAnesthesiology
 Clinical Curricul...
AN_AA_11_13_2008AN_AA_11_13_2008
Common CitationsCommon Citations
Adult Cardiothoracic AnesthesiaAdult Cardiothoracic Anes...
AN_AA_11_13_2008AN_AA_11_13_2008
Pediatric AnesthesiologyPediatric Anesthesiology
7/07-6/087/07-6/08 ––
45 programs45 prog...
AN_AA_11_13_2008AN_AA_11_13_2008
Common CitationsCommon Citations
Pediatric AnesthesiaPediatric Anesthesia 7/05-9/087/05-9...
AN_AA_11_13_2008AN_AA_11_13_2008
Critical Care AnesthesiologyCritical Care Anesthesiology
7/07-6/087/07-6/08 ––
50 program...
AN_AA_11_13_2008AN_AA_11_13_2008
Critical Care AnesthesiologyCritical Care Anesthesiology
Proposed new program requirement...
AN_AA_11_13_2008AN_AA_11_13_2008
Common CitationsCommon Citations
Critical CareCritical Care 7/05-9/087/05-9/08
 Institut...
AN_AA_11_13_2008AN_AA_11_13_2008
Pain MedicinePain Medicine
Multidisciplinary PRs inMultidisciplinary PRs in
effecteffect ...
AN_AA_11_13_2008AN_AA_11_13_2008
Initial Experience -Initial Experience -
New Pain Program RequirementsNew Pain Program Re...
AN_AA_11_13_2008AN_AA_11_13_2008
Common CitationsCommon Citations
Pain MedicinePain Medicine 7/05-9/087/05-9/08
 Institut...
AN_AA_11_13_2008AN_AA_11_13_2008
Recommendations to avoidRecommendations to avoid
citationscitations
Low hanging fruit (Lo...
AN_AA_11_13_2008AN_AA_11_13_2008
Learning Portfolio ProgramLearning Portfolio Program
Individual learning plans, self-refl...
AN_AA_11_13_2008AN_AA_11_13_2008
Further SuggestionsFurther Suggestions
 Bookmark Anesthesiology RRC site (Bookmark Anest...
AN_AA_11_13_2008AN_AA_11_13_2008
What else?What else?
 Your questions …Your questions …
Thank you!Thank you!
AN_AA_11_13_2008AN_AA_11_13_2008
Theoretical Competency Report Card Summary,Theoretical Competency Report Card Summary,
Pr...
AN_AA_11_13_2008AN_AA_11_13_2008
Theoretical Competency Report Card Summary,Theoretical Competency Report Card Summary,
Pr...
AN_AA_11_13_2008AN_AA_11_13_2008
Theoretical Competency Report Card Summary,Theoretical Competency Report Card Summary,
Pr...
AN_AA_11_13_2008AN_AA_11_13_2008
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2008 SAAA Presentation, Anesthesiology RRC Update by Lois - ACGME ...

  1. 1. AN_AA_11_13_2008AN_AA_11_13_2008 ACGME AnesthesiologyACGME Anesthesiology RRC UpdateRRC Update SAAA 2008 Annual Meeting - 11/2/08SAAA 2008 Annual Meeting - 11/2/08 Lois L. Bready, M.D.Lois L. Bready, M.D. Anesthesiology RRC ChairAnesthesiology RRC Chair Professor and Vice Chair, AnesthesiologyProfessor and Vice Chair, Anesthesiology Associate Dean for GMEAssociate Dean for GME UTHSC San AntonioUTHSC San Antonio
  2. 2. AN_AA_11_13_2008AN_AA_11_13_2008 What’s NewWhat’s New  Anesthesiology programsAnesthesiology programs – New core PRs - effective 7/1/08New core PRs - effective 7/1/08 – Electronic case log – online 7/1/09Electronic case log – online 7/1/09 – Progress on phase 3Progress on phase 3 – Update on Innovative ProjectsUpdate on Innovative Projects – International rotationsInternational rotations – Common citationsCommon citations – UpdatesUpdates  Fellowship programsFellowship programs Core 130 ACT 42 Peds 45 CCA 48 PM 94 Total 359
  3. 3. AN_AA_11_13_2008AN_AA_11_13_2008 Executive Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee Transitional Year Review Committee Specialty Review Committee Specialty Review Committee Specialty Review Committee The Complexity of Relationships withinThe Complexity of Relationships within the ACGMEthe ACGME Monitoring Committee Requirements Committee (Ad Hoc) Appeals Committees Institutional Review Committee Council of Review Committee Chairs Policies and Procedures Specialty Review Committee Accreditation Council (BOD) Awards Committee Committee On Innovation ByLaws Strategic Initiatives Finance Committee
  4. 4. AN_AA_11_13_2008AN_AA_11_13_2008 What’s NewWhat’s New Update onUpdate on Core ProgramsCore Programs 7/07-6/087/07-6/08  131 programs, 5266 positions filled131 programs, 5266 positions filled 7/08-6/097/08-6/09  130 programs, 5337 positions filled130 programs, 5337 positions filled
  5. 5. AN_AA_11_13_2008AN_AA_11_13_2008 New AnesthesiologyNew Anesthesiology Requirements – 7/1/08Requirements – 7/1/08 Increased options for entry into AN programs:Increased options for entry into AN programs:  Integrated CBY (4 year program)Integrated CBY (4 year program)  PGY–1 + 3-year programPGY–1 + 3-year program  Transfer after 1+ years of GMETransfer after 1+ years of GME New requirements strictly applied to:New requirements strictly applied to:  7/08 beginning7/08 beginning PGY1PGY1 residents –residents – yesyes  7/08 beginning7/08 beginning CA-1CA-1 residents –residents – nono
  6. 6. AN_AA_11_13_2008AN_AA_11_13_2008 Additional ComponentsAdditional Components AllAll PGY-1 residentsPGY-1 residents must have:must have:  6 months6 months ofof inpatientinpatient care including internalcare including internal medicine, surgery, pediatrics, surgicalmedicine, surgery, pediatrics, surgical specialties, OB/Gyn, Neurology, Familyspecialties, OB/Gyn, Neurology, Family Medicine or a combinationMedicine or a combination  1 -2 months1 -2 months of emergency medicine andof emergency medicine and critical care medicinecritical care medicine  May haveMay have up to 1 monthup to 1 month of anesthesiologyof anesthesiology
  7. 7. AN_AA_11_13_2008AN_AA_11_13_2008 CA-1 – CA-3 YearsCA-1 – CA-3 Years  Minimum of 2, 1-month rotations in peds,Minimum of 2, 1-month rotations in peds, cardiac, neuro, and OB anesthesiacardiac, neuro, and OB anesthesia  4 months of CCM – up to 2 months in PGY-4 months of CCM – up to 2 months in PGY- 1; take in at least one month intervals1; take in at least one month intervals  3 months of PM – up to 1 month in PGY-1;3 months of PM – up to 1 month in PGY-1; taken in at least one month intervalstaken in at least one month intervals  1 month of perioperative medicine; taken in1 month of perioperative medicine; taken in at least one week intervalsat least one week intervals
  8. 8. AN_AA_11_13_2008AN_AA_11_13_2008 Elective ExperiencesElective Experiences  6 mo of elective time6 mo of elective time  Can be used to finish all required PGY-1Can be used to finish all required PGY-1 experiences for residents who transfer fromexperiences for residents who transfer from other specialtiesother specialties  ResearchResearch  Advanced anesthesia rotationsAdvanced anesthesia rotations  Other activities related broadly toOther activities related broadly to perioperative medicineperioperative medicine
  9. 9. AN_AA_11_13_2008AN_AA_11_13_2008 Educational ProgramEducational Program The program must contain:The program must contain: OverallOverall educational goalseducational goals that must bethat must be distributed to residents and facultydistributed to residents and faculty annuallyannually Competency-based goals and objectivesCompetency-based goals and objectives forfor each assignmenteach assignment atat each educational leveleach educational level Regularly scheduledRegularly scheduled didacticdidactic sessionssessions Delineation of resident responsibilitiesDelineation of resident responsibilities forfor patient care, progressive responsibility forpatient care, progressive responsibility for patient management, and supervision ofpatient management, and supervision of residents over the continuum of the programresidents over the continuum of the program
  10. 10. AN_AA_11_13_2008AN_AA_11_13_2008 Residents’ Scholarly ActivitiesResidents’ Scholarly Activities  Curriculum must advance students’Curriculum must advance students’ knowledge of the basic principles ofknowledge of the basic principles of research, including how research isresearch, including how research is conducted, evaluated, and explained toconducted, evaluated, and explained to patients, and applied to patient carepatients, and applied to patient care  Residents should participate in scholarlyResidents should participate in scholarly activityactivity  Sponsoring institution and program shouldSponsoring institution and program should allocate adequate educational resources toallocate adequate educational resources to facilitate residents involvement in scholarlyfacilitate residents involvement in scholarly activitiesactivities
  11. 11. AN_AA_11_13_2008AN_AA_11_13_2008 Resident EvaluationResident Evaluation  FormativeFormative – faculty must evaluation resident– faculty must evaluation resident performance in a timely manner during eachperformance in a timely manner during each rotation or similar educational assignment, androtation or similar educational assignment, and document this evaluation at completion of eachdocument this evaluation at completion of each assignmentassignment  Program must provideProgram must provide objective assessmentsobjective assessments ofof competence in patient care, medical knowledge,competence in patient care, medical knowledge, practice-based learning and improvement,practice-based learning and improvement, interpersonal and communion skills,interpersonal and communion skills, professionalism, and system-based practiceprofessionalism, and system-based practice  UseUse multiple evaluatorsmultiple evaluators  Document progressive performance andDocument progressive performance and improvement appropriate to education levelimprovement appropriate to education level  Document semiannual evaluation of performanceDocument semiannual evaluation of performance withwith feedbackfeedback
  12. 12. AN_AA_11_13_2008AN_AA_11_13_2008 Summative EvaluationSummative Evaluation  Program Director must provide a summativeProgram Director must provide a summative evaluation for each resident upon completion of theevaluation for each resident upon completion of the programprogram  Evaluation must become part of the resident’sEvaluation must become part of the resident’s permanent record that is maintained by thepermanent record that is maintained by the institution; must be accessible for review by theinstitution; must be accessible for review by the residentresident  Must document the resident’s performance duringMust document the resident’s performance during the final period of educationthe final period of education  Must verify that the resident has demonstratedMust verify that the resident has demonstrated sufficient competence to enter practice withoutsufficient competence to enter practice without direct supervisiondirect supervision
  13. 13. AN_AA_11_13_2008AN_AA_11_13_2008 Faculty EvaluationFaculty Evaluation  At least annually,At least annually, the programthe program mustmust evaluateevaluate faculty performancefaculty performance as it relates toas it relates to the educational programthe educational program  Evaluations should include a review ofEvaluations should include a review of clinical teaching abilitiesclinical teaching abilities,, commitment to thecommitment to the educational programeducational program,, clinical knowledgeclinical knowledge,, professionalismprofessionalism, and, and scholarly activitiesscholarly activities  Must include at least annual writtenMust include at least annual written confidential evaluations by the residentsconfidential evaluations by the residents
  14. 14. AN_AA_11_13_2008AN_AA_11_13_2008 Program Evaluation & ImprovementProgram Evaluation & Improvement  Program must document formal, systematicProgram must document formal, systematic evaluation of theevaluation of the curriculumcurriculum annuallyannually  Program must monitor and track:Program must monitor and track: – resident performanceresident performance – faculty developmentfaculty development – graduate performance on certifying examinationgraduate performance on certifying examination – resident and faculty confidential evaluationsresident and faculty confidential evaluations – use residents’ assessments and otheruse residents’ assessments and other evaluations to improve the programevaluations to improve the program
  15. 15. AN_AA_11_13_2008AN_AA_11_13_2008 Resident Duty HoursResident Duty Hours  Program must be committed to and beProgram must be committed to and be responsible for promoting patient safety andresponsible for promoting patient safety and resident well-being and to provide aresident well-being and to provide a supportive educational environmentsupportive educational environment  Program learning objectives must not beProgram learning objectives must not be compromised by excessive reliance oncompromised by excessive reliance on resident to fulfill service obligationsresident to fulfill service obligations  Priority for didactic and clinical educationPriority for didactic and clinical education
  16. 16. AN_AA_11_13_2008AN_AA_11_13_2008 What’s NewWhat’s New  Electronic case log – online 7/1/09Electronic case log – online 7/1/09 – Developed over past yearDeveloped over past year – Aligns with program requirementsAligns with program requirements – Piloted by __ programsPiloted by __ programs – Training resources online early 2009Training resources online early 2009 – Will require entry of cases by residentsWill require entry of cases by residents
  17. 17. AN_AA_11_13_2008AN_AA_11_13_2008 What’s NewWhat’s New  Outcome Project - Phase 3Outcome Project - Phase 3 – Programs are making excellent progressPrograms are making excellent progress
  18. 18. AN_AA_11_13_2008AN_AA_11_13_2008 What is “experientialWhat is “experiential learning?”learning?”  learning through reflection on doing, which islearning through reflection on doing, which is often contrasted with rote oroften contrasted with rote or didacticdidactic learninglearning  focuses on the learning process for thefocuses on the learning process for the individualindividual  make discoveries and experiment withmake discoveries and experiment with knowledge firsthand, instead of hearing orknowledge firsthand, instead of hearing or reading about others' experiencesreading about others' experiences  ““experience” – 42 times in core programexperience” – 42 times in core program requirementsrequirements
  19. 19. AN_AA_11_13_2008AN_AA_11_13_2008 What is “experientialWhat is “experiential learning?”learning?” IV.A.5.a).(1)(o)IV.A.5.a).(1)(o) (o) Patients who require specialized(o) Patients who require specialized techniques for their perioperative care. There musttechniques for their perioperative care. There must be significantbe significant experienceexperience with a broad spectrum ofwith a broad spectrum of airway management techniques (e.g., performanceairway management techniques (e.g., performance of fiberoptic intubation and lung isolation techniquesof fiberoptic intubation and lung isolation techniques such as double lumen endotracheal tube placementsuch as double lumen endotracheal tube placement and endobronchial blockers).and endobronchial blockers).
  20. 20. AN_AA_11_13_2008AN_AA_11_13_2008 Innovative ProjectsInnovative Projects Process has evolved; now governed by ACGME Pol & Proc 6/08
  21. 21. AN_AA_11_13_2008AN_AA_11_13_2008 Innovative ProposalsInnovative Proposals Proposal ContentProposal Content The program director submits the proposal using the ACGME form,The program director submits the proposal using the ACGME form, “Proposal for Program Experimentation and Innovation” to the“Proposal for Program Experimentation and Innovation” to the Review Committee Executive Director. The institution’s andReview Committee Executive Director. The institution’s and program’s responsibilities are to clearly demonstrate that the projectprogram’s responsibilities are to clearly demonstrate that the project willwill improve resident educationimprove resident education and/orand/or patient carepatient care. The proposal. The proposal must include the following:must include the following: a) description of the project,a) description of the project, b) rationale for the project,b) rationale for the project, c) method of evaluation,c) method of evaluation, d) accreditation requirements from which the program/institution willd) accreditation requirements from which the program/institution will deviate,deviate, e) description of any new, missing or variant on-line submission ofe) description of any new, missing or variant on-line submission of information through the Accreditation Data System (ADS) thatinformation through the Accreditation Data System (ADS) that would require Review Committee approval,would require Review Committee approval, f) approval by the institutional GME Committeef) approval by the institutional GME Committee g) signature of the designated institutional official.g) signature of the designated institutional official. ACGME Pol & Proc 6/08, pp. 103-5
  22. 22. AN_AA_11_13_2008AN_AA_11_13_2008 Innovative ProposalsInnovative Proposals Approval ProcessApproval Process  Institutional (DIO)Institutional (DIO)  RRC – Executive Director reviewsRRC – Executive Director reviews – screen for variance to CPRs/Instit Reqs; ACGME judges whetherscreen for variance to CPRs/Instit Reqs; ACGME judges whether the proposal justifies granting a variance to the common programthe proposal justifies granting a variance to the common program and/or institutional requirements.and/or institutional requirements. – ADS issues? Addressed prior to RRC reviewADS issues? Addressed prior to RRC review  RRC reviewRRC review – Formal review at regular meetings; documentation in program’sFormal review at regular meetings; documentation in program’s historyhistory – Determine whether request justifies granting approval of theDetermine whether request justifies granting approval of the project;project; – stipulate the duration of the approval, which will be no longerstipulate the duration of the approval, which will be no longer than the next review;than the next review; – inform the program and/or institution of the form of monitoring byinform the program and/or institution of the form of monitoring by the Review Committee;the Review Committee; – enter information regarding the approved Innovative Projects inenter information regarding the approved Innovative Projects in the Accreditation Data System.the Accreditation Data System. ACGME Pol & Proc 6/08, pp. 103-5
  23. 23. AN_AA_11_13_2008AN_AA_11_13_2008 Innovative ProposalsInnovative Proposals  StatusStatus – 14 proposals received by RRC14 proposals received by RRC  3 denied (design; program/institution status)3 denied (design; program/institution status)  1 currently undergoing ABA review1 currently undergoing ABA review  10 underway10 underway  Themes to dateThemes to date – Supervisory ratio/transition to practiceSupervisory ratio/transition to practice – eICUeICU – Specialty tracks/combined fellowshipSpecialty tracks/combined fellowship
  24. 24. AN_AA_11_13_2008AN_AA_11_13_2008 What’s NewWhat’s New  International rotationsInternational rotations ABA and RRC support programsABA and RRC support programs integrating international rotations asintegrating international rotations as standing electivesstanding electives and seek RRCand seek RRC approval rather than seeking ABAapproval rather than seeking ABA approval on a case-by-case basis.approval on a case-by-case basis.
  25. 25. AN_AA_11_13_2008AN_AA_11_13_2008 Common CitationsCommon Citations Core ProgramsCore Programs 7/05-9/087/05-9/08  Institutional supportInstitutional support – Sponsoring Inst’n, PD support, space, call rooms, etc.Sponsoring Inst’n, PD support, space, call rooms, etc.  Resident appointment issuesResident appointment issues  Program personnel & resourcesProgram personnel & resources – Qual/responsibilities of PD; of facultyQual/responsibilities of PD; of faculty  The Education ProgramThe Education Program – G&O, curriculum, procedural experience, competencies,G&O, curriculum, procedural experience, competencies, progressive responsibility, service/education, scholarlyprogressive responsibility, service/education, scholarly activity, supervision, duty hoursactivity, supervision, duty hours  EvaluationEvaluation – residents, faculty, program, board scoresresidents, faculty, program, board scores
  26. 26. AN_AA_11_13_2008AN_AA_11_13_2008 Program DirectorProgram Director  Increasing quantity and quality ofIncreasing quantity and quality of responsibilitiesresponsibilities  RRC expects protected time for PD*RRC expects protected time for PD* – 1 day/week for fellowships, small programs1 day/week for fellowships, small programs – 2 days/week for core programs2 days/week for core programs  RRC discourages Department Chairs fromRRC discourages Department Chairs from serving simultaneously as Program Directorserving simultaneously as Program Director for the core anesthesiology programfor the core anesthesiology program *Anesthesiology RRC website - FAQs
  27. 27. AN_AA_11_13_2008AN_AA_11_13_2008 Other ACGME InformationOther ACGME Information  ACGME Resident SurveyACGME Resident Survey – Any report of duty hours violations will beAny report of duty hours violations will be taken VERY seriouslytaken VERY seriously
  28. 28. AN_AA_11_13_2008AN_AA_11_13_2008
  29. 29. AN_AA_11_13_2008AN_AA_11_13_2008
  30. 30. AN_AA_11_13_2008AN_AA_11_13_2008 What’s NewWhat’s New  Fellowship programsFellowship programs – Adult CardiothoracicAdult Cardiothoracic – Pediatric AnesthesiologyPediatric Anesthesiology – Pain MedicinePain Medicine – Critical CareCritical Care
  31. 31. AN_AA_11_13_2008AN_AA_11_13_2008 Adult CardiothoracicAdult Cardiothoracic AnesthesiologyAnesthesiology Program requirementsProgram requirements approvedapproved 2/14/062/14/06 7/07-6/087/07-6/08 –– 33 programs33 programs 88 positions filled88 positions filled 7/08-6/097/08-6/09 –– 42 programs42 programs 99 positions filled99 positions filled 0 20 40 60 80 100 7/07- 6/08 7/08- 6/09 # progs # fellows
  32. 32. AN_AA_11_13_2008AN_AA_11_13_2008 Adult CardiothoracicAdult Cardiothoracic AnesthesiologyAnesthesiology  Clinical CurriculumClinical Curriculum – 1 mo noncardiac thoracic1 mo noncardiac thoracic  Thoracic stents under anesthesiaThoracic stents under anesthesia count (but can’t becount (but can’t be all the thoracic cases)all the thoracic cases) – 1 mo ICU - adult CT surgery/non-surg1 mo ICU - adult CT surgery/non-surg – 2 mos electives (2 mos electives (min 2 wksmin 2 wks) or 1-2 mos research) or 1-2 mos research – Experience withExperience with pediatricpediatric cardiothoraciccardiothoracic anesthesia is encouragedanesthesia is encouraged – 300 complete perioperative echo exams300 complete perioperative echo exams  at least 150 comprehensive intraoperative TEEat least 150 comprehensive intraoperative TEE examinations performed, interpreted, and reported byexaminations performed, interpreted, and reported by the fellowthe fellow
  33. 33. AN_AA_11_13_2008AN_AA_11_13_2008 Common CitationsCommon Citations Adult Cardiothoracic AnesthesiaAdult Cardiothoracic Anesthesia 7/05-9/087/05-9/08  Institutional supportInstitutional support – Sponsoring Inst’n, PD support, space, call rooms, etc.Sponsoring Inst’n, PD support, space, call rooms, etc.  Resident appointment issuesResident appointment issues  Program personnel & resourcesProgram personnel & resources – Qual/responsibilities of PD; of facultyQual/responsibilities of PD; of faculty  The Education ProgramThe Education Program – G&O, curriculum, procedural experience, competencies,G&O, curriculum, procedural experience, competencies, progressive responsibility, service/education, scholarlyprogressive responsibility, service/education, scholarly activity, supervision, duty hoursactivity, supervision, duty hours  EvaluationEvaluation – residents, faculty, programresidents, faculty, program
  34. 34. AN_AA_11_13_2008AN_AA_11_13_2008 Pediatric AnesthesiologyPediatric Anesthesiology 7/07-6/087/07-6/08 –– 45 programs45 programs 162 positions filled162 positions filled 7/08-6/097/08-6/09 –– 45 programs45 programs 171 positions filled171 positions filled 0 50 100 150 200 7/07- 6/08 7/08- 6/09 # progs # fellows
  35. 35. AN_AA_11_13_2008AN_AA_11_13_2008 Common CitationsCommon Citations Pediatric AnesthesiaPediatric Anesthesia 7/05-9/087/05-9/08  Institutional supportInstitutional support – Sponsoring Inst’n, PD support, space, call rooms, etc.Sponsoring Inst’n, PD support, space, call rooms, etc.  Resident appointment issuesResident appointment issues  Program personnel & resourcesProgram personnel & resources – Responsibilities of PD; of facultyResponsibilities of PD; of faculty  The Education ProgramThe Education Program – G&O, curriculum, procedural experience, competencies,G&O, curriculum, procedural experience, competencies, progressive responsibility, service/education, scholarlyprogressive responsibility, service/education, scholarly activity, supervision, duty hoursactivity, supervision, duty hours  EvaluationEvaluation – residents, faculty, program, board scoresresidents, faculty, program, board scores
  36. 36. AN_AA_11_13_2008AN_AA_11_13_2008 Critical Care AnesthesiologyCritical Care Anesthesiology 7/07-6/087/07-6/08 –– 50 programs50 programs 82 positions filled82 positions filled 7/08-6/097/08-6/09 –– 48 programs48 programs 88 positions filled88 positions filled 0 20 40 60 80 100 7/07- 6/08 7/08- 6/09 # progs # fellows
  37. 37. AN_AA_11_13_2008AN_AA_11_13_2008 Critical Care AnesthesiologyCritical Care Anesthesiology Proposed new program requirementsProposed new program requirements  Proposed revision 2007-8Proposed revision 2007-8  Undergoing review by ACGMEUndergoing review by ACGME Requirements Development CommitteeRequirements Development Committee  Then, to beThen, to be posted for formal commentposted for formal comment  Final approval expected 6/09Final approval expected 6/09  Formal rotations in pediatrics are notFormal rotations in pediatrics are not required, but there should be educationrequired, but there should be education about differences in approach to theabout differences in approach to the critically ill adult vs. pediatric patient.critically ill adult vs. pediatric patient.
  38. 38. AN_AA_11_13_2008AN_AA_11_13_2008 Common CitationsCommon Citations Critical CareCritical Care 7/05-9/087/05-9/08  Institutional supportInstitutional support – Sponsoring Inst’n, PD support, spaceSponsoring Inst’n, PD support, space  Resident appointment issuesResident appointment issues  Program personnel & resourcesProgram personnel & resources – Responsibilities of PD; of faculty, resourcesResponsibilities of PD; of faculty, resources  The Education ProgramThe Education Program – G&O, curriculum, procedural experience, competencies,G&O, curriculum, procedural experience, competencies, progressive responsibility, scholarly activity, supervision,progressive responsibility, scholarly activity, supervision, duty hoursduty hours  EvaluationEvaluation – residents, faculty, program, board scoresresidents, faculty, program, board scores
  39. 39. AN_AA_11_13_2008AN_AA_11_13_2008 Pain MedicinePain Medicine Multidisciplinary PRs inMultidisciplinary PRs in effecteffect 7/1/077/1/07 7/07-6/087/07-6/08 –– 92 programs92 programs 314 positions filled314 positions filled 7/08-6/097/08-6/09 –– 94 programs94 programs 316 positions filled316 positions filled 0 100 200 300 400 7/07- 6/08 7/08- 6/09 # progs # fellows
  40. 40. AN_AA_11_13_2008AN_AA_11_13_2008 Initial Experience -Initial Experience - New Pain Program RequirementsNew Pain Program Requirements Multidisciplinary Program RequirementsMultidisciplinary Program Requirements 7/1/077/1/07  Anesth, Neurology, PM&R, PsychiatryAnesth, Neurology, PM&R, Psychiatry  Significant challenge to incorporate all requiredSignificant challenge to incorporate all required experiences in 12 month programexperiences in 12 month program  Pain Advisory Committee – conducts prescreenPain Advisory Committee – conducts prescreen  Reviews to date = significant challenges for someReviews to date = significant challenges for some programsprograms
  41. 41. AN_AA_11_13_2008AN_AA_11_13_2008 Common CitationsCommon Citations Pain MedicinePain Medicine 7/05-9/087/05-9/08  Institutional supportInstitutional support – Sponsoring Inst’n, PD support, participating inst’n, spaceSponsoring Inst’n, PD support, participating inst’n, space  Resident appointment issuesResident appointment issues  Program personnel & resourcesProgram personnel & resources – Responsibilities of PD; of faculty, resourcesResponsibilities of PD; of faculty, resources  The Education ProgramThe Education Program – G&O, curriculum, procedural experience, competencies,G&O, curriculum, procedural experience, competencies, progressive responsibility, service/education, scholarlyprogressive responsibility, service/education, scholarly activity, supervision, duty hoursactivity, supervision, duty hours  EvaluationEvaluation – residents, faculty, program, board scoresresidents, faculty, program, board scores
  42. 42. AN_AA_11_13_2008AN_AA_11_13_2008 Recommendations to avoidRecommendations to avoid citationscitations Low hanging fruit (Low hanging fruit (avoiding common citationsavoiding common citations))  Conduct annual program review & create writtenConduct annual program review & create written action planaction plan  Evaluations - residents (360*), faculty, programEvaluations - residents (360*), faculty, program  Internal review - midpoint of accreditation cycleInternal review - midpoint of accreditation cycle  Program letters of agreementProgram letters of agreement  G&O and outcome measures – by rotation and byG&O and outcome measures – by rotation and by training leveltraining level  Competency-based languageCompetency-based language  Education – sleep and fatigue – faculty, too!Education – sleep and fatigue – faculty, too!
  43. 43. AN_AA_11_13_2008AN_AA_11_13_2008 Learning Portfolio ProgramLearning Portfolio Program Individual learning plans, self-reflection,Individual learning plans, self-reflection, trackingtracking  ACGME pilot programACGME pilot program  Electronic portfoliosElectronic portfolios  Hardcopy portfoliosHardcopy portfolios
  44. 44. AN_AA_11_13_2008AN_AA_11_13_2008 Further SuggestionsFurther Suggestions  Bookmark Anesthesiology RRC site (Bookmark Anesthesiology RRC site ( www.acgme.orgwww.acgme.org))  Update and save on your desktop:Update and save on your desktop: – Program requirementsProgram requirements – Program information form (PIF)Program information form (PIF) – Other items useful to your programOther items useful to your program  Contacts for questions/suggestionsContacts for questions/suggestions – Core programs - Missy Fleming PhD (Core programs - Missy Fleming PhD ( mfleming@acgme.orgmfleming@acgme.org)) – Subspecialties - Linda Thorsen (Subspecialties - Linda Thorsen (lmt@acgme.orglmt@acgme.org ))
  45. 45. AN_AA_11_13_2008AN_AA_11_13_2008 What else?What else?  Your questions …Your questions … Thank you!Thank you!
  46. 46. AN_AA_11_13_2008AN_AA_11_13_2008 Theoretical Competency Report Card Summary,Theoretical Competency Report Card Summary, Program XProgram X All Residents, All LevelsAll Residents, All Levels 0 10 20 30 40 50 60 70 80 90 100 P-1 P-2 P-3 P-4 P-5 P-6 PTC-1 PTC-2 PTC-3 PTC-4 PTC-5 PTC-6 C-1 C-2 C-3 C-4 C-5 C-6 MK-1 MK-2 MK-3 MK-4 MK-5 MK-6 PBLI-1 PBLI-2 PBLI-3 PBLI-4 PBLI-5 PBLI-6 SBP-1 SBP-2 SBP-3 SBP-4 SBP-5 SBP-6 National %at or above milestone ProfessionalismProfessionalism Patient CarePatient Care CommunicationsCommunicationsMedicalMedical KnowledgeKnowledge Systems BasedSystems Based PracticePractice PracticePractice BasedBased LearningLearning AndAnd ImprovementImprovement
  47. 47. AN_AA_11_13_2008AN_AA_11_13_2008 Theoretical Competency Report Card Summary,Theoretical Competency Report Card Summary, Program XProgram X All Residents, All LevelsAll Residents, All Levels 0 10 20 30 40 50 60 70 80 90 100 P-1 P-2 P-3 P-4 P-5 P-6 PTC-1 PTC-2 PTC-3 PTC-4 PTC-5 PTC-6 C-1 C-2 C-3 C-4 C-5 C-6 MK-1 MK-2 MK-3 MK-4 MK-5 MK-6 PBLI-1 PBLI-2 PBLI-3 PBLI-4 PBLI-5 PBLI-6 SBP-1 SBP-2 SBP-3 SBP-4 SBP-5 SBP-6 National % at or above milestone 2 SD or more below National Mean % ProfessionalismProfessionalism Patient CarePatient Care CommunicationsCommunicationsMedicalMedical KnowledgeKnowledge Systems BasedSystems Based PracticePractice PracticePractice BasedBased LearningLearning AndAnd ImprovementImprovement
  48. 48. AN_AA_11_13_2008AN_AA_11_13_2008 Theoretical Competency Report Card Summary,Theoretical Competency Report Card Summary, Program XProgram X All Residents, All LevelsAll Residents, All Levels 0 10 20 30 40 50 60 70 80 90 100 P-1 P-2 P-3 P-4 P-5 P-6 PTC-1 PTC-2 PTC-3 PTC-4 PTC-5 PTC-6 C-1 C-2 C-3 C-4 C-5 C-6 MK-1 MK-2 MK-3 MK-4 MK-5 MK-6 PBLI-1 PBLI-2 PBLI-3 PBLI-4 PBLI-5 PBLI-6 SBP-1 SBP-2 SBP-3 SBP-4 SBP-5 SBP-6 Program %at or above milestone National %at or above milestone 2 SD or more below National Mean % ProfessionalismProfessionalism Patient CarePatient Care CommunicationsCommunicationsMedicalMedical KnowledgeKnowledge Systems BasedSystems Based PracticePractice PracticePractice BasedBased LearningLearning AndAnd ImprovementImprovement
  49. 49. AN_AA_11_13_2008AN_AA_11_13_2008
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