AGA 2013        GI Training Directors             Workshop  Jo Meyer, Education CoordinatorAmy Oxentenko, MD, Program Dire...
Next Accreditation System          (NAS)for Program Coordinators
How Bad Is This Going To Hurt?
Yet – To Be DeterminedFrom ACGME FAQs about NAS-December 2012
NAS is a Moving Target
What We Will Review• Overview of NAS  (Background; Core, Detail,  Outcome; WebAds)• CLER Program• Clinical Competency Comm...
What We Will Review• Overview of NAS  (Background; Core, Detail,  Outcome; WebAds)• CLER Program• Clinical Competency Comm...
Differences    Accreditation            NAS* PIF                    * No PIF – Annual Data                                ...
Other New Aspects of NAS•   Program Requirement Re-categorization•   Development of Milestones•   WebAds (Faculty Survey)•...
Timeline of NAS• Phase 1 – Core Programs, (Internal Medicine)     Specialty Milestones Complete• Spring 2013 – Final Site ...
Timeline of NASFor GI•   Late Spring 2012 – Resident/Fellow Survey•   September 2012 – WebAds Update•   Late Fall 2012 – F...
Annual Data Collection• ADS Update    –   Attrition (PD / core faculty / residents)    –   Program Characteristics (block ...
FAQs of NAS              (updated Dec. 2012)http://www.acgme-nas.org/assets/pdf/NASFAQs.pdf
Program Requirements (PR)• PRs have been re-categorized “core” &  “detailed”• NAS – focus is on “outcomes”• “Detail” requi...
“Core,” “Detailed,” &    “Outcome”
Examples PR “Core”Taken from 2012 APDIM Fall Meeting – ACGME•PD Salary Support•Inpatient Caps•Faculty Qualifications (e.g....
Examples PR “Detail”Taken from 2012 APDIM Fall Meeting – ACGME•Simulation•Minimum 1/3 ambulatory, 1/3 inpatient•5 year rul...
Examples PR “Outcome”Taken from 2012 APDIM Fall Meeting – ACGME•80% / 80% board take / board pass rule•PR’s related to pri...
MilestonesACGME December 2012 FAQ’s defineMilestones as:  – observable developmental steps,    organized under the six com...
Development of Milestones                  Raising a ChildGrade school•Know how to brush their teeth•Know how to make thei...
GI Milestones• Development of milestones for  subspecialty programs scheduled to  begin July 2013• Subspecialty milestones...
Milestone Questions Answered       by ACGME FAQshttp://www.acgme-nas.org/assets/pdf/NASFAQs.pdf
What We Will Review• Overview of NAS  (Background; Core, Detail,  Outcome; WebAds)• CLER Program• Clinical Competency Comm...
Clinical LearningEnvironment Review  (CLER) Program
Aims of CLER• Promote safety and quality of care• Focus on six areas• Care residents give and will provide  after residency
Six Areas of Focus•   Engaging Residents in Patient Safety•   Engaging Residents in Quality Improvement•   Patient Care Tr...
CLER Visits• Team of dedicated site visitors• During the first 18-month cycle, SVs will visit  only one major participatin...
CLER Visits (cont.)• Will be asked to share existing documents  –   Quality and safety strategies  –   Policies on supervi...
Data From CLER Visits• Testing phase• Continue to develop, test,  implement• Gather baseline data• Give formative feedback
CLER Eval ProcessProvide 3 opportunities for feedback  1. Oral report  2. Written report to institution before     submiss...
Examples of CLER Data1) Patient Safety
Examples of CLER Data2) Quality Improvement    All fellow are required to complete a QI project during fellowship
Examples of CLER Data3) Patient Care Transitions
Examples of CLER Data3) Patient Care Transitions
Examples of CLER Data4) Resident Supervision
Examples of CLER Data5) Duty Hours  - Back-up fellow on call 24/7  - Fellows on at-risk rotations monitored weekly  - Fell...
Examples of CLER Data5) Duty Hours
Examples of CLER Data5) Duty Hours
Examples of CLER Data5) Duty Hours
Examples of CLER Data - DOM6) Enhancing Professionalism
Examples of CLER - MMS6) Enhancing Professionalism
Resources for CLER Program1)   https://www.aamc.org/members/gra/306034/clerwebinar.html2)      http://www.acgme-nas.org/
Thank you!Joanna L. Meyer (Jo) jmeyer@mayo.edu
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Next accreditation system for program coordinators meyer3

  1. 1. AGA 2013 GI Training Directors Workshop Jo Meyer, Education CoordinatorAmy Oxentenko, MD, Program Director Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN
  2. 2. Next Accreditation System (NAS)for Program Coordinators
  3. 3. How Bad Is This Going To Hurt?
  4. 4. Yet – To Be DeterminedFrom ACGME FAQs about NAS-December 2012
  5. 5. NAS is a Moving Target
  6. 6. What We Will Review• Overview of NAS (Background; Core, Detail, Outcome; WebAds)• CLER Program• Clinical Competency Committee• Direct Observation/ Supervision of Fellows
  7. 7. What We Will Review• Overview of NAS (Background; Core, Detail, Outcome; WebAds)• CLER Program• Clinical Competency Committee• Direct Observation/ Supervision of Fellows
  8. 8. Differences Accreditation NAS* PIF * No PIF – Annual Data Collection* Site Visits (5 yrs) * Site Visits (10 yrs) Self Study* ACGME Oversight * Local Oversight (MSGME/DIO)* Internal Reviews * Verify Oversight – CLER (midway site visit) (every 18 mo.)
  9. 9. Other New Aspects of NAS• Program Requirement Re-categorization• Development of Milestones• WebAds (Faculty Survey)• Resident survey with new focus – Quality, safety, transitions of care, fatigue• CLER Program (Clinical Learning Environment Review)• Clinical Competency Committee• Direct Observation/Supervision
  10. 10. Timeline of NAS• Phase 1 – Core Programs, (Internal Medicine) Specialty Milestones Complete• Spring 2013 – Final Site Visit• July 2013 – Subspecialty Milestone Development Begins• January 2014 – RC Reviews Annual Data• May 2014 – Self-Study Visits Begin (Cores, Subs)
  11. 11. Timeline of NASFor GI• Late Spring 2012 – Resident/Fellow Survey• September 2012 – WebAds Update• Late Fall 2012 – Faculty Survey• Late Spring 2013 – Resident Survey
  12. 12. Annual Data Collection• ADS Update – Attrition (PD / core faculty / residents) – Program Characteristics (block diagram, sites) – Faculty Scholarly Activity (ACGME populates from Pub Med)• Board Pass Rates (graduates)• Case Logs / Experience• Resident Survey• Faculty Survey• Milestones Report (semi-annual, CCC report) – Program reports on milestones – RRC reviews de-identified, aggregated resident data • Progress of a resident cohort over time • Are residents progressing? • Achieving competency for independent practice?
  13. 13. FAQs of NAS (updated Dec. 2012)http://www.acgme-nas.org/assets/pdf/NASFAQs.pdf
  14. 14. Program Requirements (PR)• PRs have been re-categorized “core” & “detailed”• NAS – focus is on “outcomes”• “Detail” requirements will be mandatory for new programs or those that have failed to meet expectations for outcomes• High-performing programs will be allowed the opportunity to innovate
  15. 15. “Core,” “Detailed,” & “Outcome”
  16. 16. Examples PR “Core”Taken from 2012 APDIM Fall Meeting – ACGME•PD Salary Support•Inpatient Caps•Faculty Qualifications (e.g. certification)
  17. 17. Examples PR “Detail”Taken from 2012 APDIM Fall Meeting – ACGME•Simulation•Minimum 1/3 ambulatory, 1/3 inpatient•5 year rule for PD’s
  18. 18. Examples PR “Outcome”Taken from 2012 APDIM Fall Meeting – ACGME•80% / 80% board take / board pass rule•PR’s related to principals of professionalism (Safety, recognition of fatigue, honesty of reporting, etc.)•Effective handoffs
  19. 19. MilestonesACGME December 2012 FAQ’s defineMilestones as: – observable developmental steps, organized under the six competency areas, that describe a trajectory of progress on the competencies from novice (entering resident) to proficient (graduating resident) and, ultimately, to expert/master.
  20. 20. Development of Milestones Raising a ChildGrade school•Know how to brush their teeth•Know how to make their bedMiddle school•Know how to do laundry•Know how to make mealsHigh school•Know how to manage money•Know how to drive a car•Know how to make decisions/prioritize/be responsible
  21. 21. GI Milestones• Development of milestones for subspecialty programs scheduled to begin July 2013• Subspecialty milestones will also focus to a much greater extent on medical knowledge and patient care skills
  22. 22. Milestone Questions Answered by ACGME FAQshttp://www.acgme-nas.org/assets/pdf/NASFAQs.pdf
  23. 23. What We Will Review• Overview of NAS (Background; Core, Detail, Outcome; WebAds)• CLER Program• Clinical Competency Committee• Direct Observation/ Supervision of Fellows
  24. 24. Clinical LearningEnvironment Review (CLER) Program
  25. 25. Aims of CLER• Promote safety and quality of care• Focus on six areas• Care residents give and will provide after residency
  26. 26. Six Areas of Focus• Engaging Residents in Patient Safety• Engaging Residents in Quality Improvement• Patient Care Transitions• Resident Supervision• Duty Hour Oversite/Fatigue Management• Professionalism in the Learning Environment
  27. 27. CLER Visits• Team of dedicated site visitors• During the first 18-month cycle, SVs will visit only one major participating site for each Sponsoring Institution• No less than 10 day’s notice• Not required to complete documents• Will be asked to share existing documents
  28. 28. CLER Visits (cont.)• Will be asked to share existing documents – Quality and safety strategies – Policies on supervision – Duty hours• Site visitors – Combine group meetings and walking rounds• Interview faculty, program directors, trainees, MSGME leadership
  29. 29. Data From CLER Visits• Testing phase• Continue to develop, test, implement• Gather baseline data• Give formative feedback
  30. 30. CLER Eval ProcessProvide 3 opportunities for feedback 1. Oral report 2. Written report to institution before submission to CLER Evaluation Committee – Institution respond 3. Final report to CLER Evaluation Committee
  31. 31. Examples of CLER Data1) Patient Safety
  32. 32. Examples of CLER Data2) Quality Improvement All fellow are required to complete a QI project during fellowship
  33. 33. Examples of CLER Data3) Patient Care Transitions
  34. 34. Examples of CLER Data3) Patient Care Transitions
  35. 35. Examples of CLER Data4) Resident Supervision
  36. 36. Examples of CLER Data5) Duty Hours - Back-up fellow on call 24/7 - Fellows on at-risk rotations monitored weekly - Fellows may seek guidance anytime - Fellows complete a module to recognize and mitigate fatigue
  37. 37. Examples of CLER Data5) Duty Hours
  38. 38. Examples of CLER Data5) Duty Hours
  39. 39. Examples of CLER Data5) Duty Hours
  40. 40. Examples of CLER Data - DOM6) Enhancing Professionalism
  41. 41. Examples of CLER - MMS6) Enhancing Professionalism
  42. 42. Resources for CLER Program1) https://www.aamc.org/members/gra/306034/clerwebinar.html2) http://www.acgme-nas.org/
  43. 43. Thank you!Joanna L. Meyer (Jo) jmeyer@mayo.edu
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