Final summit presentation suzanne rose

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Final summit presentation suzanne rose

  1. 1. 2/25/13   Internal  Medicine  Subspecialty    Milestones  Summit:     February  11-­‐12,  2013,  Alexandria,  VA     Milestone   Suzanne  Rose,  MD,  MSEd   Senior  Associate  Dean  for  Educa2on   Professor  of  Medicine   University  of  Connec2cut  School  of  Medicine   Background  •  New  ERA  for  GME  •  Next  AccreditaMon  System:    NAS    New  Nomenclature,  Processes,  and  Compliance  •  Competencies  and  Milestones  •  EPA’s:    Entrustable  Professional  AcMviMes  •  CLER  Visits   A  Key  element  of  the  NAS  is  the  measurement  and  reporMng  of  outcomes   through  the  educaMonal  milestones….   Programs  in  the  NAS  will  submit  composite  milestone  data  on  their  residents   every  6  months,  synchronized  with  residents’  semiannual  evaluaMons.   1  
  2. 2. 2/25/13   Components  of  NAS   •  Program  aXriMon   •  Program  changes   •  Resident  survey   •  Board  pass  rate   •  Clinical  experience  log   •  Core  faculty  scholarly  acMviMe   •  Faculty  survey   •  CLER  visit   • Repor&ng  of  milestones   Where  are  we  now?  •  Six  specialMes  ready  for  the  ACGME  Milestones  2013   –  DiagnosMc  radiology   –  EM   –  IM   –  Neuro  Surg   –  Orthopedics   –  Pediatrics   –  Urology  •  IM  has  established  22  sub-­‐competencies  •  Now  it  is  Mme  for  the  IM  subspecialMes  to  create  their   competencies/milestones  •  Summit  organized  to  bring  together  the  Chairs  of  the   EducaMon  and  Training  CommiXees  in  the  Sub-­‐specialty   socieMes  •  Develop  subspecialty  milestones  now  •  ImplementaMon  in  2014   Before  the  MeeMng   2  
  3. 3. 2/25/13   MeeMng  Agenda  •  Key  Stakeholder  PerspecMves  –  AAIM,  ABIM,  and   ACGME  •  Basics  of  Competency-­‐based  Medical  EducaMon:     Concepts  of  Curricular  Milestones,  EPAs,  and  NAS   ReporMng  Milestones  •  Review  of  some  of  the  subspecialty  work:   –  Geriatrics   –  Cardiology   –  GI-­‐Transplant  Hepatology  (wonderful  work  of  Oren  Fix,   MD  and  colleagues!)    •  Small  group  work  •  Large  group  review  of  small  group  work  RepresentaMon  from  GI  at  the  meeMng:    AASLD,  ACG,  AGA,  ASGE   ACGME  Competencies       Introduced    1999     Implemented    2001    •  PaMent  Care      •  Medical  Knowledge  •  Systems-­‐Based  PracMce    •  PracMce-­‐Based  Learning  &  Improvement    •  Professionalism    •  Interpersonal  &  CommunicaMon  Skills     CBME,  NAS,  EPA  •  CBME:  assessing  meaningful  outcomes   –  Work-­‐based   –  AuthenMc  •  NAS:    reporMng  meaningful  outcomes   –  Developmental  progression  over  Mme   (MILESTONES)  •  EPA:    strategy  to  create  meaningful,  work-­‐ based  assessments  of  residents/fellows   –  can  generate  data  for  reporMng  milestones  in  NAS   3  
  4. 4. 2/25/13   Entrustable  Professional  AcMviMes   “…  idenMfy  the  criMcal  ac2vi2es  that  consMtute  a  specialty   …  the  ac2vi2es  of  which  we  would  all  agree  should  be   only  carried  out  by  a  trained  specialist.”     •  Observed  and  measurable                      to  an  conclusion   •  Reflects  expected  competencies   •  EPA’s  =  Core  of  the  profession   •  EPA’s  are  not  mandatory  and  not  reportable  to   ACGME   •  EPA’s  =  strategy  for  meaningful,  work-­‐based   assessment  of  a  resident/fellow   •  EPA’s  provide  assessment  data  for  reporMng  of   milestones  to  the  ACGME  via  NAS     ten  Cate  et  al.  Acad  Med  2007;  82:  542-­‐47     How  will  we  use  milestones?   •  Clinical  Competency  CommiXee  (CCC)  will   review  all  assessment  data  (end-­‐of-­‐rotaMon   faculty  evaluaMons,  peer  evals,  case  logs,   simulaMon,  self-­‐assessments)   •  CCC  will  review  and  assess  data  from  these   mulMple  evaluaMons  and  apply  them  to  the   milestones  to  note  the  progress  of  a  resident/ fellow   IM  Milestones  and  Sub-­‐competencies  •  PC:  PaMent  Care  -­‐  5  •  MK:    Medical  Knowledge  -­‐  2  •  SBP:    Systems-­‐Based  PracMce  -­‐  4  •  PBLI:    PracMce-­‐Based  Learning  and  Improvement  -­‐  4  •  PROF:  Professionalism  -­‐  4  •  ICS:    Interpersonal  and  CommunicaMon  Skills    –  3  Total  of  22  Subcompetencies   4  
  5. 5. 2/25/13   Summit  Small  Group  AcMvity  •  IM  reporMng  milestones  for  the  6  ACGME   General  Competencies  are  composed  of  22  sub-­‐ competency  streams   –  Do  these  22  streams  make  sense  for  sub-­‐specialMes?  •  Each  sub-­‐competency  stream  is  composed  of  a   series  of  milestones  that  describe   developmental  competence  of  learner  in   behavioral  terms   –  Can  these  be  applied  to  a  fellow?   IM  Sub-­‐Competencies   PaMent  Care   1.  Gathers  and  synthesizes  essenMal  and  accurate   informaMon  to  define  each  paMent’s  clinical   problem(s).    (PC1)   2.  Develops  and  achieves  comprehensive   management  plan  for  each  paMent.  (PC2)   3.  Manages  paMents  with  progressive  responsibility   and  independence.    (PC3)   4.  Skill  in  performing  procedures.  (PC4)   5.  Requests  and  provides  consultaMve  care.    (PC5)   Sub-­‐Competency   Milestone   5  
  6. 6. 2/25/13   IM  Sub-­‐Competencies  Medical  Knowledge   6.  Clinical  knowledge.  (MK1)   7.  Knowledge  of  diagnosMc  tesMng  and  procedures.   (MK2)   IM  Sub-­‐Competencies  Systems-­‐Based  PracMce   8.  Works  effecMvely  within  an  interprofessional  team   (e.g.  peers,  consultants,  nursing,  ancillary   professionals  and  other  support  personnel.    (SBP1)   9.  Recognizes  system  error  and  advocates  for  system   improvement.    (SBP2)   10.  IdenMfies  forces  that  impact  the  cost  of  health  care,   and  advocates  for,  and  pracMces  cost-­‐effecMve  care.     (SBP3)   11.  TransiMons  paMents  effecMvely  within  and  across   health  delivery  systems.    (SBP4)   IM  Sub-­‐Competencies  PracMce-­‐Based  Learning  and  Improvement   12. Monitors  pracMce  with  a  goal  for  improvement.     (PBLI1)   13. Learns  and  improves  via  performance  audit.     (PBLI2)   14. Learns  and  improves  via  feedback.    (PBLI3)   15. Learns  and  improves  at  the  point  of  care.     (PBLI4)   6  
  7. 7. 2/25/13   IM  Sub-­‐Competencies  Professionalism   16.  Has  professional  and  respecpul  interacMons  with   paMents,  caregivers  and  members  of  the   interprofessional  team  (e.g.  peers,  consultants,   nursing,  ancillary  professionals  and  support   personnel.    (PROF1)   17.  Accepts  responsibility  and  follows  through  on  tasks.     (PROF2)   18.  Responds  to  each  paMent’s  unique  characterisMcs   and  needs.    (PROF3)   19.  Exhibits  integrity  and  ethical  behavior  in   professional  conduct.    (PROF4)   IM  Sub-­‐Competencies  Interpersonal  and  CommunicaMon  Skills   20. Communicates  effecMvely  with  paMents  and   caregivers.    (ICS1)   21. Communicates  effecMvely  in  interprofessional   teams  (e.g.  peers,  consultants,  nursing,  ancillary   professionals  and  other  support  personnel).   (ICS2)   22. Appropriate  uMlizaMon  and  compleMon  of  health   records.    (ICS3)   Summit  Process  •  Small  group  work  by  subspecialty  •  Our  small  group  had  representaMon  from     –  AASLD   –  ACG   –  AGA   –  ASGE  •  The  group  concluded:   –  Sub-­‐competencies  from  medicine  could  apply  to  GI/ Hepatology  with  different  behavioral  milestones   –  May  require  a  shiq  to  the  leq  in  terms  of  our  fellows   starMng  out  at  a  higher  level  than  a  resident  in  IM   7  
  8. 8. 2/25/13   Summit  Discussions  The  large  group  reconvened:   •  Consensus:     The  IM  reporMng  subcompetencies  seem  like  a  good  foundaMon   and  can  apply  to  the  subspecialMes     –  Systems-­‐Based  PracMce   –  PracMce-­‐Based  Learning  and  Improvement   –  Professionalism   –  Interpersonal  and  CommunicaMon  Skills     Should  be  applicable  even  with  the  same  EPA’s  but  the  levels  of   competency  may  shiq  if  we  assume  the  fellow  comes  in  at  the   milestone  level  of  a  resident     •  Concerns:    Not  clear  if  PaMent  Care  and  Medical  Knowledge  can  be  the  same   Next  Steps   •  OWN  (Oversight  Working  Network)  will  meet  at  DDW   •  The  GI  SocieMes  have  made  a  commitment  to  work   jointly  on  this  endeavor   •  Summit  organizers  will  convene  a  smaller  group  of   subspecialty  educators     –  To  create  a  template     –  To  make  a  proposal  regarding  what  the  subspecialMes  can   keep  from  the  IM  effort     –  To  determine  what  new  informaMon  needs  to  be  created   •  OWN  will  need  to  work  on  the  PC  and  MK  areas  in   parMcular   How  can  you  help?   •  Program  Directors  for  all  GI/Hepatology   programs  are  key  stakeholders  in  this  process   •  Through  OWN  and  this  group  convening  at  this   Summit,  we  must  work  together  to:     –  Create  what  makes  sense   –  Develop  what  is  pracMcal   –  Achieve  the  goals  of  the  ACGME,  ABIM,  AAIM   –  Generate  what  speaks  to  the  needs  of  our  PD’s  and   our  fellows   •  Must  consider  a  uniform  tracking  system  across   all  programs  to  make  this  pracMcal,  transferable,   and  helpful…   8  
  9. 9. 2/25/13   Final  Thoughts  •  We  are  at  a  crossroads,  advancing  towards  a  new   paradigm  for  GME  •  It  will  be  a  lot  of  work  •  But  there  are  opportuniMes:   –  Career  paths  for  many  of  you   –  RecogniMon  of  the  great  work  you  do   –  Dedicated  Mme  to  do  what  you  do  in  Graduate   Medical  EducaMon   –  Improved  educaMon  for  our  trainees   –  CollaboraMve  work  that  will  role  model  the  team  spirit   we  are  trying  to  inculcate  in  our  trainees   Time  to:   Contact  Info  for  Suzi  Rose:    srose@uchc.edu     9  

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