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Nas lisa

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Nas lisa

  1. 1. Next Accreditation System For Program Coordinators Lisa Thornton, Program CoordinatorAmy Oxentenko, M.D., Program Director Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN
  2. 2. Disclosures No RelevantFinancial Relationships
  3. 3. Learning ObjectivesParticipants 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
  4. 4. Program Coordinator’s Perception
  5. 5. Program Coordinator’s Perception
  6. 6. What is NAS?• Named after Dr. Thomas “NAS”ca?• No…..• NAS = Next Accreditation System
  7. 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
  8. 8. What is NAS?
  9. 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. 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. 11. Next Accreditation SystemEducational Milestones:•Developmentally-based, specialty-specificachievements that fellows are expected todemonstrate at progressive intervals as theyadvance through training•Data will be submitted on fellows every 6months, synchronized with fellows’ semiannualevaluations
  12. 12. Next Accreditation SystemEducational Milestones:•~20-30 descriptions of competency which arespecialty-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. 13. Next Accreditation SystemEducational 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. 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. 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. 16. Clinical Competency Committee What is the role of this committee? It varies….•Decides on composition, procedure, dataelements•Meets every 6 months to review assessmentsin trainee portfolio•Determines milestone levels or progress ofeach trainee
  17. 17. Clinical Competency CommitteeBenefits/Opportunities:•Group versus single decision maker•Especially helpful to have group decisionwhen issues of remediation raised•Narrative comments versus numbers onevaluations with no feedback; more likely touncover deficiencies•Offers the trainee the insight and perspectiveof a group of faculty members
  18. 18. Clinical Competency CommitteeBenefits/Opportunities:•Improve quality of faculty observation anddocumentation; faculty development isessential•Same set of eyes looking at all data and sameprocess is applied•Committee serves as an early warning systemif a trainee fails to progress in the educationalprogram
  19. 19. Clinical Competency CommitteeBenefits/Opportunities:•Multiple tools are available for assessingtrainee 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. 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. 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. 22. Clinical Competency CommitteeChallenges:•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. 23. One Tool For Evaluating Fellow Competency Direct Observation of Trainees
  24. 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. 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. 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. 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. 28. Fellows Identified By Highlights
  29. 29. How You Will Know on Outlook
  30. 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
  31. 31. Patient Information
  32. 32. Logging Onto System• Log onto office session• Click desktop icon – GI Fellow Go 9-452 – GI Fellow Ma 9/35E
  33. 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. 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
  35. 35. CEX Evaluation
  36. 36. CEX EvaluationIn a staff’s evaluation box by the day of observation
  37. 37. ABIMDirect Observation Tool
  38. 38. What is in it for Faculty?• Can get practice improvement points for ABIM MOC
  39. 39. Cost
  40. 40. Program Coordinator Concerns/ChallengesOpen for questions and concerns you all have!
  41. 41. Program Coordinator Concerns/ChallengesChallenges:•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
  42. 42. Summary• Reviewed a few of the NAS requirements• Reviewed examples of how to get started• Discussed Program Coordinator concerns
  43. 43. Thank you!thornton.lisa@mayo.edu

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