Sent email to epcs at Mayo what their perception of NAS was and here are a few pictures describing their thoughts.
And some thought jumping through hoops would be appropriate, I guess those going to the dolphin next week for the ACGME meeting, will find out more!
We will start off with some real basics, what is the definition of NAS….some thought Dr. Thomas Nasca had something to do with this and wanted to name it after himself, but we all know it stands for …
ACGME has given us some verbiage on the big picture divided into 4 categories
As for now, GI is scheduled to begin implementation in July 2014
What to expect, the final reporting systems for the NAS are still under development, however much of the data used to accredit programs is available now which includes our annual data collection – we are all familiar with Ads, the faculty surveys are new however we just have gone through that cycle. “Site visit” is now a “self study”
What are milestones? They are defined as….
Each program is expected to form a ccc and begin to develop its members by June 2013 (ACGME)
Benefits are…..We ALL will have
We at Mayo are just starting to establish our ccc…who should members be, it can vary.
What is role…that can also vary
We use the AGA in-training exam, have used BB for end of rotation exams.
This is just to name a few, I left a little bit of time at the end for feedback on additional concerns. Change to direct observation
Review one tool of how we evaluate fellow competency by direct observation.
Clinical Evaluation Exercise Evaluation (CEX)
DONE AFTER THIS SLIDE
Next Accreditation System For Program Coordinators Lisa Thornton, Program CoordinatorAmy Oxentenko, M.D., Program Director Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN
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
What is NAS?• Named after Dr. Thomas “NAS”ca?• No…..• NAS = Next Accreditation System
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
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.”
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
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
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)
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
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
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)
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
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
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
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
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
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
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
One Tool For Evaluating Fellow Competency Direct Observation of Trainees
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.
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*
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)
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
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
Program Coordinator Concerns/ChallengesOpen for questions and concerns you all have!
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
Summary• Reviewed a few of the NAS requirements• Reviewed examples of how to get started• Discussed Program Coordinator concerns