This document summarizes a presentation on the Next Accreditation System (NAS) for gastroenterology program coordinators. It discusses key aspects of NAS including the transition from process to outcomes-based accreditation, new requirements like the Clinical Learning Environment Review (CLER) program and milestones, and timelines for implementation. Details are provided on how requirements have been re-categorized as core, detailed, or outcomes and how programs will be evaluated annually through data collection, surveys, and site visits every 10 years with formative feedback.

1. AGA 2013
GI Training Directors
Workshop
Jo Meyer, Education Coordinator
Amy Oxentenko, MD, Program Director
Division of Gastroenterology and Hepatology
Mayo Clinic, Rochester, MN

2. Next Accreditation System
(NAS)
for Program Coordinators

3. How Bad Is This Going To Hurt?

4. Yet – To Be Determined
From ACGME FAQs about NAS-December 2012

5. NAS is a Moving Target

6. What We Will Review
• Overview of NAS
(Background; Core, Detail,
Outcome; WebAds)
• CLER Program
• Clinical Competency Committee
• Direct Observation/
Supervision of Fellows

7. What We Will Review
• Overview of NAS
(Background; Core, Detail,
Outcome; WebAds)
• CLER Program
• Clinical Competency Committee
• Direct Observation/
Supervision of Fellows

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. 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. 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. Timeline of NAS
For GI
• Late Spring 2012 – Resident/Fellow Survey
• September 2012 – WebAds Update
• Late Fall 2012 – Faculty Survey
• Late Spring 2013 – Resident Survey

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. FAQs of NAS
(updated Dec. 2012)
http://www.acgme-nas.org/assets/pdf/NASFAQs.pdf

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. “Core,” “Detailed,” &
“Outcome”

16. Examples PR “Core”
Taken from 2012 APDIM Fall Meeting – ACGME
•PD Salary Support
•Inpatient Caps
•Faculty Qualifications (e.g. certification)

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. 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. Milestones
ACGME December 2012 FAQ’s define
Milestones 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. Development of Milestones
Raising a Child
Grade school
•Know how to brush their teeth
•Know how to make their bed
Middle school
•Know how to do laundry
•Know how to make meals
High school
•Know how to manage money
•Know how to drive a car
•Know how to make decisions/prioritize/be responsible

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. Milestone Questions Answered
by ACGME FAQs
http://www.acgme-nas.org/assets/pdf/NASFAQs.pdf

23. What We Will Review
• Overview of NAS
(Background; Core, Detail,
Outcome; WebAds)
• CLER Program
• Clinical Competency Committee
• Direct Observation/
Supervision of Fellows

24. Clinical Learning
Environment Review
(CLER) Program

25. Aims of CLER
• Promote safety and quality of care
• Focus on six areas
• Care residents give and will provide
after residency

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. 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. 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. Data From CLER Visits
• Testing phase
• Continue to develop, test,
implement
• Gather baseline data
• Give formative feedback

30. CLER Eval Process
Provide 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. Examples of CLER Data
1) Patient Safety

32. Examples of CLER Data
2) Quality Improvement
All fellow are required to complete a QI project during
fellowship

33. Examples of CLER Data
3) Patient Care Transitions

34. Examples of CLER Data
3) Patient Care Transitions

35. Examples of CLER Data
4) Resident Supervision

36. Examples of CLER Data
5) 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. Examples of CLER Data
5) Duty Hours

38. Examples of CLER Data
5) Duty Hours

39. Examples of CLER Data
5) Duty Hours

40. Examples of CLER Data - DOM
6) Enhancing Professionalism

41. Examples of CLER - MMS
6) Enhancing Professionalism

42. Resources for CLER Program
1) https://www.aamc.org/members/gra/306034/clerwebinar.html
2) http://www.acgme-nas.org/

43. Thank you!
Joanna L. Meyer (Jo)
jmeyer@mayo.edu