Transitional Year RRC Update Brian M. Aboff, MD, Chair RRC Team

Accreditation Council for Graduate Medical Education
Transitional Year Review Committee (TYRC)
Update
Julie McCausland, MD, MS, FACEP
Vice Chair, TYRC
Anne Gravel Sullivan, PhD
Executive Director, TYRC
AHME Conference
May 15, 2015
Disclosures
• Vice Chair, TYRC
• Program Director, TY Program at
UPMC
• No conflicts of interest to report
Objectives for today’s session
• Summarize the TYRC’s NAS annual program review
process and outcomes
• Describe role of the CCC in assessing resident
performance and the milestone reporting process
• Describe role of the PEC in TY programs’ Annual Review
• Provide update on key changes in TY Program
Requirements
• Summarize new resident eligibility requirements going into
effect July 1, 2016
• Provide an update on the implementation of the Single
Accreditation System; and
• Summarize the ACGME’s Self-Study process and timeline
Transitional Year Review Committee Members
Brian Aboff, M.D. (Chair)
IM & TY Program Director
Gerard Costello, MD
Anesthesiology & TY Program
Director
Steven R. Craig, MD
Internal Medicine & TY Program
Director
Andrew S. Flotten, MD (Resident)
Radiology
Susan Guralnick, MD
(Chair-Elect)
Pediatrics, DIO
Matthew Short, MD
Family Medicine, former TY
Program Director
Julie McCausland, MD, MS
(Vice-Chair)
Emergency Medicine & TY Program
Director
Paul M. Sherman, MD
Diagnostic Radiology
Robert Sticca, MD
Surgery
ACGME TYRC Staff
• Anne Gravel Sullivan PhD, Executive Director
• asullivan@acgme.org
• 312-755-7032
• Nicole Wright, Accreditation Administrator
• nwright@acgme.org
• 312-755-5491
• Sonia Sangha, Accreditation Administrator
• ssangha@acgme.org
• 312-755-5493
• Louis Ling, MD, Senior Vice President,
Hospital-based programs
Accreditation Council for Graduate Medical Education
Update on Program
Requirements
New Resident Eligibility
Requirements (July 1, 2016)
• All prerequisite training (PGY1) must
occur in:
• ACGME-accredited programs
• Canadian-accredited programs
• TY and other preliminary year
programs must send Milestones
assessments from new training
program after acceptance
Fundamental Clinical Skills Education
FCS Education Year (replaces CBY)—PR
IV.A.6 (Core)
• Changes are in title only
• Residents must complete at least 28 weeks in
rotations provided by a discipline or disciplines
offering FCS in the primary specialties
• Emergency medicine, family medicine, general
surgery, internal medicine, obstetrics and
gynecology or pediatrics
• At least four weeks (140 hours) of FCS rotations
must be in emergency medicine.
Fundamental Clinical Skills
Education
• Subspecialty experiences, with the exception of
critical care unit experiences, must not be used
to meet FCS curriculum requirements.
• Rotations must be overseen by ACGMEaccredited residency programs.
• Must be at least 140 hours of documented
experience in ambulatory care.
• Outpatient experiences must be provided in FM
or primary care IM, general surgery, obstetrics
and gynecology, or pediatrics at the sponsoring
institution or at participating sites.
Clinical Competence Committee
• Milestones Reporting
• Evaluations are assessment tools
• Milestones are benchmarked
progress reports that synthesize
assessment data
• “Rules” for reporting
Milestone Assessments
• TY Programs must send semi-annual and final
summative assessments
• Do not send advanced programs Milestone
reports—they will automatically be sent to
programs via ADS when resident transitions
• Use TY rather than specialty milestones unless
residents listed in specialty program’s ADS
roster during PG1 year
• TYRC Subcommittee formed to determine
specialty program needs and develop
standardized template
Accreditation Council for Graduate Medical Education
Update on the NAS
Experience
PIFs & Site visits
Cycle lengths
Annual reviews
Annual accreditation
The Conceptual Change
To…
The “Next Accreditation System”
“Continuous”
Observations
Assure that the Program
fixed the problem
Concerns Identified
Diagnose the Problem
(If there is one)
Pictorial Representation of
Review Process
10 Year Cycle
Each arrow represents yearly
annual review by TYRC. Programs
notified each year of the review
outcome
Self-Study
Annual Timeline
Aug/Sept
Annual ADS
data input
Oct/Nov
Jan/Feb
May/June
Data
analysis
TYRC
meeting
review
TYRC
meeting
follow up
Programs doing well or
with minor / moderate
concerns reviewed &
accreditation letter sent
with citations and/or AFIs
Data Used for
Annual Review Process
•
•
•
•
•
Resident & Faculty survey
Clinical Experience survey
Faculty & Resident scholarly activity
Attrition & Omission
Major Changes (e.g. PD, DIO, CEO)
TYRC NAS
Annual Review Process
• A program is reviewed
• When multiple criteria flagged with issues
(e.g. low resident survey scores, low faculty
scholarly activity)
• If it received citations since July 1, 2013 (the
inception of the NAS)
• If it is currently on Continued Accreditation
with Warning or Probation
Annual Review of Programs
Accreditation Statuses
Applications
for New
Programs
Accreditation
with Warning
Continued
Accreditation
Initial
Accreditation
Structure
Structure
Core Process
Core Process
Detailed Process
Detailed Process
Outcomes
Outcomes
STANDARDS
Structure
Core Process
Detail Process
Adverse Actions
Outcomes
Structure
Core Process
Detailed Process
Outcomes
Accreditation Outcomes in NAS
Continued Accreditation
• Continued Accreditation
- substantial compliance
with requirements
• Programs may or may not
have Citations or Areas
for Improvement (AFIs)
issued
• Programs w/CA can
innovate around detailed
requirements
• Programs reviewed next
year
Citations
• Represent more serious concerns
(than AFIs)
• Linked to core program requirement
• Require a PD’s written response in ADS
• Results in TYRC more carefully reviewing
the program the following year by TYRC
members
Areas for Improvement
• Not as serious as citations
• TYRC’s way of letting you know we’re
concerned and you should take notice
• Does not require written response in ADS
• Needs to be reviewed with your PEC
• May not directly be linked to core program
requirement
• AFIs reviewed following year; unresolved issues
may then turn into citations
Top Five Citations
Academic Years 2008-2014
• The Educational Program- Curricular
Development: 50
• Program Personnel & Resources• Responsibilities of the Program Director: 42
• Resources: 37
• Program Institutional Support-Sponsoring
Institution: 33
• The Educational Program- Scholarly Activity: 25
What happens to citations &
AFIs?
• TYRC reviews PD responses to citations
• These could be removed quickly based
upon:
• Progress report
• Site visit (focused or full)
• New annual data from program
Focused Site Visits
• Assesses selected aspects of a program
and may be used:
• to address potential problems identified during
review of annually submitted data;
• to diagnose factors underlying deterioration in
a program’s performance
• to evaluate a complaint against a program
• Very short notification
• Team of site visitors
Full Site Visits
• RRC identifies broad issues/concerns
• RRC Identifies other serious conditions or
situations
Also when:
• Application for a new core program
• At the end of the initial accreditation period
• 30-day notification period
• Team of site visitors
Annual Review of Programs
Accreditation Statuses
Applications
for New
Programs
Accreditation
with Warning
Continued
Accreditation
Initial
Accreditation
Structure
Structure
Core Process
Core Process
Detailed Process
Detailed Process
Outcomes
Outcomes
STANDARDS
Structure
Core Process
Detail Process
Adverse Actions
Outcomes
Structure
Core Process
Detailed Process
Outcomes
Continued Accreditation with Warning
• Continued Accreditation with Warning –
areas of non-compliance jeopardize
accreditation status
Programs w/status of CAW:
• Can receive no permanent increase in
complement
• Need make no announcement to residents
• Status is made public on website
2015 TY NAS Accreditation
Outcomes
• 96 Programs and one application reviewed
• 92 Programs given Continued
Accreditation
• 1 Program given Initial Accreditation with 2
years
• 2 Site Visits
• 1 Program Voluntarily Withdrawn
• 1 Program Withheld
NAS Summary Points
• Each program gets annual accreditation letter
• Program AFIs revisited the following year to
track trends
• Programs entering NAS with pre-existing
citations and CA status will, after two years
on the RC’s Consent Agenda, have those
citations automatically “resolved” and
removed from the program history
• Additional elements to be added (2015-2017)
• NAS & Milestones trend data
• Self-studies
Common Issues in ADS Update
• Incomplete faculty certification/other
qualifications information
• Re-certification/In MOC Phase
• Explain equivalent qualifications for RRC
consideration if not ABMS certified
• Out of date faculty scholarly activity
• Failure to provide response to citations in
annual program update
• Failure to document annual program
evaluation process and action plan
Block Schedule
• Uploaded by program as PDF
• Instructions and formats detailed in ADS
• Essential elements:
•
•
•
•
Clinical site
Rotation name (Specific)
Documentation of ambulatory hours
Vacation time
• Important for RRC to understand program
Accreditation Council for Graduate Medical Education
The Self-Study
& Ten-Year Site Visit
The Program Self-Study
• A comprehensive review of the program
• Focuses on program’s ability to create an effective
learning/working environment and how this leads to
desired educational outcomes
• Analysis of strengths, weaknesses, opportunities and
threats, and ongoing plans for improvement
• 12-18 months later: the 10-Year Site Visit
• Time lag is by design to give programs time to make
improvements
© 2015 Accreditation Council for Graduate Medical Education
Program’s Self-Study Summary
•
4-5 page summary of key dimensions of the SelfStudy
• Aims
• External environmental assessment (Opportunities
and Threats)
• Process of the Annual Program Evaluation and the
Self-Study
• Learning that occurred during the self-study
(Optional)
•
Information on areas for improvement identified in
the self-study not included in the Summary
•
Summary is uploaded into ADS
© 2015 Accreditation Council for Graduate Medical Education
10-Year Accreditation Site Visit
• 30-month period allows programs time to
improve
• Different team of site visitors
• Program updates self-study summary and
provides information ONLY on improvements
realized from the self-study
• Team provides verbal feedback
• Team prepares report for RC
• Visit the Self-Study Website for more information
© 2015 Accreditation Council for Graduate Medical Education
Review Committee Actions
• Review Committee reviews:
• ADS Data
• Program’s self-study summary
• The site visitors’ report from the full accreditation site
visit (includes info on self-study improvements)
• RC provides a Letter of Notification from the Full
Accreditation Site Visit
• Citations & Areas for Improvement
• Review Committee provides feedback on the Self-Study
taking into consideration
• No accreditation impact for initial feedback on self-study
© 2015 Accreditation Council for Graduate Medical Education
Accreditation Council for Graduate Medical Education
TY Program Summary
© 2014 Accreditation Council for Graduate Medical Education
ACGME 2009-15 TY Program Data
Year
# of Programs
# of Residents
2009-10
116
1238
2010-11
114
1204
2011-12
112
1188
2012-13
108
1184
2013-14
108
1179
2014-15
102
1097
© 2015 Accreditation Council for Graduate Medical Education
NRMP 2015 TY Match Data
•
•
•
•
•
•
•
Number of Programs: 101
Positions Offered: 842
Unfilled Programs: 12
Number of Applicants: 2977 (2219 US Seniors)
Number of Matches: 790 (685 US Seniors)
Percent Filled: 93.9 (81.4% US Seniors)
Ranked Positions: 18,736 (15,726 US Seniors)
© 2015 Accreditation Council for Graduate Medical Education
NRMP 2011-15 TY Match Data
Year
Positions
Offered
Percentage
across
Specialties
2011
952
4.1
2012
941
3.9
2013
937
3.6
2014
868
3.3
2015
842
3.1
© 2015 Accreditation Council for Graduate Medical Education
AOA-Accredited Internships
• 121 AOA Internship programs in U.S.
• 19/121 co-exist with ACGME-accredited TY
programs in an accredited Sponsoring Institution
• 44/121 are housed in an institution that sponsors
at least one ACGME-accredited program.
• Any or all of these programs could potentially
merge with TY programs
• These are only “Traditional Rotating Internships”
• Other, highly tailored one-year Preliminary Year
programs
© 2015 Accreditation Council for Graduate Medical Education
Accreditation Council for Graduate Medical Education
Single GME Accreditation System
@2014 Accreditation Council for Graduate Medical Education (ACGME)
Rationale
• One accreditation system transparent to:
• Federal government, licensing boards
• Credentials committees
• Public
•
•
•
•
Consistent evaluation and accountability
Enhanced opportunities for trainees
Eliminate unnecessary duplication
Efficiencies and cost-savings in
accreditation
New Committees
• Osteopathic Neuromusculoskeletal RC
• Delegated accreditation authority for accreditation of
Neuromusculoskeletal and Osteopathic Manipulative
Medicine residency programs
• Osteopathic Principles Committee
• Responsible for review and evaluation of the
osteopathic principles dimension of programs
that seek ongoing Osteopathic Recognition
• Chairs will sit on CRCC
AOA Members on RCs
Hospital-Based
Medical
# AOA
Committee
Surgical
# AOA
# AOA
Members
Committee
Members
Anesthesiology
1
Dermatology
1
Neurosurgery
1
Emer Med
2
Family Med
3
OB-Gyn
2
Diag Radiology
1
Internal Med
3
Ophthalmology
1
PM&R
1
Neurology
1
Orthopaedics
1
Transitional
3
Pediatrics
1
Otolaryngology
1
Psychiatry
2
Plastic Surgery
1
Surgery
1
Urology
1
Institutional
1
Committee
Members
Program Director and Faculty
• Qualifications
• Program must have an ABMS-certified
Director (TYRC to discuss in June 2015)
• Programs may be co-directed by an AOAcertified as well as a an ABMS-certified
Program Director
• Qualifications of program faculty
• ABMS-certified or “meets other qualifications”
deemed acceptable to RC
AOA Program Application Process
Existing AOA-accredited programs can apply to
receive Pre-Accreditation Status from 2015-2020
•Institutions must apply for pre-accreditation before
programs
•Institutional Application—Opens April 1, 2015
•Program Application—Opens July 1, 2015
• Sponsoring Institutions must have pre-accreditation
status
• Core, subs and single programs apply together
• Residents from a program in pre-accreditation status
will be held to the 2013 policies
Process for Current AOA Programs
RC reviews
Just like a new application
• Citations
• AFI
Program applies
Application received
Accreditation?
Pre-Accreditation Status
YES
Site Visit
Core & Subs
Together
NO
•
Status posted
•
•
Keep in pre-accreditation
status
Review yearly
Look at all data
Pre-Accreditation Status
• Created for and to be applied only during the
transition to ACGME accreditation of currently
AOA-approved programs
• Is not synonymous with Initial Accreditation
• Granted upon receipt of completed application
• Does not require IRC / RRC review
• Status will be publicly acknowledged on
website
Pre-Accreditation Status
Importance to AOA programs:
• Individuals who complete programs that have
previously* achieved “Pre-Accreditation
Status” will be subject to eligibility standards
in effect 30 June 2013 or 1 July 2016 –
whichever is less restrictive
Note: This does not mean that such graduates are
eligible for all ACGME subspecialty programs
* Pre-Accreditation Status cannot be retroactively granted (“grandfathered”)
AOA to TY Transition Challenge
• ACGME TY applications and Match for AY
2017 occur concurrently
• Core PDs will still not know if their DO
applicants’ PG1 TRI program will become
ACGME-accredited
• Some AOA programs may not be even be
pre-accredited yet
AOA to TY Transition Challenge
• RCs have been asked to allow Core Program
PDs to consider these DO candidates
without adverse decision consequence
during 2015-16
• Programs should check with the appropriate
board regarding certification.
• For more information, visit the SAS Webpage
TYRC SAS Agenda
• Work with ACGME and AACOM to engage
in education, outreach to AOA internship
stakeholders
• Subcommittee convened to assess
program requirements around sponsoring
programs
• TYRC Staff and ACGME Leadership to
explore AOA application obstacles and
facilitators
Questions?
Thank you!