““The Next Accreditation System The Next Accreditation System (NAS)” (NAS)”

Brian L. Cohen, MD, FRCOG, FACOG

PROGRAM DIRECTOR’S ROLE PROGRAM DIRECTOR’S ROLE

Associate Dean of Graduate Medical Education

Professor of Obstetrics, Gynecology and Women’s Health

1999: ACGME introduced the domains of clinical competency

2009: ACGME began a multiyear process to restructure the

accreditation system to be based on outcomes

2013: Phased implementation of the NAS

IntroductionIntroduction

Aims of NASAims of NAS

Enhance the peer review system to prepare physicians

Accelerate ACGME accreditation based on outcomes

Reduce the burden of the current system which is process based

BasisBasis

Institute of Medicine Report

Public pressure

Congressional pressure

Constrained finances and possible reductions for GME

July 2013 July 2013 Phase I Phase I

Emergency medicine Internal medicine Pediatrics Diagnostic radiology Neurosurgery Orthopedic surgery Urology

NAS will be implemented by 7 of 26 core specialties

All other specialties and preliminary programs implementation - July 2014

GME communities must be prepared for changes

NAS ComplianceNAS Compliance

① Annual ADS consists of: Program statistics Program structure & resources Scholarly activity Teaching responsibilities

Five important data collection areas:

NAS ComplianceNAS Compliance

② Board Pass Rates Improve curriculum / didactics

NAS ComplianceNAS Compliance

③ Clinical Experience Case log Case mix Minutes from meetings of program

evaluation

NAS ComplianceNAS Compliance

④ Resident Survey Duty hours Supervision & teaching Teamwork Education vs. service Evaluations Patient safety

NAS ComplianceNAS Compliance

⑤ Patient Safety Resident participation

Additional InformationAdditional Information

Minutes from annual meetings to be submitted annually

Residents on committees Sample PLA & LOA policy Policies- Supervision

- Handover rounds

- Work hours

- Others

Essential component of NAS are the MILESTONES Basis is to track development in the 6 competencies Dreyfus Model:

- Novice

- Advanced beginner

- Competent

- Proficient

- Expert

- Master

MilestonesMilestones

RRC

Boards

P.D.’s

Residents

Milestones Milestones

Milestones Developed By

Develop by December 2012Submission to ACGME 2013 & 2014

Milestones Will Supplement, Not Replace Existing Assessment Tools

Timeline: Timeline:

Milestones Milestones

Clinical Competency Committee (C.C.C.)Clinical Competency Committee (C.C.C.)

Core faculty

Program director- professionalism

Chief resident

IncludeInclude

FunctionFunction

FunctionFunction

Evaluate milestones & early warning

Track progress of residents

Faculty development

Reduce potential bias/subjective

Performance measure

Decision making by multiple people

Evaluate 360° assessments

PurposePurpose

Clinical Learning Environment Clinical Learning Environment Review (CLER)Review (CLER)

On resident learning of patient safety

Institution responsibility for quality and safety of the learning environment

Focus is:

Focus Comprises Six Areas:

1. Patient safety

2. QI by residents

3. Transition of care

4. Supervision

5. Duty hours & fatigue management

6. Professionalism

Clinical Learning Environment Clinical Learning Environment Review (CLER)Review (CLER)

Evaluation by Site VisitsEvaluation by Site Visits

Site visitors CEO of medical institution DIO GMEC chair Residents Safety officer Senior administration

Personnel Involved:

Three weeks advance notice

No advance documentation

Conduct interviews

Work hour reports

Visit learning environment

ProcessProcess

1. NAS itself

2. Milestones

3. Clinical competency committee

4. CLER

SummarySummary

NAS will involve four areas (2013 & 2014):

Begin the process NOW (2013 & 2014)

Structured & standardized protocols Assess resident skills Use of technology

Handoff / Handover ProcessHandoff / Handover Process

Program directors provide:

May be: Verbal Written Written & verbal Electronic

Objective: Accuracy Patient safety

Sick – degree

Identifying data

General hospital course

New events

Overall health status

Upcoming plan

Tasks to complete

Questions

Standardized ToolStandardized Tool

2000

2013