Surgical Education WeekMarch 19-24, 2012

San Diego, California

James C. Hebert, MD, FACSChair, Surgery RRC

RRC Surgery What is New

Disclosures

• None

RRC—Surgery Members• James C. Hebert, MD, Chair

• John H. Armstrong, MD

• Paris Butler, MD, Resident

• Timothy R. Billiar, MD

• Ronald Dalman, MD

• Peter J. Fabri, MD

• Linda M. Harris, MD

• G. Whit Holcomb, MD

• Peggy Simpson, EdD – Executive Director

• John J. Ricotta, MD

• Marshall Z. Schwartz, MD

• Steven Stain, MD

• Charles W. Van Way III, MD, Vice Chair

• Marc K. Wallack, MD

• Frank Lewis, MD, Ex-Officio ABS

• Patrice Blair, MPH, Ex-Officio ACS

RRC Meeting Activity

• 253 programs were surveyed– 164 post-site visit reviews– 89 administrative requests at meetings

• 391administrative interim decisions

Surgery PR Changes ( 7/1/12)

• New expectations for simulation learning• Removal of the distinction between

“designated preliminary” (DP) and “non-designated preliminary” positions– 300% limit on Preliminary Positions

• Clarification of transplant surgery experience• Flexibility for required chief year

– 4 to 6 month maximum.

Program Requirements- Simulation

II.D.2. Resources must include simulation

and skills laboratories. These

facilities must address acquisition

and maintenance of skills with a

competency – based method of

evaluation

RRC Review- Simulation

• Review Simulation G & O’s• Review Evaluation Methods and Tools• Encourage Best Practices (such as ASC-

AEI)• FAQs

Preliminary Residents

• III.B.1. Residency positions must be allocated to one of two groups: categorical or preliminary positions.

• III.B.1.b) Preliminary (P) residents are accepted into the program for one or two years before continuing their education.

• III.B.1.b).(1) The number of preliminary positions in the PG1 and PG2 years combined must not exceed 300% of the number of approved categorical chief resident positions.

Transplant Experience

• IV.A.5.a).(3).(d) A formal transplant experience is required. It must include patient management and cover knowledge of the principles of immunology, immunosuppression, and the management of general surgical conditions arising in transplant patients. Clearly documented goals and objectives must be presented for this experience;

• Formal rotation may be easiest

Chief Year Clinical Rotations

• IV.A.5.a).(3).(f).(iv): Clinical assignments during the chief year must be in the essential content areas of general surgery. No more than six months of the chief year may be devoted exclusively to only one essential content area;

• Aligns with current ABS requirements; (requires ABS approval)

Goals of The “Next Accreditation System”

• To begin the realization of the promise of Outcomes• To free good programs to innovate• To assist poor programs to improve• To reduce the burden of accreditation• To provide accountability for outcomes (in tandem with

ABMS) to the Public

Challenges/Opportunities

• Culture Change and Faculty Development

• Program Directors, Designated Institutional Officials

• Faculty

• Review Committee Members

• “Retooling” of ACGME Infrastructure and Personnel

• The “Community of Educators” in each specialty must come together and agree on:

• core elements of the competencies

• levels of performance

New Administrative Structure

• John R. Potts, III, MDSenior Vice President, Surgical Accreditation

• Louis J. Ling, MDSenior Vice President, Hospital-Based Accreditation

• Mary Lieh-Lai, MDSenior Vice President, Medical Accreditation

• Kevin B. Weiss, MD, MPHSenior Vice President, Institutional Accreditation

Surgical Accreditation

• John R. Potts, III, MDSenior Vice President, Surgical Accreditation

• Peggy Simpson, EdDExecutive Director, RRCs for Plastic Surgery, Surgery, Thoracic Surgery

• Pamela L. Derstine, PhD, MHPEExecutive Director, RRCs for Colon and Rectal Surgery, Neurological Surgery, Orthopaedic Surgery, Otolaryngology

• Patricia Levenberg, PhDExecutive Director, RRCs for Obstetrics & Gynecology, Ophthalmology, Urology

The “Next Accreditation System” in a Nutshell

• Continuous Accreditation Model – annually updated• Based on annual data submitted, other data requested, and

program trends

• Scheduled Site Visits replaced by 10 year Self Study Visit

• Standards revised every 10 years• Standards Organized by

• Structure• Resources• Core Processes• Detailed Processes• Outcomes

The Conceptual ChangeFrom…

The Current Accreditation System

Rules

Corresponding Questions

“Correct or Incorrect” Answer

Citations and Accreditation Decision

Rules

Corresponding Questions

“Correct or Incorrect” Answer

Citation andAccreditation Decision

The Conceptual ChangeTo…

“Continuous”

Observations

Assure that the Program Number of Potential Fixed the Problem Related “Rules” Problems

Promote

Innovation

Diagnose

the Problem

If there is one!

The “Next Accreditation System”

Conceptual Model of Standards Implementation Across the Continuum of Programs in a Specialty

STANDARDS

StructureResources

Core ProcessDetailed Process

Outcomes

InitialAccreditation

New Programs

StructureResourcesCore ProcessDetailed ProcessOutcomes

Withhold AccreditationWithdrawal of Accreditation

2-4% 15% 75%

6-8%

Accreditation with Warning

New Programs,Accredited Programs with Major Concerns

Probationary Accreditation

StructureResourcesCore ProcessDetailed ProcessOutcomes

Maintenance ofAccreditation

Accredited Programs without Major Concerns

Maintenance of Accreditation with

Commendation

StructureCore ProcessResourcesDetailed ProcessOutcomes

Next Accreditation System

• Seven specialties/RRC’s begin training 7/2012• Pediatrics• Internal Medicine• Diagnostic Radiology• Emergency Medicine• Orthopedic Surgery• Neurological Surgery• Urological Surgery

• Sponsor Visit Program begins 9/2012• The “Next Accreditation System” begins 7/2013• These seven specialties “go live” 7/2013• The remaining specialties begin training 7/2013• All specialties/RRC’s using the “Next Accreditation System” 7/2014• Visits to IRC and all 7 RRC’s this Spring

Thank You

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