Updates from the Residency Review Committee for Pediatrics

Jerry Vasilias, PhD, Executive Director

Caroline Fischer, Associate Executive Director

RRC Composition• 3 appointing organizations - AAP, ABP, AMA• 10 voting members; due to workload increase to 13• members serve a term of 6 years -- except resident• Generalists and subspecialists

+ Critical Care Medicine, Hematology/Oncology, Pediatric Emergency Medicine, Gastroenterology, Neurology, Nephrology, Rheumatology

• Geographic Distribution – CA, CT, DC, GA, MI, MD, OH, PA, WA

• Ex-officio members from each appointing organization (non-voting)

RRC Review of Programs• Peer Review – 2 reviewers• Reviewers use the following information to determine

whether program is in compliance with the requirements: - Program Information Forms (PIF) - Site visitor’s report - Board scores

• Program Directors: this is an open book test - Questions in PIF correspond to program requirements

• Reviewers present program to Committee• Committee assigns accreditation status along with review

cycle, range of 1-5 years

Review Cycle of Cores and Subs

• Historically: Review cycle of sub was aligned with core. - If core has a three year cycle, sub had a three year cycle.

- The cycle of the sub did not exceed that of the core

• Now: ACGME has allowed RRC to un-couple subs cycle from core. - Subs are still considered dependent, but the cycle of the sub can

exceed that of the core.

• Continued with warning status- If receive a 2 year cycle warning language is included in letter

• New subspecialty applications: - Do not require a site visit

- Maximum of a three year cycle

Citation

Citation = the program has not documented/provided evidence of substantial compliance with the minimum requirements, or, an area identified by the site visitor as non-compliant

Summary of Activities in 2006

• The RRC meets twice a year – Spring and Fall

+ Workload per meeting in 2006: approximately

- 30 core programs- 120 subspecialty programs

- 15 progress reports

Core20%

Subs80%

Accreditation Decisions in 2006 --Subspecialties of Pediatrics

Types of Review Cycles

2 yrs19%

3 yrs27%

5 yrs25%

4 yrs24%

1 yr5%

Types of Status Decisions in 2006

Accreditation 22

Continued Accreditation 182

Voluntarily Withdrawal 9

Accreditation Withheld 7

Proposed Adverse Actions 15

Total 236

Most Frequent Citations in 2006 – Subspecialties of Pediatrics

236 Programs Reviewed for a Status Decision Total of 963 citations -- about 5 citations/program1. Research and Scholarly Activity – faculty and fellow lacking 133

2. Patient Care Experience – lacking adequate patient population 119

3. Evaluation of the Program – no documentation (minutes); don’t include fellows

100

4. Curricular Development – general curriculum issues; research methodology, etc

85

5. Evaluation of Fellows – semi-annually; not written; competent and independent

71

6. Procedural Experience – lack required # of procedures; lack logging of procedures

61

7. Didactic Components – conference attendance; particular curriculum lacking

53

8. Qualifications of Faculty – not ABP certified; no evidence of on-going scholarship

52

9. Responsibilities of the PD – providing accurate info; sufficient time to the prog

48

10. Institutional Support – internal review; facilities issues; personnel issues

43

11. Goals and Objectives – not being rotation and level specific 34

12. Evaluation of Faculty – not being done; not confidential 26

New General Subspecialty RequirementsWent into effect January 1, 2007

+ Competencies!- “Companion document”

+ Collaboration between programs - Documented semi-annual meetings b/w subs and core

- Departmental approach to common educational issues (core curriculum, competencies, evaluation, SOC etc).

- Message: Don’t reinvent the wheel!

+ New language for administering and managing a subspecialty program

General Subspecialty Requirements (cont)

+ Research and scholarly activity - Faculty:

> must have ongoing scholarship – peer reviewed funding and pubs> scholarly environment outside of the training program can supplement, but does

not replace within program

- Fellow: > must design + conduct a scholarly project in sub w/ guidance of PD and mentor

- Program: > must identify a mentor and scholarship oversight committee to oversee fellow’s

progress related to scholarly activities

+ Board Score Information- Deficient if over 6 yrs LT 75% take, of those who take LT 75% pass it.

- Exceptions will made for programs with small # of fellows

• Revised Common Program Requirements go into effect July 1, 2007+ Review language for PD duties and responsibilities; appointment

of PD; participating sites; competencies

• Changes to the PIF+ Common requirements questions will migrate to ADS --

Electronic PIF + More information will be provided from ACGME on this in the

near future

Common Requirements

www.acgme.orgwww.acgme.org • Staff contact information • ACGME Policies & Procedures• Competencies/Outcomes Project• ADS/List of accredited programs• Duty hours Information/FAQ• Affiliation Agreements FAQ• General information on site visit process and your site visitor

Pediatrics Webpage• Resident complement increase• Application timeline• Frequent citations• Program Requirements• PIFs• Archive of RRC Updates/Email Communications

Resident Survey• New survey

+ Heavily vetted – residents, RRCs

+ implemented in waves starting in January - May

+ contains elements of the common requirements, not just duty hours

• Who participates:+ All core programs and subspecialty programs with 4 or more

residents/fellows

• Survey programs every other year • Programs are notified directly – not residents • 70% compliance required

ACGME’s Strategic PlanIn November 2005, ACGME endorsed 4 strategic priorities.

1) Foster innovation and improvement in the learning environment

2) increase the accreditation emphasis on educational outcomes3) Increase efficiency and reduce burden from accreditation4) Improve communication and collaboration with key internal

and external stakeholders

Many of the changes ACGME has implemented in the recent past and will continue to roll out in the future can be seen from the vantage point of the 4 strategic priorities.

Innovations and Improvements to the Learning Environment• Conference on Educational Re-Design• ACGME focus on innovation• Portfolios• Innovation within the RRC

+ R3P

+ “Companion Documents”

Increase Emphasis on Outcomes

• RRC has been front-runner with competencies + Core requirements – January 1, 2006

+ Subspecialty requirements -- January 1, 2007

+ Competency PIF questions

+ “Companion documents”

+ Competency citations

• New common requirements• Competencies modules are available on outcome

webpage

Increase Efficiency and Reduce Burden -- ACGME • E-mail status of programs on RRC agenda

- Within 3-5 days of RRC meeting will receive an email with the accreditation status and review cycle.

• E-mail to notify you that your notification letter is posted on ADS. - Will no longer send notification letters.

• Standard letters of notification• New ADS features

- Field to response to citations- Making complement, PD, VW and participating institutions- This will feed directly into part 1 of the PIF

Increase Efficiency and Reduce Burden -- RRC• New PIF for core and subs

- Streamlining the document and making it less onerous to complete

- More checkboxes and forced choice responses

- Narrative sections remain, but there is a limit on amount allowed  

• No Competencies Assessment Form• Collaboration stressed in requirements • Collaboration with CoPS for PIF

Improve Communication and Collaboration • Email updates from RRC are posted on website • Collaboration in the requirements• Engaging CoPS on PIF construction for new

requirements• jvasilias@acgme.org• cfischer@acgme.org• dbraun@acgme.org

Requirements

Effective July 1, 2006Combined Training in Internal Medicine/Pediatrics

Effective July 1, 2007 Requirements to be RevisedAdolescent Medicine Developmental-BehavioralCritical Care Medicine EndocrinologyPediatric Cardiology GastroenterologyPediatric Emergency Medicine Infectious DiseasesPediatric Hematology-Oncology NephrologyNeonatal-Perinatal Medicine PulmonologyPediatric Rheumatology Sports Medicine