Accreditation – Learning from Each Other

1. Accreditation – Learning from Each Other Jane C.K. Fitch, MD John L. Plewes Professor & Chair University of Oklahoma

2. Summary • ACGME/RRC info • Data from ACGME website and Grogono’s 13th annual anesthesiology NRMP report • Survey info • Example • Discussion/discussion/discussion

3. ACGME • 7,800 GME programs • 118 specialty programs • 27 RRCs • RRCs include AMA (CME), ABMS (ABA), and academic specialty organization (ASA)

4. ACGME • 3 basic functions of accreditation: • Establishment and periodic revision of publicly available accreditation standards • Measure compliance by program with accreditation standards • Notify the general public of a program’s accreditation status

5. Accreditation Actions • Withheld Accreditation** • Initial Accreditation • Continued Accreditation • Probationary Accreditation** • Withdrawal of Accreditation** (** indicates adverse actions)

7. Anesthesiology Notification Letter • Accreditation Status • Length of Training • Maximum Number of Residents • Notification Letter • Effective Date • Next Site Visit • Program Listing

8. ACGME RRCAnesthesiolgy Staff • Judith Armbruster, PhD, Executive Director • Linda Thorsen, MA, Associate Executive Director • Norma R. DeYagcier, Accreditation Administrator • Denise Braun, Accreditation Assistant

9. RRC Anesthesiology Committee Members • J. Jeffrey Andrews, M.D. ASA • Audree A. Bendo, M.D. ASA • Philip D. Lumb, MB, BS ASA • Lois L. Bready, M.D. CME • David L. Brown, M.D. CME • Jeffrey R. Kirsch, M.D. CME • Steven C. Hall, M.D. ABA • Mark A. Rockoff, M.D. ABA • Mark A. Warner, M.D. ABA • Corey E. Collins, D.O Resident

10. Anesthesiology RRC • Average accreditation length is 3.7 years (range of 1 to 5 years) • Longer accreditation (4 or 5 years) indicates the ACGME and RRCs are more confident about a program’s ability to provide quality education.

11. ACGME • Field staff (FS) vs Specialist Site Visitor (SSV) • FS if cycle is 4 or 5 years • SSV if cycle is 1 to 3 years

12. Number of Anesthesiology Programs

13. Newly Accredited Programs by Academic Year

14. Withdrawn Programs by Academic Year (Voluntary Withdrawal, Accreditation Withdrawn, or Administrative Withdrawal)

15. Number of Anesthesiology Positions Filled

16. Positions Matched by State • 1999 - 2005 • NY, CA, MA, PA, TX, IL • 24 % top 2 states • 44 % top 5 states • 64 % top 10 states

17. Positions Matched per Million Population • Avg 30 matched per 6.6 million • 4.37 matched/million • Range 1.1 – 20.98 matched/million

18. 2005 NRMP • 2.5 % incr recruitment (1200 to 1230) • 0.5 % decr positions offered (1289 to 1283) • 83 % programs filled (89 to 53) • 6.22 % NRMP students match into anesthesiology

19. Residency Programs Compiled by Quartiles

20. Number and Percent of New Program Directors by Academic Year

21. Accreditation Decisions in 2004-05 for All Core Anesthesiology Programs • 132 Total programs • 33 Reviewed • 28 Cited • 1 Full Accreditation • 27 Continued Full Accreditation

22. Frequent Anesthesiology Citations • Evaluations • None by resident, faculty • Scholarly Activity • Few pubs, little or no ADs • PACU • Little organized teaching, other duties, not contiguous • Critical Care • No anesthesiology involvement • Resident Complement • Exceeded without approval

23. Frequent Anesthesiology Citations (con’t) • Clinical Experience (logs) • Uneven distribution, lack minimum requirement, not regularly monitored by PD • Goals and Objectives • Not detailed, not developed for all rotations, not distributed • Affiliation Agreements • Not signed, not updated, not all with PIF, integrated agreements not specify PD to make all appointments • Competencies • Not incorporated into curriculum, not familiar with Outcomes initiative

24. Frequent Anesthesiology Citations (con’t) * • Poor board scores • Continual faculty turnover • Inadequate supervision • Excess number of residents • Inadequate scholarly activity • Inadequate institutional support * JSA

25. Programs With a Probationary Status 2005-06

27. AK – West HI - West ID - West MT – West NV - West WY - West DE – NE RI – NE ND - Central SD - Central States with No Anesthesiology Residency Programs

28. AL - South AR – South MS – South OK – South SC – South WV – South AZ - West CO – West NM - West OR - West UT - West IN - Central IA – Central NE – Central NH - NE VT – NE ME - NE States with Only One Anesthesiology Residency Program

30. OU • Nov 2000 “The Scarlet P”, 11 citations • Nov 2001 • Site visit 3/02 • See you in 2 years! • Site visit 5/04 • 4 year review cycle, no citations

31. OU • 3 areas: • ICU • Board scores • Scholarly activity

32. OU • 3 areas: • ICU • Then • Pulm/med ICU & PICU • No anesthesiology intensivists • Now • NICU, PICU, Surgery/trauma • 3 intensivists • Future • Multidisciplinary fellowship

33. OU • 3 areas: • Board scores • Then • 1 year curriculum, 6 AM lectures, ITE, AKT pre, no mock orals, no review course program, 65 % • Now • 3 yr curriculum, WEB 3 – 5 PM, ITE, AKT pre/post/6/18, mock orals, $ and time for one review course/yr/resident, 83 % • Future • 100 % pass rate

34. OU • 3 areas: • Scholarly activity • Then • No clinical or basic research, no infrastructure, no ADs • Now • Both clinical and basic research, infrastructure, CST last 2 years, ADs • Future • PhD, peer reviewed funding

35. OU • Support (aka $$$) • Dean, COM • CEO, Hospital (HCA) • OK Board of Health • Conrad 30 plan • HPSA, MUA, MUP

36. Summary • ACGME/RRC info • Data from ACGME website and Grogono’s 13th annual anesthesiology NRMP report • Survey info • Example • Discussion/discussion/discussion