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Preparation for the ACGME Site Visit

Preparation for the ACGME Site Visit. Stanley Dea, MD Associate Program Director UCLA Integrated Training Program in Gastroenterology. Objectives. Learn how our program prepared for the 2010 ACGME site visit Review what ACGME will emphasize Learn to prepare critical ACGME requirements.

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Preparation for the ACGME Site Visit

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  1. Preparation for the ACGME Site Visit Stanley Dea, MD Associate Program Director UCLA Integrated Training Program in Gastroenterology

  2. Objectives • Learn how our program prepared for the 2010 ACGME site visit • Review what ACGME will emphasize • Learn to prepare critical ACGME requirements

  3. “Frame-Off Restoration” Given new requirements, what was adequate previously is no longer acceptable

  4. Where to Start • Insiders Guide to the ACGME Site Visit: Second Edition • Kathryn Andolsek, MD • $149 on Amazon.com

  5. Keys To A Successful Visit • Program Requirements • Program Information Form (PIF) • Resident Documentation • Faculty and Housestaff Education

  6. Go Electronic! There is a vast amount of documentation Storage and retrieval is best done electronically We have adopted Verinform Programming Verinform can be tricky

  7. PLAs • Program Letters of Agreement • Any site that is part of an official rotation must have a PLA! • Reviewed and up-to-date • Correct signatures on PLA

  8. Policies and Procedures • Be sure all policies exist and have been recently reviewed • Don’t re-invent the wheel – UCLA may have an existing policy • You need a program policy as well as institutional (may be the same) • Must be distributed to residents (can use Verinform)

  9. Policies and Procedures At a mininum: • Duty hours / Fatigue • Working environment • Moonlighting • Selection / Evaluation / Promotion • Supervisory • Disciplinary action / Due process

  10. Resident Documentation • Document: • Rotation evaluations / Bi-annual review • Duty hours • Procedures • Scholarly activity / Research • Keep files up-to-date and organized (Go electronic!) • Need paper copies for site visit

  11. Program Information Form (PIF) • The PIF is the foundation of your program • Every detail about the program of interest to the ACGME is in the PIF • Include highlights/unique features! • Usually written by one primary author but should be read (and re-read) by everybody • PIF should be updated regularly (not just before site visit)

  12. Competencies Teaching and Assessment are based on competencies! • Patient Care (PC) • Medical Knowledge (MK) • Professionalism (P) • Interpersonal and Communication Skills (ICS) • System-Based Practice • Practice-Based Learning

  13. Professionalism & ICS Teach: Patient care rounds Professionalism lecture series Ethics lecture Participation in journal club, case conference Mock patient oral examinations • Assess: • Patient care rounds • Review H&Ps, reports • Formal 360 evaluations, esp. patient evaluations • Mock patient oral examinations • Biannual program director meeting • Core curriculum attendance (P only)

  14. Resident Evaluations • Verinform will give monthly e-mail reminders • Evaluations must be available to residents • Must be a 360o evaluation • Four months before site visit, run an evaluation audit

  15. Education Usually program director is the only one who knows ACGME requirements Faculty (at least those meeting with the site visitor) should be aware as well Residents also need education (information, not indoctrination!)

  16. Say What? • Describe an activity that fulfills the requirement for experiential learning in identifying system errors. • Explain what dyads you evaluate. • ACGME requirements are vast • Learning terminology has steep learning curve • Honestly, material ispretty dry and boring

  17. Education • Created a six page “FAQ” with questions and answers • E-mailed daily quiz questions to faculty meeting with site visitor • Intensive (1-2 hour) “Boot Camp” sessions to cover material • Mock site visits with Dr. Parker and Dr. Baillie

  18. Consistency • The site visitor will look for consistent answers • PIF = Program Director = Faculty = Residents • Site visitor is more likely to believe residents in a discrepancy • Education is key

  19. Take Home Points • Everything must be based on the ACGME competencies • The PIF is your foundation • Address any citations • Keep extensive and accurate documents (Go Electronic!)

  20. There Is No “I” in Team • Brennan Spiegel, MD – Program Director • Stanley Dea, MD – APD • Kathy Oka – Fellowship Coordinator • Bradley Snyder – Assistant Coordinator • Curriculum Action Committee • Fellow Action Committee • Key Clinical Faculty Members “I love it when a plan comes together.” - Col. John “Hannibal” Smith

  21. ANY QUESTIONS?

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