1. PROGRAM DIRECTOR’S ROLE “The Next Accreditation System (NAS)” Brian L. Cohen, MD, FRCOG, FACOG Associate Dean of Graduate Medical Education Professor of Obstetrics, Gynecology and Women’s Health

2. Introduction 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

3. Aims 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

4. Basis • Institute of Medicine Report • Public pressure • Congressional pressure • Constrained finances and possible reductions for GME

5. July 2013 - Phase I • NAS will be implemented by 7 of 26 core specialties • Emergency medicine • Internal medicine • Pediatrics • Diagnostic radiology • Neurosurgery • Orthopedic surgery • Urology • All other specialties and preliminary programs implementation - July 2014 • GME communities must be prepared for changes

6. NAS Compliance • Annual ADS consists of: • Program statistics • Program structure & resources • Scholarly activity • Teaching responsibilities Five important data collection areas:

7. NAS Compliance • Board Pass Rates • Improve curriculum / didactics

8. NAS Compliance • Clinical Experience • Case log • Case mix • Minutes from meetings of program evaluation

9. NAS Compliance • Resident Survey • Duty hours • Supervision & teaching • Teamwork • Education vs. service • Evaluations • Patient safety

10. NAS Compliance • Patient Safety • Resident participation

11. Additional Information • Minutes from annual meetings to be submitted annually • Residents on committees • Sample PLA & LOA policy • Policies • Supervision • Handover rounds • Work hours • Others

12. Milestones • 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

13. Milestones • RRC • Boards • P.D.’s • Residents Milestones Developed By

14. Milestones Develop by December 2012 Submission to ACGME 2013 & 2014 Milestones Will Supplement, Not Replace Existing Assessment Tools Timeline:

15. Clinical Competency Committee (C.C.C.) Core faculty Program director- professionalism Chief resident Evaluate milestones & early warning Track progress of residents Faculty development Include Function Purpose • Reduce potential bias/subjective • Performance measure • Decision making by multiple people • Evaluate 360° assessments Function

16. Clinical Learning Environment Review (CLER) • On resident learning of patient safety • Institution responsibility for quality and safety of the learning environment Focus is:

17. Clinical Learning Environment Review (CLER) Focus Comprises Six Areas: • Patient safety • QI by residents • Transition of care • Supervision • Duty hours & fatigue management • Professionalism

18. Evaluation by Site Visits Personnel Involved: • Site visitors • CEO of medical institution • DIO • GMEC chair • Residents • Safety officer • Senior administration

19. Process • Three weeks advance notice • No advance documentation • Conduct interviews • Work hour reports • Visit learning environment

20. Summary • NAS itself • Milestones • Clinical competency committee • CLER NAS will involve four areas (2013 & 2014): Begin the process NOW (2013 & 2014)

21. Handoff / Handover Process Program directors provide: • Structured & standardized protocols • Assess resident skills • Use of technology May be: • Verbal • Written • Written & verbal • Electronic Objective: • Accuracy • Patient safety

22. Standardized Tool Sick – degree Identifying data General hospital course New events Overall health status Upcoming plan Tasks to complete Questions

24. 2000

25. 2013