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Milestones

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Milestones

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  1. Milestones Emergency Medicine Milestones April 2, 2012 2012 CORD Academic Assembly

  2. Birmingham Hip Resurfacing

  3. Emergency Medicine Milestones • Based on Core Competencies • Patient Care- 14 • Medical Knowledge-1 • Professionalism- 2 • Interpersonal Communication Skills- 2 • Practice-based Learning and Improvement- 2 • Systems-based Practice- 3 • A total of 24 Milestones

  4. Emergency Medicine Firsts • Developed and completed Milestones in 5 months • Approved by ABEM BOD 1/2012, and by RRC-EM 2/2012 • Based on Milestone progress, EM invited into NAS trial rollout July, 2013 • Milestones are truly along a continuum of end of medical school to certification standards • Only specialty to take ABMS certification standards and apply to Milestones • Milestones are based on extensive survey data related to ABEM certification standards • Only specialty allowed to make revisions in program requirements • Only specialty to integrate the Milestones into proposed program requirement changes

  5. How Did We Get to Milestones as a Specialty?

  6. Overall Milestone Project Goal

  7. Next Accreditation System

  8. Uses and Implications

  9. Guiding Principles

  10. Milestone Development

  11. Milestone Development • Who • Expert Panel • Developing milestones for ICS, Prof, PBLI, SBP • For adaption or adoption • Who • Assessment Group • Identifying assessment tools • Developing implementation guidelines

  12. Outcome Project – Continued • 2009 – 2012 • Milestone Development • 2013 & Beyond • 1999 - Outcome Project Begins • 2001- Quadrads (Board, PD, RRC, Res) Convened • 2002-2008 – Implementation of 6 Competency Domains • All specialties to be completed by 12/2012 • Pilot testing ongoing • Large scale implementation of milestones for testing • New accreditation system launch ~ staggered approach (e.g. 4-5 specialties at first)

  13. Development of Milestones Almost as if there was a plan… Emergency Medicine

  14. Milestone Working Group • Chair: Michael Beeson (Vice Chair, RRC-EM) • Ted Christopher, M.D. (AACEM) • Kevin Rodgers, M.D. (AAEM) • Jamie Jones, M.D. (ABEM) • Mary Jo Wagner, M.D. (ACEP) • Philip Shayne, M.D. (CORD) • Jonathan Heidt, M.D. (EMRA) • Susan Promes, M.D. (SAEM)

  15. ABEM’s Work • The Model of the Clinical Practice of Emergency Medicine • Most are familiar with the “Listing of Conditions and Components” • There is another aspect: • Physician Task Definitions

  16. Physician Task Definitions from the Model • Prehospital Care • Emergency Stabilization • Performance of Focused History and Physical Exam • Modifying Factors • Professional and Legal Issues • Diagnostic Studies • Diagnosis • Therapeutic Interventions • Pharmacotherapy • Observation & Reassessment • Consultation and disposition • Prevention & Education • Documentation • Multi-tasking and Team Management

  17. ABEM Initial Certification Task Force (ICTF) • Made up of ABEM Board members • Tasked with looking at entire initial certification process • What are the standards? • Have they changed?

  18. Along Came the ABEM REPP Task Force (Relevance of Examinations to Physician Practice) • Evaluated changes in physician practice • Recommended changes to the content and methods of administration of ABEM’s examinations to assure relevancy to EM practice • The result was additive and claritive to physician task definitions

  19. Physician Task Definitions • Multi-tasking (Task-switching) • Team Management • General Approach to Procedures • Procedures • Contract Principles • Financial Issues • Operations • Clinical Informatics • Knowledge Translation • Performance Improvement • Systems-based Management • Disaster Management • Communication and Interpersonal Skills • Teaching • Research • Pre-hospital Care • Emergency Stabilization • Performance of Focused History and Physical Exam • Modifying Factors • Professional and Legal Issues • Diagnostic Studies • Diagnosis • Therapeutic Interventions • Pharmacotherapy • Observation & Reassessment • Consultation • Disposition • Prevention & Education • Documentation

  20. ABEM Initial Certification Task Force • With physician task definitions in place and the REPP report’s addition, ABEM was ready to write the Knowledge, Skills, and Abilities (KSAs) that should make up an Initial Certification Exam • An Advisory Panel was created in which KSAs were written that defined expectations of an individual pursuing initial certification in EM

  21. KSAs • Based upon using Physician Task Definitions as starting point • Each KSA was then developed into hierarchical scales of performance competency • Accepted level of performance for the ABEMDiplomate

  22. KSAs • ABEM sent a survey to EM Diplomates and had over 7000 responses • The survey queried importance and frequency for each of the identified KSAs and Model Content • The result is EM is a specialty in which our practitioners have defined the frequency and importance of expert panel defined KSAs

  23. KSAs to Milestones to Markers • A smooth transition?

  24. Milestone Working Group • Identified the Physician Task Definitions essential to the defined needs for Milestones

  25. Physician Task Definitions • Multi-tasking (Task-switching) • Team Management • General Approach to Procedures • Procedures • Contract Principles • Financial Issues • Operations • Clinical Informatics • Knowledge Translation • Performance Improvement • Systems-based Management • Disaster Management • Communication and Interpersonal Skills • Teaching • Research • Pre-hospital Care • Emergency Stabilization • Performance of Focused History and Physical Exam • Modifying Factors • Professional and Legal Issues • Diagnostic Studies • Diagnosis • Therapeutic Interventions • Pharmacotherapy • Observation & Reassessment • Consultation • Disposition • Prevention & Education • Documentation

  26. Milestone Working Group • Identified the Physician Task Definitions essential to the defined needs for Milestones • Narrowed the list to 17 from 29 • Then looked at ABEM’s additional work on hierarchical scales of performance • Identified Milestones for each core competency

  27. Uniformity of Milestone Reporting • Five levels • Level 1- entry level for a medical school graduate • Level 4- The ABEM certification standard • By definition where an individual should be at time of graduation • Level 5- Attained after practice experience

  28. Emergency Medicine Milestones • Based on Core Competencies • Patient Care- 14 • Medical Knowledge-1 • Professionalism- 2 • Interpersonal Communication Skills- 2 • Practice-based Learning and Improvement- 2 • Systems-based Practice- 3 • A total of 24 Milestones

  29. Milestones • PC1- Emergency Stabilization • PC2- Performance of Focused History and Physical Examination • PC3- Diagnostic Studies • PC4- Diagnosis • PC5- Pharmacotherapy • PC6- Observation and Reassessment • PC7- Disposition • PC8- Multi-tasking (Task-switching)

  30. Milestones • PC9- General Approach to Procedures • PC10- Airway Management • PC11- Anesthesia and Acute Pain Management • PC12-Other Diagnostic and Therapeutic Procedures: Ultrasound (Diagnostic / Procedural) • PC13- Other Diagnostic and Therapeutic Procedures: Wounds Management • PC14-Other Diagnostic and Therapeutic Procedures: Vascular Access

  31. Milestones • MK- Medical Knowledge • PROF1- Professional values • PROF2- Accountability • ICS1-Patient Centered Communication • ICS2-Team Management • PBLI1- Teaching • PBLI2-Practice Based Performance Improvement • SBP1-Patient Safety • SBP2- Systems-based Management • SBP3-Technology

  32. EM Milestones Working Group Meeting March 10, 2012 CORD, CDEM invited Evaluated potential assessment methods Made recommendations for assessment End of shift, direct observation, and simulation were determined to likely be best assessment methods Validity studies ABEM undertaking at end of April, 2012 Avoid use as a simple subjective Likert scale Base marker scoring on objective measures

  33. Next Steps EM will be used as pilot specialty in NAS Begins July, 2013 Integration of Milestones into EM Program Requirements A first! Development of assessment methodology Specialty-wide implementation of assessment methods? Partner with CORD

  34. Challenges Can CORD develop tools that are accepted by most programs, that can be applied to end of shift, direct observation, or simulation methods? Example is SDOT as a tool used with direct observation as an assessment method Can CORD develop validity and reliability studies for developed tools? Inter-rater reliability Can CORD develop faculty development programs that teach use of developed tools to ensure reliable application?