Accreditation Council for Graduate Medical Education Residency Review Committee for Internal Medicine (RRC-IM) Update – NAS and the IM Program Requirements 22001122 AAPPDDIIMM FFaallll MMeeeettiinngg Phoenix, AZ James Arrighi, MD, Chair JJeerrrryy VVaassiilliiaass, PPhhDD, EExxeeccuuttiivvee DDiirreeccttoorr © 2012 Accreditation Council for Graduate Medical Education (ACGME) 1 Nasca, T.J., Philibert, I., Brigham, T.P., Flynn, T.C. The Next GME Accreditation System: Rationale and Benefits. New England Journal of Medicine. Published Electronically, February 22, 2012. In Print, March 15, 2012. DDOOII::1100.11005566//nneejjmmssrr11220000111177 wwwwww.nneejjmm.oorrgg . NEJM. 2012.366;11:1051-1056. © 2012 Accreditation Council for Graduate Medical Education (ACGME) WWhhaatt ddooeess NNAASS mmeeaann?? • Describe NAS • DDeessccrriippttiioonn ooff NNAASS MMeettrriiccss • Timeline © 2012 Accreditation Council for Graduate Medical Education (ACGME) WWhhaatt ddooeess NNAASS mmeeaann?? • Describe NAS • DDeessccrriippttiioonn ooff NNAASS MMeettrriiccss • Timeline “What fresh hell is this?” Dorothyy Parker © 2012 Accreditation Council for Graduate Medical Education (ACGME) WWhhyy NNAASS?? • Foundation for NAS started in 2005: At its retreat, the ACGME Executive Committee endorsed four strategic pprriioorriittiieess ddeessiiggnneedd ttoo eennaabbllee eemmeerrggeennccee ooff tthhee nneeww accreditation model: • Foster innovation and impprovement in the learningg environment • Increase the accreditation emphasis on educational outcomes • Increase efficiency and reduce burden in accreditation • Improve communication and collaboration with key internal and external stakeholders •• RReeaalliizzaattiioonn tthhaatt PPRRss hhaavvee bbeeccoommee vveerryy pprreessccrriippttiivvee • Process-oriented accreditation, discouraging innovation © 2012 Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS) Big picture… • Less prescriptive program requirements that promote curricular innovation • “Continuous accreditation model” • Monitoring of programs based on “performance indicators” • Continuously holding sponsoring institutions responsible for oversight of educational and clinical systems – via CLER (Clinical Learning Environment Review) program © 2012 Accreditation Council for Graduate Medical Education (ACGME) NNAASS:: CCaatteeggoorriieess ooff PPRR’ss • CCattegoriizattiion off PPRRs: OOuttcome, CCore andd Detailed Process • WWhhy iis cattegoriizattiion off PPRRs iimporttantt iin tthhe NNAASS?? • Programs identified as being in “good standing” based on defined mmeettrriiccss wwiillll bbee aalllloowweedd ttoo “iinnnnoovvaattee”,, mmeeaanniinngg tthheeyy wwiillll nnoott bbee asked whether they are adhering to detailed process PRs. • Detailed process PRs do not go away. PDs will not need to ddemonsttratte complliiance w// tthhese PPRRs, unlless iitt bbecomes eviiddentt that a particular outcome or core process is not being achieved. • CCaatteeggoorriizzaattiioonnss aapppprroovveedd aatt tthhee SSeepptt 22001122 ACGME Board meeting (for Core and Subs) © 2012 Accreditation Council for Graduate Medical Education (ACGME) Proggram Reqquirements 6600 50 40 Core 30 Detail Outcome 2200 10 0 Common IM © 2012 Accreditation Council for Graduate Medical Education (ACGME) Examples of Program Requirements ““CCore”” • PD salary support • Inpatient caps • Faculty qualifications (e.g. certification) • Overall resources needed “for resident education” • Specific resources, e.g. angiography, are detail • Continuity clinic experience inclusive of “cchhrroonniicc ddiisseeaassee mmaannaaggeemmeenntt, pprreevveennttiivvee hheeaalltthh, ppaattiieenntt counseling, and common acute ambulatory problems.” •• MMaajjoorr dduuttyy hhoouurrss rruulleess © 2012 Accreditation Council for Graduate Medical Education (ACGME) Examples of Program Requirements ““Detail”” • Simulation • Minimum 1/3 ambulatoryy, 1/3 inppatient • Critical care min (3 mos) and max (6 mos) •• 113300--sseessssiioonn cclliinniicc rruullee • Specific conference structure • Verbal discussion of evaluation at end rotation • Specific aspects of evaluation structure • Semiannual evals remain core • 55 yyeeaarr rruullee ffoorr PPDD’ss © 2012 Accreditation Council for Graduate Medical Education (ACGME)