PowerPoint Presentation · 8 Family Medicine Practice ACGME • Residents must provide care for a...

3/14/2016

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TRANSITIONING TO ACGME STANDARDS IN FAMILY

MEDICINE: CURRICULUM AND GAP ANALYSIS

OR

“HOW DO WE GET THERE FROM HERE?”

John R Bucholtz DO

Director of Medical Education

Columbus Regional Health

Columbus, Georgia

Rob Danoff DO, MS, FACOFP, FAAFP

Director, Family Medicine Residency

Director, combined Family

Medicine/Emergency Medicine Residency

Aria Health

Philadelphia, Pennsylvania

Workshop Goals

• Compare current Family Medicine

Residency Program Requirements for

AOA/ACOFP and ACGME

• Determine what modifications current

AOA/ACOFP accredited Family Medicine

residency programs as well as new

programs will need to make as we move

toward the AOA-ACGME Single

Accreditation System by 2020.

Disclaimer

The following presentation hopes to serve as a framework

for NAS/SAS implementation based upon the experience of

two gray haired DME/DIO (current PD’s)

This is not an official ACGME presentation.

We are on this journey, too

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ACGME Requirements Definitions

• Core Requirements: Statements that define structure, resource, or process elements essential to every graduate medical educational program

• Detail Requirements: Statements that describe a specific structure, resource, or process, for achieving compliance with a Core Requirement (some latitude in meeting detail requirement once fully accredited)

• Outcome Requirements: Statements that specify expected measurable or observable attributes (knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medical education

ACGME “speak”• Must-chiseled in stone

• Should-You better have a good excuse or

provide a fairly equal alternative

• FAQ-modifiable and flexible Program

Requirements (by the RC, not you) – for

example, if rotation was far from FMP

beyond requirement, no citation.

I.A. Sponsoring Institution

ACGME

The sponsoring institution

and the program must

ensure that the program

director has sufficient

protected time and financial

support for his or her

educational and

administrative

responsibilities to the

program. (Core)

AOA/ACOFP

OPTI as Institutional Sponsor

vs your individual Hospital

Must have an organized

department or section of

Family Medicine

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Program Director

ACGME

• The sponsoring institution and

participating sites must:

provide at least 70 percent

salary support (at least 28

hours per week=1400 hrs/yr)

for the program director as

protected time for

administration, evaluation,

teaching, resident precepting,

and scholarship; and, (Core)

AOA/ACOFP

• The Program Director must

devote a minimum of 1,200

hours per year to residency

training activities. This may

include time spent in teaching,

precepting, administration, and

scholarly activities.


Electronic Health RecordACGME

The sponsoring institution

should provide access to

an electronic health record

system. (Detail)

In the absence of an existing

electronic health record system, the

sponsoring institution must

demonstrate institutional

commitment to its development, and

progress towards its implementation.

(Detail)

AOA/ACOFP

Medical Records

Residencies must utilize electronic

health records (EHR) for the

inpatient and outpatient sites, or a

plan in place with a target date for

the implementation of an EHR

system.

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Faculty

ACGME

• Some family medicine

physician faculty

members must have

admitting privileges in the

hospital(s) where FMP

patients are hospitalized. (Core)

AOA/ACOFP

• There must be family

medicine program faculty

with admitting privileges in

the hospital(s) where the

residents' patients are

hospitalized.

Faculty Scholarship

ACGME

II.B.5. The faculty must

establish and maintain an

environment of inquiry and

scholarship with an active

research component. (Core)

AOA/ACOFP

6.1 The faculty as a whole must demonstrate

involvement in scholarly activity. At a minimum

this must include the following:

a. Participation in clinical discussions and

conferences.

b. Participation in national and regional

professional societies, particularly through

presentations and publications.

c. Participation in research, especially projects

that are funded following peer review.

d. Provision of guidance and support to

residents involved in research.

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Faculty Scholarship

ACGME

• Some members of the faculty should also demonstrate scholarship by one or more of the following: peer-reviewed funding; (Detail) publication of original research or review articles in peer reviewed journals, or chapters in textbooks; (Detail) publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; or, (Detail) participation in national committees or educational organizations. (Detail)

AOA/ACOFP

The faculty as a whole must

demonstrate involvement in scholarly

activity. At a minimum this must

include the following:

a. Participation in clinical discussions

and conferences.

b. Participation in national and

regional professional societies,

particularly through

presentations and publications.

c. Participation in research,

especially projects that are funded

following peer review.

d. Provision of guidance and support

to residents involved in research.

Faculty Ratio

ACGME

There must be at least one

core family medicine

physician faculty member,

in addition to the program

director, for every six

residents in the program. (Core)

AOA/ACOFP

There must be at least one

full-time equivalent (FTE)

family physician faculty for

each six residents in the

program.

Faculty

ACGME

Core physician faculty

members must: dedicate at

least 60 percent time (at

least 24 hours per week, or

1200 hours per year), to

the program, exclusive of

patient care without

residents; and, (Detail)

AOA/ACOFP

A faculty is considered full-

time based on time devoted

to residency related

activities such as teaching,

preceptoring, scholarship

and administration). Any of

the following methods may

be utilized to determine

FTE status:

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Faculty

ACGME

Core physician faculty

members must: dedicate at

least 60 percent time (at

least 24 hours per week, or

1200 hours per year), to

the program, exclusive of

patient care without

residents; and, (Detail)

AOA/ACOFP

Any of the following

methods may be utilized to

determine FTE status:

• a. 24 hours/week.

• b. 1200 hours/year.

• c. 100 hours/month.

Faculty

ACGME

All programs must have

family medicine physician

faculty members providing

and teaching care for each

of the following: maternity

care, including deliveries;

inpatient adults; and

inpatient children.(Core)

AOA/ACOFP

There must be family medicine

program faculty with admitting

privileges in the hospital(s) where the

residents' patients are hospitalized.

The family medicine program faculty

shall, as a group, be qualified to teach

all required procedures as listed in

this document.

Faculty

ACGME

• Some family medicine physician faculty members must see patients in each of the FMPs used by the program. (Detail)

• There must be faculty members dedicated to the integration of behavioral health into the educational program. (Detail)

AOA/ACOFP

The program must include

training in behavioral science.

At a minimum this shall

include:

a. Psychiatric and

psychological diagnoses

common to family medicine.

b. The treatment of substance

abuse.

c. Didactic instruction and

clinical experiences.

d. Interviewing skills.

e. Counseling skills.

f. Psychopharmacology.

g. Physician well being.

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Faculty

ACGME

There must be a structured program of faculty development that involves regularly scheduled faculty development activities designed to enhance the effectiveness of teaching, administration, leadership, scholarship, clinical, and behavioral components of faculty members’performance. (Detail)

AOA/ACOFP

In addition to meeting all Program

Director responsibilities stipulated in

the AOA Basic Documents, the

Program Director’s responsibilities

shall include:

Leading the family medicine faculty

in developing, scheduling, and

evaluating all educational

experiences.

Other Program Personnel

ACGME

The institution and the

program must jointly

ensure the availability of all

necessary professional,

technical, and clerical

personnel for the effective

administration of the

program. (Core) The program

must have a program

coordinator. (Core)

AOA/ACOFP

The program must

have a designated

residency program

coordinator.

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Family Medicine Practice

ACGME

• Residents must provide care for a

minimum of 1650 in-person patient

encounters in the FMP site. (Core)

• The majority of these visits must

occur in the resident’s primary

FMP site. (Detail)

• One hundred sixty-five of the FMP

site patient encounters must be

with patients younger than 10

years of age. (Detail)

• One hundred sixty-five of the FMP

site patient encounters must be

with patients 60 years of age or

older. (Detail)

AOA/ACOFP

• The three year continuity of

care site experience must

include at least 1,650 in-person

patient visits, with a minimum

cumulative visits of:

• 150 occurring by end of

OGME-1 year

• 650 by end of OGME-2

• 1,650 by end of OGME-3

• before a resident can proceed

to the next year of training or

graduate

• May be at two FM sites


ACGME

Residents’ patient encounters

should include telephone visits,

e-visits, group visits, and patient-

peer education sessions. (Detail)

AOA/ACOFP

a. Defined space for waiting area, examination rooms, resident’s office, laboratory, business office.

b. OMM capability.

c. On site procedural capability including: blood sugar, throat culture or rapid strep screen, urinalysis, office microscopy, EKG, spirometry, and screening audiometry.

d. Minor surgery capability.

e. Online access to reference sources.


ACGME

1. Mission Statement

2. Meeting and classrooms

3. EMR

4. Res:Fac = 4:1 50% rule

5. 2 rooms/provider

6. Ongoing QI program

AOA/ACOFP

a. Appropriate utilization of osteopathic principles and manipulative treatment.

b. Diagnose and manage medical and surgical conditions.

c. Perform office procedures.

d. Incorporate preventive measures.

e. Provide patient education.

f. Provide counseling.

g. Coordinate care.

h. Manage consultations.

i. Maintain medical records.

j. Fac:Res = 1:4

k.CMS teaching rules

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Hospital

ACGME

• II.D.3. The inpatient facilities must have occupied teaching beds to ensure a patient load and variety of problems sufficient to support the education of the number of residents and other learners on the services. (Core)

• II.D.4. Inpatient facilities must also provide physical, human, and educational resources for education in family medicine. (Core)

AOA/ACOFP

• 4.1 The program must utilize at least one hospital where family physicians have admitting privileges. At a minimum, hospital training resources shall include:

• a. Adult inpatient.

• b. Critical care.

• c. Surgery.

• d. Obstetrics.

• e. Emergency medicine.

• f. Newborn care.

• g. Pediatrics.

II.E. Medical Information Access

ACGME

• Residents must have

ready access to specialty-

specific and other

appropriate reference

material in print or

electronic format.

Electronic medical

literature databases with

search capabilities should

be available. (Detail)

AOA/ACOFP

Residents must have ready

access to specialty-specific

and other appropriate

reference

material in print and/or

electronic format.

Electronic medical literature

databases with search

capabilities shall be

available.

III. Resident Appointments

ACGME

The program must offer at

least four resident positions

at each educational level.

(Detail) The program should

have at least 12 on-duty

residents. (Detail)

N=12

AOA/ACOFP

The institution shall

maintain a minimum

program size of six filled

Family Medicine residents.

This will be calculated as a

five-year rolling average.

N=6

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Rotations

Long Term Care Facility

ACGME

IV.A.6.a).(3).(a) Long-term

care experiences must

occur over a minimum of

24 months. (Detail)

AOA/ACOFP

4.1 The program must

utilize at least one

extended care facility

where family medicine

residents can care for

patients under supervision

by residency faculty.

Inpatient Medicine

ACGME

• Residents must have at

least 600 hours (or six

months) and 750 patient

encounters dedicated to

the care of hospitalized

adult patients with a broad

range of ages and

medical conditions. (Core)

AOA/ACOFP

The program must provide at least thirty-two weeks of clinical training in internal medicine disciplines, including at least eight weeks of general internal medicine experiences during the OGME-1 year (can be met by either inpatient internal medicine or inpatient family medicine service).

At a minimum internal medicine training must include:

a. Twenty-four weeks of inpatient experience

b. Four weeks of training in critical care medicine.

c. Didactic and clinical training.

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ICU

ACGME

Residents must have at

least 100 hours (or one

month) or 15 encounters

dedicated to the care of

ICU patients. (Detail)

AOA/ACOFP

Four weeks of training in

critical care medicine.

Emergency Medicine

ACGME


least 200 hours (or two

months) or 250 patient


the care of acutely ill or

injured adults in an

emergency department

setting. (Detail)

AOA/ACOFP

5.6 The program must

provide at least eight

weeks of training in

emergency medicine,

including at least four

weeks of training during the

OGME-1 year.

GeriatricsACGME

• Residents must have at

least 100 hours (or one

month) or 125 patient


the care of the older

patient. (Core)

AOA/ACOFP

The program must provide at least

100 hours or 1 month of training in

the care of the geriatric patient. This

is in addition to training that occurs

in the continuity of care site or

general internal medicine rotations.

At a minimum this shall include:

a. Physiological changes of aging.

b. Pharmacokinetics in the elderly.

c. Functional assessment of the

elderly.

d. ECF management.

e. Hospice.

f. Home care.

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Pediatrics

ACGME

Residents must have at least 200 hours (or two months) and 250 patient encounters dedicated to the care of ill child patients in the hospital and/or emergency setting. (Core)

(1) This experience should include a minimum of 75 inpatient encounters with children. (Detail)

(2) This experience should include a minimum of 75 emergency department patient encounters with children. (Detail)

AOA/ACOFP

The program must provide at least sixteen weeks of training in pediatrics and adolescent medicine, including at least four weeks of training during the OGME-1 year.


a. Care of the newborn.

b. Ambulatory pediatrics.

c. Well childcare.

d. Inpatient pediatrics.

e. Emergency care of children.

Pediatrics

ACGME

Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of children and adolescents in an ambulatory setting. (Core)

(1) This care must include well-child care, acute care, and chronic care. (Detail)

Residents must have at least 40 newborn patient encounters, including well and ill newborns. (Core)

AOA/ACOFP

The program must provide at least sixteen weeks of training in pediatrics and adolescent medicine, including at least four weeks of training during the OGME-1 year.


a. Care of the newborn.

b. Ambulatory pediatrics.

c. Well childcare.

d. Inpatient pediatrics.

e. Emergency care of children.

General Surgery

ACGME

• Residents must have at least 100

hours (or one month) dedicated to

the care of surgical patients,

including hospitalized surgical

patients. (Core)

• The program must ensure that

every resident has exposure to a

variety of medical and surgical

subspecialties throughout the

educational program. (Detail)

AOA/ACOFP


sixteen weeks of training in surgical

disciplines, including at least four weeks

of general surgery training during the

OGME-1 year.


a. Preoperative and post- operative

care.

b. Training in the following sub-

specialties, which may be ambulatory or

inpatient.

c. Ophthalmology.

e. Orthopedics.

d. Urology.

e. ENT.

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Musculoskeletal

MusculoskeletalACGME


least 200 hours (or two

months) dedicated to the

care of patients with a

breadth of musculoskeletal

problems. (Core)

This experience must

include a structured sports

medicine experience. (Detail)

AOA/ACOFP

Sports Medicine


50 hours or two weeks of training in

Sports Medicine. This is in addition

to time spent in the continuity of care

ambulatory site. At a minimum this

must include:

a. Pre-participation assessment.

b. Didactic and clinical experiences.

c. Management of uncomplicated

sports related injuries.

d. Rehabilitation of athletic related

injuries.

e. Injury prevention/training.

Women’s Health

Gynecology

ACGME

Residents must have at least 100 hours (or one month) or 125 patient encounters dedicated to the care of women with gynecologic issues, including well-woman care, family planning, contraception, and options counseling for unintended pregnancy. (Core)

AOA/ACOFP

3 months total

The gynecological portion of this training experience shall include both ambulatory and in-hospital patient care. At a minimum this shall include:

a. Family planning.

b. Preventive medicine.

c. Management of the abnormal PAP smear.

d. Disorders of menstruation.

e. Gynecological infections.

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Women’s Health

ObstetricsACGME

Residents must document 200 hours

(or two months) dedicated to

participating in deliveries and

providing prenatal and post-partum

care. (Core)

Must include a structured curriculum

in prenatal, intra-partum, and post-

partum care. (Core)

Programs should provide an

experience in prenatal care, labor

management, and delivery

management. (Detail)

Some of the maternity experience

should include the prenatal, intra-

partum, and post-partum care of the

same patient in a continuity care

relationship. (Detail)

AOA/ACOFP

The dedicated obstetrical portion of this training experience shall include both ambulatory and in-hospital patient care. At a minimum this shall include:

a. Prenatal care.

b. Labor and delivery.

c. Postnatal care.

d. Medical complications of pregnancy.

Dermatology

ACGME

Residents must have

experience in diagnosing

and managing common

dermatologic conditions. (Core)

AOA/ACOFP

Internal medicine training shall

include exposure to the following

disciplines, in either inpatient or

outpatient settings:

a.Allergy and immunology.

b. Cardiology.

c.Dermatology.

Et al…

Behavioral Medicine

ACGME

The curriculum must be

structured so behavioral health is

integrated into the residents’total educational experience, to

include the physical aspects of

patient care. (Detail)

There must be a structured

curriculum in which residents are

educated in the diagnosis and

management of common mental

illnesses. (Detail)

AOA/ACOFP

The program must include training in behavioral science. At a minimum this shall include:

a. Psychiatric and psychological diagnoses common to family medicine.

b. The treatment of substance abuse.

c. Didactic instruction and clinical experiences.

d. Interviewing skills.

e. Counseling skills.

f. Psychopharmacology.

g. Physician well being.

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Health and Practice Management

ACGME

Residents must have at least 100

hours (or one month) dedicated to

health system management

experiences. (Core)

This curriculum should prepare

residents to be active participants

and leaders in their practices, their

communities, and the profession of

medicine. (Detail)

Residents must receive regular

reports of individual and practice

productivity, financial performance,

and clinical quality, as well as the

training needed to analyze these

reports. (Detail)

AOA/ACOFP

The program must provide at least one hundred hours or one month of structured educational experiences in practice management.

This training shall include:

a. Debt management.

b. Retirement planning.

c. Financial planning.

d. Disability insurance.

e. Medical liability insurance.

f. Risk management.

g. Coding.

h. HIPAA requirements in the ambulatory setting.

i. OSHA requirements for private practices.

j. Payer mix and practice overhead management.

k. Personnel management.

Community Medicine

ACGME

Residents must demonstrate an

awareness of and

responsiveness to the larger

context and system of health

care, as well as the ability to call

effectively on other resources in

the system to provide optimal

health care. (Outcome)

AOA/ACOFP

The program must provide 50 hours or two weeks of documented training in community medicine. This shall include time spent in any of the following experiences:

a. Occupational health.

b. Mental health agencies.

c. Community based screening programs.

d. Public health agencies.

e. Community health centers.

f. Free clinics.

g. Drug and alcohol treatment centers.

h. School health programs.

i. Homeless shelters.

Diagnostic Imaging

ACGME

Patient Care and

Procedural Skills

interpret basic clinical tests

and images; (Outcome)

The curriculum should

include diagnostic imaging

interpretation and nuclear

medicine therapy pertinent

to family medicine. (Detail)

AOA/ACOFP

There must be a structured

curriculum to train the

resident in Diagnostic

Imaging. At a minimum this

shall include: a. Didactic

and clinical experiences.

b. Utilization of appropriate

radiographic studies.

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Procedural MedicineACGME

The program director and family

medicine faculty should develop a

list of procedural competencies

required for completion by all

residents in the program prior to

graduation. (Core)

In creating this list, the faculty should

consider the current practices of program

graduates, national data regarding

procedural care in family medicine, and

the needs of the community to be served.

(Core)

Residents must be able to competently

perform all medical, diagnostic, and

surgical procedures considered essential

for the area of practice. Residents must

appropriately use and perform diagnostic

and therapeutic procedures. (Outcome)

AOA/ACOFP

The program must have defined mechanisms to

train residents to competency in the following 16

required procedures:

a. Joint injections.

b. Biopsy of dermal lesions.

c. Excision of subcutaneous lesions.

d. Incision and drainage of abscess.

e. Cryosurgery of skin.

f. Curettage of skin lesion.

g. Laceration repair.

h. Endometrial biopsy.

i. Office microscopy.

j. Splinting.

k. EKG interpretation.

l. Office spirometry.

m. Toenail removal.

n. Defibrillation.

o. Removal of cerumen from ear canal.

p. Endotracheal intubation.

Electives

ACGME


least 300 hours (or three

months) dedicated to

elective experiences.

(Core)

AOA/ACOFP

There shall be a minimum

of sixteen weeks and a

maximum of twenty-eight

weeks of supervised

electives available to all

residents during the course

of the residency.

KEY POINTS ACGME PROGRAM REQUIREMENTS FOR

GRADUATE MEDICAL EDUCATION IN

FAMILY MEDICINE

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Program Letter of Agreement - PLA

• There must be:

• A PROGRAM LETTER OF AGREEMENT (PLA)

between the program and each participating site

providing a required assignment. The PLA must be

renewed at least every five years. (Core)

Qualifications of the program director

must include:

• Requisite specialty expertise and documented

educational and administrative experience acceptable

to the Review Committee; (Core)

• Current certification in the specialty by the American

Board of Family Medicine, or specialty qualifications

that are acceptable to the Review Committee; (Core)

• A minimum of five years of clinical experience in

family medicine, with two years as a core faculty

member in an *ACGME-accredited family medicine

residency program. (Core)

• *Updated information on the FAQ site to “accredited

program” or specific training (NIPDD or similar activity)

Family Medicine Faculty

• The physician faculty must have current certification

in the specialty by the American Board of Family

Medicine, or possess qualifications judged

acceptable to the Review Committee. (Core)

• Family medicine physician faculty members who are not

certified by the American Board of Family Medicine

(ABFM) must demonstrate ongoing learning activities

equivalent to the ABFM Maintenance of Certification

process, including demonstration of professionalism,

cognitive expertise, self-assessment and life-long

learning, and assessment of performance in practice.

(Core)

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Family Medicine Program Requirement

• All programs must have family medicine physician faculty

members providing and teaching care for each of the

following: maternity care, including deliveries; inpatient

adults; and inpatient children.(Core)

Other Faculty

• Physician faculty members from other specialties must

have current certification in their specialties by a

member board of the American Board of Medical

Specialties, or possess qualifications acceptable to the

Review Committee. (Core)

Resident Experiences

• There must be a structured curriculum in which

residents address population health, including the

evaluation of health problems of the community. (Detail)

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Resident Experiences

• The curriculum must advance residents’ knowledge of

the basic principles of research, including how

research is conducted, evaluated, explained to

patients, and applied to patient care. (Core)

• Residents should complete two scholarly activities, at

least one of which should be a quality improvement

project. (Outcome)

• The sponsoring institution and program should allocate

adequate educational resources to facilitate resident

involvement in scholarly activities. (Detail)

Clinical Competency Committee

• The program director must appoint the Clinical

Competency Committee. (Core)

• At a minimum the Clinical Competency Committee

must be composed of three members of the program

faculty. (Core)

• There must be a written description of the

responsibilities of the Clinical Competency

Committee. (Core)

Clinical Competency Committee SHOULD

• Review all resident evaluations semi-annually; (Core)

• Prepare and ensure the reporting of Milestones

evaluations of each resident semi-annually to

ACGME; and, (Core)

• Advise the program director regarding resident

progress, including promotion, remediation, and

dismissal. (Detail)

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Program Evaluation and Improvement

• The program director must appoint the Program

Evaluation Committee (PEC). (Core)

• Must be composed of at least two program faculty

members and should include at least one resident;

• The program, through the PEC, must document

formal, systematic evaluation of the curriculum at

least annually, and is responsible for rendering a

written, annual program evaluation. (Core)

Thank You• Thank you for your time

• Thank you for your teaching

• Thank you for your passion

• Thank you for your effort

• Thank you for your dedication

• Thank you for mentoring our future physicians

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