Residency Model from the Medical Profession Perspective of ... · Senior VP for Educational Affairs...
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Residency Model from the Medical Profession – Perspective of a DIO
Donald W. Brady, MD
Senior VP for Educational Affairs
ACGME/NRMP Designated Institutional Official
Senior Associate Dean for GME and Continuing Professional Development
AUD Education Summit
October 26, 2016
ASHA National Office
Rockville, MD
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Disclosures• No financial disclosures
• Member, ACGME Board of Directors
• Speaking from my personal perspective as an institutional
GME leader
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VUMC Graduate Medical Education 88 ACGME accredited
programs
1 CODA-accredited
programs
55+ “other” fellowships
1006 residents and
fellows
July Orientation: 300
new house staff
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Objectives
• Why accredit?
• What is “medical” accreditation like?
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Why Accreditation?
• Benefit to the public
– Patient Safety
– Consistency of “product”
• Benefit to the resident
– Education vs service
– Ensure basic needs
• Aid to the programs
– Basic needs of programs/program leaders
– Independent review
– Held to same standards
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ACGME – Accreditation Council for
Graduate Medical Education
“The mission of the ACGME is to improve health care and population health by assessing and advancing the quality of resident physicians' education through accreditation. ”
• Roughly 10,000 accredited programs
• 150 specialties/subspecialties
• 800 sponsoring institutions
• 125,000+ resident/fellow physicians
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ACGME Accreditation – Brief History• 1889 – Hopkins opens first “residency” program in US
• 1914 – AMA Council on Medical Education and Hospitals: “approves” hospitals for MD internships
• 1923 – AMA Council on Medical Education releases “Principles Regarding Graduate Medical Education” – specialty review committees: Internal Medicine, Pediatrics,
Neuropsychiatry, Dermatology, Surgery, Ophthalmology, Orthopedic Surgery, Urology, OB/GYN, Public Health/Hygiene, and Pathology
• 1928 – AMA’s “Essentials of Approved Residencies and Fellowships”
• 1939 – American College of Surgeons: hospitals approved for residency education in surgery
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ACGME Accreditation – Brief History
• 1942 – AMA and AAMC establish LCME
• 1940s-1965 – individual residency review committees
• 1965 – Medicare Bill – need focused GME oversight
• 1972 – LCGME
– AMA, AAMC, ABMS, AHA, CMSS
– Coordinating Committee on Medical Education
– Coordinate/oversee Residency Review Committees (RRCs)
– 1972-80: system failing, CCME abolished
• 1981 – LCGME becomes ACGME
• 1998 – ACGME: Designated Institutional Officials
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ACGME Accreditation – Brief History
• 2000 – ACGME becomes separately incorporated
• 2000-2002 – Establishment of 6 core competencies
• 2003 – common duty hour standards for residents
• 2014 – ACGME, AOA, AACOM announce single accreditation system (2015-2020)
• 2010s
– Next Accreditation System
– Clinical Learning Environment Review
– Sponsoring Institution 2025
– Physician Wellbeing
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ACGME – What Do They Accredit?
• Physician Training Programs (RRCs)
– Residencies
– Clinical fellowships
• Sponsoring Institutions (IRC)
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ACGME – How Do They Accredit?
• Program Requirements– Common
– Specialty-specific
– Set by experts in the field
• Institutional Requirements
• Monitoring– Surveys
– Annual updates
– Site visits
– Resident services/other reporting
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Common Program Requirements
• Introduction
• Institutions
• Program Personnel and Resources
• Resident Appointments
• Educational Program
• Evaluation
• Resident Duty Hours in the Learning and Working Environment
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Institutions
• Sponsoring Institution
• Participating Sites
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Program Personnel and Resources
• Program Director
• Faculty
• Other Program Personnel
• Resources
• Medical Information Access
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Resident Appointments
• Eligibility Requirements
• Number of Residents
• Resident Transfers
• Appointment of Fellows and Other Learners
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Educational Program
• Curricular Educational Components– Goals and objectives
– Didactics
– Integration of 6 core competencies
• Residents’ Scholarly Activity
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Evaluation
• Resident Evaluation– Formative
– Summative
• Faculty Evaluation
• Program Evaluation and Improvement
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Resident Duty Hours in theLearning and Working Environment
• Professionalism, Personal Responsibility, and Patient Safety
• Transitions of Care
• Alertness Management/Fatigue Mitigation
• Supervision of Residents
• Clinical Responsibilities
• Teamwork
• Resident Duty Hours
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Institutional Requirements
• Structure for Educational Oversight– Sponsoring Institution
– GMEC
• Institutional Resources– Institutional GME Infrastructure
– Program Administration
• Resident Learning and Working Environment– Mirror of Section VI of Common Program Reqs
• Institutional GME Policies and Procedures
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Next Accreditation System
• Old: “PIF” every 3-5 years with a site visit
• New:
– Annual re-accreditation• Fellow & faculty surveys
• Annual update
– Self-study every 10 years (May 1, 2017)
– Site visit after self-study (12-18 months later)
• Changing Focus from Process to Outcomes
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Clinical Learning Environment Review
• Every 12-18 months, not an accreditation visit
• The CLER program’s ultimate goal is to …. deliver both high-quality physicians and higher quality, safer, patient care
• Focus Areas– Patient Safety
– Quality Improvement
– Transitions in Care
– Supervision
– Duty Hours Oversight, Fatigue Mgmt/Mitigation
– Professionalism