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Department of Graduate Medical Education (GME) Conflict of Interest Kim Walker – No conflicts of interest to disclose Ann Dohn – No conflicts of interest.

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Presentation on theme: "Department of Graduate Medical Education (GME) Conflict of Interest Kim Walker – No conflicts of interest to disclose Ann Dohn – No conflicts of interest."— Presentation transcript:

1 Department of Graduate Medical Education (GME) Conflict of Interest Kim Walker – No conflicts of interest to disclose Ann Dohn – No conflicts of interest to disclose Nancy Piro – No conflicts of interest to disclose

2 Kim Walker, PhD Program Manager/Education Specialist Ann Dohn, MA DIO & GME Director Nancy Piro, PhD Program Manager/Education Specialist PC002c Coordinators and Clinical Competency Committees: How to Streamline and Support the Work of your Program’s CCC

3 Department of Graduate Medical Education (GME) Session Outcomes Participants will be able to: Identify new aspects of the coordinators’ evolving role in program administration. Understand and use program requirements as a guide for planning, organizing and implementing educational and assessment tools. Develop and utilize a newly developed comprehensive resident performance profile tool to streamline the work of the CCCs.

4 Department of Graduate Medical Education (GME) New Role

5 Department of Graduate Medical Education (GME) Evolving Role for Coordinators in Evaluations Deliver evaluations Develop evaluation forms for PDs to approve Schedule semi annual evaluations Ensure summative evaluations completed and filed Constructing new milestone evaluations to pilot/deliver Reviewing evaluation completion data for accuracy Aggregating data for the CCC from multiple sources and forms Milestone data to ACGME Administrator Scheduler Supreme Education & Evaluation Coordinator/Manager Extraordinaire

6 Department of Graduate Medical Education (GME) Now I’m really confused! CCCs EPAs Milestones Outcomes Goals and Objectives Evaluations

7 Department of Graduate Medical Education (GME) Where do I begin?

8 Department of Graduate Medical Education (GME) Know the NAS Building Blocks: Concepts defined NAS Core Competencies – Milestones – EPAs – Curriculum and Evaluations Clinical Competency Committee (CCC)

9 Department of Graduate Medical Education (GME) NAS – Next Accreditation System What is NAS – in a nutshell: “an outcomes-based accreditation process through which the doctors of tomorrow will be measured for their competency in performing the essential tasks necessary for clinical practice in the 21 st century.” http://www.acgme.org/acgmeweb/tabid/435/ProgramandInstitutionalAccred itation/NextAccreditationSystem.aspx

10 Department of Graduate Medical Education (GME) Major Changes: Accreditation based on… Pre-NAS – Competencies – Site Visits – Up to 5+ year cycles – Internal Reviews – ADS Updates – PIFs – Resident Surveys Current (New) NAS – Competencies with Milestones – Self-Studies at ~ 8-10 year intervals – Detailed ADS Updates – CLER Visits ~ 18 – 24 months (Institution) – Resident & Faculty Surveys

11 Department of Graduate Medical Education (GME) The New Accreditation System (NAS)… Outcomes Increased Annual reporting by Programs (online) Reduced volume of accreditation demands … but increased attention to accuracy and completeness of information submitted online PIF-less Surveyor visits (unless new application) – Two Field Surveyors per visit No Faculty CVs (only PD)….but Faculty & Resident Scholarly Activity required.

12 Department of Graduate Medical Education (GME) The Six AGME Core Competencies Medical Knowledge Six Core Competencies For Quality Patient Care Practice- based Learning & Improvement Professionalism Systems-based Practice Patient Care Interpersonal & Communication Skills

13 Department of Graduate Medical Education (GME) What Are Milestones? High Level - Milestones are simply defined as areas of competency/expectations for our trainees Linked to six core competencies Defined as a continuum of progressive growth/learning

14 Department of Graduate Medical Education (GME) Dreyfus Model (1980): Stages of developing expertise Source: Eraut, M. Developing Professional Knowledge and Competencies. (1994)

15 Department of Graduate Medical Education (GME) Milestone Level Definitions Level 1: The resident is a graduating medical student/experiencing first day of residency. Level 2: The resident is advancing and demonstrating additional milestones. Level 3:The resident continues to advance and demonstrate additional milestones; the resident consistently demonstrates the majority of milestones targeted for residency.

16 Department of Graduate Medical Education (GME) Milestone Level Definitions (continued) Level 4: The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. This level is designed as the graduation target – not requirement. Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this level.

17 Department of Graduate Medical Education (GME) Reporting the Milestones V.A.1.b).(1).(b) prepare and assure the reporting of Milestones evaluations of each resident semi-annually to ACGME (Core) Milestones are reported directly through ADS Reporting windows are: – November 1- December 31 – May 1- June 15

18 Department of Graduate Medical Education (GME) Entrustable Professional Activities (EPA) Professional life activities that define a medical specialty: – Ground the competencies in a physician’s everyday work – Activities lead to some outcome that can be observed – Complexity of the activities requires an integration of knowledge, skills and attitudes across competency domains

19 Department of Graduate Medical Education (GME) Examples of EPAs Facilitate handovers to another healthcare provider either within or across settings Contribute to the scholarly work of the subspecialty Co-manage patients with generalists and other subspecialists Source: https://www.abp.org/abpwebsite/taskforce/reslib/24.ppt

20 Department of Graduate Medical Education (GME) Curriculum: Rotation-specific goals and objectives & links to milestones

21 Department of Graduate Medical Education (GME) Milestones Impact on Evaluations: Linking questions to milestones Step Two: Ensure specific evaluation questions are linked to milestones Advises the referring health care provider(s) about the appropriateness of a procedure in routine clinical situations

22 Department of Graduate Medical Education (GME) Milestones Impact on Evaluation System Allows for more objective methods of assessment and provide better feedback Provides a process for early identification of residents that are having difficulties All old and new evaluations and questions should be aligned with and tracked to milestones

23 Department of Graduate Medical Education (GME) Clinical Competency Committee (CCC) V.A.1. The program director must appoint the Clinical Competency Committee.(Core) V.A.1.a) At a minimum the Clinical Competency Committee must be composed of three members of the program faculty.(Core) V.A.1.a).(1) Others eligible for appointment to the committee include faculty from other programs and non- physician members of the health care team.(Detail) ACGME Common Program Requirements Approved: February 7, 2012; Effective: July 1, 2013 Approved focused revision: June 9, 2013; Effective: July 1, 2013

24 Department of Graduate Medical Education (GME) V.A.1.b).(1) The Clinical Competency Committee should: V.A.1.b).(1).(a) review all resident evaluations semi- annually; (Core) V.A.1.b).(1).(b) prepare and assure the reporting of Milestones evaluations of each resident semi-annually to ACGME; and, (Core) V.A.1.b).(1).(c) advise the program director regarding resident progress, including promotion, remediation, and dismissal. (Detail) Clinical Competency Committee (CCC)

25 Department of Graduate Medical Education (GME) V.A.1.b) There must be a written description of the responsibilities of the Clinical Competency Committee. (Core) ACGME Common Program Requirements Approved: February 7, 2012; Effective: July 1, 2013 Approved focused revision: June 9, 2013; Effective: July 1, 2013 Clinical Competency Committee (CCC)

26 Department of Graduate Medical Education (GME) Clinical Competency Committee (CCC): Written description

27 Department of Graduate Medical Education (GME) How the CCC does its work can be decided by the Program Director – Subcommittees – Assigning residents to faculty members for pre-review – Pre-review work will vary – Scheduling and frequency of meetings Clinical Competency Committee (CCC)

28 Department of Graduate Medical Education (GME) What Should a CCC Do First? Understand their specialty Milestones (Posted on acgme.org) Decide how to assess the Milestones – Program Evaluation Strategy If necessary, identify new evaluation tools from program director associations, societies, colleges

29 Department of Graduate Medical Education (GME) NAS and Milestones and YOU The program coordinator will play a crucial role in developing, implementing, collecting data on and reporting of milestone evaluation tools.

30 Department of Graduate Medical Education (GME) Managing it all…

31 Department of Graduate Medical Education (GME) U - R - IT! 1. U nderstanding RRC program requirements 2. R equirements applied to evaluation methods/process 3. I mplementing new evaluation system 4. T racking completion and accuracy (outliers) for data aggregation

32 Department of Graduate Medical Education (GME) 1. Understand Your Program’s New Requirements Core Outcomes Details

33 Department of Graduate Medical Education (GME) Each standard/requirement is categorized: Outcome - All programs must adhere Core - All programs must adhere Detail – Considered mandatory for new programs and those that fail to meet core requirements. Allows high-performing programs to innovate. Source: Implementing The Next Accreditation System ACGME Webinar John R. Potts, III, M.D.: 4 November 2013 1. Understand Your Program’s New Requirements

34 Department of Graduate Medical Education (GME) Example Program Requirement: VI.B. Transitions of Care 1. Understand Your Program’s New Requirements (Core) (Outcome)

35 Department of Graduate Medical Education (GME) Example Program Requirement: VI.B. Transitions of Care When core and outcome not in compliance, then: 1. Understand Your Program’s New Requirements Details

36 Department of Graduate Medical Education (GME) U - R - IT!

37 Department of Graduate Medical Education (GME) 2. Requirements Specific to CCC Review of Trainee Aggregating/compiling multiple evaluations of individual trainees (V.A.1. Formative Evaluation) Tracking trainee participation in conferences, journal clubs, didactics (IV.A.3. Didactic Sessions) Monitoring duty hour compliance (VI.G. Duty Hours) Reviewing involvement in quality improvement and patient safety activities (IV.A.5.c. PBLI) Reviewing scholarly work (IV.B. Scholarly Work) Monitoring and reporting procedure logs (IV.A.5.a)

38 Department of Graduate Medical Education (GME) U - R - IT!

39 Department of Graduate Medical Education (GME) 3. Implementing Evaluation systems – Milestone-based/EPAs – Rotation-specific – Patient handovers – Define evaluator groups (faculty, staff, patients) – Set up and timing of delivery systems

40 Department of Graduate Medical Education (GME) 3. Implementing Documentation and reporting systems for: – Conference attendance – Scholarly work (Learning Portfolios) – Quality Improvement and Patient Safety (Learning Portfolios / Safety reporting systems) – Duty Hours (recording, monitoring, reporting) – Case Logging (if applicable)

41 Department of Graduate Medical Education (GME) U - R - IT!

42 Department of Graduate Medical Education (GME) 4. Tracking and Reporting… Start with the end in mind: – CCC biannual reporting windows to ACGME November 1- December 31 / May 1 - June 15 Back track and set calendar events for: – Periodic monitoring of evaluation completion – Running aggregate reports and reviewing milestone evaluation data – Reviewing case logs, learning portfolios, duty hours

43 Department of Graduate Medical Education (GME) Pulling the Data Together Clinical Competency Committee End-of- Rotation Evaluations Safety Incident Reports Case Logs Patient/ Family Evaluations Clinical Skills Assessment Nursing and Staff / Techs Evaluations Progress on Milestones Sim Lab Sim Lab In-service training exams Quality Improvement Activities

44 Department of Graduate Medical Education (GME) Managing it all: How will I pull this off?

45 Department of Graduate Medical Education (GME) The Toolbox

46 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Goals to support your CCC Resident performance data that is: Comprehensive Consolidated / Aggregated Easy for CCC to identify strengths, areas for improvement, opportunities for advancement

47 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile: Compiling and centralizing data

48 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile: Apply visual formatting for trends

49 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 1 – Defining what to track

50 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 1 – Defining what to track

51 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 1 – Defining what to track

52 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 1 – Defining what to track

53 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 1 – Defining what to track

54 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 1 – Defining what to track

55 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 2 - Link data sources to milestones

56 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 3: CCC defines performance ranges At or Above Expectation: 2.8 and higher Below Expectation: 1.7 – 2.7 Remediation: Below 1.7 Example: For all aggregate milestone evaluation scores for a PGY 3, the CCC has defined these ranges by PGY level in advance of the meeting: STRENGTHWATCHAT RISK

57 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 4 – Set conditional formatting

58 Department of Graduate Medical Education (GME) Example: Aggregate milestone evaluation data cells Highlight cells to apply the conditional formatting Creating a Resident Performance Profile Step 4 – Set conditional formatting

59 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Step 4 – Set conditional formatting Set Ranges: >, <, between

60 Department of Graduate Medical Education (GME) Select, “Greater Than” “Less Than” or “Between” to Set Value Ranges Choose the corresponding fill color (e.g., red, yellow, green) Creating a Resident Performance Profile Step 4 – Set conditional formatting

61 Department of Graduate Medical Education (GME) Resident Performance Profile: Step 5: Enter in data

62 Department of Graduate Medical Education (GME) Creating a Resident Performance Profile Visual trends and detailed data

63 Department of Graduate Medical Education (GME) More tools…

64 Department of Graduate Medical Education (GME) Leveraging Resident Management System (RMS)Tools, if Available RMSs – becoming more feature rich Curriculum – Goals and Objectives and learning outcomes by rotation – Teaching and Assessment methodologies Evaluation tool development – Sharing between programs and institutions

65 Department of Graduate Medical Education (GME) Conference attendance statistics – Core competencies linked to specified conferences – Attaching conference materials for later reference Procedures and levels; linked procedure evaluations Leveraging Resident Management System (RMS)Tools, if Available

66 Department of Graduate Medical Education (GME) Resident portfolio tools QI participation and outcomes Scholarly Activity logs Leveraging Resident Management System (RMS)Tools, if Available

67 Department of Graduate Medical Education (GME) Aggregate reporting and graphic summaries Peer or departmental average, individual average, minimum and maximum scores, standard deviation or listing of all scores Leveraging Resident Management System (RMS)Tools, if Available

68 Department of Graduate Medical Education (GME) Set “data gathering and reporting” appointments with yourself Remember to start with the end in mind (e.g., CCC meeting dates) Break down large tasks into smaller tasks to keep it manageable Leveraging Calendaring and Task Management Software

69 Department of Graduate Medical Education (GME) Leveraging Calendaring and Task Management Software

70 Department of Graduate Medical Education (GME) Learning through Experience

71 Department of Graduate Medical Education (GME) When a CCC Meeting… Doesn’t go well Data – not complete – not organized – not accurate PD or faculty member dominates meeting Prolonged inefficient decision making with inability to gain consensus Unsubstantiated/unreliable conclusions Does go well Data – complete – organized – accurate Cooperative, collaborative decision making Efficient use of time Sound valid conclusions aligned with data

72 Department of Graduate Medical Education (GME) Successful Resident Ranking PGY1- 4: Ready to graduate

73 Department of Graduate Medical Education (GME) PGY 1 Ranked at Graduation Level 1 Milestone range for a PGY1 should not be a 4.0, 4.5 or 5.0 …

74 Department of Graduate Medical Education (GME) Improvement evident

75 Department of Graduate Medical Education (GME) We Should not be at this Point

76 Department of Graduate Medical Education (GME) Beyond data…Creating a climate of CCC Success Gentle Words of Wisdom Tight efficient meetings Ground Rules Beware of Negative Group Think Schedule firm standing meeting dates in advance Reserve room of appropriate size with required audio-visual tools if needed …..and have snacks

77 Department of Graduate Medical Education (GME) Use Technology to Your Advantage… You can be a ‘Rock Star’

78 Department of Graduate Medical Education (GME) Session Recap in a Nutshell… Know your program requirements and follow them unconditionally Use simple spreadsheet, calendaring and task organizational tools to manage, track and present resident performance data to your CCC Resident education is a cyclical process – revisit and revise tools and processes each year

79 Department of Graduate Medical Education (GME) Questions

80 Department of Graduate Medical Education (GME) Contacts Kim Walker - kwalker5@stanford.edukwalker5@stanford.edu Ann Dohn - adohn1@stanford.edu Nancy Piro - npiro@stanford.edu


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