Presentation on theme: "Milestone Project Update"— Presentation transcript:
1 Milestone Project Update Emergency Medical ServicesJanuary 17, 2014Jane Brice MD, MPHProfessorLaura Edgar EdD, CAEExecutive Director
2 Presentation Topics Milestone Background and Purpose Implementation Clinical Competency CommitteesBreakout Groups
3 THANK YOU Peter Pons, MD Jane Brice, MD, MPH Debra Perina, MD Charles Beaudette, MD (Fellow)Mike Beeson, MDNicholas Rathert, MD (Fellow)Stacy Weisberg, MDFelicia DavisNoel Wagner, MD, NREMT-PAnne Harvey, PhD
4 Milestones: WhatMilestones describe performance levels fellows are expected to demonstrate for skills, knowledge, and behaviors in the six competency domains.Milestones will lay out a framework of observable behaviors and other attributes associated with fellows’ development as physicians.In the next accreditation system , aggregate fellow performance on the milestone level will be used as one indicator of a fellow’s educational effectiveness.Nasca, TJ et. Al. The Next Accreditation System :
5 Key Points: Milestones Articulate shared understanding of expectationsDescribe trajectory from beginner in the specialty to exceptional resident or practitionerOrganized under six domains of clinical competencyRepresent a subset of all sub-competenciesSet aspirational goals of excellence
6 Milestones: Why Fulfill the promise of the Outcome Project: Increased use of educational outcome data in accreditationACGME accountability to publicSupport the educational process
7 Uses and Implications Milestones ACGME Accreditation – continuous monitoring of programs; lengthening of site visit cyclesPublic Accountability – report at a national level on competency outcomesCommunity of practice for evaluation and research, with focus on continuous improvementFellowship ProgramsGuide curriculum developmentMore explicit expectations of fellowsSupport better assessmentEnhanced opportunities for early identification of under-performersCertification BoardsPotential use – ascertain whether individuals have demonstrated qualifications needed to sit for Board examsFellowsIncreased transparency of performance requirementsEncourage fellow self-assessment and self-directed learningBetter feedback to fellowsThere are four primary stakeholders in the Milestone Project: ACGME, Residency Programs, Residents, and Certification Boards. The CAGME will primarily use milestones for accreditation of GME programs. They will also use them for reporting to nation al interests and for research purposes. Residency programs may use the milestones to help guide curriculum and to aid residents. For residents that are not performing at expectation, the milestones become a clear means of explanation as to where the problems lie. Residents can use the milestones to do more self-assessment and to prepare for future learning. The results of a milestone evaluation will help the resident to understand their strengths and weaknesses. Each certification board will decide for themselves what they will do with this information. They may use it as a requirement for sitting for the board exams or as a launching point for maintenance of certification.
8 Milestone TemplateThis is the template the groups started with. The template demonstrates the expectations of the levels. Level 1 is for the beginning resident. The beginning resident is different for each specialty – some residents have come direct from medical school, some have had a transition year, some have even already completed another residency program. Level 4 is for the graduating resident. A resident who achieves a Level 4 is someone who is ready for certification and independent practice. Levels 2 and 3 are those steps in-between – these residents are continuing to learn. Level 5 is for those residents who exceed the expectations of the graduating resident.
9 EMS Milestones GroupCame together for a 1.5 day meeting We had representatives from the RRC, ABEM, NAEMSP and two recently graduated fellows Made decisions about framework for milestones and then got to work
10 EMS MilestonesOptions for creation and organization of milestones – many to choose from:EMS Core ContentEMS CurriculumEMS Board Exam OutlineEMS Program RequirementsFellowship Experience (both as a fellow and as a program director
11 EMS Milestones Organized under the 6 domains of Clinical Competence Patient careProcedures performed in the prehospital environmentPrehospital recognition and stabilization of time/life-critical conditionsRecognition and treatment of prehospital conditionsMass casualty and disaster managementGeneral special operations in EMS
12 EMS Milestones Medical knowledge Systems-based practice 6. Medical oversightSystems-based practiceEMS personnel (supervision and training)System managementPractice-based Learning and Improvement9. Quality management10. Research
13 EMS Milestones Professionalism Interpersonal Communication Skills 11. Ethics and professional behavior12. AccountabilityInterpersonal Communication Skills13. Team communications and management14. Patient-centered communications
15 Milestones are progressive over time Milestones are progressive over time. There is no prescribed speed at which residents must complete a milestone set.Selecting a response box in the middle of a level implies that milestones in that level and in lower levels have been substantially demonstrated.Selecting a response box on the line in between levels indicates that milestones in lower levels have been substantially demonstrated as well as some milestones in the higher level(s).
18 Clinical Competency Committee Composed of a minimum of 3 faculty membersNon-physician members can be appointedReviews all evaluations by all evaluators semi-annuallyReviews residents against milestones semi-annuallyMake recommendations for progress – promotion, remediation and dismissal
20 Who should be on the CCC? Decision for PD Consider: Representation from each major siteSubspecialty representationDedication to education
21 How do we DO the evaluation? Understand the milestones & their useLeave personal bias at the doorReview all evaluations for each resident“Consider the source(s)”For each resident, decide for each milestone the narrative that best fits that resident
22 The Clinical Competency Committee Avoids common problematic issues:“I don’t like to give negative evaluations”“I spent little time working with this resident”“Herd” mentality: positive or negativeGrade inflationVague statements:“I just didn’t like this resident, but I can’t put my finger on it”Hearsay: I’ve heard she is lazy
24 Milestones: Reporting All programs within a specialty use the specialty’s milestonesPrograms will report semi-annuallyMilestone data will be reported to ACGME through direct entry into ADS
25 Implementation Next Accreditation System for EMS starts July 1, 2014 First Milestone reporting is December 2014
26 MOCK CCCBreak into groups – members of the Milestone Group are here and can help answer questionsEvaluate Resident X against a 6 milestonesShare your experience with your faculty – excellent faculty training opportunity