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Milestone Project Update

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Presentation on theme: "Milestone Project Update"— Presentation transcript:

1 Milestone Project Update
Emergency Medical Services January 17, 2014 Jane Brice MD, MPH Professor Laura Edgar EdD, CAE Executive Director

2 Presentation Topics Milestone Background and Purpose Implementation
Clinical Competency Committees Breakout Groups

3 THANK YOU Peter Pons, MD Jane Brice, MD, MPH Debra Perina, MD
Charles Beaudette, MD (Fellow) Mike Beeson, MD Nicholas Rathert, MD (Fellow) Stacy Weisberg, MD Felicia Davis Noel Wagner, MD, NREMT-P Anne Harvey, PhD

4 Milestones: What Milestones 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 expectations Describe trajectory from beginner in the specialty to exceptional resident or practitioner Organized under six domains of clinical competency Represent a subset of all sub-competencies Set aspirational goals of excellence

6 Milestones: Why Fulfill the promise of the Outcome Project:
Increased use of educational outcome data in accreditation ACGME accountability to public Support the educational process

7 Uses and Implications Milestones ACGME
Accreditation – continuous monitoring of programs; lengthening of site visit cycles Public Accountability – report at a national level on competency outcomes Community of practice for evaluation and research, with focus on continuous improvement Fellowship Programs Guide curriculum development More explicit expectations of fellows Support better assessment Enhanced opportunities for early identification of under-performers Certification Boards Potential use – ascertain whether individuals have demonstrated qualifications needed to sit for Board exams Fellows Increased transparency of performance requirements Encourage fellow self-assessment and self-directed learning Better feedback to fellows There 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 Template This 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 Group Came 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 Milestones Options for creation and organization of milestones – many to choose from: EMS Core Content EMS Curriculum EMS Board Exam Outline EMS Program Requirements Fellowship Experience (both as a fellow and as a program director

11 EMS Milestones Organized under the 6 domains of Clinical Competence
Patient care Procedures performed in the prehospital environment Prehospital recognition and stabilization of time/life-critical conditions Recognition and treatment of prehospital conditions Mass casualty and disaster management General special operations in EMS

12 EMS Milestones Medical knowledge Systems-based practice
6. Medical oversight Systems-based practice EMS personnel (supervision and training) System management Practice-based Learning and Improvement 9. Quality management 10. Research

13 EMS Milestones Professionalism Interpersonal Communication Skills
11. Ethics and professional behavior 12. Accountability Interpersonal Communication Skills 13. Team communications and management 14. 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).

16 When should we start? NOW

17 What is the Clinical Competency Committee?

18 Clinical Competency Committee
Composed of a minimum of 3 faculty members Non-physician members can be appointed Reviews all evaluations by all evaluators semi-annually Reviews residents against milestones semi-annually Make recommendations for progress – promotion, remediation and dismissal

19 How does the CCC actually work?

20 Who should be on the CCC? Decision for PD Consider:
Representation from each major site Subspecialty representation Dedication to education

21 How do we DO the evaluation?
Understand the milestones & their use Leave personal bias at the door Review 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 negative Grade inflation Vague statements: “I just didn’t like this resident, but I can’t put my finger on it” Hearsay: I’ve heard she is lazy

23 Clinical Competence Committee
Self Evaluations Case Logs Mock Orals End of Rotation Evaluations Operative Performance Rating Scales Unsolicited Comments ITE Sim Lab Student Evaluations Nursing and Ancillary Personnel Evaluations Clinic Work Place Evaluations Clinical Competence Committee OSCE Peer Evaluations Patient / Family Evaluations Assessment of Milestones © 2012 Accreditation Council for Graduate Medical Education (ACGME)

24 Milestones: Reporting
All programs within a specialty use the specialty’s milestones Programs will report semi-annually Milestone 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 CCC Break into groups – members of the Milestone Group are here and can help answer questions Evaluate Resident X against a 6 milestones Share your experience with your faculty – excellent faculty training opportunity

27 Thank you!

28 Contact Information Accreditation Questions: Felicia Davis Milestones Questions: Laura Edgar

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