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Accreditation Council for Graduate Medical Education Milestone Project Update Emergency Medical Services January 17, 2014 Jane Brice MD, MPH Professor.

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Presentation on theme: "Accreditation Council for Graduate Medical Education Milestone Project Update Emergency Medical Services January 17, 2014 Jane Brice MD, MPH Professor."— Presentation transcript:

1 Accreditation Council for Graduate Medical Education 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 2

3 THANK YOU Peter Pons, MD Debra Perina, MD Mike Beeson, MD Stacy Weisberg, MD Noel Wagner, MD, NREMT-P Jane Brice, MD, MPH Charles Beaudette, MD (Fellow) Nicholas Rathert, MD (Fellow) Felicia Davis 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 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 Milestones 7

8 Milestone Template 8

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 1.Procedures performed in the prehospital environment 2.Prehospital recognition and stabilization of time/life-critical conditions 3.Recognition and treatment of prehospital conditions 4.Mass casualty and disaster management 5.General special operations in EMS

12 EMS Milestones Medical knowledge 6. Medical oversight Systems-based practice 7.EMS personnel (supervision and training) 8.System management Practice-based Learning and Improvement 9. Quality management 10. Research

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


15 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). Selecting a response box in the middle of a level implies that milestones in that level and in lower levels have been substantially demonstrated. Milestones are progressive over time. There is no prescribed speed at which residents must complete a milestone set.

16 When should we start? NOW 16

17 Accreditation Council for Graduate Medical Education What is the Clinical Competency Committee? 17

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 Accreditation Council for Graduate Medical Education How does the CCC actually work? 19

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

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

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 26

27 Accreditation Council for Graduate Medical Education Thank you! 27

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

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