Presentation on theme: "RRC-EM: EMS Fellowship ACGME Accreditation NAEMSP® EMS Fellowship Forum January 2014 Tucson, AZ Wallace Carter, MD Chair, Residency."— Presentation transcript:
1RRC-EM: EMS Fellowship ACGME Accreditation NAEMSP® EMS Fellowship Forum January 2014 Tucson, AZ Wallace Carter, MDChair, Residency Review Committee for Emergency MedicineLouis Ling, MDSenior Vice-President, Hospital Based Accreditation
2DisclosureCarter: New York Presbyterian Columbia University and Weill Cornell Ling: Hennepin County Medical Center University of Minnesota Textbooks: Rosen, Harwood-Nuss
3Learning Objectives Next Accreditation System (NAS) Quick ReviewUpdate and New DevelopmentsEMS Specific InformationIntroduction to Self-Study Visits
4NAS The Next Accreditation System: A quick review
5What is the NAS and when does it start? The Next Accreditation System began July 1, 2013 for all core EM and EM subspecialty programsNAS Strategic Plan:Foster innovation and improvement in the learning environmentIncrease the accreditation emphasis on educational outcomesIncrease efficiency and reduce burden in accreditationImprove communication and collaboration with key internal and external stakeholders
6The Building Blocks of The Next Accreditation System SelfStudyInstitutional Reviewprn Site Visits(Program or Institution)Continuous RRC Oversight and AccreditationSponsor OversightCLER Visits
8NAS Instead of biopsies, annual data collection Trends in key performance measurementsMilestones, Residents, fellows and faculty surveyScholarly activity templateOperative & case log dataBoard pass ratesScheduled accreditation visits every 10 yearsFocused site visits if annual data trends suggest problemsPIF replaced by self-study
9NAS and ADS Annual Updates Each year, programs data will be required to entered in ADS such as:Faculty informationFellow informationBlock diagrams/curricular informationScholarly activity informationParticipating site informationResponses to previous citationsDuty Hour, Patient Safety and Learning Environment informationEvaluation informationReporting of major changes in the program
10All 9,022 ACGME Accredited Residency and Fellowship Programs All 9,022 ACGME Accredited Residency and Fellowship Programs* January 1, 2013Adding short cycles (<3 years), approximately 4.0%* Excludes programs with Initial Accreditation@ 2013 Accreditation Council for Graduate Medical Education (ACGME)@ 21213Accreditation Council for Graduate Medical Education (ACGME)
11All 9,022 ACGME Accredited Residency and Fellowship Programs All 9,022 ACGME Accredited Residency and Fellowship Programs* January 1, 201395.7%Adding short cycles (<3 years), approximately 4.0%4%0.3%, n=27* Excludes programs with Initial Accreditation@ 2013 Accreditation Council for Graduate Medical Education (ACGME)@ 21213Accreditation Council for Graduate Medical Education (ACGME)
12NAS Ongoing data collection and trend analysis Enhance oversight to ensure high quality education and a safe and effective learning environmentHigh-quality programs will be freed to innovate – detailed process standardsPrograms with continued accreditation in good standing will not have to demonstrate compliance with the “detail” program requirements as written, but are allowed to innovate
13What are core, detail and outcome program requirements? Core Requirements: Statements that define structure, resource, or process elements essential to every graduate medical educational program.Detail Requirements: Statements that describe a specific structure, resource, or process, for achieving compliance with a Core Requirement. Programs in substantial compliance with the Outcome Requirements may utilize alternative or innovative approaches to meet Core Requirements.Outcome Requirements: Statements that specify expected measurable or observable attributes (knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medical education.
14What are core, detail and outcome program requirements? II.A.2. Qualifications of the program director must include:II.A.2.b) current certification in the subspecialty by the American Board of Emergency Medicine, or specialty qualifications that are acceptable to the Review Committee; and, (Core)II.A.2.d) at least three years’ experience as a core physician faculty member in an ACGME-accredited emergency medicine program or emergency medical services program; (Detail)IV.A.2.a).(2).(b).(i) participation in a mass casualty/disaster triage at an actual event or drill; (Outcome)
15Do I have to adhere to the “detail” program requirements? Programs that have initial accreditation or are in trouble must demonstrate compliance with all “detail” program requirements as written.Programs that have continued accreditation will be allowed to “innovate” on those program requirements that are identified as “detail”.
16Trended Data Elements Annual ADS Update Program Attrition – Changes in PD/Core Faculty/ResidentsProgram Characteristics – Structure and ResourcesScholarly ActivityBoard Pass Rate – Rolling RatesResident Survey – Common and Specialty ElementsClinical Experience – Case Logs or otherFaculty Survey – Core FacultySemi-Annual Resident Evaluation and FeedbackMilestonesAnnual Sponsor Site Visit (CLER)
17Annual Data Collected and Reviewed (Focus on Existing Information) Annual ADS Update - StreamlinedProgram AttritionProgram Characteristics – Structure and ResourcesScholarly ActivityBoard Pass Rate – Rolling multi-year ratesClinical ExperienceResident SurveyFaculty Survey – Core FacultySemi-Annual Resident Evaluation and FeedbackMilestonesClinical Competency CommitteesSponsor Site Visit (CLER) TBD-total picture
19Annual evaluation of program outcome data (modified from TJN) Applications for New ProgramsInitial AccreditationAccreditation with WarningContinuedAccreditationStructureCore ProcessDetailed ProcessOutcomesStructureCore ProcessDetailed ProcessOutcomesStructureCore ProcessDetailed ProcessOutcomesSTANDARDSStructureCore ProcessDetail ProcessOutcomesAdverse Actions
20Accreditation Actions in NAS Accreditation Policies and ProceduresEffective date: 7/1/2013Copyright Accreditation Council for Graduate Medical Education 2013
21Accreditation Status Options Actions not open to appealContinued Accreditation - GREENContinued Accreditation with Warning - YELLOWInitial Accreditation - BLUEInitial Accreditation with Warning - BLUEVoluntary Withdrawal of AccreditationAdministrative Withdrawal of AccreditationAdministrative Withdrawal due to withdrawal of sponsoring institution’s accreditation
22Accreditation Status Options Adverse actions open to appeal- REDAccreditation WithheldProbationary AccreditationWithdrawal of AccreditationWithdrawal of Accreditation Under Special CircumstancesNon-voluntary reduction in resident complement by the RRC is also open to appeal
23Continued Accreditation (AO) Continued Accreditation - substantial compliance with requirementsCan followInitial AccreditationInitial Accreditation with WarningContinued Accreditation with WarningProbationary Accreditation
24Continued Accreditation with Warning Continued Accreditation with Warning – areas of non-compliance jeopardize accreditation statusCan followContinued AccreditationProbationary AccreditationNo permanent increase in complement
25Initial Accreditation (IA) Core programs Core programs will have site visit prior to review. RRC options:WithholdInitial AccreditationWithin 2 years of granting IA, full site visit and review. RRC options:Continued AccreditationInitial Accreditation with Warning – 1 year onlyWithdrawal
26Initial Accreditation (IA) Fellowships Fellowship applications are reviewed without a site visit. Within 2 years of granting IA, a site visit will be scheduledRRC options when reviewing applicationInitial AccreditationWithholdRRC options following IA site visitContinued AccreditationInitial Accreditation with Warning – 1 year onlyWithdrawal
27Site Visits Focused: isolated concern about data elements Full: for IA or general concern about program, more than one isolated issueNo PIF to prepareIssues will be known for focus30 day noticeTeams for larger than 4 residents/fellowsSelf-studies after 2015
28Adverse Actions: What has changed No proposed adverse actionsAdverse accreditation status can only be conferred following a site visitPrograms with adverse accreditation status cannot request an increase in resident complementProbation cannot exceed 2 consecutive annual reviews
29Adverse Actions: What hasn’t changed A program on Withdrawal can complete the current academic yearWith RRC approval can complete 1 more yearNo new residents can be appointedIf program re-applies within 2 years, they must address previous citationsA site visit is needed for all applications following a withdrawal
30Relationship of Core and Subs Fellowships must have a relationship with a core residency programSelf-study visits of core and associated fellowships will occur at the same timeAdverse action in core results in the same status for their associated fellowshipsWithdrawal of core means withdrawal of all associated fellowshipsNew fellowships can only be granted IA status if core status is Continued AccreditationNO attached programs can be on Probation or in appeal
31Building the case for milestones……… Defer to Laura Edgar, EdD NASBuilding the case for milestones……… Defer to Laura Edgar, EdD
32RRC-EM: EMS Fellowship ACGME Accreditation NAEMSP® EMS Fellowship Forum January 2014 Tucson, AZ Wallace Carter, MDChair, Residency Review Committee for Emergency MedicineLouis Ling, MDSenior Vice-President, Hospital Based Accreditation
33New Application Process as of July 1, 2013 All new program applications must be initiated in ADS by the DIO of your institution
34New Application Process as of July 1, 2013 The program director must complete 2 partsPart 1 – Complete the ADS electronic portion initiated by the DIOPart 2 – Download and complete the new application specialty specific Word document from the website and upload into ADSThe completed application is submitted electronically in ADS
35New Application Process as of July 1, 2013 The new application specialty specific Word document can be found on the ACGME EM Web page:
36Information: RC-EM Web Page Recommended Links Program Requirements: Currently In EffectNew Applications – Word documentsFAQsCommon Resources:ACGME Glossary of TermsApply for Accreditation in Eight Easy StepsProgram Director Guide to Common Program RequirementsProgram Directors’ Virtual Handbook
37Faculty RosterWhen completing the faculty roster in ADS, enter core EMS faculty that have at least 5 hours per week and any other non-EMS physicians who provide at least 10 hours per week
38Faculty Qualifications If faculty members are ABOEM boarded and obtain the specialty certificate in EMS from the ABOEM, does the RC view this as being “acceptable”?A CAQ in EMS by the ABOEM is viewed as being acceptable
39For Requested Positions, can I ask for a range, e.g. 1-2? The RC-EM does not accept ranges of positions, only a specific number, so instead of requesting 1-2 position, you should request 2 positions (you are not required to fill all positions). You need to demonstrate in your application that you have enough resources to support the number of fellows requested. (e.g. you would need to have enough opportunity to have each fellow lead a disaster drill if that is part of your program so you provide the same experience for both fellows.)
40How do I know if I need a PLA? Here is an FAQ regarding Master Affiliation Agreements and PLAs. There is a PLA template at the end of the document/site:Program letters of agreement originate at the program (instead of the institutional) level and are required for each participating site providing a required assignment.Program letters of agreement are required between the residency program and all sites to which residents rotate for required education or assignments.
41How do I know if I need a PLA? However, if the two sites operate essentially as one entity, that is, they are governed by one governing body (e.g. Board of Directors) neither a master affiliation agreement nor a program letter of agreement would be necessary. Program letters of agreement are not necessary if the following on-campus or off-campus site is under the governance of the sponsoring institution or is an office of a physician who is a member of the sponsoring institution’s teaching faculty/medical staff: nursing and assisted-living homes; hospice facilities; faculty patient care offices; private physicians’ offices (volunteer faculty); ambulatory surgical centers; diagnostic centers, e.g. imaging, laboratory, etc.; treatment centers, e.g. dialysis, rehabilitation, chemotherapy, etc.; other similar sites.
42New EMS FAQ for PLAsQuestion When is it necessary for a program to obtain a Program Letter of Agreement (PLA) with an EMS agency? [Program Requirement I.B.1]
43New EMS FAQ for PLAs Answer: There must be a program letter of agreement (PLA) between the program and each participating site providing a required assignment. A fellow may interact with a number of EMS agencies in different capacities.The Review Committee guidelines on PLAs specify:A PLA is required for any EMS agencies with which the fellow provides in person participation as part of the required curriculumIf the sponsoring institution owns the company, no PLA is needed.If the participating site is an independent company, a PLA is still needed for liability reasons even if the program director or a faculty member of the EMS program is the medical director (and is signing the document on behalf of the program and on behalf of the participating site) at the participating site/independent company.
44Medical School Letter of Understanding I.B.6. The program must be affiliated with a medical school. I.B.6.a) The program must have a written letter of understanding which documents the duties and responsibilities of both the medical school and the program.This is similar to an affiliation agreement.May state that the program will be compliant with the regulations and rules of the institution in matters related to the functioning of the program and that the institution will provide appropriate oversight to assure compliance with accreditation standards as well as hospital and state rules, regulations and lawsSee the following web page for more information:https://www.acgme.org/acgmeweb/Portals/0/PDFs/FAQ/ab_FAQAgreement.pdf
45Information: Application Deadline Applications received by April 28th, 2014 will be reviewed at the June 23-24, 2014 RC Meeting
46Information: Application Review Process Completed application and all attachments uploaded in ADSNo site visit requiredApplication reviewed based upon program requirements at an upcoming RC meeting.In 2014 RC meets February and JunePrograms are not reviewed by RC members in same state or with a conflict of interest
47Information: Application Review Process Within 5 business days after the meeting, s will be sent regarding the RC’s decisionInitial Accreditation OR WithholdWithin 60 days after the meeting, a Letter of Notification (LON) will be available.
48Initial Accreditation: EMS Effective Dates EMS Program Requirements were approved and were given an effective date of 9/30/2012For applications reviewed at both the February and June 2014 meetings and granted initial accreditation, programs may choose to have an effective date of either 7/1/2013 or 7/1/2014.
49What about current EMS fellows? Q) If my program is accredited at the February 2014 RC meeting and I chose an effective date of July 1, 2014, what does that mean for my current fellows scheduled to finish June 30, 2014?If they finish the program on or before June 30, 2014, they will not graduate from an accredited program and will be ineligible to take ABEM’s EMS CAQ exam.
50EMS Applications Reviewed 24 applications reviewed in February 201313 applications reviewed in September 20136 applications scheduled for February 201433/37 - Total EMS applications approved to date
51Top 3 Most Common EMS Citations Lack of PLAsPD responsibility – Inaccurate Application FormScholarly Activity – Core faculty
52Phase I and Phase II Programs Phase I, aka Early Adopters, Early 7:Internal MedicinePediatricsUrologyOrthopedic SurgeryEmergency MedicineDiagnostic RadiologyNeurologic SurgeryPhase II – All remaining specialties