Trends at the ACGME (where we are going Trends at the ACGME (where we are going?) Louis Ling, MD Senior VP, Hospital-based accreditation Professor of Emergency Medicine University of Minnesota

Evolution of the ACGME Courtesy of John Potts MD CLER Milestones Single Accreditation CLER NAS ACGME-I Milestones Project JGME First residency RRC ACGME established independent Outcomes Project 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Pace of change is accelerating Courtesy of John Potts MD

Evolution of the ACGME 60 yrs Courtesy of John Potts MD CLER Single Accreditation CLER NAS ACGME-I Milestones Project 60 yrs JGME First residency RRC ACGME established independent Outcomes Project 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Pace of change is accelerating Courtesy of John Potts MD

Evolution of the ACGME 91 yrs Courtesy of John Potts MD CLER Single Accreditation CLER NAS 91 yrs ACGME-I Milestones Project JGME First residency RRC ACGME established independent Outcomes Project 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Courtesy of John Potts MD

Evolution of the ACGME 15 yrs Courtesy of John Potts MD CLER Single Accreditation 15 yrs CLER NAS ACGME-I Milestones Project JGME First residency RRC ACGME established independent Outcomes Project 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Courtesy of John Potts MD

Evolution of the ACGME 15 yrs 2003 Duty Hours 2011 Duty Hours Single Accreditation CLER NAS ACGME-I Milestones JGME First residency RRC ACGME established independent Outcomes Project 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2015 Duty Hours studies in Medicine and Surgery 2003 Duty Hours 2011 Duty Hours Courtesy of John Potts MD

Megatrends at the ACGME Change in attitude at the ACGME Limitation of rules Need to improve and innovate faster Need to train physicians for future practice Partners with programs, institutions and others

Megatrends at the ACGME Professional expectations to Public expectations Expert-based to Evidence-based Process to Outcomes based Rules based to QI based ACGME control to Local control Focus on Accreditation to GME Improvement Periodic review to Annual review Paper (PIF) to Computer (ADS) ACGME focus to Collaborative focus

Trends at the ACGME 1. Professional expectations to Public expectations Patient safety and competency concerns Duty hours and IOM reports Public members added Congress and GME funding ACGME Resource accountability

Trends at the ACGME 2. Expert-based to Evidence-based JGME Milestones 2.0 Duty Hours: FIRST and iCOMPARE Future program requirement changes

Trends at the ACGME 3. Process based to Outcomes based Outcomes project Core Competencies Milestones NAS screening Focus from individual citations to overall accreditation status

Trends at the ACGME 4. Rule-based model to QI model: Minimum compliance (just getting by) to encourage excellence (to be the best) Internal reviews CLER Pathways to Excellence Annual Program Review 10 Year Self-studies/Program Aims

Trends at the ACGME 5. ACGME Control to Local Control Internal reviews and GMECs Annual Program Evaluations and PECs Linking core programs and fellowships Areas for Improvement (AFIs) Recognition of programs and institutions Best practices

Trends at the ACGME 6. Accreditation moving to Improving GME Feedback at the site visit More Education Annual Education Conference larger New Assessment workshops Coordinator and chief resident training Distance learning Wellness and Learning Environment

Trends at the ACGME 7. Periodic 4.5 year avg to Annual Review Annual review of data Annual review to resolve citations Annual review of surveys Annual review of case logs Shift from citations to accreditation

Trends at the ACGME 8. Paper (PIF) to Electronic (ADS) Overall GME Summary reports Analysis (and research) is possible Trends are measurable More uniformity between specialties Expect initial bugs and transition woes

Trends at the ACGME 9. ACGME focus to Collaborative focus Comment period before requirement changes Milestones process Wellness efforts Duty Hours Reassessment Research efforts

Trends at the ACGME Impact on RCs Embrace and track outcomes Let go of reliance on process every year Not checking on all requirements for CA More use of annual data and trends Review of only high risk programs

Trends at the ACGME Impact on RC workload Target: Review 20% of programs annually Ten year review at steady state 10% Data review identify 10%

Trends at the ACGME Impact on programs Greater importance of annual data Less oversight of good programs Earlier detection of programs at risk Need faster response to citations AFIs may or may not need attention

Trends at the ACGME Impact on programs More self-assessment and improvement More focus on what you do best More focus on your outcomes Graduation based on competency

Trends at the ACGME Impact on institutions Importance of annual program data More responsible for programs Know program needs before the ACGME CLER as a mirror, not as a hammer Develop a wellness culture (supportive environment for all)

Trends at the ACGME Impact on institutions Help programs self-assess and improve Shift focus: compliance to education

Megatrends at the ACGME Professional expectations to Public expectations Expert-based to Evidence-based Process to Outcomes based Rules based to QI based ACGME control to Local control Focus on Accreditation to GME Improvement Periodic review to Annual review Paper (PIF) to Computer (ADS) ACGME focus to Collaborative focus

Program Coordinator Advisory Group To advise ACGME administration concerning coordinator, GME, learning environment and accreditation matters One source of insight in improving communications, ACGME process and interactions with the GME community Responsible to the ACGME Overall goal is to further ACGME mission

Program Coordinator Advisory Group Represent coordinators as a whole Not representative of any specific organization, institution or specialty Diverse group by location, size of program, specialty

Program Coordinator Advisory Group September 8-9, 2016 topics Improving the Next Accreditation System Input on Sponsoring institution 2025 Improving communications Understanding the Coordinator role

Understanding the Coordinator role Joys Always learning Variety Purpose Relationships Career, not just a job

Understanding the Coordinator role Frustrations Lost connections with residents Relationship with PD Non-responsive faculty Overwork and overwhelmed Lack of respect Lack of communication Lack of recognition and thanks

Understanding the Coordinator role Advice Reminders of seasonal tasks Tutorials and professional developmen Accessible training Learning from others and mentoring Redundant data entry GME finance

Program Coordinator Advisory Group Ongoing conversation Input considered with other stakeholders