Welcome to…..

The Single Accreditation System: AOA/ACGME Integration At Last! Judith Pauwels, MD AAFP Residency Program Solutions Consultant

Disclosures I have no conflicts of interest to report regarding this presentation.

Disclosures And I DO represent two organizations actively collaborating to assist AOA programs with the SAS: Association of Family Medicine Residency Directors (AFMRD) American College of Osteopathic Family Physicians (ACOFP)

Polling Question #1

Goals Describe the Single Accreditation System process for Sponsoring Institutions and Programs. Discuss Institutional Accreditation and CLER requirements. Discuss common questions related to Program Accreditation in Family Medicine. Identify resources to help!

The ultimate goal: Preserving and enhancing the primary care workforce critical to health care system reform

SAS Process and Timelines What has changed in the pathways that our students and residents will follow? What is the process for achieving ACGME accreditation for both the Sponsoring Institution, and for the sponsored program? What are the key timelines and dates for doing this?

Medical School US MLECOMLEX NRMP Match NMS Match Residency Specialty Boards LCME NBME NBOM E AOA AAMC AOA ACGME AOA ABFM AOBF P Initial Accreditation Residency ACGME SOAP Match OPTI Accreditation Status, 2014 Sponsoring Institution: Hospital, CHC MD Students DO Students MDDO Updated 8/6/2015

ACGME Pre- accredited Residency Medical School US MLECOMLEX NRMP Match NMS Match Residency Specialty Boards LCME NBME NBOM E AOA AAMC AOA ACGME ABFM AOBF P Initial Accreditation Residency ACGME SOAP Match Sponsoring Institution: Hospital, CHC, OPTI* Moving to the Unified Accreditation Process: Residency AOA OPTI MD Students DO Students Osteopathic Recognition DO only OPTI(? ) Unknown MDDO Updated 8/6/2015 *may apply

Medical School US MLECOMLEX NRMP Match NMS Match Residency Specialty Boards LCME NBME NBOM E AOA AAMC AOA ACGME ABFM AOBF P MD Students DO Students Initial Accreditation Residency SOAP Match Accredited Sponsoring Institution: Hospital, CHC Fully Implemented Unified Pathway: 2020 Osteopathic RecognitionOPTI (?) Unknown DO only MDDO Updated 8/6/2015

SAS Process Note several issues yet to be fully resolved: The Match systems are still separate. Board certification systems are still separate. Separate ACGME requirements for resident pass rates for residency (ABFM) and Osteopathic Recognition (AOA).

SAS Process and Timelines The Sponsoring Institution (SI) must receive Institutional Accreditation before a Program can receive initial accreditation. However, both can be in “pre- accreditation” status and application work move forward simultaneously.

SAS Process and Timelines All AOA-only residents must be graduated by Family Medicine programs must achieve Initial Accreditation by June 30, Although this is almost 5 years away, the accreditation process will take significant time and resources, with many complex questions still be be answered….

Polling Question #2

Sponsoring Institutions Who can be a Sponsoring Institution (SI)? Or… What are the responsibilities and authorities of the SI?

SI Responsibilities Institution must demonstrate assumption of ultimate financial and academic responsibility for the programs that it sponsors, and be in substantial compliance with other relevant ACGME Institutional Requirements. No distance requirement.

SI Responsibilities Oversight of resident/ fellow assignments and of the quality of the learning and working environment, extending to all participating sites. Financial support for administrative, educational, and clinical resources, including personnel.

Institutional Accreditation ACGME institutional objectives: SI resources in support of GME. SI oversight of learning and working environment. Structure for SI oversight of programs. SI policies and procedures for GME.

Structure for SI oversight of programs Critical elements: Institutional commitment to GME. Designated Institutional Official (DIO): May be the Program Director in single- program SI (SPSI). An engaged Graduate Medical Education Committee (GMEC).

Structure for SI oversight of programs GMEC structure: DIO, program directors. Must include residents/fellows (at least two). Must include patient safety/quality officer (or designee). For SPSI: must include at least one person from outside the program who’s involved with GME. Must meet at least quarterly, and keep minutes of these meetings.

Structure for SI oversight of programs GMEC responsibilities: Oversight of learning environment Oversight of sponsored programs accreditation status, and annual evaluation activities Compliance with policies

SI GME policies and procedures Resident/fellow recruitment and selection Resident/fellow contract, including specific list of what must be in the contract Promotion, appointment renewal, and dismissal Grievances Resident services (behavioral health, policies on harassment, disabilities, impairment) Supervision, duty hours Vendor interactions Non-competition Closures and reductions, disasters

SI oversight of learning and working environment: CLER

What is CLER? “The Clinical Learning Environment Review (CLER) is a mechanism by which the ACGME assesses a Sponsoring Institution (SI) to evaluate its commitment to developing a culture of quality, patient safety, and performance improvement for both resident education and patient care.”

CLER Focus Areas Professionalism Supervision Healthcare Quality Healthcare Disparities Transitions of Care Duty Hours Fatigue Management Patient Safety

Sponsoring Institutions Who can be a Sponsoring Institution (SI)?

Polling Question #3

PROGRAM requirements Common Requirements: Apply to ALL programs, regardless of specialty. Specialty-specific Requirements: Define each specialty.

Common Program Requirements Affiliation of Sponsoring and Participating Institutions, and “PLAs” Specifications about program director and faculty General information about resident appointments, educational program, and the competencies Expectations of resident scholarly activity Evaluation systems Resident supervision Resident duty hours

Family Medicine Program Requirements: potential issues Program size (minimum 4-4-4) Specifications for the “Family Medical Practice” Program director qualifications and time allocated to program Core faculty ratio and time allocated to program Faculty roles; scholarly activity Rotation / experience requirements

Family Medicine Program Requirements: potential issues Supervision requirements Evaluation system complexities: Incorporating the Milestones Direct observations CCC (Clinical Competency Committee) Administrative complexities: PEC (Program Evaluation Committee) ADS (Accreditation Data System) reports

Financial Considerations Federal and state GME funding streams: CMS rules only relate to accreditation in that either AOA or ACGME accreditation is required to claim residents. Program must maintain AOA accreditation until Initial Accreditation by ACGME is received. Sponsoring Institution costs Program costs for meeting ACGME requirements…

Program Pre-accreditation Process: Writing the PIF (Program Information Form) Submitting the PIF and attachments in ACGME ADS (Accreditation Data System) Site visit Deadlines for submission on ACGME website for the specialty (note: includes site visit!)

Program Pre-accreditation Process: Initial accreditation will be for two years. If not approved the first time, the program can continue to revise its plans and then reapply, until June 2020.

Program Pre-accreditation Programs must start reporting all required ACGME annual information: ADS annual update Resident survey Faculty survey Milestone assessment and reporting Can simultaneously start application for Osteopathic Recognition

Polling Question #4

Networking for Strength Fundamental belief in the need for primary care, and specifically family medicine, for our patients and communities. Core value that all of us working together are stronger than working in isolation. NO program has found all of this “easy.” But ALL programs have found this rewarding!

Resources Accreditation Navigation – Attend an intensive two-session program to cover all aspects of the transition to ACGME accreditation and to provide a networking opportunity with fellow directors and experienced faculty. See details at Association of Family Medicine Residency Directors (AFMRD) – Become a member and have access to the members only toolbox and discussion list. Residency Program Solutions – When a program consultation is called for, AAFP’s RPS has experienced consultants to meet your needs.