Next Accreditation System and
Milestones:
Harvard Dermatology Status Update
Rachel Reynolds, MD
Program Director
Harvard Combined Dermatology
Training Program
“Outcome-based accreditation process through
which the doctors of tomorrow will be
measured for their competency in
performing the essential tasks necessary for
clinical practice in the 21st century.”
Nasca et al. NEJM 366;11:1051-56
ACGME Next Accreditation System
(NAS)
• New format for ACGME evaluation of programs
• Response to increasing accountability to
stakeholders (patients, payers, congress, the
public) regarding the role of physicians in teamoriented, cost-effective, patient-oriented care
• Phase I: July 2013 for seven specialties
• Phase II: July 2014 Dermatology
• System of continuous reporting to ACGME
replaces “site-visit” model
Nasca et al. The Next GME Accreditation System. Rationale and
Benefits. NEJM 366;11:1051-56
Program Changes
Formation of a Program Evaluation
Committee (PEC)---formerly Education
Operations (EdOps) committee.
– Has oversight of educational content, program
evaluation and program policies
Development of a Clinical Competency
Committee (CCC)—AY 2013-14
Clinical Competency Committee (CCC)
• Meet q6mos to review resident performance,
evaluate performance, form action plan, oversee
corrective action
• Feedback provided to resident 1:1 with PD/APD
• Submits semiannual reports to ACGME
Clinical Competency Committee (CCC)
Title
Name
Site
Program Director:
Rachel Reynolds
BIDMC
Associate Program
Director Med-Derm:
Andy Werchniak
BWH
Affiliated Site Directors: Harley Haynes
Faculty Directors:
VA
Marilyn Liang
CHB
Mayra Lorenzo
MGH
Siobhan Mannion
Lahey
Ruth Ann Vleugels
BWH
Peggy Wu
BIDMC
Mat Avram
Laser Cosmetics/MGH
Susan Burgin
Education/BIDMC
Daihung Do
Surgery/BIDMC
Su-Jean Seo*
Derm Path/BIDMC
Clinical Competency Committee (CCC)
• Per recent ACGME clarification, chief residents
in their senior year of training do not serve on
the CCC
ACGME Next Accreditation System
Milestones
• Resident performance will be measured
against specialty-specific, competency-based
milestones
• Dermatology milestones developed and
finalized by APD, ABD and Dermatology RRC
• CCC responsible for assessment and reporting
Turiansky GW, et al. The Dermatology Milestones Project. JGME
March 2014 s44-70.
To fill out evaluations!!!!!
ACGME Next
Accreditation System
Milestones
• “Milestones are knowledge, skills,
attitudes…organized in a
developmental framework from
less to more
advanced...descriptors and targets
for resident performance from
entry into residency through
graduation.”
Turiansky GW, et al. The Dermatology
Milestones Project. JGME March 2014 s44-70.
ACGME Competencies
•
•
•
•
•
•
Patient Care
Medical Knowledge
Practice-based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
Systems-based Practice
Milestones—important points
• Milestone scores reflect a “new” range that
correlates with training progress
• While level 4 is recommended milestones for
graduation level, achieving level 4 in all
milestones is NOT a graduation requirement
• ACGME will expect to see a range of milestone
scores for each resident and for each
residency program!
Evaluation of Residents:
Current process
• Competency-based end
of rotation evaluations
-General/medical derm rotations x 3
-Dermpath rotation
-Procedural rotation
• Competency-based mini Clinical Evaluation
Exercise (mini-CEX)—q6mos
• Patient evaluations—q6mos
• Self-Assessment--yearly
APD Milestones Tools
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Consultation Letter Milestones Tool
Patient Letter Milestones Tool
Evidence-Based Practice
Simple Excision & Repair Assessment Tool
In-Office Diagnostics Evaluation Exercise (IODEX)
In-Office Procedure Evaluation Exercise (IOPEE)
Mini-Dermatopathology Evaluation Exercise (DPEX)
Pediatric Dermatology Clinical Evaluation Exercise (CEX)
Conference Didactic/Lecture Presentation Assessment
Professionalism and Communication Journal Entry
Competency Assessment (ProCom JECA)
Harvard Derm New Evaluation System
• Consolidate best features of current evals,
add APD tools as warranted, develop new
tools
• Easily maps to milestones
• More observation-based, higher quality
evaluation
• More meaningful feedback and evaluation
Harvard Derm New Evaluation System
• Efficient delivery and
collection across
complex program
• Incorporate into New
Innovations
Jennifer Huang
Ines Wu
Susan Burgin
Daihung Do