 Optimizing your “PIF-manship”
 Day of Reckoning: The visit Itself
 Behind the Scenes (ACGME / RRC)
 Avoiding the MOST Common Citations
 How the GME Office Can Help!

 Why it matters
 Understanding the rules
 Timeline for completion
 Attachments and Supporting Documents
 Avoiding the most common errors
*****Group Exercise: Common PIF Competency Ideas

 Majority of ultimate citations result directly from information provided in the PIF (others primarily from resident interview, resident survey, and document review)
 A well-written PIF can minimize a multitude of sins!
 A platform to prepare all survey day participants (best completed as a group effort for optimal buy-in…)
 Ideally functions as a self-study to help ID areas of
“opportunity”

 Review your CURRENT program requirements before beginning work on your PIF
 All PIF questions track DIRECTLY to a program requirement
(common or specialty)
 There ARE many PIF questions with RIGHT and WRONG answers!
 READ (and follow!) THE DIRECTIONS!!!!!!!! (“one” examples means ONE, “describe” means DESCRIBE)
 NEVER send extra attachments or unsolicited information with the PIF
 Be CLEAR, CONCISE, & CONSISTENT!

 Many experts recommend beginning formal writing at the point of Internal Review (response to last citations, etc.)
 On-going prep is best (track data, keep files organized, example folders of key requirements, etc.
 ALWAYS at least 6-12 months before anticipated review date

 Site surveyor must receive PIF and attachments 2 weeks before site visit
 DIO must review and sign off before document can be mailed to surveyor
 Optimally DIO reviews polished draft 4-6 weeks before survey, recommends changes, and signs final copy 3 weeks before survey date ***
 Dept Chair, Chief Residents, Key Faculty should read and edit PIF prior to sending to DIO

 Anticipated Date of Next Review: 4/2010
 Send to Site surveyor: 3/15/2010
 Send draft to DIO: 2/15 - 3/1/2010
 Draft for CR/key Faculty review: 2/1 – 3/1/2010
 90-120 Day survey date notice: 12/15/2009
 Best you start writing by: 10 – 11/ 2009

 Acgme.org
 Web-ads sign-in and print out PIF
 Part 1 is pre-populated program description; check for accuracy, make changes as needed thru web-ads
 Part 2 is questions and narrative specific to your programs
 Tackle the PIF in small bites / sections
 JUST DO IT!!! (procrastination compromises product!)

 Unanswered questions / Missing information
 Failure to follow directions
 Spelling / Grammar / Structure Structure errors
 Including unformatted faculty CV’s, manuscripts, etc.!!!!!!
 PIF faculty CV’s with publications from the 70’s & 80’s, (last 5 years
ONLY!!!)
 Pages incorrectly numbered
 Inconsistent data
 Inaccurate block diagrams
 Failure to fully explain unique approached to satisfying requirements
 Failure to TELL the TRUTH!!!

 # residents in ACGME database = number of names on resident list = #of residents listed in PIF
 Months / FTE’s at each participating site = number of rotations on block diagram
 # of resident evaluations in folders = frequency of resident reviews reported
 Institution mentioned in narrative is not referenced elsewhere
 Faculty List / Faculty Credentials = faculty CV’s attached
 Procedures listed for individual residents = numbers of total program procedures

 May be slightly different for different RRC’s
 Usually:
 Policy for resident supervision
 Moonlighting policy
 Duty Hours Policy
 Competency Assessment Tools
 Evaluation tools
 Overall Educational Goals for the Program
 Sample Goals & Objectives for a rotation
 Program Letters of Agreement

 Policy for Supervision of residents
 Program Policies for duty hours and work environment
 Moonlighting policy
 Documentation of internal review (DIO provides)
 Overall Program Goals
 Competency Based Goals & Objectives by rotation and level of trainee
 Current Program Letters of Agreement
 Files of current residents (sample transfer & problems)
 File of recent program graduate (final summative eval, “competent to practice independently”)

 Evaluations of residents at end of rotation
 Examples of completed 360* evaluations
 Sample of written semi-annual evaluation by PD
 Completed confidential evals of faculty by residents
 Completed confidential evals of program by residents
 Completed confidential evals of program by faculty
 Minutes of annual program evaluations and written improvement plan
 Resident duty hour tracking

 Complete Program Curriculum
 Examples of scholarly activity (resident and faculty)
 Documentation of program improvement projects
 Conference schedules with documentation of attendance
 Board Exam Results of graduates
 Copies of alumni surveys if done
 Trainee handbooks
 Any other examples of “special” things you do!

 The site visitor
 Preparation
 Program Director Prep
 Program Administrator Prep
 Faculty / Chair Prep
 RESIDENT PREP
 Last Minute Reminders
 The Schedule

 Professional profile of your surveyor available on acgme.org
 Confirms and clarifies the PIF (Does NOT make accreditation decision!)
 Documents the data and the processes
 Writes fair, objective, and accurate report
 Does NOT make recommendations regarding accreditation action
 Will have a specific structure they wish to follow for the day---ACCOMMODATE them!!!!

 Make sure everyone meeting with the surveyor has read the
PIF (and agrees with its content!!!)
 Design the day’s schedule as directed by your site surveyor
 Communicate any changes or problems directly to your surveyor
 Identify and schedule a room for the survey day which can accommodate all interviews
 Have three copies of PIF for surveyor
 Decide who will hold / answer pagers for participants!

 Know your Program Requirements inside / out, forwards & backwards!
 Know your PIF/ prep your people
 Have all supportive documentation, well-organized and optimally ordered by PIF topics
 Have interview room neat and stocked with water
 Surveyor may also wish to tour lounge and call rooms
(make sure they are clean, too!)

 Hold peer election in larger programs to select who will meet with the surveyor (Surveyor will tell you how many; usually 10-12)
 Provide PIF to residents for review 2-4 weeks prior
 Meet with residents 1-2 weeks prior and review anticipated surveyor questions
 Make sure they understand how previous citations have been addressed
 Make certain ALL “non-compliant” issues in ACGME resident surveys have been addressed, and be sure residents feel efforts have been effective for all remedies

 Select faculty per site surveyor directions
 Provide PIF to faculty for review 2-4 weeks prior
 Meet with faculty 1-2 weeks prior and review anticipated surveyor questions
 Make sure they understand how previous citations have been addressed
 Pagers must be OFF (or absent) during the meeting

 PD / PA meeting with review of PIF / Documents
 Chair Meeting
 DIO Meeting
 Key Faculty Meeting
 Resident Meeting
 Wrap Up meeting with PD

 Site Surveyor completes a written report- just the facts, designed to verify
PIF information, summarize document review, and clarify issues raised in the ACGME resident survey
 Surveyor report is forwarded to designated RRC to be added to next open agenda (agendas usually finalized 2 months in advance of actual meeting)
 RRC committee members (1-3) are assigned PIF and surveyor report for review & to present at meeting (actual surveyors do not participate)
 Committee discusses and determines status and cycle length
 E-mail notice received within 2 weeks of meeting re status decision and cycle length
 Full Letter of Report (LOR) with citations received 8-12 weeks after RRC meeting

 Nationally Most Common Citations
 UMC Most Common Citations
 The Nine Red Flags

 Duty Hour Violations
 Service versus Education Issues
 Evaluation problems
 Board Pass Rate Citations
 Written Curriculum Inadequacies

 Qualifications and Number of Faculty (14)
 Procedural Experience (13)
 Patient Care Experience (12)
 Institutional Support (10)
 Evaluation of Program (9)
 Scholarly Activities (9)
 Responsibilities of Program Director (9)
 Performance on Board Exams (8)

 From ACGMe-Bulletin February 2008
 Barbara Bush, William Robertson, Ingrid Philibert authors
 Key issues to AVOID in program & site surveys
 These problems most likely to result in adverse accreditation citations

 PD and Faculty fail to advocate for residents on important education and patient care issues
 Lack of response to issues raised by residents/fellows
 Too much reliance on communication and preparation
PIF by program coordinator or other staff members
 Repeat citations on successive reviews

 Insufficient clinical or didactic curriculum
 Insufficient systems for evaluation of residents, faculty or program

 Insufficient volume or balance of patients (diagnoses, clinical problems, acuity and demographics)
 Disputes with other disciplines affecting numbers of patients available to the teaching program
 Too many residents, fellows, other learners competing for same patient populations

 High Resident Turn-over
 Unfilled resident positions
 Poor record for graduates sitting for and passing board exam (reflects poorer quality applicants / trainees?)
 May be due to geography, program or institutional reputation, interest in specialty, etc.

 Faculty unwillingness or inability to devote added time required for effective teaching (at the bedside and in operating room, during conferences, rounds, and other didactics)
 Problem may present with low numbers of board-certified faculty or not enough key faculty
 Too much or too little supervision
 Failure to provide meaningful feedback and evaluation
 Fellows doing all the teaching

 Didactics don’t cover the essential body of knowledge required by RRC (basic science and clinical)
 Frequent cancellation of conferences
 Lack of sufficient faculty attendance or participation in conferences
 Over-reliance on residents or fellows to organize and present at conferences

 Inadequate or outdated facilities
 Excessive clinical demands on faculty / PD
 Excessive clinical demands on faculty including PD
 Excessive “services needs” / Residents need to “cover” too many hospitals
 Inadequate number of administrative and ancillary staff for size of program
 Lack of funding for program

 Undue reliance on residents to provide service including clinical services that cannot run without the presence of residents
 Residents being “pulled” to “cover” services regularly
 Duty hour violations affecting a significant percentage of the residents
 Residents being required to provide coverage or crosscoverage on inpatient units during their ambulatory, subspecialty, or research rotations.

 On site survey day, a program leader or faculty member who does not understand, argues about the standards, or lacks “buy-in” for the requirements
 Poorly prepared PIF
 Obvious errors, inconsistencies or failure to follow instructions
 Missing documents
 PIF that arrives late to site visitor

(BUT Frequent Area of Citation in many specialty areas)

 Many required topics are covered in orientation annually
 We provide notification of campus wide activities that offer opportunities to meet program requirements
 Evaluation Tools ; Faculty Development Opportunities
 Problem Resident / Faculty Intervention
 Anonymous Resident Complaint Line
 internal reviews/ Annual Survey/ Duty Hours Survey designed to help you maintain compliance and identify problems early
 Resident Focus Groups convened as needs identified
 PIF REVIEW!!!! (in draft form!)
 Mock Surveys on request or consultant visits

 Start early
 Review and know Program and Institutional
Requirements
 Correct ALL previous citations
 Have on-going program improvement processes
 Good communication and preparation with residents and faculty
 Convey the strengths and unique attributes of your program clearly to the surveyor!