PROGRAM DIRECTOR ’S ROLE
Brian L. Cohen, MD, FRCOG, FACOG
Associate Dean of Graduate Medical Education
Professor of Obstetrics, Gynecology and Women ’s Health

1999: ACGME introduced the domains of clinical competency
2009: ACGME began a multiyear process to restructure the accreditation system to be based on outcomes
2013: Phased implementation of the NAS

 Enhance the peer review system to prepare physicians
 Accelerate ACGME accreditation based on outcomes
 Reduce the burden of the current system which is process based

 Institute of Medicine Report
 Public pressure
 Congressional pressure
 Constrained finances and possible reductions for GME

July 2013
-
Phase I
 NAS will be implemented by 7 of 26 core specialties
 Emergency medicine
 Internal medicine
 Pediatrics
 Diagnostic radiology
 Neurosurgery
 Orthopedic surgery
 Urology
 All other specialties and preliminary programs implementation July 2014
 GME communities must be prepared for changes

Five important data collection areas:
① Annual ADS consists of:
 Program statistics
 Program structure & resources
 Scholarly activity
 Teaching responsibilities

② Board Pass Rates
 Improve curriculum / didactics

③ Clinical Experience
 Case log
 Case mix
 Minutes from meetings of program evaluation

④ Resident Survey
 Duty hours
 Supervision & teaching
 Teamwork
 Education vs. service
 Evaluations
 Patient safety

⑤ Patient Safety
 Resident participation

Additional Information
 Minutes from annual meetings to be submitted annually
 Residents on committees
 Sample PLA & LOA policy
 Policies
Supervision
Handover rounds
Work hours
Others

 Essential component of NAS are the MILESTONES
 Basis is to track development in the 6 competencies
 Dreyfus Model:
Novice
Advanced beginner
Competent
Proficient
Expert
Master

Milestones Developed By
 RRC
 Boards
 P.D.
’s
 Residents

Milestones Will Supplement,
Not Replace Existing Assessment Tools
Timeline:
Develop by December 2012
Submission to ACGME 2013 & 2014

Clinical Competency Committee (C.C.C.)
Include
 Core faculty
 Program directorprofessionalism
 Chief resident
Function
 Evaluate milestones & early warning
 Track progress of residents
 Faculty development
Purpose
 Reduce potential bias/subjective

Function measure
 Decision making by multiple people
 Evaluate 360 ° assessments

Clinical Learning Environment
Review (CLER)
Focus is:
 On resident learning of patient safety
 Institution responsibility for quality and safety of the learning environment

Clinical Learning Environment
Review (CLER)
Focus Comprises Six Areas:
1.
Patient safety
2.
QI by residents
3.
Transition of care
4.
Supervision
5.
Duty hours & fatigue management
6.
Professionalism

Evaluation by Site Visits
Personnel Involved:
 Site visitors
 CEO of medical institution
 DIO
 GMEC chair
 Residents
 Safety officer
 Senior administration

 Three weeks advance notice
 No advance documentation
 Conduct interviews
 Work hour reports
 Visit learning environment

NAS will involve four areas (2013 & 2014):
1.
NAS itself
2.
Milestones
3.
Clinical competency committee
4.
CLER
Begin the process NOW (2013 & 2014)

Handoff / Handover Process
Program directors provide:
 Structured & standardized protocols
 Assess resident skills
 Use of technology
May be:
 Verbal
 Written
 Written & verbal
 Electronic
Objective:  Accuracy
 Patient safety

Standardized Tool
S ick – degree
I dentifying data
G eneral hospital course
N ew events
O verall health status
U pcoming plan
T asks to complete
Q uestions

2000

2013