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Clinical Competency
Committees
What Faculty need to know
Academic Affairs Committee
ACEP,JMTF, CORD
WHAT…are Clinical Competency
Committees (CCC’S)?
 A group of faculty members tasked with
 Assessing resident performance and progress based on multisource data
 Determining individual resident’s level on Milestones
 Making formal recommendations to the PD regarding
remediation, promotion and graduation
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WHAT...are the (EM) Milestones?
 23 (core) SKILLS, KNOWLEDGE AREAS, ATTITUDES
 Specific to the 6 CORE COMPETENCIES FOR EM
 (PC, MK, PROF, ICS, PBLI, SBP)
 Organized in developmental framework of levels 1-5
 1—entry level
 2-3 mid level resident advancing appropriately
 4 target for graduation
 5 expert level
 Descriptors of levels
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EM MILESTONES
1. (pc-1) Resuscitation
8. (pc-8) Multi-tasking
2. (pc-2) H&P
9. (pc-9) Procedures
3. (pc-3) Labs/Studies
10. (pc-10) Airway
4. (pc-4) DDx
11. (pc-11) Pain
management/sedation
5. (pc-5) Pharmacotherapy
6. (pc-6) Reassessment, F/U
7. (pc-7) Disposition
12. (pc-12) ED Ultrasound
13. (pc-13) Wound manage
14. (pc-14) Vascular Access
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EM Milestones continued…
15. (mk-1) Medical knowledge
16. (prof-1) Compassion,
Integrity, Respect, Ethics
17. (prof-2) Accountability to
society, patients, profession
and self.
18. (ics-1) Patient centered
communication
19. (ics-10) Team Managment
20. (pbli-1) Follow up, CQI,
EBM
21. (sbp-1) Patient safety—
SBAR, handoffs, checklists…
22. (sbp-2) Efficiency, flow
23. (sbp-3) Technology (EMR),
data and information access
WHY… is my program initiating
CCC’s?
 ACGME mandate: ALL programs must have CCC’s up and
running by July 2013 as part of the Next Accreditation
System (NAS).
 All programs begin reporting aggregate data on
residents’ milestone achievement by December 2013.
 In NAS, CCC’s are integral in the process of interpreting
data and assigning milestone levels.
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WHAT FOR?
 What purpose does the ACGME hope to accomplish by
requiring programs to establish CCC’s?
 Increase the validity and accuracy of program assessment of
resident competence throughout training and at graduation.
 Provide the benefit of “the insight and perspective of a group”
to the resident evaluation process.
 Assure that programs detect resident deficiencies EARLY and
provide meaningful recommendations for remediation.
 Ultimately assure the competence of graduates to practice
independently.
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WHO…comprises the CCC?
 The ACGME allows programs flexibility.
 Some parameters:
 5-7 members
 MUST include clinically active core faculty “dedicated to
resident education.”
 MAY include non MD medical educators
 Suggestions:
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PD,APD, core faculty
Faculty who primarily supervise in clinical setting
Site directors
Involved nursing staff
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HOW will the CCC’s function?
 Meet quarterly, biannually, or more frequently as
necessary to allow semi-annual evaluation of each
resident
 Review multi-source data (previously compiled) for each
resident.
 Come to consensus on resident’s achievement of
milestone level (possible milestone level 1-5).
 Generate report with competency determination for
each resident with recommendation for advancement,
graduation or remediation.
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HOW…will CCC’s function?
 CCC Chair (Ideally NOT PD) directs process
 Members must maintain confidentiality of proceedings
 Deliberations, decisions and reports may be protected
(not discoverable) under peer-review confidentiality
depending on state laws.
 Ongoing evaluation of CCC process to allow
recommendations for continued improvement of process
regarding activities of CCC
WHAT…are examples of data CCC
may use in resident assessment?
 In-Service Scores
 Direct observation data
 Rotation/shift evaluations
 Self evaluations/reflection
 Patient satisfaction data
 Adverse information
(complaints, misconduct)
 Procedure logs
 360 evaluations
 Scholarly work
 Oral board performance
 Administrative compliance
 Structured chart review
 Core measures
 Provider Reports
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How will CCC’s compile data?
 Programs are free to develop Assessment Tools for
compiled data or use one already made.
 Consistency of approach will increase accuracy even for
un-validated assessment tools.
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WHAT…is the role of the PD?
 Receives report/consensus determinations with
recommendations of CCC.
 Includes report in resident record.
 Carries responsibility of ultimate decision making with
regard to advancement, remediation, graduation.
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DATA Sources
 FAQs ACGME Website:
 www.acgme-nas.org/assets/pdf/NASFAQs.pdf
 www.acgmenas.org/assets/pdf/Milestones/EmergencyMedicineMiles
tones.pdf