Accreditation Council for Graduate Medical Education
RRC-EM: EMS Fellowship ACGME
Accreditation
NAEMSP® EMS Fellowship Forum
January 2014
Tucson, AZ
Wallace Carter, MD
Chair, Residency Review Committee for Emergency Medicine
Louis Ling, MD
Senior Vice-President, Hospital Based Accreditation
Disclosure
Carter:
New York Presbyterian
Columbia University and Weill Cornell
Ling:
Hennepin County Medical Center
University of Minnesota
Textbooks: Rosen, Harwood-Nuss
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Learning Objectives
• Next Accreditation System (NAS)
• Quick Review
• Update and New Developments
• EMS Specific Information
• Introduction to Self-Study Visits
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
NAS
The Next Accreditation System:
A quick review
What is the NAS and when does it start?
• The Next Accreditation System began July 1, 2013
for all core EM and EM subspecialty programs
• NAS Strategic Plan:
• Foster innovation and improvement in the learning
environment
• Increase the accreditation emphasis on educational
outcomes
• Increase efficiency and reduce burden in accreditation
• Improve communication and collaboration with key
internal and external stakeholders
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
The Building Blocks of
The Next Accreditation System
Self
Study
Institutional
Review
prn Site Visits
(Program or Institution)
Continuous RRC Oversight and
Accreditation
Sponsor Oversight
CLER Visits
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
NAS
• Instead of biopsies, annual data collection
•
•
•
•
•
Trends in key performance measurements
Milestones, Residents, fellows and faculty survey
Scholarly activity template
Operative & case log data
Board pass rates
• Scheduled accreditation visits every 10 years
• Focused site visits if annual data trends suggest
problems
• PIF replaced by self-study
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
NAS and ADS Annual Updates
• Each year, programs data will be required to
entered in ADS such as:
•
•
•
•
•
•
•
Faculty information
Fellow information
Block diagrams/curricular information
Scholarly activity information
Participating site information
Responses to previous citations
Duty Hour, Patient Safety and Learning Environment
information
• Evaluation information
• Reporting of major changes in the program
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
All 9,022 ACGME Accredited
Residency and Fellowship Programs*
January 1, 2013
* Excludes programs with Initial Accreditation
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
@ 2013 Accreditation Council for Graduate Medical Education (ACGME)
All 9,022 ACGME Accredited
Residency and Fellowship Programs*
January 1, 2013
95.7%
4%
0.3%, n=27
* Excludes programs with Initial Accreditation
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
@ 2013 Accreditation Council for Graduate Medical Education (ACGME)
NAS
• Ongoing data collection and trend
analysis
• Enhance oversight to ensure high
quality education and a safe and
effective learning environment
• High-quality programs will be freed to
innovate – detailed process standards
• Programs with continued accreditation in
good standing will not have to demonstrate
compliance with the “detail” program
requirements as written, but are allowed to
innovate
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
What are core, detail and outcome
program requirements?
• Core Requirements: Statements that define structure,
resource, or process elements essential to every
graduate medical educational program.
• Detail Requirements: Statements that describe a
specific structure, resource, or process, for achieving
compliance with a Core Requirement. Programs in
substantial compliance with the Outcome Requirements
may utilize alternative or innovative approaches to meet
Core Requirements.
• Outcome Requirements: Statements that specify
expected measurable or observable attributes
(knowledge, abilities, skills, or attitudes) of residents or
fellows at key stages of their graduate medical
education.
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
What are core, detail and outcome
program requirements?
• II.A.2. Qualifications of the program director must
include:
• II.A.2.b) current certification in the subspecialty by
the American Board of Emergency Medicine, or
specialty qualifications that are acceptable to the
Review Committee; and, (Core)
• II.A.2.d) at least three years’ experience as a core
physician faculty member in an ACGME-accredited
emergency medicine program or emergency medical
services program; (Detail)
• IV.A.2.a).(2).(b).(i) participation in a mass
casualty/disaster triage at an actual event or drill;
(Outcome)
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Do I have to adhere to the “detail” program
requirements?
• Programs that have initial accreditation or are in
trouble must demonstrate compliance with all
“detail” program requirements as written.
• Programs that have continued accreditation will
be allowed to “innovate” on those program
requirements that are identified as “detail”.
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Trended Data Elements
 Annual ADS Update
 Program Attrition – Changes in PD/Core Faculty/Residents
 Program Characteristics – Structure and Resources
 Scholarly Activity





Board Pass Rate – Rolling Rates
Resident Survey – Common and Specialty Elements
Clinical Experience – Case Logs or other
Faculty Survey – Core Faculty
Semi-Annual Resident Evaluation and Feedback
 Milestones
 Annual Sponsor Site Visit (CLER)
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Annual evaluation of program
outcome data (modified from TJN)
Applications
for New
Programs
Accreditation
with Warning
Continued
Accreditation
Initial
Accreditation
Structure
Structure
Core Process
Core Process
Detailed Process
Detailed Process
Outcomes
Outcomes
STANDARDS
Structure
Core Process
Detail Process
Adverse Actions
Outcomes
Structure
Core Process
Detailed Process
Outcomes
Initial Accreditation (IA) Fellowships
• Fellowship applications are reviewed without a
site visit. Within 2 years of granting IA, a site
visit will be scheduled
• RRC options when reviewing application
• Initial Accreditation
• Withhold
• RRC options following IA site visit
• Continued Accreditation
• Initial Accreditation with Warning – 1 year only
• Withdrawal
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Site Visits
• Focused: isolated concern about data elements
• Full: for IA or general concern about program,
more than one isolated issue
•
•
•
•
No PIF to prepare
Issues will be known for focus
30 day notice
Teams for larger than 4 residents/fellows
• Self-studies after 2015
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Adverse Actions: What has changed
• No proposed adverse actions
• Adverse accreditation status can only be
conferred following a site visit
• Programs with adverse accreditation status
cannot request an increase in resident
complement
• Probation cannot exceed 2 consecutive annual
reviews
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Adverse Actions: What hasn’t changed
• A program on Withdrawal can complete the
current academic year
• With RRC approval can complete 1 more year
• No new residents can be appointed
• If program re-applies within 2 years, they must
address previous citations
• A site visit is needed for all applications following a
withdrawal
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Relationship of Core and Subs
Fellowships must have a relationship with a core
residency program
• Self-study visits of core and associated fellowships will
occur at the same time
• Adverse action in core results in the same status for their
associated fellowships
• Withdrawal of core means withdrawal of all associated
fellowships
• New fellowships can only be granted IA status if core
status is Continued Accreditation
• NO attached programs can be on Probation or in appeal
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
NAS
Building the case for milestones………
Defer to Laura Edgar, EdD
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Accreditation Council for Graduate Medical Education
RRC-EM: EMS Fellowship ACGME
Accreditation
NAEMSP® EMS Fellowship Forum
January 2014
Tucson, AZ
Wallace Carter, MD
Chair, Residency Review Committee for Emergency Medicine
Louis Ling, MD
Senior Vice-President, Hospital Based Accreditation
New Application Process
as of July 1, 2013
• All new program applications must be initiated in
ADS by the DIO of your institution
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
New Application Process
as of July 1, 2013
• The program director must complete 2 parts
• Part 1 – Complete the ADS electronic portion initiated
by the DIO
• Part 2 – Download and complete the new application
specialty specific Word document from the website
and upload into ADS
• The completed application is submitted
electronically in ADS
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
New Application Process
as of July 1, 2013
• The new application specialty specific Word document
can be found on the ACGME EM Web page:
http://www.acgme.org/acgmeweb/tabid/131/ProgramandInstitutionalAccreditation/Hos
pital-BasedSpecialties/EmergencyMedicine.aspx
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Information: RC-EM Web Page
Recommended Links
•
•
•
•
Program Requirements: Currently In Effect
New Applications – Word documents
FAQs
Common Resources:
• ACGME Glossary of Terms
• Apply for Accreditation in Eight Easy Steps
• Program Director Guide to Common Program
Requirements
• Program Directors’ Virtual Handbook
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Faculty Roster
• When completing
the faculty roster
in ADS, enter
core EMS
faculty that have
at least 5 hours
per week and
any other nonEMS physicians
who provide at
least 10 hours
per week
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Faculty Qualifications
• If faculty members are ABOEM boarded and
obtain the specialty certificate in EMS from the
ABOEM, does the RC view this as being
“acceptable”?
• A CAQ in EMS by the ABOEM is viewed as
being acceptable
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
For Requested Positions, can I ask for a
range, e.g. 1-2?
• The RC-EM does not accept ranges of positions,
only a specific number, so instead of requesting
1-2 position, you should request 2 positions (you
are not required to fill all positions).
• You need to demonstrate in your application that
you have enough resources to support the
number of fellows requested. (e.g. you would
need to have enough opportunity to have each
fellow lead a disaster drill if that is part of your
program so you provide the same experience for
both fellows.)
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
How do I know if I need a PLA?
• Here is an FAQ regarding Master Affiliation
Agreements and PLAs. There is a PLA template at
the end of the document/site:
http://www.acgme.org/acgmeweb/Portals/0/PDFs/F
AQ/ab_FAQAgreement.pdf
• Program letters of agreement originate at the
program (instead of the institutional) level and are
required for each participating site providing a
required assignment.
• Program letters of agreement are required between
the residency program and all sites to which
residents rotate for required education or
assignments.
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
How do I know if I need a PLA?
However, if the two sites operate essentially as one entity,
that is, they are governed by one governing body (e.g.
Board of Directors) neither a master affiliation agreement
nor a program letter of agreement would be
necessary. Program letters of agreement are not
necessary if the following on-campus or off-campus site is
under the governance of the sponsoring institution or is an
office of a physician who is a member of the sponsoring
institution’s teaching faculty/medical staff: nursing and
assisted-living homes; hospice facilities; faculty patient care
offices; private physicians’ offices (volunteer faculty);
ambulatory surgical centers; diagnostic centers, e.g.
imaging, laboratory, etc.; treatment centers, e.g. dialysis,
rehabilitation, chemotherapy, etc.; other similar sites.
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
New EMS FAQ for PLAs
Question
When is it necessary for a program to obtain a
Program Letter of Agreement (PLA) with an EMS
agency? [Program Requirement I.B.1]
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
New EMS FAQ for PLAs
Answer:
There must be a program letter of agreement (PLA) between the
program and each participating site providing a required assignment. A
fellow may interact with a number of EMS agencies in different
capacities.
The Review Committee guidelines on PLAs specify:
• A PLA is required for any EMS agencies with which the fellow
provides in person participation as part of the required curriculum
• If the sponsoring institution owns the company, no PLA is needed.
• If the participating site is an independent company, a PLA is still
needed for liability reasons even if the program director or a faculty
member of the EMS program is the medical director (and is signing
the document on behalf of the program and on behalf of the
participating site) at the participating site/independent company.
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Medical School Letter of Understanding
I.B.6. The program must be affiliated with a medical school.
I.B.6.a) The program must have a written letter of
understanding which documents the duties and
responsibilities of both the medical school and the program.
This is similar to an affiliation agreement.
May state that the program will be compliant with the regulations and
rules of the institution in matters related to the functioning of the
program and that the institution will provide appropriate oversight to
assure compliance with accreditation standards as well as hospital and
state rules, regulations and laws
See the following web page for more information:
https://www.acgme.org/acgmeweb/Portals/0/PDFs/FAQ/ab_FAQAgree
ment.pdf
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Information: Application Deadline
• Applications received by April 28th, 2014 will be
reviewed at the June 23-24, 2014 RC Meeting
Information: Application Review
Process
• Completed application and all
attachments uploaded in ADS
• No site visit required
• Application reviewed based upon
program requirements at an
upcoming RC meeting.
• In 2014 RC meets February and June
• Programs are not reviewed by RC
members in same state or with a conflict
of interest
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Information: Application Review
Process
• Within 5 business days after the
meeting, emails will be sent
regarding the RC’s decision
• Initial Accreditation OR Withhold
• Within 60 days after the meeting, a
Letter of Notification (LON) will be
available.
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Initial Accreditation: EMS Effective Dates
EMS Program Requirements were approved and
were given an effective date of 9/30/2012
For applications reviewed at both the February
and June 2014 meetings and granted initial
accreditation, programs may choose to have an
effective date of either 7/1/2013 or 7/1/2014.
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
What about current EMS fellows?
Q) If my program is
• If they finish the
accredited at the
program on or before
February 2014 RC
June 30, 2014, they
meeting and I chose
will not graduate from
an effective date of
an accredited
July 1, 2014, what
program and will be
does that mean for my
ineligible to take
current fellows
ABEM’s EMS CAQ
scheduled to finish
exam.
June 30, 2014?
EMS Applications Reviewed
• 24 applications reviewed in February 2013
• 13 applications reviewed in September 2013
• 6 applications scheduled for February 2014
33/37 - Total EMS applications approved to
date
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Top 3 Most Common EMS Citations
• Lack of PLAs
• PD responsibility – Inaccurate Application Form
• Scholarly Activity – Core faculty
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Self Study & Program Improvement
ACGME self study visits begin 2015
Fellowships will be reviewed with their core
programs
Tool for program improvement
Individualized Learning Plan (ILP) on steroids
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Self Study & Program Improvement
NOT A PIF
Tool for improvement
Regular goal setting
Longer term: 3-5 years
Includes self-reflection/self-study
Consider SWOT (strengths/weaknesses/
opportunities and threats)/stakeholders
Consider program outcome trends
Don’t have to wait until ACGME
announces visit
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
Questions??
© 2012 Accreditation Council for Graduate Medical Education (ACGME)