Accreditation Council for Graduate Medical Education
Nuclear Medicine
Review Committee Update
SNMMI Winter 2015
Jon Baldwin, DO
Chair
RC Nuclear Medicine
Disclosure
• No conflicts of interest to report
Session Overview
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RC structure and NM program stats
Program requirements update
Resident case logs
NAS/ ADS Updates
Questions
Nuclear Medicine
Medical specialty that uses the tracer
principle, most often with
radiopharmaceuticals, to evaluate
molecular, metabolic, physiologic and
pathologic conditions of the body for
purposes of diagnosis, therapy
and research
Current Committee Membership
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Jon Baldwin, DO (AMA) – Chair
David Lewis, MD (AMA) – Vice Chair
Helena Balon, MD (SNM)
Frederick Grant, MD (SNM)
Barry Shulkin, MD (ABNM)
Kirk Frey, MD (ABNM)
Erica Cohen, DO (Resident)
RC Meetings
• 2 meetings per year
• Check RC website for agenda closing dates &
meeting dates
• February 13-14, 2015 (closing date December 12, 2014)
• May 29-30, 2015
• Meeting Length: 1 – 1 ½ days
• Program reviews & Other pertinent matters
Nuclear Medicine 2014-2015
• 43 accredited programs
• 93/159 (58%) filled vs approved
residents positions
Nuclear Medicine 10-year Stats
Academic Year
Programs
Residents On
duty
2004-2005
62
149
2005-2006
61
161
2006-2007
61
160
2007-2008
57
161
2008-2009
56
149
2009-2010
56
166
2010-2011
54
155
2011-2012
54
136
2012-2013
50
120
2013-2014
47
111
2014-2015
43
93
Nuclear Medicine Programs
2004-2014
Nuclear Medicine
Program Requirements
Effective July 1, 2014
Major Changes
• Program Director Qualifications:
• (II.A.3.b).(1) - Other acceptable qualifications are
certification by the American Board of Radiology with
subspecialty certification in Nuclear Radiology. (Core)
• (II.A.3.b).(1).(a) - The program director must be an
authorized user 132 for 10CFR 35.190, 290, and 390,
including 392, 133 394, and 396. (Core)
• Program Director Responsibilities
• (II.A.4.s) - The program director must: ensure that
residents log cases in the ACGME Case Log
System. (Core)
Major Changes
• Other learners
• (III.D.2) The presence of nuclear medicine residents
must not dilute or detract from the educational
opportunities available to the residents in the core
diagnostic radiology residency and to the fellows in
the nuclear radiology fellowship if these programs are
sponsored by the same institution. (Core)
• Removed NM level specifications in ACGME
Competency section
Major Changes
IV.A.6 – Curriculum
• Documentation in the ACGME Case Log System
• IV.A.6.a).(4).(a).(i).(a) - a minimum of 10 30 cases of oral
administration of less than or equal to 1.22 gigabecquerels
(33 millicuries) of sodium iodide I-131, for which a written
directive is required; (Detail)
• IV.A.6.a).(4).(a).(i).(a).(i) – 10 cases of benign and 10
cases of malignant disease (Detail)
• IV.A.6.a).(4).(a).(i).(a).(ii) – 3 cases <= and 3 cases >
1.22 gigabecquerels (33 millicuries) of sodium
iodide I-131 (Detail)
Major Changes
• IV.A.6.a).(4).(a).(i).(b) - a minimum of three five cases of
parenteral administration of any alpha emitter, any beta
emitter, or a photon-emitting radionuclide with a photon
energy less than 150 keV, for which a written directive is
required, and/or parenteral administration of any other
radionuclide, for which a written directive is required;
(Detail)
• IV.A.6.a).(4).(a).(i).(c) - a minimum of 100 50
cardiovascular pharmacologic and/or exercise stress
studies. (Detail)
• IV.A.6.a).(4).(a).(iv) – 100 pediatric nuclear medicine
procedures
Major Changes
V. Evaluation
• When averaged over the preceding five years:
• V.C.2.c).(1).(a) - at least 70 percent of residents who enter
a program should graduate; (Outcome)
• V.C.2.c).(1).(b) - at least 75 percent of a program’s
graduates should take the American Board of Nuclear
Medicine (ABNM) certifying examination within three years
of graduation; and, (Outcome)
• V.C.2.c).(1).(c) - at least 75 percent of a program’s
graduates taking the ABNM certifying examination
for the first time should pass. (Outcome)
2014 NM Eligibility Changes
• III.A. Eligibility
• Language referring to AOA-accredited training
has been removed
• Prerequisite criteria III.A.1.b) “Two or more
years of GME and passing USMLE Step 3”
has been removed
• These changes were made in anticipation of the
new ACGME eligibility requirements.
Eligibility
• Exception options available 2016
• These exceptions are not available in 2014
version of NM requirements
• Until 2016, RC-NM will allow programs to use
eligibility options outlined in pre-2014
requirements
• See 2014 NM FAQs
Eligibility FAQ
Question:
The program requirements that become effective on July 1,
2014 limit eligibility to residents whose prior training was
accredited by the ACGME or the Royal College of
Physicians and Surgeons of Canada (RCPSC), but the
common eligibility requirements that become effective on
July 1, 2016 permit exceptions as specified in the
requirements. Will I be able to appoint a resident with prior
training accredited by the AOA between 2014-2016?
[Program Requirement: III.A.]
Eligibility FAQ
Answer:
The revised specialty requirement revision was intended to align with the
implementation of the new common program requirements related to resident
eligibility, which were originally planned to become effective on July 1, 2014.
The further revision of the common program requirements related to eligibility
approved by the ACGME Board this year permit exceptions as detailed in the
requirements and will take effect on July 1, 2016. As it was not the intent of the
Review Committee to change the eligibility requirements before the new
common program requirements were implemented, the Review Committee will
permit programs to appoint residents to the program as specified in the pre2014 version of the requirements in sections III.A.1 – III.A.3.a), which specifies
that residents must complete (a) a prerequisite year of clinical education
accredited by the ACGME, RSPSC, or American Osteopathic Association
(AOA), or (b) two years or more of graduate medical education with a passing
score on the United States Medical Licensing Examination (USMLE) Step 3.
Effective July 1, 2016 all programs must comply with the new eligibility
requirements.
Case Logs
Resident Case Logs
All programs are now required to use the
ACGME Case Log System
• Letter sent December 2012
Resident procedure logs make it possible to:
• Track individual resident learning experiences
• Identify individual/program deficiencies
• Establish future training requirement
benchmarks
Resident Case Logs
• Residents should enter all specified procedures
performed during their residency education into
the ACGME case log system
• RC-NM Case Log message on 12/18/13
Program directors are expected to ensure that:
• Residents understand how to use the system
• Entries are accurate and complete
• Review resident case logs with residents during
semi-annual evaluations
NM Case Log Changes
• Removal of the “Attending” field
• “Case ID” field not required
• Required procedures to be tracked:
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Parenteral therapy
Radioiodine therapy
PET/CT
Cardiac Stress Test (Pharmacologic or Exercise)
Pediatric Procedures
• Several “Other” CPT codes in the system
grouped under “Non-Required Additional
Procedures”
Not required
“Attending” has been
removed
NAS
What is NAS and when does it start?
• The Next Accreditation System (NAS) Phase II
begins July 1, 2014 for Nuclear Medicine 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
Accreditation System
Comparison
Current Accreditation System
Next Accreditation System
Site visits every 5 years (or less)
Scheduled self-study visits every 10
years
Programs evaluated by RRC in
conjunction with site visits
Program data evaluated annually by
the RRC
Large printed Program Information
Form (PIF)
No PIF; data transmitted
electronically to ACGME annually
Periodic evaluation
Continuous, longitudinal evaluation
Process oriented (provide appropriate
documentation)
Performance oriented (Outcomes
based)
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.
Core & Detail PR Examples
• There must be a formal didactic lecture schedule
(Core)
• The didactic lecture schedule should indicate the
specific date and time of each lecture, the topic of
each lecture, the individual presenting the lecture,
and the duration of the lecture (Detail – describes
how to achieve core PR)
• Participation in regularly scheduled seminars,
conferences and journal clubs should be documented
with attendance logs. (Detail – describes how to
achieve core PR)
Do I have to adhere to the “detail”
program requirements?
• “Innovation” does not mean you don’t have to adhere to
the requirement, it means you can do it a different way.
• Programs that have initial accreditation or are in trouble
must demonstrate compliance with all “detail” program
requirements as written.
• Programs that have a status of continued accreditation
will be allowed to “innovate” or use alternate methods for
those program requirements that are identified as
“detail”.
NAS Screening Data
Reviewed by RRC
 Annual ADS Update
 Program Characteristics – Structure and resources
 Program Changes – PD / core faculty / residents
 Scholarly Activity – Faculty and Residents
 Omission of data
 Board Pass Rate – 3-5 year rolling averages
 Resident Survey
 Faculty Survey
 Clinical Experience – Case logs
 Milestones - TBD
 Ten year self-study - TBD
© 2013 Accreditation Council for Graduate Medical Education (ACGME)
Look for the green
checkmarks or the
word “complete”
Click on the down
arrows for more
information
Scholarly activity is
required to be entered
in the NAS
Ensure that the faculty
certification information has
been entered and current. A
yellow flag will appear if
missing data.
Those identified
as a “core” faculty
member will be
given the faculty
survey and must
have scholarly
activity entered
into ADS
If these 4 boxes
total 15 hours or
more, then this
person is
considered to be a
core faculty member
Scholarly activity for faculty and
residents must be entered
3200000000 – University of Sample
Pediatrics - Anytown, IL
000000 – University of Sample College of Medicine
Doe
Jane
1
Active Full Time
7/1/2012
6/30/2015
John Doe
*** - ** - xxxx
Scholarly Activity for all
residents is required.
Block Diagram Upload
Detailed on following slide
All three years must be submitted, even
if you currently only have NM3 residents.
Print a program summary
of your updates for your
records.
NM First NAS Review
• 14 programs passed with no flags
• 16% of pgms flagged for board pass rate.
• Several programs flagged for lack of data
reporting: no case log data, multiple zeros
reported for procedures, no faculty or
resident scholarly activity
PD Responsibility: Accurate Data
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Program Director:
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Must provide complete and accurate information
Review all information before “hitting” the submit button
DIO should also review before submission
Common Omissions:
• Faculty credentials (degree, certification, re-cert)
• Participating sites
• Updated response to citation(s)
• Complete block diagram
ACGME Staff Contact List
Executive Director
Felicia Davis, MHA
312-755-5006
fdavis@acgme.org
Senior Accreditation Administrator
Sara Thomas
312-755-5044
sthomas@acgme.org
Nuclear Medicine ADS Representative
Samantha Alvarado
312-755-7118
salvarado@acgme.org
Case Log questions
oplog@acgme.org
Questions?
Thank you