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Implementing Milestones & NAS: Harbor-UCLA Peds Journey

Implementing Milestones & NAS: Harbor-UCLA Peds Journey. Sylvia Yeh, MD March 14, 2014. Change is coming…. Fall 2011 – draft new RRC recommendations to be implemented July 1, 2013 Milestones Flexible 6 months “Individualized Educational Experiences” (IEE)

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Implementing Milestones & NAS: Harbor-UCLA Peds Journey

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  1. Implementing Milestones & NAS:Harbor-UCLA Peds Journey Sylvia Yeh, MD March 14, 2014

  2. Change is coming… • Fall 2011 – draft new RRC recommendations to be implemented July 1, 2013 • Milestones • Flexible 6 months “Individualized Educational Experiences” (IEE) • January 2012 – Pediatric Milestones published • 7 competencies (ACGME only has 6) • 51 sub-competencies • Spring 2012 - NAS

  3. Help!!! • Association of Pediatric Program Directors • Conference Calls re the 6 Individualize Educational Experiences • Questions/Clarifications/Appeals to RRC • Examples shared from other programs with “tracks” • Spring Meeting – April 2012 • Milestones • 6 IEE • How to implement??? • Fall Meeting – Sept 2012 (after final version of RRC) • Milestones • Next Accreditation System (NAS)/Overview of CLER

  4. Our Timeline • April 2012 – Milestones chosen for repeated rotations • June 2012 – Faculty retreat • NAS • Anticipated Changes • Sept 2012 • Education Committee (now our PEC) working on the 6 IEE • Nov 2012 • Faculty ACGME Survey • Updated ADS – new format • Education Committee reformmated to comply with PEC

  5. Timeline cont’ • April 2013 • Resident Review Committee formatted to meeting Clinical Competency Committee • Selection of Milestones for all rotations • May/June • Reformatting of evaluations & mapping in Verinform

  6. Rotations Mapped to Milestones

  7. Program Evaluation Committee • Pre-existing: Education Committee • Meets monthly (except during recruitment season) • Selected core faculty, peer nominated resident representatives • Reviews group ITE performance, Certifying Exam performance, rotational evaluations, institutional surveys, etc… • Subcommittee – charged with how to meet 6 IEE (Fall 2012) • Reformatted to meeting PEC requirements (Aug 2013) • Adapted PEC statement from another institution

  8. Clinical Competency Committee • Pre-existing: Resident Review & Promotion committee • Faculty: Gen Peds, Subspecialists, Intensivists • Met 3-4 times/year • Adapted to meet CCC requirements • Discussed as group on what changes needed to meet reporting milestones semi-annually • Examples from other programs (APPD) shared • Now meet 6 times/year: Sept, Oct, Nov; March, April, May • Ad-hoc meetings as needed

  9. CCC • Opportunity to improve communication back to faculty advisor and resident • Changed tracking records • Changed report forms • Major change: Program Director runs meeting but not a voting member

  10. ACGME Faculty Survey • CORE faculty only • Need to update ADS faculty roster • Min 15 hours work with trainees • Provide key reminders to faculty regarding components of the program

  11. Challenges • Milestones (in use since July 2012) • Wide variability in faculty scoring • Verinform: verb-age, averaging • ACGME reporting • not blinded • manual input of data for each resident • CCC • Philosophical differences esp: overperformers • 6 Individualize Educational Experiences • Ensuring coverage • Ensuring educational value for “novel” rotations • Faculty availability for “novel” rotations

  12. Take Aways • Engage with/Use resources provided by similar groups of PDs • APPD • Council of Pediatric Subspecialist (CoPS) • Acceptance once recommendations finalized • Prioritize • Determine based on your current format, what needs to be addressed to be compliant • List in what order to be tackled • Opportunity to improve? • Engage your faculty early (but not too early)

  13. NAS Hurdles for PDsVishadNabili, MD FACSProgram DirectorUCLA Head and Neck Surgery

  14. Too many milestones and too little time… • How to get faculty, often super sub-specialized, to answer each of the milestones? • Not to mention each milestone has 5 levels? • Not to mention in each there are “in between” levels, i.e. 9 levels? • How to minimize faculty bias? • Milestones explicit questions may solve this.

  15. 1.) We have created a customized “verinform” template. 2.) Captures the key features that define a Level. 3.) Many of the level 1 and 2 areas in most milestones are repetitious and can be captured by a general Medical knowledge and Patient Care question as before in Verinform. 4.) CCC will be able to decipher more clearly the milestones 5.) KEY: get faculty feedback and educate them.

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