The next accreditation system nas
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PROGRAM DIRECTOR ’ S ROLE. “ The Next Accreditation System (NAS) ”. Brian L. Cohen, MD, FRCOG, FACOG. Associate Dean of Graduate Medical Education Professor of Obstetrics, Gynecology and Women ’ s Health. Introduction. 1999: ACGME introduced the domains of clinical competency

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“ The Next Accreditation System (NAS) ”

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The next accreditation system nas

PROGRAM DIRECTOR’S ROLE

“The Next Accreditation System (NAS)”

Brian L. Cohen, MD, FRCOG, FACOG

Associate Dean of Graduate Medical Education

Professor of Obstetrics, Gynecology and Women’s Health


The next accreditation system nas

Introduction

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


Aims of nas

Aims of 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


Basis

Basis

  • Institute of Medicine Report

  • Public pressure

  • Congressional pressure

  • Constrained finances and possible reductions for GME


July 2013 phase i

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


Nas compliance

NAS Compliance

  • Annual ADS consists of:

    • Program statistics

    • Program structure & resources

    • Scholarly activity

    • Teaching responsibilities

Five important data collection areas:


Nas compliance1

NAS Compliance

  • Board Pass Rates

    • Improve curriculum / didactics


Nas compliance2

NAS Compliance

  • Clinical Experience

    • Case log

    • Case mix

    • Minutes from meetings of program evaluation


Nas compliance3

NAS Compliance

  • Resident Survey

    • Duty hours

    • Supervision & teaching

    • Teamwork

    • Education vs. service

    • Evaluations

    • Patient safety


Nas compliance4

NAS Compliance

  • Patient Safety

    • Resident participation


Additional information

Additional Information

  • Minutes from annual meetings to be submitted annually

  • Residents on committees

  • Sample PLA & LOA policy

  • Policies

    • Supervision

    • Handover rounds

    • Work hours

    • Others


The next accreditation system nas

Milestones

  • 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


The next accreditation system nas

Milestones

  • RRC

  • Boards

  • P.D.’s

  • Residents

Milestones Developed By


The next accreditation system nas

Milestones

Develop by December 2012

Submission to ACGME 2013 & 2014

Milestones Will Supplement,

Not Replace Existing Assessment Tools

Timeline:


Clinical competency committee c c c

Clinical Competency Committee (C.C.C.)

Core faculty

Program director- professionalism

Chief resident

Evaluate milestones & early warning

Track progress of residents

Faculty development

Include

Function

Purpose

  • Reduce potential bias/subjective

  • Performance measure

  • Decision making by multiple people

  • Evaluate 360° assessments

Function


Clinical learning environment review cler

Clinical Learning Environment Review (CLER)

  • On resident learning of patient safety

  • Institution responsibility for quality and safety of the learning environment

Focus is:


Focus comprises six areas

Clinical Learning Environment Review (CLER)

Focus Comprises Six Areas:

  • Patient safety

  • QI by residents

  • Transition of care

  • Supervision

  • Duty hours & fatigue management

  • Professionalism


Evaluation by site visits

Evaluation by Site Visits

Personnel Involved:

  • Site visitors

  • CEO of medical institution

  • DIO

  • GMEC chair

  • Residents

  • Safety officer

  • Senior administration


Process

Process

  • Three weeks advance notice

  • No advance documentation

  • Conduct interviews

  • Work hour reports

  • Visit learning environment


Summary

Summary

  • NAS itself

  • Milestones

  • Clinical competency committee

  • CLER

NAS will involve four areas (2013 & 2014):

Begin the process NOW (2013 & 2014)


Handoff handover process

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

Standardized Tool

Sick – degree

Identifying data

General hospital course

New events

Overall health status

Upcoming plan

Tasks to complete

Questions


The next accreditation system nas

2000


The next accreditation system nas

2013


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