Albanese Handout Aaos 2010 Meeting

AAOS Annual Meeting ICL- 311 Residency Accreditation Friday, March 12, 2010 Stephen Albanese, MD I. Requirements/Guidelines A. ACGME (RRC) 1. www.acgme.org B. ABOS 1. www.abos.org II. Program requirements A. Define the structure and activities in the program 1. Basis for citations 2. Common a. Apply to all specialties 3. Specialty specific B. Revisions 1. Common requirements a. Responsibility of the ACGME Council of Review Committees b. Listed in bold in the program requirements and in this handout. 2. Specialty specific a. RRC responsible b. Major revision required every 5 years (1) Currently undergoing major revision c. Reviewed by ACGME Committee on Requirements d. Period of public comment e. Details of the procedure are on the ACGME web site C. Major sections of program requirements (These are changing.) 1. Introduction 2. Institutions 3. Program Personnel and Resources 4. Resident Appointments 5. Educational Program a. Core Competencies 6. Evaluation 7. Resident Duty Hours in the Learning and Working Environment 8. Experimentation and Innovation III. Program structure A. PG-I year (Orthopedic specialty specific program requirement) In order to meet these goals, the PGY-1 year must include: a) a minimum of six months of structured education in surgery, to include multi-system trauma, plastic surgery/burn care, intensive care, and vascular surgery;

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b) a minimum of one month of structured education in at least three of the following: emergency medicine, medical/cardiac intensive care, internal medicine, neurology, neurological surgery, pediatric surgery or pediatrics, rheumatology, anesthesiology, musculoskeletal imaging, and rehabilitation; and, c) a maximum of three months of orthopaedic surgery. 1 2 3

How to count pediatric surgery Surgical intensive care (ABOS) Block diagram on PIF

2. PGY 2-5 (total = 48 months) The program director is also responsible for the design, implementation and oversight of PGY-2 through PGY-5 years that: a) must include at least three years of rotations on orthopaedic services, and b) may include rotations on related services such as plastic surgery, physical medicine and rehabilitation, rheumatology, or neurological surgery. The ABOS has specific time requirements in subspecialty areas. IV. Education Program A. Core competencies (Outcome Project) 1. The Outcome Project is a long-term initiative by which the ACGME is increasing emphasis on educational outcomes in the accreditation of residency education programs. (ACGME website) 2. Rather than concentrating only on assessment of a program’s potential to educate, the future for GME accreditation envisioned by the ACGME Outcome Project emphasizes a program’s actual accomplishments through assessment of program outcomes. (ACGME website) 3. ACGME competencies in the program requirements Patient care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents: Specialty specific requirement emphasizing the use of scientific evidence: make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment; Medical knowledge Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socialbehavioral sciences, as well as the application of this knowledge to patient care. Residents:

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Practice based learning and improvement Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals: Interpersonal communication skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to: Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: System based practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: B. Curriculum (Common program requirement section IV) The curriculum must contain the following educational components: 1. Overall educational goals for the program, which the program must distribute to residents and faculty annually; 2. Competency-based goals and objectives for each assignment at each educational level, which the program must distribute to residents and faculty annually, in either written or electronic form. These should be reviewed by the resident at the start of each rotation; Resident survey questions: Has your program provided you access to, either by hard copy or electronically, written goals and objectives for each rotation and major assignment? Do you receive written or electronic feedback on your performance for each rotation and major assignment? 3. Regularly scheduled didactic sessions; Document attendance Resident survey questions: Do your faculty members regularly participate in organized clinical discussions?

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Do your faculty members regularly participate in rounds? Do your faculty members regularly participate in journal clubs? Do your faculty members regularly participate in conferences? 4. Delineation of resident responsibilities for patient care, progressive responsibility for patient management, and supervision of residents over the continuum of the program; and, Resident survey questions: Do the faculty spend sufficient time teaching residents/fellows in your program? Do the faculty spend sufficient time supervising the residents/fellows in your program? V. Evaluation A. Resident evaluation V.A.1.a) The faculty must evaluate resident performance in a timely manner during each rotation or similar educational assignment, and document this evaluation at completion of the assignment. These evaluations must provide objective assessments in the core competencies, use multiple evaluators, document progressive improvement appropriate to the educational level and be accessible for review by the resident. Each resident must be provided with a documented performance evaluation at least semiannually. FREQUENTLY USED ASSESSMENT TOOLS 1. Clinical Performance (Global) Ratings: individual faculty, all 6 competencies + performance on that particular rotation; end of rotation 2. 360-degree evaluation: allied-health care specialists; interpersonal skills, and professionalism; annually 3. Case logs: program director, medical knowledge and patient care; program director 4. Cognitive evaluation: program director, medical knowledge and patient care; program director V.A.2. Summative Evaluation The program director must provide a summative evaluation for each resident upon completion of the program. This evaluation must become part of the resident’s permanent record maintained by the institution, and must be accessible for review by the resident in accordance with institutional policy. This evaluation must: V.A.2.a) document the resident’s performance during the final period of education, and V.A.2.b) verify that the resident has demonstrated sufficient competence to enter practice without direct supervision. B Evaluation of the faculty and program by the residents.

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Confidential faculty evaluation by the residents at least annually. Confidential review of the program by the residents at least annually. Formal program review at least annually. Must include residents’ assessments of the program as well as other information. Written action plan for deficiencies should be developed. Action plan should be reviewed by the teaching faculty and documented in the minutes.

VI. Duty Hours A. Part of the Common program requirements. B. Included in the resident survey 1. Problems will result in a follow up survey the following year 2. Problems identified on consecutive surveys will prompt a site visit C. It helps to assess the compliance if programs have a mechanism to document compliance VII. A. B. C. D.

Request for change in resident complement Request must be done through the Accreditation Data System (ADS) Need formal designated institutional official (DIO) approval Program must be fully accredited May require a site visit:

VIII. Responding to the RRC A. Respond promptly B. Non adverse actions no progress report 1. : PD enters response in ADS as soon as possible, at the latest before the next internal review or site visit C. Non Adverse action, progress report requested 1. Progress Report, response to citations - enter in ADS and email or send hard copy to ACGME. D. Adverse Action 1. Enter response in ADS and provide hard copy response on appropriate letterhead to ACGME. Email the hard copy in a pdf file is also acceptable. 2. State citation from RRC E. Call ACGME if there are questions IX. Most common citations A. Most common category is educational program (51.8%) 1. Deficiencies in patient care experience (n=81) 16% a. Participation in pre and post operative care of patients b. Insufficient mix of pediatric patients c. Deficiency with specific anatomic regions: spine, foot, ankle, hand, shoulder d. Deficient oncology experience e. Insufficient experience with orthopedic trauma 2. Deficiencies in procedural experience case log or PIF (n=69) a. Uneven experience within resident groups- some residents >300 procedures in pediatric patients and some <150 b. Deficient number of spine procedures

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c. Deficient volume of cases overall d. Deficient number: arthroscopy, anesthesia, microsurgery, oncology and sports medicine e. Erroneous case log entries 3. Second cluster Deficiencies in scholarly activities (n=59) 11.66% a. Insufficient research and/or publications-resident b. Insufficient research and publications-faculty c. Insufficient number of faculty involved in research d. Insufficient mentoring of residents by faculty e. Insufficient research and publications by both faculty and residents B. Second most common citation cluster 14.1% 1. Responsibilities of faculty (n=21) 4.15% 2. Qualifications of faculty (n=20) 3.95% 3. Responsibilities of program director (n=18) 3.56% 4. Other program personnel (n=12) 2.4% C. Third most common citation cluster 1. Institutional support- sponsoring institution (n=20) 3.95% 2. Institutional support- facilities, library, educational space (n=8) 1.58% 3. Institutional support- clinical space (n=6) 1.19% D. Least common citations 1. Institutional support of program director (n=1) 0.2% 2. Resident appointment issues (n=3) 0.59% 3. Duty hours/ working environment (n=4) 0.8%

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