Accreditation Council for Graduate Medical Education

Accreditation Process for Psychiatry

Residency Programs –
The RC Essentials

Christopher R. Thomas, MD, RC Chair

Louise King, MS, Executive Director

ACGME Annual Educational Conference

Orlando, Florida
Thursday, February 28, 2013 – Sunday, March 3, 2013
 Discussion Topics
• Review Committee Membership
• Overview of Accreditation Process
• Specialty/Subspecialty Update
• ACGME Milestone Project
• ACGME Next Accreditation System
(NAS)
• ACGME Clinical Learning Environment
Review (CLER) Program
 ACGME
•ACGME is a private, nonprofit council that evaluates and
accredits medical residency programs in the United States
•The ACGME mission is to improve health care by
assessing and advancing the quality of resident
physicians’ education through exemplary accreditation
•The ACGME has five member organizations:
– American Board of Medical Specialties
–American Hospital Association
–American Medical Association
–Association of American Medical Colleges
–Council on Medical Specialty Societies
 ACGME
• 28 Review Committees
• 26 specialties, 1 transitional-year, 1
institutional review
• In 2010-2011
• ACGME-accredited residency programs –
8,887 in 133 specialties and
subspecialties
• Active full-time and part-time residents –
113,142
 Review Committee
Membership
• Christopher R. Thomas, MD • Robert J. Ronis, MD
RC Chair • Cynthia W. Santos, MD*
• Donald E. Rosen, MD • Mark Servis, MD
RC Vice Chair
• Dorothy E. Stubbe
• Elizabeth L. Auchincloss,
MD* • M. Philip Luber, MD
• Jonathan F. Borus, MD • Alik Sunil Widge, MD*
• Carlyle H. Chan, MD Resident
• Stephen P. Cuffe, MD • Larry Faulkner, MD
ABPN Ex-Officio
• Mina Dulcan, MD
• Deborah J. Hales, MD
• Marshall Forstein, MD APA Ex-Officio
• Gail H. Manos, MD*
• George A. Keepers, MD
*Terms on RC end June 30,
2013
 Incoming RC Members
• Iqbal “Ike” Ahmed, MD
replacing Elizabeth L. Auchincloss, MD
• Josepha A. Cheong, MD
replacing Cynthia Santos, MD
• Gerald A. Maguire, MD
replacing Gail H. Manos, MD
• Heather Schultz, MD
replacing Alik Sunil Widge, MD (resident
member)
 RC for Psychiatry Functions
• Primary responsibilities
• Set accreditation standards
• Peer evaluation of residency programs and
subspecialties
• Preparation & periodic revisions of program
requirements for the specialty
• Recommend to the ACGME improvements in
accreditation policies and procedures
Note: Current RC members are not permitted to review PIFs
outside of meetings or act as consultants
 ACGME Staff
RC Staff
• Louise King, MS
Executive Director
• Debra Martin
Accreditation Administrator
• Jordan Elvord
Accreditation Assistant

Other Important ACGME Contacts

• Raquel Eng – ADS Representative
• Jane Shapiro – Department of Field Activities
 RC for Psychiatry Meetings
• April 11-13, 2013
Agenda closing date: January 31, 2013 (closed)
Agenda closing date for new subspecialty
applications: January 18, 2013 (closed)
• October 11-12, 2013
Agenda closing date: August 2, 2013
Agenda closing date for new subspecialty
applications: July 19, 2013
• Requests for increases in resident complements
can be at any time. Programs will be notified of
the accreditation decision in approximately 3
weeks.
 Accreditation Process Overview
• Program receives notice of site visit date
• 90-120 days in advance
• Program Information Form (PIF)
• Begin one year in advance of anticipated SV date
• Site visit takes place
• Review Committee reviews program
• Site Visit Report (SVR) submitted by agenda closing
date
• E-mail decision by 5 business days after RC meeting
• Letter of Notification (LON) by 60 business days after
RC Meeting
 Accreditation Resources
• RC website:
http://www.acgme.org/acWebsite/navPages/nav_400.asp
• RC Newsletters (two per year)
• Application guidelines
• Resident transfers
• Resident complement changes
• ACGME weekly e-communication
• Phone and email RC staff
• ACGME/Program Directors and Coordinators website:
http://www.acgme.org/acWebsite/navPages/nav_PDcoord.asp
• ACGME policies and procedures
• Resident survey information
• Resident duty hour documents
 Summary of Actions Taken at October
2012 Meeting of RC for Psychiatry

Initial Accreditation 4
Continued Accreditation 59
Continued Accreditation with warning 0
Progress/Duty Hour Reports Reviewed 9
Proposed Probation 1
Other Request (complement/part. site) 1

*The Review Committee considers complement change requests not

associated with a program review as they are received.
 Current RC Projects
• Revision Program Requirements
• Psychiatry Milestone Project
• ACGME Next Accreditation System (NAS)
 PR Revision Timelines

Post for Public ACGME Board

Specialty Review and Review & Effective Date
Comment approval
Adult Psychiatry ON HOLD
Child and
Adolescent ON HOLD
Psychiatry
Other
7/2011 2/2013 7/2013
Fellowships
 Combined Programs
Total # Accredited General Programs 184
Total Participating in Combined Program(s) 38
Total # Accredited Child Programs 124
Total Participating in Combined Program(s) 10

Of the 48 programs participating in combined program(s), 11

have identified how the approved positions are allocated
between accredited and unaccredited combined programs.

 All programs that have not allocated approved positions have

been contacted
 Staff is working with each program to determine how positions
should be allocated and if an increase needs to be requested
 Staff will assist in submitting increase requests via ADS; such
requests will be reviewed outside of a scheduled RRC meeting
 Combined Programs

Why is this important?

• Permits registration of combined residents in ADS
• ADS-registered residents have access to
o Resident Survey
o All ACGME resident data systems (e.g., case log
system)
• ADS-registered residents participate in program
reviews (e.g., site visits)
 Milestones
• Next step in the Outcome Project
• Milestone definition: A description (in specific
behavioral terms) of the performance level
expected of a resident by a particular time
during their residency
• Aggregate resident performance on the
milestones used as an indicator of a program’s
educational effectiveness
• Board use as part of eligibility for certification
 Milestones
• Measure a residents progress in training
• Assessed every 6 months
• Grouped by Core Competencies
• Established by profession consensus
• Assist in program self evaluation and
accreditation
 Reporting Template
Milestone of Competency Development
Level 1 Level 2 Level 3 Level 4 Level 5
Entry – Mid-Program - Mid-Program - Graduation – Stretch Goals –
Baseline, Developmental Developmental Expected level Exceeds
expected level at levels of levels of of performance expectations
time of entry performance performance at entry into
into residency Offers road Offers road unsupervised
map and map and practice
assurance that assurance that Level required
residents are residents are to gain eligibility
attaining attaining for ABMS
appropriate appropriate certification
educational educational
goals goals

Comments:
 Guiding Principles

Feasibility Quality Reporting

• Balance • Improvement • Specialty-

costs with over current wide use of
benefits approaches 5-level
• Manageable • Meaningful & template for
number of substantive milestones
milestones • “Measurable” reporting
• Central data
repository
 Membership
Working Group
• Chris Thomas (chair) • Donald Rosen
• Sheldon Benjamin • Kathy Sanders
• Adrienne Bentman • Mark Servis
• Robert Boland • Kallie Shaw
• Deborah Cowley • Alik Widge (resident)
• Jeffrey Hunt • Susan Swing (ACGME)
• George Keepers • Louise King (ACGME)
• Gail Manos
Advisory Group
• Chris Thomas (chair) • Deborah Hales
• Timothy Brigham (ACGME) • Victor Reus
• Susan Swing (ACGME) • Richard Summers
• Carol Bernstein • Beth Ann Brooks
• Larry Faulkner
 Patient Care
1. Evaluation
2. Formulation and Differential Diagnosis
3. Treatment Planning and Management
4. Psychotherapy
5. Somatic Therapies

22
 Medical Knowledge

1. Development Through the Life Cycle

2. Psychopathology
3. Clinical Neuroscience
4. Psychotherapy
5. Somatic Therapies
6. Practice of Psychiatry

23
 Professionalism
1. Compassion, Integrity, Respect for
Others, Sensitivity to Diverse Patient
Populations, and Adherence to Ethical
Principles
2. Accountability to Self, Patients,
Colleagues and the Profession
 Interpersonal & Communication Skills

1. Relationship Development and Conflict

Management with Patients, Families,
Colleagues, and Other Members of
Health Care Team
2. Information Sharing and Record Keeping
 Practice-Based Learning &
Improvement
1. Critical Evaluation of Research and
Clinical Evidence
2. Development and Execution of Life-
Long Learning through Constant Self-
Evaluation
3. Formal Practice-Based Quality
Improvement on Established and
Accepted Methodologies
4. Teaching
 Systems Based Practice
1. Patient Safety and the Healthcare Team
2. Resource Management
3. Community Based Care
4. Consultation to Non-Psychiatric Medical
Providers and Non-Medical Systems
 Moving Forward
• Release of Psychiatry Milestones Draft
• Survey
• Comments
• Presentations at AADPRT, APA & ACP
• Articles
• Pilot Project
• Review & Development of Assessments
 Why Milestones?

The Next Accreditation System

Goals of the Next Accreditation System
• Begin the realization of the promise of Outcomes
• Free good programs to innovate
• Assist poor programs to improve
• Reduce the burden of accreditation
• Provide accountability for outcomes (in tandem
with ABMS) to the Public
 The Next Accreditation System
in a Nutshell
Continuous Accreditation Model
• Based on annual data submitted, other data
requested, and program trends
Scheduled Site Visits replaced by 10 year
Self-Study Visit
Standards revised every 10 years
• Standards organized by
o Structure
o Resources
o Core Processes
o Detailed Processes
o Outcomes
Trended Performance Indicators
• Annual ADS Update
• Program changes in PD, Core Faculty &
Residents
• Program Characteristics: Structure &
Resources
• Board Pass Rate – Rolling Average
• Surveys
• Resident
• Faculty
• Milestones
 Resident seeks out opportunities
Professionalism
Resident frequently fails to
recognize or actively avoids
opportunities for compassion
to demonstrate compassion and
empathy in the care of all patients;
or empathy. On occasion and demonstrates respect and is
demonstrates lack of sensitive to the needs and
respect, or overt disrespect concerns of all patients, family
for patients, family members, members, and members of the
or other members of the health care team.
health care team

Resident demonstrates
compassion and empathy in care
of some patients, but lacks the
skills to apply them in more
complex clinical situations or
settings. Occasionally requires
guidance in how to show respect
for patients, family members, or
other members of the health care
team.
 Next Accreditation System

• Seven specialties/RC’s began training 7/2012

• Pediatrics
• Internal Medicine
• Diagnostic Radiology
• Emergency Medicine
• Orthopedic Surgery
• Neurological Surgery
• Urological Surgery
• Sponsor Visit Program begins 9/2012
• The “Next Accreditation System” begins 7/2013
• The remaining specialties begin training 7/2013
• All specialties/RC’s using the “Next Accreditation System” 7/2014
 Questions

• http://www.acgme-nas.org/
 The Next Accreditation System
in a Nutshell
Continuous Accreditation Model
• Based on annual data submitted, other data
requested, and program trends
Scheduled Site Visits replaced by 10 year
Self-Study Visit
Standards revised every 10 years
• Standards organized by
o Structure
o Resources
o Core Processes
o Detailed Processes
o Outcomes
 Conceptual Model of Standards Implementation
Across the Continuum of Programs in a Specialty

Accreditation Maintenance of
Initial with Warning Accreditation
Accreditation New Programs,
Accredited Programs Accredited Programs without
with Major Concerns Major Concerns
New
Probationary Maintenance of
Programs
Accreditation with
Accreditation Commendation
2-4% 15% 75%
STANDARDS

Structure Structure Structure Structure

Resources Resources Resources Core Process
Core Process Core Process Core Process Resources
Detailed Process Detailed Process Detailed Process Detailed Process
Outcomes Outcomes Outcomes Outcomes

Withhold Accreditation
Withdrawal of Accreditation
6-8%
 Next Accreditation System

• Seven specialties/RC’s begin training 7/2012

• Pediatrics
• Internal Medicine
• Diagnostic Radiology
• Emergency Medicine
• Orthopedic Surgery
• Neurological Surgery
• Urological Surgery
• Sponsor Visit Program begins 9/2012
• The “Next Accreditation System” begins 7/2013
• The remaining specialties begin training 7/2013
• All specialties/RC’s using the “Next Accreditation System” 7/2014
Questions