Subspecialty Update from the Residency Review Committee RRC

1
Subspecialty Update from the Residency Review
Committee (RRC)

• Jerry Vasilias, PhD, Executive Director
• Caroline Fischer, Associate Executive Director

APPD 9/06
2
Setting the Stage

• Overviews to ACGME and RRC
• Citations
• Whats Available on Website
• New Changes
• Requirements Updates
• PIFs Updates
• Staff Contact Information

3
ACGME

• Five member organizations/four board members from
  each AAMC, ABMS, AHA, AMA, CMSS
• Independent accrediting organization
• Governed by statutes of incorporation
• Approves program requirements
• Accredit GME/residency programs
• 28 review committees
• 26 RRCs
• TYRC
• IRC

4
RRC Composition

• 3 appointing organizations - AAP, ABP, AMA
• 10 voting members
• 3 from each appointing org 1 resident member
• Committee approved to increase by three members
• Members serve a term of 6 years -- except
  resident
• Generalists and subspecialists
• Critical Care Medicine, Hematology/Oncology,
  Pediatric Emergency Medicine, Gastroenterology,
  Neurology, Nephrology, Rheumatology
• Geographic Distribution CA, CT, DC, GA, MI, MD,
  OH, PA, WA
• Ex-officio members from each appointing
  organization (non-voting)

5
RRC Review of Programs

• Peer Review
• Reviewers use the following when they review a
  program to determine whether it is in compliance
  with the requirements
• Program Information Forms (PIF) prepared by the
  program
• The site visitors report
• Program Directors this is an open book test
• The questions in the PIF correspond to program
  requirements
• Reviewers present program to Committee
• Committee assigns accreditation status along with
  review cycle

6
Review Cycle of Subs

• Historically Review cycle of sub was aligned
  with core.
• If core has a three year cycle, the sub (s) will
  have a three cycle.
• - The cycle of the sub did not exceed that of the
  core
• Now ACGME has allowed RRC to un-couple subs
  cycle from that of the core.
• Subs are still considered dependent on the core,
  but the cycle of the sub can exceed that of the
  core.
• New subspecialty applications
• No site visit
• Maximum of a three year cycle

7
Citations

• Citation the program has not documented/provided
  evidence of compliance with the requirements, or
  an area identified by the site visitor as
  non-compliant
• Three Broad Categories of Citations
• Dont Have
• Dont Do
• Didnt Bother

8
Citations Dont Have/Dont Do/Didnt Bother

• Dont Have
• Resources -- Patients ( types) Required
  faculty Required educational experience
  Facilities/equipment Time/Support Other program
  personnel
• Dont Do
• Research/Scholarly activity Formally structured
  curriculum
• Development of goals and objectives
  Evaluations (fellow, faculty, program)
  Supervision Monitor/track fellows procedures
  Comply with duty hours.
• Didnt Bother Doing
• Proof/edit PIF Incomplete or contained
  inconsistent information Unclear from PIF that
  there is compliance with the requirements Did
  not fully describe/provide sufficient details.

9
Most Frequent Citations

• Insufficient patient /types of patients
• Lack of required experience/procedures
• No evidence of productivity in research/scholarly
  activity
• Faculty do not demonstrate commitment to
• Residents research must begin in year 1 and
  continue protected time evidence
• Inappropriate Goals and Objectives
• rotation and level specific
• Lack of formal evaluation mechanisms
• Fellow written evaluation formally reviewed
  semi-annually final written evaluation verifying
  ability to practice competently and independently
• Faculty annual participation by
  residents/fellows needs to be confidential
  formal feedback provided to faculty
• Program regular, documented meeting to review G
  Oseffectiveness in achieving them written
  evaluation by residents are used annual meeting
  with at least one fellow representative

10
www.acgme.org

• www.acgme.org
• Staff contact information
• ACGME Policies Procedures
• Competencies/Outcomes Project
• List of accredited programs
• ADS
• Duty hours Information/FAQ
• Affiliation Agreements FAQ
• General information on site visit process and
  your site visitor
• Pediatrics Webpage
• Resident complement increase
• Application timeline
• Frequent citations
• Program Requirements
• PIFs
• Archive of RRC Updates/Email Communications

11
New Changes

• E-mail status of programs on RRC agenda
• Within two weeks of an RRC meeting programs on
  the agenda will receive an email notification
  with the accreditation status and review cycle.
• Programs that received an adverse action/proposed
  adverse action will not get such an email
• E-mail to notify you that your notification
  letter is posted on ADS.
• Will no longer send notification letters via
  mail. You will receive email to check ADS for
  letter.
• Inactive status has been eliminated
• Programs that are without a resident or fellow
  for 4 years will be asked to voluntarily withdraw
  their accreditation

12
New General Subspecialty Requirements

• Approved February, 2006 to go into effect January
  1, 2007
• Competencies!
• Collaboration between programs
• - Documented semi-annual meetings b/w subs and
  core to address a departmental approach to common
  educational issues (core curriculum, competencies
  and evaluation practices).
• Mentor fellows to develop clinical, educational,
  admin, and research skills
• Greater specificity on scholarly activity for
  faculty and fellows
• Faculty activities that are evidence of ongoing
  commitment to scholarly activity
• Fellow ...must conduct a scholarly project in
  sub area with guidance of PD and mentor.
• Program must identify a mentor and scholarship
  oversight committee to oversee fellows progress
  related to scholarly activities
• Board Score Information
• Deficient if over 6 yrs LT 75 eligible take, of
  those who take LT 75 pass it.
• Exceptions will made for programs with small of
  fellows

13
New Administration Language

• All three years fellowship programs must address
  the following areas of administration
•  
• 1. An awareness of regional and national access
  to care, resources, workforce, and financing
  appropriate to their specialty through guided
  reading and discussion.
• 2. Organization and management of a subspecialty
  service within ones own delivery system by
  engaging fellows as active participants in
  discussions (e.g., through already scheduled
  division activities/meetings ) that involve
•  
• a) staffing a service or unit, including managing
  personnel and making and adhering to a schedule
• b) drafting policies and procedures, leading
  interdisciplinary meetings and conferences,
  providing in-service teaching sessions
• c) discussions/proposals for hospital and
  community resources including clinical,
  laboratory and research space, equipment and
  technology necessary for the program to provide
  state-of-the-art care while advancing knowledge
  in the field
• d) business planning and practice management that
  includes billing and coding, personnel management
  policies and professional liability
• e) division or program development, organization,
  and maintenance and
• f) necessary collaborations within (e.g.,
  pathology, radiology, surgery) and beyond the
  institution (e.g., participation in national
  specialty societies, cooperative care groups,
  multi-center research collaboratives) as
  appropriate to their specialty.
•  
• This language is much more flexible than what had
  been vetted.

14
Updates to Subpecialty PIFs

• So, the new General Requirements for the
  Subspecialties in Pediatrics go into effect
  January 1, 2007. Accordingly, all of the
  subspecialty PIFs have been modified to reflect
  the changes. All subspecialty programs with site
  visits after January 1, 2007 will need to use the
  new updated subspecialty PIFs. The PIFs now have
  three parts.
• Part 1 Accreditation Data System (ADS) Section
  of PIF
• Information that is entered in ADS as part of the
  annual update will need to printed and appended
  to PIF (e.g., information related to the PD,
  sponsor, participating institutions, residents,
  faculty roster, etc.).
• Part 2 Common Subspecialties Section of PIF
• This section will contain common questions that
  pertain to all subspecialties (e.g., questions on
  the competencies, research, duty hours,
  evaluation, etc..).
• Part 3 Subspecialty Specific Section of PIF
• This section will contain subspecialty specific
  questions.

15
Revised Subspecialty Requirements

• The followings subspecialty requirements have
  been approved and have a July 1, 2007 effective
  date
• Adolescent Medicine
• Critical Care Medicine
• Pediatric Cardiology
• Pediatric Hematology-Oncology
• Neonatal-Perinatal Medicine
• Pediatric Rheumatology
• So, Part 3 of the PIF (subspecialty section) will
  be updated again for all of the aforementioned
  subspecialty PIFs to be in line with the new
  requirements.
• This will be done in spring of 2007.
• RRC has solicited input on the data collection
  section of the PIFs.
• Common Requirements have gone out for review and
  comment -- yesterday

16
Questions and Answers

• ?s about the PIF that are technical
• Contact ACGME Help Desk helpdesk_at_acgme.org or
  312/755-7464
• For Part I of PIF of WebADS rsmith_at_acgme.org
• ?s about PIF content/program requirements
• Call or email the RRC staff
• For PIF questions dbraun_at_acgme.org or (312)
  755-5478
• For Program Requirements questions
  jvasilias_at_acgme.org or [phone]
• cfischer_at_acgme.org or [phone]
• Look on Peds website/FAQ

17