Under the Microscope An RRC Site Visit

1
Under the Microscope An RRC Site Visit

• 2009 Annual AADPRT Meeting
• March 12 March 15, 2009
• Tucson, AZ

2
The PIF

• Program Information Form or Psychosis Inducing
  Format

3
Program Information Form - PIF

• Two sections to the PIF
• Common PIF- Located under PIF preparation section
  on the ACGME website but cannot be downloaded
  must be updated and saved within the ACGME
  website.
• Specialty Specific PIF - Located under PIF
  preparation section on the ACGME website. This is
  the file that can be downloaded and saved to your
  desktop/personal computer for future work.

4
Time Consuming Issues

• Common PIF
• Physician Faculty Roster and CVs
• Takes a lot of time to gather and enter this
  information.

5
Time Consuming Issues

• Specialty Specific PIF
• Scheduled Didactic Seminars
• Learning Activities for
• Practice-Based Learning
• Interpersonal and Communication Skills
• Systems-Based Practice

6
The key is to start early

• Organization and an early start can help avoid
  the need for an inpatient stay.

7
The Internal Review

• Or
• Why Cant They Leave Me Alone?

8
Purpose

• To insure institutional oversight of residency
  program activities

9
Internal Review Includes Assessment of

• Compliance with the Common, Program and
  Institutional Requirements
• Educational objectives and effectiveness in
  meeting these objectives
• Educational and financial resources
• Effectiveness in addressing areas of
  non-compliance and concerns in previous ACGME
  accreditation letters and internal reviews

10
Internal Review Assessment (continued)

• Effectiveness of educational outcomes in the
  ACGME general competencies
• Effectiveness in using evaluation tools and
  outcome measures to assess competency
• Annual program improvement efforts
• Resident performance
• Faculty development
• Graduate performance
• Program quality

11
Materials and Data to be Used Include

• ACGME Common, Program and Institutional
  Requirements
• Accreditation letters from ACGME
• Reports from previous internal reviews
• Previous annual program evaluations
• Results from internal or external resident
  surveys, if available

12
Internal Review Committee interviews

• Program Director
• Key faculty members
• At least one peer-selected resident from each
  level of training
• Other individuals deemed appropriate by the
  committee

13
Internal Review Report

• Written report including
• Description of how the process was conducted
• Documentation to demonstrate a comprehensive
  review,
• List of citations, etc., from previous surveys
• Summary of how these items were subsequently
  addressed

14
Following the Internal Review

• The DIO and GMEC must monitor the response by the
  program to actions recommended in the internal
  review process.
• The Sponsoring Institution must submit the most
  recent internal review for each training program
  as part of the Institutional Review documentation.

15
Whats in it for my program?

• It forces evaluation of all facets of the program
  in time to make adjustments before the next site
  visit.
• Gives the program coordinator something extra to
  do in addition to recruitment/orientation/graduati
  on/rotation schedules, EValue, etc.

16
Dont be Stranded without the Right Tools to do
the Job

• Documentation is Essential to a successful Site
  Visit

17
Be Organized

• Organization is invaluable to a less stressful
  visit so spend time finding a way to organize all
  the documentation that allows you to quickly find
  any information the site visitor requests.

18
Preparation is Key.

• Educating Faculty and Residents for the Site Visit

19
Preparation is NOT Coaching

• Do they understand the purpose of a Site Visit?
• Have they seen the PIF?
• Do the residents understand the Resident Survey?
• Make sure they are aware of the six core
  competencies and how each competency is
  evaluated.
• Do they know the RRC requirements and how the
  program is meeting those requirements?
• Goals and Objectives for each rotation. Do they
  know what they are and what tools are used to
  evaluate success?
• Do residents know the resources that are
  available to them?
• Do they know how you are responding to past
  concerns?

20
The Purpose of a Site Visit

• The Site Visit is to review the compliance of the
  training program with the ACGME Guidelines.
• This is not the time or place to air grievances.
• If there is a concern, it should be discussed
  with Program Administration prior to being a
  conversation with the Site Visitor.
• Be honest.

21
The PIF

• Your residents and core faculty members should
  have seen the PIF. This gives everyone a global
  view of the program.
• The quickest way to receive a citation is for
  your PIF to say one thing and your residents
  and/or faculty to say something different.
• It is also a great way to trigger their memory.
  

22
ACGME Resident Survey

• Review the questions on the ACGME Resident Survey
  with your residents prior to having them complete
  the survey.
• Dont tell them how to answer the questions, but
  you can let them know what the program is doing
  for each question.
• You should have read the responses of your most
  recent resident survey and the Programs
  Education Committee should have developed a plan
  of action to respond to areas of concern. Have
  documentation showing what you are doing.

23
Do they know the Core Competencies?

• Residents were asked to name the six core
  competencies and how they were evaluated on those
  competencies.
• Do the faculty know the competencies they are
  assessing?
• They were asked if they felt they were being
  adequately trained in all those areas.
• Program Director Guide to the Common Program
  Requirements.
• http//www.acgme.org/acWebsite/navPages/nav_common
  pr.asp

24
Goals and Objectives

• Send out the Goals and Objectives again to both
  residents and faculty.
• Remind them where they can find them at any give
  time.
• Make sure they faculty read the Goals and
  Objectives, after all this is what they are
  teaching the residents.

25
Remind them of their resources

• Does the program have a library?
• Do they have access to a medical library in the
  Institution?
• Copy or Book allowances, travel allowances, etc.
• Employee Wellness area

26
Past Concerns

• Make sure you have read the results of the ACGME
  Resident Survey, discuss them with core faculty
  and the residents. How are you going to respond
  to concerns?
• Does your GME office do a survey? Those results
  should also be reviewed.
• The annual program survey from both residents and
  faculty, address those results.
• Remind them of the progress that has been made
  with past concerns.

27
Take Foot. Stick in Mouth.

• An important point both Faculty and Residents
  need to understand is to only answer the question
  they are asked. DONT ELABORATE!

28
Tips and Suggestions

• from those who have been there and done that!

29
Tips and Suggestions

• Some questions on the ACGME Resident Survey may
  be ambiguous, go over the survey with your
  residents explaining what each questions is
  asking prior to them going on-line to complete
  the survey.
• Know your PIF, make sure your residents and
  faculty know your PIF.
• Focus on and know your Affiliation Agreements, to
  the extent you can find the answer in the
  document to show the site visitor.
• If you have questions about the preparation of
  the PIF, call the RRC Executive Directors
  office.

30
Tips and Suggestions for the Day of the Site Visit

• Make sure you have a schedule, anyone
  participating in the site visit has a schedule,
  and remind everyone on that day when and where
  they need to show up.
• You want the site visitor to have a very easy,
  relaxed day. Make things as easy for him/her as
  possible.
• It is okay to ask them their preferences, for
  lunch, arrangement of documentation, etc.
• BREATHE RELAX BREATHE - RELAX

31
Thank You

• Lisa Miller, C-TAGME University of Michigan
• millerlm_at_med.umich.edu
• Karyn Kitchen, C-TAGME University of Michigan
• ksk_at_med.umich.edu
• Barbara Burns, C-TAGME University of Maryland
• bburns_at_psych.umaryland.edu
• Pamela Whisenhunt, C-TAGME St. Louis University
  
• whisenpa_at_slu.edu