ACGME Update: Review Committee for Orthopaedic Surgery Pamela

ACGME Update: Review Committee for Orthopaedic Surgery Pamela

ACGME Update: Review Committee for Orthopaedic Surgery Pamela L Derstine, PhD, MHPE Executive Director ARCOS Annual Meeting March 14, 2019 Las Vegas NV Disclosure No conflicts to report 2019 ACGME Discussion Topics

Review Committee Members and Staff Accreditation and Program Statistics Case Logs Milestones NAS ACGME #ACGME2019 2019 ACGME REVIEW COMMITTEE MEMBERS AND STAFF

#ACGME2019 2019 ACGME Review Committee Membership Nominating Organizations 12 voting members 3 members (ABOS) 3 members (AAOS) 3 members (AMA) 1 resident member (at large) 1 member (AOA-osteopathic) 1 public member (at large) 2 non-voting Ex-Officio David Martin, MD, ABOS #ACGME2019 Lee Vander Lugt, DO, AOA 2019 ACGME

Review Committee Membership: Current Peter M Murray, MD, Chair Dawn M LaPorte, MD, Vice Chair S Elizabeth Ames, MD James E Carpenter, MD Charles F Carr, MD John Gorczyca, MD Richard F Howard, DO Eugene S Jang, MD, Resident Member Paul J Juliano, MD Theodore W Parsons III, MD #ACGME2019 James R Roberson, MD James H Taylor, Dman MHA MBA, Public Member

2019 ACGME New Members Effective 7/1/2019 Stuart J Davidson, MD, resident member Kimberly J Templeton, MD SAUSHEC University of Kansas #ACGME2019

2019 ACGME ACGME Review Committee Staff Pamela L. Derstine, PhD, MHPE Executive Director Susan E. Mansker Associate Executive Director Kevin Bannon ADS Jennifer M Luna Senior Accreditation Administrator

Citlali Meza, MPA Accreditation Administrator #ACGME2019 2019 ACGME ACCREDITATION AND PROGRAM STATISTICS #ACGME2019 2019 ACGME Accreditation Statistics: Current Total Current Accredited Programs # Core 183 # Fellowships

259 Pending Applications (April 2019) # Core Allopathic 0 # Core Osteopathic 4 # Fellowships 3 #ACGME2019 2019 ACGME Accreditation Statistics: Current Program Accreditation Status: Core

Status Continued Accreditation Continued Accreditation w/o Outcomes Continued Accreditation w/ Warning Initial Accreditation Initial Accreditation w/ Warning Probationary Accreditation Continued Pre-Accreditation #ACGME2019 # Programs 142 5 10 24 2

0 19 2019 ACGME Accreditation Statistics: Current Program Accreditation Status: Fellowships STATUS Adult Recon Foot/Ankle Hand Pediatric Spine Sports Trauma #ACGME2019 Oncology

Continued Accred. 20 6 64 24 16 87 9 10 Continued w/warning 2

1 1 Initial Accred. 4 1 3 1 1 5 2 1 Application

1 1 1 1 PreAccred. 1 2019 ACGME Other Meeting Decisions (January 2019) Requests Permanent Complement Increase Core # Requested /# Approved Permanent Complement Increase Fellowship

# Requested /# Approved Temporary Complement Increase Core # Requested /# Approved Site Visit Focused/Full Progress Report 10/4 2/2 4/3 4/2 4 #ACGME2019 2019 ACGME Citation Statistics CORE: January 2019

#ACGME2019 2019 ACGME AFI Statistics CORE: January 2019 #ACGME2019 2019 ACGME Citation Statistics FELLOWSHIP: January 2019 #ACGME2019 2019 ACGME AFI Statistics FELLOWSHIP: January 2019 #ACGME2019 2019 ACGME

CASE LOG UPDATE #ACGME2019 2019 ACGME #ACGME2019 2019 ACGME #ACGME2019 2019 ACGME #ACGME2019 2019 ACGME #ACGME2019 2019 ACGME

MILESTONES UPDATE #ACGME2019 2019 ACGME Call for Task Group volunteers ended 11/30/2018 Milestone Task Group members selected December 2018 Milestone survey January-February 2019 First of 3 Task Group meetings November 2019 Public comment period on completed draft TBA #ACGME2019 Effective approximately 7/1/2021 2019 ACGME Milestones Resources

Clinical Competency Committee Guidebook https://www.acgme.org/Portals/0/ACGMEClinicalCompetencyCommitteeGuidebook.pdf?ver=2017-10-18-141733-920 Milestones Guidebook https://www.acgme.org/Portals/0/MilestonesGuidebook.pdf?ver=2016-05-31-113245-103 Guidebook for Residents and Fellows https:// www.acgme.org/Portals/0/PDFs/Milestones/MilestonesGuidebookforResidentsFellows.pdf?ver=2017-06-29-090859-107 Milestones Annual Report 2018 New!! https:// www.acgme.org/Portals/0/PDFs/Milestones/2018_Milestones_National_Report_2018-09-18_final.pdf?ver=2018-09-19-142602 -030 #ACGME2019

2019 ACGME NAS UPDATE #ACGME2019 2019 ACGME Upcoming Review Committee Meetings April 12-13, 2019 Agenda closed September 14, 2019 Agenda close: July 20, 2019 January 17-18, 2020 Agenda close: November 8, 2019 April 17-18, 2020 #ACGME2019 Agenda close: March 6, 2020

2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting Clinical Experience Case Logs CORE Minimum Number reports for 20172018 program graduates were reviewed Graduates expected to comply with minimum number requirements for all categories #ACGME2019 2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting Only 5 of

729 Clinical Experience Case Logs graduates CORE failedreports a for 2017-2018 Minimum Number program graduates were reviewed minimum Graduates expected to comply with minimum number requirements for all categories #ACGME2019 2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting

Clinical Experience Case Logs CORE Case Log Program reports for 20172018 program graduates were reviewed Anatomic areas 10th percentile (all patients) subject to AFI or citation #ACGME2019 2019 ACGME Program Report Percentile Summary Graph #ACGME2019 2019 ACGME

Available reports to assist in tracking #ACGME2019 2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting Clinical Experience Case Logs MSK FELLOWSHIP Minimum Number reports for 20172018 program graduates were reviewed Graduates expected to comply with minimum number requirements for all categories #ACGME2019

2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting Clinical Experience Case Logs All Other FELLOWSHIPS Case Log Program reports for 20172018 program graduates were reviewed Subspecialty-specific case categories 10th percentile (all patients) subject to AFI or citation #ACGME2019 2019 ACGME Program Report Percentiles Summary Graph

for a sports program Subspecialty-specific Key Procedure Report available in the case log system to assist in tracking #ACGME2019 2019 ACGME Development of minimum number requirements for hand programs initiated.

Proposed effective date: 2020-2021 #ACGME2019 2019 ACGME #ACGME2019 2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting Board Scores First-time takers only during the most recent 5 years reported by ABOS to Data Dept.

Written: 80% pass rate Oral: 75% pass rate #ACGME2019 2019 ACGME 2018-19 Annual Program Review: 2020 RC Meeting Board Scores: new CPR First-time takers only during the most recent three years reported by ABOS to Data Dept. Bottom 5th percentile nationally for the specialty AND Subject to citation if <80% pass rate #ACGME2019 2019 ACGME

2018-19 Annual Program Review: 2020 RC Meeting Board Scores: new CPR If the new CPR had been applied to data reviewed in January 2019: Written: 2 programs subject to citation Oral: 8 programs subject to citation #ACGME2019 2019 ACGME Example: 5th Percentile = 25% Example 1: Program G - 3-Year Aggregate Pass Rate = 68.2% Program pass rate is greater than the 5th percentile

Sorted by Pass Rate N = 20 Programs Program Specialty A ACGME Specialty 3-Year Aggregate Board Name Exam Type Pass Rate ABMS Board Written 25.0 Sort Order 1

5.0% 10.0% B ACGME Specialty ABMS Board Written 25.0 2 C ACGME Specialty

ABMS Board Written 50.0 3 15.0% D ACGME Specialty ABMS Board Written 50.0

4 20.0% 25.0% E ACGME Specialty ABMS Board Written 59.3 5 F

ACGME Specialty ABMS Board Written 66.7 6 30.0% 35.0% G ACGME Specialty ABMS Board Written

68.2 7 H ACGME Specialty ABMS Board Written 71.4 8 40.0% 45.0%

I ACGME Specialty ABMS Board Written 75.0 9 J ACGME Specialty ABMS Board Written 80.0

10 50.0% K ACGME Specialty ABMS Board Written 83.3 11 55.0%

L ACGME Specialty ABMS Board Written 87.5 12 60.0% M ACGME Specialty ABMS Board Written

90.5 13 65.0% N ACGME Specialty ABMS Board Written 92.3 14

70.0% O ACGME Specialty ABMS Board Written 93.8 15 75.0% 80.0% P

ACGME Specialty ABMS Board Written 97.2 16 Q ACGME Specialty ABMS Board Written 100.0 17

85.0% R ACGME Specialty ABMS Board Written 100.0 18 90.0% S

ACGME Specialty ABMS Board Written 100.0 19 95.0% T ACGME Specialty ABMS Board Written 100.0

20 100.0% Bottom 5% of the distribution defines the 5th percentile 2 programs have a pass rate below the 5th percentile 18 of 20 programs have a pass rate > 5th percentile

2019 ACGME Example: 5th Percentile = 91.3% Example 3: Program 3-Year Pass Rate = 75% Program pass rate is less than the 5th percentile and <80% Program Pass Rate = 75% 2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting

Resident Survey (completed Feb-Mar 2018) Faculty Survey (completed Feb-Mar 2018) 7 survey question domains 70% response rate required Aggregated non-compliant survey responses for each domain reviewed Trends monitored 5 survey question domains (mirrors Resident Survey) 60% response rate required Program director and core

faculty members only Trends monitored Resident/faculty member responses to same domains compared #ACGME2019 2019 ACGME 2017-18 Annual Program Review: 2019 RC Meeting Resident Scholarly Activity 2017-2018 ADS Update

Residents in program AY 2016-2017 SA completed AY 2016-2017 #ACGME2019 Faculty Scholarly Activity 2017-2018 ADS Update Faculty in program AY 2016-2017 SA completed AY 2016-2017

Major Changes and Responses to Citations** 2018-2019 ADS Update Reported Fall 2018 Locked approx. October 1, 2018 **Also participating site information; duty hours/learning environment section items 2019 ACGME 2018-19 Annual Program Review: 2020 RC Meeting New Scholarly Activity Reporting System: reported

for program not individual faculty (Core programs) Complete a summary table for all physician faculty Complete a summary table for all non-physician faculty PMIDs will be also reported Scholarly activity for fellowship programs will continue use the current reporting system #ACGME2019 2019 ACGME #ACGME2019 fi t o N

l na b u s o t t c je e g n a

ch 2019 ACGME ADS Change: Faculty Scholarly Activity IV.D.2.a) Among their scholarly activity, programs must demonstrate accomplishments in at least three of the following domains (Core) #ACGME2019 2019 ACGME ADS Change: Faculty Scholarly Activity

IV.D.2.b) The program must demonstrate dissemination of scholarly activity within and external to the program by the following methods: #ACGME2019 2019 ACGME Other ADS Changes for 2019-20 Annual Update Site Directors identified for each site

Identify core faculty via checkbox Must enter certification expiration date for all faculty New questions added to Annual Update, e.g., Done on the Sites tab by editing each

site Program mission statement Site Directors identified on the faculty roster Program aims guided by mission statement #ACGME2019 2019 ACGME ADS Change: Site Director Identification

Edit Participatin g Sites #ACGME2019 2019 ACGME Upcoming Changes in ADS Changes will be published after June 24, 2019. Accredited programs will be required to respond to new/updated questions in the Annual Update. Applications (new and re-applications) will be required to respond to new/updated ADS elements.

#ACGME2019 2019 ACGME Self-Study/10 Year Visit Update Programs scheduled with a self-study date prior to April 2019 will likely have their 10-year site visit more than 24 months after the self-study date listed in ADS Programs with self-study dates of May 2019 and beyond will have their self-study dates moved forward into the future (exact time-frame under review) More information about the date changes are forthcoming #ACGME2019 2019 ACGME

ACGME UPDATE: SINGLE ACCREDITATION SYSTEM #ACGME2019 2019 ACGME #ACGME2019 As of 2/28/2019 2019 ACGME ACGME UPDATE: COMMON PROGRAM REQUIREMENTS SECTION I-V MAJOR REVISION IMPLEMENTATION TIMELINE

#ACGME2019 2019 ACGME Implementation of CPRs (CORE) The following are effective 7/1/2020 I.D.2.c) Lactation facilities I.D.2.e) Accommodation for resident disabilities II.A.4.a).(2) Design and conduct program consistent with community needs, mission II.B.2.g) (1-4) Faculty development specifics All other CPRs, including ALL CPRs in section VI, are effective 7/1/2019 See https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidencyImple #ACGME2019 mentationTable.pdf

2019 ACGME Implementation of CPRs (FELLOWSHIP) The following are effective 7/1/2020 I.D.2.c) Lactation facilities I.D.2.e) Accommodation for resident disabilities II.A.4.a).(2) Design and conduct program consistent with community needs, mission IV.E.1 Independent Practice option (subject to public comment) All other CPRs, including ALL CPRs in section VI, are effective 7/1/2019 See https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidencyImple #ACGME2019 mentationTable.pdf 2019 ACGME

RC Decisions for Fellowship Eligibility and Scholarly Activity Prerequisite education must be completed in an ACGME, ACGME-I, AOA, RCPSC-accredited program (exceptions permitted) RC requires faculty scholarly activity dissemination by PMID See decisions for all RCs at: https://www.acgme.org/What-We-Do/Accreditation/Common-Progra #ACGME2019 m-Requirements 2019 ACGME Specialty-Specific Requirements Current requirements updated for new CPRs posted by April 1, 2019 Deleted, renumbered, and edited PRs shown with track changes

Effective 7/1/2019 #ACGME2019 2019 ACGME Specialty-Specific Requirements Focused Revisions CORE RCs must further specify the following IV.C.1: The curriculum must be structured to optimize resident educational experiences, the length of these experiences, and supervisory continuity. (Core) Other focused revisions under consideration Public comment period this summer Effective date: 7/1/2020 #ACGME2019 2019 ACGME

Specialty-Specific Requirements Major Revision FELLOWSHIPS Newly approved one-year fellowship CPRs Public comment period this summer Effective date: 7/1/2020 #ACGME2019 2019 ACGME Implementation of CPRs Program Director Guide to the Common Program Requirements is under

development #ACGME2019 2019 ACGME ACGME UPDATE: OTHER INITIATIVES #ACGME2019 2019 ACGME Back To Bedside applications due 3/15/2019 2020 ACGME Award nominations due 3/29/2019 Upcoming Workshops Experienced Coordinators: Advancing, Collaborating, Innovating

April 14-15, 2019 Developing Faculty Competencies in Assessment October 13-18, 2019 October 27-November 1, 2019 #ACGME2019 Other Educational Activities (see website) 2019 ACGME #ACGME2019 2019 ACGME #ACGME2019 2019 ACGME

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