Challenges in Resident Education: Is the Next Accreditation System (NAS) the Answer?

Abstract

Seven specialties, including orthopaedic surgery, started the Next Accreditation System (NAS) in July 2013. Changes to program accreditation in NAS include milestones, emphasis on case-log procedural minimums, continuous data assessment, greater institutional oversight, eliminating the program information form (“PIF”), and fewer and different types of site visits. In the traditional accreditation process, emphasis was placed on process and the details of the administration of educational programs. In the NAS, the accreditation process will emphasize measurable and meaningful outcomes of educational programs. The Residency Review Committee (RRC) will review each program’s annually submitted data, supplemented by reports of self-study visits every ten years, and, when requested by the RRC, progress reports and site visit reports. The RRC will evaluate comparative data between programs and within programs and will look for trends that have occurred over the years. Within these data elements, tools have been developed and weighted that will provide screening criteria for program performance. Board scores, the resident survey, and procedural experiences will be weighted more heavily than other data elements. Case logs will be a critical element of NAS data analysis. The RRC has required that finishing residents log between 1000 and 3000 total codes. In the NAS, these self-reported procedural experiences will be assessed in more detail. The RRC will assess program percentile ranked data as compared with national norms in anatomic areas. Procedural minimums for thirteen procedures and overall pediatric and oncology cases have been developed by the RRC. The minimums in these fifteen areas will be used as one of the critical data elements and will be the primary procedural experience screening tool. Residents who finished the program the previous year will be expected to have met procedural minimums. The degree to which a program deviates from this expectation will be screened against national data. The …