ACGME Accreditation Research Articles

ACGME Accreditation, Resident Unions, and the Centrality of Patient Welfare.

ACGME Accreditation, Resident Unions, and the Centrality of Patient Welfare.

Trends in End-of-Life Care and Satisfaction Among Veterans Undergoing Surgery.

To examine trends in end-of-life care services and satisfaction among Veterans undergoing any inpatient surgery. The Veterans Health Administration has undergone system-wide transformations to improve end-of-life care yet the impacts on end-of-life care services use and family satisfaction are unknown. We performed a retrospective, cross-sectional analysis of Veterans who died within 90 days of undergoing inpatient surgery between 01/2010 and 12/2019. Using the Veterans Affairs (VA) Bereaved Family Survey (BFS), we calculated the rates of palliative care and hospice use and examined satisfaction with end-of-life care. After risk and reliability adjustment for each VA hospital, we then performed multivariable linear regression model to identify factors associated with the greatest change. Our cohort consisted of 155,250 patients with a mean age of 73.6 years (standard deviation 11.6). Over the study period, rates of palliative care consultation and hospice use increased more than two-fold (28.1% to 61.1% and 18.9% to 46.9%, respectively) while the rate of BFS excellent overall care score increased from 56.1% to 64.7%. There was wide variation between hospitals in the absolute change in rates of palliative care consultation, hospice use and BFS excellent overall care scores. Rural location and ACGME accreditation were hospital-level factors associated with the greatest changes. Among Veterans undergoing inpatient surgery, improvements in satisfaction with end-of-life care paralleled increases in end-of-life care service use. Future work is needed to identify actionable hospital-level characteristics that may reduce heterogeneity between VA hospitals and facilitate targeted interventions to improve end-of-life care.

Assessing the impact of adopting a competency-based medical education framework and ACGME-I accreditation on educational outcomes in a family medicine residency program in Abu Dhabi Emirate, United Arab Emirates.

Competency-Based Medical Education (CBME) is now mandated by many graduate and undergraduate accreditation standards. Evaluating CBME is essential for quantifying its impact, finding supporting evidence for the efforts invested in accreditation processes, and determining future steps. The Ambulatory Healthcare Services (AHS) family medicine residency program has been accredited by the Accreditation Council of Graduate Medical Education-International (ACGME-I) since 2013. This study aims to report the Abu Dhabi program's experience in implementing CBME and accreditation. Compare the two residents' cohorts' performance pre-and post-ACGME-I accreditation.Study the bi-annually reported milestones as a graduating residents' performance prognostic tool. All residents in the program from 2008 to 2019 were included. They are called Cohort one-the intake from 2008 to 2012, before the ACGME accreditation, and Cohort two-the intake from 2013 to 2019, after the ACGME accreditation, with the milestones used. The mandatory annual in-training exam was used as an indication of the change in competency between the two cohorts. Among Cohort two ACGME-I, the biannual milestones data were studied to find the correlation between residents' early and graduating milestones. A total of 112 residents were included: 36 in Cohort one and 76 in Cohort two. In Cohort one, before the ACGME accreditation, no significant associations were identified between residents' graduation in-training exam and their early performance indicators, while in Cohort two, there were significant correlations between almost all performance metrics. Early milestones are correlated with the graduation in-training exam score. Linear regression confirmed this relationship after controlling the residents' undergraduate Grade Point Average (GPA). Competency development continues to improve even after residents complete training at Post Graduate Year, PGY4, as residents' achievement in PGY5 continues to improve. Improved achievement of residents after the introduction of the ACGME-I accreditation is evident. Additionally, the correlation between the graduation in-training exam and graduation milestones, with earlier milestones, suggests a possible use of early milestones in predicting outcomes.

A Survey of Craniofacial Fellowships in North America: The Craniofacial Fellowship Experience Outside of the Operating Room

Residencies are governed by the Accreditation Council for Graduate Medical Education’s (ACGME) common program requirements to help ensure that residents are adequately trained to practice medicine independently. Fellowships either rely on ACGME accreditation for standardization, have developed their own specialty accreditation councils, or have no governing body to monitor programs, such as in craniofacial surgery. This study was designed to capture the clinical, educational, and scholarly experiences of craniofacial fellows to better understand the current craniofacial fellowship landscape. An anonymous online survey was sent to all North American craniofacial surgery fellowship program directors via email. The first question group focused on program characteristics: ACGME accreditation, core faculty, and patient population. The second question group focused on the fellow’s scholarly experience: educational meetings and research requirements. The third question group focused on the fellow’s non-operative experience: clinic participation and call experience. The fourth question group focused on the fellow’s international experience. A total of 22 of 31 programs directors (71%) responded to the survey. The majority of fellowship programs (95.5%) had an educational program of meetings. The majority of programs (82.8%) mandated clinic time for the fellows. Five programs (22.7%) had a fellow’s clinic. The majority of fellowship programs (95.5%) had research expectations for the fellow. Call type and frequency varied widely between fellowship programs. Less than half (47.6%) of programs had an international experience for the fellow. Three-fourths of fellows only interacted with subspecialties of the cleft and craniofacial multidisciplinary clinic during clinic time. A total of 16 fellowship programs (72.7%) were non-ACGME accredited. Despite rapid growth in craniofacial fellowships and a lack of current oversight as to content, programs provide a similar experience for fellows outside of the operating room. Areas for further discussion regarding standardizing programs may include international experiences and formal exposure to other disciplines within the cleft and craniofacial clinic.

41. CREATING A STANDARDIZED TEMPLATE FOR LEARNING GOALS AND OBJECTIVES IN RESIDENCY ELECTIVE CURRICULA

Background ACGME accreditation requires residency programs have curricula with competency-based goals and objectives at each educational level. Prior published attempts at standardizing learning goals and objectives (LGO) mostly focus on specific fields, thus limiting generalizability for programmatic use. The recently published ACGME accreditation criteria prompted our institution to review our elective LGOs and develop a process to facilitate both ease of LGO creation and accreditation compliance. Objectives 1) Identify published standards for residency elective curricula; 2) evaluate the current state of our program's elective LGOs, and 3) pilot a process to implement LGO best practices. Methods We designed an electronic form (e-form) to compare our institution's elective LGOs to those reported in the literature. Two authors independently evaluated and scored our program's electives. Results informed the design of a second e-form for guiding elective directors in creating LGOs meeting accreditation expectations. This form was piloted by 5 elective directors. Results Review of prior studies revealed two major types of elective LGO features: common “core” characteristics, and less frequent “secondary” characteristics. Core characteristics included: demonstration of learner progression over time, inclusion of ACGME's core competencies, measurable deliverables, and expected outcomes. Secondary characteristics included: orientation and reference materials, formal didactics, milestone calendars, and scholarly products. We evaluated 55 unique electives at our program using these characteristics. Twenty percent of our current electives did not have LGOs available. Over 94% of LGOs had not been updated for at least 2-3 years. We also identified gaps between best practices and the current state of our elective LGOs (Figure 1). The new electronic form was piloted by 5 elective directors. Director feedback from our pilot included: checkboxes for common responses; free-text options in all areas; and providing a customizable “sample week” calendar. Conclusions While electives are highly customized by design, establishing LGO guidelines helps to define goals for learner progression, minimizes the difficulties in the transition process, and provides a framework for elective directors as they strive to design the best experience. Our next step will be to implement the e-form for all of our electives.

Analysis of musculoskeletal radiology fellowship websites.

Due to the relative lack of standardization in the fellowship application processes for musculoskeletal radiology, program websites are of paramount importance as application resources. This study evaluates the comprehensiveness of these websites and the potential effects of program ACGME accreditation, region, and size on website comprehensiveness. The websites of musculoskeletal fellowship programs listed on the Society of Skeletal Radiology website were assigned a validated comprehensiveness score based on the presence of 19 specific informative components pertaining to the program's characteristics. The correlations of comprehensiveness scores with program ACGME accreditation, region, and size were evaluated. A total of 90 musculoskeletal radiology fellowship program websites were reviewed, yielding a mean comprehensiveness score of 55.1% (10.5 out of 19 criteria). Only 3 of the 19 criteria-application information (88.9%), stand-alone webpage (87.8%), and affiliated hospital information (84.4%)-were present in more than 80% of all websites. Eleven criteria, most notably away rotation information (6.7% presence) and case log (0.0% presence), were absent from at least 50% of all websites. Program ACGME accreditation was correlated with significantly higher website comprehensiveness scores compared with non-accreditation (p = 0.087). There is lack of sufficient, useful information and standardization on the websites of MSK fellowship programs throughout the country. According to our review and analysis, addition of specific information regarding each fellowship program and implementing some type of standardization may optimize fellowship matching for both applicants and the programs.

03:45 PM Abstract No. 349 IR training in transition: how will it all turn out, and who will fund it?

By 2020, most IR training programs will convert from a one-year PGY-6 fellowship to a 5-year integrated IR/DR residency and/or a 2-year independent IR residency. The type of IR training program offered by each institution (integrated, independent, or both) is determined by each institution’s preference, funding availability, and ACGME accreditation. We undertook a survey to determine how IR training programs have handled the new training paradigm in this time of transition. 111 members of the Association of Program Directors in Interventional Radiology (APDIR) were e-mailed a 12-question survey. Questions pertained to expected number and type of IR training positions, new position creation, and sources of funding for new positions. 75 of 111 (68%) programs completed the survey. At these 75 programs, 20% will offer integrated only, 25% will offer independent only, 49% will offer independent and integrated, 4% will offer ESIR only, and 2% are no longer planning to train fellows. Of those surveyed, there will be a total of 116 integrated IR positions available for future matches, 90/116 (78%) are positions created from diagnostic radiology conversions and 26/116 (22%) are new integrated positions. Of the 26 newly created positions, the funding for the positions came from the medical center in 15/26 (58%) and from the radiology department in 11/26 (42%.). After the fellowship gap years, there will be 135 ESIR training positions and 157 independent IR training positions, at these 75 institutions. Combining the integrated and independent data results in 273 training positions, 42% from integrated positions and 58% from independent positions. Institutions have approached the change in IR training from IR fellowship to integrated and independent residency in a variety of ways. Most programs surveyed (69%) will provide an integrated IR training option to medical students. Enthusiasm for this new option is reflected by the new funding made available by administrators in one in five institutions. However, diagnostic radiology trainees will not be squeezed out of IR training, as over half of all future IR training positions (58%) will be from the independent pathway.

The Next Accreditation System in Radiology: A Report From the APDR Residency Structure Committee

In a move to emphasize the educational outcomes of training programs, the ACGME has created the Next Accreditation System (NAS). The stated goals of NAS include aiding the ACGME in the accreditation of programs based on educational outcome measures, decreasing program burdens associated with the conventional process-based approach to ACGME accreditation, allowing good programs to innovate while enabling struggling programs to steadily improve, and providing public accountability for outcomes. Diagnostic radiology is among the first group of specialties to undergo NAS implementation and began operating under the NAS in July 2013. This article describes the various components of the NAS and explains the new elements, including the clinical learning environment review program, the milestones, the clinical competency committee, and the self-study visits.

Giving Feedback to Palliative Care Learners (522)

1.Discuss the challenges of giving feedback to learners, both general and those more specific to palliative care.2.Identify specific strategies for overcoming challenges to giving learner feedback in the palliative care setting.3.Apply skills for giving feedback using a structured approach appropriate for palliative care bedside teaching. Giving feedback to learners is a skill that has gained increasing attention in recent years but still causes discomfort for both educators and trainees. Many educators have not received training in how to give feedback effectively, leading to avoidance, missed opportunities for teaching and learning, and under-supervised learners. As the field of palliative care grows and training programs move toward more stringent requirements, like ACGME accreditation and site visits for Hospice and Palliative Medicine physician fellowships, the need to provide effective competency-based feedback to trainees becomes increasingly important. The challenges common to giving feedback are further heightened by the nature of palliative care. Major interventions often rely on strong communication skills and involve intensity around emotions and ethical issues. At a very basic level, those giving feedback to learners need opportunities to practice and receive feedback themselves. This interactive skill-building session will focus on specific strategies to overcome the challenges of giving feedback to palliative care learners. It will begin with a participant needs assessment and an overview of principles for giving feedback from the education literature. Attendees will then discuss an algorithm developed for giving feedback to palliative care learners and define the parallels between giving feedback and breaking bad news. Emphasis will be on the importance of choosing an appropriate setting, titrating the amount of information given, attending to affect, and making a plan for next steps. Participants will then practice these steps and receive feedback themselves in facilitated small groups. Finally, the group will reflect on lessons learned and develop individual action plans to apply these skills in their teaching practice. Resources for further enhancing skills, structure, and data in the feedback process, including tools from the HPM Toolkit of Assessment Methods, will also be highlighted.

Similar Deficiencies in Procedural Dermatology and Dermatopathology Fellow Evaluation Despite Different Periods of ACGME Accreditation: Results of a National Survey

Similar Deficiencies in Procedural Dermatology and Dermatopathology Fellow Evaluation Despite Different Periods of ACGME Accreditation: Results of a National Survey

The ACGME Audit of the IR Fellowship Program: “Surviving an Attack of Bureaucracy”

Abbreviations: ACGME Accreditation Council on Graduate Medical Education, AMA American Medical Association, ACS American College of Surgeons, RRC residency review committees, ABMS American Board of Medical Specialties, AHA American Hospital Association, AAMC Association of American Medical Colleges, CCME Coordinating Council on Medical Education, LCGME Liaison Committee for Graduate Medical Education, IRC Institutional Review Committee