Program Director Corner – January 2018
Alan C. Dalkin, MD
Professor of Medicine, Endocrinology and Metabolism
University of Virginia
ACD6V@hscmail.mcc.virginia.edu
Next Accreditation System – Self Study
Dear APDEM Members,
In the last few years there have been a number of important changes at the Residency Review Committee that have affected the ongoing work we, the Internal Medicine Review Committee, do to evaluate programmatic compliance. As you well know, the Next Accreditation System (NAS) now forms the construct around which we annually monitor all Internal Medicine residency programs and subspecialty fellowship programs. In the more recent past, the process includes having a self-study internal evaluation followed ~ 12-18 months later by a 10-year accreditation site visit. Those steps have evolved since inception, and hence I wanted to briefly summarize for you the big picture.
NAS includes our annual data review of key indicators including board pass rate, resident and faculty surveys, annual updates and such. The self-study is meant to be a constructive experience in which programs can evaluate all aspects of their training program to assess, modify and optimize their educational environment. The overall plan for including the vision of how the annual NAS review interdigitates with the self-study process is depicted in this PowerPoint presentation. The self-study activity is entirely meant to be constructive with no risk to the program for accreditation. Indeed, the field-staff who conducts the site visits and previously served as only information gatherers, have taken it upon themselves to capitalize on their expertise and provide both on-site feedback and a full written evaluation of the self-study findings with a goal toward program improvement. In the end, a formal letter back to the programs includes feedback and an analysis of programmatic strengths and weaknesses.
None of that information is formally carried forward into the 10-year accreditation assessment. Here you can find the generic letter from the RC to the programs with directions how to approach this site visit. As there is no longer a PIF, the process is not particularly burdensome, primarily consisting of updates for changes after the self-study, responses to prior citations, major changes and information on rotations and curriculum. When reviewing the findings of the site-visit, we, the IM-RC, have access to the self-study and site visitor reports, but do not consider it specifically in decisions regarding areas for improvement, citations or accreditation. In fact, the 10-year accreditation assessment is essentially a focused look at each program’s compliance with core training requirements, leaving room for each program to develop their best approach to meet the detail requirements. The RC has really made an effort to frame findings in terms of citations or AFIs (area for improvement) such that programs will realize that the goal is ongoing improvement and optimization, not a penalty-based system in which we are searching for every possible violation/problem. The ACGME and the RC-IM hope that these visits are less onerous than the old site visits and, with the self-study feed-back, that they become a valuable tool in ongoing program improvement. I have been asked about providing you data on common citations and patterns that have emerged in these visits. Unfortunately, we have only reviewed a handful of institutional “series” and it really would be misleading to try and place those in buckets. If, over time, a trend or two appear, I would be happy to provide updates to the APDEM membership.
In sum, the IM-RC encourages evaluation, innovative problem solving and curricular updates as a standard part of program optimization. Program Directors and key faculty should take advantage of the “blank slate” of self-study and subsequently the feedback from field staff with their vast expertise, when they visit your programs. They are entirely “on our side” and want to contribute to the superb fellowship training that we strive to provide.
Sincerely,
Alan C. Dalkin, M.D.
Endocrinology Member
Internal Medicine Review Committee (2013-2019) (And past APDEM President when many of you were in training!)