Subspecialty Milestones Summit

Transcription

1 Subspecialty Milestones Summit February , 2009 American Board of Internal Medicine All rights reserved.

2 The NAS Charge Develop Subspecialty Milestones by , 2009 American Board of Internal Medicine All rights reserved.

3 Nine Components of the NAS Program Attrition Program Changes Resident Survey Board Pass Rate Clinical Experience Log Core Faculty Scholarly Activity Faculty Survey CLER Visit Reporting of Milestones

4 ACGME Milestones 2013 Diagnostic Radiology Emergency Medicine Internal Medicine Neurological Surgery Orthopedic Surgery Pediatrics Urological Surgery

5 Milestones By definition a milestone is a significant point in development. Milestones should enable the trainee, program and the accreditation (and certification) board to know an individuals trajectory of competency acquisition.

6 Milestones and Trajectories Fully Competent A A B C Start PGY Milestones Finish PGY Lucey and Boote

7 Internal Medicine Milestones Version 12/2012 sub-competency 5. Requests and provides consultative care. (PC5) Critical Deficiencies Ready for unsupervised practice Aspirational Is unresponsive to questions or concerns of others when acting as a consultant or utilizing consultant services Unwilling to utilize consultant services when appropriate for patient care Inconsistently manages patients as a consultant to other physicians/health care teams Inconsistently applies risk assessment principles to patients while acting as a consultant Inconsistently formulates a clinical question for a consultant to address Provides consultation services for patients with clinical problems requiring basic risk assessment Asks meaningful clinical questions that guide the input of consultants Provides consultation services for patients with basic and complex clinical problems requiring detailed risk assessment Appropriately weighs recommendations from consultants in order to effectively manage patient care Switches between the role of consultant and primary physician with ease Provides consultation services for patients with very complex clinical problems requiring extensive risk assessment Manages discordant recommendations from multiple consultants Comments: Patient Care Milestone The resident is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in training. He/she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, timely, equitable, effective and patient-centered care. Yes No Marginal Copyright (c) 2012 The Accreditation Council for Graduate Medical Education and The American Board of Internal Medicine. All rights reserved. The copyright owners grant third parties the right to use the Internal Medicine Milestones on a non-exclusive basis for educational purposes.

8 Summit Goals Make the work of developing subspecialty milestones for use in the NAS as meaningful and efficient as possible. Understand how milestones can facilitate improvements in fellowship training. Review the approach the general internal medicine community developed that led to the published IM reporting milestones. Highlight the work advancing competency-based medical education completed by the Geriatrics, Cardiology and GI/Transplant Hepatology communities and determine how this work could facilitate the work of other subspecialties.

9 Summit Goals Propose that the IM reporting milestones can serve as a starting framework and template for this work. Determine if subspecialties can use some portion of the IM reporting milestones for specialty level reporting. Both ACGME and ABIM would like to test the assumption that the Internal Medicine Reporting Milestones for the four general competencies of IPCS, P, PBLI and SBP can be very similar, if not identical for the subspecialties. Determine how much revision would be needed to use the Internal Medicine Reporting Milestones in PC and MK. Come to consensus on a strategy to meet the charge of developing subspecialty milestones for use in the ACGME Next Accreditation System (NAS) by 2014.

10 The Charge 19 subspecialties of Internal Medicine A common set of milestones or 18? NAS Milestones Can the IM Milestones meet this need? Reporting in the NAS

11 Competency Across the Continuum Medical School Professional Career Residency Fellowship How do milestones facilitate this continuum?

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14 You are here

15 Choose wisely!

16 The Big Picture Residents/Fellows Institution and Program Accreditation: ACGME/RRC Assessments within Program: Direct observations Audit and performance data Multi-source FB Simulation ITExam Judgment and Synthesis: Committee Program Aggregation NAS Milestones ABIM Fastrak No Aggregation Faculty, PDs and others Certification: ABIM Curricular Milestone and EPAs as Guiding Framework and Blueprint

17 Summit Questions The IM Reporting Milestones for the six ACGME General Competencies are composed of 22 Sub-competency streams. Do those sub-competency streams make sense for the subspecialties? Each sub-competency stream is composed of a series of milestones that describe the development of competence in the individual learner? Can those milestones be applied to a fellow? If the answer to these two questions is no, what changes would be necessary?

18 Version 12/2012 Internal Medicine Milestones 5. Requests and provides consultative care. (PC5) Critical Deficiencies Ready for unsupervised practice Aspirational Is unresponsive to questions or concerns of others when acting as a consultant or utilizing consultant services Unwilling to utilize consultant services when appropriate for patient care Inconsistently manages patients as a consultant to other physicians/health care teams Inconsistently applies risk assessment principles to patients while acting as a consultant Inconsistently formulates a clinical question for a consultant to address Provides consultation services for patients with clinical problems requiring basic risk assessment Asks meaningful clinical questions that guide the input of consultants Provides consultation services for patients with basic and complex clinical problems requiring detailed risk assessment Appropriately weighs recommendations from consultants in order to effectively manage patient care Switches between the role of consultant and primary physician with ease Provides consultation services for patients with very complex clinical problems requiring extensive risk assessment Manages discordant recommendations from multiple consultants Comments: Patient Care The resident is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in training. He/she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, timely, equitable, effective and patient-centered care. Yes No Marginal Copyright (c) 2012 The Accreditation Council for Graduate Medical Education and The American Board of Internal Medicine. All rights reserved. The copyright owners grant third parties the right to use the Internal Medicine Milestones on a non-exclusive basis for educational purposes.

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21 Change and Cognitive Dissonance Cognitive dissonance is the feeling of discomfort when simultaneously holding two or more conflicting ideas, beliefs, values or emotional reactions. In a state of dissonance, people may sometimes feel "disequilibrium, frustration, hunger, dread, guilt, anger, embarrassment, anxiety, etc.

22 Good Cognitive Dissonance

23 Bad Cognitive Dissonance

24 Monday, February 11, 2013 Agenda Room: Edison EF 5:15 p.m. to 5:45 p.m. Welcome and Introductions 5:45 p.m. to 6:15 p.m. Meeting Goals William Iobst, MD -American Board of Internal Medicine 6:15 p.m. to 7:00 p.m. Key Stakeholder Perspectives AAIM, ABIM, and ACGME D. Craig Brater, MD - Alliance for Academic Internal Medicine Scott Gitlin, MD - Association of Specialty Professors Timothy Brigham, MDiv, PhD Accreditation Council for Graduate Medical Education 7:00 p.m. to 7:15 p.m. Break Lee Berkowitz, MD - American Board of Internal Medicine 7:15 p.m. to 8:30 p.m. Basics of Competency-based Medical Education: Concepts of Curricular Milestones, EPAs, and NAS Reporting Milestones Kelly Caverzagie, MD University of Nebraska College of Medicine Rosanne Leipzig MD - Mount Sinai School of Medicine 8:30 p.m. to 9:00 p.m. Q&A Sharon Levine MD - Boston University School of Medicine

25 Tuesday, February 12, 2103 Room: Edison EF 7:30 to 8:00 Breakfast available 8:00 a.m. to 9:00 a.m. Overview of the Day and Observations from the Group 9:00 a.m. to 9:30 a.m. Geriatric Approach to Competency-based Medical Education Rosanne Leipzig, MD, PhD Mount Sinai School of Medicine 9:30 a.m. to 9:45 a.m. Break 9:45 a.m. to 10:15 a.m. Cardiology Milestones Eric Williams, MD Indiana University School of Medicine 10:15 a.m. to 10:45 a.m. GI TH Pilot Experience Oren Fix, MD, MSc University of California, San Francisco 10:45 a.m. to 11:15 a.m. Milestones and the Department of Medicine Strategies to Overcome Barriers Gregory Kane, MD Jefferson Medical College 11:15 a.m. to 11:45 a.m. Q&A 11:45 a.m. to 1:30 p.m. Lunch & Small Group Review of the IM Milestones 1:30 p.m. to 1:45 p.m. Break 1:45 p.m. to 3:00 p.m. Small Group Report Out 3:00 p.m. to 3:30 p.m. General Discussion and Next Steps

26 In times of change, learners inherit the earth while the learned find themselves beautifully equipped to deal with a world that no longer exists. -Eric Hoffer

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