Testing a Site Visit Approach for the Next Accreditation System

摘要

Introduction In 2009, the Accreditation Council for Graduate Medical Education (ACGME) began work on a Next Accreditation System (NAS), a more outcomes-based and improvement-focused approach to the accreditation of programs and sponsoring institutions. The transition to the NAS is scheduled for phased implementation, beginning July 2013 with 7 Phase I specialties and their subspecialties (emergency medicine, internal medicine, neurological surgery, orthopaedic surgery, pediatrics, diagnostic radiology, and urology).1 The remaining specialties, their subspecialties, and the institutional review will implement NAS data collection and review starting in July 2014. A key objective of the NAS entails reducing the burden of accreditation, and one readily identifiable source of burden in the current process was the preparation of the Program Information Form (PIF). To reduce the onus of site visit preparation for programs and to enhance the focus of the visit on the “real” program (as contrasted with a written description), the ACGME decided to explore whether site visits in the NAS could be conducted without a PIF. Types of site visits considered for a PIF-less approach included Full visits, to assess compliance with all pertinent program requirements (eg, the core and detailed requirements for new programs or solely the core requirements for programs on continued accreditation), and Focused site visits, to assess a complaint and/or a potential problem suggested by data from the continuous accreditation process, as defined in the ACGME Manual of Policies and Procedures effective July 1, 2013.2 Here we describe a test of a site visit without the traditional PIF (a “PIF-less” visit) to validate the model that will be used beginning in July 2013 for Full and Focused site visits of NAS Phase I and Phase II programs. The Test of the PIF-Less Site Visit Testing PIF-less site visits began in August 2011. A total of 3 sponsoring institutions and 14 individual programs were included in the test, planned as a “proof of concept” pilot to confirm that a site visit to assess compliance with the ACGME accreditation requirements could occur without a PIF. The first set of visits resulted from a timely offer by the designated institutional official of a large university teaching hospital to test a site visit without a PIF, using that institution's GME database. During the planning for the first visit, a second university teaching hospital volunteered for a test visit, and a third institution, an urban public hospital affiliated with a major university, was recruited to increase the diversity of institutions in the test. The aims of these PIF-less site visits were to (1) assess compliance with the ACGME program requirements, (2) include a focus on educational outcomes and physician competencies, and (3) test a process by which the site visitor(s) would provide practical feedback to the program, highlighting areas of strength and suggestions for improvement, as appropriate. It was decided that the information from these test visits would not be shared with the Residency Review Committees (RRCs). The 14 participating programs would use the information from these visits for local program improvement—either as data gathering for the internal review or as an input into that process. All PIF-less visits were conducted by teams made up of ACGME field staff and Department of Field Activities leadership. Program and institutional participants included the program director, selected faculty, residents, the coordinator, and the designated institutional official; their respective time commitments were comparable to those of established ACGME site visits. Comprehensive field notes were taken during the visits. Data were also collected during debriefing sessions with the site visitors and program participants. During the visits, the site visit team used interviews and review of data existing at the program to assess the following program dimensions: Compliance wi