Implementing the Next Accreditation System: Results of the 2014–2015 Annual Data Review

摘要

Introduction On July 1, 2013, the Accreditation Council for Graduate Medical Education (ACGME) began the phased initiation of the Next Accreditation System (NAS). The goals of this new model of accreditation were to reduce the burden on accredited programs and transition to an accreditation process that could respond in a more timely and focused way to potential problems in the educational environment.1 Seven specialties entered the NAS in 2013, and the remaining specialties followed 1 year later on July 1, 2014. By moving away from episodic program site visits and reviews, and implementing a data-driven, annual review of performance, low-performing programs are promptly identified. Review Committees can then use requests for clarifying information and site visits, if necessary, to gather additional information and to provide targeted feedback to help these programs improve. Performance problems that would previously not have been identified until the next full review of a program can now be captured and addressed in a much more timely fashion. Concurrently, high-functioning programs are granted relief from adhering to all the detailed program requirements; the annual review of data for all programs allows the ACGME to extend the period between scheduled site visits to 10 years, reducing the burden of site visit preparation. In the new model, the ACGME uses extensive data collected throughout the academic year to assess program performance against a set of standard performance measures. Data reviewed annually include information about the program characteristics, the clinical learning environment, program and institutional leadership, the environment of scholarship, the opinions of faculty and residents through ACGME surveys, resident clinical experience data, and first-time pass rate data provided to the ACGME by the American Board of Medical Specialties member boards. Review Committees assess the overall performance, looking at trends and instances of potential noncompliance with the accreditation standards, to identify underperforming programs. These programs then undergo an in-depth review to determine which ones are not meeting the core and outcome standards. In the new accreditation system, Review Committees have the ability to make accreditation decisions in a more proactive manner: identifying and addressing downward trends before true problems arise, as well as moving programs out of a “Probationary Accreditation” or “Continued Accreditation With Warning” status when they see improvements. The annual review cycle begins in the fall of each academic year and officially ends once all programs have been issued an accreditation status decision, the majority of which are issued in the spring of the same academic year. In 2014–2015, the NAS was fully phased in and all Review Committees participated in the annual review cycle, the result being that for the first time in a single year, every residency program accredited by the ACGME (beyond initial accreditation) received an accreditation status decision. Programs applying for accreditation and programs having a status of “Initial Accreditation” or “Initial Accreditation With Warning” were fully reviewed and assessed for compliance to the standards, unchanged with the implementation of the NAS. In this article, we compare the accreditation decisions and citation distribution among programs before the NAS implementation (pre-NAS) to the decisions and citations issued to programs following its full implementation in 2014–2015 (in-NAS).;Methods We identified pre-NAS accreditation status decisions for all programs as the most recent decision made by the Review Committee before the first annual review cycle. To transition to the new accreditation system, the status of all programs with a 1- or 2-year cycle with “Continued Accreditation” was converted to “Continued Accreditation With Warning.” The annual review process was phased in over the course of 2 years, with Phase 1 Review C