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ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION
Symposium onPhysician Well-Being
NOVEMBER 17-18, 2015
Understanding the ACGME
Thomas J Nasca MD MACPChief Executive Officer
ACGME
• Professor of Medicine and Physiology• Full Time Salaried by ACGME• No Conflicts to Disclose
Disclosure
• Mission: We improve health and health care by assessing and advancing the quality of resident physicians’ education through accreditation
• Basis for our engagement: Impairment of Physician Well-Being impairs the profession’s ability to improve the health and health care provided to the public
The ACGME
ABMS – Certification, MOC FSMB – Licensure, MOL LCME
NBMEFSMBMCAT
SAT
Performance in PracticeTransition
to College
CollegiateAccreditation
Transition to Medical School
Transition to
Residency
The Continuum of Developmentof the Specialist Physician
Nov
ice
A
dvan
ced
C
ompe
tent
Prof
icie
nt
E
xper
t M
aste
rB
egin
ner
Transition to
Retirement
Transition to
Practice
See Programs Immersed In, Influenced By, and Influencing the Sponsoring Institution(s)
1 Nasca, T.J., Philibert, I., Brigham, T.P., Flynn, T.C. The Next GME Accreditation System: Rationale and Benefits. NEJM. 2012.366;11:1051-1056.
CLER
Continuous Program Improvement Cycle“Practice Based Learning and Improvement for Programs”
Goal: Excellence in Achievement of Program Aims
Annually Study Your ProgramEstablished Program Aims
Annual Peer Feedback (NAS-AR)Milestone EvaluationsResident EvaluationFaculty EvaluationBoard Performance
Clinical Context EvaluationCommunity Need Assessment
Annual Program Evaluation
ModifyProgram Elements
Conduct YourProgram
10 YearSelf-Study
Accreditation Site Visit
(Re)EstablishAims
Chen, C., Petterson, S., Phillips, R., Bazemore, A., Mullan, F.
JAMA. 2014;312(22):2385-2393
Physician Median Medicare Spending per Beneficiary Stratified by Residency Program Hospital Referral Region
vs Years in Clinical Practice
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
1 to 7 8 to 15 16 to 19
Low Training HRR Medium Training HRR High Training HRR
Data from Table 2., Chen, C., Petterson, S., Phillips, R., Bazemore, A., Mullan, F. JAMA. 2014;312(22):2385-2393
.02
<.001
.01
<.001.02
.19
25% Difference
SummaryChen, C., Petterson, S., Phillips, R., Bazemore, A., Mullan, F.
JAMA. 2014;312(22):2385-2393
• Clinical training environment patient care expenditures are reproduced in clinical practice of graduates
• The effect persists even when the graduate practices in a different clinical care setting
• The effect persists for up to 19 years after graduation
Evaluating Residency Programs Using Patient Outcomes n= 4,906,169 deliveries in Florida and New York, 1992-2007
4124 physician program graduates of 107 residency programs
0
2
4
6
8
10
12
14
Q5 Q4 Q3 Q2 Q1 Q1-Q5
Residency Program of Origin, Ranked (Quintile) by Program Complication Rate
Rate of Major Obstetric Complications by Graduates (%)
10.1-10.5
11.3-11.411.9-12.0
12.3-12.5
13.6-14.0
2.8 – 3.8
∆
Difference remainsafter correction for
USMLE performance
Excess Risk ∆ 33%Q1 vs Q5
JAMA 2009;302(12):1277-1283. Asch, DA, et.al., Table 4
Difference in Complication RateFourth versus First Quartile
Epstein, AJ, Nicholson, S, Asch, DA. The Production Of and Market For New Physicians’ Skill.Working Paper 18678 – http:/www.nber.org/papers/w18678
National Bureau of Economic ResearchJanuary, 2013
• Commit• Convene• Collaborate• Change
ACGME
• Opportunity to constructively intervene with Educational Program Structure/Content– LCME, COCA– ACGME– ACCME
• Opportunity to constructively intervene in the Learning Environment– AAMC, AMA, AOA, AIAMC, AHME, N-CICLE, Alliance for
Physician Accountability, OPDA
• National Medical Culture Change– AAMC, AMA, AOA, AACOM, CMSS, FSMB, ABMS
Medical School/Residency Impact is Career Long
• Committed to helping to solve this challenge through collaboration across the continuum– Includes keeping the issue in the forefront
• Consistent with our commitment to the Public Trust• Cannot be done alone
– Requires ongoing commitment of all of us
ACGME
