Clinical Competency Committees: 3 different

Report
Clinical Competency
Committees (CCC):
3 different perspectives
Sharon Dabrow: Pediatrics PD
Cuc Mai: Internal Medicine PD
Todd Kumm: Radiology PD
ACGME requirements & CCC
• Required in the Next Accreditation System
• A trained group who can make assessments of the competency of
a resident based on milestones and the evaluation tools used
within the residency.
Questions to Answer…
1. Who serves (any role for residents, chiefs) and how large
2. Role of Program Director
3. Role of committee members and how frequent the
committees are meeting
4. Faculty Development & Support
5. Administrative support
6. The phase in process
Diagnostic Radiology
How in the world can I do this?
ADS
ADS
ADS
Building the CCC…
TIME AND
ORGANIZATION …
In March of
2012
DATA
EDUCATION
FACULTY
PLAN
I began to
build our
“CCC”
Diagnostic Radiology
•
•
•
•
32 residents
2 chief residents (PL5)
1 Assoc. Program Director
Work at TGH, Moffitt, JAHVA, ACH & Bay Pines
• “Site Director”
• Faculty assigned as “educational leader” at each site
Committee Structure
• Program Director
• 3 Core Clinical Faculty (TGH, MCC & JAHVA)
• Appointed for minimum 2 year term
• Selected by site director; approved by PD
• Chief Residents not involved
• Department chair
• Included initially as resident advocate
• Program Coordinator
Program Directors Role
• Program Chair = Program Director
• Establish “charter” for the CCC
• Member responsibilities
• Define term of members
• Set date & time of CCC meetings
• Work with Program coordinator to ensure “upload” of
milestone data to ACGME ADS
• Revise & update evaluation process to match MILESTONES
The CCC “Charter” was drafted
Committee “roll-out”
• Committee members selected
• Easier than I expected
• Confirmed commitment and “TIME” of committee members
• Supported by Chair & site directors
• Sufficient time for meaningful review of resident & data
• Committee informational & educational meetings
• Quarterly prior to December 2013
And then I waited. . .
ADS
ADS
ADS
Minor setback. No big deal
TIME AND
ORGANIZATION …
DATA
EDUCATION
FACULTY
PLAN
ACGME
Timeline for “roll-out”
• This is going to be a piece of cake!
Organize
Educate
Evaluate & Submit to
ADS!
So it’s December. Let’s get back on
track…
• Work on the education
Organize
Educate
Evaluate & Submit to
ADS!
From Competencies to
Milestones…
Don’t forget the RESIDENTS
Development
Faculty
Residents
Resident Education &
Development
Resources
• Remember, you are not alone.
• Annual Meetings (ACGME & Specialty meetings)
• Networking with other program directors
• Program Director Associations
PEDIATRIC RESIDENCY
PROGRAM
SHARON DABROW M.D.
PROGRAM DIRECTOR
Pediatrics
•
•
•
•
54 residents
2 PL3 chief residents
2 Assoc. Program Directors (1 ACH faculty)
Work at All Children’s Hospital, TGH and many out patient
locations
Committee Structure
•
•
•
•
•
•
Program Director, Chair
2 Assoc. Directors
2 Chief Residents
3-4 Additional Faculty—chosen from the Core faculty.
Faculty appointed for 2-3 year term
Per ACGME--(Can include non-physician faculty or PL3 if
desired)
Program Director’s Role
•
•
•
•
•
Determine goals and organizational structure
Ensure files and data available for review
Work closely with office staff in preparation
Can vote
Reviews and determines remediation plan when necessary
and ensures compliance
Committee Members
• Meet at minimum twice per year. May increase to quarterly
• May be required to review and follow a subset of residents
during their term; mentor them?
• Must understand milestones and competencies
• Must have time to attend meetings
What else can they do?
Serve as observer for SCOs, mentor for various activities, serve
as core evaluators. Could be responsible for coordination all
materials.
•
Faculty Devp./Support
• Need to learn about new requirements and NAS. Should
attend fac. devp workshops, etc.
• PD to provide education as needed
Administrative Support
• Residency coordinators critical
• Present at all meetings; must take specific minutes that should
be reviewed by PD and placed in res. file
Internal Medicine
Residency
Cuc Mai MD
Program Director
Morsani College of Medicine
Internal Medicine Residency
Program
• 85 residents across 3 years
• Inpatient rotations available at 3 different affiliate sites and
another outpatient ambulatory site
• 4 Associate Program Directors with potentially 3 fourth year
chief residents
Who serves on our committee?
• Committee chair is assigned by program director. Chair is
usually an associate program director.
• All associate program directors, all site directors, 4th year chief
residents, and 2 additional chair appointed faculty members.
Currently 9 members.
• Appointed faculty members serve a two year term.
What is Program Director’s role?
• Assigns chair of committee.
• Serves as non-voting member and mainly resident advocate.
• Has final decision on remediation recommendations made by
committee.
Committee Member Duties and
Roles
• Currently meeting every 3 months. Meetings usually last 2
hours.
• Committee Chair has been presenting and reviewing files for
discussion. However, ultimately will assign smaller group to
review files. Assignment will be based on residency class.
• Also, committee is now given task of evaluating our evaluation
system and making appropriate changes.
Faculty Development & Support
• Started by sending committee chair to American Board of
Internal Medicine (ABIM) faculty development workshop on
evaluation.
• In the process of developing and using the ABIM workbook for
continuous development. (Holmboe and Hawkins. Practical Guide to the
Evaluation of Clinical Competence. )
• Plan on sending a committee member to the ABIM workshop
every year.
Administrative Support
• Residency coordinator present at all meetings
• Documentation of minutes
• Gives another perspective on professionalism competency
What we have learned?
• Committee members benefit from faculty development and
co-mentoring on the evaluation process.
• We have been able to identify residents at risk earlier and
remediating residents earlier takes additional resources to
improve resident’s success.
• Have identified areas for improvement in our evaluation
system and are still working on milestones evaluations.
• Could use committee members as mentor or direct observers
especially in scenarios where evaluation is inconsistent.
Conclusions from all of our
experiences
• Committee decisions can improve accuracy and timeliness of
evaluations and contribute to more accurate and appropriate
remediation plans.
• Many ways to design your CCC. Details need to fit the needs
of your program and residents.
• The process should be dynamic; focused on improving
weaknesses in the process (evaluation system, faculty
understanding of milestones, remediation process, etc…)

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