Radiology Review Committee Update

Transcription

1 Radiology Review Committee Update AUR/APDR Annual Meeting 2017 James Anderson, MD Chair RC Radiology Felicia Davis, MHA Executive Director RC Radiology

2 Disclosure No financial conflicts of interest to report

3 Topics for Today Committee Composition/Staff Accreditation Decisions NAS Observations Review Committee Discussions IR and ESIR Updates

4 RC Composition Appointing Organizations: ABR, ACR, AMA, AOA 12 voting members o o One public member One resident member 2 nominations from each ACR and APDR; RC then selections from nominated candidates Ex Officios (non-voting): ABR, AMA

5 Radiology Review Committee Composition 4 appointing organizations - ABR, ACR, AMA and AOA 13 voting members (includes one resident and one public member) 6 year terms -- except resident (2 years) Program Directors, Chairs, DIOs, Faculty Ex-officios from ABR and AMA (non-voting)

6 Current RC Members Jim Anderson, MD (Chair) Oregon Health Science University (Neuroradiology) Susan John, MD (Vice Chair) University of Texas at Houston (Pediatric Radiology) Janet Bailey, MD University of Michigan (Breast Imaging) Jennifer Bosma, PhD Retired (Public Member) Kristen DeStigter, MD University of Vermont (Ultrasound) George Erbacher, DO Oklahoma State University (AOA Member) Donald Flemming, MD Penn State University (Musculoskeletal Radiology) Jeanne LaBerge, MD University of California-San Francisco (Interventional Radiology) Duane Mezwa, MD University of Oakland (Abdominal Radiology) M. Elizabeth Oates, MD University of Kentucky (Nuclear Radiology) Gautham Reddy, MD University of Washington (Cardiothoracic Radiology) Karl Soderlund, MD Naval Medical Center (San Diego) (Resident Member)

7 RC Member Geographic Distribution

8 Welcome New Members!! Effective July 1, 2017 M. Vicki Marx, MD University of Southern California/LAC+USC Medical Center Krishna Patel, MD Dartmouth-Hitchcock Medical Center (Resident)

9 Scheduled RC Meeting Dates January 26-28, 2017 April 24-25, 2017 January 25-27, 2018 April 26-27, 2018 September 18-19, 2017 NEW! Please contact RC staff for all agenda closing dates/deadlines

10 Radiology Review Committee Staff Felicia Davis, MHA Executive Director Kate Hatlak, MSEd Assoc. Exe. Director Sara Thomas Sr. Accreditation Administrator Brenda Trevino Assoc. Exe. Director

11 Accreditation Actions and Stats

12 Radiology Accredited Programs Specialty # of Programs #of Trainees on Duty Diagnostic Radiology 194 4,790 Abdominal Radiology Endovascular Surgical Neuroradiology 4 6 Musculoskeletal Radiology Neuroradiology Nuclear Radiology Pediatric Radiology Vascular/Interventional Radiology

13 Radiology RC Accreditation Actions January - April 2017 Core DR Programs Count Continued Accreditation 183 Warning 1 Probation 1 Initial Accreditation 3 Initial Accreditation (AOA) 2 Applications Withheld 0

14 AOA Applicant Status 14 Original AOA Radiology programs All AOA Radiology program applications require a site visit prior to review by the Committee AOA DR Core Program Status Count Initial Accreditation 7 Pre-Accreditation 0 Continued Pre Accreditation 2

15 Radiology RC Accreditation Actions January April 2017 IR Integrated Programs Count Initial Accreditation 4 Applications Withheld 0 ESIR DR Programs Count Approve 27 Deny 5 IR - Independent Programs Count Initial Accreditation 16 Applications Withheld 0

16 Interventional Radiology and ESIR Stats Specialty # of Programs IR-Integrated 65 IR-Independent 16 ESIR approved DR 72

17 NAS Review Observations

18 Annual Accreditation Data Reporting Cycle

19 Annual Accreditation Data Reporting Cycle RC Reviewed RC Reviewed

20 Annual NAS Data Review Annual ADS Update All data Program Characteristics Structure and resources Program Changes PD/Administration/Core Faculty/Residents Scholarly Activity Faculty and Residents Omission of Data Board Pass Rate Core Exam Surveys Faculty and Residents Clinical Experience Case Logs Completion only Milestones

21 Case Logs Extreme minimums and maximums still being reported The program director must assess/review logs annually for accuracy [Requirement II.A.4.p).(1)] The RC is following up with programs reporting non-compliant Case Log data o o Citations will be issued for repeat offenders Programs with multiple years of noncompliance will have more rigorous follow up Once archived, Case Log data for the graduates cannot be amended/added to

22 Case Log Inaccuracies

23 Non-Compliance w/case Logs Improving! programs flagged 32 programs flagged, 9 repeat

24 Most Common DR Citation Categories 1. Faculty Responsibilities Subspecialty chiefs, conference participation, interest in education 2. Resident evaluation Learning portfolio, summative evals 3. Program Evaluation Program evaluation, confidential evals 4. Faculty Scholarly Activity 5. Educational Program

25 Most Common DR AFIs 1. Case Logs 2. Evaluations 3. Educational Content 4. Faculty Supervision/Teaching 5. Resources

26 Accurate Information is Essential! Watch out for common error/omissions: o o o o o Faculty credentials (degree, certification/recertification/licensure, etc.) Participating sites Complete scholarly activity (faculty and residents) Updated and complete responses to citations Complete block diagram

27 Accurate Information is Essential! Program director is ultimately responsible for all information reported to the ACGME o Review all data with your PD and DIO before submitting Inaccurate/missing information could results in follow up by the RC

28 Review Committee Discussions

29 Ongoing Discussions Can a clinical year obtained abroad count for the required preliminary year for entry into a Diagnostic Radiology residency? No, for all residents entering the PGY2 in July 2017 for Diagnostic Radiology and Interventional Radiology residencies, the preliminary year must be in ACGME (or RCPSC/CFPC) accredited programs. The only exceptions will be for AOA clinical years.

30 Ongoing Discussions Can we have some of our residents fulfill their PET/CT minimum case log requirements by attending the ACR- Dartmouth PET/CT course? No, the Committee feels strongly that procedures done during a conference/course do not provide the same experience. Conferences and courses are no substitute for independent interpretation of cases. The case log minimums are set such that if a resident in a program experiences problems meeting the minimum case log numbers, this deficiency may be indicative of a resource issue in the department.

31 Ongoing Discussions Must all residents complete a QI project? The program requirements do not require resident completion of a Quality Improvement project. The requirement (VI.A.2) requires that residents be integrated and actively participate in QI and patient safety programs.

32 Program Requirement Revisions

33 Program Requirement Purpose Establish what is needed to start a program Set minimum standards for resident training in the specialty Set expectations for resident outcomes Provide guidelines for oversight, monitoring, and improvement

34 Revision Process Major revision process for DR started in 2015 o Last DR major revision 2008 o Intent to better reflect current educational environment Focused revision process for IR started in 2016 Intent to synch DR and IR Changes in both documents will go into effect July 1, 2018

35 Timeline Reviewed internally by ACGME Posted for public comment Review public comments Final Draft Submission to Committee on Requirements (CoR) Address CoR concerns if any Submission to ACGME Board for approval

36 Program Requirements Revision Highlights Number of core faculty Alignment with ABR and Core Exam 8 Practice Domains Minimum of 8 core faculty to oversee those areas 9 additional Educational Content areas Individuals that oversee these areas do NOT need to be unique individuals

37 Program Requirements Revision Highlights 66% of the Radiology Program Requirements are Common Program Requirements (not Radiology specific)

38 Practice Domains Abdominal Imaging (includes gastrointestinal and urinary) Breast Imaging Cardiothoracic Imaging (includes cardiac and thoracic) Musculoskeletal Imaging Neuroradiology Nuclear Radiology and Molecular Imaging Pediatric Radiology Interventional Radiology

39 Educational Content Areas CT MRI U/S Radiography/fluoro Reproductive/endocrine Vascular imaging Physics Quality and Safety Radiology informatics

40 Key Points Programs must designate individuals to oversee Practice Domains and educational areas Minimum of 8 individuals Allows more flexibility for assigning faculty to educational areas Stresses importance of organ based education as well as education of the modalities and physics Aligns with current ABR testing paradigm

41 PD/APD Protected Time Support Sliding scale based on program size Recognition that there are more demands on PD time Scaled back a bit from original draft Smallest programs need 0.3 FTE Allows the protected time to be divided between PD and APDs o If a large program has 0.7 FTE support required, the PD can be 0.4 and an APD could be 0.3. etc.

42 PD/APD Final Proposal Program Size FTE Support 8-15 residents residents residents residents residents residents residents residents residents 1.1

43 Coordinator Support Sliding scale for Program Coordinators Finally required support Recognition of importance

44 Coordinator Final Proposal Programs approved for 8-24 residents must have at least 1.0 FTE program coordinator support. (Core) Programs approved for residents must have at least 1.50 FTE program coordinator support. (Core) Programs approved for 40 or more residents must have at least 2.0 FTE program coordinator support. (Core)

45 PD Qualifications Set at 3 years experience as faculty member Prior vagueness in this area led to a decision that a certain amount of experience as a faculty member is valuable prior to being a program director In reality, some training either with a current PD or through national organizations should be done to prepare people for the position. The days of you re it are in the past.

46 Board Pass Rate First This is a whole new concept from the previous program requirements Based on Core exam, not oral or certifying No longer first time pass rate, now by end of residency Reviewed on a year by year basis (not 5 year intervals of PIFS and site reviews)

47 Board Pass Rate Careful analysis of ABR data from programs Reviewed yearly with a 3-year rolling average One component of each years review Isolated individuals that fail will not put your program at risk

48 Board Pass Rate Final Proposal V.C.2.c).(1) At least 90 percent of a program s residents and graduates from the preceding five three year period who take the ABR Core Examination must pass by the end of the PGY-5.

49 Physics ACGME and the RC is not a curriculum organization/committee Establishment of expected outcomes and support for the training in Physics

50 Physics Expectations In-person educational content delivery should be provided. o o o o Again, a remote course taught in-person is not the intent. Personnel at your institution or affiliated with your institution is the expectation. On-line module content alone is not acceptable. Remote physics courses and on-line content can supplement your curriculum.

51 Interventional Radiology and ESIR

52 First IR Integrated Applications An IR Advisory Committee has been appointed to pre-review all IR and ESIR applications o Consists of 7 IR specialists List of approved IR programs available on ACGME website List of programs with ESIR approval on Review Committee webpage.

53 IR Integrated Application Findings Several DR programs planned decrease to accommodate IR IR programs are required to have their own CCC and PEC, cannot state that the existing DR committees will be used; but faculty members can serve on both Some programs expanding from current DR numbers, need to ensure 7000 radiological exams available for both DR and IR residents For those programs with moderate to low procedural volume and/or expanding significantly, RC will closely evaluate these resources upon reviewing independent IR applications

54 IR Integrated Program Key Facts Will be able to match from med school to PGY-2 program Prelim clinical year + 5 year program First 3 years are essentially = Diagnostic Radiology training ABR Core exam taken after 36 months 2 years primarily in IR, but allowances for some DR rotations Qualifies for ABR new IR/DR certificate

55 IR Integrated Program PGY-5 (DR4, IR-Int4) year can have some DR components Call/float, Mammo, Nuc Med Rotations in the IR domain Procedure/patient care oriented rotations

56 Equivalent Training

57 What are IR-Related Rotations? If the purpose of the rotation is to provide procedural experience, a substantial portion of the rotation should be spent in procedures. General guide includes minimums of: o 50% of rotation time related to procedures and peri-procedural patient care o 30 varied procedures in the 4-week period o If a rotation does not meet the above criteria, then the program director should submit a narrative to explain how this rotation will meet the educational objectives of an IR-Related rotation. If the purpose of the rotation is to provide clinical experience outside of IR (such as a rotation on the hepatology or oncology service) the RRC expects that IR residents will see a substantial number of patients in clinic or on inpatient rounds (a number of 30 patients can serve as a guide).

58 IR Related Rotations Special Cases A dedicated rotation of Vascular Imaging would be acceptable as this is believed to be core to the knowledge domain of IR. A separate month of IR Research on a topic within the knowledge domain of IR is acceptable. A focused month of Breast Interventions can count as an IR Related rotation, but it cannot be also counted as one of the three required diagnostic mammography rotations. Only one month of Breast Interventions can be used as an IR Related rotation.

59 What is ESIR? Early Specialization in Interventional Radiology Part of DR program, in cooperation with IR Takes advantage of R4 year flexibility Is NOT a separate program, but an approved curriculum in DR Allows grads of DR ESIR approved program advanced standing to enter IR Independent program in 2 nd year

60 ESIR Considerations An IR-related breast intervention rotation does not count toward the mandatory 12 weeks of breast imaging required in DR (IV.A.6.c) Diagnostic imaging mammograms interpreted/ dictated by an ESIR resident on an IR-related breast intervention rotation could count towards the MQSA minimum of 240 IR Research rotations should not be included as part of ESIR curriculum

61 Applying for ESIR Details on ACGME website

62 ESIR Block Diagram

63 Terminology Rotation o o Defined as 4 weeks If you use a different paradigm for your rotations, convert to equivalent weeks o o Need minimum 44 weeks in IR/IRR Need 4 weeks in critical care (ICU)

64 Terminology Current Situation

65 Terminology Future Situation

66 Terminology Current Situation

67 IR Residency Current Situation

68 Current Status IR Integrated IR - Integrated o 62 programs have been approved 55 from existing VIR fellowships 6 are new (no pre-existing VIR fellowship) o More applications coming in o 21 current IR-Integrated residents o IR in NRMP Main Match this year o Estimated between positions

69 Current Status IR Independent IR - Independent o First applications reviewed in Jan 2017 o Integrated programs have variably indicated their Independent plans o No idea yet on how many non-fellowship programs will apply IR Independent programs will not be active until after the VIR fellowships end on June 30, 2020 First Independent IR Match (NRMP subspecialty Match) in spring 2019 (Matching for July 2020)

70 Current Status - ESIR ESIR Total number approved 55 o There are ~185 approved DR programs in the country Many programs have not yet applied Completing an ESIR curriculum will allow a DR resident to be eligible to complete the 2-year Independent IR residency in 1 year

71 What does this mean for Trainees?

72 Hold on won t everyone switch into the IR-Integrated and there won t be any fellow positions left over? NO!!!! Transfers can only occur within an institution. Someone from DR program at Institution A can only transfer into the IR program at Institution A. (i.e. my resident in DR at OHSU cannot transfer to the IR program at UCSF. If my resident wants to go to UCSF to train in IR, they would currently need to apply to the fellowship and in the future apply to the IR- Independent residency.)

73 Transfers Transfers between DR and IR within an institution should occur at the change of academic year. Final 2 years of training in IR-Integrated i.e. can t transfer after you have started DR-4 (PGY5)

74 VIR Fellowships Last fellowship year will be the academic year (match in spring of 2018). All VIR fellowships must VW by June 30, 2020 or will be administratively withdrawn.

75 Timeline Key Dates o Now Dept, GME, funding decisions application o IR-Integrated Match o Probable last IR fellowship Match o Probable 1 st IR-Independent Match o Last IR fellowship year o st IR-Independent Residents o Residents that matched to IR-Integrated finish at end of this year

76 New ACGME Common Requirements Section VI. Review ACGME s new microsite dedicated to Section VI changes for more helpful information: All questions should be submitted to ACGME via new address: SectionVI@acgme.org

77 Questions?