Scholarly Activity Evaluation to Adhere to the ACGME Outcome-based Milestones Dr. Suporn Sukpraprut-Braaten, MSc, MA, PhD Dr. Dewey McAfee DO, FACOFP, PharmD Dr. David Covey, MD, FACP Graduate Medical Education Unity Health Searcy, Arkansas
INTRODUCTION Unity Health is the largest employer in an eight surrounding county area in with more than 2,000 associates located in Searcy, Newport, and Bradford, Arkansas. The facility has a combined total of 438 licensed beds and a medical staff of more than 150 physicians that specialize in various areas of healthcare. Location of White County, Arkansas Unity Health White County Medical Center Unity Health Harris Medical Center 2
UNITY HEALTH WHITE COUNTY MEDICAL CENTER NYIT ARCOM 104 miles to Memphis 54 miles to Little Rock 3
Dr. Suporn Sukpraprut-Braaten INTRODUCTION Assistant Professor for Research, Unity Health Vice Chair on the Scholarly Activity & Faculty Development Committee of Kansas City University of Medicine and Biosciences (KCUMB) - GME Consortium Adjunct Clinical Assistant Professor of Preventive Medicine, Department of Specialty Medicine, KCUMB Adjunct Clinical Assistant Professor in the Department of Academic Affairs, Arkansas College of Osteopathic Medicine (ARCOM), Fort Smith, AR Former Director of Preventive Medicine Research Center and Assistant Professor of Preventive Medicine and Public Health at Edward Via College of Osteopathic Medicine (VCOM) Virginia Campus 4
KEY PERSONNEL Unity Health s Osteopathic Residency Program Dr. Dewey McAfee Director of Medical Education Family Medicine Program Director Dr. David Covey Internal Medicine Program Director Arkansas s White County Health Officer Dr. James S. Stanley Psychiatry Program Director Dr. John Henderson Chief Medical Officer Dr. Delaney Kinchen Institutional Education Officer Dennis Yecke, MBA Operations Director 5
RESIDENCY PROGRAM Unity Health s Osteopathic Residency Program: Unity Health s Residency Program is affiliated with Kansas City University of Medicine and Biosciences Graduate Medical Education Consortium (KCU-GME Consortium). The program is the first osteopathic residency program in the state of Arkansas. The program is the second residency program in the state after a residency program at University of Arkansas Medical Center (UAMS). 6
RESIDENCY PROGRAM Unity Health s Osteopathic Residency Program: The program was started in July, 2015 and approved for three specialty programs Family Medicine 3 PGY1 and 1 PGY2 Internal Medicine 5 PGY1 and 2 PGY2 Psychiatry 3 PGY1 and 1 PGY2 7
AOA Requirements AOA Basic Documents for Postdoctoral Training Research & Scholarly Activity: IX.D Research and Scholarly Activity Common Program 9.1 Each OPTI shall require each member institution to establish policies and guidelines that govern scientific research activities in accordance with local, state and federal guidelines. 9.2 Each OPTI shall facilitate and provide research education, assistance and resources directly to trainees and institutions to encourage research and to meeting the Specialty College requirements. 9.3 Each OPTI shall provide in collaboration with its member COM(S), hospitals and other teaching institutions access to basic science and/or clinical research mentorship. 9.4 The OPTI shall support and provide a mechanism to recognize trainees who conduct research activities. 9.5 The OPTI shall provide budgeted funding for OPTI-wide or program specific research for its trainees. 9.6 The OPTI shall demonstrate its support of trainee scholarly activity. ACGME Requirements ACGME Common Program Requirements Residents Scholarly Activities: IV.B Residents Scholarly Activities IV.B.1 The curriculum must advance residents knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. IV.B.2 Residents should participated in scholarly activity. IV.B.3 The sponsoring institution and program shall allocate adequate educational resources to facilitate resident involvement in scholarly activities. 8
Family Medicine Program Family Medicine: AOA Requirements VII.B.7.1.e) Attend a minimum of one of the following: National American College of Osteopathic Family Physicians (ACOFP) annual convention or the AOA Osteopathic Medical Conference & Exposition (OMED), registered as an ACOFP Family Physician. VII.C Research and Scholarly Activity Requirements VII.C.7.1 The participation of each resident in a scholarly activity is required. This requirement can be met by participating in or completion of any of the following: a. Resident scholarly project within the department of family medicine b. Institutional or regional research programs in which family physicians are actively involve c. Authoring an original paper on a health-care related topic d. Presentation at a state, regional, or national meeting e. Authoring a grant Family Medicine: ACGME Requirements IV.B Residents Scholarly Activities IV.B.1 The curriculum must advance residents knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. * IV.B.2 Residents should participate in scholarly activity. * IV.B.2.a) Residents should complete two scholarly activities, at least one of which should be a quality improvement project. IV.B.3 * Core requirement The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities. * 9
Internal Medicine Program AOA Requirements Internal Medicine: VII. Resident Requirements VII.7.7 The residents must attend the American College of Osteopathic Internists (ACOI) Annual Convention and Scientific Sessions or another ACOI continuing education program once during the training program. VII.7.8 The resident must complete a scholarly project that is approved by the program director and submitted for publication or presented at a scientific meeting, or participate in two critiqued evidenced-based presentations. ACGME Requirements Internal Medicine: IV.B Residents Scholarly Activities IV.B.1 The curriculum must advance residents knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. * IV.B.2 Residents should participate in scholarly activity. * IV.B.3 The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities. * * Core requirement 10
Psychiatry: AOA Requirements VII. Resident Requirements VII.B.4 Write one (1) professional research project pertinent to psychiatry which is suitable for publication. The paper shall be submitted the American College of Osteopathic Neurologists and Psychiatrists (ACONP) during the last year of training prior to completion of the residency training. Psychiatry Program Psychiatry: IV.B IV.B.1 ACGME Requirements Residents Scholarly Activities The curriculum must advance residents knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. * IV.B.2 Residents should participate in scholarly activity. * IV.B.2.a) The program must provide residents with the opportunities for research and development of research skills for residents interested in conducting research in psychiatry or related fields. IV.B.2.b) The program must provide interested residents access to and the opportunity to participate actively in ongoing research under a mentor. IV.B.2.c) All residents must be educated in research literacy and in the concepts and process of evidence-based clinical practice to develop skills in question formulation, information searching, critical appraisal, and medical decision-making. IV.B.3 The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities. * * 11 Core requirement
SUMMARY Common Program Requirements: I. Establish policies and guidelines that govern scientific research activities II. Provide research education and establish a curriculum to advance residents knowledge of the basic principles of research III. Provide access to basic science and/or clinical research mentorship IV. Allocate adequate educational resources to facilitate resident involvement in scholarly activities and provide budgeted funding for the residents V. Have the residents participate in scholarly activity 12
I. Establish policies and guidelines that govern scientific research activities 13
II. Establish a curriculum to advance residents knowledge of the basic principles of research Unity Health s GME has created a course titled Principles of Evidence Based Medicine and Research. Unity Health s GME has created: A course titled Principles of Evidence Based Medicine and Research. The curriculum is designed to advance the residents knowledge of basic principles of evidence based medicine and research. Monthly Meeting with Research Mentors 14
II. Establish a curriculum to advance residents knowledge of the basic principles of research Course Structure: The course is started in January and end June during the noon didactic once a month. At the end of each lecture, there is a workshop section to go through some practice questions and calculations related to the materials in the lecture. Lecture Description 1 The Foundation of Evidence Based Clinical Practice and Hierarchy of Research Evidence and Study Designs 2 Methods and Requirements for using of human subjects for Institutional Review Board (IRB) 3 Validity of Diagnostic Test and Random Error 4 Types of Data, Test Hypothesis, and Statistical Analyses 5 Understand How to Interpret the Results and Translate the Evidence to Patient Care 6 Research Biases: Sources of Bias and Strategies for Minimizing Biases 15
III. Provide access to basic science and/or clinical research mentorship Unity Health s GME allocates two types of research mentors to provide assistance regarding research methodology and clinical guidance to facilitate the residents involvement in scholarly activities. Clinical Research Mentor is an expert in the field of the resident s research area of interest. The clinical research mentor will help the resident by: Approving the research topic and study design Determining an appropriate conference and journal in order to submit the research poster and/or manuscript Approving the final abstract, poster, and/or manuscript 16
Study Research Mentor is an expert in study design and research methodology. The study research mentor will help the resident by: Teaching the residents to understand principles of research and become competent in research skills Advising the residents in designing a research study, including providing an assistance in choosing an appropriate data set, statistical analysis, interpretation of results, conducting a research poster, and/or writing a manuscript 17
IV. Allocate adequate educational resources to facilitate resident involvement in scholarly activities and provide budgeted funding for the residents Unity Health s GME allocates the following educational resources: For internal medicine and family medicine residents: 1. Harrison s Principles of Internal Medicine Textbook 2. American College of Physicians (ACP) MKSAP 17 Part A and B books For psychiatry residents: 1. Kaufman s Clinical Neurology for Psychiatrists Textbook 2. Stahl s Essential Psychopharmacology Textbook 3. The Human Brain Book 18
Unity Health s GME allocates the following educational resources to all of the residents: 1. Microsoft Surface Pro to allow the residents to access patient s information and search for research articles 2. Educational stipend: $1,000 for the PGY1 and PGY2 $1,500 for the PGY3 and PGY4 3. Scholarship fund to help the residents to pay for conference attendance and presentation 4. Monthly meeting with the research mentors 5. High quality noon didactic lectures with the CME credit available for faculty and free lunch 6. Access to the KCUMB library 7. Discount rate for an access to the COMBANK to help the residents to prepare for the COMLEX-3 8. Provide a dedicated time for the residents to prepare for their special board exams 19
V. Have the residents participate in scholarly activity A. Scholarly activity productivity B. Expectation for graduation C. Research timeline D. Scholarly activity evaluation: 1. Research Responsibility 2. Research Project or Case Report Progression 3. Scholarly Activity Productivity 4. ACGME Milestones 5. Overall Competency 20
V.A: Scholarly Activity Productivity Required Scholarly Activity: Level 1: Literature Review The residents are required to conduct a literature review for the following activities: Research project or case report Noon didactic Journal club Patients support group Level 2: Attend a regional or national medical conference 21
V.A: Scholarly Activity Productivity Level 2: Attend a regional or national medical conference (required) Family Medicine Residents: Attend the American College of Osteopathic Family Physicians (ACOFP) or AOA OMED Conference (AOA VII.B.7.1.e) Internal Medicine Residents: Attend the American College of Osteopathic Internists (ACOI) Annual Convention and Scientific Sessions (AOA VII.7.7) Psychiatry Residents: Attend the American College of Osteopathic Neurologists and Psychiatrists (ACONP) (AOA VII.7.7) 22
Optional Scholarly Activity: V.A: Scholarly Activity Productivity Level 3: Level 4.1 : Level 4.2 : Level 4.3 : Level 5.1: Level 5.2: Conduct a case report and a poster presentation at a regional or a national conference Conduct an original research project and a poster presentation at a regional or a national conference Publish an original research article in a peer review scientific journal Submit a grant proposal as a principal investigator or a co-investigator Write a book chapter in a textbook related to medicine Receive a grant award as a as a principal investigator or a co-investigator Level 4 is designed as a graduation target. The residents are not required to be listed as the primary investigator or the first author of the research poster or research article. 23
V.A: Expectation for Graduation 1. Every resident is required to provide noon didactics, conduct literature review for his/her case report or research project, present/attend journal clubs and patients support group, and attend a medical conference 2. Every resident is required to accomplish one of the following four options of scholarly activity productivities in order to graduate from Unity Health s residency program Option 1: Two case reports for poster presentations (Level 3) Option 2: An original research project for a poster presentation or publication (Level 4 ) Option 3: A grant application (Level 4 ) or grant award (Level 5) Option 4: Accomplish a submission of a text book chapter (Level 5) Level 4 is designed as a graduate target. 24
V.B Research Project Timeline 25
V.B Case Report Timeline 26
V.C: Scholarly Activity Evaluation Clinical Competency Committees (CCC) of each program evaluate and monitor the residents scholarly activity and progression. A CCC is the ACGME required body comprising three or more members of the active teaching faculty who is advisory to the program director and reviews the progress of all residents in the program 1. The evaluation is conducted semi-annually. The evaluation results are reported to the GME Committee. 27 1 Source: Andolsek K, Padmore J, Hauer KE, and Holmboe E. A Guidebook for Programs: Clinical Competency Committees. Accreditation Council for Graduate Medical Education, Jan. 2015. Web. 1 April 2016.
V.C: Scholarly Activity Evaluation The residents are evaluated according to these sections: 1. Research Responsibility 2. Research Project or Case Report Progression 3. Scholarly Activity Productivity 4. ACGME Milestones 5. Overall Competency 28
1. Research Responsibility 29
2. Research Project or Case Report Progression PGY 1 30
2. Research Project or Case Report Progression PGY 2 31
2. Research Project or Case Report Progression PGY 3 32
3. Scholarly Activity Productivity 33
4. ACGME Milestones The ACGME Review Committee will examine milestone performance data for each program s residents as one element in the Next Accreditation System (NAS) to determine whether residents overall are progressing according to the following areas: PC Patient Care PBLI Practice-Based Learning and Improvement MK Medical Knowledge PROF Professionalism SBP System-Based Practice C - Communication 34
4. ACGME Milestones Family Medicine ACGME Milestones PBLI-1: Locates, appraises, and assimilates evidence from scientific studies related to the patients health problems PBLI-1: Locates, appraises, and assimilates evidence from scientific studies related to the patients health problems Milestones Achievement Month Level Competency Component 6 12 18 24 30 36 Level 1 Able to describe basic concepts in clinical epidemiology, biostatistics, and clinical reasoning Level 1 Know different categories of research study design Level 2 Able to identify pros and cons of various study designs, associated types of bias, and patient-centered outcomes Level 2 Able to formulates a searchable question from a clinical question Level 2 Able to evaluates evidence-based point-of-care resources Level 3 Able to apply a set of critical appraisal criteria to different types of research, including synopses of original research findings, systematic reviews and meta-analyses, and clinical practice guidelines Level 3 Able to critically evaluate information from others, including colleagues, experts, and pharmaceutical representatives, as well as patient-delivered information Level 4 Level 5 Able to incorporates principles of evidence-based care and information mastery into clinical practice Able to independently teach and assess evidence-based medicine and information mastery techniques PBLI = Practice-Based Learning and Improvement Level 4 is designed as the graduation target 35
Family Medicine ACGME Milestones PBLI-2: Demonstrates Self-Directed Learning PBLI = Practice-Based Learning and Improvement Level 4 is designed as the graduation target 36
Internal Medicine ACGME Milestones PROF-4: Exhibits Integrity and Ethical Behavior in Professional Conduct i. Critical Deficiencies: Dishonest in clinical interactions, documentation, research, or scholarly activity ii. Professionalism Early Concern Note will be written if the resident is suspected of dishonesty in reporting his/her scholarly activities or plagiarism on the research abstract, poster, or manuscript PROF = Professionalism PBLI = Practice-Based Learning and Improvement Ready for Unsupervised Practice: This level is designed as the graduation target 37
Internal Medicine ACGME Milestones PBLI-2: Learns and Improves via Performance Audit PBLI = Practice-Based Learning and Improvement Ready for Unsupervised Practice: This level is designed as the graduation target 38
Internal Medicine ACGME Milestones PBLI-4: Learns and Improves at the Point of Care PBLI = Practice-Based Learning and Improvement Ready for Unsupervised Practice: This level is designed as the graduation target 39
Psychiatry ACGME Milestones PBLI-1: Development and execution of lifelong learning through constant self-evaluation, of research and clinical evidence A: Self-Assessment and self-improvement B: Evidence in the clinical workflow PBLI = Practice-Based Learning and Improvement 40
PBLI-1: (Continue) Psychiatry ACGME Milestones PBLI = Practice-Based Learning and Improvement Level 4: This level is designed as the graduation target 41
PBLI-3: Teaching A: Development as a teacher B: Observable teaching skills Psychiatry ACGME Milestones PBLI = Practice-Based Learning and Improvement 42
V.E: Overall Competency in Scholarly Activity 43
Research Project Team Structure 44
Family Medicine Residents 45
Internal Medicine Residents 46
Psychiatry Residents 47
Medical Students (OMS III) 48
Ray Montgomery, FACHE Unity Health s President and CEO John Henderson, M.D., FACC Chief Medical Officer Dewey McAfee, D.O., FACOFP, PharmD Director of Medical Education/Family Program Director James S. Stanley, M.D., FANP Psychiatry Program Director Delaney Kinchen, D.O., FAEP Institutional Education Officer Dennis Yecke, MBA Operations Director, Graduate Medical Education Program Rachael Sowers, MBA Program Coordinator, Graduate Medical Education Program Leslie Provence, MBA Program Coordinator, Graduate Medical Education Program Kelly Bopp Administrative Assistant, Graduate Medical Education Program 49
THANK YOU 50