Title: The Accreditation Process: Using what you already have to get where you want
1WELCOME!!
2The Foundations of a Fellowship Program
- CURRICULUM
- SCHOLARSHIP
- EVALUATION
- PROGRAM DIRECTOR and FACULTY
- FELLOWS SELECTION, CARE
- POLICIES
- ACCREDITATION
- INNOVATION
- INTERACTION WITH THE INSTITUTION
3The Accreditation ProcessUse what you already
have to get to where you want to be!
4Strategize!
- Read all four documents
- Common program requirements
- ACGME program requirements for HPM
- Companion document
- Program Information Form THE PIF
- i.e. sleep with them!
- The program requirements will inform the way you
answer narrative questions in the PIF
5EXAMPLE
- PIF QUESTION
- Will there be other learners (such as fellows
from other specialties, subspecialty fellows,
nurse practitioners, PhD or MD students) in the
program, sharing educational or clinical
experiences with the fellows? If yes, describe
the impact those other learners will have on the
programs fellows.
6- HPM PRG REQUIREMENTS
- Appointment of Fellows and Other Students
- The presence of other students (including but
not limited to, residents from other specialties,
subspecialty fellows, PhD students and nurse
practitioners) in the program must not interfere
with the appointed fellows education. The
program director must report the presence of
other learners to the DIO or GMEC in accordance
with sponsoring institution guidelines.
7So, how might you answer?
8Strategize!
- Read the PIFwith a group put it on the radar
screen. Read carefully with your coordinator. - Who is your coordinator? Divide and conquer.
He/she can begin compiling CVs, policies, while
you are thinking about narratives and how to meet
all requirements. - Read the program requirements with your faculty.
- Develop a mission statement and goals for the
fellowship - Fill in what you can the first time through, make
notes. - Your DIO needs to get you started. Make an
appointment. He/She is now your best friend.
9Strategize!
- Develop a website or page on your GME site. A
great place to keep - mission and goals,
- policies
- conferences
- duty hours
- recruitment material
- research
- links
- faculty
- bragging
10STRATEGIZE!
- Think in terms of the six competencies!
11The Core Competencies
6
- Patient Care
- Medical Knowledge
- Practice Based Learning and Improvement
- Communication and Interpersonal Skills
- Professionalism
- Systems Based Practice
12- 6 Core Competencies
- Supported by HPM specialty-specific
competencies, - Enhanced by the Companion Document
- The Core and HPM-specific Competencies (including
the companion document) inform - The program requirements
- Evaluation
- Curriculum
- The PIF
13Patient Care
- Fellows must be able to provide patient care that
is compassionate, appropriate and effective for
the treatment of health problems and the program
of health. - Fellows are expected to demonstrate assessment,
interdisciplinary care planning, management,
coordination and follow-up of patients with
life-threatening illness.
14Patient Care
- Fellows are expected to demonstrate assessment,
interdisciplinary care planning, management,
coordination and follow-up of patients with
life-threatening illness.
15Patient Care
- -The care provided will be patient-and family
centered care that optimizes quality of life by
anticipating, preventing and treating suffering - . Fellows will provide palliative care throughout
the continuum of illness while addressing
physical, intellectual, emotional social and
spiritual needs and facilitating patient
autonomy, access to information and choice.
16Patient Care
- Fellows are expected to coordinate, orchestrate,
and facilitate key events in patient care, such
as family meetings, consultation around goals of
care, advance directive completion, conflict
resolution, withdrawal of life-sustaining
therapies, and palliative sedation, involving
other team members as appropriate. -
17Patient Care
- Fellows are expected to provide care to patients
and families that reflects unique characteristics
of different settings along the palliative care
spectrum -
18Patient Care
- Fellows are expected to recognize signs and
symptoms of impending death and appropriately
care for the imminently dying patient and their
family members and - Fellows are expected to provide treatment and
counseling to the bereaved. -
19Patient Care
- The fellow should be able to
- Gather accurate, essential information from all
sources - Make informed recommendations about diagnostic
and therapeutic interventions, based on clinical
judgment, scientific evidence, and patient
preference. - Develop and implement patient management plans
20THE COMPANION DOCUMENT
- Developed to assist program directors in
demonstrating compliance with the program
requirements and to also delineate the competent
hospice and palliative medicine specialist beyond
the program requirements. - http//www.acgme.org/acWebsite/downloads/RRC_progR
eq/540_hospice_and_palliative_medicine_companion_0
2122008.pdf
21What does the PIF ask about patient care?
- Throughout the PIF, either implicitly or
explicitly, you must document that the fellow is
meeting the program requirements for patient
care. - Provide a narrative description of the inpatient
acute care experience.
22Developing a Curriculum Use the Competencies!!
- Example Palliative Care Curriculum for residents
- How would you develop your fellows curriculum?
- Use the competencies as an outline or as the
underlying driver of the curriculum
23Medical Knowledge
- Fellows must demonstrate knowledge of established
and evolving biomedical, clinical and social
sciences as well as the application of that
knowledge to patient care and the education of
others.
24Medical Knowledge
- Fellows are expected to learn the scientific
method of problem solving and evidence-based
decision making and develop commitment to
lifelong learning, and an attitude of caring that
is derived from humanistic and professional
values. -
25Practice-Based Learning and Improvement
- The ability to investigate and evaluate their
care of patients, to appraise and assimilate
scientific evidence, and to continuously improve
patient care based on constant self evaluation
and lifelong learning.
26Practice-Based Learning and Improvement
- Fellows are expected to develop skills to meet
the following goals - Identify strengths, deficiencies and limits in
ones knowledge and expertise - Set learning and improvement goals
- Identify and perform appropriate learning
activities
27Practice-Based Learning and Improvement
- 4. Systematically analyze practice, using quality
improvement methods, and implement changes with
the goal of practice improvement - 5. Demonstrate knowledge of ethical issues,
clinical utilization and financial outcomes of
palliative care.
28Practice-Based Learning and Improvement Activities
- Pre clinic conferences
- 11 discussions with attendings, fellow fellows,
colleagues on the IDT - Debriefing after critical incidents
- Biannual evaluations
- Monthly evaluations
29Interpersonal and Communication Skills
- Fellows must demonstrate interpersonal and
communication skills that result in the effective
exchange of information and collaboration with
patients, their families, and professional
associates.
30Interpersonal and Communication Skills, examples
- The fellow should demonstrate the ability to
- Provide effective and professional consultation
to other physicians and health care professionals - Sustain therapeutic and ethically sound
professional relationships with patients, their
families and colleagues
31Professionalism
- Fellows must demonstrate a commitment to carrying
out professional responsibilities and an
adherence to ethical principles.
32Systems-Based Practice
- Fellows must demonstrate an awareness of and
responsiveness to the larger context and system
of health care as well as the ability to call
effectively on other resources in the system to
provide optimal health care.
33The Mini CEX
- Focuses on core skills that fellows demonstrate
in patient encounters - 15-20 minute observation or snapshot of a
fellow/patient interaction. - Multiple encounters over time
- Provides a valid, reliable measure of residents
performance.
34Mini-CEX
- Medical Interviewing Skills
- Facilitates patients telling of story
- Effectively uses questions/directions to obtain
accurate, adequate information needed - Responds appropriately to affect, non-verbal
cues.
35Mini-CEX
- Physical Examination Skills
- Follows efficient, logical sequence
- Balances screening/diagnostic steps for problem
- Informs patient
- Sensitive to patients comfort, modesty
36Mini-CEX
- Humanistic Qualities/Professionalism
- Shows respect, compassion, empathy
- Establishes trust
- Attends to patients/familys needs of comfort,
modesty, confidentiality, information
37Mini-CEX
- Clinical judgment
- Selectively orders/performs appropriate
diagnostic studies - Considers risks and benefits
- Counseling Skills
- Explains rationale for test/treatment
- Obtains patient consent
- Educates/counsels regarding management
38Mini-CEX
- Organization/Efficiency
- Prioritizes
- Is timely
- Succinct
39Mini-CEX
- Overall Clinical Competence
- Demonstrates judgment
- Synthesis
- Caring
- Effectiveness
- Efficiency
40Mini CEX
- Family meeting
- Breaking bad news
- Discussion of advance directives
- Discussion about resuscitation
- Student/resident teaching
- Presentation at conferences
41Mini CEX
6
- STEPS BREAKING BAD NEWS
- Setting sitting down, who is there, etc
- Asks what the patient knows
- Asks what they want to know
- Tells in basic terminology Takes time for patient
to process, ask questions - Arranges for next step
- Provides patient with written/typed transcript
of meeting, and other informative documents.
42Mini CEX Palliative Care
- Made eye contact
- Listened attentively
- Invited questions
- Assumed comfortable distance
- Appeared empathetic
- Presented information in a balanced way
- Was easily understood
- Assessed patient understanding
Han, et al Academic Med July 2005
43The mini-clinical evaluation exercise (mini-CEX)
form
Norcini, J. J. et. al. Ann Intern Med
2003138476-481
44Mini CEX Palliative Care
- Used open ended questions
- Avoided medical jargon
- Sat down
- Attempted to elicit patients goals
- Suggested follow up plan
- Concluded with review and plan
- Gave warning shot
- Used appropriate level of directness
- Discussed particular treatment options
- Included discussion of prognosis
Han, et alAcademic Med July 2005
45Other forms of evaluation
- 360s
- Praise card
- Early concern card
46HPM Competencies Project Phase 3
- Toolkit of
- Assessment Methods
47Project Objectives
- Define 2 suggested evaluation methods for each
ACGME domain, i.e. attending evaluation - Present at least one suggested assessment tool
for each evaluation method, i.e. self-evaluation
checklist or - chart abstraction tool, etc.
48Current Status
- Tools still being modified
- Suggested evaluation approach and strategies for
tool use still being created - Goal is flexibility
- Webinar for piloting summer
- AAHPM is considering continued support for this
ongoing project as we hope for an online
interactive format in the future and ongoing
development and monitoring
49The Foundations of a Fellowship Program
- CURRICULUM
- SCHOLARSHIP
- EVALUATION
- FACULTY AND PROGRAM DIRECTOR
- FELLOWS CARE, NURTURING
- POLICIES See PIF!
- ACCREDITATION
- INNOVATION
- INTERACTION WITH THE INSTITUTION
50Summary
- BE Prepared!
- READ AND RE-READ the COMMON And SPECIFIC program
requirements and the COMPANION DOCUMENT. - Use them to help define your curriculum and your
answers to the PIF questions! - Dont be afraid! You already have a good program
the PIF will help you figure out what you need to
make it complete!
51Summary
- Remember to count, to dot is and cross ts, to
follow directions and read them carefully. - Ask several people to edit your pif for both
grammar, spelling, accuracy and content. - AAHPM may consider a mentoring program for
fellowship directors.
52Summary
- DONT REINVENT THE WHEEL!!!
- Your GME already has most policies in place, you
just need to adapt them to your program. - Similarly, your GME may also have other programs
that help to fulfil some of the necessary
criteria.
53INTERMISSION
- http//www.youtube.com/watch?vgeBfyxqVGB8