The Accreditation Process: Using what you already have to get where you want - PowerPoint PPT Presentation

1 / 53
About This Presentation
Title:

The Accreditation Process: Using what you already have to get where you want

Description:

The Mini CEX. Focuses on core skills that fellows demonstrate in patient encounters ... Mini-CEX. Clinical judgment. Selectively orders/performs appropriate ... – PowerPoint PPT presentation

Number of Views:94
Avg rating:3.0/5.0
Slides: 54
Provided by: lauriel2
Category:

less

Transcript and Presenter's Notes

Title: The Accreditation Process: Using what you already have to get where you want


1
WELCOME!!
2
The Foundations of a Fellowship Program
  • CURRICULUM
  • SCHOLARSHIP
  • EVALUATION
  • PROGRAM DIRECTOR and FACULTY
  • FELLOWS SELECTION, CARE
  • POLICIES
  • ACCREDITATION
  • INNOVATION
  • INTERACTION WITH THE INSTITUTION

3
The Accreditation ProcessUse what you already
have to get to where you want to be!
4
Strategize!
  • 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

5
EXAMPLE
  • 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.

7
So, how might you answer?
8
Strategize!
  • 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.

9
Strategize!
  • 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

10
STRATEGIZE!
  • Think in terms of the six competencies!

11
The 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

13
Patient 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.

14
Patient Care
  • Fellows are expected to demonstrate assessment,
    interdisciplinary care planning, management,
    coordination and follow-up of patients with
    life-threatening illness.

15
Patient 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.

16
Patient 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.

17
Patient Care
  • Fellows are expected to provide care to patients
    and families that reflects unique characteristics
    of different settings along the palliative care
    spectrum

18
Patient 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.

19
Patient 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

20
THE 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

21
What 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.

22
Developing 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

23
Medical 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.

24
Medical 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.

25
Practice-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.

26
Practice-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

27
Practice-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.

28
Practice-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

29
Interpersonal 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.

30
Interpersonal 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

31
Professionalism
  • Fellows must demonstrate a commitment to carrying
    out professional responsibilities and an
    adherence to ethical principles.

32
Systems-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.

33
The 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.

34
Mini-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.

35
Mini-CEX
  • Physical Examination Skills
  • Follows efficient, logical sequence
  • Balances screening/diagnostic steps for problem
  • Informs patient
  • Sensitive to patients comfort, modesty

36
Mini-CEX
  • Humanistic Qualities/Professionalism
  • Shows respect, compassion, empathy
  • Establishes trust
  • Attends to patients/familys needs of comfort,
    modesty, confidentiality, information

37
Mini-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

38
Mini-CEX
  • Organization/Efficiency
  • Prioritizes
  • Is timely
  • Succinct

39
Mini-CEX
  • Overall Clinical Competence
  • Demonstrates judgment
  • Synthesis
  • Caring
  • Effectiveness
  • Efficiency

40
Mini CEX
  • Family meeting
  • Breaking bad news
  • Discussion of advance directives
  • Discussion about resuscitation
  • Student/resident teaching
  • Presentation at conferences

41
Mini 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.

42
Mini 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
43
The mini-clinical evaluation exercise (mini-CEX)
form
Norcini, J. J. et. al. Ann Intern Med
2003138476-481
44
Mini 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
45
Other forms of evaluation
  • 360s
  • Praise card
  • Early concern card

46
HPM Competencies Project Phase 3
  • Toolkit of
  • Assessment Methods

47
Project 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.

48
Current 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

49
The Foundations of a Fellowship Program
  • CURRICULUM
  • SCHOLARSHIP
  • EVALUATION
  • FACULTY AND PROGRAM DIRECTOR
  • FELLOWS CARE, NURTURING
  • POLICIES See PIF!
  • ACCREDITATION
  • INNOVATION
  • INTERACTION WITH THE INSTITUTION

50
Summary
  • 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!

51
Summary
  • 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.

52
Summary
  • 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.

53
INTERMISSION
  • http//www.youtube.com/watch?vgeBfyxqVGB8
Write a Comment
User Comments (0)
About PowerShow.com