The Internal Medicine Reporting Milestones and the Next Accreditation System

Caverzagie, Kelly J.; Iobst, William; Aagaard, Eva; Hood, Sarah; Chick, Davoren; Kane, Gregory C.; Brigham, Timothy P.; Swing, Susan R.; Meade, Lauren; Bazari, Hasan; Bush, Roger W.; Kirk, Lynne M.; Green, Michael L.; Hinchey, Kevin; Smith, Cynthia D.

doi:10.7326/0003-4819-158-7-201304020-00593

Cited by 59 publications

(41 citation statements)

References 4 publications

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“…The ACGME has already incorporated skills in cost-conscious care as part of the internal medicine reporting milestones and CLER. 6,7 Similarly, specialty boards could use Maintenance of Certification to promote training and mastery of cost-conscious care among faculty physicians. Several non-profit organizations are raising awareness of factors that contribute to health care costs and are looking for innovative solutions.…”

Section: Discussionmentioning

confidence: 99%

“…The 2013 internal medicine reporting milestones include a competency-based evaluation of skills in cost-conscious care. 6 The new Clinical Learning Environment Review (CLER) also examines the extent to which residents receive training in overuse and misuse in the diagnosis or treatment of patients. 7 Physicians begin to form habits during residency training that may impact their future practice patterns.…”

Section: Introductionmentioning

confidence: 99%

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Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

et al. 2015

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BACKGROUND:Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care. OBJECTIVE: We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in costconscious care impacted responses. DESIGN: Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently rolemodel cost-conscious care from residency program, resident, and program director characteristics. PARTICIPANTS: Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included. MAIN MEASURES: The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care. KEY RESULTS: Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently rolemodeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in costconscious care did not have a significant impact on survey responses (odds ratio [OR] were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in costconscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

et al. 2015

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“…3 EPAs are broad activities of practice that the public entrusts all physicians with being capable of performing. 4,5 Many authors have suggested mapping EPAs to competencies and milestones to measure developmental progression, [6][7][8] and this is a focus of the reporting milestone component of the Next Accreditation System (NAS). 9 The number and size of EPAs in a curriculum has been the subject of debate.…”

Section: Introductionmentioning

confidence: 99%

Entrustment and Mapping of Observable Practice Activities for Resident Assessment

et al. 2014

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Entrustable Professional Activities (EPAs) and the Next Accreditation System reporting milestones reduce general competencies into smaller evaluable parts. However, some EPAs and reporting milestones may be too broad to use as direct assessment tools. We describe our internal medicine residency curriculum and assessment system, which uses entrustment and mapping of observable practice activities (OPAs) for resident assessment. We created discrete OPAs for each resident rotation and learning experience. In combination, these serve as curricular foundation and tools for assessment. OPA performance is measured via a 5-point entrustment scale, and mapped to milestones and EPAs. Entrustment ratings of OPAs provide an opportunity for immediate structured feedback of specific clinical skills, and mapping OPAs to milestones and EPAs can be used for longitudinal assessment, promotion decisions, and reporting. Direct assessment and demonstration of progressive entrustment of trainee skill over time are important goals for all training programs. Systems that use OPAs mapped to milestones and EPAs provide the opportunity for achieving both, but require validation.

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“…Current resident assessment tools may be inadequate to assess resident performance using the milestones criteria [2][3][4]. The ACGME listed operative procedures a graduate should be capable of performing (Table 2), such as a primary total hip and total knee replacement [8].…”

Section: Limitations Of the Next Accreditation Systemmentioning

confidence: 99%

What the ACGME’s Next Accreditation System Means to You

Dougherty

2013

Clinical Orthopaedics &Amp; Related Research

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The Internal Medicine Reporting Milestones and the Next Accreditation System

Cited by 59 publications

References 4 publications

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

Entrustment and Mapping of Observable Practice Activities for Resident Assessment

What the ACGME’s Next Accreditation System Means to You

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