Nuclear Medicine Review Committee Update SNMMI Winter 2015 Jon Baldwin, DO Chair RC Nuclear Medicine

Disclosure No conflicts of interest to report

Session Overview RC structure and NM program stats Program requirements update Resident case logs NAS/ ADS Updates Questions

Nuclear Medicine Medical specialty that uses the tracer principle, most often with radiopharmaceuticals, to evaluate molecular, metabolic, physiologic and pathologic conditions of the body for purposes of diagnosis, therapy and research

Current Committee Membership Jon Baldwin, DO (AMA) – Chair David Lewis, MD (AMA) – Vice Chair Helena Balon, MD (SNM) Frederick Grant, MD (SNM) Barry Shulkin, MD (ABNM) Kirk Frey, MD (ABNM) Erica Cohen, DO (Resident) 5

RC Meetings 2 meetings per year Check RC website for agenda closing dates & meeting dates February 13-14, 2015 (closing date December 12, 2014) May 29-30, 2015 Meeting Length: 1 – 1 ½ days Program reviews & Other pertinent matters

Nuclear Medicine 2014-2015 43 accredited programs 93/159 (58%) filled vs approved residents positions

Nuclear Medicine 10-year Stats Academic Year Programs Residents On duty 2004-2005 62 149 2005-2006 61 161 2006-2007 160 2007-2008 57 2008-2009 56 2009-2010 166 2010-2011 54 155 2011-2012 136 2012-2013 50 120 2013-2014 47 111 2014-2015 43 93

Nuclear Medicine Programs 2004-2014

Nuclear Medicine Program Requirements Effective July 1, 2014

Major Changes Program Director Qualifications: (II.A.3.b).(1) - Other acceptable qualifications are certification by the American Board of Radiology with subspecialty certification in Nuclear Radiology. (Core) (II.A.3.b).(1).(a) - The program director must be an authorized user 132 for 10CFR 35.190, 290, and 390, including 392, 133 394, and 396. (Core) Program Director Responsibilities (II.A.4.s) - The program director must: ensure that residents log cases in the ACGME Case Log System. (Core)

Major Changes Other learners (III.D.2) The presence of nuclear medicine residents must not dilute or detract from the educational opportunities available to the residents in the core diagnostic radiology residency and to the fellows in the nuclear radiology fellowship if these programs are sponsored by the same institution. (Core) Removed NM level specifications in ACGME Competency section

Major Changes IV.A.6 – Curriculum Documentation in the ACGME Case Log System IV.A.6.a).(4).(a).(i).(a) - a minimum of 10 30 cases of oral administration of less than or equal to 1.22 gigabecquerels (33 millicuries) of sodium iodide I-131, for which a written directive is required; (Detail) IV.A.6.a).(4).(a).(i).(a).(i) – 10 cases of benign and 10 cases of malignant disease (Detail) IV.A.6.a).(4).(a).(i).(a).(ii) – 3 cases <= and 3 cases > 1.22 gigabecquerels (33 millicuries) of sodium iodide I-131 (Detail)

Major Changes IV.A.6.a).(4).(a).(i).(b) - a minimum of three five cases of parenteral administration of any alpha emitter, any beta emitter, or a photon-emitting radionuclide with a photon energy less than 150 keV, for which a written directive is required, and/or parenteral administration of any other radionuclide, for which a written directive is required; (Detail) IV.A.6.a).(4).(a).(i).(c) - a minimum of 100 50 cardiovascular pharmacologic and/or exercise stress studies. (Detail) IV.A.6.a).(4).(a).(iv) – 100 pediatric nuclear medicine procedures

Major Changes V. Evaluation When averaged over the preceding five years: V.C.2.c).(1).(a) - at least 70 percent of residents who enter a program should graduate; (Outcome) V.C.2.c).(1).(b) - at least 75 percent of a program’s graduates should take the American Board of Nuclear Medicine (ABNM) certifying examination within three years of graduation; and, (Outcome) V.C.2.c).(1).(c) - at least 75 percent of a program’s graduates taking the ABNM certifying examination for the first time should pass. (Outcome)

2014 NM Eligibility Changes III.A. Eligibility Language referring to AOA-accredited training has been removed Prerequisite criteria III.A.1.b) “Two or more years of GME and passing USMLE Step 3” has been removed These changes were made in anticipation of the new ACGME eligibility requirements.

Eligibility Exception options available 2016 These exceptions are not available in 2014 version of NM requirements Until 2016, RC-NM will allow programs to use eligibility options outlined in pre-2014 requirements See 2014 NM FAQs

Eligibility FAQ Question: The program requirements that become effective on July 1, 2014 limit eligibility to residents whose prior training was accredited by the ACGME or the Royal College of Physicians and Surgeons of Canada (RCPSC), but the common eligibility requirements that become effective on July 1, 2016 permit exceptions as specified in the requirements. Will I be able to appoint a resident with prior training accredited by the AOA between 2014-2016? [Program Requirement: III.A.]

Eligibility FAQ Answer: The revised specialty requirement revision was intended to align with the implementation of the new common program requirements related to resident eligibility, which were originally planned to become effective on July 1, 2014. The further revision of the common program requirements related to eligibility approved by the ACGME Board this year permit exceptions as detailed in the requirements and will take effect on July 1, 2016. As it was not the intent of the Review Committee to change the eligibility requirements before the new common program requirements were implemented, the Review Committee will permit programs to appoint residents to the program as specified in the pre-2014 version of the requirements in sections III.A.1 – III.A.3.a), which specifies that residents must complete (a) a prerequisite year of clinical education accredited by the ACGME, RSPSC, or American Osteopathic Association (AOA), or (b) two years or more of graduate medical education with a passing score on the United States Medical Licensing Examination (USMLE) Step 3. Effective July 1, 2016 all programs must comply with the new eligibility requirements.

Case Logs

Resident Case Logs All programs are now required to use the ACGME Case Log System Letter sent December 2012 Resident procedure logs make it possible to: Track individual resident learning experiences Identify individual/program deficiencies Establish future training requirement benchmarks

Resident Case Logs Residents should enter all specified procedures performed during their residency education into the ACGME case log system RC-NM Case Log message on 12/18/13 Program directors are expected to ensure that: Residents understand how to use the system Entries are accurate and complete Review resident case logs with residents during semi-annual evaluations

NM Case Log Changes Removal of the “Attending” field “Case ID” field not required Required procedures to be tracked: Parenteral therapy Radioiodine therapy PET/CT Cardiac Stress Test (Pharmacologic or Exercise) Pediatric Procedures Several “Other” CPT codes in the system grouped under “Non-Required Additional Procedures”

Not required “Attending” has been removed

NAS

What is NAS and when does it start? The Next Accreditation System (NAS) Phase II begins July 1, 2014 for Nuclear Medicine programs NAS Strategic Plan: Foster innovation and improvement in the learning environment Increase the accreditation emphasis on educational outcomes Increase efficiency and reduce burden in accreditation Improve communication and collaboration with key internal and external stakeholders

Accreditation System Comparison Current Accreditation System Next Accreditation System Site visits every 5 years (or less) Scheduled self-study visits every 10 years Programs evaluated by RRC in conjunction with site visits Program data evaluated annually by the RRC Large printed Program Information Form (PIF) No PIF; data transmitted electronically to ACGME annually Periodic evaluation Continuous, longitudinal evaluation Process oriented (provide appropriate documentation) Performance oriented (Outcomes based)

What are core, detail and outcome program requirements? Core Requirements: Statements that define structure, resource, or process elements essential to every graduate medical educational program. Detail Requirements: Statements that describe a specific structure, resource, or process, for achieving compliance with a Core Requirement. Programs in substantial compliance with the Outcome Requirements may utilize alternative or innovative approaches to meet Core Requirements. Outcome Requirements: Statements that specify expected measurable or observable attributes (knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medical education.

Core & Detail PR Examples There must be a formal didactic lecture schedule (Core) The didactic lecture schedule should indicate the specific date and time of each lecture, the topic of each lecture, the individual presenting the lecture, and the duration of the lecture (Detail – describes how to achieve core PR) Participation in regularly scheduled seminars, conferences and journal clubs should be documented with attendance logs. (Detail – describes how to achieve core PR)

Do I have to adhere to the “detail” program requirements? “Innovation” does not mean you don’t have to adhere to the requirement, it means you can do it a different way. Programs that have initial accreditation or are in trouble must demonstrate compliance with all “detail” program requirements as written. Programs that have a status of continued accreditation will be allowed to “innovate” or use alternate methods for those program requirements that are identified as “detail”.

NAS Screening Data Reviewed by RRC Annual ADS Update Program Characteristics – Structure and resources Program Changes – PD / core faculty / residents Scholarly Activity – Faculty and Residents Omission of data Board Pass Rate – 3-5 year rolling averages Resident Survey Faculty Survey Clinical Experience – Case logs Milestones - TBD Ten year self-study - TBD © 2013 Accreditation Council for Graduate Medical Education (ACGME)

Look for the green checkmarks or the word “complete” Click on the down arrows for more information

Scholarly activity is required to be entered in the NAS Ensure that the faculty certification information has been entered and current. A yellow flag will appear if missing data.

Those identified as a “core” faculty member will be given the faculty survey and must have scholarly activity entered into ADS If these 4 boxes total 15 hours or more, then this person is considered to be a core faculty member

Scholarly activity for faculty and residents must be entered

Scholarly Activity for all residents is required. 3200000000 – University of Sample Pediatrics - Anytown, IL 000000 – University of Sample College of Medicine Doe Jane 1 Active Full Time 7/1/2012 6/30/2015 Scholarly Activity for all residents is required. John Doe *** - ** - xxxx

Block Diagram Upload Detailed on following slide

All three years must be submitted, even if you currently only have NM3 residents.

Print a program summary of your updates for your records.

NM First NAS Review 14 programs passed with no flags 16% of pgms flagged for board pass rate. Several programs flagged for lack of data reporting: no case log data, multiple zeros reported for procedures, no faculty or resident scholarly activity

PD Responsibility: Accurate Data Program Director: Must provide complete and accurate information Review all information before “hitting” the submit button DIO should also review before submission Common Omissions: Faculty credentials (degree, certification, re-cert) Participating sites Updated response to citation(s) Complete block diagram

ACGME Staff Contact List Executive Director Felicia Davis, MHA 312-755-5006 fdavis@acgme.org Senior Accreditation Administrator Sara Thomas 312-755-5044 sthomas@acgme.org Nuclear Medicine ADS Representative Samantha Alvarado 312-755-7118 salvarado@acgme.org Case Log questions oplog@acgme.org

Questions? Thank you Our Answers