The ACGME Transitional Year Application Process Cheryl Gross, MA, CAE, Executive Director Transitional Year Review Committee March 2018

Disclosure No disclosures to report

Discussion Topics Overview – role of transitional year Review – application process Block diagram Application actions Letters of notification Common Program Requirements – proposed revisions

Transitional Year Goal To provide a well-balanced program of GME in multiple clinical disciplines designed to facilitate the choice of and preparation for a specific specialty, including specialties requiring a year of fundamental clinical education as a prerequisite

Transitional Year Goal Broad spectrum of clinical experience Robust and healthy learning environment Enhance team skills and function as a team leader Meets twice per year

Transitional Year Goal Focused opportunity to fully develop basic clinical skills Obtaining comprehensive medical history Performing comprehensive medical exam Assessing patient’s problems/chief complaint Appropriately using diagnostic studies and tests Integrating information to develop differential diagnosis Developing and implementing a treatment plan

Similarities – AOA TRI and ACGME TY Programs Different types of preliminary / transitional year programs Applicants need to determine which type of program they need Overseen by institutional GMEC Minimum of 4 positions Focus on “fundamental clinical skills” education Flexible curriculum within parameters of TY program requirements

Single Accreditation System AOA traditional rotating internships 121 official TRIs as of 6/30/2015 Current Applications (being reviewed 4/2018) 9 programs Initial Accreditation 10 programs Osteopathic Recognition – 3 initial, 2 application

Minimum Requirements Sponsoring Institution – ACGME accredited or pre-accredited (1) Sponsoring Program – ACGME accredited or pre-accredited Must be at the same institution as the TY program Must be in a Fundamental Clinical Skills specialty

Fundamental Clinical Skills Emergency medicine Family medicine General surgery Internal medicine Obstetrics and gynecology Pediatrics

Specialties Requiring a Preliminary Year Anesthesiology Dermatology Diagnostic radiology Nuclear medicine Ophthalmology Osteopathic neuromusculoskeletal medicine Physical medicine and rehabilitation Preventive medicine Radiation oncology

Curriculum Requirements At least 24 weeks must include rotations in which residents from other ACGME- accredited programs rotate Must have 28 weeks of FCS rotations ICU, general acute care surgery, trauma surgery and critical care unit experiences DO count Any other subspecialty experiences DO NOT count

Curriculum Requirements 140 hours in emergency medicine Continuous 4-week block No vacation permitted during EM rotation 140 hours in ambulatory care Time may be divided through the training year Minimum – ½-day sessions

Curriculum Requirements Must be 8 weeks of elective rotations Maximum of 8 weeks of non-patient care experience Ex. research, administration, clinical informatics

Curriculum Requirements Night float Residents must not be scheduled for more than 4 consecutive weeks of night float Scheduled night float must not exceed 8 weeks during the training year

Milestones, CCC, PEC Program director guides for each on ACGME website Final summative evaluation SHOULD NOT state that the resident has demonstrated sufficient competence to practice without direct supervision

Program Evaluation Committee Members Program director Program directors of sponsoring program(s) Program directors of disciplines regularly included in the curriculum DIO Peer-selected residents – 1 must be a TY resident May include designees, but need to represent

Program Evaluation Committee Must be a separate committee or subcommittee of the GMEC MUST MEET AT LEAST QUARTERLY! May include designees, but need to represent

Submitting Applications Review Committee meets in December and April Possible late summer / early fall meeting, NOT guaranteed Submit application NO LATER than 4-5 months before the scheduled meeting

Your Application Two parts Cannot be changed after submitting General information for all programs (ADS) TY-specific application (Word document) Cannot be changed after submitting Describe plan to meet each requirement Reference program requirements while completing application Use ACGME language – policies, etc.

Application Review Concerns Faculty and resident scholarly activity Block diagram formatting Use of AOA terminology and forms Inaccurate info – faculty roster CONTACT ME WITH ANY QUESTIONS!

Block Diagram Program snapshot Follow ADS instructions and format! Don’t make the TYRC assume anything

RC Uses for Block Diagram Ensure program requirements are being met by the program Determining best practices Other Review Committee activities Quality improvement Review of standards

What is a Block Diagram? Block Diagram IS Block Diagram IS NOT Representation of sample rotation schedule Single table Rotations in a given year Information related to FCS Outpatient Research Vacation Specific trainees’ rotation schedules Multiple tables Representative of the order in which rotations occur Duty hours listing

Sample IS

Sample IS NOT

Parts of the Block Diagram Guide to Construction of a Block Diagram Program name and number All participating sites (group rotations by site) Name of rotation at each site

Parts of the Block Diagram (cont’d) Legend – Key Identify abbreviations Identify sites Provide any information as Notes that will help RC understand the diagram Electives % of time – Outpatient % of time – Research TY – if FCS Vacation time

Additional Info If FCS (and counting toward 24 weeks), the categorical program shouldbe noted Example: if a general surgery rotation occurs in an ACGME-accredited family medicine program, should be listed in block diagram as “GS/FM”

Abbreviations List any participating site abbreviations used EM – emergency medicine FM – family medicine GS – general surgery IM – general internal medicine OB/GYN – obstetrics and gynecology PEDS - pediatrics

Process Models: Create PDF Upload to ADS Use samples as a guide 12 blocks (monthly) 13 blocks (4 weeks – 28 days) Create PDF Upload to ADS Use samples as a guide Upload new one if substantive changes made

Fundamental Clinical Skills Transitional Year Rotations that count Emergency Medicine Family Medicine General Surgery, Trauma Surgery, Acute Care Surgery Internal Medicine (incl. Night Float) Obstetrics & Gynecology Pediatrics ICU / Critical Care Units

Fundamental Clinical Skills Transitional Year (cont’d) Rotations that DON’T count Highly specialized experiences - Subspecialty rotations Dermatology Cardiology Endocrinology Otolaryngology Urology NICU Cardiac Care Units

TYRC Actions Initial Accreditation – 1 or 2 years Site visit scheduled at the end of the period Continued Pre-Accreditation Resubmit application Must respond to citations Possible site visit

Letter of Notification Areas for Improvement (AFIs) Concerns not reaching level of citation No written response required Review with PEC

Letter of Notification Citations More serious concerns than AFI Linked to 1 or more program requirements Require written response in ADS TYRC will review again

Common Program Requirements Proposed – Sections I-V Review & Comment Period open until 3/22 Encourage community to reply

Common Program Requirements Transitional year potential concerns A number of CPRs which apply to full residency programs, but not to transitional year Resident scholarly activity Ability to enter practice without supervision Pass rates PEC membership – request to include institutional leadership

Resources ADS ACGME Website Email for technical questions Program Requirements Frequently Asked Questions by Specialty (FAQs) Block Diagram Samples

Thank you!! Contact ACGME Staff – We want to help! Cheryl Gross, MA, CAE, Executive Director cgross@acgme.org 312-755-7417 Aimee Morales, Accreditation Administrator amorales@acgme.org 312-755-7419