ACGME Update: Review Committee for Orthopaedic Surgery Pamela L Derstine, PhD, MHPE Executive Director ARCOS Annual Meeting March 14, 2019 Las Vegas NV

Disclosure No conflicts to report

Discussion Topics Review Committee Members and Staff Accreditation and Program Statistics Case Logs Milestones NAS ACGME

Review Committee Members and Staff

Nominating Organizations Review Committee Membership Nominating Organizations 12 voting members 3 members (ABOS) 3 members (AAOS) 3 members (AMA) 1 resident member (at large) 1 member (AOA-osteopathic) 1 public member (at large) 2 non-voting Ex-Officio David Martin, MD, ABOS Lee Vander Lugt, DO, AOA

Review Committee Membership: Current Peter M Murray, MD, Chair Dawn M LaPorte, MD, Vice Chair S Elizabeth Ames, MD James E Carpenter, MD Charles F Carr, MD John Gorczyca, MD Richard F Howard, DO Eugene S Jang, MD, Resident Member Paul J Juliano, MD Theodore W Parsons III, MD James R Roberson, MD James H Taylor, Dman MHA MBA, Public Member

New Members Effective 7/1/2019 Stuart J Davidson, MD, resident member Kimberly J Templeton, MD SAUSHEC University of Kansas

ACGME Review Committee Staff Pamela L. Derstine, PhD, MHPE Executive Director Susan E. Mansker Associate Executive Director Jennifer M Luna Senior Accreditation Administrator Citlali Meza, MPA Accreditation Administrator Kevin Bannon ADS

Accreditation and Program Statistics

Accreditation Statistics: Current Total Current Accredited Programs # Core 183 # Fellowships 259 Pending Applications (April 2019) # Core Allopathic # Core Osteopathic 4 # Fellowships 3

Program Accreditation Status: Core Accreditation Statistics: Current Program Accreditation Status: Core Status # Programs Continued Accreditation 142 Continued Accreditation w/o Outcomes 5 Continued Accreditation w/ Warning 10 Initial Accreditation 24 Initial Accreditation w/ Warning 2 Probationary Accreditation Continued Pre-Accreditation 19 Both ESN programs have continued accreditation status

Program Accreditation Status: Fellowships Accreditation Statistics: Current Program Accreditation Status: Fellowships STATUS Continued Accred. Continued w/warning Initial Accred. Application Pre- Accred. Adult Recon 20 4 Foot/Ankle 6 1 Hand 64 2 3 Pediatric 24 Spine 16 Sports 87 5 Trauma 9 Oncology 10

Other Meeting Decisions (January 2019) Requests Permanent Complement Increase Core # Requested /# Approved 10/4 Permanent Complement Increase Fellowship 2/2 Temporary Complement Increase Core 4/3 Site Visit Focused/Full 4/2 Progress Report 4

Citation Statistics CORE: January 2019

AFI Statistics CORE: January 2019

Citation Statistics FELLOWSHIP: January 2019

AFI Statistics FELLOWSHIP: January 2019

Case Log Update

Milestones Update

Effective approximately 7/1/2021 Public comment period on completed draft TBA First of 3 Task Group meetings November 2019 Milestone survey January-February 2019 Milestone Task Group members selected December 2018 Call for Task Group volunteers ended 11/30/2018

Milestones Resources Clinical Competency Committee Guidebook https://www.acgme.org/Portals/0/ACGMEClinicalCompetencyCommitteeGuidebook.pdf?ver=2017-10-18-141733-920 Milestones Guidebook https://www.acgme.org/Portals/0/MilestonesGuidebook.pdf?ver=2016-05-31-113245-103 Guidebook for Residents and Fellows https://www.acgme.org/Portals/0/PDFs/Milestones/MilestonesGuidebookforResidentsFellows.pdf?ver=2017-06-29-090859-107 Milestones Annual Report 2018 New!! https://www.acgme.org/Portals/0/PDFs/Milestones/2018_Milestones_National_Report_2018-09-18_final.pdf?ver=2018-09-19-142602-030

NAS Update

Upcoming Review Committee Meetings April 12-13, 2019 Agenda closed September 14, 2019 Agenda close: July 20, 2019 January 17-18, 2020 Agenda close: November 8, 2019 April 17-18, 2020 Agenda close: March 6, 2020

Clinical Experience – Case Logs CORE 2017-18 Annual Program Review: 2019 RC Meeting Clinical Experience – Case Logs CORE Minimum Number reports for 2017-2018 program graduates were reviewed Graduates expected to comply with minimum number requirements for all categories

Clinical Experience – Case Logs CORE 2017-18 Annual Program Review: 2019 RC Meeting Only 5 of 729 graduates failed a minimum Clinical Experience – Case Logs CORE Minimum Number reports for 2017-2018 program graduates were reviewed Graduates expected to comply with minimum number requirements for all categories

Clinical Experience – Case Logs CORE 2017-18 Annual Program Review: 2019 RC Meeting Clinical Experience – Case Logs CORE Case Log Program reports for 2017-2018 program graduates were reviewed Anatomic areas ≤ 10th percentile (all patients) subject to AFI or citation

Program Report Percentile Summary Graph

Available reports to assist in tracking

Clinical Experience – Case Logs MSK FELLOWSHIP 2017-18 Annual Program Review: 2019 RC Meeting Clinical Experience – Case Logs MSK FELLOWSHIP Minimum Number reports for 2017-2018 program graduates were reviewed Graduates expected to comply with minimum number requirements for all categories

Clinical Experience – Case Logs All Other FELLOWSHIPS 2017-18 Annual Program Review: 2019 RC Meeting Clinical Experience – Case Logs All Other FELLOWSHIPS Case Log Program reports for 2017-2018 program graduates were reviewed Subspecialty-specific case categories ≤ 10th percentile (all patients) subject to AFI or citation

Program Report Percentiles Summary Graph for a sports program Subspecialty-specific “Key Procedure Report” available in the case log system to assist in tracking

Proposed effective date: 2020-2021 Development of minimum number requirements for hand programs initiated.

Board Scores 2017-18 Annual Program Review: 2019 RC Meeting First-time takers only during the most recent 5 years reported by ABOS to Data Dept. Written: 80% pass rate Oral: 75% pass rate

Board Scores: new CPR 2018-19 Annual Program Review: 2020 RC Meeting First-time takers only during the most recent three years reported by ABOS to Data Dept. Bottom 5th percentile nationally for the specialty AND Subject to citation if <80% pass rate

Board Scores: new CPR 2018-19 Annual Program Review: 2020 RC Meeting If the new CPR had been applied to data reviewed in January 2019: Written: 2 programs subject to citation Oral: 8 programs subject to citation

Example: 5th Percentile = 25% Example 1: Program G - 3-Year Aggregate Pass Rate = 68.2% Program pass rate is greater than the 5th percentile Sorted by Pass Rate N = 20 Programs Bottom 5% of the distribution defines the 5th percentile Program Specialty Board Name Exam Type 3-Year Aggregate Pass Rate A ACGME Specialty ABMS Board Written 25.0 B C 50.0 D E 59.3 F 66.7 G 68.2 H 71.4 I 75.0 J 80.0 K 83.3 L 87.5 M 90.5 N 92.3 O 93.8 P 97.2 Q 100.0 R S T 2 programs have a pass rate below the 5th percentile Sort Order   1 5.0% 2 10.0% 3 15.0% 4 20.0% 5 25.0% 6 30.0% 7 35.0% 8 40.0% 9 45.0% 10 50.0% 11 55.0% 12 60.0% 13 65.0% 14 70.0% 15 75.0% 16 80.0% 17 85.0% 18 90.0% 19 95.0% 20 100.0% 18 of 20 programs have a pass rate > 5th percentile

Example: 5th Percentile = 91.3% Example 3: Program 3-Year Pass Rate = 75% Program pass rate is less than the 5th percentile and <80% Program Pass Rate = 75%

2017-18 Annual Program Review: 2019 RC Meeting Resident Survey (completed Feb-Mar 2018) 7 survey question domains 70% response rate required Aggregated non-compliant survey responses for each domain reviewed Trends monitored Faculty Survey (completed Feb-Mar 2018) 5 survey question domains (mirrors Resident Survey) 60% response rate required Program director and core faculty members only Resident/faculty member responses to same domains compared

2017-18 Annual Program Review: 2019 RC Meeting Resident Scholarly Activity 2017-2018 ADS Update Residents in program AY 2016-2017 SA completed AY 2016-2017 Faculty Scholarly Activity Faculty in program AY 2016-2017 Major Changes and Responses to Citations** 2018-2019 ADS Update Reported Fall 2018 Locked approx. October 1, 2018 **Also participating site information; duty hours/learning environment section items

2018-19 Annual Program Review: 2020 RC Meeting New Scholarly Activity Reporting System: reported for program not individual faculty (Core programs) Complete a summary table for all physician faculty Complete a summary table for all non-physician faculty PMIDs will be also reported Scholarly activity for fellowship programs will continue use the current reporting system

Not final-subject to change

ADS Change: Faculty Scholarly Activity IV.D.2.a) Among their scholarly activity, programs must demonstrate accomplishments in at least three of the following domains (Core)

ADS Change: Faculty Scholarly Activity IV.D.2.b) The program must demonstrate dissemination of scholarly activity within and external to the program by the following methods:

Other ADS Changes for 2019-20 Annual Update Site Directors identified for each site Done on the Sites tab by editing each site Site Directors identified on the faculty roster Identify core faculty via checkbox Must enter certification expiration date for all faculty New questions added to Annual Update, e.g., Program mission statement Program aims guided by mission statement

ADS Change: Site Director Identification Edit Participating Sites

Upcoming Changes in ADS Changes will be published after June 24, 2019. Accredited programs will be required to respond to new/updated questions in the Annual Update. Applications (new and re-applications) will be required to respond to new/updated ADS elements.

More information about the date changes are forthcoming Self-Study/10 Year Visit Update Programs scheduled with a self-study date prior to April 2019 will likely have their 10-year site visit more than 24 months after the self-study date listed in ADS Programs with self-study dates of May 2019 and beyond will have their self-study dates moved forward into the future (exact time-frame under review) More information about the date changes are forthcoming

ACGME Update: Single Accreditation System

As of 2/28/2019

ACGME Update: Common Program Requirements Section I-V Major Revision Implementation Timeline

Implementation of CPRs (CORE) The following are effective 7/1/2020 I.D.2.c) Lactation facilities I.D.2.e) Accommodation for resident disabilities II.A.4.a).(2) Design and conduct program consistent with community needs, mission II.B.2.g) (1-4) Faculty development specifics All other CPRs, including ALL CPRs in section VI, are effective 7/1/2019 See https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidencyImplementationTable.pdf

Implementation of CPRs (FELLOWSHIP) The following are effective 7/1/2020 I.D.2.c) Lactation facilities I.D.2.e) Accommodation for resident disabilities II.A.4.a).(2) Design and conduct program consistent with community needs, mission IV.E.1 Independent Practice option (subject to public comment) All other CPRs, including ALL CPRs in section VI, are effective 7/1/2019 See https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidencyImplementationTable.pdf

RC Decisions for Fellowship Eligibility and Scholarly Activity Prerequisite education must be completed in an ACGME, ACGME-I, AOA, RCPSC-accredited program (exceptions permitted) RC requires faculty scholarly activity dissemination by PMID See decisions for all RCs at: https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements

Specialty-Specific Requirements Current requirements updated for new CPRs posted by April 1, 2019 Deleted, renumbered, and edited PRs shown with track changes Effective 7/1/2019

Specialty-Specific Requirements Focused Revisions CORE RCs must further specify the following IV.C.1: The curriculum must be structured to optimize resident educational experiences, the length of these experiences, and supervisory continuity. (Core) Other focused revisions under consideration Public comment period this summer Effective date: 7/1/2020

Specialty-Specific Requirements Major Revision FELLOWSHIPS Newly approved one-year fellowship CPRs Public comment period this summer Effective date: 7/1/2020

Implementation of CPRs Program Director Guide to the Common Program Requirements is under development

ACGME Update: Other Initiatives

Back To Bedside applications due 3/15/2019 2020 ACGME Award nominations due 3/29/2019 Upcoming Workshops Experienced Coordinators: Advancing, Collaborating, Innovating April 14-15, 2019 Developing Faculty Competencies in Assessment October 13-18, 2019 October 27-November 1, 2019 Other Educational Activities (see website)