Residency Review Committee for Emergency Medicine Report to CORD Art Sanders, MD, Chairman October 2004

AMERICAN BOARD OF EMERGENCY MEDICINE Dane Chapman, M.D. Daniel Danzl, M.D., Vice-Chair Rebecca Smith-Coggins, M.D. MaryAnn Reinhart, Ph.D, Ex-officio COUNCIL ON MEDICAL EDUCATION (AMA) Louis S. Binder, M.D. Charles K. Brown, M.D. Arthur Sanders, M.D., Chairman AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Francis Counselman, M.D. Sandra Schneider, M.D. David Overton, M.D. Marjorie Geist, Ph.D., Ex-officio EMERGENCY MEDICINE RESIDENTS ASSOCIATION Kelly Corrigan, M.D. RRC for Emergency Medicine

Committee ActionSeptember nd Review of Program Application Confirmed Withhold01 1 st Review of Program Applications Proposed Withhold02 Provisional Accreditation02 UMNDJ-New Jersey Medical School (Newark) University of Utah (Salt Lake City) Review of Applications (9/2004)

Status Decisions Accreditation Cycle 2 Provisional - 3 year cycles 2 Full Accreditation - 3 year cycle 6 Full Accreditation - 4 years/7 years pilot 6 Full Accreditation - 5 years/8 years pilot

RRC-EM Pilot Project Extend max accreditation cycle from 5 to 8 yrs Require yearly QI indicators of the program Update of citations Changes in program Procedures, resuscitations of graduating residents ED volume, faculty supervision Resident survey yearly

RESIDENT SURVEY 3 year plan to survey 1/3 of residents each year for 3 years Year 1 had 85% compliance rate and over 25,000 respondents Survey programs with 5 residents or more Survey January through April Internet based – Average 9 minutes to complete

RESIDENT SURVEY Used by site visitors as additional data element to augment resident interview and as early warning of non-compliance indicator 32 Questions pertaining to Duty Hours, Competencies, Evaluation, and Supervision Ability for residents to enter comments and/or connect to confidential resident complaint system

RESIDENT SURVEY  PDs and DIOs have access to aggregate reports if compliance is 70% or higher  Plan to have every resident complete survey annually (5 or more in program)  Plan to add Specialty specific questions to aid in program review

RRC-EM Pilot Project It is inappropriate to claim that programs in the pilot with longer accreditation cycles are better than other programs.

New Program Requirements Approved in June 2004 Effective January 2005 Competencies - Guidelines on Competencies Yearly competency assessment, 3 procedures, 3 chief complaints, 1 resuscitation, 50% off service Duty Hours New PIF

Program Requirements Revision Subspecialties Toxicology Pediatric Emergency Medicine

New PIF Questions on Clinical Operations ED volume and supervision ratio Time to CT scan, blood, etc. Throughput time for admitted and discharged pts. Ambulance diversion time On call consultants

New PR - Clinical Operations The hospital must assure that all clinical specialty and subspecialty services are available in a timely manner…If any clinical services are not available for consultation or admission, the hospital must have a written protocol for provision of these services elsewhere. This may include written agreements for the transfer of these patients to a designated hospital that provides the needed clinical services. (PR II.E.2)

Guideline - EM Faculty Qualifications All EM faculty supervising EM residents on EM rotations must be board certified by ABEM or have appropriate qualifications in EM. Examples of educational qualifications acceptable to the RRC: Certification by the AOBEM Certification by a subspecialty board of ABEM Recent residency or fellowship graduates working toward certification by the above Boards Qualifications must be relative to the pt population supervised

RRC-EM Outcomes Project RWJ Grant to ACGME - Competency Project To identify patient care quality measures that are appropriate to use to assess the outcomes of GME in EM To link patient care quality measures in EM to the quality and effectiveness of GME Can accreditation decisions be outcome rather than process based?

RRC Report to CORD Questions???