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

2. Disclosure
No conflicts of interest to report

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

4. 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

5. 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

6. 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

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

8. Nuclear Medicine 10-year Stats
Academic Year
Programs
Residents On duty 62
149 61
161
160 57 56
166 54
155
136 50
120 47
111 43 93

9. Nuclear Medicine Programs 2004-2014

10. Nuclear Medicine
Program Requirements
Effective July 1, 2014

11. 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 , 290, and 390, including 392, , 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)

12. 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

13. Major Changes IV.A.6 – Curriculum
Documentation in the ACGME Case Log System
IV.A.6.a).(4).(a).(i).(a) - a minimum of 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)

14. 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 cardiovascular pharmacologic and/or exercise stress studies. (Detail)
IV.A.6.a).(4).(a).(iv) – 100 pediatric nuclear medicine procedures

15. 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)

16. 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.

17. 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

18. 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 ?
[Program Requirement: III.A.]

19. 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, 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, 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.

20. Case Logs

21. 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

22. 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

23. 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”

24. Not required
“Attending” has been removed

27. NAS

28. 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

29. 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)

30. 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.

31. 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)

32. 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”.

33. 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)

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

35. 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.

36. 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

37. Scholarly activity for faculty and residents must be entered

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

39. Block Diagram Upload
Detailed on following slide

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

41. Print a program summary of your updates for your records.

42. 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

43. 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

44. ACGME Staff Contact List
Executive Director
Felicia Davis, MHA
Senior Accreditation Administrator
Sara Thomas
Nuclear Medicine ADS Representative
Samantha Alvarado
Case Log questions

45. Questions?
Thank you
Our Answers