1. Welcome to…..

2. The Single Accreditation System: AOA/ACGME Integration
Judith Pauwels, MD
AAFP Residency Program Solutions Consultant

3. Disclosures
I have no conflicts of interest to report regarding this presentation.

4. Disclosures
And I DO represent two organizations actively collaborating to assist AOA programs with the SAS:
Association of Family Medicine Residency Directors (AFMRD)
American College of Osteopathic Family Physicians (ACOFP)

5. Polling Question #1

6. Goals
Describe the Single Accreditation System process for Sponsoring Institutions and Programs.
Discuss Institutional Accreditation requirements.
Discuss common questions related to Program Accreditation in Family Medicine.
Identify resources to help!

7. The ultimate goal:
Preserving and enhancing the primary care workforce critical to health care system reform

8. SAS Process and Timelines
What has changed in the pathways that our students and residents will follow?
What is the process for achieving ACGME accreditation for both the Sponsoring Institution, and for the sponsored program?
What are the key timelines and dates for doing this?

9. Accreditation Status, 2014 MD DO Medical School Medical School US MLE
MD Students
DO Students
Accreditation Status, 2014 MD DO
LCME
Medical School
Medical School
AOA
NBME
US MLE
COMLEX
NBOME
AAMC
NRMP Match
NMS Match
AOA
SOAP
Match
ACGME
Residency
Sponsoring Institution: Hospital, CHC
Initial Accreditation
Residency
ACGME
Residency
OPTI
AOA
ABFM
Specialty Boards
Specialty Boards
AOBFP
Updated 8/6/2015

10. Moving to the Unified Accreditation Process: 2015-2020 MD DO
MD Students
DO Students
Moving to the Unified Accreditation Process: MD DO
LCME
Medical School
Medical School
AOA
NBME
US MLE
COMLEX
NBOME
AAMC
NRMP Match
NMS Match
AOA
SOAP
Match
ACGME
Residency
Sponsoring Institution: Hospital, CHC, OPTI, other
Initial Accreditation
Residency
ACGME
OPTI
Pre-accredited Residency
Residency
AOA
Dually accredited
OPTI
DO only
ABFM
Specialty Boards
Specialty Boards
AOBFP
Updated 8/6/2015
*may apply

11. Fully Implemented Unified Pathway: 2020 MD DO
MD Students
DO Students
Fully Implemented Unified Pathway:
2020 MD DO
LCME
Medical School
Medical School
AOA
NBME
US MLE
COMLEX
NBOME
AAMC
NRMP Match
SOAP
Match
ACGME
Residency
Accredited Sponsoring Institution: Hospital, CHC, OPTI, other
Initial Accreditation
Residency
Points:
Both USMLE and COMLEX will continue.
Boards will remain separate. Grads of SAS program could choose either; MD grads completing Osteopathic Recognition could choose to sit for DO Boards.
Osteopathic Recognition
ABFM
Specialty Boards
Specialty Boards
AOBFP
Updated 8/6/2015

12. SAS Process The Match systems are still separate.
Final AOA Match expected no later than 2019 (but caveats…).
Must maintain AOA certification to participate in AOA Match.

13. SAS Process and Timelines
All AOA-only residents must be graduated by 2020.
All current AOA-only programs must achieve Initial Accreditation by June 30, 2020.
This is now less than 4 years away, and the accreditation process will take significant time and resources.
FM programs MUST have submitted for ACGME accreditation by 1/1/2018 to participate in 2018 AOA match.
Programs 4 years or more in length are required to be in pre-accreditation to participate in 2017 AOA match; programs 3 years in length (FM) will have to be in pre-accreditation to participate in the 2018 AOA match.

14. SAS Process Board certification systems are still separate.
Clarification of requirements to sit for AOBFP Boards under SAS still not announced.
Must maintain AOA certification for graduating AOA residents to sit for AOBFP Boards.
For AOA resident to sit for ABFM Boards, must complete BOTH PGY-2 and -3 years in ACGME-accredited program.

15. SAS Process and Timelines
“Pre-accreditation” means that the Institution or Program has submitted an initial application for ACGME accreditation (granted immediately upon receipt of the application).
“Continued pre-accreditation” means that the Institution or Program was reviewed by ACGME but did not receive Initial Accreditation; it can re-apply.
“Initial accreditation” means the the ACGME has approved the Institution or Program.

16. SAS Process and Timelines
The Sponsoring Institution (SI) must receive Institutional Accreditation before a Program can receive Initial Accreditation.
However, both can be in “pre-accreditation” status and application work move forward simultaneously.
A Program can be provisionally approved pending SI accreditation.
Osteopathic Recognition can also be provisionally approved.

17. Polling Question #2

18. Sponsoring Institution
Who can be a Sponsoring Institution (SI)?
Or…
What are the responsibilities and authorities of the SI?

19. SI Responsibilities
Institution must demonstrate assumption of ultimate financial and academic responsibility for the programs that it sponsors, and be in substantial compliance with other relevant ACGME Institutional Requirements.
No distance requirement.

20. SI Responsibilities
Oversight of resident/ fellow assignments and of the quality of the learning and working environment, extending to all participating sites.
Financial support for administrative, educational, and clinical resources, including personnel.

21. Institutional Accreditation
ACGME institutional objectives:
SI resources in support of GME.
SI oversight of learning and working environment.
Structure for SI oversight of programs.
SI policies and procedures for GME.

22. Structure for SI oversight of programs
Critical elements:
Institutional commitment to GME.
Designated Institutional Official (DIO):
May be the Program Director in single-program SI (SPSI).
An engaged Graduate Medical Education Committee (GMEC).

23. Structure for SI oversight of programs
GMEC structure:
DIO, program directors.
Must include residents/fellows (at least two).
Must include patient safety/quality officer (or designee).
For SPSI: must include at least one person from outside the program who’s involved with GME.
Must meet at least quarterly, and keep minutes of these meetings.

24. Structure for SI oversight of programs
GMEC responsibilities:
Oversight of learning environment
Oversight of sponsored programs accreditation status, and annual evaluation activities
Compliance with policies

25. SI GME policies and procedures
Resident/fellow recruitment and selection
Resident/fellow contract, including specific list of what must be in the contract
Promotion, appointment renewal, and dismissal
Grievances
Resident services (behavioral health, policies on harassment, disabilities, impairment)
Supervision, duty hours
Vendor interactions
Non-competition
Closures and reductions, disasters

26. SI oversight of the Clinical Learning Environment: CLER
Professionalism
Supervision
Healthcare Quality
Healthcare Disparities
Transitions of Care
Duty Hours
Fatigue Management
Patient Safety

27. Sponsoring Institutions
Who can be a Sponsoring Institution (SI)?

28. Polling Question #3

29. PROGRAM requirements Common Requirements:
Apply to ALL programs, regardless of specialty.
Specialty-specific Requirements:
Define each specialty.

30. Common Program Requirements
Affiliation of Sponsoring and Participating Institutions, and “PLAs (Program Letters of Agreement)”
Specifications about program director and faculty
General information about resident appointments, educational program, and the competencies
Expectations of resident scholarly activity
Evaluation systems
Resident supervision
Resident duty hours

31. Family Medicine Program Requirements
The requirements that define how our specialty trains its residents.
Specifics about program constructs (program director, faculty, administration, training environment); educational program; resources needed; evaluation systems; etc.
Some of the CPR are more specifically defined here.

32. Family Medicine Program Requirements: potential issues
Program size
Specifications for the “Family Medicine Practice” site
Program director qualifications and time allocated to program
Core faculty ratio and time allocated to program
Faculty roles; scholarly activity
Rotation / experience requirements

33. Family Medicine Program Requirements: Program size
Minimum defined as 4-4-4
Can smaller programs demonstrate “substantial compliance?”
Slots must be filled each year under ACGME rules
Strategies for AOA programs currently smaller than the minimum

34. Family Medicine Program Requirements: Rotation/experiences
Problematic areas for many programs:
Maternity care
Pediatrics care
Inpatient internal medicine
Faculty, especially family medicine
Availability of experiences

35. Family Medicine Program Requirements: Other potential issues
Supervision requirements
Evaluation system complexities:
Incorporating the Milestones
Direct observations
CCC (Clinical Competency Committee)
Administrative complexities:
PEC (Program Evaluation Committee)
ADS (Accreditation Data System) reports

36. Common questions
What are the implications for current residents in AOA-only programs before achieving ACGME Initial Accreditation?
Which ACGME requirements do current residents have to meet?
Can residents part-way through sit for ABFM Boards?
Can residents apply for ACGME fellowships?
ACGME: must meet requirements for Initial Accreditation.
ABFM: PGY-1 year can count, but not next two years.
Fellowships: yes, once in pre-accreditation status, but can’t sit for the “CAQ” until ABFM-certified. Note difference between “accredited” and “non-accredited” fellowships.

37. Financial Considerations
Federal and state GME revenue streams:
CMS rules only relate to accreditation; either AOA or ACGME accreditation is required to claim residents.
Program must maintain AOA accreditation until Initial Accreditation by ACGME is received.

38. Financial Considerations
Sponsoring Institution costs:
DIO, GMEC
Increased administrative requirements
Program costs:
Additional director and faculty time
Family Medicine practice site requirements
Educational requirements
Systems/administrative requirements

39. Program Pre-accreditation
Process:
Assessing and implementing the changes needed to meet the requirements
Writing the PIF (Program Information Form)
Submitting the PIF and attachments in ACGME ADS (Accreditation Data System)
Site visit
Deadlines for submission on ACGME website for the specialty (note: includes site visit!)

40. Program Pre-accreditation
Process:
Initial accreditation will be for two years.
If not approved the first time, the program can continue to revise its plans and then reapply, until June 2020.

41. Program Pre-accreditation
Programs must start reporting all required ACGME annual information:
ADS annual update
Resident survey
Faculty survey
Milestone assessment and reporting
Can simultaneously start application for Osteopathic Recognition

42. Polling Question #4

43. Networking for Strength
Fundamental belief in the need for primary care, and specifically family medicine, for our patients and communities.
Core value that all of us working together are stronger than working in isolation.
NO program has found all of this “easy.”
But ALL programs have found this rewarding!

44. Resources
Accreditation Navigation – Attend an intensive two-session program to cover all aspects of the transition to ACGME accreditation and to provide a networking opportunity with fellow directors and experienced faculty. See details at
Association of Family Medicine Residency Directors (AFMRD) – Become a member and have access to the members only toolbox and discussion list.
Residency Program Solutions – When a program consultation is called for, AAFP’s RPS has experienced consultants to meet your needs.