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

2. Disclosure
No conflicts to report

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

4. Review Committee Members and Staff

5. 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

6. 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

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

8. 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

9. Accreditation and Program Statistics

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

11. 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

12. 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

13. 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

14. Citation Statistics CORE: January 2019

15. AFI Statistics CORE: January 2019

16. Citation Statistics FELLOWSHIP: January 2019

17. AFI Statistics FELLOWSHIP: January 2019

18. Case Log Update

23. Milestones Update

24. 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

25. Milestones Resources Clinical Competency Committee Guidebook
Milestones Guidebook
Guidebook for Residents and Fellows
Milestones Annual Report New!!

26. NAS Update

27. 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

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

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

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

31. Program Report Percentile Summary Graph

32. Available reports to assist in tracking

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

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

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

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

38. 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

39. 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

40. 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

41. 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

42. 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%

43. 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

44. 2017-18 Annual Program Review: 2019 RC Meeting
Resident Scholarly Activity
ADS Update
Residents in program AY
SA completed AY
Faculty Scholarly Activity
Faculty in program AY
Major Changes and Responses to Citations**
ADS Update
Reported Fall 2018
Locked approx. October 1, 2018
**Also participating site information; duty hours/learning environment section items

45. 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

46. Not final-subject to change

47. 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)

48. 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:

49. 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

50. ADS Change: Site Director Identification
Edit Participating Sites

51. 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.

52. 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

53. ACGME Update: Single Accreditation System

54. As of 2/28/2019

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

56. 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

57. 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

58. 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:

59. 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

60. 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

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

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

63. ACGME Update: Other Initiatives

64. 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)