1. Clinical Competency Committees What Faculty need to know Academic Affairs Committee ACEP,JMTF, CORD 1

2. WHAT…are Clinical Competency Committees (CCC’S)? A group of faculty members tasked with Assessing resident performance and progress based on multi- source data Determining individual resident’s level on Milestones Making formal recommendations to the PD regarding remediation, promotion and graduation 2

3. WHAT...are the (EM) Milestones? 23 (core) SKILLS, KNOWLEDGE AREAS, ATTITUDES Specific to the 6 CORE COMPETENCIES FOR EM (PC, MK, PROF, ICS, PBLI, SBP) Organized in developmental framework of levels 1-5 1—entry level 2-3 mid level resident advancing appropriately 4 target for graduation 5 expert level Descriptors of levels 3

4. EM MILESTONES 1.(pc-1) Resuscitation 2.(pc-2) H&P 3.(pc-3) Labs/Studies 4.(pc-4) DDx 5.(pc-5) Pharmacotherapy 6.(pc-6) Reassessment, F/U 7.(pc-7) Disposition 8. (pc-8) Multi-tasking 9. (pc-9) Procedures 10. (pc-10) Airway 11. (pc-11) Pain management/sedation 12. (pc-12) ED Ultrasound 13. (pc-13) Wound manage 14. (pc-14) Vascular Access 4

5. EM Milestones continued… 15. (mk-1) Medical knowledge 16. (prof-1) Compassion, Integrity, Respect, Ethics 17. (prof-2) Accountability to society, patients, profession and self. 18. (ics-1) Patient centered communication 19. (ics-10) Team Managment 20. (pbli-1) Follow up, CQI, EBM 21. (sbp-1) Patient safety— SBAR, handoffs, checklists… 22. (sbp-2) Efficiency, flow 23. (sbp-3) Technology (EMR), data and information access 5

6. WHY… is my program initiating CCC’s? ACGME mandate: ALL programs must have CCC’s up and running by July 2013 as part of the Next Accreditation System (NAS). All programs begin reporting aggregate data on residents’ milestone achievement by December 2013. In NAS, CCC’s are integral in the process of interpreting data and assigning milestone levels. 6

7. WHAT FOR? What purpose does the ACGME hope to accomplish by requiring programs to establish CCC’s? Increase the validity and accuracy of program assessment of resident competence throughout training and at graduation. Provide the benefit of “the insight and perspective of a group” to the resident evaluation process. Assure that programs detect resident deficiencies EARLY and provide meaningful recommendations for remediation. Ultimately assure the competence of graduates to practice independently. 7

8. WHO…comprises the CCC? The ACGME allows programs flexibility. Some parameters: 5-7 members MUST include clinically active core faculty “dedicated to resident education.” MAY include non MD medical educators Suggestions: PD,APD, core faculty Faculty who primarily supervise in clinical setting Site directors Involved nursing staff 8

9. HOW will the CCC’s function? Meet quarterly, biannually, or more frequently as necessary to allow semi-annual evaluation of each resident Review multi-source data (previously compiled) for each resident. Come to consensus on resident’s achievement of milestone level (possible milestone level 1-5). Generate report with competency determination for each resident with recommendation for advancement, graduation or remediation. 9

10. HOW…will CCC’s function? CCC Chair (Ideally NOT PD) directs process Members must maintain confidentiality of proceedings Deliberations, decisions and reports may be protected (not discoverable) under peer-review confidentiality depending on state laws. Ongoing evaluation of CCC process to allow recommendations for continued improvement of process regarding activities of CCC 10

11. WHAT…are examples of data CCC may use in resident assessment? In-Service Scores Rotation/shift evaluations Patient satisfaction data Procedure logs 360 evaluations Scholarly work Oral board performance Direct observation data Self evaluations/reflection Adverse information (complaints, misconduct) Administrative compliance Structured chart review Core measures Provider Reports 11

12. How will CCC’s compile data? Programs are free to develop Assessment Tools for compiled data or use one already made. Consistency of approach will increase accuracy even for un-validated assessment tools. 12

13. WHAT…is the role of the PD? Receives report/consensus determinations with recommendations of CCC. Includes report in resident record. Carries responsibility of ultimate decision making with regard to advancement, remediation, graduation. 13

14. DATA Sources FAQs ACGME Website: www.acgme-nas.org/assets/pdf/NASFAQs.pdf www.acgme- nas.org/assets/pdf/Milestones/EmergencyMedicineMiles tones.pdf 14