Accreditation Council for Graduate Medical Education Nuclear Medicine

Accreditation Council for Graduate Medical Education Nuclear Medicine Review Committee Update SNMMI Winter 2016 Jon Baldwin, DO Chair Review Committee for Nuclear Medicine

Disclosures • None

Session Overview • • • RC structure NM program stats Eligibility NAS Updates Milestones/CCC Questions

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) Mary Beth Farrell, MS (Public) Adonteng Kwakye, MD(Resident)

RC Meetings • 2 meetings per year • Check RC website for agenda closing dates & meeting dates • Upcoming: April 8, 2016 (agenda closing date: March 7, 2016) • Meeting Length: 1 – 1 ½ days • Program reviews & other Review Committee business

Nuclear Medicine 2015 -2016 • 43 accredited programs • 84/157 (54%) filled vs approved resident positions

Nuclear Medicine 10 -year Stats Academic Year Programs Residents On duty 2005 -2006 61 161 2006 -2007 61 160 2007 -2008 57 161 2008 -2009 56 149 2009 -2010 56 166 2010 -2011 54 155 2011 -2012 54 136 2012 -2013 50 120 2013 -2014 47 111 2014 -2015 43 93 2015 -2016 43 84

Nuclear Medicine Programs 2005 -2015 Nuclear Medicine 10 -year Trend 180 160 140 120 100 80 60 40 2005 -2006 -2007 -2008 -2009 -2010 -2011 Programs 2011 -2012 On duty 2012 -2013 -2014 -2015 -2016

Eligibility

2016 NM Eligibility FAQ • As AOA-approved programs transition to ACGME accreditation, are there any considerations for nuclear medicine programs considering applicants who have previously completed AOA-approved training? • [Program Requirement: III. A. 1. c)]

2016 NM Eligibility FAQ • Answer: The Review Committee understands that during the transition to a single accreditation system, nuclear medicine programs may wish to consider NM 1 applicants who have completed one year of graduate medical education in an AOA-approved program. Nuclear medicine programs will not jeopardize their accreditation status if they accept these individuals. All programs should check with the American Board of Nuclear Medicine (ABNM) and/or the American Osteopathic Board of Nuclear Medicine (AOBNM) regarding certification eligibility.

NAS Review Discussions

NAS Summary 40% programs Compliant, no feedback 37% programs Minor issues in 1 -2 areas, feedback in the form of AFIs 20% programs Concerns, feedback either as citations and/or AFIs 3% programs Site visits requested for more information Area for Improvement (AFI) • • Areas noted by the Committee for program improvement before it gets worse, “Heads Up” Does not require program response Citations • • Areas of non-compliance with the requirements Requires full program response for Committee review

NAS Most Common Flagged Items • Clinical Experience (Case Logs) • Many data entry discrepancies still occurring • Board Pass Rate • Reminder that the new pass rate is 75% for first time takers for 5 yr period • Pgms below 75% can anticipate feedback from the Review Committee • Resident Survey • Flagged programs with less than 4 residents can anticipate feedback on the multi-year aggregate survey results.

Block Diagram in ADS • Many programs providing inadequate block diagrams • Not representative of a 3 -year curriculum • NM is a three-year specialty. This should be reflected on the block diagram. • Even programs with recruiting practices that only consider NM 2 or NM 3 residents

Block Diagram in ADS • Block diagram should be free of individual resident names or identifiers • If abbreviations are used for rotations or site names, a Key must be provided • Block diagram guide posted on Committee’s webpage

Block Diagram Example

Clinical Experience - Case Logs • All programs are required to use the ACGME Case Log System • Residents must enter all specified procedures performed during their residency education into the ACGME case log system regardless of stated minimums. • Inaccurate data will impede the Committee’s ability to set accurate and realistic future benchmarks for the specialty.

Clinical Experience - Case Logs • Among the graduates of 2015, the minimum number of procedures reported for all procedural categories was “ 0” • The highest procedural category reported was for parenteral therapies at 283

Omission of Data • 5% of programs flagged for not providing data • Faculty Scholarly Activity • No Core Faculty designation • Program Director: • • Must provide complete and accurate information (II. A. 4. h). (1) Review all information before “hitting” the submit button

Milestones

NM Milestones Reporting • Data appears skewed for resident competency progression • Most likely linked to inaccurate resident reporting in ADS • Several residents reported in ADS with inaccurate “Year in Program” compared to their NM year

NM Year Consideration < 12 months of training remaining = NM 3 (or year in program 3) Between 24 and 12 months of training remaining = NM 2 (or year in program 2) Between 36 and 24 months of training remaining = NM 1 (or year in program 1)

EXAMPLE Resident length of training was 1 yr, Year In Program should be 3

Milestones • Milestones designed to help residencies/fellowships produce highly competent physicians to meet the health and healthcare needs of the public • Guide curriculum development • Provide developmental framework for Clinical Competency Committee (CCC) • Residents do not have to achieve level 4 to graduate from the program • The determination of an individual’s readiness for graduation is at the discretion of the program director

Milestones/ Clinical Competency Committee • CCC should help analyze and synthesize resident assessments • Using milestones, CCC should reach consensus judgement regarding resident performance • CCC provides conclusions to program director • Program director has ultimate authority to determine residents’ milestone developmental level at least twice yearly Journal of Graduate Medical Education, September 2015

Clinical Competency Committee • For CCC composition, programs should consider including a physicist or other faculty member who assesses NRC/AU requirements • A Clinical Competency Committee (CCC) Guidebook is posted on the Milestones webpage

ACGME Staff Contact List Executive Director Felicia Davis, MHA 312 -755 -5006 fdavis@acgme. org Associate Executive Director Kate Hatlak, MSEd 312 -755 -7416 khatlak@acgme. org Senior Accreditation Administrator Sara Thomas 312 -755 -5044 sthomas@acgme. org Case Log questions oplog@acgme. org

Questions? Thank you