Accreditation Council for Graduate Medical Education

Nuclear MedicineReview Committee Update

SNMMI Winter 2016

Jon Baldwin, DOChairReview Committee for Nuclear Medicine

Disclosures

• None

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

Session Overview

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

• 43 accredited programs

• 84/157 (54%) filled vs approved resident positions

Nuclear Medicine 2015-2016

Nuclear Medicine 10-year StatsAcademic 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 Programs2005-2015

2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-20160

20

40

60

80

100

120

140

160

180

Nuclear Medicine 10-year Trend

Programs On duty

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 NM1 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 Summary40% 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) Citations• Areas noted by the Committee for

program improvement before it gets worse, “Heads Up”

• Does not require program response

• 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 5yr

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 NM2 or NM3 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                                           

= NM3 (or year in program 3)

Between 24 and 12 months of training remaining             

= NM2 (or year in program 2)

Between 36 and 24 months of training remaining             

= NM1 (or year in program 1)

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

EXAMPLE

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 ListExecutive DirectorFelicia Davis, MHA 312-755-5006 fdavis@acgme.org

Associate Executive DirectorKate Hatlak, MSEd 312-755-7416 khatlak@acgme.org

Senior Accreditation AdministratorSara Thomas 312-755-5044

sthomas@acgme.org

Case Log questions oplog@acgme.org

Questions?

Thank you

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