Residency Review Committee for Emergency Medicine

Report to CORDArt Sanders, MD, Chairman

October 2004

AMERICAN BOARD OF EMERGENCY MEDICINE

Dane Chapman, M.D.

Daniel Danzl, M.D., Vice-Chair

Rebecca Smith-Coggins, M.D.

MaryAnn Reinhart, Ph.D, Ex-officio

COUNCIL ON MEDICAL EDUCATION (AMA)

Louis S. Binder, M.D.

Charles K. Brown, M.D.

Arthur Sanders, M.D. , Chairman

AMERICAN COLLEGE OF EMERGENCY PHYSICIANS

Francis Counselman, M.D.

Sandra Schneider, M.D.

David Overton, M.D.

Marjorie Geist, Ph.D., Ex-officio

EMERGENCY MEDICINE RESIDENTS ASSOCIATION

Kelly Corrigan, M.D.

RRC for Emergency Medicine

Committee Action September 2004

2nd Review of Program ApplicationConfirmed Withhold 01

1st Review of Program ApplicationsProposed Withhold 02Provisional Accreditation 02

• UMNDJ-New Jersey Medical School (Newark)• University of Utah (Salt Lake City)

Review of Applications (9/2004)

Status Decisions Accreditation Cycle

2 Provisional - 3 year cycles

2 Full Accreditation - 3 year cycle

6 Full Accreditation - 4 years/7 years pilot

6 Full Accreditation - 5 years/8 years pilot

RRC-EM Pilot Project

Extend max accreditation cycle from 5 to 8 yrs

Require yearly QI indicators of the program

Update of citations

Changes in program

Procedures, resuscitations of graduating residents

ED volume, faculty supervision

Resident survey yearly

RESIDENT SURVEY

•3 year plan to survey 1/3 of residents each year for 3 years

•Year 1 had 85% compliance rate and over 25,000 respondents

•Survey programs with 5 residents or more

•Survey January through April

•Internet based – Average 9 minutes to complete

RESIDENT SURVEY

•Used by site visitors as additional data element to augment resident interview and as early warning of non-compliance indicator

•32 Questions pertaining to Duty Hours, Competencies, Evaluation, and Supervision

•Ability for residents to enter comments and/or connect to confidential resident complaint system

RESIDENT SURVEY

PDs and DIOs have access to aggregate reports if compliance is 70% or higher

Plan to have every resident complete survey annually (5 or more in program)

Plan to add Specialty specific questions to aid in program review

RRC-EM Pilot Project

It is inappropriate to claim that programs in the pilot with longer accreditation cycles are better than other programs.

New Program Requirements

Approved in June 2004

Effective January 2005

Competencies - Guidelines on Competencies

Yearly competency assessment, 3 procedures, 3 chief complaints, 1 resuscitation, 50% off service

Duty Hours

New PIF

Program Requirements RevisionSubspecialties

Toxicology

Pediatric Emergency Medicine

New PIF Questions on Clinical Operations

ED volume and supervision ratio

Time to CT scan, blood, etc.

Throughput time for admitted and discharged pts.

Ambulance diversion time

On call consultants

New PR - Clinical Operations

The hospital must assure that all clinical specialty and subspecialty services are available in a timely manner…If any clinical services are not available for consultation or admission, the hospital must have a written protocol for provision of these services elsewhere. This may include written agreements for the transfer of these patients to a designated hospital that provides the needed clinical services. (PR II.E.2)

Guideline - EM Faculty Qualifications All EM faculty supervising EM residents on EM rotations must be board certified by ABEM or have appropriate qualifications in EM. Examples of educational qualifications acceptable to the RRC:

Certification by the AOBEM

Certification by a subspecialty board of ABEM

Recent residency or fellowship graduates working toward certification by the above Boards

Qualifications must be relative to the pt population supervised

RRC-EM Outcomes Project

RWJ Grant to ACGME - Competency Project

To identify patient care quality measures that are appropriate to use to assess the outcomes of GME in EM

To link patient care quality measures in EM to the quality and effectiveness of GME

Can accreditation decisions be outcome rather than process based?

RRC Report to CORD

Questions???