and LengthofTraining 4year Pilot Perry A Pugno MD Vice President Education AAFP James C Puffer MD President and CEO American Board of Family Medicine Perry A Pugno ID: 928051
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ACGME Milestones ProjectandLength-of-Training (4-year) Pilot
Perry A. Pugno, MD
Vice President, Education – AAFP
~
James C. Puffer, MD
President
and CEO – American Board of Family Medicine
Slide2Perry A. Pugno, M.D., MPH, FAAFP, FACPEOther AffiliationsAAFP Alternative Delegate to the American Medical Association (AMA)
AAFP Representative to the Council for Medical Specialty Societies (CMSS)
AAFP Liaison to the Council for Academic Family Medicine (CAFM)
Vice President for Education
American Academy of Family PhysiciansAuthor / co-author of many articles and the book “Physicians as Leaders”
Educational Background:
University of California – Davis, School of MedicineVentura General Hospital Family Medicine Residency (UCLA-affiliated)Masters of Public Health – Loma Linda University School of Public HealthBoard-certified , Family Medicine and Emergency MedicineFellow of the AAFP, American College of Emergency Physicians, and American College of Physician Executives
Previous Affiliations / Responsibilities:Director, Division of Medical Education, American Academy of Family PhysiciansDirector, Residency Program Solutions (RPS)Founding Chair, National Institute for Program Director Development (NIPDD)President, Association of Family Medicine Residency Directors (AFMRD)President, UC Medical Alumni AssociationChair, ACGME Residency Review Committee (RRC) for Family MedicineFamily Medicine Residency Program Director, various public, private and university programsVP of GME and Medical Affairs, Mercy Healthcare Sacramento – a division of Catholic Healthcare West Public Health Officer and Medical Director, Mercy Health Plan (CHW)Family Physician, National Health Services Corps, Barstow, CA
Conflict of Interest Disclosure
Slide3Milestones Project• Joint initiative of the ACGME and the specialty certification boards•Process driven by ACGME•Working Group: Individuals representing the constituencies of the RC-FM, ABFM, AAFP, STFM, AFMRD, ADFM and ACGME•Timeline: March through December 2012
Slide4Milestones Project Working GroupSuzanne Allen*Tanya AnimDavid Araujo
Diane
Beebe
†
Julie DostalTricia ElliottLarry GreenAmy McGaha
Richard Neill*
Steven NestlerPerry Pugno†Martin Quan†Adam Roise*Allen ShaughnessyPenny Tippy* ACGME STAFFEileen Anthony (Exec Dir)Erin
Axley (Admin Asst)*current RC-FM member †past RC-FM member
Slide5The Progress of Development
Medical School Residency Practice
Beginner
Advanced Beginner
CompetencyProficiencyMastery
Slide6Slide7MilestonesMilestones describe performance levels residents are expected to demonstrate for skills, knowledge, and behaviors in the six general competency domains. Milestones will lay out a framework of observable behaviors and other attributes associated with residents’ development as physicians. Identification of assessment methods that will be effective in evaluating performance on the milestones is a part of this effort.
Slide8Milestones“How far along the road to your goal are you right now?”
Slide9Implications and Uses
Slide10How Does This RelateTo What We Know?
ACGME Milestones Entrustable
Competencies Prof. Activities
Slide11Entrustable Professional ActivitiesJGME – Sept ‘10“EPAs are simply the routine professional-life activities of physicians based on their specialty and subspecialty.”
Slide12Entrustable Professional Activities
Slide13Slide14Slide15Sometimes, directions are not clear…
Slide16Slide17Length-of-TrainingPilot Project
Slide18Family Medicine Length of Training Pilot (FM-LTP)“The purpose of the pilot is to examine whether extending the length of Family Medicine training to 4 years through the development of innovative training paradigms further prepares family physicians to serve as highly effective personal physicians in a high performance health care system.”
Slide19Family Medicine Length of Training Pilot (FM-LTP)BACKGROUND1966 Willard Report – “The program [should] be kept flexible in order that it might be tailored to the individual’s background, future need, and level of progress”, and that “a satisfactory program for family practice will generally require 3-4 years after medical school, the exact time will vary with the organization of the program and the individual trainees’ particular needs.”
Slide20Family Medicine Length of Training Pilot (FM-LTP)BACKGROUND1969 First RRC Program Requirements – “There is wide variation of circumstances under which the family physician will function, both geographically and in his association with other physicians. His educational program is to be designed in conformity with the general principles set forth in the following basic program. Flexibility is necessary and the program may be adjusted according to his predicted needs and should be carried out under the guidance and control of his program director.”
Slide21Family Medicine Length of Training Pilot (FM-LTP)BACKGROUND2004 Task Force II, FFM Project – “That, in the interest of promoting active experimentation in Family Medicine education, the relative merits of 3-year versus 4-year training programs be evaluated through a national experiment based in pilot programs approved by the American Board of Family Medicine (ABFM) and the RC-FM that will measure and report on learning, outcomes, costs, benefits, and disadvantages.”
Slide22Preparing the Personal Physician for Practice (P4)HendersonvilleMiddlesexUniversity of MissouriLoma Linda (and others)
Slide23Should I.M. Residency Training Be Extended?NoRef.The HospitalistApril 2011
Slide24The PilotDesigned as a cross-sectional study of 20-25 residency programs (based on power analysis) with an equal number of programs to serve as controlsThe ACGME RC-FM will provide ultimate oversightEstablish policies for the pilotDefine selection criteriaChoose participating residenciesWith the ABFM, appoint a Steering Committee to oversee evaluationAssure communication among RC-FM, ACGME, and the family medicine organizations… as well as other key stakeholders from other fields
Assist with interpretation of the evaluation results
Slide25Steering CommitteeJim Martin, ChairPeter CarekColleen ConrySteve CranePerry DickinsonAlan
Douglass
Jay Fetter
Lars Peterson
Jim PufferPerry Pugno
Slide26Key Assumptions and Founding PrinciplesDecreased clinical experience and responsibility in medical schoolDecreased hours of trainingIncreased scope of biomedical knowledge and the need to obtain skills using new technologiesIncreased scope of responsibilityIncreased flexibility of training is a desired feature of residency redesign
Slide27Evaluation FrameworkThe ABFM Foundation has committed up to $2 million to finance the evaluation of the pilotThe Steering Committee (appointed by RC-FM/ABFM) will guide the process and report resultsComparative case studyMixed methods approachQuantitative and qualitative methodsSpecific hypotheses evaluatedMeasurement of both processes and outcomes
Core evaluation team
plus
on-site faculty project leader and evaluator
Pre-, Interim, and Post-study periods
Slide28Evaluation FrameworkCore to the evaluation process will be the assessment of core competencies (i.e. patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and system-based practice) as well as the ability of residents and graduates to manage the health of populations through both quantitative and qualitative research methods.
Slide29Length-of-Training Pilot Announced in ACGME NewsletterACGME e-CommunicationFebruary 20, 2012RRC News―Family Medicine• The RRC for Family Medicine (in partnership with the American Board of Family Medicine) has submitted and received approval from the ACGME Board of Directors for a pilot project that will examine the length of residency education in family medicine.Specifically, the purpose of the pilot is to examine whether extending the length of family medicine residency education to four years through the development of innovative education paradigms further prepares family physicians to serve as highly effective personal physicians in a high performance health care system.Additional details of the pilot, including the application process, will be posted to the RRC for Family Medicine web page within the coming weeks. Once the details are posted, the links will be included in an upcoming issue of ACGME e-Communication.
Slide30TimelineAnnouncement – February 2012Selected Programs Notified – Summer 2012Programs Begin Pilot – July 2013Pilot Duration – 2013 - 2019
Slide31To be announced soon…Eligibility ParametersApplication Process (including the standardized ACGME Proposal for Program Experimentation and Innovation Project form)Selection CriteriaRequirements for Participation