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Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multisociety Interventional Pulmonology Fellowship Accreditation Committee.
Mullon JJ, Burkart KM, Silvestri G, Hogarth DK, Almeida F, Berkowitz D, Eapen GA, Feller-Kopman D, Fessler HE, Folch E, Gillespie C, Haas A, Islam SU, Lamb C, Levine SM, Majid A, Maldonado F, Musani AI, Piquette C, Ray C, Reddy CB, Rickman O, Simoff M, Wahidi MM, Lee H
(2017) Chest 151: 1114-1121
MeSH Terms: Accreditation, Bronchoscopy, Clinical Competence, Curriculum, Education, Medical, Graduate, Faculty, Medical, Fellowships and Scholarships, Humans, Pulmonary Medicine, Societies, Medical, Thoracoscopy, Time Factors
Show Abstract · Added April 3, 2017
Interventional pulmonology (IP) is a rapidly evolving subspecialty of pulmonary medicine. In the last 10 years, formal IP fellowships have increased substantially in number from five to now > 30. The vast majority of IP fellowship trainees are selected through the National Resident Matching Program, and validated in-service and certification examinations for IP exist. Practice standards and training guidelines for IP fellowship programs have been published; however, considerable variability in the environment, curriculum, and experience offered by the various fellowship programs remains, and there is currently no formal accreditation process in place to standardize IP fellowship training. Recognizing the need for more uniform training across the various fellowship programs, a multisociety accreditation committee was formed with the intent to establish common accreditation standards for all IP fellowship programs in the United States. This article provides a summary of those standards and can serve as an accreditation template for training programs and their offices of graduate medical education as they move through the accreditation process.
Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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12 MeSH Terms
Automated Case Cancellation Review System Improves Systems-Based Practice.
Starnes JR, McEvoy MD, Ehrenfeld JM, Sandberg WS, Wanderer JP
(2015) J Med Syst 39: 134
MeSH Terms: Accreditation, Anesthesiology, Clinical Competence, Efficiency, Organizational, Health Knowledge, Attitudes, Practice, Humans, Information Systems, Internship and Residency, Interpersonal Relations, Preoperative Period, Problem-Based Learning, Professionalism, Time Factors
Show Abstract · Added October 17, 2015
BACKGROUND - Accreditation Council for Graduate Medical Education (ACGME) core competencies of systems-based practice and practice-based learning and improvement are difficult to assess, as they are often not directly measurable or observable. Reviewing day-of-surgery cancellations could provide resident learning opportunities in these areas.
OBJECTIVE - An automated system to facilitate anesthesiology resident review of cancelled cases was implemented on the Preoperative Evaluation Clinic (PEC) rotation at the authors' institution. This study aims to evaluate its impact on resident education.
METHODS - Residents on the PEC rotation during the 6 months preceding (n = 22) and following (n = 13) implementation in 2014 were surveyed about their experience performing cancelled case reviews in order to ascertain the effect of the intervention on their training.
RESULTS - Significant changes were reported in the number of cases reviewed by each resident (p < 0.0001), perceived importance of review (p = 0.03), and ease of review (p = 0.03) after system implementation. There was also an increase in the proportion of cancelled cases reviewed from 17.3% (34 of 196) to 95.6% (194 of 203) (p < 0.0001). Non-significant trends were seen in perceived rotation effect on ACGME competencies, including systems-based practice. Several specific improvements to our clinical practice, including the creation of standardized guidelines, arose from these case reviews.
CONCLUSION - Implementation of automated systems can improve compliance with educational goals by clarifying priorities and simplifying workflow. This system increased the number of cases reviewed by residents and the perceived importance of this review as a part of their educational experience.
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13 MeSH Terms
Early experience in establishing and evaluating an ACGME-approved international general surgery rotation.
Tarpley M, Hansen E, Tarpley JL
(2013) J Surg Educ 70: 709-14
MeSH Terms: Accreditation, Adult, Clinical Competence, Competency-Based Education, Education, Medical, Graduate, Female, General Surgery, Guidelines as Topic, Humans, Interdisciplinary Communication, International Educational Exchange, Internship and Residency, Kenya, Male, Program Evaluation, Societies, Medical, Time Factors, United States
Show Abstract · Added March 7, 2014
BACKGROUND - In 2011, the Accreditation Council for Graduate Medical Education Surgery Residency Review Committee first provided guidelines for elective international general surgery rotations. The Vanderbilt general surgery residency program received Surgery Residency Review Committee approval for a fourth-year elective in Kenya beginning in the 2011-2012 academic year. Because this rotation would break ground culturally and geographically, and as an educational partnership, a briefing and debriefing process was developed for this ground-breaking year.
OBJECTIVES - Our objectives were to prepare residents to maximize the experience without competing for cases with local trainees or overburdening the host institution and to perform continuous quality assessment and improvement as each resident returned back.
METHODS - Briefing included health protection strategies, a procedures manual containing step-by-step preparation activities, and cultural-sensitivity training. Institutional Review Board exemption approval was obtained to administer a questionnaire created for returning residents concerning educational value, relations with local trainees, physical environment, and personal perceptions that would provide the scaffold for the debriefing conference.
RESULTS - The questionnaire coupled with the debriefing discussion for the first 9 participants revealed overall satisfaction with the rotation and the briefing process, good health, and no duty hours or days-off issues. Other findings include the following: (1) emotional effect of observing African families weigh cost in medical decision making; (2) satisfactory access to educational resources; (3) significant exposure to specialties such as urology and radiology; and (4) toleration of 4 weeks as a single and expressed need for leisure activity materials such as books, DVDs, or games. The responses triggered adjustments in the briefing sessions and travel preparation. The host institution invited the residents to return for the 2012-2013 year as well as 2013-2014.
CONCLUSION - Detailed preparation and the follow-up evaluation for assessment and improvement of this nascent international surgery experience are associated with resident satisfaction and the host institution has agreed to continue the rotation.
Copyright © 2013 Association of Program Directors in Surgery. All rights reserved.
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18 MeSH Terms
Systematic barriers to the effective delivery of home dialysis in the United States: a report from the Public Policy/Advocacy Committee of the North American Chapter of the International Society for Peritoneal Dialysis.
Golper TA, Saxena AB, Piraino B, Teitelbaum I, Burkart J, Finkelstein FO, Abu-Alfa A
(2011) Am J Kidney Dis 58: 879-85
MeSH Terms: Accreditation, Health Services Accessibility, Hemodialysis, Home, Humans, Kidney Failure, Chronic, Medicare, Nephrology, Patient Education as Topic, Peritoneal Dialysis, Prospective Payment System, Total Quality Management, United States
Show Abstract · Added March 19, 2014
Home dialysis, currently underused in the United States compared with other industrialized countries, likely will benefit from the newly implemented US prospective payment system. Not only is home dialysis less expensive from the standpoint of pure dialysis costs, but overall health system costs may be decreased by more subtle benefits, such as reduced transportation. However, many systematic barriers exist to the successful delivery of home dialysis. We organized these barriers into the categories of educational barriers (patient and providers), governmental/regulatory barriers (state and federal), and barriers specifically related to the philosophies and business practices of dialysis providers (eg, staffing, pharmacies, supplies, space, continuous quality improvement practices, and independence). All stakeholders share the goal of delivering home dialysis therapies in the most cost- and clinically effective and least problematic manner. Identification and recognition of such barriers is the first step. In addition, we have suggested action plans to stimulate the kidney community to find even better solutions so that collectively we may overcome these barriers.
Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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12 MeSH Terms
The use of a multidisciplinary morbidity and mortality conference to incorporate ACGME general competencies.
Kauffmann RM, Landman MP, Shelton J, Dmochowski RR, Bledsoe SH, Hickson GB, Beauchamp RD, Dattilo JB
(2011) J Surg Educ 68: 303-8
MeSH Terms: Accreditation, Clinical Competence, Congresses as Topic, Education, Medical, Graduate, General Surgery, Humans, Interdisciplinary Communication, Internship and Residency, Male, Morbidity, Mortality, Quality Improvement, Retrospective Studies, United States
Show Abstract · Added May 3, 2013
BACKGROUND - The Surgical Morbidity and Mortality conference has long been used as an opportunity for both process improvement and resident education. With recent heightened focus on creating environments of safety and on meeting the Accreditation Council for Graduate Medical Education (ACGME) General Competencies, novel approaches are required. With the understanding that the provision of medical care is an inherently multidisciplinary enterprise, we advocate the creation and use of a Multidisciplinary Morbidity and Mortality conference (MM&M) as a means to establish this culture of safety while teaching the ACGME General Competencies to surgery residents.
METHODS - A quarterly MM&M conference was implemented to foster communication between disciplines, provide a forum for quality improvement, and enhance patient care. All stakeholders in the perioperative enterprise attend, including the departments of surgery, anesthesia, radiology, pharmacy, nursing, environmental services, risk management, and patient services. Cases that expose system issues with potential to harm patients are discussed in an open, nonconfrontational forum. Solutions are presented and initiatives developed to improve patient outcomes. We retrospectively reviewed the topics presented since the conference's inception, grouping them into 1 of 7 categories. We then evaluated the completion of the improvement initiatives developed after discussion at the conference.
RESULTS - Over a 21-month period, 11 cases were discussed with 23 "actionable" initiatives for quality improvement. Cases were grouped by category; procedures (36.5%), process (36.5%), patient-related (9%), communication (9%), medication (9%), device (0%), and ethics (0%). All cases discussed addressed at least 4 of the 6 ACGME General Competencies.
CONCLUSIONS - Like the practice of medicine, the occurrence of adverse outcomes is frequently multidisciplinary. An MM&M conference is useful in its potential to meet ACGME General Competencies, engender a culture of patient safety, and rapidly achieve quality improvement and systems health care delivery initiatives in a large academic medical center.
Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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14 MeSH Terms
The patient-centered medical home: managed care repackaged or something better?
Wish J, Golper TA
(2009) Nephrol News Issues 23: 56, 58, 60-2
MeSH Terms: Accreditation, Chronic Disease, Health Care Rationing, Health Care Reform, Health Resources, Home Care Services, Humans, Kidney Diseases, Patient-Centered Care, United States
Added March 19, 2014
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10 MeSH Terms
Peers, regulators, and professions: the influence of organizations in intensive insulin therapy adoption.
Campion TR, Gadd CS
(2009) Qual Manag Health Care 18: 115-9
MeSH Terms: Critical Care, Decision Making, Organizational, Diffusion of Innovation, Humans, Insulin, Joint Commission on Accreditation of Healthcare Organizations, Peer Group, United States
Show Abstract · Added January 20, 2015
INTRODUCTION - Following the landmark Leuven study in 2001, health care organizations implemented intensive insulin therapy (IIT) as the standard of care for critically ill patients. However, a recent meta-analysis showed no mortality benefit and an increased safety risk for patients treated with IIT. IIT affects labor and capital decisions related to nurses, physicians, pharmacists, managers, laboratory personnel, and informatics staff. The expenditure of labor and capital to provide IIT without corresponding outcome improvements suggests the adoption of IIT produces inefficiency in hospital.
THEORETICAL BACKGROUND - In sociology and organizational studies, the tendency for organizations to become more similar without necessarily becoming more efficient is called normalfont institutional isomorphism. Institutional isomorphism examines the pressure that organizations encounter from peers, regulators, and professions through mimetic, coercive, and normative mechanisms, respectively. To enhance their prospects of survival, organizations establish and maintain legitimacy by adopting socially acceptable approaches to work endorsed by successful peer organizations, regulatory agencies, and professional societies. ORGANIZATIONAL INFLUENCE IN THE ADOPTION OF IIT: This paper describes how organizational influence-through the Leuven study, the Joint Commission, and professional organizations-played a role in the widespread adoption of IIT. Divergence from institutionalized forms may explain variation in IIT studies following Leuven.
CONCLUSION - Health care researchers practitioners, and managers should consider organizational influence when implementing large-scale clinical activities.
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8 MeSH Terms
Resident duty hour restrictions: is less really more?
Brion LP, Neu J, Adamkin D, Bancalari E, Cummings J, Guttentag S, Juul S, Norwood VF, Ryan RM
(2009) J Pediatr 154: 631-632.e1
MeSH Terms: Accreditation, Clinical Competence, Continuity of Patient Care, Hospitals, Teaching, Humans, Internship and Residency, National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division, Personnel Staffing and Scheduling, Physician-Patient Relations, Quality Assurance, Health Care, United States, Workload
Added January 20, 2015
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12 MeSH Terms
Assessing retroperitoneal lymphadenectomy experience in United States urological residency programs.
Lowrance WT, Cookson MS, Clark PE, Smith JA, Chang SS
(2007) J Urol 178: 500-3; discussion 503
MeSH Terms: Accreditation, Clinical Competence, Curriculum, Humans, Internship and Residency, Lymph Node Excision, Retroperitoneal Space, United States, Urology
Show Abstract · Added May 27, 2014
PURPOSE - Surgical experience is important for the mastery of operative procedures. We evaluated the current United States urological surgical resident training in performing retroperitoneal lymph node dissection.
MATERIALS AND METHODS - The Accreditation Council for Graduate Medical Education Residency Review Committee for Urology operative log reports from 2000 through 2004 were reviewed. We analyzed resident retroperitoneal lymph node dissection experience as surgeon and first assistant by examining CPT codes for retroperitoneal lymph node dissection (CPT codes 38780, 38570 and 38572).
RESULTS - The overall number of retroperitoneal lymph node dissections performed at urological residency training programs has increased from 2000 to 2004 (781 to 924). The average number of retroperitoneal lymph node dissections performed by graduating residents in 2001 and 2004 did not change significantly (3.5 vs 4.0). Half of all graduating urology residents in 2004 had performed 2 or fewer retroperitoneal lymph node dissections as the primary surgeon and 1 or none as the first assistant during their training program. However, a small percentage (10%) of graduating residents completed their respective programs with 9 or more retroperitoneal lymph node dissections as primary surgeon and 4 as first assistant. There were no laparoscopic retroperitoneal lymph node dissections logged by graduating residents from 2001 through 2004.
CONCLUSIONS - Accreditation Council for Graduate Medical Education data suggest that many urology residents have minimal surgical exposure and training in retroperitoneal lymphadenectomy. These results indicate that alternative strategies should be explored not only to improve the residency training experience but also to determine minimum training criteria.
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9 MeSH Terms