ACGME Roadmap to a Successful General Surgery Program

Joe Catanese | April 15, 2019

Joe brings significant subject matter expertise in strategic planning, new program development, development of GME institutional accreditation/sponsorship documents, and accreditation of new ACGME programs. In this webinar, he'll guide you through a roadmap to implementing and maintaining a successful general surgery residency program.

"Hi, I’m Joe Catanese, I’m a managing director at Germane Solutions. I lead our academic and accreditation consulting here at Germane. Here, our main task is to run through an ACGME roadmap to a successful general surgery program. When you look at all of these items on this whiteboard, it can seem very overwhelming, but our main task is to try and outline all of the items for you in a way that is easy to understand. A very easy method to look through this plan to make this intense process look a little easier. Now, as you might be expecting, we do have a longer work plan that we’re able to show and utilize for you, so be sure to contact us following this webinar.

When you’re going through the process for general surgery, you’ve already figured out that you have the capabilities to do the service lines. You’ve gone through Feasibility and you’ve determined that you will be financially successful and able to support this program. So, we’re just starting when you’re filling out the application and all of the items you need to fill out to submit successfully to the accreditation council for graduate medical education (ACGME).

Now as you can see, the first step is going to be the naming of a program director. This is a very, very vital step as this individual is going to set the tone for the program. You’re going to want to make sure you meet three criteria for ACGME standards. First, is this individual formerly a part of an ACGME accredited program or an AOA program, as its going to be very helpful if that individual has past teaching experience. Do they have a faculty appointment? Were they an associate professor at a medical school or a different type of institution, getting that full-fledged administrative experience? Also, where do they stand in terms of scholarly endeavors? Peer-reviewed publications, book chapters. They’re really going to be setting the tone in that regard as well, if we are in a community hospital setting we’re really going to want to make sure that if we have faculty that needs some development for research, that this program director is really going to set the tone there and make a really good curriculum for us moving forward.

Once you choose a program director, you can open what is called the web accreditation data system (WebADS). All of these items on display here are all going to be uploaded and placed into the WebADS system for us to submit successfully to the ACGME as one full PDF.

Stemming from that, the program director will then name core faculty members. These faculty members are going to be those that are devoting a large majority of their time to the program. A large majority is currently about in the 15 hour per week time frame. Currently, you need one for every chief resident in your program. Thus, if you have a 15-resident program, 5 years with 3 per year, you would need three core faculty because you will have three chiefs. This is in addition to the program director. One other added piece is that if you have over 20 residents that you’re applying for, you need an associate program director or an APD.

Now when we’re thinking of our core faculty members, these can be core or adjunct faculty members, we have to think of our essential content areas of general surgery. Or some of our other specialty areas. The main specialty areas are going to be Vascular, thoracic, abdomen and its contents (which will really be pancreas and liver – this is an area where we always find that a lot of hospitals are severely lacking in that regard), Alimentary tract, skin soft tissue & breast, endocrine, head and neck, pediatrics, transplant, and trauma & surgical critical care. We really want to make sure that we have a large division of faculty that are all-encompassing that they go through different specialty areas so we can show the ACGME that we have a lot of faculty interest there.

Now, we get into item five where we are going to have three of the most difficult pieces that many programs are going to find. I try to get this out into the open early. Once you obtain all of the correct faculty, trying to obtain their CVs can be very challenging. Not because they don’t have them, it’s just because they haven’t been updated in a long time. So, if we can get those to be properly updated, we have to insert each one manually into the web accreditation data system (WebADS). From there, we also want to determine, when we start determining our faculty and filling out a faculty roster, which of the necessary specialty areas do we not have. That means that we have to go outside of the system and name a different site to obtain case volumes in those areas. So, we would have to do a program letter of agreement (PLA). This is a very simple one to one-and-a-half-page document where we list a site supervisor at this different facility, and we show that we are going to follow certain policies and that they are going to evaluate residents as such. We follow that with specific goals and objectives. So, if we’re going to hospital B for transplant, we have to have goals and objectives for the transplant rotation following that. Finally, naming a program coordinator. This is an individual that we will need to place on the application that is going to provide more administrative support for the program. This is not going to be a physician or faculty member; this is going to be someone who is really going to be the face of our program.

Procedural volumes for the ACGME. We must, must, must make sure that we exceed the ACGME minimums per resident in general surgery. I also encourage that we look at the national resident average and that we meet at least the 50% percentile there. This is going to show the ACGME that not only are we prepared as far as faculty for the program, but that we are also ensuring adequate case volumes to train the residents. In all honesty, the faculty and the procedures are going to be the most vital pieces for a successful program.

Step seven is to confirm a block diagram. This is going to be a five-year block schedule that you will then create for one resident that you would then upload into WebADS. You’ll want to start that early on in the process, that way you can be editing and when you get core faculty together that we are not overwhelming any of them with too many or too few residents.

The eighth step is confirming program-specific policies. In conjunction with institutional policies that you completed to become an institutional sponsor; we now have to make program-specific policies. And in conjunction with the 2019 common program requirements, we want to make sure that we have policies in the following areas: supervision and accountability, clinical experience and education (formerly duty hours), transitions of care, fatigue mitigation, moonlighting, professionalism, well-being, and teamwork. Again, all of the policies will get uploaded into WebADS. Supervision and accountability gets uploaded on its own, the remainder of the policies get uploaded in a combined document.

Step nine. This is a piece that you will be able to get on the ACGME website, this is called the specialty-specific application. This is going to be a word document that we have to answer a lot of questions, based on our case volumes, based on the ACGME core competencies, we have to fill out our didactic schedule, and we will also talk about simulation and other items there. This is going to be another important piece as well that we want to work on as early as possible and have the program director working on that piece so that it can be edited and re-edited prior to submission.

As you can see, these items on the left side of the page are really going to be our most time-consuming pieces. So, if we can look at this and really try to work on those, these are things we would really try to impress on you to work on early and often.

Now, we move forward to step 10. Here, we have the WebADS common application. This is going to be the piece where the program director is first named, they will receive a username and password. You then will use the username and password to access and upload the documents to WebADS. There is also some narrative that we have to answer in the WebADS system.

This is going to be where steps six, seven, and eight come in. We’re going to answer questions around resident clinical experience and education (formerly duty hours), we’ll answer questions on the competency committee (who are the members, what are their responsibilities), the program evaluation committee (again who are the members, and what are their responsibilities). How are we addressing transitions of care? And how are we addressing progressive responsibility for the residents going through the program? We will also upload the faculty CVs here and will upload all attachments.

Moving forward, we have creating goals and objectives. We need two sets of goals and objectives here for upload. First are overall educational goals with a clearer mission and vision statement. Next are PGY-specific goals all merged together. You only need one example per PGY level, meaning if you had PGY 1-5, you’d have one rotation and have competency-based goals and objectives there. However, for the official site visit, you need a whole set of goals and objectives for the application.

We then move into our evaluations. We have three different types of evaluations. I separated the second type into two evaluations. First, we have program-specific evaluations. This is going to be a merge of all different types of evaluations. You could combine multi-source or 360 eval, resident evaluation after the rotation by the faculty. Then you have our anonymous evaluations, this will be our resident and faculty evaluating the program and the residents evaluating the faculty. Then we have our summative and semi-annual evaluations. Semi-annual every six months and summative at the end of training. Saying that they have correct skills to practice general surgery at the end of the program without supervision.

Now some areas that we want to make sure that we’re having the faculty take care of here. Faculty development sessions. We want to make sure that if we have new faculty, that we instruct them how to teach, proper bedside manner, way to teach surgical care, and we also want to make sure that we’re educating our entire hospital system of what it means to have a surgery residency.

Research curriculum. Demonstrating what sort of research curriculum, you want to make available for your faculty.

Prepping the entire hospital for GME and surgical residents.

We need to create a detailed 5-year didactic schedule for the program, so that’s something that is very important for a program. Incorporating basic science conferences, clinical conferences, morbidity and mortality, journal club and simulation.

Then, once we work through all of these items. We want to make sure that we are really reviewing and making proper drafts of our application. Having them reviewed by our faculty, our DIO, the program director, any outside entities that might have some important input. We want to make sure we solve all spelling and grammar issues and typos.

Finally, the program director, once everything is all together, you will submit the application to the ACGME. Once the program director hits submit, it goes to the DIO, and the DIO (designated institutional officer), will be the final sign-off before the document goes to the ACGME.

Now, you can see that this looks like a lot, but we tried to condense it in a way that it will be down to steps and you can check everything off on your way. So, once you submit, you’ll then be off and preparing for your site visit.

I appreciate your time, and if you have any questions please reach out to me at Germane Solutions online and we can give you a more in-depth consultation, thank you."

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