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Pathways To Excellence

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As you may know, the ACGME is coming to visit the DMC residency programs that operate out of Detroit Receiving Hospital for a CLER visit as part of the Next Accreditation System.

First of all, what is the Next Accreditation System? The ACGME has been implementing a new accreditation system for residency and fellowship programs. Among the changes include the new Milestones evaluation system which we have already seen being incoporated into our evaluation process in New Innovations.

As a review, the Internal Medicine Milestones are progressive stages of resident competance that are monitored by faculty and track the progress from “critical deficiencies” to “ready for unsupervised practice” to “aspirational”.  These are based on tangible sklils that residents are able to perform in various areas.  There are 22 milestones within six core areas. These areas include patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.  For more information on the milestones, please read here.

The CLER visit is an additional aspect of the accreditation system for residency programs and fellowships. According to the ACGME, “CLER emphasizes the responsibility of the sponsoring institution for the quality and safety of the environment for learning and patient care.” The following information comes from the ACGME website.

CLER assesses sponsoring institutions in the following six focus areas:

  • Patient Safety – including opportunities for residents to report errors, unsafe conditions, and near misses, and to participate in inter-professional teams to promote and enhance safe care.
  • Quality Improvement – including how sponsoring institutions engage residents in the use of data to improve systems of care, reduce health care disparities and improve patient outcomes.
  • Transitions in Care – including how sponsoring institutions demonstrate effective standardization and oversight of transitions of care.
  • Supervision – including how sponsoring institutions maintain and oversee policies of supervision concordant with ACGME requirements in an environment at both the institutional and program level that assures the absence of retribution.
  • Duty Hours Oversight, Fatigue Management and Mitigation – including how sponsoring institutions: (i) demonstrate effective and meaningful oversight of duty hours across all residency programs institution-wide; (ii) design systems and provide settings that facilitate fatigue management and mitigation; and (iii) provide effective education of faculty members and residents in sleep, fatigue recognition, and fatigue mitigation.
  • Professionalism—with regard to how sponsoring institutions educate for professionalism, monitor behavior on the part of residents and faculty and respond to issues concerning: (i) accurate reporting of program information; (ii) integrity in fulfilling educational and professional responsibilities; and (iii) veracity in scholarly pursuits.

So what is it that we need to know as residents to prepare for the visit??  The best thing is to simply be aware of the progress made is the focus areas above and work daily to integrate these into your medical and professional practice.  A few of the notable tools and practices we use at the DMC include the following:

  • Core Measures Initiative
  • MIDAS Incident Reporting (EPIR reporting at the VAMC)
  • CORES Signout Tool (built-in signout inside of PowerChart)
  • Taxi ride reimbursement for tired residents
  • QUESST Resident Quality Improvement
  • Net Learning Modules

What now??

From now on we will be addressing each of these six core areas as each Resident Council meeting to help identify areas of concern more quickly, correct these problems efficiently, and prospectively act to help bring our programs to the forefront of medical education.

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