1	What Every Ophthalmologist Should Know About the ACGME Core Competencies
2	Accreditation Council for Graduate Medical Education’s Six (7) Core Competencies Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice + Surgery
3	"1" 1. Patient Care: compassionate, appropriate, and effective. 2. Medical Knowledge: established and evolving biomedical, clinical sciences and the application of this knowledge to patient care.
4	"3" 3. Practice-Based Learning and Improvement: learn from patient care and literature then improve patient care. 4. Interpersonal and Communication Skills: effectively exchange information and teaching with patients, families, and health care team.
5	"5" 5. Professionalism: commitment to professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. 6. Systems-Based Practice: awareness of the larger context and system of health care and the ability to use the system. 7. Surgery: capable of doing surgical procedures expected of comprehensive ophthalmologist.
6	Why should you care? 1. Resident assessment is based on the competencies.
7	“Minimum Program Requirements” Educational Program The residency program must require its residents to obtain competence in the 7 areas below to the level expected of a new practitioner.
8	“Minimum Program Requirements” Evaluation of Residents: The residency program must demonstrate that it has an effective plan for assessing resident performance and for utilizing assessment results to improve resident performance.
9	Out with the Old “Minimal Threshold Model” for accreditation Minimum numbers (cases, patients) Minimum threshold does not measure competence!
10	In with the New Competency-based model Evidence (not just talk) Competency-based model examines whether the program is actually educating
11	ACGME Outcome Project Long term initiative emphasizing clinical outcomes Phase One: 7/01-6/02 (completed) Resident Review Committee (RRC) define approach appropriate to specialty. Programs plan to integrate competencies and develop new assessment tools RRC’s can make constructive criticisms in the form of citations before July, 2002
12	ACGME Outcome Project Phase Two: 7/02-6/06 (current) Improve evaluation process for each competency Provide aggregated resident performance data RRC to review teaching and assessing competencies with new better tools.
13	ACGME Outcome Project Phase Three: 7/06-6/11 Performance data used as basis for improvement and accreditation. RRC to review improvements to program are data driven Phase Four: 7/11 and beyond Identify benchmarks Educate community about good GME
14	Why Change? Accountability Public funding supports system System is accountable to the “public” Public demands “proof of quality” Government regulations Marketplace “wants their money’s worth” So What? If we (MDs) don’t do it, someone else (politicians) will! Produce better Docs?
15	“Minimum Program Requirements” We need: Valid & reliable measures of competence Regular and timely performance feedback To use assessment results to achieve progressive improvements
16	Resident Assessment Tools OKAP faculty evaluations “360-Degree Evaluations”
17	Assessment Tool
18	OCEX
19	OCEX Scoring Rubric
20	Interpersonal Skills
21	OCEX: Interrater Reliability 110 video CDs sent 94 completed OCEXs Data analyzed by SPSS software Interrater reliability coefficient α = 0.81 This is good! ACGME wants α ≥ 0.80
22	Assessment Tool
23	Portfolio A purposeful, continuous collection of resident work that exhibits the resident’s progress, effort and achievement. Includes examples of work and measures of accomplishments. Periodic review allows self-assessment, reflection on progress and provide a basis for change. Program director will periodically review.
24	Assessment Tool
25	Surgical Skills Checklist
26	Assessment Tool
27	On-Call Assessment Tool (OCAT)
28	Assessment Tool
29	Assessment Tool
30	WHAT SHOULD PROGRAMS DO? Think in terms of competencies Develop measurable learning objectives Choose a few tools (matrix) for measuring objectives CAN NOT “DO NOTHING”
31	A Plan Pick tools to cover each competency Consider existing tools (global eval, 360) New validated tools (OCEX) Portfolio
32	The main barrier(s) to success: Overcoming inertia Unfunded mandate Getting faculty “Buy in”
33	Barriers to Buy-in Physicians dislike being told what to do Ingenious faculty dodge formal processes Additional time commitment
34	Achieving Faculty Buy-in The PD has to be the internal champion Start simple & small Show success with ONE tool at a time “Peer to Peer” = superior tactic Form intradepartmental Task Force Select individuals with interest in education Spread out burden (res & faculty)
35	Why you should care: Resident assessment is based on the competencies. Maintenance of certification (MOC) is based on the competencies.
36	Maintenance of Certification (MOC) MOC focuses on 6 general competencies integral to quality care: Patient care Medical knowledge Practice-based learning Interpersonal & communication skills Professionalism Systems-based practice
37	Maintenance of Certification (MOC) Evidence of professional standing (professionalism) Maintenance of license
38	Maintenance of Certification (MOC) 2. Evidence of practice performance. (patient care, practice based learning, systems based practice) Office record review 3 of 32 topic areas 5 charts per topic area Review sheets submitted (15) Years 3-4
39	Maintenance of Certification (MOC) Evidence of professional standing (professionalism) Maintenance of license
40	Maintenance of Certification (MOC) 2. Evidence of practice performance. (patient care, practice based learning, systems based practice) Office record review 3 of 32 topic areas 5 charts per topic area Review sheets submitted (15) Years 3-4
41	Office Record Review: Categories (32 total) Myopia Amblyopia Esotropia Dry eyes Open angle glaucoma Cataract Diabetic retinopathy Ptosis Refractive surgery
42	Office Record Review
43	Office Record Review
44	Maintenance of Certification (MOC) 3. Evidence of commitment to life-long learning & self-assessment. (medical knowledge, PBL) Part A: Continuing Medical Education (CME) 30 credit hours/year (3 ethics) Part B: Periodic Ophthalmic Review Test (PORT) 2 - 50 item review tests
45	Periodic Ophthalmic Review Test (PORT) categories:
46	Maintenance of Certification (MOC) 4. Evidence of cognitive expertise. (medical knowledge) Documentation of Ophthalmic Knowledge (DOCK) test closed book 50 item tests 1- core 2- practice specific years 8-10
47	Maintenance of Certification (MOC) Timeline
48	Long term implications Maintenance of certification (MOC) process will follow competency model & use same tools (already happening!) Pay for performance models will follow same structure and process Outcomes measures will be standardized across specialty and will be used in hiring/firing and reimbursement decisions
49	Why you should care: Resident assessment is based on the competencies. Maintenance of certification (MOC) is based on the competencies. Lifetime certificate holders may need MOC.
50	The Bottom Line The concept of competence is something we can all agree upon. How to assess/measure it is hard. How to relate it to outcomes is harder.
51	The Bottom Line Medical education in the USA is undergoing a paradigm shift! Can we educate Do we educate? (PROVE IT!)
52	The Real Issue Will this lead to better Ophthalmologists? Don’t know Think so!
53	Thank you for your attention