Next accreditation system focus of CEO’s speech at 2010 ACGME Annual Educational Conference Thomas J. Nasca, MD, MACP, gave welcoming address to 1,600 conference attendees

CHICAGO, March 23, 2010 –-The Accreditation Council for Graduate Medical Education is continuing its transition to a system of accreditation that encourages and recognizes innovation, improvement, and excellence, said Thomas J. Nasca, MD, MACP, chief executive officer of the ACGME.

Dr. Nasca discussed the ACGME’s shift to the next accreditation system in his March 6 welcoming address, “Transitions in the Learning Environment: Milestones, the Next Accreditation System, and Other Factors Influencing Graduate Medical Education,” to attendees of the 2010 ACGME Annual Educational Conference. The conference, which was held March 4-7 at the Gaylord Opryland in Nashville, Tennessee, attracted a record crowd of approximately 1,600 program directors, program coordinators, designated institutional officials, and other people involved in graduate medical education.

The shift to the next accreditation system began in the early 1990s when the ACGME introduced the Outcome Project, which requires residents to master six general competencies: interpersonal skills and communication, medical knowledge, patient care, practice-based learning and improvement, professionalism, and systems-based practice.

Now the ACGME is working with Review Committees, specialty medical organizations, and specialty boards to develop specific benchmarks of skills and knowledge that residents in every specialty must achieve at certain stages in their residencies, such as the third month, first year, and second year. These benchmarks, or milestones, of skills and knowledge will document their steadily increasing mastery of the six competencies.

Citing the example of the Milestone Group for Internal Medicine, Dr. Nasca said creating the milestones in internal medicine will demonstrate that “every internal medicine graduate meets the core competencies that are important to the public.”

Creating milestones for every specialty, he said, will ensure that “each program can certify, and the ACGME can certify, collectively, to the public that the residents meet these competencies.”

The next accreditation system will have longer accreditation cycles for strong programs, an emphasis on innovation and excellence, and more frequent collection and review of data between site visits.

In addition, the next accreditation system will require more accountability from institutions that sponsor residency programs, said Dr. Nasca, as well as more sharing of aggregate graduate medical education data and less frequent revisions of standards.

Underlying everything the ACGME does, he noted, are three principles: the safety of patients under the care of residents and faculty in teaching institutions, the safety of the patients that residents will care for in later years when they are in independent practice, and the assurance that residents are being educated in a safe, humanistic environment that nurtures professionalism and the effacement of self-interest.

As the next step in the process toward a new model of accreditation, the ACGME Board of Directors held a strategic retreat in February. The Board appointed a task force that will develop recommendations for the next accreditation system and present them to the Board in February 2011.

The ACGME is moving toward its next accreditation system in the context of increasing public scrutiny of physician training.

“We have entered an era of zero tolerance for medical errors and the public has very high expectations for the quality of care that they will receive,” said Dr. Nasca. “The profession, and those of us involved in the education of the next generation of physicians, must enhance the public’s trust in the profession and the quality of care provided by our residents in the teaching setting.

“There is pressure in the profession to try to mend the fraying social contract. We live and teach in the context of the real word. We need to understand that these pressures exist. The public and government are paying attention to graduate medical education, and we need to respond to the public’s and profession’s calls for redesign of graduate medical education in response to future needs of the public.”

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The ACGME is a private, non-profit council that accredits approximately 8,800 residency programs in 130 specialties and subspecialties educating 112,600 residents. Its mission is to improve health care by assessing and advancing the quality of resident physicians’ education through accreditation.