Evaluations: The Next Accreditation System

Download as PDF

The “Next Accreditation System” (NAS) is the new ACGME mechanism for evaluating and accrediting residency programs. It is based on learning stages called “Milestones”, which serve as the benchmark for evaluating resident performance in the clinical setting [see Nasca et al The Next GME Accreditation System – Rationale and Benefits, N Engl J Med 366(11):1051-1056, March 15th 2012.].

The Milestones are observable developmental steps that describe a trajectory of academic progress in about 30 domains of neurological training, including history-taking, neurological examination, neurological subspecialties and diagnostic tests. Using the evaluations of fellow’s performance on every rotation, the Department’s Clinical Competency Committee will track each fellows’s learning progress, from the first day to graduation, towards the goal of achieving independence for clinical practice. The Milestone evaluations on each fellow will be reported to the ACGME twice annually.

You can access the ACGME Clinical Neurophysiology Milestones using the following link:

https://www.acgme.org/Portals/0/PDFs/Milestones/ClinicalNeurophysiologyMilestones.pdf

The following elements will be used for the evaluation of fellows achieving core competencies:

  1. Faculty/Attending Evaluation of Resident Performance

    • During clinical rotations, the attending will provide verbal evaluation and feedback during clinical case presentations, patient examination, discussion of differential diagnosis and management, and review of neuroradiology studies.
    • During clinical rotations, the attending will review fellows’ notes – both admission history and physicals as well as daily progress notes.  He/She will evaluate notes for appropriate structure, thoughtful differential diagnosis, and formation of appropriate management plan.
    • At the completion of clinical rotations, the attending will complete written evaluations using the MedHub system.  These evaluations include measures of the six core competencies as identified by the ACGME.
    • After completion of rotations, fellows will present at monthly morbidity and mortality conference, where they receive verbal and written feedback on difficult clinical scenarios.

  2. Program Director Evaluations

    1. Every quarter, the fellows will have a face to face meeting with the program director.  During this meeting, the program director will review written feedback, give direct verbal feedback and discuss fellowship and career planning.
    2. At completion of fellowship training, the program director will complete a summary evaluation that confirms competence to begin practice without direct supervision.

  3. Nurse Practitioner Evaluation of Fellow Performance

    • The nurse practitioners who work with the fellows for the care of the inpatient neurology services evaluate competency in a number of domains, including but not limited to: interpersonal skills and communication, including signing out patient information; practice-based learning and improvement, including time management skills; professionalism; and systems-based practice, including the ability to work with other members of the health care team and share information with other providers at interdisciplinary rounds.

  4. Self-Assessment

    • Fellows will evaluate themselves, and use these self-assessments of their own knowledge and skills as a way to address practice-based learning and improvement and foster thoughtful reflection on their own career progress and plans.

  5. Attendance at Conferences (EEG Major)

    • Attendance at conferences will be used as one way of assessing medical knowledge, professionalism, and practice-based learning and improvement.
    • Fellows are expected to attend all conferences unless exempted because of urgent patient care responsibilities, Bell Commission requirements, or permission from the Chief of Service.  Conferences include:
      1. Summer Lecture Series (Dr. Rachael Benson)
      2. Weekly Epilepsy Surgery Case Conference (Dr. Carl Bazil)
      3. Weekly Epilepsy Research Conference (Dr. Michelle Bell)
      4. Monthly Journal Club (rotating faculty)
      5. Fellows Weekly Didactic Lecture Series (Dr. Rachael Benson)
      6. Department of Neurology Grand Rounds (Dr. Richard Mayeux)
      7. Monthly Institute of Genomic Medicine Epilepsy Conference (Dr. David Goldstein)

  6. Fellows Evaluation of Program

    All fellows will have the opportunity to evaluate the program confidentially and in writing at least annually, and the program will use this feedback to make improvements to the training experience.

    • The following mechanisms will be used to evaluate the program:

      1. Online feedback of the program in a written format through the MedHub system.

      2. Annual meeting of all fellows to discuss weaknesses and items of deficiency in the program.

      3. Annual written feedback and evaluation of the fellowship program

        • Items identified through the annual program evaluation meetings and written evaluations will be used to develop an action plan in conjunction with the program director and faculty. 
      4. Individual in-person meetings between each fellow and the program director to give verbal evaluation and feedback on the fellowship program strengths and weaknesses.