Evaluations: The Next Accreditation System

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The “Next Accreditation System” (NAS) is the 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 fellow’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 Epilepsy milestones using the following link:

https://www.acgme.org/Portals/0/PDFs/Milestones/EpilepsyMilestones.pdf?ver=2015-11-06-120531-877

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

  1. Faculty/Attending Evaluation of Resident Performance

    1. 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.
    2. 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.
    3. 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.
    4. 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

    • 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.
    • At completion of fellowship training, the program director will complete a summary evaluation that confirms competence to begin practice without direct supervision.

  3. 360 Evaluation of Fellow Performance

    • The nurse practitioners and technical, administrative and hospital nursing staff who work with the fellows for the care of the inpatient and outpatient 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

    • 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. Weekly Epilepsy Surgery Case Conference (Rotating Faculty)
      2. Weekly Epilepsy Research Symposium (Dr. Michelle Bell)
      3. Monthly Epilepsy Journal Club (rotating faculty)
      4. Fellows Weekly Didactic Lecture Series (Dr. Rachael Benson)
      5. Department of Neurology Grand Rounds (Dr. Richard Mayeux)
      6. Monthly Epilepsy Radiology Rounds (Dr. Angela Lignelli)