New Initiatives Aim to Improve Residency Application, Program Evaluation

Once NAS begins, all graduating otolaryngology (and other medical specialty) residents will need to show competency in 16 areas, known as milestones. Such milestones are developmentally based, specialty-specific achievements that residents are expected to demonstrate in established intervals throughout their training.

“The milestone project is the next step in the movement from process-based accreditation to outcomes-based accreditation,” said John Nylen, MBA, the chief financial officer and a senior vice president at the ACGME. The American Board of Medical Specialties and the ACGME are working together with residents and resident review committees, including OPDO, to create specific language for the otolaryngology milestones. They will “allow evaluators to determine the level of growth of the resident within that competency,” said Nylen.

Twenty U.S. otolaryngology residency programs will begin using the milestones on a trial basis in 2013. When the new milestones are fully implemented, a process that is planned to begin with the 2014–2015 academic year, all otolaryngology programs, along with all residency programs in all medical specialties, will evaluate their residents—and, consequently, the training program—using these milestones.

Milestones proposed by the otolaryngology RRC include 16 objective measurements, said Dr. Zacharek. Patient care objectives include topics relating to aerodigestive tract lesions, salivary disease lesions, sleep-disordered breathing/sleep medicine, facial trauma, rhinosinusitis, chronic ear disease and pediatric otitis media. Medical knowledge areas will cover upper aerodigestive tract malignancies, hearing loss, dysphasia and dysphonia and inhalant allergy. Other milestones reflect the ACGME’s existing core competencies of interpersonal and communication skills, practice-based learning and improvement, professionalism, systems-based practice for patient safety and systems-based practice for resource utilization.

The ACGME will continue to administer resident surveys and will add faculty surveys for the core faculty beginning in 2014. Both faculty and resident surveys will ask questions related to program resources, faculty involvement in education, the evaluation process, patient safety and duty hours.

“These surveys are anonymous, and the RRC sees only aggregate data,” said Dr. Choi. “Resident surveys in particular can highlight problems that the residents in a specific program may be having, and the RRC can then help the program address these issues.” Resident surveys have typically been administered in January or February of each year, and it’s likely the faculty surveys will be distributed around the same time.

Under the NAS, all residency programs will also be evaluated yearly, rather than the current frequency of every three to five years. Increasing the frequency will make it easier to identify underperforming programs earlier. “If the annual data indicates that the program may be struggling, the ACGME will schedule a focused or diagnostic site visit, which can be done on short notice, and help the program diagnose the problem and bring them back on track.”