The ACGME Core Competencies

					The BWH/CH Neurosurgery
  Department Curriculum

Dong H. Kim, Mark Proctor, Arthur Day
• Models of accreditation
• ACGME Core Competencies
• New teaching methods/curriculum is
• New evaluation methods are required
• BWH/CH curriculum
• BWH/CH evaluation plan
      Models of Accreditation
• Previous Model
  – Emphasized the POTENTIAL of a program to
    educate residents by focusing on structure and
    process components.
     • Does the program comply with existing
     • Are there established objectives and an organized
     • Does the program evaluate its residents and itself?

     Models of Accreditation
• New Model
  – Emphasizes a program’s ACTUAL
    ACCOMPLISHMENTS through assessment
    of educational outcomes
    • Do the residents achieve the learning objectives set
      by the program?
    • What evidence can the program provide to support
      this achievement?
    • How does the program demonstrate continuous
      improvement in its own educational processes?

     ACGME Core Competencies
•   Patient Care
•   Medical Knowledge
•   Practice-Based Learning and Improvement
•   Interpersonal and Communication Skills
•   Professionalism
•   Systems-Based Practice
       ACGME Competencies
• Patient Care that is compassionate, appropriate,
  and effective for the treatment of health
  problems and the promotion of health

• Medical Knowledge about established and
  evolving biomedical, clinical, and cognate (e.g.,
  epidemiological and social-behavioral) sciences
  and the application of this knowledge to patient

       ACGME Competencies
• Practice-Based Learning and
  Improvement that involves investigation
  and evaluation of their own patient care,
  appraisal and assimilation of scientific
  evidence, and improvements in patient care

• Interpersonal and Communication Skills
  that result in effective information exchange
  and teaming with patients, their families,
  and other health professionals
       ACGME Competencies
• Professionalism, as manifested through a
  commitment to carrying out professional
  responsibilities, adherence to ethical
  principles, and sensitivity to a diverse patient

• Systems-Based Practice, as manifested by
  actions that demonstrate an awareness of and
  responsiveness to the larger context and system
  of health care and the ability to effectively call
  on system resources to provide care that is of
  optimal value
         Our Educational Activities:
Must be monitored and supervised by an attending!!

 •   Operating Room
 •   ICU Rounds (family meetings)
 •   Clinic
 •   Grand Rounds
 •   Conferences
 •   M and M
                         Educational Activities
                         Patient Medical   PBL   Interpers- Professio-   SBP
                          Care Knowledge         onal Skills nalism
Operating Room            X       X                 X           X        X
ICU Rounds                X       X                 X           X        X
Family Meetings                                     X           X
Clinic                    X       X                 X           X        X
Grand Rds-prof.                                                 X        X
Grand Rds-CPC             X       X        X                             X
Grand Rds-                        X        X

M and M                                    X
Conferences                       X
             Operating Room
• Teach surgical competence (PC)
• Discuss the indication and scientific basis for
  surgery (MK)
• Attendings serve as role models for Interpersonal
  Skills and Professionalism (ISP)
• Observe and mentor the resident on ISP
• Discuss the rationale for use of OR resources
  (cost-benefit analysis), discuss OR systems and
  how it relates to service/hospital efficiency (SBP)
• Complete review of medical/ICU management
• Teach procedural competence - lines, EVD
• Residents conduct occasional family meetings,
  with attending present; mentor the resident on ISP
• Teach the resident to work with nurses, other
  services and consultants (ISP, SBP)
• Discuss the rationale for use of hospital resources
  (length of stay), discuss interactions with care
  coordinators, therapists, other hospitals, including
  transfer and insurance issues (SBP)
       M&M, Grand Rounds
• M/M: practice-based learning and

• Grand Rounds: 4 week cycle
  – Week 1: Research
  – Week 2: Neurosurgery CPC
  – Week 3: Professionalism and Systems Based
  – Week 4: Controversies in Neurosurgery
         Grand Rounds: summer
• 8 sessions in July and August
• Keep current format; acute neurosurgery
   –   Trauma/ICP management
   –   SAH/vasospasm management
   –   Seizures/Epilepsy
   –   Acute stroke/cerebrovascular
   –   Acute tumor presentation/management
   –   Spinal cord compression/fracture
   –   Hydrocephalus
   –   Pediatric emergencies
   Grand Rounds-Research
– 10 sessions (September to June)
– Joe Madsen to lead
– Content:
   • Faculty presentation (particularly research faculty)
   • Invited talks
   • Resident research updates:
       – Before starting in lab
       – After year one
       – After year two
  Grand Rounds: CPC (10 sessions)
• Run by PGY 6
   – each PGY 6 does one session every other month
• Resident picks case for discussion
   – interesting medical issue or surgical case, unusual
     lesion, etc. - does not have to be a complication
• Invites a multidisciplinary group of experts that
  were involved
   – ICU team, pathologists, radiologists, consultants,
     neurologists, etc
• After discussion, literature review by the resident
   – 15 minutes (PC, MK, and PBL)
• Will promote multi-disciplinary understanding and
   Grand Rounds: Professionalism and
  Systems-Based Practice (10 sessions)
• Joe Madsen to lead
• Recurring, invited talks (CH and BWH staff)
   – State of the residency (matching program,
     ACGME/RRC reports, etc)
   – Risk management
   – Professionalism in workplace
   – Ethics in neurosurgery
      • Our responsibility to our patients, informed consent, end of life
        issues, relationship to equipment manufacturers/pharma
   – National regulatory bodies and laws
      • JCAHO, RRC, ACGME, federal funding of graduate ed.
Professionalism and Systems-Based
        Practice -continued
– NS leadership
   • National organizations (what it does, how to get involved)
   • What can we do locally, regionally, and nationally?
   • Requirement for certification by the board
– Payment/insurance (2 sessions)
   • CPT system, E/M, ICD 9, billing requirements
   • HCVA, contracts, HMO, PPO
   • State and national laws on billing
– Career options
   • Academic, private, Kaiser, VA/military, research
   • Role of fellowships in career development
– Future of medicine/neurosurgery
   • Coming trends, future of medicare, partners policies
    Controversies in Neurosurgery
            (10 sessions)
• Run by PGY 7 (each PGY 7 does one session
  every other month)
• Resident picks case for discussion
   – case with several treatment options
• Discussion led by specific faculty member (with
  remaining faculty interaction)
   – risks and benefits of each option
   – what option was used
   – what others would do
• Literature review of the controversy and possible
  treatments – 30 minutes (PC, MK, and PBL)
Conferences; on-service residents
• Wednesday
    6:45am:     Mock Oral Boards
    7:30am:     M&M

• Thursday
     7:00am:    Grand Rounds
     8:00am:    Radiology conferences
     9:00am:    Chief’s Conf (once/month)
     12:30pm:   Program Director’s Conf
     1:00pm:    Surgical Anatomy Conf
     2-4pm:     Curriculum Conf
Conferences (research residents)
• Surgical Anatomy and Skull Base Lab
  – 9am-12pm; two Thursdays/month
  – In anatomy lab at HMS (David Cardozo)
  – Taught by Bill Gormley and Dong Kim
• Review of all Rhoton anatomy papers
• Direct dissection on cadaver heads
  – All aspects of anatomy and surgical approaches covered
    over two years
  – Research residents continue to think “surgically”
  – Bill Gormley can impart his surgical experience
  – Our dissections and faculty help teach the medical
  BWH/CH Radiology Conference
• Maintain case-based format
• In addition, presentation every session from a
  neuroradiology fellow
   – 10-20 minutes at the beginning
   – Review of specific aspect of neuroimaging
      • Review of various MRI imaging sequences (what each is
        designed to detect)
      • Review of best test to detect specific lesions (abscess?
        Glioma? Etc)
      • Discuss complications of imaging (contrast, dose, etc)
      • Show “teaching cases” of images we don’t see often
        (neurodegeneration, encephalopathy, etc)
        Curriculum Conference
• 48 sessions per year
   – leaves 5 for meetings and holidays
• Over 2 year cycle, comprehensive review of all
  relevant topics in NS
   – as defined by the CNS education committee
• Resident preparation with attending proctoring of
  each topic
• All faculty are encouraged to participate in their
  areas of expertise
• Mark Proctor and/or Dong Kim will attend most
        Curriculum Conference
• Each resident will prepare a one-hour presentation
  per month (for PGY 6 and 7’s; grand rounds
  presentation counts as one hour)
• The topics will be pre-defined to complete review
  over 2 year cycle
   – (series of questions set by CNS committee)
• Each talk will be saved on our website
   – review in the next cycle will mean updating to topic
• Each resident will have 2+ cycles of review by
Curriculum Conference (cont’d)
• one intern and one pathology session per month
   – One hour basics review by the intern
   – One hour slide-review (with neuropathologist)

• 3 two-hour sessions per month
   – Tumor, Spine/PN, Cerebrovascular, Pediatrics
      • 15 sessions each
   – Trauma and Functional/Pain
      • 6 sessions each:
• Use of SANS to assess progress
ICU/critical care conferences

 • ICU core lecture/training

   – During 6 month PGY1 ICU rotation
   – Under Bill Gormley’s Direction

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