#37 Board Member
Are you aware of the new mission, vision and values recently developed by ACGME?
Yes, briefly.
What impact, if any, does their new mission, vision, values have on you and your associates?
They do because currently I am resident director.
In general, what can the ACGME do to make your life easier?
Looking for ways that help rural programs where physicians are needed the most to reduce the administrative burden. Also to be able to model programs dependent on where they’re at. Not every program can fulfill every area of the mission we’d like, but that doesn’t mean they can be a good program.
We know that not all family docs that will do OB, but we still need to have it as an emphasis available to those who do. Within one program there might be different tracks that the resident could choose from.
Are you familiar with the governance structure and the board? Do you presently know how new members of the board of the ACGME are appointed?
Yes.
Do we have the right appointing organizations? (To the board? To the RRCs?) Should others be appointing? Who?
Yes.
Is there adequate representation on the executive committee?
Yes.
Should the Board be composed of competencies rather than representation?
I think they should have competence on the board and they could ask for certain competency requirements from the organizations that do the nominating.
Who should appoint members to the RRC’s?
What recommendations would you offer to strengthen the governance of ACGME?
It seems that the RRC has too much autonomy and the ACGME feels they can’t change what they decide. I want to see more oversight by the ACGME. They need to address the impact these decisions have.
What would make the board more inclusive?
What’s the optimal size for the board?
What do you see as your biggest challenge in coming onto the board?
The issue of oversight will be the biggest one. How do they handle the response when a program or RRC is out of bounds.
Is there something you would change in the relationship between ACGME and the RRCs?
How should the ACGME deal with consistency?
The need to look at the ramifications of any uniqueness in each program. The RRCs sometimes decide to go down a path that is contrary to the specialty itself. Most specialties and their boards are separate entities. The ACGME needs to make sure that what they’re deciding has been discussed, debated and reviewed the consequences before an actual decision gets made.
Should the RRCs do more collaborating between them?
Not necessarily but the RRC within that specialty and the board within it should collaborate. Those decisions should be scrutinized by the ACGME as a governing body.
Is there anything you could say about transparency?
No.
Do you think patients should be involved in assessing the competency of the RRCs?
Yes. We already do that in our institution. Patients can anonymously provide feedback about their experience.
How can we make sure that there is adequate representation from the RRCs in the halls of the ACGME?
What would you say is the greatest strength of the ACGME?
They are an independent body and can be unbiased to the extent that none of the organizations have any control over them. It’s a balanced group within the house of medicine because they do have representation.
What’s the blind spot of the ACGME?
If they have someone on the board who is an overbearing personality, they could sway things. It is so important that the nominating committee need to be very careful in their selection.
If you were going to send a message to the Board of ACGME about what should be changed, what would that be?
Work more closely with the programs that they are representing. First is going through a lot of groups and not truly know what’s going on the ground floor.
They need to get information from the people who have to implement.
Did you have challenges in implementing the competencies?
Not in implementing but in measuring the outcomes. To me, before an organization rolled out the competencies, they should have had the instruments for measuring them. Now we have all these different groups who try to come up with different ways to measure them.
If the competencies are a good idea and the ACGME wants to implement but the assessment tools are the hard part, would you delay the implementation?
No. But they should also say that within one year you should have an exact tool for assessment.
#38 ACGME employee
Are you aware of the new mission, vision and values recently developed by ACGME?
Yes.
What impact, if any, does their new mission, vision, values have on you and your associates?
It has a tremendous impact. The issues of developing innovative ways to promote them is a major force in the ACGME.
In general, what can the ACGME do to make your life easier?
The biggest issue for me is the paperwork issue. We are moving towards an electronic system, but that’s still a ways down the road. If the ACGME were to focus more of their efforts in that area, it would be very beneficial.
Do you presently know how new members of the board of the ACGME are appointed?
Yes.
Do we have the right appointing organizations? (To the board? To the RRCs?) Should others be appointing? Who?
The problem we have is that the appointing organizations have their own agendas and despite their fiduciary responsibility to the ACGME, those agendas come through in the nominations. I think individual appointments might be better than appointing organizations.
Should the Board be composed of competencies rather than representation?
Maybe. A better member would have more experience in medicine. By the time, members actually get to know the organization, they’re rotating off the board.
What do you think would improve the transparency between the ACGME and its constituencies?
A lot of times decisions are made in the executive committee but not communicated to the board. I’m comfortable in general with the overall transparency.
What recommendations would you offer to strengthen the governance of ACGME?
None.
What is the right relationship between ACGME and the RRCs?
The ACGME has authority over the RRCs but has let them be fairly independent. So I wouldn’t change anything in that regard.
How should the ACGME deal with consistency?
There are about 27 RRCs and about 27 ways of doing things. I know there has been some effort made to standardize, but the new electronic system will help a lot with that. There is a big difference in committees that use a computerized system and those that don’t.
Where is the line between standardization and flexibility?
You can standardize data collection and responses from site visits, but the accreditation is a peerdecision and that can’t really be standardized.
Should the RRCs do more collaborating between them?
I think so. There is a lot to be learned from each other. They could solicit innovation and information from pilots could be shared.
How can we make sure the voice of the RRCs in the halls of the ACGME?
The RRC council does that. That gives them a voice at the board of directors meeting.
What about the voice of the residents?
The ACGME needs to keep resident representatives on the committees and have residents play active role.
Do you have opinion about having patients being involved in assessing resident competencies?
They need to be involved in the quality of care they receive.
What would you say is the greatest strength of the ACGME?
It is committed to pursuing excellence in medical education. The ACGME’s biggest mantra is that they can ensure that residents can guarantee a quality education.
What’s the blind spot of the ACGME?
They’re moving from minimum requirements to excellence.
If you were standing in front of the Board of ACGME with a recommendation, what would it be?
Develop innovative ways to meet requirements.
Continue on the number of process-based requirements and look at what makes a physician.
What do you see as the challenges and what could be done to improve the competencies?
The local restrictions make it difficulty in assessing the competencies. They need tools and help in how they can implement these into their day-to-day lives and education. I think the ACGME is developing this in the portfolio but there needs to be more effort in that regard.
Anything else internally that could make things operationally better?
I think the effort to standardize the way things are being done in the individual RRCs really help. The internal communication could definitely be improved. I learn about other initiatives that are going on and if we knew about them, maybe we wouldn’t
#39 Member Organization - AAMC
Are you aware of the new mission, vision and values recently developed by ACGME?
Yes.
What impact, if any, does their new mission, vision, values have on you and your associates?
I am the fulltime president COO of the Association of American Medical Colleges. We have over 400 employees.
In general, what can the ACGME do to make your life easier?
The thing I’m most concerned about and gratified to see the ACGME taking on is the issue of conducting training that builds important core competencies and how we engage in assessment that measures the development of those competencies.
One of the biggest struggles of the ACGME is that the viscosity created by the RRCs and the turf mentality makes it extremely difficult to improve medical education.
Are you familiar with the governance structure and the board? Do you presently know how new members of the board of the ACGME are appointed?
No.
Do we have the right appointing organizations? (To the board? To the RRCs?) Should others be appointing? Who?
Yes. Even though the sponsors may be appointing, the key issue is assuming its proper fiduciary responsibilities for the organization they serve, the ACGME. I don’t know if the board behaves the way they should.
Should the Board be composed of competencies rather than representation?
I don’t know.
Are you aware of the executive committee?
No.
Should anything be done to improve transparency between the ACGME board and its constituencies?
I don’t know.
What recommendations would you offer to strengthen the governance of ACGME?
I don’t know how well it functions.
What is the right relationship between ACGME and the RRCs?
The RRC should understand that the institutional requirements trump the specific requirements. A capable competent physician is first and a capable competent specialist is second.
Are the individual programs tightly coupled with the RRC?
The board itself
How should the ACGME deal with consistency?
I’m talking about a cultural issue. There was a lot of hegemony in the RRCs. There was individual program accreditation. What needs to continue happening is that the RRC needs to understand the overarching institutional accreditation.
Can the ACGME help that?
I don’t know.
Should the RRCs do more collaborating between them?
The ACGME is the venue in which they’re supposed to collaborate. They could collaborate on things that are required for the core competencies. My sense is that the RRCs want to control all of that at the programmatic level.
Can the ACGME help that?
I think they are. They were able to help them institute the regulation on duty hours. I think they’ve been on a strong track in that regard. From my distant observation that has been driven by David Leach with the help of his board.
Is there anything that should be done to improve from the RRCs in the halls of the ACGME?
The voice of the RRCs is deafening in the ACGME. It should be turned down.
Residents’ voices?
I think that is being done well.
Program directors? Institutions?
I think they’re all getting represented reasonably well. The problem is getting the RRCs to make enough space.
What would you say is the greatest strength of the ACGME?
They are being increasingly identified as advocates for the creation of capable physicians and less extensions of trade unions. The more they can do to that will identify them with that mission the less they look like a collection of trade unions the better.
What’s the blind spot of the ACGME?
They need to have more communication between the ACGME and its counterparts in the CME and undergraduate medical education.
If you were going to send a message to the ACGME Board and you could tell them anything, what would it be?
Get on their knees and beg David to extend the timing of his departure. When you a board that has to face strong
What would you tell the search committee about finding a replacement for David Leach?
The candidate needs to have David’s vision. He needs to be a diplomat and an alliance builder. Some of the next steps will not be under the ACGME’s control. It will take someone who understands that much of the good they need to accomplish comes through their ability to make alliances with other entities.
#40Resident
Are you aware of the new mission, vision and values recently developed by ACGME?
I think so.
What impact, if any, does their new mission, vision, values have on you and your associates?
It gives us guidance and helps us improve our programs. As a physician and a resident, I believe in what the ACGME does. They can be a bit heavy-handed but someone needs to have oversight.
In general, what can the ACGME do to make your life easier?
Change is hard and changing to a new system of competencies is difficult for programs to move to. When I started my residency one of the things that was difficult was the change of the 80-hour work week requirement. But I think that’s just because change is hard. Sometimes there is a rift between the practicing faculty and the residents. Sometimes I’m immune to that but I’ll see them talking amongst themselves and it comes up in conversation that people training are lazy because of the change in the 80-hour work week.
Is it just because they had to go through it that they expect new people to do it?
Probably. Though there is some concern over continuity of care. I think there was some animosity coming to the ACGME based on mistrust and then they started to roll out the 6 core competencies and told the RRCs to evaluate it. I think that anyone would say professionalism is important but hard to evaluate. There are ways to work it out that don’t cause as many problems. I don’t think it was considered that the faculty will have to pick up the slack that now the residents can’t do. There are multiple things that have happened in succession that have made for some bad feeling.
Are you familiar with the governance structure and the board?Do you presently know how new members of the board of the ACGME are appointed?
No.
Do we have the right appointing organizations? (To the board? To the RRCs?) Should others be appointing? Who?
Probably they’re right.
Should anything be done to improve transparency between the ACGME board and its constituencies?
I haven’t been involved in any board activities, but I’ve gone to the meetings and they seem to be transparent. I haven’t felt like they do anything behind closed doors.
Should the Board be composed of competencies rather than representation?
Who should appoint members to the RRC’s?
What recommendations would you offer to strengthen the governance of ACGME?
I don’t’ know.
What’s the right relationship between ACGME and the RRCs?
I think the RRCs think that the ACMGE doesn’t have enough consultation with them. If there was more feedback from the RRCs before decisions were made that would be helpful.
How should the ACGME deal with consistency?
They do a lot in terms of the common requirements. They help by taking the best practices from the RRCs and find ways to help them with implementing them. I don’t know if that will change with the new structure of the executive directors.
Where is the line between standardization and flexibility?
Should the RRCs do more collaborating between them?
Is there anything that can be done to ensure the voice of the RRCs in the halls of the ACGME?
I think they’ve done a lot. Having the RRCs involved in discussions as much as possible would be helpful. I know the learning curve is very steep.
What would you say is the greatest strength of the ACGME?
What’s the blind spot of the ACGME?
If you were going to send a message to the Board of the ACGME, what would that be?
The relationship with the RRCs have to be continued to be nurtured. Maybe they should hire a PR firm. I wish people understood more. I think all of medicine needs to move in a direction where there is a stick for accreditation. The ACGME needs to be thought of as an organization that’s thought to help the quality of education and the process of healthcare. I believe that that’s their aim, but it’s sad to me to see that some people out there think that it is a big agency that is heavyhanded and miring things with unfounded mandates. They look at the ACGME as that instead of someone trying to help.