Observations: The Next Accreditation System: A Perspective

For the 7 Phase I programs, the Accreditation Council for Graduate Medical Education's (ACGME) Next Accreditation System (NAS) is here, and for Phase II programs, NAS will go into effect in July 2014. The NAS annual data include current citations, program attrition/changes, scholarly activity, board examination pass rates, elements from the ACGME resident and faculty surveys, residents' clinical experiences based on case log or survey data, and Milestone data. Another area at the institutional level is the results of the Clinical Learning Environment Review (CLER). To facilitate ongoing local improvement, triggers defined by the graduate medical education (GME) committee will need to be established to determine whether a program requires additional attention, similar to an internal review that assesses the program's performance on the common program requirements without a program information form.

Another area critical to success will be adequate communication with and education of all local stakeholders, ranging from the chief medical officer to institutional leaders, GME staff, program directors/coordinators, fellows/residents, and others such as nurses. This is particularly true for CLER visits, as site visitors may randomly speak with any stakeholder about such topics as professionalism, transitions of care, supervision, and fatigue education and mitigation.

The Milestone evaluations that are part of NAS will also require added support of programs by their central GME office. The GME office should establish a group of people with knowledge about assessment to handle questions and to educate all clinical competency committee members, faculty, and other stakeholders.

In the long run, these activities to usher in the NAS will likely improve institutional GME processes in ways that will benefit the quality of residents' education and professional development.