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AAOS 2010 Annual Meeting

Instructional Course #311
Residency Accreditation

William W. Robertson, Jr., MD
The ACGME Site Visit-
Preparation and the Day

I. 9 “Red Flags”
• Lack of Program Leadership
• Lack of Infrastructure for Teaching and Evaluation
• Lack of Appropriate Volume and Variety of Patients
• Problems Resident (Fellow) Recruitment and/or Retention
• Lack of Dedicated Teachers (Number, Turn-over)
• Lack of Meaningful Didactics (Rounds, Conferences and Lectures)
• Lack of Financial and Human Resources
• Priority of Service over Education
• Lack of Preparation for the Accreditation Process

II. Preparation
A. Program Citations 2007-2009
1. Educational Program-61%
a. Patient care (procedural experience deficiencies - spine, foot,
pediatric, etc.)
b. Competencies
c. Duty hours (1 day in 7 free, 80 hours per week, etc.)
2. Program Personnel and Resources-16%
a. Qualifications of faculty
(with required expertise)
b. Responsibilities of Program Director (ensure residents use Case
Log System)
3. Institutional Support-11%
a. Facilities (educational space including library)
b. Sponsoring institution deficiencies (time, funding, facilities)
4. Evaluation-10%
a. Resident evaluation (Summative evaluations not provided)
b. Program evaluation (confidentiality, must be done annually)
c. Board score performance

B. Specific Comments
1. Patient Care Citations
• Pre-operative care
• Post-operative care
• Pediatric orthopaedic patients
• Orthopaedic trauma
• Non-operative care
2. Procedural Experience Citations
<1000 procedures by graduating residents
>3000 procedures by graduating residents
Uneven experience among residents
Too few CPT Codes in, for example: arthroscopy, microsurgery,
foot & ankle, pediatrics, trauma
3. The Case Log System
621 Residents Finishing in 2008
– Mean # CPT Codes Reported: 1,910
– Adults: 1616
– Children: 294
– Trauma: 489
4. Program Director and Case Logs
• RRC recommends review at least every 2 months
• At least with 6-month summative evaluation of resident &
• Compare members of same PGY “Class”
5. Scholarly Activity
• Resident publications and/or presentations
• Faculty publications
• Number of faculty involved in scholarship
• Mentoring of residents in scholarship
• Instruction in research methods
6. PIFs for Fellowships
• Common PIF format April 2009
• “Previous Citations” and “Changes” Sections
(automatically completed)
III. Surviving the Site Visit

A. The Day of the Visit
• Do not change the Site Visitor’s suggested schedule unless you
have a good reason.
• Have immediately available those documents referenced in “List
of Documents” just before Table of Contents in “Specialty Specific”
Note Especially-
• Current Program Letters of Agreement (PLAs)
• Files for current residents/fellows and most recent program
• Resident evaluation at the end of each rotation or similar
educational experience
• Written or electronic semiannual evaluation of the resident
with feedback
• A final (summative) evaluation for each resident that
documents the resident’s performance during the final period
of education and verifies that the resident has demonstrated
sufficient competence to enter practice without direct
supervision (files for the most recent year’s graduates for
review by the site visitor)
• Files of residents/fellows who have transferred into the
program (if applicable), including documentation of previous
experience and competency-based performance evaluation
• Not mentioned (in the list, but in program requirements), are
similar letters that you have written for anyone who transfers
out of the program.
• The written improvement action plan the program prepared
after a review of the aggregated results of residents’
performance and/or other program evaluation results

B. Understand the role of the Site Visitor
• Only a reporter (The on-site eyes and ears of the RC)
• Makes no recommendations to RC
• Not a consultant
• Cannot give feedback on “How program did”