The ACGME is implementing an outcomes-based evaluation system in which the doctors of tomorrow will be measured for their competency in performing the essential tasks necessary for clinical practice in the 21^st century.

Under the new system, medical residency programs in the U.S. will be accredited based on national benchmarks for physician competence within each specialty, including the core competencies and clinical skills necessary for future physicians to respond to rapid developments in health care delivery.

• What are the goals of the Next Accreditation System (NAS)?

The goals of the NAS are:

• To begin the realization of the promise of the Outcomes Project
• To free good programs to innovate
• To assist poor programs in improving
• To reduce the burden of accreditation
• To provide accountability for outcomes (in tandem with the American Board of Medical Specialties (ABMS)) to the public
• What are the attributes of the NAS?

The attributes of the NAS emerged from the strategic priorities identified by the ACGME Board of Directors in 2005, and include:

• Foster Innovation
• Reward Excellence
• Less Frequent Revision of Standards
• Continuous Accreditation
• Less Frequent, More Rigorous Self-Study Site Visits for Successful Programs
• Concentrate on Problem Programs to Rapidly Enhance Performance/Outcomes
• How is the NAS different from the existing model of accreditation?
• Continuous annual accreditation versus current “biopsy” evaluation every 3-5 years
• 10-year self-study visit, instead of site visits determined by cycle length
• Annual data collection and analysis (Resident and Faculty Surveys, Case Logs, Milestones)
• Elimination of the program information forms (PIFs) for site visits of accredited programs
• Standards revised every 10 years instead of every five years
• How does the NAS incorporate the Milestone Project?

In 2009 the ACGME began developing milestones of clinical education for each specialty within the six domains of clinical competence. Groups composed of members of the ABMS Specialty Boards, Program Director Associations, Specialty Colleges, ACGME Review Committees, and residents have been meeting to define outcomes-based milestone expectations throughout residency education. These milestones will become a source of specialty-specific normative data for the Review Committees and Boards to use in assessing the quality of the residency program (ACGME) and the individual resident (ABMS Specialty Boards).

This will allow the ACGME to demonstrate to the public the effectiveness of competency-based education with the information collected annually through the structure of the NAS.

• When will the NAS be in place?

The ACGME will implement the next accreditation system in phases. Starting this year, the ACGME will train the Review Committees responsible for redesigning the accreditation programs for the seven medical specialties as mentioned in the New England Journal of Medicine article. These seven medical specialties will implement the new system in July 2013. The remaining specialties and the Institutional Review Committee will implement the NAS in July 2014.

• Will the ACGME’s NAS have any impact on the new requirements for the number of hours residents are expected to work?

The NAS will not change any of the ACGME’s existing duty hours and supervision standards that were enacted in July, 2011. These supervision standards set separate requirements for teamwork, clinical responsibilities, communication, professionalism, personal responsibility, and transitions of care. As a component of the NAS, the ACGME will implement an institutional visit program. Each sponsoring institution will be visited every 18 months to review the involvement of residents in the institution’s quality improvement and patient safety initiatives. The purpose of this review is to ensure that the clinical learning environment within the sponsoring institution supports safe patient care and reduced disparities in care, and demonstrates quality improvement in areas such as resident supervision, fatigue management, patient hand-offs, and resident duty hours.