General Background on the Participants
ACGME TASK FORCE ON QUALITY CARE AND PROFESSIONALISM
Backgrounder
The Accreditation Council for Graduate Medical Education (ACGME) is the independent nonprofit organization responsible for setting standards, monitoring and accrediting medical residency programs throughout the U.S. In this role it conducts periodic reviews of the graduate medical learning environment including duty hours, professionalism and supervision of residents, and issues new standards as needed to ensure excellence in medical education and quality patient care.
In 2003, the ACGME implemented a new set of common duty hour standards, promising to revisit the topic in five years after a cohort of residents had completed training under the new standards. The ACGME began the review process in February 2009, sponsoring an International Symposium on Resident Duty Hours and the Learning Environment in March of that year and forming a task force to systematically review the issues after that. The task force is composed of 16 members, 12 of whom are clinician educators with vast experience in the organization and provision of medical education in the context of patient care. Six of the task force members are from the surgical community, six are from the medical community and three are from the hospital-based specialties community. In addition the task force has one member who is a public representative with extensive experience in evaluation of health care related issues. The medical members include three physicians who were nearing completion of their residencies when the task force convened. Two are now fellows and one is an attending physician.
For nearly a year the task force conducted a comprehensive review of duty hour standards, resident supervision, compliance monitoring and related issues. As part of this effort it commissioned and received three external reviews of the past 20 years of literature on patient safety and resident duty hours, patient “handovers,” the impact of resident duty hour standards on educational outcomes, and resident safety and duty hour schedules. It also conducted a survey of residents, faculty, program directors and designated institutional officials.
Task force members received the written formal positions of more than 100 medical organizations and heard directly from 72 of those groups. They heard testimony by nearly 100 individuals including medical professionals from Canada and the U.K. The testimony included presentations by experts in fatigue mitigation, patient safety, sleep physiology, quality improvement, transitions of care, professionalism, the legal dimensions of duty hour standards, the impact of the New York State duty hour standards, and the unique challenges and trade-offs faced by America’s public hospitals. They read the Institute of Medicine (IOM) committee report, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety" which was issued in December 2008 and heard presentations from four members of the IOM committee, inviting three members back for more in-depth discussions.
From this extensive information-gathering process, the task force distilled a cohesive set of proposed standards that reflect its view that patient safety is influenced by more than resident duty hours; that supervision, fatigue mitigation, handovers of patient care, clinical responsibilities, patient safety and quality improvement systems, and the effectiveness of interdisciplinary teams are the factors that have the greatest influence on the wellbeing of patients in a teaching environment.
On June 18, 2010, the task force presented the draft standards to the ACGME board and the Council of Review Committees, a group made up of the chairs of the Residency Review Committees which review residency programs in the various specialties. Following input from these groups, the standards were posted for public comment on June 23 for 45 days. After all public comments are reviewed and considered, the final version of the standards goes to the Committee on Requirements of the ACGME Board for approval and, if approved, to the full board in September 2010. Pending approval by the Board, the final standards will be implemented in July 2011.
Task Force on Quality Care and Professionalism Members
E. Stephen Amis, Jr., M.D., FACR, Chair, Council of Review Committees and Co-Chair of the task force -- University Chair, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
Susan Day, M.D., Chair, ACGME Board of Directors and Co-Chair of the task force -- Chair, Department of Ophthalmology, California Pacific Medical Center (CPMC), San Francisco; Program Director, Department of Ophthalmology, CPMC
Thomas Nasca, M.D., MACP, CEO and Vice Chair of the task force -- CEO, ACGME and ACGME International LLC, Chicago; Professor of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia
Paige Amidon, Vice President, Health Programs, Consumers Union; ACGME Board of Directors, public member -- serving on the task force as a representative of the public, not as a formal representative of Consumers Union.
Jaime Bohl, M.D., Staff Surgeon, Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans; Principal Site Investigator NSABP Statin polyp prevention trial in patients with resected colon and cancer (resident representative)
Lois Bready, M.D., Associate Dean for Graduate Medical Education, University of Texas Health Science Center, San Antonio (UTHSCSA); Professor, Department of Anesthesiology, UTHSCSA; Designated Institutional Official, UTHSCSA
Ralph Dacey, Jr., M.D., Henry G & Edith R. Schwartz Professor and Chair, Department of Neurological Surgery, Washington University School of Medicine, St. Louis; Professor and Chair, Department of Neurological Surgery, Washington University
Rosemarie Fisher, M.D. , Director, Graduate Medical Education, Yale-New Haven Hospital, New Haven, Conn.; Associate Dean, Graduate Medical Education, Yale University School of Medicine; Attending Physician, Yale-New Haven Hospital
Timothy Flynn, M.D., FACS, Professor, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; Senior Associate Dean for Clinical Affairs, University of Florida College of Medicine; Chief of Staff, Shands HealthCare; chair-elect, ACGME Board of Directors
Stephen Ludwig, M.D., Professor of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia; Professor of Emergency Medicine, University of Pennsylvania School of Medicine; Senior Physician, The Children's Hospital of Philadelphia; Executive Committee, Department of Pediatrics, University of Pennsylvania School of Medicine; Chairman, Graduate Medical Education Committee and Designated Institutional Official, Senior Advisor for Medical Education, The Children's Hospital of Philadelphia
Robert L. Muelleman, M.D., FACEP; Professor and Chairman, Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Neb.; Medical Director, Emergency Medical Services, The Nebraska Medical Center
Janice Nevin, M.D., MPH, Senior Vice President, Executive Director, Christiana Care Health System, Wilmington, Del .; Associate Chief Medical Officer, Christiana Care Health System; Associate Professor of Family Medicine, Jefferson Medical College, Philadelphia
Meredith Riebschleger, M.D.; Fellowship, Pediatric Rheumatology, University of Michigan Health System – Mott Children’s Hospital. Ann Arbor, Mich. (resident representative)
William J. Walsh, III M.D., MPH, Research Fellow, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City (resident representative)
George Wendel, Jr., M.D., Professor, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical School, Dallas, Texas; Residency Program Director, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical School; Medical Director, Perinatal Intervention Program, Parkland Memorial Hospital, Dallas; Medical Staff, St. Paul University Hospital and Zale-Lipshy University Hospital, Dallas; member, board of directors, American Board of Obstetrics and Gynecology
Thomas V. Whalen, M.D., MMM, CPE, FACS, FAAP, Chairman, Department of Surgery, Lehigh Valley Health Network; Professor of Surgery, Penn State University College of Medicine/The Milton S. Hershey Medical Center; Adjunct Associate Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md.