Elizabeth Morency, MD

As a newly minted Fellowship Program Director, I was excited and anxious for the responsibilities my new role would entail; however I could not have imagined being at the helm of the Cytopathology Program during the behemoth that was the ACGME self-study. Herein, I will share a bit of my experience going through this process, so hopefully you won’t be quite as surprised as I was when your turn comes around. To begin with, a little historical perspective, the Accreditation Council for Graduate Medical Education (ACGME) was established with the goal of addressing the issues of variability in educational quality between Resident and Fellowship Programs. It set out a series of competencies that trainees of successful programs across all medical specialties should exhibit upon graduation in the following six realms:  patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice. In 2013, the Next Accreditation System (NAS) was developed to encourage continuous assessment and quality improvement as opposed to a static picture of where the program was during the previous policy of 5-year site visits.  The NAS requires a 10-year formal self-study, followed by a site visit 12-18 months later.

Our Cytopathology Program as well as our main Residency Program and several other subspecialty fellowships conducted our first self-study in the winter of 2017-2018. To begin, we familiarized ourselves with the 8 steps of the self-study laid out by the ACGME, which are paraphrased and summarized follows:

1) Assemble the self-study group,

2) Establish program aims,

3) Aggregate and analyze data from annual program evaluation (APE) and self-study to determine program strengths and areas for improvement,

4) Examine program environment for opportunities and threats,

5) Obtain stakeholder input to perform SWOT analysis (program Strengths, Weaknesses [or Areas of Improvement], Opportunities and Threats) in order to prioritize actions,

6) Interpret data and aggregate findings,

7) Discuss and validate findings with stakeholders, and

8) Develop a succinct self-study document for use in further program improvement and as documentation for the 10-year site visit.

Once you understand these steps and are ready to begin, one of the most important keys to success is to set a timeline. Looking back, I don’t think there is any way we would have been successful as we were, had we not laid out a week-by-week schedule of each objective we wanted to achieve. You will not always be able to adhere to the schedule, and factoring in a little wiggle room never hurts, but having a framework established at the outset will keep you from falling completely off track.

The next major key is assembling the right self-study group. A good start is with your Program Evaluation Committee (PEC) and other good constituents; include program leadership, other subspecialty program directors, senior residents and/or Clinical Competency Committee (CCC) members. Having a variety of members from different levels of training and experience will ensure you have the most robust and comprehensive discussions as to the state of the Program and input from a true representative sample of individuals. One of the highlights of this experience was getting to hear back from past graduates of our programs via the graduate external survey about how the strengths of our programs lead to their professional development and success, and gaining insight into our weaknesses, giving us the opportunity to grow and improve.

Next key, be organized! A lot of this process depends on the review of years’ worth of previous ACGME surveys and trainee responses to internal surveys, and I could not have kept it all straight without the help of my program coordinator. Designate a program coordinator or administrative assistant to help aggregate and collate the surveys you will need to review in order to glean the data necessary for the self-study document. Use folders/binders/tabs etc. to separate documents by year. This probably sounds self-evident but as someone who isn’t naturally the most organized, emails and paper documents started to pile up fast, and creating new email folders and paper folder for printed documents helped me keep everything straight.

I could probably go on for a while but to wrap this up, the most important thing is to enjoy the experience (and don’t worry, at the end of this document are links to references that outline this process far more eloquently and comprehensively than I have). Yes, hindsight is 20-20 and having finished, it is easy to say that from my vantage point, but once I was able to process the steps required to successfully complete this endeavor, I really enjoyed the opportunity to brainstorm with other Program Directors, some of whom I had never had the opportunity to work with, catch up with previous graduates and to hear from the residents and fellows in the trenches. I really feel like the process opened up lines of communication that would not have otherwise been established and brought the department closer as a whole.

Thank you for reading and best of luck on your self-study journey. Before I sign off I must acknowledge the work of our Residency Program Director, Kruti Maniar, MD, who wrote an article summarizing the Northwestern Pathology self-study experience, from which I borrowed some information to aid in writing this summary (Kruti P. Maniar, MD; Nicoleta Arva, MD, PhD; Luis Z. Blanco, Jr, MD; Quinwen Mao, MD, PhD; Elizabeth G. Morency, MD; Raven Rodriguez; Kristy Wolniak, MD, PhD; Nabeel R. Yaseen, MD, PhD; Ritu Nayar, MD: ACGME Self-Study for Pathology: One Institution’s Experience and Lessons Learned. Arch Pathol Lab Med 2019, accepted for publication).

Please see below for helpful resources about the self-study process:

1) Nasca TJ, Philibert I, Brigham T, Flynn TC: The next GME accreditation system–rationale and benefits. N Engl J Med 2012, 366:1051-6.

2) Guralnick S, Hernandez T, Corapi M, Yedowitz-Freeman J, Klek S, Rodriguez J, Berbari N, Bruno K, Scalice K, Wade L: The ACGME Self-Study-An Opportunity, Not a Burden. J Grad Med Educ 2015, 7:502-5.

3) Martinez S, Robertson WW, Jr., Philibert I: Initial Tests of the ACGME Self Study. J Grad Med Educ 2013, 5:535-7.

4) Philibert I, Nasca TJ: The Program Self-Study and the 10-Year Site Visit: Rationale for a New Approach. J Grad Med Educ 2015, 7:310-2.

5) Self-Study. Accreditation Council for Graduate Medical Education, 2018. https://www.acgme.org/What-We-Do/Accreditation/Self-Study

6) Philibert I, Lieh-Lai M: A Practical Guide to the ACGME Self-Study. J Grad Med Educ 2014, 6:612-4.

7) Philibert I, Beernink JH, Bush BH, Caniano DA, Chow A, Coyle JJ, Gilhooly J, Kraybill DE, Larson D, Moran S, Nace MC, Robertson WW, Jr., Rubin JD, Sanford T: Improvement in Context: Exploring Aims, Improvement Priorities, and Environmental Considerations in a National Sample of Programs Using “Small Data”. J Grad Med Educ 2017, 9:791-7.

Elizabeth Morency, MD is the Cytopathology Fellowship Program Director at Northwestern University, Feinberg School of Medicine.