An Early Evaluation of Remote Site Visits for ACGME Program Applications.

Background: Prior to the COVID-19 pandemic, accreditation site visit interviews occurred in-person. In response to the pandemic, the Accreditation Council for Graduate Medical Education (ACGME) developed a remote site visit protocol. Objective: To perform an early assessment of the remote accreditation site visits for programs applying for initial ACGME accreditation. Methods: A cohort of residency and fellowship programs that had remote site visits was evaluated from June to August 2020. Surveys were sent to program personnel, ACGME accreditation field representatives, and executive directors following the site visits. Comparison of accreditation decisions (Initial Accreditation or Accreditation Withheld) was completed for matched residency or fellowship programs having in-person site visits in 2019. Results: Surveys were sent to all program personnel from the 58 residency and fellowship programs that had remote site visits for new program applications, as well as the accreditation field representatives who performed the remote visits. The survey response rate was 58% (352 of 607). Ninety-one percent of all respondents were extremely or very confident that remote site visits provided a thorough assessment of proposed residency or fellowship programs. Fifty-four programs having remote site visits were matched by specialty to programs having had in-person program application site visits in 2019. Forty-six programs that had remote site visits received Initial Accreditation, and 52 programs that had in-person site visits in 2019 received Initial Accreditation (P=.093, 95% CI 0.91-22.38). Conclusions: Most program personnel and accreditation field representatives were confident that remote site visits conducted for program applications provided fair and thorough assessments of the program.

Improvement in Context: Exploring Aims, Improvement Priorities, and Environmental Considerations in a National Sample of Programs Using "Small Data".

BACKGROUND: In 2013, the Accreditation Council for Graduate Medical Education (ACGME) transitioned into a new accreditation system to reduce burden, focus on outcomes, and promote innovation and improvement. One component is a self-study that includes aims, an environmental assessment, and setting improvement priorities. The ACGME initiated voluntary site visits following the self-study. OBJECTIVE: We explored common themes in program aims and assessment of their environment. METHODS: Using grounded theory, inductive and deductive qualitative methods, and truth grounding, we analyzed data from voluntary site visits of 396 core and subspecialty programs between June 2015 and September 2017, with a focus on common themes. RESULTS: We report common themes for aims and the dimensions of the environmental assessment. Themes for strengths include a collegial, supportive learning environment; responsive leaders; and experiences that prepare residents for unsupervised practice. Improvement priorities encompass low learner engagement and "content mismatch" in didactic education, balancing education and service at a time of growing clinical volumes, and improving the utility of assessment systems. Common opportunities encompass collaborations that improve education, involving alumni and harnessing technology to enrich education, while threats include an unsustainable effort for many program leaders, clinical pressures on faculty, and loss of external sites important for education. Linked dimensions of the environmental assessment suggest benefit in a growing focus on learners, and approaches to ensure a humanistic learning environment that allows for growth, self-determination, and inclusion. CONCLUSIONS: The findings highlight actionable themes for the environmental assessment. We discuss implications for programs, institutions, and the ACGME.

Power lawnmower injuries.

Power lawnmowers are among the most ubiquitous household tools, yet they pose significant danger to operator and bystanders. Despite of the United States Consumer Products Safety Commission's push to have safety standards established for walk-behind mowers in 1982 and for ride-on mowers in 1986, by 2000 approximately 80,000 injuries nationwide were estimated to be associated with power mowers. Large numbers of these injuries are thought to be preventable, especially those to individuals younger than 14 years. Orthopaedic surgeons treat a significant number of the injuries associated with mower use including lacerations, amputations, fractures, infections, and skin defects. Therefore, the orthopaedic community has a stake in the prevention and outcome of these injuries. To date, changes in mower design have seemed to be more successful than user education programs in decreasing the numbers of these injuries. Involving orthopaedists in safety education programs to help prevent injuries associated with power mower use may be one method of increasing user knowledge and preventing injury.

Teenage driver safety: should graduated drivers licensing be universal?

The number of motor vehicle deaths has decreased significantly in the last quarter century. However, there remain a disproportionate number of automobile crashes involving teenage drivers. Studies have shown these accidents are related to several, possibly behavioral, factors, including driver error, speeding, and increasing numbers of passengers. The injuries and fatalities also involve a disproportionate number of teenage passengers. A three-stage Graduated Drivers Licensure process has been adopted by 34 states to try to address this potentially preventable problem. The Graduated Drivers Licensure involves a very well-supervised permit period, a lengthened provisional period that includes advanced drivers' education and supervised practice, and finally a full license. Studies from Maryland, California, Oregon, Florida, Michigan, North Carolina, and Kentucky have shown significant decreases in the crash rates among teenage drivers. The Graduated Drivers Licensure, if adopted as a national standard, may be effective in decreasing the toll of teenage driving accidents.