ACGME Flashcards
At a monthly departmental Morbidity and Mortality conference, a case is presented that describes a patient with an aneurysmal subarachnoid hemorrhage who had a pneumothorax after undergoing placement of a central line for fluid management while treating vasospasm. This case resulted in a change in protocol for supervision and placement of central venous catheters. This change in protocol is an example of which of the following core competencies?
A. Systems-Based Practice (SBP)
B. Practice-Based Learning and Improvement (PBLI)
C. Patient Care (PC)
D. Professionalism (P)
E. Interpersonal and Communication Skills (ICS)
B. Practice-Based Learning and Improvement (PBLI)
The correct answer is Practice-Based Learning and Improvement (PBLI). PBLI requires residents to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
Systems-Based Practice (SBP) would be the next best answer, but a key component of Systems- Based Practice SBP is identifying system errors and implementing potential systems solution and working in interprofessional teams to enhance patient safety and improve patient care quality.
Professionalism is incorrect because there was no question of the team’s ability to carry out their professional responsibilities and/or adhere to ethical principles. Interpersonal communication skills is incorrect because there was no indication from the question stem that this was a problem.
Using the Agency for Healthcare Research and Quality (AHRQ) system, which of the following is the evidence class for a prospective, randomized, controlled trial of clipping versus endovascular coiling of anterior circulation aneurysms presenting with subarachnoid hemorrhage, performed at a single institution?
A. Insufficient
B. Class II
C. Class III
D. Class I
E. None of the above
D. Class I
The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments.
The correct answer in this case is Class I. Based on study design, randomized control trials initially start with a provisional grade of high strength of evidence. Class I means that the study was well conducted and one can be confident that the estimate of effect lies close to the true effect for the evaluated outcome. The body of evidence has few or no deficiencies. It means that the findings are stable, or rather another study would not change the conclusions. Class II means that they are moderately confident that the estimate of effect lies close to the true effect for the evaluated outcome. Class III means that they have limited confidence that the estimate of effect lies close to the true effect for this outcome. Insufficient means that the AHRQ has no evidence, is unable to estimate an effect, or has no confidence in the estimate of effect for the evaluated outcome.
A neurosurgery resident who is involved in a multidisciplinary work group to investigate the circumstances surrounding a series of postoperative infections is participating in which of the following core competencies, as outlined by the Accreditation Council for Graduate Medical Education (ACGME)?
A. Patient Care and Procedural Skills
B. Interpersonal and Communication Skill
C. Professionalism
D. System Based Practice
E. Practice-Based Learning and Improvement.
D. System Based Practice
The correct answer is System Based Practice (SBP). This core competency requires that residents demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to work in interprofessional teams to enhance patient safety and improve patient care quality, and participate in identifying system errors and implementing potential systems solutions. Practice-Based Learning and Improvement requires residents demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Patient Care and Procedural Skills require residents to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Interpersonal and Communication Skill requires residents to interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Professionalism requires residents to demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
A neurosurgery resident and attending physician are preparing to operate on a patient with a colloid cyst. Before the operation, they research whether there are any differences in functional outcomes between patients who are treated endoscopically as compared to those treated with a transcallosal resection. This exercise is an example of which of the following core competencies, as outlined by the Accreditation Council for Graduate Medical Education (ACGME)?
A. Practice-Based Learning and Improvement
B. Medical Knowledge
C. Systems-Based Practice
D. Patient Care
E. Professionalism
A. Practice-Based Learning and Improvement
The correct answer is Practice-Based Learning and Improvement. This requires that residents demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self- evaluation and life-long learning. Systems-Based practice requires that residents demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Professionalism requires that residents demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Patient Care requires that residents provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
A neurosurgeon plans to share protected health information (PHI) with an organization that proposes to analyze his patient data to promote quality assurance and improvement. Before PHI can be transferred, Health Insurance Portability and Accountability Act (HIPAA) regulations state that he, as a “covered entity,” must first perform which of the following activities?
A. The covered entity must have approval by an Institutional Review Board
B. The covered entity must obtain permission from his/her department head
C. The covered entity must obtain satisfactory assurances, generally in the form of a contract
D. The covered entity must obtain informed consent from all patients
E. No additional documentation is required
C. The covered entity must obtain satisfactory assurances, generally in the form of a contract
Before the covered entity discloses protected health information (PHI) to a business associate, the covered entity must obtain satisfactory assurances, generally in the form of a contract, that the business associate will appropriately safeguard the information. With a few limited exceptions, the contract may not authorize the business associate to use or further disclose the PHI in a manner that would violate the Privacy Rule if done directly by the covered entity.
Covered entities are defined in the HIPAA rules as (1) health plans, (2) health care clearinghouses, and (3) health care providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards. Generally, these transactions concern billing and payment for services or insurance coverage. For example, hospitals, academic medical centers, physicians, and other health care providers who electronically transmit claims transaction information directly or through an intermediary to a health plan are covered entities. Covered entities can be institutions, organizations, or persons.
A neurosurgical group plans to do a retrospective analysis of patient charts to determine the factors that influence the probability of ventriculostomy infections in the neurosurgical ICU. The primary purpose is quality assessment and improvement. All unique identifying links to patients will be removed during the analysis. Before initiating this project, which of the following is the group’s obligation under the common and privacy rules with respect to institutional review board (IRB) review, patient informed consent, and Health Insurance Portability and Accountability Act (HIPAA) authorization?
A. All study subjects are required to sign a consent form prior to initiation of quality improvement project
B. IRB approval is required
C. Strictly quality improvement assessment activities do not require IRB oversight
D. Approval from department head is required
E. Approval from U.S. Department of Health & Human Services is required
C. Strictly quality improvement assessment activities do not require IRB oversight
Quality Improvement (QI) is defined as systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings. Research is defined by the U.S. Department of Health & Human Services as a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge. Research requires the oversight and approval of an Institutional Review Board when it involves human subjects. Human Subjects are defined as living individuals about whom a research investigator obtains data through intervention or interaction with the individual or from individually identifiable information.
In research, the purpose is to establish new knowledge that is generalizable or to reinforce existing knowledge for which inconclusive evidence exists. In QI projects, the purpose is to assess or improve a process, program, or system or to improve performance as judged by established/accepted standards of care.
Federal regulations require human subject research to reviewed and approved by the IRB, while strictly QI activities do not require IRB oversight.
Which of the following refers to a set of codes that match a specific treatment, including surgical and interventional procedures?
A. Accreditation data system
B. Milestones
C. Current Procedural Terminology system
D. International Statistical Classification of Diseases and Related Health Problems
E. Physician’s Recognition Award
C. Current Procedural Terminology system
Qualified healthcare professionals (QHPs) need to identify the professional services they provide and to report those services in a way that can be universally understood by institutions, private and government payers, researchers, and others interested parties. To ensure that healthcare data are captured accurately and consistently and that health claims are processed properly for Medicare, Medicaid, and other health programs, a standardized coding system for medical services and procedures is essential. The Current Procedural Terminology (CPT®) system, developed by the American Medical Association (AMA), is used for just these purposes. The AMA system provides a standard language and numerical coding methodology to accurately communicate across many stakeholders, including patients, the medical, surgical, diagnostic, and therapeutic services provided by QHPs. The CPT descriptive terminology and associated code numbers provide the most widely accepted medical nomenclature used to report medical procedures and services for processing claims, conducting research, evaluating healthcare utilization, and developing medical guidelines and other forms of healthcare documentation.
A resident who treated a patient for traumatic cervical spinal subluxation receives a negative critique from the attending physician for providing substandard care. The resident researches how to manage this type of injury and assesses his own performance. He then uses the newly gained information to alter his practice and better comply with recommended best-available practices. The resident is improving upon which of the following core competencies?
A. Systems-Based Practice (SBP)
B. Medical Knowledge (MK)
C. Professionalism (P)
D. Practice-Based Learning and Improvement (PBLI)
E. Patient Care (PC)
D. Practice-Based Learning and Improvement (PBLI)
The correct answer is Practice-Based Learning and Improvement (PBLI). For PBLI, requires residents to incorporate formative evaluation feedback into daily practice and to locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems (evidence- based medicine) . Medical Knowledge (MK) requires that residents Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. The fact that the resident received feedback from a senior surgeon on daily practice makes this more PRLI compared to MK.
