American Board of Medical Genetics and Genomics

V. Reid Sutton, MD, Chair Miriam G. Blitzer, PhD, CEO

April 13, 2017

The mission of the ABMGG is to serve the public and the medical profession by promoting and assuring standards of excellence in medical genetics and genomics. To accomplish this, the ABMGG:

• accredits medical genetics and genomics laboratory training programs, • credentials and certifies practitioners of medical genetics and genomics, and • fosters life-long learning through maintenance of certification.

We credential/certify both MDs and PhDs ◦ Most ABMS-recognized Boards only credential and certify MDs

AND

We accredit training programs related to genetics/genomics clinical laboratory specialties Clinical Biochemical Genetics Laboratory Genetics and Genomics Clinical Cytogenetics and Genomics (for existing trainees) Clinical Molecular Genetics and Genomics (for existing trainees)

◦ ABMGG does not accredit training programs for Medical

Genetics and Genomics Residencies This is done through the Accreditation Council for

Graduate Medical Education (ACGME)

National Commission for Certifying Agencies (NCCA) ◦ Certifying bodies cannot also accredit the institutions that train those who are

being certified This creates a potential conflict of interest Trainees are required to have trained at programs you have accredited in order to

take your certification exam

International Organization for Standardization (ISO) ◦ Certifying bodies can also accredit programs ◦ BUT there are strict standards separating program accreditation and individual

certification (to avoid conflict of interest)

Concerns of (perceived) Conflict of Interest

Does not follow “best practice” guidelines

Example: American Board of Genetic Counseling (ABGC) split program accreditation and individual certification for this reason ◦ NOW: ABGC AND Accreditation Council for Genetic Counseling (ACGC)

Longstanding Model– the ABMS Member Boards and the ACGME

Maintain the status quo ◦ Program accreditation by the ABMGG via the Accreditation Committee

with continued separation of functions from Credentials Committee

Create a separate, new entity (a separate “Board”) to accredit training programs for genetics/genomics laboratory specialties

Have an experienced external entity like the ACGME assume accreditation of lab training programs

©2017 Accreditation Council for Graduate Medical Education (ACGME)

Accreditation Council for Graduate Medical Education

• 1981 – ACGME established (formerly LCGME) by the AMA • 2000 – ACGME became a separately incorporated organization;

private, 501(c)(3), not-for-profit organization

Mission: to improve health care and population health by assessing and advancing the quality of resident physicians' education through accreditation.

• Sets and monitors the professional educational standards essential in preparing physicians to deliver safe, high-quality medical care to all Americans.

©2017 Accreditation Council for Graduate Medical Education (ACGME)

What is ACGME Accreditation?

• Sets standards for effective training programs, and monitors compliance with those standards (the Institutional and Program Requirements).

• Specialty-specific committees (Review Committees, RCs) of volunteers create a uniform set of high standards for each accredited specialty and subspecialty applied across all accredited programs to ensure the highest quality physicians and patient care.

• Programs are continuously monitored for substantial compliance with the requirements set by the applicable RC, including through data collection and evaluation, surveys, and site visits.

©2017 Accreditation Council for Graduate Medical Education (ACGME)

What is ACGME Accreditation?

• The RCs regularly review the accreditation requirements to ensure they are based on current and best practices in the field.

• The ACGME sets standards designed to cultivate a team-based learning environment and culture in which trainees serve as both learners and mentors in delivering high-quality patient-focused care.

• Trainees provide regular feedback to the ACGME about their programs, offering an inside view that helps the organization to improve the overall quality of accredited programs.

©2017 Accreditation Council for Graduate Medical Education (ACGME)

Who Sits on the Genetics RRC?

• Medical Geneticists with experience with training programs (current or past PD or significant engagement with training program) • 2 Nominated by ABMGG • 2 Nominated by ACMG • 2 Nominated by AMA

• Resident Member • Public Member • Ex-Officio Member – ABMGG CEO (does not participate in reviews;

attends as a resource to the Committee)

©2017 Accreditation Council for Graduate Medical Education (ACGME)

Recent Evolution of ACGME

• Many new residencies or fellowships added/assumed (e.g. ABOG) • ACGME – International (accredits programs in Singapore, Middle East,

etc.) • New Accreditation System (NAS)

• Annual assessment of programs with metrics; only those with concerning indicators receive RC review

• 10-year self study for programs (replaces regular site visits) • Increased focus on Clinical Learning Environments (i.e.

Hospitals/Institutions) – every 2 year review for systems based issues

©2017 Accreditation Council for Graduate Medical Education (ACGME)

Cost of ACGME Accreditation

• Currently ~$4000 per specialty program per year (no discount for multiple programs)

• ACGME sends bill for accreditation to local GME office • Fee payment may come entirely from institutional GME budget • Fee payment may come entirely from local department budget • Fee payment may be shared between GME and department budget

Total Number of Accredited Institutions 44 Clinical Biochemical Genetics 24 Clinical Cytogenetics and Genomics 43 Clinical Molecular Genetics and Genomics 42 Laboratory Genetics and Genomics 22*

*additional programs currently under review with anticipation of being accredited in LGG by July 2017

2015 – Approached ACGME to consider accrediting lab-based medical genetics training programs

4/16 – Met with ACGME leadership; they were positive and receptive 5/16 – Announced possibility of ACGME accreditation at APHMG and

Lab PD SIG 5-8/16 – Submitted application for CBG and LGG for review to ACGME Process moving forward to determine feasibility and final approval by

ACGME Board of Directors this year

ABMGG has not made a final decision at this time

◦ Will accredit post-doctoral educational programs in a medical or medical-

related field that is not a core specialty or a subspecialty

◦ Trainees must have a doctoral level degree (PhDs and MDs)

◦ Training programs are clinically distinct from what is already accredited (e.g., the medical genetics and genomics residency)

◦ The postdoctoral training is primarily clinical

◦ Will the lab specialties still be their own specialties or will they be considered subspecialties of clinical genetics and genomics? The lab specialties will not be subspecialties under clinical genetics; they will

be their own unique specialties.

◦ Will ACGME require that there must be an accredited residency in order to accredit laboratory programs? There is no reason to anticipate this will be a requirement. However, it is very

likely the programs will need to be at an institution where there is a GME office and a DIO, namely institutions with other ACGME-accredited residencies.

◦ What is a DIO (Designated Institutional Official)? The individual at the sponsoring institution who has the authority and

responsibility for all of the ACGME accredited programs.

◦ Will the Medical Genetics RC composition change? Yes, the membership to the RC will increase since laboratory geneticists will

be appointed to facilitate program reviews.

◦ Who will determine the CBG and LGG program requirements? The RC, along with input from other as needed, will define the requirements.

Then the program requirements will nee to be reviewed and approved by the ACGME Requirements Committee.

◦ Who will review the programs for accreditation? The MGG Review Committee, which will have lab experts, will review the

programs

◦ What will the timeline for transition be? If the ABMGG decides to transition lab training program accreditation to the

ACGME (again, this has not been finalized), we will then work with ACGME to develop a defined timeline.

We anticipate a decision being made sometime this summer. Required steps would include: expansion of the RRC to include lab experts;

defining the program requirements; approval by the ACGME Requirements Committee; development of application and process, transition plan from ABMGG to ACGME, etc. The ACGME is currently doing this with all Osteopathic residencies and ABOG subspecialties, both activities going smoothly.

We anticipate that it likely would take around 18+ months after approval. We have asked the ACGME to work with us now to address this question more thoroughly.

◦ ACGME accreditation may be a positive imprimatur for programs fellows will be able to state that they trained in an ACGME-accredited

program, well recognized by medical institutions and licensing organizations.