D avid Pizzimenti, DO, Program Director at Magnolia Regional Health Center in Corinth, Mississippi and graduate of Nova Southeastern University College of Osteopathic Medicine (NSU-COM), led his institution and program to be among the first to apply to ACGME for Initial Accreditation under the single GME accreditation system (SAS). Dr. Pizzimenti, who completed his residency at Mount Sinai in internal medicine, has practiced as an internist for 13 years.
Magnolia Regional Health Center became a core teaching site for medical students in August of 2006 and now has core site affiliations with five medical schools. The Center has two residency programs; an internal medicine residency and a cardiology fellowship. The institution was among the first to receive ACGME initial accreditation under SAS.
The internal medicine program submitted its application in July when the window for program applications opened and on September 18, was granted initial accreditation status by the ACGME
Internal Medicine Review Committee. The program is also one of the first to apply for Osteopathic Recognition and will likely be reviewed by the ACGME Osteopathic Principles Committee (OPC) at their meeting in November 2015. Magnolia Regional Health Center in Corinth, Mississippi (pictured at right) was one of the first institutions to apply and receive initial accreditation as an ACGME institutional sponsor.
The following interview was conducted by AACOM staff in September 2015, shortly after the internal medicine program received an ACGME site visit.
Q: Who decided to apply for ACGME accreditation right away? Who was in charge?
A: As the program director and director of medical education, I made the decision immediately after the [Memorandum of Understanding] MOU was announced that we needed to apply right away for ACGME accreditation. I then began to prepare our faculty, administration and residents for the upcoming transition and we dove right into it. Q: How did you prepare for this process? Were there models or templates you looked at beforehand? How different was the experience from going through AOA accreditation?
A: I read through all of the ACGME institutional and program standards to get a very good understanding of them. I then prepared a presentation that I gave to our core faculty members and residents comparing osteopathic and ACGME standards. This allowed us to collectively identify the problems that we would have moving forward with the ACGME application process. There really weren't any type of models or modules to use as templates. The experience was somewhat different from AOA accreditation in the sense that the application was different. The actual ACGME site visit was much better than I thought and very similar to AOA site visits.
Q: Did you hire a consultant? Was there a project manager?
A: We did not hire a consultant. My excellent clinical faculty team and most importantly my program manager and now new Designated Institutional Officer (DIO) Gena Lindsey was a phenomenal champion and MVP of the accreditation process.
I would NEVER have been able to finish the application process by myself, you really need to have an excellent team in order to complete the process.
Q: Were there any surprises throughout the application and site visit process? Any surprise costs? Any surprises in meeting the requirements?
A: There weren't really any surprises. The application is tedious but it is straightforward. The initial institution application requires a lot of data submission about the institution and other affiliated institutions. The program application was definitely much more in depth and required a tremendous amount of documentation. Additionally we had to overhaul our department to create the newly formed program evaluation committee (PEC) and clinical competency committee (CCC). We also had to change all of our resident evaluation forms to include the ACGME next accreditation resident milestones. There were no surprise costs. Our site visit was last Thursday, and I was really quite nervous about it. However after having gone through it, it was very straightforward and was not unpleasant at all. I found the inspectors to be very friendly and gracious. I felt like they had a very well organized agenda and the inspection process was very much like what we are used to from our AOA inspections.
Q: What advice would you give to other internal medicine programs going through the process?
A: In terms of advice I would give to other programs would be to just get it over with. I feel that it is unfair for the hard working residents enrolled in our programs to not allow them the ability to apply to ACGME fellowships if they so choose. Having gone through the process it is long, difficult, and anxiety provoking however it is not impossible. It is going to be necessary to do it by 2020 so why keep waiting?? I also felt that if we apply and get rejected or receive citations it is important to identify them early and rectify them. In summary, I felt it was important for the future of my program to solidify our status and ensure the future of our hospital as an academic institution to get accredited early.
Q: What made you decide to apply for osteopathic recognition at this point? What was the application process like?
A: I decided to apply for osteopathic recognition after speaking with my core faculty members and residents. We have an osteopathic clinic affiliated with our residency program where we offer OMT to our patients and want to continue that. We also feel it will be an important recruiting tool for osteopathic students into our program. We all are very proud of our osteopathic heritage and feel that we have a lot to offer to ACGME. That being said, I look forward to having both allopathic and osteopathic residents in our program one day. I feel like we can all learn a lot from each other.
Q: Does your institution plan to publicize their ACGME accreditation status?
A: We absolutely do plan to publicize our ACGME status. When we go to residency fair hospital days at the medical schools many of the medical students ask what our plans are for ACGME accreditation. Additionally when interviewing medical students for spots in our residency many of them ask what our plans are. Now it is a nice to be able to tell them that they will be able to go to any fellowship that they choose if they graduate from our program and can get in on their own merit.
Q: What (if anything) kept you up at night in going through the process?
A: Fear of the unknown has been the main thing that has made me anxious about the transition. We are all busy taking care of patients, teaching and doing our other work related duties that it is very hard to take on this new application process. I was able to put together an excellent team and great staff members over the years and without them it would've been impossible.
Q: In retrospect, what resource or information do you wish you had as you went through the process? What could have made the process smoother?
A: I really am unsure what resource would have been helpful. It is most important to sit down and read through all of the standards line by line. Then realistically look at your program to understand what you are lacking in those standards. By and large, the standards are very similar to AOA accredited program standards. There are some major differences like the aforementioned committees that have to be formed. There are also many more faculty-dependent requirements. Faculty must commit a specified amount of their work schedule to academics. Each program also needs to have a specific number of core faculty. In addition, core faculty is responsible for more scholarly activity. We also had to do a major overhaul in our new innovations process for the milestone evaluations.
Having help with some of these things such as how to set up the committees appropriately, what is expected of these ACGME committees, how to get faculty more involved in scholarly activity, and how to enroll in the ACGME milestones would be extremely helpful. Luckily on these topics I was able to find many things online from ACGME and ACGME accredited programs that were very helpful. I also emailed the RRC director a few times concerning questions we had and he was very helpful with providing answers.
Q: Anyone opposed to going ahead with ACGME accreditation? If so, how did you manage this?
A: No one really was opposed. When the memorandum of understanding was first announced there were some naysayers from my core faculty and residents. However as the director of medical education and program director I said that this is the rule that the AOA and ACGME came to and this is what we are going to do. I then enrolled everyone's help in making it happen so that everyone took ownership of the merger. I feel that overall it has allowed us to look at ourselves in the mirror and reinvent a better version of our already excellent program.
All this being said, we are not fully accredited yet but we are getting closer. I feel like I have a very good understanding of the expectations of ACGME. Though the application has been long we are almost through it and we have managed to take great care of patients and educate our residents in the process.