From the Deputy Director for Intramural Research

Giving Credit Where Credit is Due

By Michael Gottesman, DDIR

In June, the NIH Animal Care and Use Program was evaluated by a team of 12 outside experts as part of our triennial Association for Assessment and Accreditation of Laboratory Animal Care (AAALAC) site visit. This review, like other rigorous reviews—such as the upcoming Association for the Accreditation of Human Research Protection Programs’ (AAHRPP) evaluation of our human subjects research program; the Joint Commission’s evaluation of the Clinical Center’s patient-care services; and the Accreditation Council for Graduate Medical Education’s (ACGME) review of the Clinical Center’s medical residency programs—is an important component of the oversight that ensures the high quality of our programs. Three points are worth making:

1. The NIH Intramural Program is a federated structure of multiple institutes and centers that are responsible for their own research activities. But in the cases of animal care and use, human-subjects research, patient care, and medical residencies, we have strong programs with centralized management and oversight to ensure consistency. Each program involves standard operating procedures that are endorsed and implemented by our institutes and centers. For AAALAC, the review process reflects more than 25 years of effort. For AAHRPP, we are in the middle of standardizing our procedures so that when we are first site-visited early next year we can make a convincing case for uniformity in a single human-subjects-protection program. For the Joint Commission, the Clinical Center provides important oversight and acts as the glue that keeps our clinical programs together and ensures high-quality patient care. And the ACGME assesses and helps to advance the quality of the Clinical Center’s resident physicians’ education.
2. For these evaluations to result in accreditation, it is critical that everyone responsible for various aspects of the programs be fully educated about the rules and demonstrate unequivocally that they put these rules into practice on a daily basis. The site visitors spend most of their time observing facilities and interviewing the people who are responsible for maintaining the high quality of our programs and, in the case of the ACGME, reviewing documentation indicative of compliance with training requirements. If even one individual is unable to describe and explain appropriate procedures, operational policies, or training requirements, this is duly noted and contributes to possible loss of accreditation.
3. The success of our accreditation programs depends on a lot of hard work by an incredible number of people. There are months of preparation so that we can put our best foot forward. We should all be grateful to the staff members who give these accreditation processes their highest attention. For AAALAC, we have just completed most of the site-visit process. The Joint Commission review was completed last year, but commission inspectors may return at any moment to confirm the continuing high quality of our patient-care services. (At our last visit, the Clinical Center received one of the highest scores possible for the quality of our facilities and clinical care). The most recent institutional ACGME review, which was completed in April 2008, confirmed that both the Clinical Center, as a sponsor for graduate medical education, and our residency programs continue to meet high standards. For AAHRPP, the work is just getting under way. We hope that everyone will put the same kind of energy into that process as we do for our regular Joint Commission, ACGME, and AAALAC accreditations.

The AAALAC site visitors were impressed by the overall quality of our program and by the dedication of the individuals who run it and participated in the interviews. There are always some things that we can improve, and these were transmitted to us in some detail. We need to determine whether any changes are needed to respond to the few concerns that were raised. In the meantime we will provide responses to the AAALAC council before they take a final vote on continuing accreditation for the NIH.

I am extremely grateful to all who work so hard to make our animal-care and -use program one of the best in the country. This achievement is particularly impressive given the complexity of our program. And this column is also an opportunity to thank those who participate in the Joint Commission and ACGME accreditation processes as well as those who will be working hard on the AAHRPP accreditation in the coming year.