Bradley F. Marple, M.D. Associate Dean, Medical Education Designated Institutional Official, ACGME Chair, Graduate Medical Education Committee

Transcription

1 ACTION May 4, 2012 Bradley F. Marple, M.D. Associate Dean, Medical Education Designated Institutional Official, ACGME Chair, Graduate Medical Education Committee

2 UTSW GME BASIC INFORMATION GETTING A FEEL OF THE HOST INSTITUTION

3 Graduate Medical Education Major Participating Institutions Children's Medical Center of Dallas Dallas County Hospital District-Parkland Dallas VA Medical Center Seton Family of Hospitals in Austin University Hospitals (St Paul and Zale) Baylor University Medical Center John Peter Smith Hospital (Tarrant County Hospital District) Methodist Health System Dallas Texas Health Presbyterian Dallas Texas Scottish Rite Hospital for Children

4 UT Southwestern Medical Center Program Information Dallas Core Programs 20 Subspecialty Programs 65 New Programs 1 Neurotology Austin Core Programs 9 Subspecialty Programs 2 New Programs 2 EM, PM&R Dallas Residents 1203 Core 902 Subspecialty Austin Residents Core 187 Subspecialty - 11 Parkland 602ish

5 TMB Approved Fellowships TMB approved 37 Total positions 75 Reserved for Programs that lack an ACGME accredited pathway Initiation of program while applying for ACGME accreditation

6 Main Residency Match Origin of Residents by Region N = 16 N = 28 N = 24 N = 11 N = 24 N = 29 N = 152 N = Western 7.3% Central 12.7% NorthEast 10.9% Southern 69.0% 2012 Western 4.9% Central 10.7% NorthEast 13.0% Southern 71.3%

7 Main Match 2012 Matched Applicants Regional by Program Dallas Programs Regions Western Central Southern N. Eastern International UT Schools Unfilled Anesthesiology Child Neurology 2 2 Dermatology Emergency Med Family Medicine Internal Medicine Medicine - Prelim Psychiatry Radiology Diagnostic Radiation Oncology Surg-Prelim Urol General Surgery NDD 1 1 Neurol. Surgery Neurology Dallas OB/Gyn Orthopaedic Surgery Otolaryngology Pathology Pediatrics Plastic Surg.-Int PM & R Ped-Prelim NDD 1 1 TOTALS: N=223

8 Graduate Medical Education CHALLENGES THAT WE FACE

9 ACGME 2011 CPR Duty Hours PGY-1 requirements Shift work asynchronous work patterns Conferences for night floats Strategic napping Resident supervision Delineation of duties and responsibilities Monitoring Patient Safety Programs Transitions of Care

10 Cost to Train Resident (AAMC Regional 75 th percentile) Stipend - $52,225 65,903 Benefits - $15,403 19,441 Administrative overhead - $30K-50K/res/yr Research and academic fees Total - $95, ,000/res/year

11 Who Pays for GME? CMS DME Direct Graduate Medical Education funding is intended to fund that portion of resident stipend and benefits proportional to inpatient medicare days within a training hospital IME Indirect Graduate Medical Education funding is intended by higher hospital costs related to the presence of residents DSH disproportionate share payments State funding Local funding Other

12 ACGME Funding at risk Federal cuts State cuts Local cuts AAMC DIO Survey revealed: All states would be affected Training slots would be reduced Significant impact on patient care

13 Somebody has to do something, and it s just incredibly pathetic that it has to be us. Jerry Garcia The Grateful Dead

14 UTSW GME Structure DEAN DIO GMEC Exec Committee GME Office Program Coordinator GMEC Subcommittees PD Advisory Council

15 UTSW UPCOMING ISSUES: THE NEXT ACCREDITATION SYSTEM

16 Accreditation Council for Graduate Medical Education The Next Step in Outcomes Evaluation and Program Accreditation Bradley F. Marple, MD (with permission from Tom Nasca, MD, CEO ACGME)

17 Accreditation Council for Graduate Medical Education Background on Milestones

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19 Supervision The Continuum of Clinical Professional Development Authority and Decision Making versus Supervision High Physical Diagnosis Clerkship Sub-Internship Graded or Progressive Responsibility Internship Residency Low Low Authority and Decision Making Fellowship Attending High

20 The Goal of the Continuum of Professional Development in the 4 year preparation of the Anesthesiologist Master Expert Anesthesia Related Technical Skills System Based Practice, OR Team Skills Patient Care, Non-Procedural Proficient Competent Advanced Beginner Novice PGY 1 PGY 2 PGY 3 PGY 4 MOC Increase the Accreditation Emphasis on Educational Outcomes

21 ACGME Goal for Milestones - Permits fruition of the promise of Outcomes Based Accreditation Tracks what is important - Outcomes Begins using existing tools and observations of the faculty Clinical Competency Committee triangulates progress of each resident ABMS Board has the opportunity to track the identified individual ACGME Review Committee tracks unidentified individuals trajectories ACGME and ABMS are able to provide accountability for effectiveness of educational program in producing outcomes, and achieved outcomes of individual trainees ACGME can work with AAMC to improve graduation level preparation

22 Accreditation Council for Graduate Medical Education The Next Accreditation System This article ( /NEJMsr ) was published on February 22, 2012, at NEJM.org.

23 Goals of The Next Accreditation System To begin the realization of the promise of Outcomes To free good programs to innovate To assist poor programs to improve To reduce the burden of accreditation To provide accountability for outcomes (in tandem with ABMS) to the Public

24 The Next Accreditation System in a Nutshell Continuous Accreditation Model annually updated Based on annual data submitted, other data requested, and program trends Scheduled Site Visits replaced by 10 year Self Study Visit Standards revised every 10 years Standards Organized by Structure Resources Core Processes Detailed Processes Outcomes

25 The Conceptual Change From The Current Accreditation System Rules Corresponding Questions Correct or Incorrect Answer Citations and Accreditation Decision Rules Corresponding Questions Correct or Incorrect Answer Citation and Accreditation Decision

26 The Conceptual Change To The Next Accreditation System Continuous Observations Assure that the Program Number of Potential Fixed the Problem Related Rules Problems Promote Innovation Diagnose the Problem If there is one!

27 Conceptual Model of Standards Implementation Across the Continuum of Programs in a Specialty STANDARDS Initial Accreditation New Programs Accreditation with Warning New Programs, Accredited Programs with Major Concerns Probationary Accreditation Maintenance of Accreditation Accredited Programs without Major Concerns Maintenance of Accreditation with Commendation 2-4% 15% 75% Structure Resources Core Process Detailed Process Outcomes Structure Resources Core Process Detailed Process Outcomes Structure Resources Core Process Detailed Process Outcomes Structure Core Process Resources Detailed Process Outcomes Withhold Accreditation Withdrawal of Accreditation 6-8%

28 The Next Accreditation System Institutional Visit Program Patient Safety, Quality Improvement Supervision, Transitions in Care, Duty Hours Institutional Review Committee Institution Oversight Review Committee Review Committee Program Program Program Review Committee Review Committee Program Program Program Review Committee Program Program Program Review Committee Review Committee Program Review Committee Review Committee Review Committee

29 Challenges/Opportunities Culture Change and Faculty Development Program Directors, Designated Institutional Officials Faculty Review Committee Members Retooling of ACGME Infrastructure and Personnel The Community of Educators in each specialty must come together and agree on: core elements of the competencies levels of performance

30 Resident frequently fails to recognize or actively avoids opportunities for compassion or empathy. On occasion demonstrates lack of respect, or overt disrespect for patients, family members, or other members of the health care team Professionalism Unprofessional Resident seeks out opportunities to demonstrate compassion and empathy in the care of all patients; and demonstrates respect and is sensitive to the needs and concerns of all patients, family members, and members of the health care team. Resident demonstrates compassion and empathy in care of some patients, but lacks the skills to apply them in more complex clinical situations or settings. Occasionally requires guidance in how to show respect for patients, family members, or other members of the health care team.

31 Expert Proficient Competent Advanced Beginner Novice Increase the Accreditation Emphasis on Educational Outcomes

32 Singapore End of PGY-1, Mid PGY-2 Year Evaluation, Overall Rating of Six Competencies across All Specialties Expert Professionalism Proficient Communications Competent Medical Knowledge Patient Care Advanced Beginner Novice End PGY 1 Mid PGY 2 Practice Based Learning and Improvement Systems Based Practice n=122 paired observations Increase the Accreditation Emphasis on Educational Outcomes

33 Singapore Milestone Data, End of PGY 1 to Mid Year PGY 2 All Specialties (n=122, 100%) Professionalism Communications Med Knowl Pt Care/Tech Sk PBLI SBP Y1 Professionalism 1 Y2 Y1 ProfessionalismCommunication Skills 1 Y2 Communication Skills Y1 Medical Knowledge 1 Y2 Medical Knowledge Y1 Patient Care and Technical Skills 1 Y2 Patient Care and Technical Skills Y1 Practice Based Learning 1 Y2 Practice Y1 Systems- Based LearningBased Practice Y2 Systems- Based Practice

34 Resident Survey 3 Year Trends in Three Programs

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36 Next Accreditation System Seven specialties/rrc s begin training 7/2012 Pediatrics Internal Medicine Diagnostic Radiology Emergency Medicine Orthopedic Surgery Neurological Surgery Urological Surgery Sponsor Visit Program begins 9/2012 The Next Accreditation System begins 7/2013 These seven specialties go live 7/2013 The remaining specialties begin training 7/2013 All specialties/rrc s using the Next Accreditation System 7/2014 Visits to IRC and all 7 RRC s this Spring

37 Institutional Implications Programs Standardized evaluations of residents Increased entry of data points relative to resident education GME centralized reporting Metrics will focus upon more continuous outcomes measures Many will be common to all programs Some will be unique to individual programs Standardization of GME processes Site visits and Internal Reviews will be phased out Increased reliance upon annual reviews, metric reporting

38 Thank you