Surgical Residency Program & Director KEN N KUO MD, FACS 1
Taiwan Surgical Association Residency Director Meeting September 17, 2011 November 5, 2011 2
Three Stages of Education Undergraduate medical education Graduate medical education Continue medical education 3
A Resident The resident is a student in learning of a medical specialty, an immediate teacher to medical students ----a a dual role in medical education---- 4
Residency Without a good residency, a teaching institute cannot offer a good teaching to medical students 5
Service Residents provide some service function to hospital healthcare The question is how to balance between learning and service 6
ACGME Accreditation Council for Graduate Medical Education American Board of Medical Specialties American Hospital Association American Medical Association Association of American Medial Colleges Council of Medical Specialty Societies 7
ACGME Board members: 4 4 from each member organization 3 3 public representatives 2 2 resident representatives Chair of the council of Review Committee Chairs A A representative for Federal Government (non-voting capacity) 8
Residency Review Committee Under the aegis of ACGME, accreditations of residency programs and institutions that sponsor them are carried out by 27 RRC and 1 institutional review committee. 9
Residency Review Committee A RRC consists of representatives appointed by American Medical Association Appropriate specialty Board National specialty organization in some cases (in case of surgery, by American College of Surgeon) 10
IOM Core Competencies Health Professions Education: A Bridge to Quality (2003) Provide patient-centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Utilize informatics 11
Six Competencies of Residency by ACGME (2003) 1) Patient care 2) Medical knowledge 3) Professionalism 4) Practice based learning and improvement 5) Interpersonal and communication skills 6) System based practice 12
Patient Care Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health; 13
Medical Knowledge Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care; 14
Practice-based Learning and Improvement Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care; 15
Interpersonal and Communication Skills Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals; 16
Professionalism Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds; 17
Systems-based Practice Systems-based practice, as manifested by actions that 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. 18
Surgical Residency Requirements RRC publishes common program requirement: Institutions: sponsoring and participating institutions Program personnel and resources Program director Faculty Other program personnel Resources 19
Surgical Residency Requirements Resident appointments: eligible criteria, number, resident transfer, fellow and students Program curriculum Program design Specialty curriculum Resident scholarly activities ACGME competencies 20
Surgical Residency Requirements Resident duty hours and working environment Supervision of residents Duty hours On-call activities Moonlighting Oversight Duty hours exceptions 21
Surgical Residency Requirements Evaluation: resident (formative and final evaluation), faculty, program Experimentation and innovation Certification 22
Duty Hours All clinical and academic activities, including in-house call. 1 1 day in 7 free from all educational and clinical responsibilities 10-hour time period between all day duty period and after in-house call Exception based on sound educational rationale 10% 23
Moonlighting Must not interfere with the ability of the resident to achieve the goals and objectives of the educational program Internal moonlighting must be consider part of the 80-hour working weekly limit on duty hours 24
A Good Surgical Residency Program Institutions Program Director Teachers Patient volume 25
A Good Surgical Residency Program Learning environment Conferences Research 26
Program Director A single program director with authority and accountability for operation of the program: 1. Specialty expertise and documented educational and administrative experiences 2. Current certification in specialty 3. Current medical licensure 27
Program Director Administer and Maintain an educational environment conducive to educating the residents in each of ACGME competency areas: Oversee and ensure the quality of didactic and clinical education Approve the selection of program faculty as appropriate Evaluate program faculty and approve continue participation Monitor resident supervision at all sites 28
Program Director Prepare and submit all information required by ACGME Provide resident semiannual evaluation of performance with feedback Ensure compliance with grievance and due process procedures Provide verification of residency education for all residents Resident selection 29
Program Director Implement policies and procedures consistent with institutional and program requirement for resident duty hours and working environment, including moonlighting Maintain all paper work for ACGME requirement, including participating institutes 30
Comparison of USA and Taiwan in Orthopedic Training 31
The comparison USA Taiwan 32
Years of Training 5 years 5 years 33
Residency Accreditation By Residency Review Committee (RRC) of Accreditation Council for Graduate Medical Education ACGME) a voluntary organization Full accreditation for 6 years By Residency Committee of each Specialty Association which is regulated by Department of Health (DOH) Full accreditation for 3 years 34
Teaching Hospital Accreditation By Residency Review Committee of ACGME By Joint Commission of Hospital Accreditation, a NGO regulated by DOH 35
The Detail of Training Requirement By ACGME, which is represented by American Board of Medical Specialties American Hospital Association American Medical Association Association of American Medial Colleges Council of Medical Specialty Societies By each specialty association and approved by Residency Committee of DOH 36
The sponsoring and Participating Institutes Well defined Less defined, and very much dominated by the Joint Commission of Hospital Accreditation 37
Program Director and Faculties Well defined by the experience and peer recognized contribution Well defined, but depend on too much quantified measurement, such as publications and years of been attending physician 38
The Institutional Resources It is well defined by ACGME, 1st year in related specialty rotations It is regulated by Joint Commission of Hospital Accreditation, 1st year in general medical rotation 39
Residency Rotation It is well defined by ACGME, strictly reviewed by RRC It is defined in less strict fashion, that some residents may miss important rotations during residency 40
Grievances and due process Compliance required Not well defined and stated 41
Surgical Log Book Well recorded, according to number, specialty rotation etc. SC SJ TA FA Less defined 42
Scholarly activity Very active in general, however there is difference between academic oriented and practice oriented programs Depend on the different program that may have discrepancies. It is now better defined. 43
Evaluations-residents Twice a year, the residents are evaluated by attending for the performance, there is a good paper trail Less regularly scheduled, and usually there is no paper trail 44
Evaluation-Faculty Usually done once a year by residents, and Program Director is responsible of final conclusion For the culture, it is very difficult doing this in Taiwan 45
Evaluation-Program Institutional Graduate Medical Education Committee usually does the evaluation of program in the institute Some institution may have GME Committee, but there is no timely schedule of this 46
In-training Examination Yearly in November by American Academy of Orthopaedic Surgeons None 47
Medical Licensure Administered by each State, after passing three part National Board Examination (first 2 parts before graduation and 3rd, after graduation) Administered by DOH after passing two part National Board (1st part before graduation and 2nd part at intern year or after graduation) 48
Board Examination Administered by American Board of Medical Specialty. It is a two part examination in two separate times, written and oral Administered by Taiwan Medical Specialty Association. It is a two part examination in two separate times, written and oral 49
Recertification Once every ten years, by the choices of written, oral or practice based examination Once every 6 years by continue medical education hours 50
Specialty Fellowship It is a structured 1 year program fellowship also accredited by RRC of ACGME There is no structured fellowship program as DOH does not administer subspecialty program 51
Added Certification Depend on specialty, there is pro and con of added certification no 52
Residency Director vs. Chairman 1. Differences in job orientation. Education oriented vs. department development 2. A lot of paper work, especially required information from ACGME 3. Dealing with attending physician for their teaching performance 4. Resident feed back and counseling 5. Protected teaching time 53
We are what we repeatedly do. Excellence, then, is not an act, but a habit. ---Aristotle 54
THANK YOU VERY MUCH FOR YOUR ATTENTION 55