Archive for: March, 2009
Patient safety vs. Education
Richard A. Friedman a professor of psychiatry at Weill Cornell Medical College wrote a really interesting opinion piece in the New York Times earlier this week describing the challenging position educators are put in as they try to balance patient safety and resident education.
Of course, patient safety is universal number one concern for all physicians. However, Friedman discusses how many residents are becoming less and less confident in their decision-making skills. He describes how residents often ask for more supervision, and even graduates call for his opinion on uncomplicated patient cases.
Have you seen this change in your residents or graduates? Why do you think they’re feeling less confident in their skills?
Monday’s Poll: Coordinators on the GMEC
This topic sparked much discussion during the session on coordinator communication skills and the 2009 ACGME Educational Conference.
Several coordinators expressed that their position is not represented on the GMEC although their jobs are significantly impacted by many of the decisions the GMEC makes. At the conference, it seemed like the majority of attendees’ institutions do not include coordinators on the GMEC, but I thought a Monday’s Poll would give everyone a good idea of how common this is.
Open Mic: What are you doing with the IOM duty hour recommendations?
As you may have read in my previous post on duty hours, the ACGME says they’re approaching duty hour reform with open ears. They want to hear from programs who are conducting pilot tests or performing cost analysis to determine whether implementing the recommendations is feasible.
At the 2009 ACGME Educational Conference, a program director described the pilot test underway in his program. It had only been a week, but the results already gave a picture as to how schedules needed to be arranged and the cost associated with implementing recommendations.
Another program director explained that it took his program five years to perfect a scheduling system to meet 2003 requirements. They started their planning in 1998.
I’m assuming many of you are taking a look at how possible changes to duty hour standards will impact your program. I would like to open the blog up to you, readers. . . Are there plans at your institution, at the program or institutional-level, to test some of the recommendations? If you’re not testing them, are you performing any cost analysis or looking at any other data? Share in the comment box below.
Quick tips for ADS pain points
ADS is a double-edged sword. It’s a great way to easily communicate information to the ACGME, but many coordinators say it’s not the most user-friendly system.
That may be why Rebecca Miller, ACGME VP of Applications and Data Analysis gave a presentation entitled, “Accreditation Database System (ADS) 2009 Update”.
To-do lists help residency coordinators get through March madness
There’s no question that Match Day is the most important and exciting day for program coordinators in March. However, with Match Day comes a long list of tasks coordinators must complete to get ready for new residents. Here a couple of items that may be on your to-do list this month:
- Begin appointment process for new residents
- Send out information packets and forms to incoming residents
- Check visa requirements for an IMGs joining the program
- Reappoint returning trainees
- Make a to-do list of all of the tasks needing to be done before orientation-note target dates for completion of each task to stay on track
- Revise recruitment materials for next year and update application dates on your Web site
- Distribute information on new house staff to appropriate institutional personnel as needed
These items are just a start. . . what else do you have on your to-do list for March? Share in the comment box below.
*This information is adapted from The Residency Coordinator Handbook.
Live blog from ACGME Conference #4: Duty hours implementation
Just a quick post before I dash to the airport to catch my flight back home. . .
The earliest the ACGME will implement new duty hour rules is July 1, 2011, said Thomas Nasca, MD, MACP, during his presentation The Recommendations of the IOM Consensus Committee to Optimize Resident Hours and Work Schedules to Improve Patient Safety: Summary and Discussion at the 2009 ACGME Educational Conference.
However, depending on how greatly the new standards differ from the current ones, the ACGME could push that date back, Nasca added.
Either way, Nasca assured attendees that they will have plenty of notification to implement new rules prior to the effective date.
After attending all but one duty-hour related session at the conference, I have to tell you that I am impressed with how the ACGME is handling the scrutiny of the public and is rising to the challenge of reviewing current requirements.
I am also heartened to hear Nasca repeat several times that he wants the GME community’s input as the ACGME considers data and new reforms.
Whether you attended the conference or not, what do you think about the ACGME’s response to re-examining duty hours? As a program director or coordinator, what are your concerns if duty hour standards are reformed?
Live blog from ACGME Conference #3: ACGME Portfolio Update
Program directors and coordinators have been waiting to find out whether the ACGME will require programs to use the ACGME Learning Portfolio (ALP).
The answer is ’sort of’, according to ACGME COO John H. Nylen, who addressed the question during his presentation ACGME Learning Portfolio: An Update.
As part of the Milestones Initiative, the ACGME will require programs to enter summative assessments, Nylen said. Programs will still be able to use residency management systems, such as New Innovations or E*Value, to distribute, collect, and store other evaluations. Nylen did not state when programs would have to start putting summative evaluations on ALP.
During the session, ALP alpha testers from the internal medicine program at Summa Health System and the neurology surgery program at the Cleveland Clinic discussed their experiences using the software. Both presenters noted that residents and faculty liked ALP better than previously used residency management suites.
Although testing of ALP may not be completed for another few years, I recommend at least checking it out. First, it’s free, unlike other systems. Secondly, ALP will be integrated with the Milestones Initiative and contribute to the national outcomes data, which can be used for program improvement.
Right now, Nylen says about 20 programs are testing the program, and the ACGME would like to have more involved in 2009. For more information, watch the ACGME’s portfolio demonstration. Nylen also encouraged participants to give the ACGME a call if they have questions.
Live blog from ACGME Conference #2: Coordinator meetings on food handling?
That’s right. . . one coordinator got a lot of laughs when she shared that the topic of one of her institution’s coordinator meetings was safe food handling. She wasn’t joking. Not surprisingly, she was asking for coordinator meeting topic ideas to take back to the institution.
During the session, Judy Paukert, PhD, DIO at Methodist Hospital emphasized the importance of holding these meetings and attending them. Many attendees said coordinators meet monthly, but Paukert advocates for having a coordinator meeting monthly.
Answer three questions in the comment section below:
1. How often do you have coordinator meetings?
2. What were the last three topics you discussed?
3. What topic would you like to see covered during the next meeting?
Lets hope the woman who had to sit through a food handling course is reading!
Live blog from ACGME Conference #1: Coordinators say faculty are most difficult to communicate with
Hello!
Sorry for my silence yesterday– I was traveling to sunny (and warm) Grapevine for the ACGME conference.
This morning has already been very informative. I attended a session in which coordinators discussed the communication challenges they face daily. When asked, “Who is the most difficult to communicate with,” faculty members were coordinators’ number one answer. Reasons preventing effective communication with faculty included:
- Faculty members do not view or value the coordinator as a professional and do not respond to his/her requests
- When hired, faculty members do not receive education on what educational responsibilities the job entails, so they do not turn in evaluations etc.
- Faculty members don’t care about ACGME requirements or standards
A few coordinators said they track faculty members’ contributions to education using a faculty scorecard. The coordinator gives the program director or department chair that information when the faculty member is up for review. Luckily, I was sitting right next to one of the coordinators who does this, and she agreed to provide an interview for an upcoming issue of Residency Program Alert. Look out for the article!!
What do you think–are faculty the most difficult group to communicate with? If not faculty, who do you have the most trouble communicating with? What have you done to make communication easier?
Check back later for more from ACGME.
Remembering the patient whose case triggered duty hour reform
This week marks the anniversary of the death of Libby Zion. Even if you don’t know who Libby Zion is, you’ve definitely seen the effects of her passing-her case thrust the issues of resident supervision and long resident work hours into the national spotlight.
Zion went to the emergency room in 1984 with a high fever and irregular jerking movements, and she later died. After an investigation, her family discovered she was treated by residents who had been up for hours and had an overwhelming amount of patients to care for. The family launched a public crusade to make sure these issues were addressed.
Although it took nearly a decade for the ACGME to implement duty hour standards, Zion’s case is widely accepted as the impetus for the reform.
In the New York Times this week, columnist Pauline Chen wrote two articles I definitely recommend reading:
- On Young Doctors and Long Work Days, which includes a Q&A with ACGME CEO Thomas J. Nasca, MD about duty hour concerns and the future of reform after the recent IOM report
- A Life Changing Case for Doctors in Training, which takes a look at the Zion case and how far regulations have come since her death.
Also, check out the comments related to the first article. They offer really interesting insights from residents, patients, and physicians.
What do you think about where duty hour reform is headed? Do you agree with Nasca’s comments?
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