Archive for: April, 2009
From APDIM: Subspecialty survival
I have just returned from a week in Dallas, TX attending our medicine conference, and I’m experiencing the buzz that results from the wonderful information sharing that always happens at these events. (Never mind that this is followed by the crashing paralysis that happens NEXT week when I realize my newly revised “TO DO” list is 85 pages long!)
My fellowship administrator and I presented a workshop on “Subspecialty Survival” during which we shared some of the organizational tips we use to keep track of the numerous years’ worth of requirements that occur in subspecialty training. We also did a lot of “comparing” with other attendees about how they run their subspecialty programs.
It appears as if the exercise we endured this year, consolidating the coordination of our programs, which I wrote about in an earlier post, is indeed the wave of the future. Inserting a fellowship administrator at either the department or even the GME level is the most logical and manageable way manage the new accountability requirement.
The “hows” of this varied significantly, and because our fellowship administrator is also the blogger for Residency Manager’s Fellowship Forum, I won’t steal her thunder.
This is just to say that if you’re interested keep an eye out for her report on this as well!
GME and The Joint Commission Site Visit
While at the AHME conference two weeks ago, I sat in on a session that gave an update on The Joint Commission and GME.
Luckily for GME leaders, speaker Carolyn C. Snipe, MA director of GME at North Shore Long Island Jewish Health System, explained that there are no new standards regarding GME.
Whew!
Although there are no new requirements, GME is still an integral part of The Joint Commission site survey.
Monday’s Poll: Electronic professionalism in the age of Facebook
Facebook, MySpace, LinkedIn, blogs. . . chances are you have residents on all of these Web sites. Often the line between the personal and professional information they share on their profiles or blogs can become extremely blurry, especially when trainees post personal information that they wouldn’t share with colleagues or patients in any other setting.
ACGME seeking proposals for duty hour literature review
The ACGME took another step forward in its duty hour review/reform process today with a letter from the organization’s CEO, Thomas Nasca, MD, MACP, requesting proposals for A Comprehensive Literature Review and Analysis of Residency Training and Duty Hours Experience.
Individuals interested in performing the review are encouraged to submit a proposal describing their plans and procedures by May 22, and the final report is due by the end of August. The final report will be the ACGME Duty Hours Task Force as they make their decisions regarding new resident work hours, the letter said.
The ACGME asks applicants to review national and international literature of peer reviewed articles regarding:
- Resident duty hours
- Supervision
- Working conditions
- Sleep needs, patterns, and deprivation
- Fatigue
- Well-being
- Education
- Learning environment
- Moonlighting
- Medical errors
- Effects of the 2003 resident duty hour standards
- Other studies about resident training in teaching and non teaching settings
The ACGME will inform any and all accepted proposals by May 27,2009.
OSCE activities for residents
In the April issue of Residency Program alert, I profiled Charleston Area Medical Center (CAMC) and the institution’s use of an OSCE during orientation to gauge new resident’s skills.
During the OSCE, residents must:
- Perform a H&P using a standardized patient
- Perform a clinical procedure using a standardized patient, partial task trainer, or hybrid combination
- Write orders for tests, labs, etc., based on their assessment
- Interpret test or lab results
- Present findings to an attending physician
- Complete a team-based ACLS activity as part of the patient cases
As you can imagine, it takes CAMC quite awhile to do all of these activities with all of their incoming residents and not everyone can be working with the standardized patients at the same time. CAMC rotates residents in groups through the OSCE as well as two other activities to ensure everyone is busy.
The first activity is a test using questions from the USMLE Step III practice exams, says Gordon Green, MD medical education consultant at CAMC. This gives program directors and faculty members a heads up on who may have trouble passing the real exam, and they can work with these residents to better prepare them for the exam.
The second activity also has to do with passing exams. Residents attend an exam preparation course to find out whether or not they have difficulty with exams from a skill perspective, anxiety, or deficits in knowledge. “We provide them with advice on how to improve their standardized exam taking ability,” Green says.
For those of you who do OSCEs in your institution/program, what do you have residents do while they wait to go through the various stations?
GME Updates: A collection of the latest news
In case you haven’t heard. . .
- The ACGME is looking for workshops for the 2010 Educational Conference. Check out their announcement.
- The ACGME also put a request for nominations for the Parker J. Palmer Courage to Teach and Lead Awards. Read about how to nominate someone for this prestigious award.
- The Association for Hospital Medical Eduction (AHME) launched a new re-designed Web site with enhanced features. Check out the new look.
- AHME also updated their bylaws. Read AHME’s bylaws.
- The AMA now has a Twitter Feed. Follow the organization on Twitter.
In the news:
- US News and World Report explains how they rank medical schools. Read the story on US News and World Report Medical School Rankings.
- University of Louisville’s may lose its neurosurgery residency program because 8 faculty members have left to practice at another hospital. Read the story from the Courier-Journal.
- New residency programs opening in Michigan. Read the story from Crain’s Detroit Business.
- Florida congressman rolls out a new pilot program that sends Medicaid patients to be treated by medical residents. Read about it on Tampa Bay Online.
Have you seen any other interesting updates from around the GME world recently? If so, share them in the comment box below.
Residency observer release
A couple of people commented about the release form Diane referred to in an earlier post describing how her program lets incoming residents shadow for a day before orientation.
In her institution, observers must sign a release before shadowing. Because the interns are not employees yet, they have to abide by the observer policy.
Download the hospital observer policy.
American Hospital Association releases opinions on duty hour reform
The American Hospital Association (AHA) released a letter outlining its opinions of the IOM duty hours report and made a few recommendations yesterday.
The letter-addressed to ACGME CEO Thomas Nasca-commends the organization for reviewing the duty hour standards, but points out that duty hours are not end-all-be-all of measuring fatigue.
“…We use duty hours as an implied proxy for measuring sleep and alertness,” according to the April 20 AHA statement. “This is, at best, an inadequate proxy because the hospital and residency program director have no information on what the resident actually did during the hours not on duty.”
Additionally, the AHA says a full cache of research on the effects of duty hours on training does not exist as some 6-7 year-long programs have yet to graduate a full class of residents trained under the five year old standards. The AHA also points out that not enough sleep research has been conducted looking specifically at physicians-in-training.
“The generic sleep literature suggests that mental alertness and task performance decline after about 16 hours of time or after four consecutive night shifts for most persons. However, it is unclear if these general findings are applicable to physicians-in-training who are young and intellectually engaged in their activities,” the AHA statement says.
The AHA does say that the 80 hour/week rule, standards for no more than every third night for in-hospital call, and the one day off per week rule should be changed.
To see the rest of the AHA’s recommendations, take a look at this crosswalk comparing the ACGME’s current standards, the IOM’s recommendations, and the AHA position.
What do you think of the AHA’s statement? Leave a comment in the box below.
Monday’s Poll: Coordinator education requirements
At AHME last week, one woman described how her institution has partially tied coordinator’s salary to the level of education they have obtained.
This made me wonder whether institutions stipulate minimum education requirements for coordinators. Take the poll below.
From Savannah: A New ACGME Competency?!
Some interesting new coming out of the “Update on ACGME” session, presented by the organization’s CEO, Thomas J. Nasca, MD, MACP.
During his presentation, he refered to 7 core competencies. Obviously, my ears immediately perked up. . . it’s always been SIX not SEVEN competencies. Sure enough, the slide projecting up on the screen listed a new competency: Procedural and Technical Skills.
Before you get into a tizzy and start searching through the Common Program Requirements looking for where the ACGME mentions this new competency, stop and take a deep breath. The competency has not been officially implemented yet by the ACGME.
Nasca says he expects this to become a 7th competency for surgical and nonsurgical programs. He didn’t give a timeline, but if the ACGME’s CEO says it’s going to happen, I believe him.
He didn’t mention the competency again, and instead went on to describe much of the same information I reported on from the ACGME Education Conference held back in March.
What do you think about a the new competency? Leave a comment in the box below.
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