Ucsf gme 2011 annual report and town hall discussion
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UCSF GME 2011: Annual Report and Town Hall Discussion. Robert B. Baron, MD MS Professor of Medicine, Associate Dean GME & CME. Mary McGrath, MD, MPH Professor of Surgery Director, Resident and Fellow Affairs. Robert B. Baron, MD, MS Professor of Medicine Associate Dean for GME and CME.

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UCSF GME 2011: Annual Report and Town Hall Discussion

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Ucsf gme 2011 annual report and town hall discussion

UCSF GME 2011:Annual Report and Town Hall Discussion

Robert B. Baron, MD MS

Professor of Medicine, Associate Dean GME & CME


Gme faculty

Mary McGrath, MD, MPH

Professor of Surgery

Director, Resident and Fellow Affairs

Robert B. Baron, MD, MS

Professor of Medicine

Associate Dean for GME and CME

Claire Brett, MD

Professor of Clinical Anesthesia

Chair, Internal Review Committee

Vice Chair, GMEC

Rene Salazar, MD

Assistant Clinical Professor of Medicine

Director, Diversity

Arpana Vidyarthi, MD

Assistant Clinical Professor of Medicine

Director, Patient Safety and Quality Innovations

GME Faculty

Susan Promes, MD

Associate Professor, Emergency Medicine

Director, Curricular Affairs


Office of gme staff

Office of GME Staff


Ucsf gme

UCSF GME

  • 25 accredited residency programs

    • Average cycle length 4.44 years (out of 5)

  • 53 accredited fellowship programs

    • Average cycle length 4.87 years (out of 5)

  • 40 non-standard programs

  • 1,365 residents and clinical fellows

  • UCSF School of Medicine is Sponsoring Institution

  • Designated Institutional Official (DIO) reports to the Dean


Short cycle programs

Short Cycle Programs

Plastic Surgery: 3 years

General Surgery: 3 years

Thoracic Surgery: 2 years

Pediatric Anesthesia: 2 years

Nephrology: 3 years

Infectious Disease: 3 years


Citations

Citations

  • No particular pattern

    • Less than 2 citations per program

  • Institutional support

    • Parking and transportation

  • Faculty

  • Education program

  • Evaluation

  • Duty Hours


Duty hours october 2010

Duty Hours – October 2010


Gme diversity 2004 2010

GME Diversity 2004-2010


Underrepresented in medicine in gme

Underrepresented in Medicine in GME


Recruitment of underrepresented in medicine ucsf gme 2010 match

Recruitment of Underrepresented in Medicine: UCSF GME 2010 Match

AppliedInterviewedRankedMatched

Residencies

838 (9.3%)179 (9.9%)157 (9.6%)30 (12.5%)

Fellowships

127 (9.6%)35 (9.4%)24 (9.8%)6 (6.3%)


Selected training outcomes 2010 resident career choices

Selected Training Outcomes: 2010 ResidentCareer Choices

  • Higher training: 51%

  • Academic position: 18%

  • Practice: 20%

  • Policy/consulting: 1%

  • Other: 10 %


Selected training outcomes 2010 fellow career choices

Selected Training Outcomes: 2010 FellowCareer Choices

  • Higher training: 31%

  • Academic position: 33%

  • Practice: 26%

  • Policy/consulting: 2.5%

  • Other: 7.5 %


Selected training outcomes 2010 resident scholarship

Selected Training Outcomes: 2010 Resident Scholarship

PRESENTATIONS

  • UCSF presentation: 28%

  • Regional presentations: 9%

  • National presentations: 17%

  • International presentations: 4%

  • Any presentation: 29 %

    PUBLICATIONS

  • First author publication: 22%

  • Peer reviewed publication: 22%

  • Any publication: 23%


Selected training outcomes 2010 fellow scholarship

Selected Training Outcomes: 2010 Fellow Scholarship

PRESENTATIONS

  • UCSF presentation: 57%

  • Regional presentations: 10%

  • National presentations: 27%

  • International presentations: 11%

  • Any presentation: 58%

    PUBLICATIONS

  • First author publication: 30%

  • Peer reviewed publication: 29%

  • Any publication: 39%


Selected training outcomes 2010 residents courses and structured electives

Selected Training Outcomes: 2010 Residents Courses and Structured Electives

  • TICR: 2 (0.2%)

  • DCR: 33 (3.8%)

  • Pathways to Discovery: 109 (12.7%)

    • 6 programs

    • Anesthesia, Dermatology, Family Medicine, Internal Medicine, OB-GYN, Pathology


Selected training outcomes 2010 fellows courses and structured electives

Selected Training Outcomes: 2010 Fellows Courses and Structured Electives

  • TICR: 33 (12.7%)

  • DCR: 12 (4.6%)

  • Pathways to Discovery: 1 (0.4%)

    • Endocrinology


New common program requirements

New Common Program Requirements

  • Effective July 1, 2011; not just changes to duty hours

  • Introduction: focus of graduate medical education on transitioning a medical student to an independent practitioner through graded and progressive responsibility in medical education.

  • Professionalism, personal responsibility, and patient safety are discussed in detail

  • Transitions of care must be minimized and structured.

  • Residents and clinical fellows must work as members of effective interprofessional teams.


Patient safety vs clinical experience

Patient Safety vs. Clinical Experience


Supervision vs autonomy

Supervision vs. Autonomy


Ucsf gme 2011 annual report and town hall discussion

High

Low

Low

High

Supervision vs. Autonomy

20

Student ---------------------------- Intern -------------- Resident ------------ Fellow---------------------Attending


Ucsf gme 2011 annual report and town hall discussion

High

Low

Low

High

Supervision vs. Autonomy

21

Student ---------------------------- Intern -------------- Resident ------------ Fellow---------------------Attending


Ucsf gme 2011 annual report and town hall discussion

Supervision vs. Autonomy

22

High

Low

Low

High

Student ---------------------------- Intern -------------- Resident ------------ Fellow---------------------Attending


New requirements fatigue

New Requirements: Fatigue

  • Fatigue education, which has been required for trainees, will be required for all teaching faculty.

  • Fatigue mitigation processes must be adopted.

    • i.e. strategic napping, back-up call schedules, etc.

    • Adequate sleep facilities and safe transportation options for those who are too fatigued to drive home (i.e. taxi vouchers, nap rooms, etc.) must be provided.


New requirements supervision

New Requirements: Supervision

  • Supervision is discussed in detail and definitions of direct and indirect supervision as well as oversight are provided.

  • Identifiable faculty and trainees may supervise trainees

    • Emphasis on progressive responsibility based on specific national standards-based criteria.

    • Interns (PGY1 residents) are required to have direct or indirect supervision at all times and day after “oversight” is no longer permitted.


New requirements duty hours

New requirements: Duty Hours

  • Duty hours must be limited to 80 hours per week over a four-week period, including all moonlighting (internal and external).

  • All trainees must have one day off in seven over a four-week period; at-home call cannot be assigned on the free day.


New requirements duty hours1

New requirements: Duty Hours

  • Maximum duty period length:

    • PGY1: must not exceed 16 hours in duration

    • PGY2 and above: may be scheduled a maximum of 24 hours of continuous duty in the hospital plus four hours for transition (with naps encouraged)

  • Minimum time off between scheduled duty periods:

    • PGY1: should have 10 hours, must have eight

    • PGY2 and above: should have 10 hours, must have eight, but this may be shortened in selected clinical circumstances.


New requirements duty hours2

New requirements: Duty Hours

  • Night float may occur no more than six consecutive nights.

  • In-house call may not occur more frequently than every third night when averaged over a four-week period.

  • At-home call must not preclude rest and as with the previous requirements counts toward the maximum 80 hour per week maximum, but not in the shift break.

  • PGY1 residents may not moonlight.


Acgme resident fellow survey 2009 10 institutional responses

ACGME Resident/Fellow Survey 2009-10 Institutional Responses


Acgme resident fellow survey 2009 10 institutional responses1

ACGME Resident/Fellow Survey 2009-10 Institutional Responses


Acgme resident fellow survey 2011

ACGME Resident/Fellow Survey 2011

  • Core specialty programs (regardless of size) and subspecialty programs (with 4 or more fellows) surveyed between January and June.

  • 13 new survey questions, including:

    • Q14. Thinking about the faculty and staff in your program overall, how interested are they in your residency education?

    • Q17. How satisfied are you that your program treats your evaluations of faculty members confidentially?

    • Q20. How satisfied are you with the way your program uses the evaluations that residents/fellows provide to improve the program?


Acgme resident fellow survey 20111

ACGME Resident/Fellow Survey 2011

  • Q34. Which of the following best summarizes your opinion of your residency program?

    - The best possible experience – if I had to select residency programs again, I’d pick this one

    - A good experience – if I had to select residency programs again, I would probably choose this one.

    - A neutral experience – if I had to select residency programs again, I might or might not choose this one.

    - A negative experience – if I had to select residency program again, I would probably not choose this one.

    - A very negative experience – if I had to select residency programs again, I would definitely not pick this one.


What is meant by non physician service obligations

What is meant by “non-physician service obligations”?

“Duties which in most institutions are performed by technologists, aides, transporters, nurses, or other categories of health care workers. Examples include transport of patients from the wards or units for procedures elsewhere in the hospital, routine blood drawing for laboratory tests, routine monitoring of patients when off the ward and awaiting or undergoing procedures, etc.”


Acgme resident fellow survey 2011 schedule

ACGME Resident/Fellow Survey 2011 Schedule

  • Jan/Feb - Surgical Subspecialties (Dermatology, Neurology, OBGYN, Radiology)

  • Feb/March - Neuro Surg, Nuc Med, Pathology, Pediatrics/Subspecialties, Psych, Rad Onc

  • March/April - Anesthesiology, Family Med, Ophthalmology, Emergency Med

  • April/May - Internal Med/Subspecialties, Surgery


Medical education and the new public interest

Medical Education and the New Public Interest

1910: train future physicians to make care more scientific to reduce the burden of disease

2011: train future physicians to continually improve the delivery of care to realize its fullest potential benefit to the health and well-being of the population

Berwick DM. Academic Medicine, 2010


Selected best practices at ucsf

Selected Best Practices At UCSF

Longitudinal clerkships (Parnassus, VA, SFGH, Fresno, Kaiser)

Pathways to Discovery Program: Health Systems and Leadership Track

Pediatric Leadership for the Underserved (PLUS)

VA Quality Scholars, VA Quality Chief Resident

VA Center of Excellence in Primary Care Education

Monthly Chief Resident Dinner with CEO and Dean

Resident and Fellow Quality and Safety Program


Building a resident and fellow quality and safety program

BUILDING A RESIDENT AND FELLOW QUALITY AND SAFETY PROGRAM

Hospital

GME Program

Operational goals

Front line provider

Educational goals:

the trainee

Residents and Fellows

Courtesy: Arpana Vidyarthi MD


Building a resident and fellow quality and safety program1

BUILDING A RESIDENT AND FELLOW QUALITY AND SAFETY PROGRAM

Hospital

GME Program

Accountable

leadership

Accountable

Leadership

Residents Council

CR development program

Patient Care Fund

RCA Engagement

Formal Curricula

Incentive Program

Educational goals:

the trainee

Operational goals

Front line provider

Residents and Fellows

Courtesy: Arpana Vidyarthi MD


Resident and fellow incentive goals 09 10

Resident and FellowIncentive Goals 09-10

Patient Satisfaction: For the period of June 2009 –July 2010, on the patient satisfaction survey likelihood of recommending question, maintain an annual average mean score of 90 or a percentile ranking of 71


Patient satisfaction 2009 10

Patient Satisfaction: 2009-10


Patient satisfaction 2010 2011

Patient Satisfaction 2010-2011

Patient Satisfaction: For the period of June 2010 –July 2011, on the patient satisfaction survey likelihood of recommending question, maintain an annual average mean score of 90.5.


Clinical housestaff incentive goals 09 10

Clinical Housestaff Incentive Goals 09-10

Patient Safety and Quality: By June 2010, residents will achieve an average combined compliance of 85% with:

Physician hand hygiene as measured by direct observation

Influenza vaccination or completion of declination form

Completion of the mandatory infection control module


Clinical housestaff incentive goals 09 101

Clinical Housestaff Incentive Goals 09-10


Hand hygiene 2010 11

Hand Hygiene: 2010-11

Patient Safety and Quality: For the period of July 2010 – June 2011, achieve 85% hand hygiene compliance for at least six of twelve months.


Resident and fellow incentive goals resident leadership

Resident and Fellow Incentive Goals:Resident Leadership

  • Angela Walker MD:

    • Pediatric-Dermatology Resident

    • Co-chair, Resident and Fellow Council

  • Devoted vacation week October 2011 to hand hygiene

    • Met with fellow residents and chief residents

    • Spoke at Grand Rounds

    • Rounded with ward teams from multiple specialties

    • Handed out cards, “Good Job, Hand-hygiene Card” good for raffle prize

    • Set up and staffed table in patient entrance to inform patients about hand hygiene


Ucsf gme 2011 annual report and town hall discussion

Hand Hygiene January 2011

45


Ucsf gme 2011 annual report and town hall discussion

Hand Hygiene January 2011

46


Uhc comparison data

UHC Comparison Data

UCSF Ranks #1 in Tests Used per Patient Discharged


Laboratory testing 2009 10

Laboratory Testing: 2009-10


Laboratory testing 2010 11

Laboratory Testing: 2010-11

Lab Utilization: By June 2011 residents will decrease by 5% the aggregated utilization of common laboratory tests (defined as tests/ inpatient day). Common tests will include, CBC, CBC with differential electrolytes (Na, K, CI, CO2, HCO3, Mg, Ca, Phos), BUN, Cr, AST, ALT, total bilirubin, alkaline phosphatase, and albumin.


Ordering electrolytes 2010 2011

Ordering Electrolytes: 2010-2011


Program specific projects 09 10

PROGRAM-SPECIFIC PROJECTS: 09-10

  • Anesthesia: Administer antibiotics within one hour of incision

    • Goal: 96% of patients

    • Results: 96.3% (Achieved)

  • Dermatology

    • Goal: Decrease wait time in clinic by 25% (below 18 minutes)

    • Results: 13.3 minutes (Achieved)

  • Emergency Medicine

    • Goal: Contact 50% of PCPs at Discharge

    • 8% (Not achieved)


Program specific projects 09 101

PROGRAM-SPECIFIC PROJECTS: 09-10

  • Internal Medicine:

    • Goal: Contact 80% of PCPs

    • Results: 87.6% (Achieved)

  • Neurology

    • Goal: Document Swallow exam 90% stroke patient)

    • Results: 91.2% (Achieved)

  • Neurological Surgery

    • Goal: Increase on time start in OR for 95% of cases

    • 97.5% (Achieved)


Program specific projects 09 102

PROGRAM-SPECIFIC PROJECTS: 09-10

  • Ob-Gyn

    • Goal: Adequate inpatient diabetes orders and outpatient follow-up of 90% of diabetes patients

    • Results: 97% (Achieved)

  • Pediatrics

    • Goal: Complete asthma care plan on 90% asthma inpatients

    • Results: 93.7% (Achieved)

  • Radiology

    • Goal: Report critical results in 95% of eligible cases

    • 97.3% (Achieved)


Program specific incentives 10 11

PROGRAM-SPECIFIC INCENTIVES: 10-11

  • Anatomic Pathology (Achieving)

    • Goal: Decrease incorrectly submitted specimens

  • Anesthesia (Achieving)

    • Goal: ICU transfer note

  • Dermatology (Achieving)

    • Goal: Appropriate Medication monitoring

  • Emergency Medicine (Close)

    • Goal: Smoking cessation in Emergency Department

  • Internal Medicine (Achieving)

    • Goal: Same day electronic discharge summary

  • Internal Medicine Subspecialty Fellowships (NA)

    • Goal: Improve consultation notes


Program specific incentives 10 111

PROGRAM-SPECIFIC INCENTIVES: 10-11

  • Neurology (Close)

    • Goal: Increase primary care provider communication

  • Ob-Gyn (Not achieving yet)

    • Goal: Decrease wait from presentation to induction

  • Otolaryngology (Achieving)

    • Goal: Patient satisfaction on “time spent with patients.”

  • Pediatrics (Close)

    • Goal: Immunization status documented

  • Radiation Oncology (Achieving)

    • Goal: Use of correct ICD-9 codes

  • Urology (Achieving)

    • Goal: Reduce use of CBC by 15%


Program specific incentives 2011 2012

PROGRAM-SPECIFIC INCENTIVES: 2011-2012

56

  • Applications for 2011-2012 Program-Specific Incentive Program now being accepted

    • Application Deadline: Tuesday, March 15, 2011

    • Application: http://medschool.ucsf.edu/gme/residents/incentives.html

  • Incentive goals should be:

    • Related to quality, safety, operations/efficiency or patient satisfaction

    • Aligned with the department and medical center quality improvement strategies

    • Feasible to measure; and

    • Educationally relevant

  • Contact Arpana Vidyarthi, Paul Day, or Kara Bischoff


Quality and safety program benefits

QUALITY AND SAFETY PROGRAM: Benefits

  • Enhanced educational outcomes (systems-based practice, practice-based learning and improvement)

  • Improved clinical outcomes and quality measures

  • Cost avoidance and savings

    • Costs to meet core measure compliance

    • Increased efficiency (e.g. OR starts)

  • Revenue Generation

    • Potential for increase market share (e.g. patient satisfaction)

  • Enhanced reputation (e.g UHC ranking, other publically reported quality measures)

  • Alignment of missions within institution


Apex update

APeX UPDATE

58

  • About 60 days from the first Go Live!

  • Upcoming Go Live Schedule:

    • April 6 & 13 – Primary Care

    • June 22 & July 13 – Peds Primary Care, OB/GYN, Peds, Adult Med Specialties, OHNS

    • October 1 – Inpatient Go Live at Parnassus (ED) and Mt. Zion (cPOE)

    • November 2011 – February 2012 – Cancer Center, Neurology, Urology

    • March 2012 – cPOE at Parnassus

    • February – April 2012 – Surgery all remaining clinics

  • Looking for SuperUsers! Be a resource tool for your clinic and receive compensation.


Keeping an e in gme

Keeping an “E” in GME


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