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Bulletin

Search Programs/Sponsors. Outcome Project. Residency Review Committee for Anesthesiology David L. Brown, M.D. Chair, RRC for Anesthesiology SAAC/AAPD: Nov 7, 2004 ACGME ( www.acgme.org ) . Chat Rooms. Site Visit. Review & Comment. Resident Information. Resident Duty Hours.

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Bulletin

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  1. Search Programs/Sponsors Outcome Project Residency Review Committeefor AnesthesiologyDavid L. Brown, M.D. Chair, RRC for AnesthesiologySAAC/AAPD: Nov 7, 2004ACGME (www.acgme.org) Chat Rooms Site Visit Review & Comment Resident Information Resident Duty Hours Res. Review Committees Parker Palmer Award Meetings Institutional Review Human Resources GME Information Data Collection Systems Newsroom Bulletin

  2. SAAC/AAPD RRC Review • ACGME & Anesthesiology RRC • Program Data • Review Cycle • Frequent Citations • Program Requirement Changes • Core • Pain Medicine • Cardiothoracic • Duty Hour Update

  3. ACGME Bulletin Samples Anesthesiology ABMS

  4. ACGME • 26 RRC’s • 1 Transitional Year Rev Committee (Phil Lumb) • 1 Institutional Rev Committee (IRC) • 7,800 programs ACGME-accredited • 26 primary specialties • 84 subspecialties

  5. Residency Review Committee for Anesthesiology David L. Brown, MD, Chair MD Anderson Cancer Center, HoustonSteven C. Hall, MD, Ex-Officio Children's Memorial Hospital, Chicago Mark A. Rockoff, MD Boston Children’s Hospital, BostonMark A. Warner, MD Mayo Clinic, RochesterJeffery Kirsch, MD Oregon Health Sciences University, PortlandJ. Jeffrey Andrews, MD UAB, Birmingham Audree A. Bendo, MD SUNY-Brooklyn, New York Susan L. Polk, MD* U Chicago, ChicagoLois L. Bready, MD UTHSC San Antonio, San AntonioCorey E. Collins, DO, Resident Member Boston Children’s Hospital, Boston

  6. Program Data – CoreOctober 2004 # programs 132 # probation 6 # withdrawals 3 # positions appv’d (CA 1-3) 4685 (1560/yr) # positions filled (CBY+CA1-3) 5051 # accredited CBY’s 88

  7. Program Data - Subs October 2004: Positions filled Critical Care Med 50 (50 programs) Pain Medicine 243 (97 programs) Ped Anesthesia 120 (43 programs)

  8. Core (132 programs) CCM (50 programs) Pain Med (97 prog) Ped Anesth (43 prog) 30 (23%) (’02-13%) 5 (10%) (’02-10%) 18 (19%) (’02-23%) 7 (17%) (’02-15%) Program Director Turnover 2003-’04

  9. Program Review Cycles (as of year end 2003) 59% 1 yr: 14.5% concern high 2 yr: 20.5% issues significant 3 yr: 23.3% challenges present 4 yr: 18.2% mostly sound 5 yr: 23.5% solid 41%

  10. Most Frequent Citations • Scholarly activity/publication: significant issue specialty wide • Service v. educational focus: present frequently within specialty • Data Logs: The resident data logs and program data entry into PIF are often unlinked to other data sources and unbelievable • Evaluations: Final written evaluation…review of performance during final period…verify resident has demonstrated sufficient professional ability to practice competently and independently • General competencies: incorporate into curriculum and evaluation forms; instruct faculty in teaching/evaluating competencies • Critical Care: AN faculty participation; pt. variety/volume • Resident complement: prior RRC approval; program communication with local GME office

  11. Program Requirement Update Goal of the program requirement revision is to make better physicians.

  12. Program Requirement Update • Internship revision • Transitional year anesthesiology track • Transfers into program: PD documents rotations • Perioperative physician focus • Pain medicine 3 months • CCM 6 months

  13. How are Program Requirements Revised? 1. RRC originates proposed changes 2001 2. Draft revision to all PDs for comment July 2003 75 responded 3. RRC reviews comment October 2003 4. Further changes? April 2004 5. RRC sends draft>RRC appt’ng org’s (ABA,AMA,ASA) all other RRC’s ACGME member org’s Current Stage Current Stage

  14. Revising Program Requirements • 6. RRC reviews comments (if significant) Conference call planned for next 30 days • 7. RRC submits revised PR to ACGME • 8. ACGME Program Reqs’ Committee reviews/approves/ACGME confirms Time line for implementation set by ACGME in consultation with RRC – July 2008 is our goal – we have successfully appealed one year implementation mandate from ACGME Hope for review at ACGME in February 2005

  15. Program RequirementsThe Continuum Considered No change 48 months as currently outlined 48 months all positions by 2007 Expand to five years with subspecialty choice for each trainee (includes research option)

  16. Program Requirement Facts • A 48-month curriculum in graduate medical education is necessary to train aphysician in anesthesiology. Goal to “fix” internship issues • The RRC for Anesthesiology and the AccreditationCouncil for Graduate Medical Education (ACGME) accredit programs only in thoseinstitutions that possess the educational resources to provide the 48 months oftraining within the parent institution or in combination with integrated or affiliated institutions or ACGME-accredited transitional year programs. Goal to support specialty at time our strength to encourage change is high, institutions need anesthesiologists

  17. Program Requirement FactsExpansion A 48-month curriculum in graduate medical education is necessary to train aphysician in anesthesiology. • Goal again to “fix” internship issues. • Transitional year RRC has agreed to create anesthesiology track within the transitional year program. • Phil Lumb will be our specialty’s representative to this RRC.

  18. Program Requirement Facts • At least 6 months of the first year of the 48-month curriculum must include training in internal medicine, general surgery, and/or pediatrics. Goal to assure depth as well as breadth in “internship” • Surgical anesthesia, pain medicine, and critical care medicine should be distributed throughout the curriculumin order to provide progressive responsibility to trainees in the later stages of the curriculum. Goal to titrate graded responsibilities to create better doctors

  19. Program Requirement Specific Rotations • Internal Med, Gen Surg, and/or Peds 6 months • Emergency Medicine 1 month • Preoperative Medicine 1 month (divided) • Postoperative (PACU) Medicine 2 weeks • Pain Medicine 3 months • Clinical Anesthesiology 24 months • Critical Care Medicine 6 months • Additional anesthesia-related experiences 6 months* *Goal to add emergency medicine, more critical care medicine without significantly altering overall clinical anesthesia care. Most currently and we expect in the future will use #8 for clinical anesthesia (ACT). Should we consider going to four months of CCM? A real question for RRC.

  20. Electives and Differentiation of Anesthesiologists As many as 6 months of the final 24 months of the 48-month curriculum may be used for experiences in related activities or research.* Examples include rotations inclinical anesthesiology subspecialties; echocardiography; critical care-relatedspecialties such as nutrition, infectious diseases, and nephrology; pain medicine-related specialties such as physical medicine & rehabilitation, neurology, and psychiatry; transfusion medicine; and anesthesia-related research. *Goal more differentiation in anesthesiologists

  21. Program Requirement Program Director Flexibility • The program director is responsible for confirming that all residents completing the program have met all requirements of the 48-month curriculum. • In the clinical setting, faculty members should not direct anesthesia at more than two anesthetizing locations simultaneously. However, faculty members may direct a third location* if appropriately qualified postgraduate year-four residents may benefit from increases in progressive responsibility through this coverage pattern. *Goal to recognize CMMS requirements and still support educational rationale.

  22. Program Requirement Program Director Flexibility • During the 48-month curriculum there must be two identifiable 1-month rotations in obstetric anesthesia, pediatric anesthesia, neuroanesthesia, and cardiothoracic anesthesia. • Additional subspecialty rotations are encouraged, but the cumulative time in any one subspecialty may not exceed 6 months.* *RRC considered creating tracks within core program and requiring all to declare a subspecialty interest to produce core resident graduates with significant experience within a subspecialty.

  23. Program Requirements Program Director Rotation Flexibility • Experiences in perioperative care must include rotations in critical care medicine, acute perioperative and chronic pain management, preoperative evaluation, and postanesthesia care. These experiences must consist of at least 6 months of divided rotations in critical care medicine, one month in an acute perioperative pain management rotation, one month in a rotation for the assessment and treatment of inpatients and outpatients with chronic pain problems, 4 weeks (contiguous or divided) in a preoperative evaluation clinic, and 2 contiguous weeks in a postanesthesia care unit. • The program director may determine the sequencing of these rotations. The rotations must provide progressive patient care responsibility and experience with increasingly complex surgical procedures and challenging patients.

  24. RRC Response to SAAC/AAPD • Internship revision • Transitional year anesthesiology track • Transfers into program: PD documents rotations – no limits here • Perioperative physician focus • Pain medicine 3 months (includes regional analgesia) • CCM 6 months (RRC will consider 4 months)

  25. Other Program Requirement Changes • Pain Medicine staying at 12 months, but significantly altered, true multiple specialty interactions • Cardiothoracic subspecialty going through approval process

  26. ACGME Duty Hours Began in 2003 • 1 day in 7 free of duties • No more than 80 hours/week averaged monthly • Call no more than every 3rd night • Call not to exceed 24 + 6 hours • 10 hour rest period between duty assignments This is a not a major problem in our specialty

  27. Anesthesiology Duty Hours During the 6 additional hours, residents may not administer anesthesia in the OR for a new operative case or accept new admissions to the ICU. The resident should not manage non-continuity patients in the 6 hours post-call.

  28. Duty Hours No new patients may be accepted after 24 hours of continuous duty. A new patient is defined as any patient for whom the resident has not previously provided care.

  29. Duty Hours • The RRC for AN will not consider requests for a rest period of less than 10 hours. • The RRC for AN will not consider requests for an exception to the limit to 80 hours per week, averaged monthly.

  30. Chair’s Motto • “The secret to managing is to keep the guys who hate you away from those that are undecided.” • Casey Stengel

  31. Search Programs/Sponsors Outcome Project ACGME (www.acgme.org) Meetings Chat Rooms Data Collection Systems GME Information Human Resources Institutional Review Parker Palmer Award Res. Review Committees Resident Duty Hours Resident Information Review & Comment Site Visit Newsroom Bulletin Review and Comment Program requirement Anesthesiology

  32. Thanks for the feedback and interest in making better anesthesiologists. • It has been positive.

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