New Program director & Program Coordinator Introduction

1. New Program director & Program CoordinatorIntroduction Office of Graduate Medical Education August 9, 2019

2. Agenda • The Nuts and Bolts of Running a GME Program • ACGME WebADS • New Innovations • The GME Yearly Cycle • SLU-Specific GME Matters

3. GME Training Oversight ACGME SLU SOM Specialty Society

4. Institutional Sponsorship Reporting Structure Board of Trustees DIO Dean of SOM GMEC Program Directors Program Coordinators Departmental Chairs Teaching Faculty

5. SLU SOM • Institutional Sponsor • 64 programs • 630 trainees • 2 states • SLUH, St. Mary’s, CGCH, VA, Mercy, St. Elizabeth’s • Employer • Policies/Processes • Accreditation/Certifications

6. Coordinator Responsibilitiesmonitor, schedule, manage • Clinical Experience and Education Hours • CCC meetings • PEC meetings • Evaluations • VA Reports (Quarterly) • Program Coordinator Meetings • Scholarly Activity Tracking • Recruitment activities • Crisis management • Procedure log confirmations • Monitor Recertification • Expirations • Resident Roster • Away Rotation Paperwork • Rotating Residents from Other Institutions • EPIC access • PD/PA Weekly Meetings • Program Coordinator Development • Elective schedule requests • MDFEA reporting • Verify and pay lab-coat and pager invoices

7. Program Director Roleteach, supervise, direct • GMEC (then Dean) approves PD • term adequate for continuity & program stability (length of program + 1 yr) • certification in the specialty • evidence of scholarship • oversee didactic, clinical and sites • approval local site directors • approve and evaluate teaching faculty • monitor resident supervision • prepare and submit ACGME materials and annual program updates • ensure compliance with grievance and due process • provide verification of residency education • implement and distribute policies and procedures • monitor resident duty hours and adjust schedules as needed • monitor and deploy backup support for residents • comply with the institution’s written policies and procedures • obtain review and approval of GMEC/DIO for ACGME matters

8. July August September October November December Specialty Match ADS Updates Orientation APE report CCC Recruiting January February March April May June Main Match PEC Meeting Graduation CCC Milestones ACGME Survey Milestones

9. APE Process May PEC Meeting PEC Meeting PEC Meeting Aug. • APE & ACTION PLAN MUST: • be distributed to and discussed with teaching faculty and residents • be reviewed by the GMEC

10. July and August Program Director • Orientation ERAS Opens • ACGME WebADS • Complete GMEC APE • Special Board Data Review • Residency Website Updates • ITE • Semi-Annual evals • Recruitment pre-activities Program Coordinator • Orientation Activities • GME Program Survey Deadline • ITE Roster/Exam • ACGME WebADS • Resident recruitment pre-interview activities • (schedule/dinner/hotel/ shuttle/arrangements) • AOA Membership • APE data gathering

11. September and October Program Director • ERAS • NRMP Registration • Register for The Match • Recruitment pre-activities • Interviews begin in October • Conduct Interviews • Crisis management Program Coordinator • Resident Recruitment (Interview, Dinners, Tours) • Renew Resident Educational Subscriptions/Board Materials • ACGME Milestones Open October 30 • Prepare Milestone Packets for CCC • National GME Census Deadline • Schedule and proctor ITE exams • Holiday Party Preparations • Crisis Management

12. November and December Program Director • Continue Resident Interviews • Mentor Meetings • CCC • PEC • Military and Fellowship Match where applicable • Semi-Annual Evals • December submit Match List Program Coordinator • Resident Recruitment (Interview, Dinners, Tours) • GME Program Survey Deadline • Renew Resident Support Materials • Semi-Annual Evaluations • AAMC Deadline for National GME Coordinate Residency meetings • Prepare recommendation letters for fellowships

13. January and February Program Director • Match Rank List Due January • Continue CCC follow-up with Residents • Recruiting Wraps UP • Milestones Due • Interviews for Chief Resident • ACGME Survey Program Coordinator • Recruitment • USMLE 3 • ACGME Surveys • Resident Deadline for National Boards • Milestones Due • Graduation Diploma/Ceremony Planning

14. March and April Program Director • Canadian Match – March 1 • NRMP Match – March 16 • Specialty Program National Conferences • Rotation schedules for Upcoming Academic Year • PLAs for New Rotations • Finish ACGME surveys • Recruitment pre-activities • Complete ACGME surveys Program Coordinator • Collect Contract Signatures • Special Program National Conferences • Solicit Schedule Requests • ERAS Registration • Review Expiring PLAs • Resident recruitment pre-interview activities • Complete ACGME surveys • Onboarding activities • Training credentials and info verification for training sites

15. May and June Program Director • Graduation Dinner • Graduation Ceremony • Welcome Party Preparations • Orientation Materials • CCC • PEC • Mentor-Milestone Evaluation Meetings • End of Year Reports for Each Resident • Summative Residency Reports • Recruitment pre-activities Program Coordinator • Prepare and Send Invitations • Graduation Dinner planning and ceremony • Create Graduation Brochure • Orientation Materials • Graduate Offboarding • Faculty Teaching Awards • ITE Exams • ACGME milestone reporting • Bi-annual evaluations • Schedule final evals for graduates • Alumni certificates • CCC • PEC • Order new lab-coats and pagers • Distribute lab coats, assign pagers • Assign lockers • Assign mailboxes • Schedule orientation breakfast and other activities • Website updates

16. GME at Saint Louis University

17. GME Website • https://www.slu.edu/medicine/medical-education/graduate-medical-education/index.php

18. SLU GMEC: ALL ARE WELCOME!2nd Wednesday 12:30-1:30pm Beaumont + lunch • oversight committee for residency, subspecialty and fellowship programs • At least 14 voting resident and faculty from clinical departments • one patient safety or quality improvement officer • 3-yr term: IM, peds, psych, neurology, FM, OB, surgery • 2-yr term: 1) Urology, plastic surgery or neurosurgery; 2) otolaryngology or orthopaedic surgery; 3) ophthalmology or dermatology; 4) pathology, radiology or anesthesiology • At least 2 at-large faulty members • At least four peer-selected residents for one-year term (peer selected/voted) 

19. GMEC Subcommittees • Patient Safety & Quality Improvement • Tracking/trending resident-placed and resident-involved events • Collaboration with SSM sites • Annual Program Evaluation (APE)/Special Review • Annual Program Review • Semi-annual action plan review • Letters on program progress • Annual Institutional Review • Institutional Executive Summary • Institutional Oversight • Professionalism Oversight • Duty Hours/Citation Monitoring • Tracking/trending resident events

20. Special Reviews • Overseen by GMEC • Required by ACGME • Identify underperforming program (data driven) • Citations, surveys, resident/faculty performance • SLU GMEC Special Reviews • PD/PC interview • Faculty interview • Resident interview • Data/training file/WebADS review • Report generated with recommendations • For Cause, pre-site visit, self-study, concern-focused

21. Centralized Processing • MO license • No Illinois clinical practice (except IL family medicine) • BNDD • Medicare/Medicaid enrollment • Malpractice • Covered at CGCH, VA, Mercy • Some covered at St. Mary’s • Invoiced to SLUH • HR/Payroll/Insurance/Benefits/Parking • Affiliate Monthly Invoicing (via MDFEA) • Onboarding, drug screening/employee health, background checks • Visas • Certificates, employment files

22. SLURA • Saint Louis University Resident Association • President, Vice President (president elect), Secretary, Treasurer • Peer selected • Peer-voted • GME provided budget • Plan and organized activities • Social, educational, volunteer • Voice for residents to GMEC and GME Office

23. GME Financing • GME paid • Stipends • benefits (29%): insurance • Parking • Malpractice • Accreditation, match, licensure costs • Departmental paid • Books, travel, research • ITE, exam costs • Lab coats, meals, pagers • Coordinators, PD, faculty • Positions paid by • Hospitals • Military • Departmental funds • Grants/contracts • Negotiated yearly • Rotations at site of FTE allocation • Germane Solutions • SSM-SLU joint venture • GME Strategic Analysis • Report being reviewed

24. Leadership • SLURA • Women in Medicine & Science (WIMS) • Student Interest Group Advisors • GMEC & Subcommittees • Wellness Champions • Code of Conduct Council • ACGME Chief Resident Training • ACGME committee membership • Coordinators Leadership Council • Hospital Committees/Subcommittees

25. ACGME expectations

27. Common Program Requirements Updates 2017, 2019 • Professionalism • Well-Being • Patient Safety • Quality improvement • Supervision • Fatigue Mitigation • Clinical Responsibilities, Teamwork, and Transitions of Care • Clinical Experience and Education (formerly “duty hours”) • 80-hour “never event”

28. Board Pass Rates • 3-year aggregate 1st time pass rate above national 5th % OR • 3-year aggregate pass rate >80% AND Rolling 3-year ultimate board certification rate at 7 years post-graduation

29. Surveys

30. Program Evaluation CommitteeConducts the Annual Program EvaluationAPE Annual Report (minutes)Written Action Plan • curriculum • outcomes from prior APE • ACGME letters, citations • quality and safety of patient care • aggregate resident and faculty: • well-being • recruitment and retention • workforce diversity • engagement in QI and patient safety • scholarly activity • resident and faculty surveys • written evaluations of the program aggregate resident: • achievement of Milestones • in-training examinations • board pass & certification rates • graduate clinical performance aggregate faculty: • faculty performance • faculty development

31. Web ADS Annual ACGME Updates (*new) • Response to Citations • Major Changes • ALL Changes!!, action items, activities, new faculty etc • Updated block schedule (use suggested online template) • Faculty certifications • Scholarship: do not leave blank • *Program mission and aims • *Resident board certification (7-yr ago) • *PLAs: date, site director (must be listed faculty), DIO signature • *CCC/PEC members and process for committees for APE/action plan

32. Web ADS: How will the program…. • achieve/ensure diversity in trainees and individuals participating in the training program (e.g. faculty, administrative personnel) • Vice Dean of Diversity Equity and Inclusion & Chief Diversity Officer, Daniel Blash, PhD • Multiple GME Orientation recordings • deal with and/or report problems and concerns in a confidential and protected manner as well as steps taken to minimize fear of intimidation • GME Website information • advance knowledge of ethical principles of medical professionalism • Ethics workshop: all new interns (recorded) • IHI module: end of life care • Compliance training modules • educates residents/fellows on event reporting of near misses, adverse events, and serious adverse events are communicated to patients and families • Event reporting and disclosure simulation training: new intern/fellows orientation (recorded) • educated about pain management, including the recognition of the signs of addiction • “responsible prescribing” presentation: new intern orientation (recorded)

33. Hospital Event Reporting Attached is an event report regarding your resident. This is Dr. XXX’s third event. Dr. Gammack and GMEC have developed a form for standardized reporting of resident events which you can use to respond. Below is the link: • https://slu.az1.qualtrics.com/jfe/form/SV_8vu7K1Cv2CFh4u9

34. Faculty Development: Annually • in quality improvement and patient safety • in fostering faculty and residents’ well-being • in patient care based on their practice-based learning and improvement efforts • in contributing to an inclusive work environment

35. Faculty Development • GME Faculty Scholarship for 6-day ACGME Competency-Based Assessment Course (March yearly) • 2 faculty per year (applications December) • ACGME 3-day/6-day Faculty Development Courses • Department of Pediatrics Faculty Development Program • Faculty Affairs Brown Bag Sessions • Semi-Annual Faculty/Staff Development Program • May/November: 2 hour evening • Sponsored periodic guest speakers • Reinert Center for Transformative Teaching & Learning (SLU)

36. Scholarship • Housestaff Research Symposium (April) • Oral and poster presentations/awards • Support for Manuscript Submission and Publication Fees • Program for Research Project Funding: max $6000 • application April 1/October 1 • Program for Away Rotation (PAR) • Scholarship for international experiences (application May/Nov) • 1 month and 1 week

37. Educational Resources • Sonosim: web-based ultrasound simulation education • AMA GME Competency Education Program: 30+ modules • IHI Open School Online Courses: 30+ safety/quality modules • GME Website: Recorded Trainings and Sessions (GME Orientation Sessions) • SLU Simulation Center (Assistant Dean, Tina Chen, MD) • ACLS/BLS certifications

38. Wellness & Recognition • Wellness Champion Program • 1 resident/faculty per department • 3x yearly workshops • Wellness resources and networking • GME Wellness website • Self-assessments, resources, educational tools • Humanistic Healer Award (quarterly nominations) • SLUH Caring Physician Awards (nominations August) • Excellence in Professionalism Award • Office of Professional Oversight

39. Professional Support Services Office of Professional Oversight Learning Specialist Sara H. Barnett, PhD Multi-Cultural Affairs-L 103A sara.barnett@health.slu.edu 314-977-9149 Test taking assistance Study strategies Time management Career challenges • Lisa Israel, M.Ed. (Director) • Lisa.Israel@health.slu.edu • 314-577-8933 • Desloge Towers, Room T-6147 • GME Ombudsman • Confidential, neutral, negotiation, navigator • Recipient of reporting, concerns, complaints • Residents, students, staff, faculty, hospital employees

40. Resident Concerns • Office of Professional Oversight. T-6417 Desloge Tower; 314-577-8933; professional.oversight@health.slu.edu. • SLU SOM Grievance Reporting: https://cm.maxient.com/reportingform.php?SaintLouisUniv&layout_id=10 • Chief residents, program director, departmental chair, Associate Dean for Graduate Medical Education • Saint Louis University Resident Association (SLURA) • Semi-annual resident forum • GMEC resident members • GME Resident ombudsman, Lisa Israel, Director of the Office of Professional Oversight • SLUSOM compliance hotline 1-877-525-KNOW (5669) • Riskonnect event reporting system • SLU SOM event reporting system • University Health Plan, 24-hour confidential behavioral health assistance..

41. Support Services • English Language Center (North Campus) • Effective Communication Course (Behavioral Medicine) • 4 X 1 hour, 1:1 communication session • Missouri Physicians Health Program (MPHM) http://www.themphp.org/ • Employee Health Saint Louis University Hospital • PPD, respirator fit, immunizations, drug testing, work-related illness/injuries • New Innovations Assistance • Nicole Herzog, SLUH Medical Staff Office • Kaitlin Schneider, GME Office

42. Behavioral Health Program • University Health Plan: Behavioral Medicine Institute • 6 free and confidential visits • does not need to be for a medical diagnosis • Referral form: single mandatory visit • Includes stress management, relationship problems, etc. • 24/7 access to an on-call clinician for urgent behavioral health matters at 314-977-1066 • Behavioral Health Advisory Board (15 to 20 residents) meets twice yearly to discuss Behavioral Health Plan benefits • Onsite service: Tues and Wed Rm M-205 in Schwitalla

43. Moonlighting: Faculty Work • Officially: not allowed • Cannot on J-1 visa • Difficult with H1B • Template for institutional approval (signed by the Dean) • At SLU-affiliated sites • External (must have own MO license, DEA) • Internal (no billing, still supervised): provided additive pay

44. Leave: per 12 month period • 3 weeks of vacation • 1 week = 5 business days or 7 consecutive days • Additional days: program-specific • Conferences, interviews etc. • 30 days sick • FMLA 12 weeks of job protected leave (not all is paid) • Apply if 3+ days of leave • 2 weeks paid caregiver sick (paternity, ill family) • Qualifying condition • 12 months employment prerequisite • Total leave (all reasons) cannot exceed specialty-society requirements (or training will need to be extended)

45. Observerships • If MD graduates – processed by GME Office • 2 weeks – 3 months • Processed by employee health, background checks • Cannot provide care (history, exam, procedures) • If students (U.S., international, high school) – processed by student affairs • If < 2 weeks (and in hospital) – processed by hospital • Must have a sponsoring faculty at SLU (we do not identify the sponsor)

46. External Rotators/Rotations • Accept outside clinical trainees • Need license, malpractice, EPIC training, employee health…. • Institutional or program agreement/contract • Can take 3-6 months to establish (if outside of Missouri) • Away Rotations • Cost is limiting factor ($6000 + malpractice) • Institutional or program agreement, license required • Visa can be limiting • Cannot extend training time • Program for Away Rotation (PAR): international experiences • Covered for some programs based on hospital/funding agreements

47. Trainee Appointment/Onboarding FAQ’s • How long does it take to obtain a MO temporary license? Generally 6 to 8 weeks Requires ECFMG, Step 1, Step 2 (H1B Step 3) • Does GME support MO Permanent licensure? • No. Housestaff that desire to obtain a full physician's license are responsible for all fees associated with the process and must secure personal DEA and BNDD licenses • Some programs pay for this.

48. Trainee Appointment/Onboarding FAQ’s • What types of visas does GME support? J-1 Visa (no cost to programs) Valid for only up to 7 years, regardless of training duration H1-B Visa (program sponsored; $960 – $2,185) All other Visas are subject to housestaff discretion

49. New Innovations: Residency Management Platform • Scheduling rotations • Managing – tracking evaluations • Reporting time to CMS • Logging duty hours • Archiving – housing resident/faculty data • Storing resident documents • Completing APE

50. Please call as soon as… • License, visa, insurance, accreditation concern • Legal paperwork, subpoena, summons • Trainee leave, illness, FMLA • Serious issue with hospital, faculty, peers • Faculty leaving • Trainee transfer, resignation, non-standard program • Considering probation, non-renewal (6 month notice), dismissal, disciplinary action