Annual Program Review

1. Annual Program Review Saturday, April 24, 2015 LKSC

2. Agenda • Update from Department Chair • 2013-2014 Action Plan and Current Progress • Resident Performance • In-service exam results • Procedures • Scholarly Activity • Aggregated Performance Data • Faculty Development • Aggregated Faculty Evaluations • Faculty Attendance at Didactics • Professional Development Activities • Graduate Performance • Review aggregated board exam pass rates • Former Fellow Feedback • Program Quality • Review evaluations from Residents • Curriculum goals and objectives review • Educational Activities for 2015-2016 • Rotation Schedule Feedback • Residency Interview Feedback • Action plan for upcoming academic year • 2014-2015 Action plan • SWOT Analysis • Discussion

3. 2013-2014 PRevious Action plan review

4. Program Areas of Improvement:Resident’s Perspective Areas of Improvement from Previous Action Plan: • Feeling unappreciated, get fewer perks than residents in other departments. • More regular faculty lectures in addition to current didactics. • Service vs. Education: Finding a good balance. • SHC: SHC junior residents do not get into OR/too much paperwork. • Getting formal feedback on individual rotations.

5. Established 2013-2014 Action #1 • Issue: Feeling unappreciated, get fewer perks than residents in other departments. • Proposed Action: Department agreed to pay for operating loupes for residents and to create a Professional Education Fund for each resident to use for educational activities & Institute a “goof day” (Resident Appreciation Day) as is done in general Surgery. • Actual Outcome: Feedback on how it went this year. • Resolved? • Further follow up needed?

6. Established 2013-2014 Action #2 • Issue: More regular faculty lectures in addition to current didactics. • Proposed Action: Will schedule weekly faculty lectures. Need to figure out time when all residents can attend. Will work with incoming chief residents to figure out adding a lecture series once a month on Mondays given by faculty. • Actual Outcome: Feedback on how it went this year. • Resolved? • Further follow up needed?

7. Established 2013-2014 Action #3 • Issue:Service vs. Education – Finding a good balance. • SHC: SHC junior residents do not get into OR/too much paperwork. • Proposed Action: Hiring of NP/PA for floor at SHC – interviews underway, should have someone hired and working by mid-year. • Outside calls for SHC resident – ES is lobbying hospital to consider RN phone triage service like they have at VA and Valley with other surgical subspecialty services that take home call. • Actual Outcome: Feedback on how it went this year. • Resolved? • Further follow up needed?

8. Established 2013-2014 Action #4 • Issue:Getting formal feedback on individual rotations. • Proposed Action: Lecture during retreat from Lisa Kubickion organizational effectiveness/seeking feedback. Will schedule a similar program for residents later in year & improve feedback process by formalizing it and regulating it better. • Actual Outcome: Feedback on how it went this year. • Resolved? • Further follow up needed?

9. Resident Performance

10. In service Exam: 2014 In-Training Exam average class scores % correct answers Uro 1: 54% (National Average: 56% ) Uro 2: 66.33% (National Average: 63% ) Uro 3: 60.33% (National Average: 67% ) Uro 4: 70.33% (National Average: 70% )

11. In-service Exam Scores 2010-2014

12. Procedures 2013-2014 • 439 procedures performed July 1 – June 30, 2013 (6 fellows) • 180 procedures performed July 1 – December 31, 2013 (5 fellows)

13. Scholarly Activity Previous Year

14. Scholarly Activity • Fellow Name: Use of novel biomarkers to identify and treat T-cell mediated acute liver injury in children – and - Impact of text messaging on adherence and outcomes in adolescent liver transplant patients • Fellow Name: CERC Fellowship • Fellow Name: Evaluation of hepatic fibrosis using ARFI in children • Fellow Name: Initial and Recurrent Clostridium Difficile Infections in Children and Clinical Implications Associated with High Virulence in BI/NAP1/027 • Fellow Name: A Novel Preparation of FecalMicrobiota Transplant in Recurrent Pediatric C DifficileInfection

15. Milestones Data: URO 1-Professionalism Averages Milestones Data

16. Milestones Data: URO 1-Interpersonal Relationship Averages Milestones Data

17. Faculty Development

18. Faculty Evaluations by the Fellows Below Expectation At Expectation Outstanding

19. FacultyEvaluations by the Fellows Below Expectation At Expectation Outstanding

20. Faculty Involvement • Attendance at Conferences, Grand Rounds, Journal Clubs (tracking attendance rates in MedHub) • Involvement in SOC and QI Projects • New Clinical Competency and Program Evaluation Committees require greater faculty involvement in program evaluation and development • More focus on improvement requires more input. Thank you for taking the time to be here tonight!

21. SFDC: Faculty Development • The Stanford Faculty Development Center(SFDC) for Medical Teachers has two major objectives: • To disseminate teaching improvement courses to medical faculty nationally and internationally through our facilitator-training programs in Clinical Teaching and Basic Science Teaching. • To provide teaching improvement support to medical teachers at Stanford University School of Medicine in undergraduate, graduate and continuing medical education through workshops and consultation. • SFDC Literature Databases: http://sfdc.stanford.edu/literature_db.html

22. GME: Professional Development Topics • PowerPoint Presentations (available on MedHub or by request) • Web Resources:

23. GRADUATE PERFORMANCE

24. Graduate Update July 2014 Exam Results (part 1): Total former residents who sat for the exam: 3 Total number that passed: 3 February 2014 (Part 2): Total former residents who sat for the exam: 2 Total number that passed: 2 Updates of recent graduates:

25. Performance on the Boards 2007-2011

26. Performance on the Boards 2013 • New scaled score makes comparison across the years difficult…

27. Former Fellow Feedback Procedures: • 2nd and 3rd years should do more procedures, research allowing. Would have felt more comfortable at the beginning. Should have done at least 20 more colos. 3rd year is a good time to jump onto more complicated procedures. The schedule ebbs and flows so I think it would be hard to have someone assigned to the APU for a week (i.e. when they are on research...) I should have done more pH probes, ARMs (they always conflicted with my Tues afternoon clinic), PEGs. • More specialty procedures (banding, sclero, polypectomy, coag) • Good to jump in on the more complicated procedures and faculty does a good job to grab us when they are happening.

28. Program Quality

29. Survey Overload • Thank you for your cooperation in completing all required surveys! • ACGME Survey • Pediatric GI Annual Program Evaluations • GME Annual House Staff Survey did not have enough responses to allow for anonymous results.

30. Program Evaluationsby the Fellows Completely unacceptable Excellent

31. Program Evaluationsby the Faculty Strongly Disagree Strongly Agree

32. Program Evaluationsby the Faculty

33. Program Evaluations • Extremely supportive faculty; Our attendings have a vested interest in our learning and are generally very supportive. • I have been very supported to pursue my desired research project, mainly by my mentor. • We see a good mix of inpatient cases. The only area I'd like to see more of is outpatient IBD; Great diversity in pathology of both liver and gidiseases • Clinical diversity of faculty, interesting range of patients, strong fellows, great support staff and allied health care professionals, transplant program, nutrition services (who knew that I could get so much help from Colleen!) • Committed Program Director and Fellowship Coordinator -Broad exposure to transplant hepatology, allowing fellowship graduates to compete for academic positions that would normally not be available without this exposure. -Strength in Nutrition Support teams. -GI consultation inpatient svc provides a broad clinical experience for GI fellows, residents. • Tertiary care hospital with broad exposure to patients with complex medical problems including extensive exposure to liver and intestinal transplant and intestinal rehabilitation. Senior faculty with extensive clinical experience. Opportunities to share difficulty clinical cases in conference (including radiology and pathology). Excellent rapport between faculty and fellows. Balance of research and clinical time through years of fellowship (allows development of project early with continued exposure to clinical time at end) STRENGTHS

34. Program Evaluations • We have excellent support in several areas including via our fellowship coordinator. Megan is available and supportive and we truly appreciate all she does. I also feel supported by the ancillary staff on the liver side. Unfortunately, I feel that we have little support in terms of managing our GI patients. Having a coordinator available would be ideal and improve my ability to provide high quality patient care. • support staff who we have are great, but need more help on basic things that take too much time (calling in meds, returning basic calls), at times too many faculty out for outreach or sabbatical and feel like too thin of a service from above. • Needs formalized didactics specifically tailored to high- yield board topics. Noon GI conf could be better tailored to fellows board rv. • Needs quality oversight in fellows meeting specific milestones at the end of each year for procedural competency. -Lack of motility exposure for fellows -- not a motility center • Fellows need support and continued encouragement from all academic faculty to excel in scholarly productivity (i.e., publications). Goal should be more formalized to have a strong presentation to submit to NASPGHAN by June (end of) second year for Oct NASPGHAN as a third year. This means wasting NO TIME at the end of first year and second yr. Projects should be off the ground by July 1 of second year, at the latest. • Busy faculty and fellow outpatient and inpatient clinical practice without sufficent ancillary staff to support triage phone calls, prior authorizations, etc. Procedural training can be variable between fellows (continue lectures re: complicated procedures, etc) WEAKNESSES/POSSIBLE ACTIONS TO TAKE

35. GME Survey Review For the 2014-2015 academic year, responses were collected between November 4 and December 15, 2014. Urology Response Rate: 8/12 (67%) Last Year: For the 2013-2014 academic year, responses were collected between November 4 and December 15, 2013. Urology Response Rate: 10/12 (83%)

36. GME Survey Review Last Year:

37. GME Survey Review Last Year:

38. GME Survey Review Last Year:

39. GME Survey Review If you were the Director of your residency/fellowship program, what is the ONE thing you would change to improve the overall educational experience for residents/fellows? (edited answer summary) • Call schedule at the valley which can be exhaustive. • Educational Seminar on a rotation basis. Assign a dedicated faculty member and a rotating research resident (PGY-4) to be responsible for the educational content. The content would range from faculty-led presentations, to focused review of high-yield Campbell's chapters, to In-service questions review, to simulation sessions such as pig lab, robotic etc. • Hire a triage nurse at night to reduce patient calls • The resident call schedule at the valley county hospital needs to be addressed. Residents are on primary call every 2 days for 4 months. The Chief Resident is on backup call whenever not on primary call. This results in 1-2 overnight cases and on bad weeks can result in 3 or more overnight cases.

40. 2013-2014 Survey (This year’s survey not yet available) ACGME Survey Review Take away: -General upward trend when compared to previous 2 years -Improvements still needed in all key areas to be at or above national levels.

41. Survey 2013-2014 ACGME Survey Review Citation Area Citation Area Citation Area *Citation areas are based on data from 2010-2011, 2011-2012 & 2012-2013

42. Survey 2013-2014 ACGME Survey Review Citation Area Citation Area Citation Area *Citation areas are based on data from 2010-2011, 2011-2012 & 2012-2013

43. ACGME Survey Review:Actions based on past survey results Service over education • Since January 2013, physician assistants have been assigned in the Stanford Cancer Center to do all pre-operative history and physical exams. • A nurse practitioner has been hired in August 2014 at Stanford to assist with all aspects of inpatient care, including routine paperwork such as discharge summaries, and handling routine ward and patient calls during the day. • As of August 2014 Pediatric calls from satellite hospitals are taken by nurse practitioners during the day and faculty after hours. • As of July 2014 residents no longer do any surgery scheduling work at the VAMC. Using program evaluation results to improve the program • Annual resident retreat – Attended by all residents, program director, chair and key faculty. • Annual faculty retreat – A whole session is dedicated to responding to feedback from the resident retreat • Biannual evaluation meetings with PD • Role of the Education Program Manager Confidentiality of evaluations • Steps to ensure confidentiality and raise concerns without fear have increased over the last year. • Annual meetings with the chair and the residents to bring up any concerns about the program. • Open lines of communication with residents and the program administration

44. ACGME Survey Review:Actions based on past survey results Faculty involvement in teaching responsibilities • Improved access to the faculty through the mentorship program • More faculty involvement with educational programs for the residents Resident Scholarly Activities • There has been marked improvement in this item in the 2014 survey with a response for “satisfied with opportunities for scholarly activities” at 90% with the national compliance at 76% this is also a vast improvement from the 55% compliance rate on the 2013 survey. This year’s survey results will come out later this summer. (92% response rate)

45. ACGME Communications We received notice of continued accreditation, but this decision does not include this year’s survey results.

46. Program Curriculum Review Activity (see hand out), 15 minute review, 20 minute discussion (5 minutes per PGY Level). Groups:

47. Educational Calendar See handout Discussion: Visiting Professor Requests Discussion: QI Projects/Patient Safety Initiatives

48. Rotational Calendar See handout

49. Resident Interview Process • 3 interview days -45 applicants interviewed this year. • Chief Residents Involved in the interviews • Topic based interviews (each room had a topic), more/stricter evaluation metrics used. • Overall high satisfaction from candidates • Got our matches from our top 10 (2 were former sub-I’s) • Proposed Changes: • Make it a 2 day interview process

50. Resident Interview Process Discussion: Any other proposed changes?