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UCF. Jay L. Falk, MD, FACEP, FCCM Chief Academic Medical Officer Medical Education Orlando Health. Professor of Medicine and Emergency Medicine University of Central Florida College of Medicine Assistant Dean for Clinical UME @ OH, UCF COM

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jay l falk md facep fccm chief academic medical officer medical education orlando health

Jay L. Falk, MD, FACEP, FCCMChief Academic Medical Officer Medical EducationOrlando Health

Professor of Medicine and Emergency Medicine

University of Central Florida College of Medicine

Assistant Dean for Clinical UME

@ OH, UCF COM

Professor of Medicine and Emergency Medicine, FSU COM, UF COM and

USF COM

slide8

Jay Falk, MD

John Hillenmeyer, President/CEO

“I’m looking for a position where I can slowly lose sight of what I originally set out to do with my life, with benefits.”

slide9

John Hillenmeyer, President/CEO

Jay Falk, MD

“You’ll be a perfect addition to our expendable workforce.”

medical education
MEDICAL EDUCATION
  • Pre-med – BS / BA
  • Medical school – MD / DO
  • GME (Graduate Medical Education)
    • Residency training
    • 3 – 7 years
    • Diplomat status
  • CME (Continuing Medical Education)
accreditation certification licensure
ACCREDITATION, CERTIFICATION, LICENSURE
  • Medical Student Education
    • 125 US med schools
    • LCME – AMA, AAMC
  • GME
  • ACGME
  • 26 RRC’s

Certification (voluntary)

Licensure (mandatory)

  • ABMS
  • 24 specialty boards
  • Recertification
  • USMLE 3 part exam
  • NBME
  • Fed State Med Boards
graduate medical education

Corporate Sponsor

Corporate Sponsor

DIO

Designated Institutional Officer

Graduate Medical Education

IRC

RRC

Program Directors

ACGME

Faculty

Residents

1º Specialties

Fellows

Subspecialties

JF ORMC 2011

medical education healthcare
MEDICAL EDUCATION & HEALTHCARE
  • Societal contract
  • History
  • Current challenges
  • Opportunities
medical education healthcare1
MEDICAL EDUCATION & HEALTHCARE

“It’s important to recognize that the caliber of doctors we have represents a negotiation between medical education and society. Our physicians reflect the type of people and society we are, not just the efforts of academic health centers. It would not be an exaggeration to say that as a nation we ultimately get the doctors we deserve.

Kenneth Ludmerer Time to Heal 1999

medical education in america
MEDICAL EDUCATION IN AMERICA
  • Civil War – 1920 – Medical Education in US worst – best in industrialized world.
  • 1893 – Johns Hopkins Medical School opens – becomes model
  • 1910 – “Flexner report” – Medical Education in the US and Canada Carnegie Foundation for the Advancement of Teaching
  • 1920’s – Flexnerian Revolution
      • Proprietary schools – University Schools
      • Public/Private Funding
      • State licensing laws
      • Proprietary schools loose accreditation
  • 1920’s – 1970’s Progressive education – Golden Era
      • Hands on – Academic medical centers (teaching hospitals)
      • GME develops
      • Medicare/Medicaid (1965)
  • 1980’s – Managed Care – Wall Street
  • 1990’s – present “Second Revolution”
the first revolution
THE FIRST REVOLUTION
  • William Welch, 1st Dean, Johns Hopkins
  • “The advancement and development of medicine in itself required an improvement in the methods of teaching medicine”
  • Johns Hopkins University Press 1920
fundraising
FUNDRAISING
  • “keep in mind that we are a public service institution and see to it that you do not fail to help the public”
  • President Nicholas Butler, Columbia University…address to the medical faculty 1919
university and teaching hospital
UNIVERSITY AND “TEACHING HOSPITAL”
  • “There are few influences that exert as elevating an effect on the standard of professional work in a hospital as the presence in it of medical teaching”
  • “This is so true that the phrase ‘teaching hospital’ is almost synonymous with a good hospital”
  • Francis W. Peabody…..1923
restoring the social contract
RESTORING THE SOCIAL CONTRACT
  • “The first step toward getting an endowment was to deserve one”
  • Charles Eliot, The Success of the Harvard Medical School. Boston Medical and Surgical Journal 1873;88:632
medical school curricula
MEDICAL SCHOOL CURRICULA
  • Flexner report 1910
    • 2 years basic sciences
      • Anatomy
      • Biochemistry
      • Physiology
      • Microbiology
    • 2 years Clinical Clerkships
      • Internal Medicine
      • Surgery
      • OB-GYN
      • Pediatrics
      • Psychiatry
      • Electives (home/away)
  • Pharmacology
  • Pathology
  • Introduction to Clinical Medicine
recent inovations in medical school curricula
RECENT INOVATIONS IN MEDICAL SCHOOL CURRICULA
  • Content
    • Geriatrics / end of life care
    • Cultural competence / nutrition / family violence
    • Genetics / molecular biology
    • Medical decision making
    • Medical ethics
  • Teaching/Learning Methods
    • Organ system approach
    • Problem based learning
      • Small groups
      • Interactive
    • Earlier patient contact
  • Information Technologies
    • Using databases
    • Multimedia
    • Simulation
medical student assessment
MEDICAL STUDENT ASSESSMENT
  • OSCE’s
    • Objective structured clinical exams
    • Trained actors
    • Standardized patients
    • Direct (remote) faculty observers
      • Communication skills
      • Professionalism
  • NBME – Clinical Skills Component 2004
    • National Board of Medical Examiners
    • 3 part exam
    • 12 interactions – standardized patients
medical student clinical education
MEDICAL STUDENT CLINICAL EDUCATION
  • Inpatient services challenges
    • Narrower scope of illnesses in hospital
    • Complex, specialized problems in hospital
    • Short length of stay
      • Outpatient pre and post stay
      • Early stages not seen in-hospital
  • Outpatient teaching challenges
    • Clinics / offices away from campus
    • Decreased efficiency (throughput)
    • Consistency
    • Faculty models (private practice)
gme teaching assessing the new competencies
GME – TEACHING /ASSESSING THE “NEW” COMPETENCIES
  • Patient care
  • Medical knowledge
  • Practice-based learning and improvement
  • Interpersonal and communication skills
  • Professionalism
  • Systems based practice
resident supervision
RESIDENT SUPERVISION
  • Graded responsibility
  • Meaningful responsibility
  • Patient safety
    • ED
    • Trauma
    • CCM
    • OR
  • Resident credentialing
gme sponsorship oversight accountability
GME SPONSORSHIP, OVERSIGHT, ACCOUNTABILITY
  • Decentralized system
  • 2003; 713 institutions, 7954 specialty programs
  • Over 100,000 residents
  • Sponsoring institution responsibility
    • Must have a DIO (designated institutional official)
      • Associate dean for GME
      • VP med-ed, DME, CAMO
    • Governing board ultimately responsible
teaching hospitals
TEACHING HOSPITALS
  • 1100 Hospitals involved in Med Ed
  • 400 AAMC COTH Hospitals
    • Council of Teaching Hospitals
    • 281 Non-federal acute care
    • 19 Children’s hospitals
    • 12 Specialty hospitals
    • 64/116 VA medical centers
  • COTH Categories
    • Integrated Academic Medical Center Hospital n = 118; 43 shared ownership + 19 were shared – now split
    • Independent Academic Medical Center Hospitals n = 163
slide29

COTH Members Provide Specialized Services…

Short-Term, Nonfederal Hospitals

Admissions

Surgical Transplant Services

COTH Members

21%

44%

Other Hospitals

6%

79%

56%

Burn Intensive Care Units

Level 1 Regional Trauma Centers

Arthritis Treatment Centers

Source: AAMC Analysis of 2002 AHA Survey Data

69%

54%

42%

31%

46%

58%

slide30

……and Contribute a Disproportionate Share of Charity Care and Services to the Medicaid Population

Short-Term, Nonfederal Hospitals

Charity Care

Medicaid Discharges

46%

26%

6%

94%

54%

74%

COTH Members

Source: AAMC Analysis of 2002 and 2003 AHA Survey Data

Other Hospitals

slide31

Hospital Total Margins by Teaching Status, 1996 - 2001

Major Teaching Hospitals

7.3%

Other Teaching Hospitals

7.0%

Other Hospitals

4.9%

3.4%

3.5%

1.1%

1996 1997 1998 1999 2000 2001

Source: MedPAC June 204 Data Book

physician manpower shortage
PHYSICIAN MANPOWER SHORTAGE
  • National problem
  • 85,000 MD’s short by 2020
  • Drivers
    • Aging population (boomers)
    • Increasing demand-specialty services
    • Earlier MD retirement
    • Younger docs work fewer hours
  • Worse in Florida
    • Managed penetration
    • Liability crisis
    • Population growth
florida lags behind other states
FLORIDA LAGS BEHIND OTHER STATES
  • 41st in medical school graduates
  • 26th in physicians per 100,000 population
  • 24% fewer physicians per 100,000 population compared to 10 highest income states
  • Imports 80-90% of its new physicians
  • 3rd highest importer of international medical graduates
florida needs more residency positions
FLORIDA NEEDS MORE RESIDENCY POSITIONS
  • Florida ranks 45th in slots/population
  • 3000 slots needed in 5 years to = national average
history of gme at oh
HISTORY OF GME AT OH
  • First Interns – 1926
    • Orange General Hospital
  • Designated teaching hospital – 1951
  • Programs based on service needs
  • All voluntary faculty
history of gme at oh1
HISTORYOF GME AT OH
  • Accreditation Council for Graduate Medical Education (ACGME) 1960’s – present
    • Teaching not service
    • Increasing regulation/documentation
    • Due Process
    • Duty Hour Restrictions
    • “Competencies”
  • Full time program directors/faculty
  • Service/Teaching balance
  • “Town-Gown” collaboration
    • Programs “unburden” private Docs
    • Stimulating environment
    • Proud tradition
gme at oh
GME at OH
  • Large full time faculty…nearly 300
  • Olando Health Physician’s Group
    • 100 in med-ed
    • 65 MD Anderson
    • Pediatric specialists (APH)
    • “Geographic” full time..EM, Path, Colorectal
  • 248 Trainees (residents/ fellows)
    • 110 over the “cap”
    • Continuing to expand core program size
    • Developing new programs (fellowships)
  • Annual budget exceeds $100 M
oh bod commitment
OH BOD Commitment
  • Service excellence

(patient satisfaction)

  • Patient Safety
    • Physician communication
    • Physician behavior
  • Outcomes (measurable)
  • Medical Education
patient first strategy
Patient First Strategy
  • Transformational
  • Long Journey
  • Needs all of us
  • Working together
it is all about quality
It is all about Quality!

Quality of Medical Staff/Teachers

Quality of Resident Education

Quality of Patient Care

Quality of Research

Culture of Quality

strategic vision patient first
Strategic Vision: Patient-First

Orlando Health will create a Patient-First clinically integrated new model of care in collaboration with our medical staff to pursue seamless, quality outcome-driven extraordinary care.

slide44

Patient safety

service

quality

What Patients Want

1. Don’t Hurt Me

2. Help Me

3. Be Nice to Me

educational challenge
Educational Challenge
  • Service versus Teaching
  • Economic Impact to Institution
  • Impact on Patient Care
    • Patient satisfaction
    • Patient Safety
      • Simulation
      • Supervision
      • Resident credentialing
      • competencies
acgme
ACGME
  • Quality management is the newest “competency”
  • Didactic and experiential curriculum needed
  • Required
  • Part of “pay for performance”
  • OH GME committed
role of gme in quality improvement
Role of GME in Quality Improvement

Residents on the Front Line

Residents as Team Members

Residents as Teachers

Residents as Students of Quality and Safety Learning

gme and quality at oh
GME and Quality at OH

AIAMC National initiative participant

Resident participation on medical staff committees

Resident initiated QI projects

Research fair 5/23/2011

slide50

On the second day the knee was better, and on the third day it disappeared.