HCPro.com - Residency - DO NOT USE Top Stories

MedPAC focuses on new ways to fund GME

Tue, 17 Nov 2009 18:34:00 GMT

The Medicare Payment Advisory Commission (MedPAC) heard a proposal for a new way to fund GME during its meeting earlier this month.

Commissioners listened to a presentation about the establishment of a “national medication education trust fund,” according to the AAMC’s government affair Web site. The speakers explained that the trust fund would pool resources "into an entity that can assess U. S. needs and allocate funds accordingly."

According to the AAMC, the funds would come from Medicare, Medicaid, and general revenues and could be distributed to a variety of entities, including providers and, potentially, residency programs.

MedPAC anticipates the release of recommendations for GME funding in its June 2010 report.

Despite more medical school enrollments, number of residency positions stable

Tue, 17 Nov 2009 18:29:00 GMT

The Association of American Medical College (AAMC) reports that the number of allopathic medical school enrollments in 2009 increased by 2% to reach 18,390 students, according to an American Medical News article.

Nearly half of the increase in 2009 is the result of four new medical schools that opened. Fifty-seven AAMC-member schools also increased their first-year class sizes by 10%.
Despite these increases, the number of residency slots has not changed.

There are approximately 24,000 positions now, the article states. As health reform moves through Congress, the AAMC says that additional residency training positions are needed to meet increasing demand for physicians.

Read more about the future of the physician workforce by viewing the AAMC’s Physician Workforce Data Book.

Ask the expert: What is the difference between IME and DME payments?

Tue, 10 Nov 2009 15:20:00 GMT

Funding for GME is right in the middle of the national healthcare debate. Although GME funding is complicated and there are several sources of funding, the Centers for Medicare & Medicaid Services (CMS) is the largest funder of GME training. There are two types of payments:

Direct payments (DME): These payments cover a portion of the direct costs of training residents, including stipends, teaching physician and resident salaries and benefits, and educational activity costs. DME is based on a prospectively determined per-resident amount, weighted FTEs, and Medicare patient load.

Indirect payments (IME): These payments compensate for the anticipated higher cost of care in teaching hospitals based on the ratio of FTEs to hospital beds. A portion of these funds are disproportionate care funding, which subsidizes uncompensated care.

Today’s question and answer are from The Complete Residency Program Management Guide, published by HCPro Inc..

Three tips to navigate the ACGME Web site

Tue, 10 Nov 2009 15:13:00 GMT

The ACGME’s Web site is full of helpful information—if you know where to look for it. The following tips are a road map for getting the most out of the site and boosting your productivity. Check the following areas of the Web site frequently for the most up-to-date information.

Note: The phrase “center menu bar” will refer to the red menu that spans the top of the ACGME Web site. The term “left menu bar” will refer to the gold menu that runs along the left side of the screen.

Review and comment. Find out about changes to specialty requirements in this section. To get there, hover your mouse over the “Review and Comment” tab in the left menu bar and then click “Program Requirements.”

In this section, the ACGME posts specialty requirements under revision so you can view proposed changes. Check this area frequently, so you’ll always know when changes are coming down the pipeline.

Approved but not in effect. The ACGME posts new versions of requirements in your specialty’s section. To get to this section, click on the “Review Committees” tab on the left menu bar and pick your specialty.

Click on “Program Requirements.” At first, everything may seem status quo, but you’re not in the clear yet. Scroll down to the “Approved but Not in Effect” section.

As its name implies, this is where the ACGME posts approved requirements that have not yet taken effect. If this section does not appear on the Web site, there are no new requirements.

If your site visit is close to the date in which the new requirements take effect, call the RRC and ask on which version it will base your review. Additionally, new requirements often mean a new PIF, so check to see whether the RRC updated that document as well.

Learning portfolios. On the left menu bar, click on the “ACGME Learning Portfolio” tab. On this page, find updates about the online portfolio tool the ACGME is developing.

Although this tool won’t be ready for several years, coordinators can see the ACGME’s portfolio expectations by following its development. Review the FAQs, portfolio demonstration, and principles and policies links.

This week’s tip is adapted from Residency Program Alert, published by HCPro Inc.

Tip of the month: Selecting residents for the GMEC

Tue, 27 Oct 2009 19:17:00 GMT

Residents bring a unique perspective to the GMEC. They’re on the front line of patient care and are impacted the most by the GMEC’s decisions. The ACGME requires that residents sit on the GMEC, but the organization doesn’t specify how many residents should be on an institution’s committee. A common standard among institutions is 1% of the total resident population. However, do not put too much emphasis on the number of residents on your committee. The key is to get good residents who take the responsibility seriously, attend meetings, and share information with their peers.

Peer nomination is a common way institutions select resident members of the GMEC.
One method for doing so is to ask residents to select from a pool of candidates. Ask the president of the housestaff organization to send an e-mail to all residents explaining the GMEC, what it does, and when it meets. Those interested in serving on the committee should respond to the e-mail. The housestaff organization president should compile a list of candidates and send another group e-mail asking residents to vote for as many residents as are seated on your GMEC. The housestaff president tabulates the results and reports who received the most votes to the designated institutional official.

This week’s tip is from The Graduate Medical Education Committee Handbook, by Vicki Hamm, now available at a reduced price!

Ask the expert: How can we assess the effectiveness of our evaluations?

Tue, 27 Oct 2009 19:13:00 GMT

Assessing the effectiveness of your evaluation tools is a critical part of the education process. Evaluation tools should be designed to give the program director a clear picture of how residents are performing. When creating an assessment tool, ask yourself the following questions:

Did the resident achieve the objectives for the educational experience?
What knowledge, skills, or attitudes does the resident need to acquire or improve?
How does you program use aggregate performance data to improve education?
How do the assessment results provide feedback to the resident?
Is the information gathered about the residents’ performance useful in determining whether they should be promoted?

Periodically examine the effectiveness of each tool to confirm that it achieves your goal(s).

This week’s question and answer are from Insider’s Guide to the ACGME Site Visit, Second Edition, by Kathryn Andolsek, MD, MPH and Shepard Cohen, now available at a reduced price!

Theater techniques teach residents interpersonal communication

Tue, 20 Oct 2009 17:58:00 GMT

Although residency programs have been the inspiration for several TV shows, there are few instances where the art of acting has been the inspiration for training residents. But acting techniques have taken center stage for residents at Virginia Commonwealth University (VCU), according to an Oct. 14th Richmond Times-Dispatch article.

Aaron Anderson, theater professor at VCU, has teamed with Alan Dow, MD, assistant dean for medical education in VCU's School of Medicine to create an interpersonal communication curriculum that uses acting methods to teach residents how to interact with patients. According to the article, residents can use the same techniques as actors to become more aware of their own body language and more attentive to patients. These lessons help resident better care for patients in situations that are often difficult for them to manage, such as breaking bad news or having an end-of-life conversation.

Anderson’s and Dow’s efforts were profiled in a Residency Program Alert article in April 2008. In the RPA article, Dow said that research indicates their unconventional method is working. The physician-actor team published results from its first training course with internal medicine residents in the August 2007 Journal of General Internal Medicine. Using a 10-point scale, observers evaluated residents’ clinical empathy communication and scored it at 8.56, up from a score of 6.88 prior to the training. A control group fell from 6.38 to 5.82 in the same period.

Medical schools and teaching hospitals fuel economy, study says

Tue, 20 Oct 2009 17:50:00 GMT

Medical schools and teaching hospitals are doing more than training tomorrow’s physicians—they’re also a powerful force in local economies.

The Association of American Medical Colleges this month reported that medical schools and teaching institutions had a combined economic impact of more than $512 billion on their state economies and the nation overall in 2008.

The nation’s 131 accredited medical schools and nearly 400 major teaching hospitals (all represented by the AAMC) employs 1.86 million individuals in full-time jobs. These institutions are also directly or indirectly responsible for 3.3 million full-time jobs.

"U.S. medical schools and teaching hospitals are substantial economic engines in terms of jobs, state tax revenues, and economic growth," said AAMC President and CEO Darrell G. Kirch, MD, in an Oct. 8th press release.

Read the complete report, The Economic Impact of AAMC-Member Medical Schools and Teaching Hospitals, 2008.

Tip of the month: Review the PIF with residents

Tue, 13 Oct 2009 18:17:00 GMT

It is essential that the residents are aware of and agree with the PIF’s content. The ACGME issues many citations based on the information residents give the site visitor. Typically, the citations occur because of one of the following two reasons:

The residents do not confirm information contained in the PIF
The residents provide answers contrary to what is written in the PIF

One month before the site visit, sit down with the residents who will meet with the site visitor and review the PIF with them. Residents may not always understand the nuances of program management or residency review committee (RRC) requirements and how the program administers and meets them. Consider this a great opportunity for discussing those topics.

Additionally, the program director should clarify any questions the residents have about the
PIF’s content. Residents should have a crystal-clear understanding of your responses and the rationale behind each.

Never coach residents on how they should answer questions posed by the site visitor. However,
it is incumbent on the program director to ensure that the residents understand the following points:

How the accreditation process works
What role the PIF plays
What role the site visitor plays
What happens to the PIF after the site visitor leaves
The kinds of questions the site visitor may be asked
The content of the PIF

This week’s tip is from Program Information Form Made Simple, by Jeri L. Whitten, C-TAGME. Come see Jeri’s presentation about PIF and site visit preparation at the 4th Annual Residency Program Management Workshop Oct. 22-23 in Atlanta, GA.

Medical errors linked to fatigue and burnout, study says

Tue, 06 Oct 2009 17:46:00 GMT

A new study confirms that fatigue and distress are associated with residents’ self-reported medical errors.

Researchers surveyed residents quarterly, asking them to report self-assessed medical errors quality of life, and fatigue. Each quarter, the residents also completed standardized questionnaires measuring burnout, depression, and sleepiness, according to the study, which was published in the Sept. 23 issue of The Journal of the American Medical Association (JAMA).

Thirty-nine percent of the 356 respondents reported making at least one major error during the study period (2003-2008). According to the JAMA study, fatigue, lower quality of life, burnout, depressive symptoms and other signs of distress, independently led to increased rates of self-reported major medical errors among medical residents.

"Our results support this but suggest that specific attention to promoting resident well-being is needed as well," said lead researcher Dr. Colin P. West, MD, in a HealthDay News article. "We don't know enough about effective ways to promote physician well-being, however, and further research is needed to answer this question."

Ask the expert: What exactly does "practice-based learning and improvement" mean?

Tue, 29 Sep 2009 17:02:00 GMT

To many, the ACGME core competency practice-based learning and improvement (PBLI) sounds like a bunch of random words strung together, but program managers must understand its meaning if they're to teach it to residents and document it for the ACGME.

Let’s break this term down. "Practice-based" is what residents do in their clinical practice, so "practice-based learning" is what they learn through their clinical practice. Program directors and faculty show residents that their daily practice of medicine is full of learning opportunities. Through portfolios and self assessments, residents reflect and learn from their experiences.

Additionally, developing evidenced-based skills is another component of "practice-based learning". When caring for patients, residents must know how to locate, appraise, and assimilate information from medical literature to make diagnosis or treatment plans.

Program directors and attending physicians teach these skills by facilitating journal clubs and by assigning research projects.

So where does the improvement part come in? Residents should take what they've learned and make quality improvements in their own medical practice and in the hospital system to improve outcomes.

Today's question and answer are from The Complete Residency Program Management Guide, published by HCPro, Inc.

Researchers link international medical graduates’ background to performance during residency

Tue, 22 Sep 2009 18:15:00 GMT

A candidate’s application materials can only tell you so much. Wouldn’t it be great if you could consult a crystal ball to find out how candidates will perform in your program? Unfortunately, crystal balls, the fountain of youth, and calorie-free chocolate cake fall into the things-you-wish-existed-but-don’t category.

Just because you don’t have a crystal ball doesn’t mean you can’t use other factors to predict how candidates will perform during residency.

Researchers from Lincoln Medical & Mental Health Center looked at whether there is an association between specific background characteristics of international medical graduates (IMGs) and performance outcomes.

Researchers examined characteristics including age, gender, self-reported ethnicity, time between medical school graduation until residency, USMLE step I and II scores, pre-GME clinical experience, and interest in pursuing fellowship education. These were compared with outcomes, such as annual aggregate graduate PGY-level specific competency-based evaluation scores, resident in-training exam scores, and acceptance to a fellowship position.

The study found that, of all the factors measured, age and USMLE scores predict performance on competency-based evaluations and in-training examination scores during residency training. For example, younger residents had higher aggregate annual scores on the competency-based evaluations than the program median.

In addition, IMGs who had an interest in fellowship training and participated in more research activities were more likely to enter into a fellowship program.

For full results, see the article “Predicting performance using background characteristics of international medical graduates in an inner-city university-affiliated Internal Medicine residency training program” in the Jul. BMC Medical Education.

Tip of the week: Ensure your infection control training is up to par

Tue, 15 Sep 2009 18:21:00 GMT

Health officials are already warning that this winter’s flu season will be severe largely due to the highly contagious H1N1 virus. It is imperative that residents receive robust infection control (IC) training and comply with all rules. Consider implementing the following tips to keep residents safe:

Monitor compliance. Despite the significant amount of IC training residents receive, reaching compliance is a major challenge. For example, residents understand the importance of hand hygiene, but it is difficult to get them to put it to practice consistently. Tackle this problem by enlisting IC department employees, nurse managers, and unit receptionists to monitor the ward and report residents or veterans who violate hand-hygiene procedures. When a breach occurs, the observer should intervene and correct the resident. If the monitor does not feel comfortable intervening, he or she should report the issue to an attending physician who then speaks with the resident. When noncompliance becomes a chronic problem, the information is relayed to the resident’s immediate supervisor and then up the chain of command to the program director.
Know personal protective equipment (PPE) inside and out. Residents sometimes become lax about wearing PPE because putting it on and discarding it can be an arduous process that adds several minutes to seeing a patient. Instructing residents on the proper way to wear gloves and gowns is critical, and involving program leadership in the training will make the lesson resonate more with residents.
Teach proactive isolation precautions. Another challenge is teaching residents the importance of taking precautions and isolating a patient. For example, residents often wait for lab work to come back before isolating a patient, but it may be too late to prevent exposure. Tell residents to isolate patients based on their symptoms rather than wait for empirical evidence. By looking at symptoms and taking proper precautions early on, residents can prevent transmission of the disease to others.
Teach residents to take care of themselves. Residents who feel ill are in a difficult situation. Not only do residents hate missing time away from the program, they may feel pressure from fellow residents to avoid missing work because the other residents would have to cover for them. However, it is crucial that ill residents stay home, and programs need to convey that message during training. Ask a supervisor—a chief resident or program director—at the training session so residents know that leadership is behind the policy.

This week’s tip is from the monthly newsletter Residency Program Alert, published by HCPro, Inc.

Ask the expert: What should program directors and coordinators look for when pre-screening candidate applications?

Tue, 15 Sep 2009 18:15:00 GMT

The interview season is in full-swing. Pre-screening applications to pick out the top candidates is a lengthy process, but it’s imperative that you be thorough to ensure you get the best candidates. Keep the following in mind when reading through candidate applications:

Account for all dates listed. If there is a break in chronology of work and education experience, look for the reason. Was the applicant studying for the USMLE? Was he or she working, and if so, where? Was the applicant on medical leave or involved with caring for a family member? These are typical reasons for a gap and are usually explained within the application materials. Look into any unexplained breaks.
The personal statement is the only part of the application that is candidate-driven.
How candidates express themselves will give you insight into their personality and their reasons for going into medicine, so do not skim over this document.
Look at what hobbies or extracurricular activities that applicants are interested in to get an idea of whether they work well in teams and have manual dexterity and problem-solving skills. For surgeons, manual dexterity is crucial. Any hobbies that require fine motor skills will lend themselves well to the potential residents’ ability to control surgical instruments and manage those instruments in small spaces. Additionally, most physicians work and interact with multiple caregivers. Hobbies or an interest in team sports shows the ability of the potential resident for working well with others.
Read letters of recommendation (LoR) and MSPEs closely, as they will give insight into any problems or issues the candidate had during medical school. Usually, issues with authority or communication skills can be gleaned from these documents. Some LoRs may give insight into an applicant’s ability to deal with adverse events or managing an intense workload. Some MSPEs may indicate reasons for leaves of absence or breaks in training. Pay attention to who the LoRs are from—there should be LoRs from the department chair and faculty from the clinical specialty to which the applicant is applying.
Do the application materials show that the individual has the characteristics and aptitude to become a physician in your clinical area? Identify characteristics you think physicians in your specialty should possess. Assess whether the applicant displays those same qualities.
The transcript should reflect appropriate ratings or grades for courses that affect the clinical specialty for which the applicant is a applying.
If the candidate is in the United States on a visa, consider the limitations of that visa and how it may affect factors such as start date, end date, fellowship opportunities, etc.

This week’s question and answer are from HCPro, Inc.’s The Complete Residency Program Management Guide, by Ruth H. Nawotniak, MS, C-TAGME.

Strategies for patient handoffs vary, study shows

Tue, 08 Sep 2009 20:09:00 GMT

One concern regarding further limits to resident work hours is the increase of patient hand-offs.

ACGME’s senior vice president for field activities, Ingrid Philibert, PhD, MBA, recently looked at factors that impact the accuracy of handoffs, including data summaries and end-of-shift transfer strategies. Data was gathered from qualitative interviews and surveys completed by internal medicine, surgery, pediatric, and OB/GYN residents.

Philibert found that the nature of residents’ work varied. Residents cared for many patients with different needs that resulted in different handoff approaches. Additionally, residents’ clinical skill levels affected the accuracy of the handoff. Cross-coverage and more duty hour limits adversely affected hand-off accuracy.

Philibert concluded that because the data showed the quality of handoffs depend on resident skill, there may be a need for education and supervision when junior residents are involved in handoffs. She also calls for more studies looking at how to conduct handoffs during shortened resident shifts.

The study, Use of strategies from high-reliability organisations to the patient hand-off by resident physicians: Practical implications, appeared in the Aug. issue of the journal, Quality and Safety in Health Care.

Duty hour reform associated with more complications after hip surgery

Tue, 08 Sep 2009 20:04:00 GMT

The effect of resident work hour limits on patient care is a big question on the minds of many graduate medical educators as the ACGME considers duty hour reform. A new study says that since duty hour standards were introduced in 2003, the rate of negative outcomes in patients treated for hip fractures in teaching institutions has increased compared to nonteaching hospitals.

Researchers of the study, which appeared in the Journal of Bone and Joint Surgery, looked at patient cases in 2001–2002, before duty hour rules went into effect, and in the years following the implementation, 2004–2005.

Researchers found significantly more cases that resulted in perioperative pneumonia, hematoma, transfusion, renal complications, nonroutine discharge, costs, and length of stay in patients who underwent treatment for a hip fracture at teaching hospitals after duty hour rules were implemented. Researchers did not find an increase in death rates.

Ask the expert: How can residency program directors and coordinators document resident participation in quality improvement activities?

Tue, 01 Sep 2009 18:58:00 GMT

The common program information form (PIF) asks for examples of quality activities in which residents participated in. Your departmental quality assurance (QA) committee should have a resident member, who should assist in the review of patient care issues assigned to the QA committee. Among QA duties, the resident could research medical literature to help determine whether patient care in a specific case was outside acceptable medical practice. The resident, as part of a resident team with input from faculty members, could initiate a quality improvement project. Documentation for such a project could include:

Written description of a quality issue
Actions necessary to correct the problem
Implementation of a new policy
Results of the new policy

Today’s question and answer are from The Residency Program Director’s Handbook, by Robert V. Higgins, MD, published by HCPro, Inc., Marblehead, MA.

Tip of the week: ERAS refresher

Tue, 01 Sep 2009 18:53:00 GMT

The madness of the recruitment season begins today with the opening of the ERAS post office. You will become intimately familiar with the ins and outs of ERAS during the next few months. The following is an overview of the program.

ERAS has four components:

MyERAS Web site: Applicants use this Web site tool to collect, submit, and track his or her documentation and then select training programs to apply to.
The Dean’s Office Workstation (DWS): The medical school deans’ offices use this tool to collect and scan documentation to forward to the selected training programs’ ERAS Post Offices.
The Program Directors Workstation (PDWS): Program directors and coordinators use this tool to manage application materials and the application process.
The ERAS Post Office: The central bank of computers that transmits the selected application materials to the designated training programs.

Applicants wishing to use ERAS must create an account on the MyERAS Web site. In doing so, they must choose a designated dean’s office through which all their supporting documentation will move. Fourth-year medical students or graduates of U.S. medical schools, both allopathic and osteopathic, will contact the dean’s office of their school; foreign medical school graduates will contact the ECFMG, and Canadian medical school graduates will contact the Canadian Residency Matching Service.

Once applicants designate a dean’s office and open an account, they will submit their application, request and attach supporting documentation, and select training programs to send their applications and documentation to. The applicant can submit documentation at any time. The following documentation is downloaded through the DWS to the ERAS Post Office of the selected training program:

The Common Application Form (CAF), which is the ERAS application form
Personal statement
Transcripts of medical school grades
USMLE and/or COMLEX scores (optional)
Medical student performance evaluation (MSPE)
Letters of recommendation (LoR)
ECFMG status report, if applicable
Photo, if available

This week’s tip is from The Complete Residency Program Management Guide, by Ruth H. Nawotniak, MS, C-TAGME, published by HCPro, Inc., Marblehead, MA.

New Match statistics released

Tue, 25 Aug 2009 18:06:00 GMT

The National Resident Matching Program (NRMP) released a new report that looks at the characteristics of applicants who were matched to their first-ranked program during the 2009 Match.

According to the report, Charting Outcomes in the Match, applicants who are successful in matching to their preferred specialty are more likely to:

Rank more programs within their preferred specialty
Be graduating seniors from U.S. allopathic medical schools
Have higher USMLE Step 1 and Step 2 scores
Be members of AOA

According to the report, programs take a variety of factors into consideration when choosing applicants. For example, despite the high correlation between USMLE scores and applicants matching to their preferred specialty, not all high scorers matched into their first choice. This indicates that other personal characteristics and other application materials are considered and weighted by programs when selecting candidates.

To see the full report, including specialty specific information, click here.