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Graduate Medical Education AY 2012 Annual Report
Submitted from Division of Education Office of Graduate Medical Education December 20, 2012 by: William Bond, MD, MS ACGME Designated Institutional Official Jennifer McCormick, MBA Director, Medical Education Development Kimberly Cornwell, C-TAGME Graduate Medical Education Specialist
2012 Annual GME Report Page 2 of 21
Table of Contents Table of Contents………………………………………………………………………….2
Introduction……..…………………………………………………………………………3
GME Stats and Trends 2010-2012 ...................................................................................... 4
Improvements in GME .................................................................................................... 5-7
Summary and Schedule of Program Reviews…………………………………………….8
Match Summary………………………………………………………………………......9
Resident Involvement in Patient Safety and Quality ........................................................ 10
Resident Scholarly Work……………………………………………………………... ..11
Resident Performance on Core Measures………………………………………………..12
Central Lines Course Update…………………………………………………………13-14
Planned Growth ................................................................................................................ 15
Finance .............................................................................................................................. 16
Faculty Development…………………………………………………………………….17
AY 2013 Priorities ............................................................................................................ 18
Policy Update……………………………………………………………………………19
Appendix: AGCME Satisfaction Survey………………………………………………..20
Appendix: A3: Achieving and Documenting Procedural Competency at LVHN………21
2012 Annual GME Report Page 3 of 21
Introduction This report covers academic year 2012 ending in June 2012. The Graduate Medical Education
community at Lehigh Valley Health Network continues to develop and implement policies and
learning strategies that achieve accreditation requirements and that prepare our resident
physicians to serve the Lehigh Valley community and beyond. The Graduate Medical Education
Committee (GMEC) and the Division of Education provides the institutional oversight required
to achieve these ends.
GMEC Mission – to offer graduate medical education programs in which physicians in training
develop personal, clinical, and professional competence under the guidance and supervision of
the faculty and staff.
GMEC Vision –to develop the strategies and mechanisms needed to ensure that LVHN’s
graduate medical education programs have adequate educational, financial, and human resources
to demonstrate measurable improvements in learning and patient outcomes.
GMEC Strategy – GMEC’s strategy is based on organizational objectives and the Accreditation
Council for Graduate Medical Education (ACGME)’s definition of “institutional competency,”
which includes an organization’s ability to:
Gather and analyze data from the educational and clinical environments.
Ensure resident education in patient safety and quality of care.
Lead program and academic innovations.
Predict and trend performance.
Develop, align and implement policies and procedures that impact graduate medical
education programs.
Create conditions that promote collaboration and knowledge sharing and transfer. We are pleased to provide the following 2012 Graduate Medical Education report highlighting
evidence of ongoing strengths, opportunities and the larger trends affecting Lehigh Valley Health
Network’s Graduate Medical Education programs.
2012 Annual GME Report Page 4 of 21
Overview: Academic Years 2010-2012
GME Demographics AY10 AY11 AY12 HIGHLIGHTS
# residents/fellows 206 215 222 off cycles, comp incr, new prgm
# visiting residents 83 73 78 Hershey's OB/Anes
# total accredited residency programs 14 15 17 1st year for Peds/HPM
# allopathic (ACGME) accredited programs 10 10 12
# osteopathic (AOA) accredited programs 4 5 5
# dually (ACGME/AOA) accredited programs 2 2 2
# re-accredited programs 1 2 5 Institutional, EMRES(x2),
OBGYN, Osteo Intern,
# new program(s) applied for 2 3 2 Hem Onc/Nephr
# of graduates 77 81 87
Resident Recruitment and Match Data
# U.S. medical school applicants 1462 1782 2360
# applicant interviews conducted 631 658 879
# match positions available 77 79 91 Neph, Peds, HPM, Incr
% from allopathic accredited medical schools 45% 49% 50%
% from osteopathic medical schools 39% 35% 33%
% from international medical schools 16% 16% 17%
% from Pennsylvania medical schools 37% 30% 33%
Program Development
# internal reviews conducted 3 4 3 Dental, Derm, Plastics
# progress reports reviewed and approved 4 2 3 EMRES, Peds, Plastics
Resident satisfaction survey (LVHN internal survey)
Participation rate 72% 92% 74%
Overall satisfaction (1=poor, 5=excellent) 4.14 4.03 4.2
Resident satisfaction survey (ACGME)
Participation rate 90% (appx for full reports) 92% 94% 90%
GME policies reviewed and updated 5 20 7 .
# residents contributing to publications 51 28 30
# residents contributing to poster presentations 38 53 15
% senior residents participating in QI 97% 100% 100%
Faculty Development (DOE provided)
# faculty development workshops offered 30 78 40 # attendees 389 401 239
# resident as teacher workshops offered 5 12 13
# attendees 46 273 291
2012 Annual GME Report Page 5 of 21
Improvements in GME
Resident Evaluation
GMEC has developed and implemented a policy to ensure timely feedback of residents. The
goal is that faculty members complete 75% of their evaluations assigned to them within 30
days of a resident’s completion of a rotation. In AY12, 85% of all faculty members who
were assigned an evaluation met the goal within 30 days.
Resident Duty Hours Tracking:
GMEC elected in AY12 to track the directive that residents “should have 10 hours off between
clinical duties” with awareness that the regulations state “must have 8 hours off.” The process for
duty hours tracking worked well in AY12 and no cases were referred to the DIO/Disciplinary
Action Review Committee. The unweighted average compliance with logging duty hours was
89% and resident signoff was 90%. Many of the duty hours violations had explanations in the
comments such as “stayed for interesting OR case,” which is allowed by AGGME rules.
AY12 ACGME Rule Compliance – Snapshot
Department 80 HR Call Off NF 24+ SB – 10 SB – 8
Cardiology Fellowship 1
Colon/Rectal Surgery 1 2 5
Dermatology
Emergency Medicine 10 5 4
Family Medicine 7 34 14
General Surgery 3 13 3 13 6
Hospice/Palliative Medicine
Internal Medicine 3 8 3 48 2
Transitional Year
Obstetrics/Gynecology
Plastic Surgery
Surgical Critical Care
SB = short break
Recruiting Efforts:
In April 2012, LVHN offered a multispecialty recruiting effort at a hotel next to the Philadelphia
College of Osteopathic Medicine. We believe pre-publication efforts by email may not have
been forwarded on to several of the medical school students thus leading to poor turnout. Those
who did attend enjoyed the experience and had very positive interactions with LVHN faculty.
2012 Annual GME Report Page 6 of 21
After further analysis, we have decided to shift future central recruiting efforts to improvement
of the website. Each residency is really targeting different sets of applicants due to their relative
competitiveness in their field. Each residency will continue to conduct the in person recruiting
activities it feels are most appropriate. The increased numbers of graduating medical students,
combined with a fixed or only slightly enlarging residency slot number nationally should lead to
more competitive applicants without any effort on our part. This year we had 1861 applicants
for all programs combined and hosted 896 interviews.
Common GME Curricula:
Resident Orientation 2012 well received:
Resident orientation meets many needs with regard to common program requirements. This
year’s common orientation included the standard HR orientation for all employees, additional
talks on professionalism, and a day-long seminar that covered the following topics:
Orientation Session (Instructor Led) Overall Satisfaction
(5 point scale)
Crucial Conversations conflict resolution (4 hour workshop) 4.3
Stress Reactivity (1 hour) 4.3
Sleep and Fatigue (1 hour) 4.6
TeamSTEPPS® (1 hour introduction) 4.6
Cultural Competency and Interpreter Services (1 hour) 4.4
IHI Open School Modules:
LVHN purchased a subscription to the IHI Open School online modules that include patient
safety and quality. Those modules were made available to the residents in spring and some
residencies are specifically assigning courses for FY13. These modules are hosted in an outside
learning management system and we anticipate reporting resident usage statistics for next year.
Data Repository Project:
As of October 2012, the repository of scholarly works was in the process of launching.
Preliminary work looks promising and there will be more to follow in next year’s report.
Support for Research in GME:
The Network Office of Research and Innovation has developed open weekly office hours for
statistical support of research projects. This came late in FY12 and the impact should become
apparent in FY13.
2012 Annual GME Report Page 7 of 21
Cultural Competency Education
In FY12, all LVHN employees, including residents completed an on-line cultural competency
program, “Exploring Cultural Awareness.” The purpose of this brief program is to ensure that
LVHN employees understand the definition, rationale and resources available to them to provide
effective cross-cultural communication and health care.
In addition, during AY12, three LVHN clinical departments requested cultural awareness
education sessions that were available for residents. Judy Sabino, diversity/cultural awareness
liaison, conducted two sessions in Family Medicine (Grand Rounds in July and a learning lab for
PGY1 residents in November), two sessions in Medicine (a Quality Improvement Forum in
December and Grand Rounds in April) and an introductory session for the Palliative Medicine
fellow in January.
In June 2012, Jarret Patton, MD and Judy Sabino provided a session on cross-cultural health care
during resident orientation. Over 80 new residents participated in this session that defined
culture and its impact on health illness as well as demonstrated a patient-based approach to cross
cultural health care.
A SELECT medical student conducted an informal assessment of cultural awareness education
in selected LVHN residency programs during his summer immersion project in June. While the
five residency programs reviewed are aware of and committed to cross cultural care; variation
exists in the approach and time given to this subject. This topic is under consideration by GMEC
as a common GME topic for either education or standardized assessments.
Resident Baseline Assessment
Baseline assessment is a competency based assessment to assess residents’ level of attitudes and
skills in communicating with patients, families and colleagues. Residents from the following
residencies participated: Dental Medicine (7), Family Medicine (5), Emergency Medicine (14),
Obstetrics & Gynecology (5), Surgery (5), and Dermatology (2). Standardized Patients were
trained to portray the patient or family member in 3 separate scenarios. The Standardized Patient
completed a checklist on the intern's performance. Each station was also recorded. This year we
placed the checklists online and provided the standardized patients and residents iPads to
complete the checklists. The overall rating by residents 3.43 out of 4 = excellent 3 = good
Comments regarding the overall experience:
Great learning experience
A very good opportunity to practice communication skills.
This exercise was great because I got the chance to practice scenarios I haven't encounter
before working with a real life scenario at the hospital.
I look forward to having more simulation experiences because these have been very
enlightening.
2012 Annual GME Report Page 8 of 21
Summary and Schedule of Program Reviews
Going forward as we move into the Next Accreditation System (NAS) of the ACGME programs
will be evaluated every 10 years with a site visit. Early site visits can occur sooner based on
annual data being submitted by the programs. The institution will have Clinical Learning
Environment Review (CLER) data submission and site visits every 18 months.
Accredited Programs Status Effective Date Next Site
Visit Date
Cycle
Length
Internal
Review
Timeline
# Citations
Colon/Rectal Surgery Continued
Accreditation 09/21/2012 09/01/2016 4 09/11/2014 2
Emergency Medicine Continued
Accreditation 02/10/2012 02/01/2022 10 02/01/2017 5
Family Medicine Continued
Accreditation 10/10/2012 10/01/2014 2 10/07/2013 6
Internal Medicine Continued
Accreditation 10/01/2006 10/01/2015 NAS 11/01/2013 3
Cardiology Continued
Accreditation 05/15/2010 10/01/2015 NAS 01/01/2013 1
Nephrology Initial
Accreditation 07/01/2012 07/01/2015 3 08/12/2013 0
Hematology/Oncology Initial
Accreditation 07/01/2012 07/01/2015 3 12/09/2013 0
OBGYN Continued
Accreditation 10/13/2011 10/01/2016 5 04/07/2014 0
Pediatrics Initial
Accreditation 07/01/2011 03/01/2014 3 09/12/2012 4
Plastic Surgery Continued
Accreditation 10/03/2008 10/01/2013 5 04/01/2013 0
Surgery Continued
Accreditation 11/01/2012 11/01/2017 5 04/01/2015 Pending
Surgical Critical Care Continued
Accreditation 11/01/2012 11/01/2017 5 04/01/2015 Pending
Hospice/Pall Med Initial
Accreditation 07/01/2011 05/01/2014 3 11/12/2012 0
Transitional year Continued
Accreditation 05/21/2008 05/01/2013 5 10/05/2010 1
2012 Annual GME Report Page 9 of 21
Match Summary
2012 Match Summary
Combined Allopathic, Osteopathic & Sub Spec. Matches
74 match positions available (+10 outside the match, +7 Dental)
91 total filled positions
50% from U.S. Allopathic schools (includes Dental)
33% from U.S. Osteopathic schools
17% from International medical schools Allopathic Match (NRMP)
44 total positions available
44 filled
73% from U.S. Allopathic schools (0% students from University South Florida; 4% or 2 students
from Penn State College of Medicine)
9% from U.S. Osteopathic schools (4)
18% from international medical schools (8) Match from LCME Schools (All matches)
27% Non-PA based
33% PA-based
- Drexel University School of Medicine (5)
- Jefferson Medical College (4)
- Penn State College of Medicine (3)
- Temple University (5)
- University of Pennsylvania (1)
- PCOM (10) Match from Osteopathic Medical Schools (DO Match)
35% Non-PA based
65% PA-based
- Philadelphia College Osteopathic Medicine (7)
- Lake Erie College Osteopathic Med (6) LVHN Clerkship Rotations
32% of matching residents (n=28) did at least one clerkship at LVHN. These residents did a total of
48 rotations made up of third year clerkships and fourth year electives. £ - Notes currently enrolled in LVHN Residency (3)
2012 Annual GME Report Page 10 of 21
Resident Involvement in Quality and Patient Safety Residents are encouraged to participate in the peer review process. Therefore, attending a peer
review committee meeting (M&M) for their department counts toward this goal. Peer review
committees discuss system factors, human factors, patient factors and medical decision making
in their deliberations. Residents may also be directly involved in performance improvement
projects. Such projects are typically interprofessional and often interdisciplinary. Network level
performance improvement projects give exposure to SPPI coaches. In addition, residents often
choose to write up their performance improvement projects at the abstract/poster level, some of
which go on to become peer reviewed publications.
Program
# Residents Performing
Case Review
# Residents Assigned
Case Review
% Residents
Completing Case
Review
Nature of Case
Review
# Senior Residents Participating in PI project
# Senior Resident
s
% of Residents
Completing a PI project
Dermatology
2 2 100
Emergency Medicine 14 14 100
Charts vs. EBM 13 13 100
Internal Medicine 16 16 100 M&M 32 32 100
General Surgery 22 22 100 M&M
Plastic Surgery 4 4 100 M&M
Colon/Rectal Surgery 2 2 100 M&M
Surgical Critical Care 1 1 100 M&M 1 1 100
Ob/Gyn 20 20 100 M&M 5 5 100
Dental 7 7 100 Treatment planning
Family Medicine 18 18 100
chronic pt chart rev 6 6 100
Cardiology 14 14 100
Structuredpeer chart
review 4 4 100
HPM*
Totals 104 104 59 59
*first year of fellowship and fellow began after start of AY
2012 Annual GME Report Page 11 of 21
Resident Scholarly Work
Research expectations vary across the different residency review committees. LVHN residents
participate in various forms of scholarly activity including case studies, retrospective data
analysis, and occasionally prospective research. Residents are encouraged to be involved in the
various stages of investigation including hypothesis refinement, IRB submission, data collection,
data analysis, and abstract writing. Some residents are fortunate enough to present at academic
meetings in poster format, some present orally with slide shows, and through continued diligence
many go on to see their work in print as published manuscripts.
Program Research Abstracts
Resident Poster or Oral Presentations
Manuscripts Published
Pediatrics N/A N/A N/A
Dermatology 5 5 6
Emergency Medicine 6 4 6
Internal Medicine 0 5 0
Transitional 0 0 0
General Surgery 9 9 3
Plastic Surgery 5 5 1
Colon/Rectal Surgery 6 6 0
Surgical Critical Care 0 0 0
Breast Surgery 1 1 0
Ob/Gyn 6 5 2
Dental 0 0 0
Family Medicine 0 1 0
Cardiology 1 9 23
HPM 0 0 0
Totals 39 50 41
2012 Annual GME Report Page 12 of 21
Resident Performance on Core Measures
Core measures were examined for patients with resident involvement and a principal diagnosis
of congestive heart failure and pneumonia. For example, in a case of heart failure, if the patient
has an ejection fraction of less 40 % (poor heart contractility), an ACE inhibitor or ARB class of
medication should be prescribed or a contraindication documented by the provider to ensure
compliance with the core measure. Likewise, patients with heart failure must have appropriately
documented discharge instructions.
Several challenges became apparent in reviewing this data set. First, defining the responsible
resident can be difficult, because the resident may be captured as the doctor on the admitting
history, the discharge summary, or for other care encounters. Residents also transfer the care of
patients multiple times during one patient’s stay. The fragmented nature of the electronic health
record at LVHN also contributes to the difficulty. In summary, the data were not considered
reliable enough for reporting purposes and we will continue to work to procure improved
resident quality data that can provide useful feedback to residents and program directors.
2012 Annual GME Report Page 13 of 21
LVHN Central Venous Catheter Course Update
LVHN has developed an uptick in Central Line Associated Bloodstream infections. This uptick
is believed to be due to special cause variation that is likely related to the maintenance process
and long catheter dwell times. A multidisciplinary and interprofessional group is actively
working on process improvement in this area. The CVC course is one piece of maintaining both
mechanical and infectious safety for this procedure. The course has reached a point of
significant refinement and was well received as noted below.
Course Modifications for the June 2012 cohort:
Pre-training by watching videos in “Access Medicine” for tracking
Only one hour of lecture format for local protocols and process
Sterile procedure video and hands-on review
Hands-on practice time increased
An ultrasound station with more machine access and learning objectives checklist
Check-off run technical checklist directly entered into New Innovations resident tracking
system via iPads
Knowledge Test Performance
2012 Annual GME Report Page 14 of 21
Technical Checklist Performance
Overall
Total resident participants 56
Total Passing 52
Total Needing Remediation 4
Total Possible Observable Actions 20
Mean Score 19.49 (97.45 percent)
Standard Deviation 0.64
Check-off run performance after training:
Post Course Evaluation Feedback:
Likert scale feedback (5 = agree, 3 = undecided, 1 = strongly disagree) for “would recommend
this activity to others” was 4.92. All residents either agreed or strongly agreed with that
statement. Representative comments follow:
Practicing the procedure. I learn best by actually doing it, so it was good to be able to
practice in small group settings then apply it by myself on the skills test portion.
I really had such a great experience with this course today. I was very nervous in my
abilities (still am a bit), but definitely feel more confident now that I've had this
opportunity. I am happy that the mannequins were left out at the end to continue to
practice. Pacing was great, and the groups were small enough that everybody got ample
time at each station.
The instructors were very helpful and through in explaining the procedures regarding
central line access and peripheral line access.
Outstanding experience!
2012 Annual GME Report Page 15 of 21
Graduate Medical Education Planned Growth
AY12
(# of residents/fellows)
AY15
(# of residents/fellows)
Cardiology Fellowship 14 15
Colon/Rectal Surgery 2 2
Dental Medicine 7 7
Dermatology 6 6
Emergency Medicine* 57 56
Emergency Medicine Services Fellowship 1 1
Family Medicine* 19 18
General Surgery ^ 28 25
Hematology Oncology Fellowship (applying) 0 2
Internal Medicine 48 48
Nephrology 0 6
OB/GYN 20 20
Hospice and Palliative Care (approved) 1 2
Pediatrics 0 18
Plastic Surgery Residents (reflects change to
integrated program)^
3 6
Surgical Critical Care Fellowship 2 (off cycle resident) 1
Transitional Year 14 14
TOTALS 222 247
* Dually Accredited programs (allopathic and osteopathic)
2012 Annual GME Report Page 16 of 21
GME Finance Update
Current residents relative to federally funded GME “slots”
Since 1965, Medicare has been reimbursing teaching hospitals for their training of doctors. In
1996, based on individual teaching hospitals’ cost reports, Medicare capped graduate medical
education reimbursements. LVHN currently trains more residents than the number of federally
funded “slots.”
In FY 11, LVHN requested 18.0 additional resident slots from CMS for the pediatrics residency
which begins AY13. LVHN also requested an additional 5.0 slots for the general surgery
program. Both were requested under section 5506 of the Affordable Care Act of Public Law
111-48: Preservation of FTE Capt Slots from Teaching Hospitals that close (slot reallocation).
During FY12 we found out that we did receive those slots, which is a significant benefit for
LVHN.
This year we plan to again apply for section 5506 redistribution slots under the criteria of “cap
relief.” We anticipate a very competitive field in this round.
Medical Education Funding (based on IME calculation)
Site CC and 17th
MHC
Total count of "allowable" resident FTEs 145 64
1996 Cap 113 3
Section 5506 Cap Adjustment 22 42
Total federally funded "slots" 135 45
Amount Above Cap* 10 19
*LVHN receives partial slot funding for an additional 41 slots under Section 422
Resident Salaries
PGY Level
2012 AAMC HSS Northeast Region 50th Percentile (Median)
FY13 LVHN Resident Base Salaries
PGY1 52,034 52,430
PGY2 54,435 55,089
PGY3 57,057 57,650
PGY4 59,395 60,738
PGY5 62,387 63,635
PGY6 & up 64,297 66,531
2012 Annual GME Report Page 17 of 21
Faculty Development
Teaching Leader Series
With generous support from the Dorothy Rider Pool Health Care Trust, the Division of
Education sponsors and delivers network-wide interprofessional workshops for all clinical
educators (i.e. physicians, nurses, physician assistants, etc.) The Teaching Leader Series
provides great topics and speakers, information and skills to take network teaching to a new
level, and opportunities to collaborate with other educators throughout the Network. This year
the series hosted 243 participants over the course of 24 classes. Following each workshop
participants are asked to complete an evaluation of the session. The overall average result of this
series is reported below:
Workshops delivered content on diverse topics including:
Medical Intervention One Minute Preceptor
Patient Preference Presentation Skills
Quality of Life Professionalism Under Pressure
Contextual Features Remediation/Academic Support Skills
Ethics Autopsy Small Group Teaching
Curriculum Design Teaching and Learning Technology
Difficult Feedback Teaching at the Bedside
Direct Observation of Clinical Skills Teaching Cultural Awareness
Effective Patient Education The “Rime” Method of Assessment
0
1
2
3
4
5
The objectivesfor this activity
were met
The speakerskept meengaged
I learned newknoledge from
this activity
I will be able toapply what I
have learned tomy job
I wouldrecommend this
activity toothers
This activity willimprove my job
performanceand productivity
2012 Annual GME Report Page 18 of 21
2013 Priorities
Next Accreditation System Next Accreditation System: In February 2012, the ACGME announced the “Next
Accreditation System” (NAS)2 that uses specialty specific competency milestones that will be
tracked via annual data collection from programs. This creates the opportunity for annual review
of performance metrics and is then supplemented with a site accreditation visit every 10 years
instead of the current 4 to 5 year cycle. The plan is to move away from detailed process
standards (hours of lecture time) toward more meaningful quantitative measures. These include
board pass rates, program attrition rates (changes in program director, faculty and residents),
benchmarked resident and faculty survey data, case log data, progress toward milestones and
summary data on scholarly output.
The Next Accreditation System (NAS) will be establishing milestone competencies in each
specialty over the coming years. They envision reporting of at least 30-36 data elements per
specialty program that would demonstrate achievement of the milestones. These metrics are to
be submitted every six months in parallel with the semiannual resident review with their program
director. This creates an unprecedented need to gather and report educational metrics. The
Office of GME is working with our Distance Learning team to assess the capabilities of New
Innovations to meet this need and share best practice across residencies.
Procedural Competency A3 The GMEC has on ongoing A3 in the area of procedural competency (see appendix). This A3 is
very much in keeping with the objectives of the NAS. The goal is to improve the process of
achieving and documenting procedural competency.
2012 Annual GME Report Page 19 of 21
GME Policies Policies Revised or Approved during AY12
Graduate Training Agreement (Annual Review)
Work Environment
GME Responsibilities
Disaster
Moonlighting
Certificate of Invasive Procedures (new)
Professionalism Statement (new)
Policy Revisions Scheduled
Faculty Evaluation of Residents
GME Responsibilities
Graduate Training Agreement Appendix II, Schedules A,B,C.
(Resident Fair Hearing and Grievance policies)
Internal Review
Institutional Agreements
Loss of Lifebook
Moonlighting
Institution Means at-a-glance Residents' overall evaluation of the program
Institution Mean National Mean
Duty Hours% Compliant Mean National
80 hours 99% 4.8 4.81 day free in 7 98% 4.9 4.9In-house call every 3rd night 99% 5.0 5.0Night float no more than 6 nights 100% 5.0 5.08 hours between duty periods (differs by level of training) 96% 4.7 4.7Continuous hours scheduled (differs by level of training) 96% 4.8 4.8
Reasons for exceeding duty hours:Patient needs 5%Paperwork 7%Ed. Experience 2%
Cover other's work 1%Night float 2%Schedule conflict 2%Other 1%
Faculty% Compliant Mean National
Sufficient supervision 93% 4.3 4.4Appropriate supervision 96% 4.7 4.7Sufficient instruction 89% 4.2 4.2Faculty and staff interested 87% 4.3 4.3Faculty and staff create environment of inquiry 84% 4.2 4.2
Evaluation% Compliant Mean National
Access evaluations 99% 5.0 5.0Evaluate faculty 100% 5.0 5.0Evaluations of faculty confidential 85% 4.2 4.3Evaluate program 97% 4.9 4.9Evaluations of program confidential 87% 4.3 4.3Program uses evaluations to improve 74% 4.0 4.0Satisfied with feedback after assignments 73% 3.9 4.0
Educational Content% Compliant Mean National
Provided goals and objectives for assignments 99% 5.0 4.9Instructed to manage fatigue 97% 4.9 4.8Satisfied with scholarly activities 69% 3.9 4.1Appropriate balance for education 83% 4.2 4.2Education (not) compromised by service 73% 3.9 4.0Supervisors delegate appropriately 86% 4.1 4.2Given data to show personal clinical effectiveness 78% 4.1 3.6Variety of patients 97% 4.9 4.9
Resources% Compliant / % Yes* Mean National
Access to reference materials 99% 5.0 5.0Electronic medical record in hospital* 98% 4.9 4.6Electronic medical record in ambulatory* 96% 4.8 4.5Electronic medical records integrated* 80% 4.5 4.7Electronic medical record effective in daily clinical work 96% 4.1 4.1Way to transition care when fatigued 75% 4.0 4.2Satisfied with process to deal with problems and concerns 77% 4.0 4.2Education (not) compromised by other trainees 89% 4.4 4.5Residents can raise concerns without fear 78% 4.1 4.2
*Responses options are Yes or No. These responses are not included inthe Program Means and are not considered non-compliant responses.
Patient Safety% Compliant Mean National
Tell patients of respective role of residents 98% 4.6 4.5Culture reinforces patient safety responsibility 99% 4.5 4.5Participated in quality improvement 76% 4.0 4.0Information (not) lost during shift changes 93% 3.8 4.0
Teamwork% Compliant Mean National
Work in interprofessional teams 98% 4.7 4.6Effectively work in interprofessional teams 98% 4.3 4.4
© 2012 Accreditation Council for Graduate Medical Education (ACGME)
2011-2012 ACGME Resident Survey - page 1
410724 Lehigh Valley Health Network - Aggregated Program Data
Programs Surveyed
Residents Responded
Response Rate
9
183 / 203
90%
Survey taken: January 2012 - May 2012
2012 Annual GME Report Page 20 of 21
cards - separate flow for cvc now that signoff required, using bedside paper cards for cvc signoff, inserted the med staff
privilege step of info flow (quarterly med staff update), summary log submitted quarterly and audited by pd, has MR numbers and is reviewed semi annually , final summary letter has numbers in prose statement includes procedures - use milestones for things like echo, levels of proficiency give certain privileges. Everything gets over-read dental
cosign of chart counts as the cosig monthly review by pds, monthly stats excel log transfer from paper OB
using a "competency tool" internal to their program and LVHN to help document competency (volume≠ competence) Much of it is not procedural, but competency in the broad sense and fits well with where NAS is heading -For bedside procedures some programs use New Innovations (NI) to document, some use paper, some use self logs acgme 14 things have mins like process, diff to implement derm
end of rotation eval , procedural skill level on that form and is summary of multiple procedures observed, all proc fully supervised, annual report by pd , number of procedures hand logged em
well evolved tracking mechanism, incorporated simulated runs using checklists, sets minimum bars, expectations for supervision, expectations for recheck of competency, logbooks for offservice get entered back into NI im
considering a separate compliance report for faculty sign off on procedures, reports of compliance with sign off go to division chiefs, core faculty and non-core get compliance reports, upper year resident or attending may be assigned as the supervisor, going back to NI for tracking
-document individual competence -document individual numbers of procedures -document programmatic numbers of procedures (benchmarking) -serves as MOC beginning point, and maybe even within residency (EM's yearly revisit) -give residents proof they need for future med staff privileges -feeds the med staff system that nurses or outsiders could check to verify status -security of MR numbers assoc with procedures must be maintained -standard checklists for the same procedure (more extensive checklists in education setting and/or competency check)
Unclear why NI is not used by many residencies and heavily used by others. Survey software has its limits (qualtrics tried) Computer / ipad / phone etc. method matters for data entry. App like approach would be great, but many different apps could be a nightmare to create, maintain, export from Is faculty sign off or faculty audit what is really needed? Probably checklist signoff for sim and competency check, but otherwise simple sign off or at a minimum audit capability. The step of posting to med staff services in some system that could be checked by a nurse or outside reviewer is lacking or not timely. Future systems should be flexible to adapt to the acgme’s growing tracking role either by export or audit Complications: resident self report may be lacking on complications and delayed complications are challenging to track/report Medical staff mainly looks at bulk data imports for incoming attendings, limited privileges for fellows, and tends to see privileges as a yes/no rather than state of evolving competency.
Title: Achieving and documenting procedural competency at LVHN
-increasing call for accountability from society funneling to ACGME -ACGME has logging mechanism for surgeries used by GS, OB, fellows -PDs can review the ACGME file and most do quarterly -To be primary surgeon they need to do 51% of the procedure, if not they don't get credit. -Most credentialling bodies rely on the PD, thus our LVHN residency records, to verify/vouch when they are getting privileges -The Next Accreditation system (NAS) will look at competencies and procedures (30-36 per residency, specialty specific) -big data collection needs coming, unclear if New Innovations (NI) will export to ACGME databases or not
Background
Current Conditions
Target/Goal(s)
Proposed Countermeasure(s)
Analysis
Plan
Followup
Ensure residents and coordinators are comfortable with the logging process in NI. Ensure login process to NI is seamless for faculty and residents Ensure that the process of signing off the first five (passing) then just logging is set up to reduce doc burden. “sign off” is either one radio button confirm pass, or an abbreviated checklist for the first five, not the long checklist of the sim lab after the first five logging, but not sign off (signoff can be required at PD / RRC discretion) work with new dL team member (TLH) on creating a first five sign-off that automatically rolls to the >5 the simple logging process within NI demonstrate that process at GMEC consider standardizing abbreviated checklists for the first five via GMEC member discussions clone the checklist process across procedures roll the process out across programs advocate for greater support of the sign off process among both core faculty and other medical staff who are credentialed in the procedure and thus able to sign off ( medexec support) side benefits of checklist discussions: Longer checklists can be available in NI for check off runs, delayed checks, and bedside use if desired.
2012 Annual GME Report Page 21 of 21