GME Break-Out Group

GME Break-out Group

Adjusting to the New Requirements: Scheduling Models

Duty hours:  Current IT Systems: How easy are these to use by residents and for program, institution to monitor and review? o New Innovations o MedHub o eValue o Survey Monkey o Individual Attestations by programs  Current Monitoring: o Monitored weekly by Program Directors and GME o Monitored weekly by Program directors and monthly by Office GME, DIO o Data presented monthly as standing agenda item to GMEC o Data presented quarterly to GMEC o Residents required to enter weekly – GME Office monitors – given one to two weeks to do this – consequences for not doing o Electric sign-outs completed as a team but this needs to be interfaced with medical records system o ACGME annual survey o Yearly or twice yearly survey by Office of GME, GMEC and/or DIO o Internal Reviews  Other models to insure compliance/adherence to duty hours logging: o Include duty hour logging compliance – including logging hours – into evaluations – as fulfilling a professionalism competency – they don’t “pass” rotation unless they do this o Put standard language related to compliance into resident contracts/letters of appointment o Require recording of internal (and external) moonlighting o Build in shift overlap to facilitate hand-offs and sign-outs

Supervision:  Should have an Escalation policy (institutional) – referenced in contract /letter of appointment and in the policy manual  Patient safety reporting tool to allow the reporting of issues anonymously – issues related to residents are forwarded to the DIO/Office of GME  Different levels of supervision according to policy – linked to electronic record so that others (nurses, other attending, other services can view)  End of rotation evaluation – include specific questions on adequacy of supervision  DIO has monthly breakfast with residents from all services – Resident Advocacy Committee – where residents are free to speak and present issues. These are reported to GMEC.  Internal reviews  Timelines from medical records showing time between resident notes and attending sign-off  Add supervision “check-off” in duty hour recording systems so residents can indicate whether supervision appropriate during each shift – drop down box with minimal number of choices  Attending report cards

Issues created by new requirements:  Patient coverage – institutional problem, not a GME one. May need to engage Division chiefs, service line chiefs, CEO, hospital leadership, physician practice plan. These patients are “the hospital’s or the practice’s” patients, not the residencies. This may vary somewhat if sponsoring institution is hospital versus a school of medicine. o One solution is additional workforce: PAs, NPs, Hospitalists o Enhance nursing and other team member abilities to work up to scope of practice (often will “do more” in community setting without GME presence). o Administrative support may be necessary (clerical support – e.g., help with follow-up appointments, durable medical equipment, transportation, prescriptions) o IT has to truly work: computerized order entering, electronic health records, e-prescribing, decision support have to work efficiently and not create more inefficiencies, increased time for residents.  Supervising physician must be credentialed appropriately.  Competencies of supervisor will need to be defined.

Questions to programs:  What changes will need to be made to existing rotations?  Add/delete rotations?  Creates changes to workforce –\+?  Other concerns? Many programs may have no impact (dermatology), however, Plan Gap analysis to address any “needs”.