Annual Report. Carol M. Rumack, MD Associate Dean for Graduate Medical Education ACGME Designated Institutional Official

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1 Annual Report Carol M. Rumack, MD Associate Dean for Graduate Medical Education ACGME Designated Institutional Official

2 Graduate Medical Education Annual Report The Graduate Medical Education (GME) Office is under the leadership and direction of Carol M. Rumack, M.D., Associate Dean for GME at the University of Colorado School of Medicine (CUSOM) and Designated Institutional Official (DIO) for the Accreditation Council for Graduate Medical Education (ACGME). Dr. Rumack and staff are responsible for the oversight of ACGME accreditation and educational environment as well as payroll, benefits and administrative issues for all residency and fellowship training programs. The GME Office implements policies of the Graduate Medical Education Committee (GMEC) of the School of Medicine. The ACGME charges the GMEC with responsibility for monitoring and advising on all aspects of residency education including compliance with ACGME duty hours, patient safety, and quality improvement requirements, and in maintaining a strong learning environment. The GMEC is composed of program directors, designated representatives of the major teaching hospitals and officers of the Housestaff Association. GMEC reports to the Dean of the School of Medicine through the Associate Dean for GME and Senior Associate Dean for Education. The website is: The University of Colorado School of Medicine GME: Trains 76% of the total residents and fellows in CO Is the largest of 13 sponsoring institutions in the state of Colorado Is the 23 rd largest institution of 676 nationally [2013/2014 ACGME Data Resource Book] Oversees and provides support to approximately 140 Program Directors, 89 Program Coordinators, and 1500 Faculty Has no institution ACGME citations Anticipates its ACGME Institutional Self Study Date in October,

3 GME Highlights GME Training Programs 149 residency and fellowship programs with 1070 residents and fellows: 28 ACGME residency programs (764 residents) 62 ACGME fellowship programs (259 fellows) 59 Non ACGME fellowship programs (47 fellows) *Numbers reflect enrollment as of August 1 st, rd Annual GME Outstanding Program Coordinator Awards The Graduate Medical Education Committee, in collaboration with the Program Coordinator Council (PCC), recognized two outstanding program coordinators. Claire Travis, MA, MBA Surgery Kathy Urban, BS, C TAGME Pediatrics Claire Travis is also the CUSOM GME Nominee for the National 2016 ACGME Program Coordinator Award. 2

4 ACGME CUSOM Resident & Faculty Survey Results Residents and Faculty of all ACGME accredited programs are required to complete this annual survey. Results of the surveys are utilized by ACGME as a key performance indicator for program quality and compliance with work and training environment requirements and for CUSOM institutional performance. 85 programs were surveyed. Resident Survey Results (6 content areas): Duty Hours Faculty Evaluation Educational Content Resources Patient Safety/Teamwork 1. 91% response rate 2. Institution is at or above national mean for each survey category Faculty Survey Results (5 content areas): Faculty Supervision & Teaching Educational Content Teamwork Resources Patient Safety 1. 83% response rate 2. Institution is at or above national mean for each survey category GMEC Oversight and Education New ACGME Programs Approved Programs Positions Filled Length of Training Site Visit Citations Critical Care Anesthesiology year 10/ Neurology Adult Epilepsy year 5/ Complex General Surgical Oncology years pending Pediatric Allergy/Immunology (CHCO) years pending 3

5 ACGME Program Site Visits Programs Site Visit Date Self Study Citations Pediatric Child Abuse August 5, 2014 October, Micrographic Surgery & Dermatologic Oncology April 16, 2015 Results pending Complex General Surgical Oncology April 28, 2015 Results pending GMEC Approved New Non ACGME Programs Neurosurgery Stereotactic & Functional Fellowship Infectious Disease Neurological Immunology & Neurological Infections Pediatric Critical Care Research Neurology Headache Hospital Medicine Fellowship in Quality & Systems Neurosurgery Skull Base Neurosurgical Oncology GMEC Program Actions Special Focused Reviews Programs Review Date Internal Medicine 7/2014 Surgical Critical Care 7/2014 Urology 7/2014 OB/GYN 8/2014 Micrographic Surgery & Dermatologic Oncology 10/2014 Vascular Surgery (new program) 1/2015 Advanced Heart Failure & Transplant Cardiology (new program) 2/2015 Internal Medicine/Pediatrics (new program) 2/2015 Neurology Pediatric Epilepsy (new program) 2/2015 4

6 New Program Directors (PDs) & Program Coordinators (PCs) ACGME Programs 2010/ / / / /15 New PDs New PCs and/or transferred to another program average turn over rate: PDs = 9% PCs = 20% Resident/Fellow Learning and Working Environment Clinical Learning Environment Review (CLER) Visit August 2014 Goals Identified 1. Patient Safety 2. Quality Improvement 2015 Orientation: All new residents report safety events Improve EMR access to Department specific data 2016 Resident Incentive Plan will require safety event reporting Involve residents in IHQSE* projects Seek cultural competency training for specific COPIC RCA experience for all residents patient populations with health disparities 2015: Form GMEC Housestaff PS/QI Committee with faculty 2015: GMEC Resident PS/QI Committee works with IHSQE* *Institute for Healthcare Quality, Safety & Efficiency 3. Transitions of Care (TOC) 2015 Orientation All residents learned I PASS* ACGME programs adopt I PASS* Create GMEC task force on Transition of Care * I PASS hand off system 5. Duty Hours, Fatigue Management & Mitigation 4. Supervision Teach residents/nurses to search UCH Hub Teach patients different roles of residents/faculty Seek options decrease large number of patients resident coverage Decrease transition of care/batch interruptions 6. Professionalism Continue monitoring get action plans when hot spots report violations 2015 Orientation Professionalism interactive lectures by behavior/legal experts Office of Professionalism 5

7 GME Training Programs GME Enrollment Data and Trends 164 residency and fellowship programs with 1111 residents and fellows: 28 ACGME residency programs (791 residents) 65 ACGME fellowship programs (268 fellows) 71 Non ACGME fellowship programs (52 fellows) *Numbers reflect enrollment as of August 1 st, 2015 Figure 1 Figure 2 6

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10 Figure 7 Graduate Satisfaction GME 2015 Exit Survey Neurological Surgery Residency For the academic year 326 residents and fellows graduated from ACGME and Non ACGME approved programs. All graduates completed the 2015 GME exit survey. 9

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13 Practice in Colorado After Completion of Training Figure 12 Figure 13 12

14 Figure Primary Care Physician Graduates Plans Figure 15 13

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