Aggressive Transitioning from. ACGME/AOA Teaching Hospital

Transcription

1 Aggressive Transitioning from Community Hospital to ACGME/AOA Teaching Hospital Joseph Stella, DO FACOS Mary Elizabeth Roth, M.D. FACPE, Linda Famiglio, M.D., John Bulger, DO Geisinger Health System Academic Affairs Geisinger i Northeast, t Wilkes-Barre, Pennsylvania

2 WHY? Growth in medical student classes including new DO medical schools 4000 graduates per year with only 2000 AOA post graduate positions Patient demand and physician shortage will require new GME and OGME opportunities and growth Family Medicine and General Surgery were (are) areas of critical shortage

3 Background Geisinger has sponsored GME for 90 years at its Danville campus but not at its two community hospitals in northeast Pennsylvania (NEPA). AOA approved programs at GMC include IM, Med- Peds, Pediatrics, and Ob-Gyn To increase opportunities, current programs were first expanded and new programs were added at the GMC campus. Development of a new teaching hospital was the only Development of a new teaching hospital was the only remaining option.

4 Total Population Growth / Decline 10% to 16% Growth Erie Warren McKean Growth (6) Growth (22) -6% to 0 Decline (35) Susquehanna Bradford Tioga Potter (3) 5% to 10% 0 to 5% Crawford Wayne Wyoming Cameron Forest Sullivan Elk Venango Lackawanna Pike Lycoming Mercer Clinton Clarion Jefferson Lawrence Clearfield Union Centre C l bi Columbia Montour Luzerne Monroe Carbon Butler Armstrong Snyder Beaver Northumberland Northampton Schuylkill Mifflin Indiana Juniata Cambria Lehigh Blair Allegheny Perry Westmoreland Dauphin Lebanon Berks Bucks Huntingdon Washington Montgomery Cumberland Somerset Fayette Greene Business Strategy and Development October 2007 Bedford Lancaster Franklin York Fulton Adams New teaching hospital Chester Philadelphia Delaware Geisinger Medical Group

5 GWV Main Campus

6 GWV

7 GMC Campus

8 GSWB

9 VAMC

10 Transition to a teaching hospital was staged over 5 years and in three phases. Phase 1 Exploration by leadership including Clinicians, Administrators and Finance about the impact of a new Osteopathic training program Exploration of the new environment through isolated GME and OGME in areas of educational critical need such as surgery, family medicine, obstetrics and emergency medicine A grass roots group met to perform SWOT analysis, to begin a change in culture and to begin planning resources for the next phase Medical staff had discussions s with the local administration at and the academic leadership in the Geisinger Healthcare system including academic chairs of specialty departments

11 Phase 2 Academic Affairs oversight was expanded from one hospital to include oversight of all GME and OGME in the system. Required rotations were developed for three ACGME accredited programs Faculty was identified and developed through onsite seminars. A leadership group met monthly to identify areas of need for specific GME programs: primary care sports medicine, orthopedics, general surgery, family medicine, geriatrics, internal medicine, reproductive gynecology and cardiac electrophysiology.

12 Phase 3 An academic presence was created at GWV for all its academic activities. Clinician educators were recruited or offered transfer from the main campus to the new teaching hospital to develop programs in these preferred areas on a faster track. An experienced physician executive with credentials in academic planning and curriculum was recruited for GWV to develop new ACGME/AOA accredited programs with upfront faculty and development program development. Osteopathic physicians leaders were identified to develop Osteopathic programs within the system

13 Year 5 Results/Outcomes/Improvements: ACGME and AOA accredited residencies in Family Medicine and General Surgery and fellowship in Sports Medicine are operational driven by educational needs of ffuture clinicians, not service needs of the medical staff. System residents participate i t in accredited d rotations from programs in emergency medicine, obstetrics/gynecology, orthopedic surgery, CCEP, cardiology, rheumatology, dermatology, Pediatrics and gynecology-endocrinology, gy,

14 Additional Outcomes Daily curriculum conferences Weekly grand rounds Osteopathic grand rounds Faculty development The new teaching hospital has applied for resident position funding through its own cap.

15 Phased Growth of GME Experiences at the New Teaching Hospital Number of Exp periences Phase 1 Phase 2 Phase 3

16 Number of Residents

17 Significance The clinical base for residents who might may choose to stay in Pennsylvania has expanded with transition of a community hospital into a teaching hospital. Additional procedures for surgery and procedural specialties expands the range of existing ACGME/AOA accredited programs. Morale of medical staff rises with the introduction of housestaff who seek evidence-based medicine, systems based practice and up to date procedures. GME operations can monitor across resident activities, its electronic monitors of best practices, clinical competencies and privileging.

18 GEISINGER HEALTH SYSTEM GRADUATE MEDICAL EDUCATION RESIDENT FTE COUNTS VERSUS MEDICARE FTE CAP BY YEAR For Medicare Indirect Medical Education (IME) Payments '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 full IME FTE RESIDENTS ADJUSTED CAP

19 Steps for Reproducibility The process can be applied by other academic medical centers working with a community hospital with qualified board certified specialists ready to transition to a teaching hospital. Leadership must come from top down to value the independent medical staff and departmental processes to rearrange their priorities over time to train residents at a community hospital. Internally the community hospital must revise its medical staff education-cme and bylaws to support medical education.

20 Osteopathic General Surgery Vision Develop and train Surgeons that could operate on me or my family Future colleagues Instill life long learning skills Commitment to Excellence in patient care, professionalism, and scholarly l activity

21 Past Spring 2008 Planning stages Fall 2008 Initial Site Visit and Program Approval from the ACOS and AOA January 2009 ERAS, Match Spring 2009 Curriculum Development July 2009, Inaugural class with 13 residents

22 Application Process Basic Standards for Residency Training ACOS website ( SECTION III Standards for Program Approval The approval process for postdoctoral surgical training i is a public trust t and its purposes are many. These include assuring: Students, Residents in training gprograms,, Trainers, Governing boards and administrators of training institutions, Certifying boards, Funding agencies, The public.

23 Postdoctoral Training

24 Approval Process

25 Approval Process

26 Site Visit

27 AOA Resurvey Review

28 One Year Review

29 Staffing Director Coordinator Administrative Assistant Faculty GMEC Academic Affairs

30 Time Management Recruitment ERAS E* Value (duty hours, evaluations, funding) Quarterly reviews Orientation Schedules Unforeseen Issues

31 Curriculum Goals and Objectives Core Competencies OMM Medical Knowledge Patient Care Practice based Learning and improvement Interpersonal and communication i skills Professionalism Systems based learning

32 Sample of Lecture Series

33 Sample of Teams

34 Sample Call Schedule

35 Future Approved for 25 positions GWV, 4 General Surgery Services CT, Vascular, Breast, Ambulatory VAMC opportunities GMC opportunities State College opportunities SCORE (Surgical Council on Resident Education) curriculum Simulation

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