New Program director & Coordinator Introduction

New Program director & Coordinator Introduction
Office of Graduate Medical Education May 14, 2018 May 22, 2018

Agenda The Nuts and Bolts of Running a GME Program
The GME Yearly Cycle SLU-Specific GME Matters New ACGME Expectations Peer Panel Discussion

Nuts and Bolts of running a GME Program
Written (and unwritten) Jobs of the Program Director and Program Coordinator Materials borrowed in part or wholly from presentations made at the annual ACGME meeting in March of 2018*

GME Training Oversight
ACGME SLU SOM Specialty Society

Institutional Sponsorship Reporting Structure
Board of Trustees Dean of SOM DIO GMEC Program Directors Program Coordinators Departmental Chairs Teaching Faculty

SLU SOM Institutional Sponsor Employer Policies/Processes
65 programs 640 trainees 2 states SLUH, St. Mary’s, CGCH, VA, Mercy, St. Elizabeth’s Employer Policies/Processes Accreditation/Certifications

A DAY IN THE LIFE OF…………. Typical Daily Activities
Program Director Rotation/Schedule Approvals Mentoring/Counseling Residency Verifications Vacation/Conference Requests Crisis Management Review Evaluations Program Coordinator Rotation/Schedule Updates Vacation Request Updates Resident Assistance* “Go to person” Notifications General Inquiries from in and out of institution Food orders and food card requests Verification of training Travel/reimbursement

Typical Weekly/Monthly Activities
Program Director GMEC meeting Program/Faculty Meetings Schedule approvals Resident/Student Mentorship Coordination of Educational activities Semi-annual evaluations Milestones ACGME paperwork/reporting Various Committees (Wellness, Curriculum, Hospital, QI) PD/PC Weekly Meetings Faculty Development Program/Faculty Oversight Crisis Management Program Coordinator Clinical Experience and Education Hours CCC meetings PEC meetings Evaluations VA Reports (Quarterly) Program Coordinator Meetings Scholarly Activity Crisis management Procedure log confirmations Monitor Recertification Expirations Resident Roster Away Rotation Paperwork Rotating Residents from Other Institutions EPIC access PD/PA Weekly Meetings Program Coordinator Development Elective schedule requests MDFEA reporting Verify and pay lab-coat and pager invoices

GME Yearly Cycle

Program Director Role authority & accountability
GMEC (then Dean) approves PD term adequate for continuity & program stability (length of program + 1 yr) certification in the specialty evidence of scholarship oversee didactic, clinical and sites approval local site directors approve and evaluate teaching faculty monitor resident supervision prepare and submit ACGME materials and annual program updates ensure compliance with grievance and due process provide verification of residency education implement and distribute policies and procedures monitor resident duty hours and adjust schedules as needed monitor and deploy backup support for residents comply with the institution’s written policies and procedures obtain review and approval of GMEC/DIO for ACGME matters

July August September October November December
Specialty Match ADS Updates Orientation APE report CCC Recruiting January February March April May June Main Match PEC Meeting Graduation Milestones CCC ACGME Survey Milestones

July and August Program Director Orientation ERAS Opens ACGME WebADS
Complete GMEC APE Special Board Data Review Residency Website Updates ITE Semi-Annual evals Recruitment pre-activities Program Coordinator Orientation Activities GME Program Survey Deadline ITE Roster/Exam ACGME WebADS Resident recruitment pre-interview activities (schedule/dinner/hotel/ shuttle/arrangements) AOA Membership APE data gathering

September and October Program Director Program Coordinator ERAS
NRMP Registration Register for The Match Recruitment pre-activities Interviews begin in October Conduct Interviews Crisis management Program Coordinator Resident Recruitment (Interview, Dinners, Tours) Renew Resident Educational Subscriptions/Board Materials ACGME Milestones Open October 30 Prepare Milestone Packets for CCC National GME Census Deadline Schedule and proctor ITE exams Holiday Party Preparations Crisis Management

November and December Program Director Continue Resident Interviews
Mentor Meetings CCC PEC Military and Fellowship Match where applicable Semi-Annual Evals December submit Match List Program Coordinator Resident Recruitment (Interview, Dinners, Tours) GME Program Survey Deadline Renew Resident Support Materials Semi-Annual Evaluations AAMC Deadline for National GME Coordinate Residency meetings Prepare recommendation letters for fellowships

January and February Program Director Match Rank List Due January
Continue CCC follow-up with Residents Recruiting Wraps UP Milestones Due Interviews for Chief Resident ACGME Survey Program Coordinator Recruitment USMLE 3 ACGME Surveys Resident Deadline for National Boards Milestones Due Graduation Diploma/Ceremony Planning

March and April Program Director Canadian Match – March 1
NRMP Match – March 16 Specialty Program National Conferences Rotation schedules for Upcoming Academic Year PLAs for New Rotations Finish ACGME surveys Recruitment pre-activities Complete ACGME surveys Program Coordinator Collect Contract Signatures Special Program National Conferences Solicit Schedule Requests ERAS Registration Review Expiring PLAs Resident recruitment pre-interview activities Complete ACGME surveys Onboarding activities Training credentials and info verification for training sites

May and June Program Director Graduation Dinner Graduation Ceremony
Welcome Party Preparations Orientation Materials CCC PEC Mentor-Milestone Evaluation Meetings End of Year Reports for Each Resident Summative Residency Reports Recruitment pre-activities Program Coordinator Prepare and Send Invitations Graduation Dinner planning and ceremony Create Graduation Brochure Orientation Materials Graduate Offboarding Faculty Teaching Awards ITE Exams ACGME milestone reporting Bi-annual evaluations Schedule final evals for graduates Alumni certificates CCC PEC Order new lab-coats and pagers Distribute lab coats, assign pagers Assign lockers Assign mailboxes Schedule orientation breakfast and other activities Website updates

SLU-Specifc GME Matters

SLU GME Training GMEC & Subcommittees
GME Office GME Website & Resources GMEC & Subcommittees AIR , APE, Professional Oversight., PSQI SLURA Orientation Faculty Development

SLU GMEC oversight committee for residency, subspecialty and fellowship programs At least 14 voting resident and faculty from clinical departments one patient safety or quality improvement officer 3-yr term: IM, peds, psych, neurology, FM, OB, surgery 2-yr term: 1) Urology, plastic surgery or neurosurgery; 2) otolaryngology or orthopaedic surgery; 3) ophthalmology or dermatology; 4) pathology, radiology or anesthesiology At least 2 at-large faulty members At least four peer-selected residents for one-year term

Centralized Processing
MO license No Illinois clinical practice (except IL family medicine) BNDD Medicare/Medicaid enrollment Malpractice Covered at CGCH, VA, Mercy Some covered at St. Mary’s Invoiced to SLUH HR/Payroll/Insurance/Benefits/Parking Affiliate Monthly Invoicing (via MDFEA) Onboarding, drug screening/employee health, background checks Visas Certificates, employment files

GME Website

SLURA Saint Louis University Resident Association
President, Vice President (president elect), Secretary, Treasurer Peer selected Peer-voted GME provided budget Plan and organized activities Social, educational, volunteer Voice for residents to GMEC and GME Office

Professional Support Services
Office of Professional Oversight Learning Specialist Lisa Israel, M.Ed. (Director) Desloge Towers, Room T-6147 GME Ombudsman Confidential, neutral, negotiation, navigator Recipient of reporting, concerns, complaints Residents, students, staff, faculty, hospital employees Sara H. Barnett, PhD Multi-Cultural Affairs-L 103A Test taking assistance Study strategies Time management Career challenges

Behavioral Health Program
University Health Plan: Behavioral Medicine Institute 6 free and confidential visits does not need to be for a medical diagnosis Referral form: single mandatory visit Includes stress management, relationship problems, etc. 24/7 access to an on-call clinician for urgent behavioral health matters at Behavioral Health Advisory Board (15 to 20 residents) meets twice yearly to discuss Behavioral Health Plan benefits Onsite service: Tues and Wed Rm M-205 in Schwitalla

SLU-Specific GME Matters
Appointment Cycle Key Dates September 15th 2019 NRMP Match Registration opens December 1st thru 15th Submission of requests for Re-appointment for all returning Residents and Fellows 15th thru 23rd Submission of Requests for Appointment (incoming non-match appointees) January 15th NRMP Rank Order List Entry Begins January 31st NRMP Match Quota Change Deadline, Withdrawal and SOAP participation deadline; 11:59pm ET February 20th NRMP Match Rank Order List Certification Deadline; no later than 9pm ET

Appointment Cycle Key Dates March 11th NRMP – Applicant unmatched information posted to the website at 10:30am ET Supplemental Offer and Acceptance Program (SOAP) begins at 11am ET March 15th NRMP Match Day! – Match results for applicants are posted to Website at 1:00pm ET March 20th Deadline to submit all Match Appointment Requests to GME Office March 29th All appointment letters returned to GME Office for inclusion in packets to residents April 15th Signed appointment letters and license applications must be returned by incoming residents to the GME Office for processing at the MO State Board

Appointment Cycle Key Dates April 30th Program confirmation of terminating housestaff May 24th Certificate requests to GME Office for processing June 7th All certificates have been signed by GME Dean and returned to Programs (Final Evaluations must be submitted to the GME Office before certificates are released) June 17th thru 19th PGY I – Housestaff Orientation July 1st PGY II and above – Housestaff Orientation

Moonlighting: Faculty Work
Officially: not allowed Cannot on J-1 visa Difficult with H1B Template for institutional approval (signed by the Dean) At SLU-affiliated sites External (must have own MO license, DEA) Internal (no billing, still supervised): provided additive pay

FAQ’s How long does it take to obtain a MO temporary license? Generally 6 to 8 weeks Requires ECFMG, Step 1, Step 2 (H1B Step 3) Does GME support MO Permanent licensure? No. Housestaff that desire to obtain a full physician's license are responsible for all fees associated with the process and must secure personal DEA and BNDD licenses Some programs pay for this.

FAQ’s When must housestaff apply for FMLA? In anticipation or the occurrence of absences greater than 3 days. Where should housestaff be directed regarding questions about healthcare insurance. University Health Plan representatives are located in the school of medicine in Room C119 and can be reached at

FAQ’s What types of visas does GME support? J-1 Visa (no cost to programs) Valid for only up to 7 years, regardless of training duration H1-B Visa (program sponsored; $960 – $2,185) All other Visas are subject to housestaff discretion When seeking a J-1 visa, it is important for programs to ensure the prospective resident or fellow has enough time left on the visa to complete the training program.

Leave: per 12 month period
3 weeks of vacation 1 week = 5 business days or 7 consecutive days Additional days: program-specific Conferences, interviews etc. 30 days sick FMLA 12 weeks of job protected leave (not all is paid) Qualifying condition 12 months employment prerequisite Total leave (all reasons) cannot exceed specialty-society requirements (or training will need to be extended

Observerships If MD graduates – processed by GME Office
2 weeks – 3 months Processed by employee health, background checks Cannot provide care (history, exam, procedures) If students (U.S., international, high school) – processed by student affairs If < 2 weeks (and in hospital) – processed by hospital Must have a sponsoring faculty at SLU (we do not identify the sponsor)

WEB-ADS The program director must: prepare and submit all information
required and requested by ACGME Required Information Duty Hour/Leaning Environment/Evaluation Major changes Responses to Citations Trainee/faculty roster license expiration, board certification Trainee/Faculty Scholarship for previous year Sites (block diagram) will be sent with window open/close dates core residencies Sept-Octover

External Rotators/Rotations
Accept outside clinical trainees Need license, malpractice, EPIC training, employee health…. Institutional or program agreement/contract Can take 3-6 months to establish (if outside of Missouri) Away Rotations Cost is limiting factor ($ malpractice) Institutional or program agreement, license required Visa can be limiting Cannot extend training time Program for Away Rotation (PAR): international experiences Covered for some programs based on hospital/funding agreements

GME Financing GME paid Departmental paid Positions paid by
Stipends benefits (29%): insurance Parking Malpractice Accreditation, match, licensure costs Departmental paid Books, travel, research ITE, exam costs Lab coats, meals, pagers Coordinators, PD, faculty Positions paid by Hospitals Military Departmental funds Grants/contracts Negotiated yearly Rotations at site of FTE allocation

New Innovations: Residency Management Platform
Scheduling rotations Managing – tracking evaluations Reporting time to CMS Logging duty hours Archiving – housing resident/faculty data Storing resident documents Completing APE

Please call as soon as… License, visa, insurance, accreditation concern Legal paperwork, subpoena, summons Trainee leave, illness, FMLA Serious issue with hospital, faculty, peers Faculty leaving Trainee transfer, resignation, non-standard program Considering probation, non-renewal (6 month notice), dismissal, disciplinary action

New ACGME expectations

Common Program Requirements
Foundational elements for all GME programs First Common Program Requirements 2003 Major Revisions 2007, 2011, 2017, 2019 Six Sections Institutions Program Personnel and Resources Resident Appointments Educational Program Evaluation The Learning and Working Environments CPR’s are available as a separate document. They are also embedded in the requirements of your specialty/subspeciality In your specialty/subsepecial requirments the CPRs are easily recognizable because they are in bold font

Section VI Revision 2017 Areas of Emphasis Professionalism Well-Being
Patient Safety Quatity improvement Supervision Fatigue Mitigation Clinical Responsibilities, Teamwork, and Transitions of Care Clinical Experience and Education (formerly “duty hours”)

Well-Being scheduling, work intensity and compression
policies and programs encouraging well being residents can attend appts during work hours attention to burnout, depression, substance abuse self-assessment tools for self-screening, access to 24/7 help

Sections I-V to be enforced July 1, 2019
Themes Intentionality in program design Increased PD authority over program Personalized guidance for resident/fellows Re-define “core-faculty” Faculty Development Support for coordinator & PD Inclusion of AOA board certification Separation of residency and fellowship CPRs Independent practice in specialty for fellows Recognition of ACGME-I in eligibility criteria

Requirements: Residency 2019
The PLA should must be renewed at least every 10 years and be approved by the DIO PD must devote 20 percent FTE (at least eight hours) non-clinical administrative program time per week PD must have at least three years educational and/or administrative experience Faculty must at least annually pursue formal faculty development designed to enhance their skills Program Coordinator must be supported at 50% FTE Prior to acceptance, verification of transferring resident previous educational experiences and summative competency-based performance

Board Pass Rates six years, aggregate pass rate of 1st time examination of program must be above the national 5th percentile programs with > 80% pass rate will have met this requirement, regardless of percentile

The Program Evaluation Committee Common Program Requirements V.C.1
Two program faculty; one resident (minimum) reviewing revision of curriculum goals and objectives addressing areas of non-compliance Review program, annually, using DATA Conducts the Annual Program Evaluation APE Annual Report (minutes) Written Action Plan progress on previous year’s action plan reviewed and approved by teaching faculty, documented in meeting minutes, distributed to faculty, trainees, and GMEC

PEC assessment elements
curriculum outcomes from prior APE ACGME letters, citations quality and safety of patient care aggregate resident and faculty: well-being recruitment and retention workforce diversity engagement in QI and patient safety scholarly activity resident and faculty surveys written evaluations of the program aggregate resident: achievement of Milestones in-training examinations board pass & certification rates graduate clinical performance aggregate faculty: faculty performance faculty development

APE Process May PEC Meeting Continuous Data Collection for APE
PEC Meeting for APE Develop APE Report & Action Plan Disseminate to Faculty, Residents & GMEC Implement Action Plan PEC Meeting PEC Meeting Aug.

The PEC must prepare a written action plan

APE SWOT Assessment Strengths Weaknesses Opportunities Threats VC.2b.

Job of CCC

Functioning of CCC Meet twice per year minimum
May work as a whole or in sub-committees to bring to the whole (pre-review work) Review all evaluations for each resident Decide how to present all data Decide how to assess milestones – milestones are to be used to summarize the results of a variety of different evaluation tools to inform the learner and program –Milestone assessment made and conveyed to PD for further action Remember levels 2,3 and 4 do not necessarily correlate to PGY 2,3,4. Residents not required to meet every level 4 item to graduate Resident not assured of graduation solely on basis of level 4 item achievement Milestones are summary not the evaluation itself, they are not to replace end-of-rotation forms

Use of Milestones Provide feedback to resident
Benchmark residents to program and national means Determine program strengths and need for improvement Benchmark program nationally ACGME used to compile national normative data and to provide common expectations for individual resident progress Milestone 2.0 is coming

Problems………. Solutions………. Tips & Advice…..
Peer Panel Discussion Problems………. Solutions………. Tips & Advice…..

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