1. Advances in GME: Think Nationally, Act Locally Faculty/Staff Development Workshop May 10, Bobby Baron, MD, MS Associate Dean for GME and CME

2. Disclosure
No relevant financial relationships

3. Topics for Today New Common Program Requirements (July 2017)
Newer Common Program Requirements (July 2019)
Resident and fellow union issues
Well-being
Program director and resident and fellow diversity
CLER 2.0 and 3.0
Milestones 2.0
Pursuing Excellence

4. UCSF GME Programs 1,524 Trainees 180 Programs 947 Residents
282 ACGME/ABMS Fellows
271 Non-ACGME Fellows
24 Non-MD Trainees
180 Programs
26 Residencies
61 ACGME/ABMS Fellowships
87 Non-ACGME Fellowships
5 Non-MD Training

5. New Common Program Requirements July 2017
Excellence in quality of care of today’s patients
Excellence in quality of care of patients cared for by today’s residents in the future
Excellence in professionalism through faculty modeling:
Effacement of self-interest in a humanistic environment
Joy of curiosity, problem-solving, intellectual rigor, discovery
Commitment to well-being of residents, faculty, students and all members of health care team

6. New Program Requirements in Patient Safety, Quality Improvement: July 2017
Resident and faculty must report events
Receive summary information
Training in disclosure of adverse events
Receive data on quality metrics
Participate in interprofessional QI activities
Including those aimed at reducing disparities

7. New Program Requirements in Work Hours: July 2017
80 hours per week
All in-house clinical and educational activities
Clinical work done from home
Documentation
Taking calls
Moonlighting
Does not include reading, studying, research done from home
More explicit about free time (education, health, well-being)

8. Work Load and Related Issues
Many of our surveys reflect moderately dissatisfied residents and fellows.
Stretched too thin for learning
Insufficient feedback
Not provided data about practice habits
Program doesn’t use feedback to improve
Creates vulnerability for accreditation
Care model must be distinct from training model (meet program requirements)

9. Newer Common Program Requirements: July 2019
Almost all requirements are “core”
RRC’s may change, but only where indicated
New Fellowship Common Program Requirements (distinct from Residency Common Program Requirements)
Current One-Year Common Program Requirements discontinued
New Program Director Guide coming soon

10. Oversight Fewer required elements for PLAs
Program must monitor clinical learning environment at all sites
Systematic recruitment of diverse workforce
Access to food, sleep and rest facilities, security and safety measures, and lactation facilities (mirror institutional requirements)

11. Program Director Support
Residency: 20% FTE minimum for program administration
RRC may specify
Fellowship: Adequate for program administration
At least 3 years of educational or admin experience
Qualifications acceptable to RRC

12. Program Director Must be role model of professionalism
Design program c/w community needs and mission of program and institution
Address community needs and health disparities
Evaluate faculty annually
Authority to appoint and remove faculty at all sites
Have authority to remove residents from interactions that do not meet program standards
Provide environment for confidential concerns without retaliation
Verification of training in 30 days

13. Faculty Faculty development annually:
As educators, in QI/PS, fostering well-being, patient care based on PBLI
Core faculty:
Based on role, not hours
Includes CCC and PEC members
Selected based on educational role, not scholarship

14. Program Coordinator
Must be a supported program coordinator in all programs
Program Coordinator is lead administrative person, part of leadership team. Needs professional development
Residency version: 50% FTE
Fellowship version: Adequate (RRC may specify)

15. Competencies Residency:
SBP: residents must learn to advocate for patients in the health care system to achieve goals, including end-of-life goals
Fellowship:
Sub-competencies for professionalism, PBLI, interpersonal and communication skills, and SBP deleted
More focus on advanced patient care and knowledge expertise

16. Scholarship
Focus on scholarship of program as a whole (rather than individual faculty)
Scholarship includes classic fields and also QI/PS initiatives, educational scholarship, innovations in education
Greater flexibility for dissemination of scholarship
Residents: Must participate in scholarship (RRC may specify)
Fellowship: RRC may specify

17. Independent Practice Fellowships
Programs may assign fellows to engage in independent practice of their core specialty during fellowship
Not exceed 20% of time per week, or 10 weeks of academic year. (RRC may specify)
Not clear if we (DOM/UCSF GME), RRC, CMS/CMS Intermediary, or UCSF Compliance will agree.

18. Resident Evaluation
Develop individualized learning plans

19. Program Evaluation
Additional elements required in Annual Program Evaluation
Annual Evaluation must be discussed with residents and faculty and distributed to GMEC

20. Union Issues
UCSF Health has a resident and fellow union as of October 2017
Have had one at SFGH since 1980 (also one at UCI, UCSD, BCHO, Highland)
All fellows are in the unit (ACGME and non-ACGME)
Contract bargaining has begun
Anticipate: fellows must receive same benefits as residents (e.g. housing allowance). Costs will increase

21. Well-Being Concern is widespread: burnout, depression, suicide
Now in program requirements
Now part of Clinical Learning Environment Review (CLER)
One of CIR/SEIU concerns
One of our (Health Systems, SOM, DOM, Divisions) main concerns, too

22. Diversity Considerable effort in residency program and faculty
Less with fellows
Strategies: holistic review, committee composition, revise process until success
Should we also re-think how we select Program Directors?
9/16/2019
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23. Milestones
Review milestones with PEC: determine areas of strength and weakness
Review both language with all faculty and provide faculty development

24. Milestones 2.0 Current milestones: Too many subcompetencies
Language too complex
Specialty variation in ICS, PBLI, PROF, and SBP
144 ways to describe ICS
200 ways to describe PROF

25. Milestones 2.0 Goal: Harmonized milestones for ICS, PBLI, PROF, SBP
Core specialties by
Subspecialties by 2020
New Milestone Implementation Guide by this summer
Faculty development courses in assessment

26. Clinical Learning Environment Review (CLER)
Patient Safety
Health Care Quality (Health Disparities)
Care Transitions
Supervision
Duty Hours/Fatigue Management & Mitigation
Professionalism
First UCSF site visit: December 2-4, 2014
Second UCSF site visit: April 25-27, 2017

27. UCSF Health CLER Findings, 2017
Overall, very positive about clinical and educational culture
Need continued work on MD incident reporting
Need better feedback and dissemination of IR results
Increase participation in RCA’s
Greater engagement of housestaff in QI strategy
More analysis and dissemination of clinical outcomes in vulnerable populations
More standardization of handoffs (all clinicians)
Occasional supervision issues
Better fatigue mitigation
Enhanced EHR professionalism

28. Results of First 300 CLER Visits
Clinical learning environments vary in (are deficient in):
Strategic planning and focus. GME is independent of organizations priorities
Patient safety and quality and engagement of residents and fellows
Faculty development in quality, safety, and systems improvement
Interprofessional coordination of educational resources
JGIM, 2016
9/16/2019
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29. Clinical Learning Environment Review (CLER) 3.0
Patient Safety
Health Care Quality (Health Disparities)
Teaming
Supervision
Well-being
Professionalism
Third UCSF site visit: ? Fall 2018

30. ACGME/UCSF Pursuing Excellence in the Clinical Learning Environment
Clinical and GME leaders from 8 institutions testing innovative approaches to improve clinical learning environments and patient care
CEO, GME Dean, Dean, CMO, CNO, CIO, CQO, Lean team, GME faculty
Four-year grant plus UCSF Health matching funds
“8 to 800”

31. Primary Drivers of Pursuing Excellence
AIM
Integrate health care delivery system and GME such that the clinical learning environment enables measurable improvement in learner experience and patient care.
Align the organization’s strategic priorities and GME strategic priorities.
Establish the processes and practices that fully integrate CLE staff and learners into the pursuit of quality, safety, equity, and value in the organization.
Create qualified, engaged, and motivated educators capable of practicing, teaching, and assessing quality, safety, equity, and value to residents.
Maximize shared learning with coordinated educational resources across health professions.