1. Regions Emergency Medicine Residency May 8, 2009 Felix Ankel, MD

2. History n Accreditation 1995, 1999, 2003, 2009 n 81 graduates 1999-present n 108 residents 1996-present

3. Mission:PAPEEMCE Provide and promote excellence in emergency medicine care and education n Patient centered n Resident focused n Team oriented n Transparency n Professionalism n Knowledge n Skills n Attitudes n Core competencies n Contribution to specialty

4. 81 graduates 1999-present n 50 Minnesota: 11 Regions, 7 Fairview-U, 6 North, 5 EPPA, 5 Abbott, 4 Duluth, 4 United, 3 HealthEast, 2 Waconia, Shakopee, Brainerd, Mayo n 26 out of state (15): SD 4, NE 3, IA 3, CO 2, IN 2, WI 2 ND 2, MS, OR, NH, MT, WA, UT, VA, NY n 12 Academic: 10 Regions, Wishard, Mayo n 15 Hybrid: 7 Fairview-U, 7 North, Mercy-Iowa City n 50 Community n 7 Fellows (2 toxicology, faculty development, critical care, simulation, informatics, ultrasound)

5. 108 residents (1996 - present) 25 medical schools n 37 U of M, n 8 UND n 6 USD, Mayo, MCW, Iowa n 4 Creighton, UW n 2 Nebraska, Loyola, Indiana, Kansas, Chicago Med School, Colorado n SUNY-Buffalo, SLU, Des Moines, Nevada, Vermont, Penn, Hawaii, East Carolina, Arizona, Utah, Michigan State, Albany, VA-COM, UCSF, Dartmouth, Yale, Tufts, Cincinnati

6. 26 Faculty (13 Different EM Residencies) n Regions x 10 n Henry Ford x 2 n Harvard Affiliated x 2 n Illinois x 2 n HCMC n Brooke Army n St Vincent’s n UCSF/Fresno n Christ n New Mexico n Indiana n Boston Medical Center n Grand Rapids n Michigan

7. Rotations (4 weeks blocks) n Year 1: ED 3.7, SICU 1.3, Ortho 1, MICU 1, Cards 1, OB 1, Mpls Kids 1, Anesthesia 1, Plastics 1, EMS 1 n Year 2: ED 7.3, SICU 1.3, Community ED 1, MICU 1, St Paul Kids 1.3, Tox/Adm 1 n Year 3: ED/ St Paul kids 9.7, SICU 1.3, Elective 1, Community ED 1

8. Residency Strategic Plan 2005-2010 4/28/05 n SWOT analysis n Conferences n Simulation n Mentorship n Administrative curriculum n Scholarly activity n Individualization of educational experience n Integration with U of M n Integration with twin city hospitals n National presence

9. 2007-2008 n Conference changes –Move to Thursdays –Increase critical case to 90 minutes –Increase simulation time during conf –Pre-conference sim sessions n Structured ultrasound workshops n Schedule change from teams to sides, 10-hr shifts n Doctors Dahms, Morgan and Taft assume roles as Asst. PDs n Incorporation of Peds-EM faculty (Ortega & Reid) into Residency n Hosting of Ecuadorian EM residents n EM/FM combined residency discussions n E-portfolio application submission to ACGME n Specialized interview days n Resident self-eval on shift cards n Nurse mentorship program

10. 2008-2009 n Community ED rotations EM-2 & EM-3 n Clarification of back-up & pull residents n Ultrasound afternoons during anesthesia rotation n Melding of cardiology & hospitalist rotation

11. Program review 2009 n Residency coordination n Toxicology rotation n Resident support n Residency leadership n Independence n Progressive responsibility n Cardiology rotation n Admin rotation n ED Conference rooms n ED Exam rooms n HCMC rotation n Plastics rotation

12. 2009-2010 n ED-Integrated rotation for EM-1 n Peds Anesthesia week during EM-3 Selective n New ED n Fellowship development (Peds-EM, EMS, International)

13. Future Directions n Less resources for GME n More resources for quality movement n Quality movement based on sustained change in behavior n Education = sustained change in behavior n Change residency from knowledge-based residency to quality residency n More resources for residency n Quality matrix (Bingham, Quinn)

14. The Matrix

15. SAEM Annual Meeting May 22, 2005 New York City, NY

16. Thoughts n Caring for patients vs. treating patients n Complex vs. complicated system n Wisdom of Crowds, James Surowiecki n The Culture Code, Clotaire Rapaille n The Foucault Reader, Paul Rabinow (Ed.) –Enlightenment vs. obedience –Knowledge, power, ethics