june 2008|Vol.1|no.2
From the Desk of the Associate Dean
The Latest on Graduate Medical Education at the School of Medicine
Spring is rapidly progressing into summer and it is a busy time for those working graduate medical education. After having an outstanding match with all of the school’s categorical programs filling, we are preparing for the arrival of our new interns and fellows. This year 15 University of Nevada School of Medicine students will be joining the first year residency classes of several of our programs. There is a lot of excitement in the air.
This is also the time when we transition our graduating residents into the "real world" where they will no longer be limited to working only 80 hours per week, but will draw a "real" paycheck. Among the celebrations, of note is that the Department of Psychiatry in Reno will graduate its first class of child psychiatry fellows. Congratulations to program director Erika Ryst, M.D. and her team, as well as to the fellows for reaching this milestone. Also, congratulations to all of the school’s graduating residents and fellows, may you be successful and find happiness in your chosen career paths.
The inaugural Reno Residents’ Research Day was held on April 23. Seven residents from the internal medicine program and one fellow from the geriatrics program presented 10 abstracts. There were six poster and four platform presentations. We hope to have increased participation from other programs next year. The second annual Las Vegas Residents’ Research Day will be on June 12 in conference rooms E/F on the sixth floor of the 2040 building. Twenty five abstracts have been submitted for both poster and platform sessions. Judges for this year’s programs have been John McDonald, M.D., Ph.D., dean, and David Lupan, Ph.D., senior associate dean for research.
The second annual chief residents’ retreat was held in Las Vegas on April 24. Chief residents from both Las Vegas and Reno participated in the day-long event. The focus of the retreat is for chief residents at the School of Medicine programs to develop leadership skills and begin to network with their fellow chiefs. Featured speakers included Steven Glyman, M.D. and Gwen Shonkwiler, Ph.D.
Between April 3 and June 18, seven of our programs will have or will have completed accreditation site visits from their discipline-specific residency review committees. These programs include internal medicine in both Las Vegas and Reno, psychiatry in Reno, child psychiatry, geriatrics, sports medicine in Las Vegas and plastic surgery. A lot of hours have been spent preparing for these visits. I want to acknowledge the hard work of the program directors, faculty, residents and residency coordinators who contributed to putting together thorough program information forms and assembling documents that described their training programs.
The American Association for the Surgery of Trauma announced on May 8 that their board of managers approved the University of Nevada School of Medicine as a training site for an acute care surgery fellowship. This is the first program in the country to be approved. John Fildes, M.D. will serve as the program director and Tim Browder, M.D. as the associate program director. This program will be two to three years in length with certification in critical care. The optional third year will enable participants to obtain a masters in public health from UNLV. Congratulations to Dr. Fildes and his team--this is a terrific achievement for the school.
As we say good by and good luck to our graduating senior residents, and hello and welcome to our new interns, I hope everyone is able to take some time to reflect on the achievements that have occurred during this academic year. Please provide me with feedback about the newsletter as we go forward as well as information that can be shared with everyone.
Miriam Bar-on, M.D.
Associate Dean for Graduate Medical Education
Designated Institutional Official
From the ACGME
Information from the Accreditation Council for Graduate Medical Education
Program evaluation is a critical part of program accreditation. In 2007 we implemented an annual program evaluation for residents to complete about their programs anonymously to meet some of the requirements. The new common program requirements go further to include confidential anonymous evaluation by faculty and the implementation of a PDSA cycle of quality improvement for the educational offerings to residents.
This coming June we will continue to survey the residents and begin to survey faculty. Program directors will be given this information to use as the basis for their QI assessment of their programs. The ACGME provides the following two commentaries about program evaluation.
Program Evaluation and Improvement: Two Practical Perspectives on a Common Program Requirement: An Explanation of Requirement V. C. "Formal Systematic Evaluation of the Curriculum" 1 Pamela Derstine, Ph.D.
A requirement in the Evaluation Section (V. C.) of the Common Program Requirements specifies a "formal, systematic evaluation of the curriculum" conducted at least annually. To meet this requirement, program directors should lead an ongoing effort to monitor and improve the quality and effectiveness of the program. This evaluation is unrelated to the internal review of the program by the institution's Graduate Medical Education Committee (GMEC), which takes place at the mid-point of the accreditation cycle. However, results of the internal review may become part of the annual program evaluation, and some data from the annual evaluation may be useful to the internal review. Programs should develop approaches to collect the data elements specified in the requirement: resident performance; faculty development; graduate performance; and program quality. To broadly assess program quality, the requirement also directs program directors to solicit confidential evaluations from residents and faculty.
The goal of this requirement is for the program to have an ongoing effort to monitor and improve
the quality and effectiveness of the program. A written plan for program evaluation and improvement will help to assure that a systematic evaluation takes place annually, that results are used to identify what is working well and what needs to be improved, and that improvements are implemented.
More information clarifying this and other Common Program Requirements can be found in the
ACGME’s Program Director Guide to the Common Program Requirements.
1 Adapted from the Program Director Guide to the Common Program Requirements
Strategies for Program Evaluation: Examples from the Field Barbara H. Bush, Ph.D.
Many program directors have acknowledged that addressing program evaluation at the monthly faculty meeting is insufficient. While there may be time for brief updates, the monthly meeting does not allow the program to conduct a "formal, systematic review of the curriculum," as specified in the Common Program Requirements. When site visitors review the minutes of faculty meetings, these rarely reflect discussions on program quality and efforts to improve it.
A growing number of programs are beginning to organize annual half- to full-day program evaluation meetings for key faculty from their major participating sites. Often, several residents or fellows are included in all or some portions of those meetings. Other faculty and residents cover the services to protect the time of the participants. The Common Program Requirements state that, "At a minimum, methods must be developed and implemented for systematically collecting and analyzing data in the following areas: resident performance, faculty development, graduate performance, and program quality."
As such, there must be ongoing data collection in these areas (discussed in more detail in the
Program Evaluation and Improvement Section of the "Program Director Guide to the Common Program Requirements," see above). The goal of the program evaluation meeting is to analyze the results of these data, make assessments and set goals for improvement.
Program directors have discovered some group process approaches that have led to more
productive evaluation meetings. Some examples follow:
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One residency program distributed program evaluation questionnaires to the residents and the faculty, containing common questions about certain aspects of the program, such as the conferences and the residents’ scholarly activity. The goal was to compare the perspectives of each group on these aspects of the program. Each questionnaire also had faculty-specific questions (such as questions about faculty development) or resident-specific questions (such as questions about the adequacy of supervision). The questionnaire data were summarized and presented at the annual evaluation meeting, with other relevant data provided by the program director.
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Another program organized a full-day retreat. During the morning all residents met privately for a structured evaluation discussion, using a list of aspects of the program (such as rotations, continuity clinics and conferences) that had been developed specifically for this purpose. One of the residents recorded the discussion. Concurrently, key faculty met in a similar session, which was recorded by a faculty scribe. In the afternoon both groups meet collectively to summarize their assessments and review additional data provided by the program director.
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One fellowship program paired six key faculty members and six fellows, and assigned each of these dyads a different component of the program for review over a four-week period. For this program, the components being investigated included clinical rotations at three sites (with each dyad responsible for one site), along with clinics, conferences and fellow research. The program director provided each dyad with data relevant to the program component they were asked to evaluate. All participants met for an evaluation meeting, at which each fellow-faculty dyad formally presented its findings to the entire group.
In all three of the above examples, program evaluation meetings were attended by key faculty and some or all of the residents/fellows. The meetings encompassed presentation of information, followed by analysis, problem-solving and the development of an action plan. During their site visits all three programs were able to provide significant documentation that they had completed formal, systematic reviews of the curriculum and had prepared and begun to implement plans to improve their programs.
Best Practices
Las Vegas Family Medicine Practice Management Curriculum: Pharmaceutical Visits in the Clinic
One hundred hours of practice management are required for each family medicine resident by the ACGME. Part of practice management includes discussion with pharmaceutical representatives (pharm reps) including critically evaluating their literature. As part of our practice management program, we will have residents interact with reps with faculty members present to better enhance their ability to critically evaluate product information and thereby become better informed of treatment options.
Goals and Objectives
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To assist resident in critically evaluating pharmaceutical representatives literature and talking points;
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To help fulfill the 100 hours of practice management required for family medicine by the ACGME;
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For residents and faculty to become better informed on drug treatment options by both talking to the reps and researching what is being said.
Measures
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Faculty will assess what residents have learned previously by observing them at future interactions;
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For each encounter the resident will fill out a mandatory pharm rep interaction form. This will be used to document how often a resident has met with reps, document practice management time and to evaluate what the resident has learned from the encounter.
Curriculum
Lecture
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At the beginning of every academic year, Thomas Hunt, M.D., presents a one hour lecture to all family medicine residents on how to critically evaluate the messages and literature given by pharm reps. He also uses published evidence to show residents what impact pharm reps and their dinners, pens, gimmicks, trips, conferences, etc.--have on physician writing prescription medications.
Pharm Rep Interaction
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Pharm reps may make appointments with the residency coordinator to meet with faculty at a maximum of two times per month during their administrative time. These visits will be approximately 15 minutes in length, at which time the rep will be allowed to discuss their products. Residents not seeing patients will attend these sessions. There must always be at least one faculty member present at all times. It is the responsibility of the faculty member to attend these sessions, encourage resident participation, and to help the residents critically evaluate the information being discussed. Pharm reps must never be left alone with residents.
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Each resident will have the opportunity to participate in these discussions at least three times per year. This will be assured by having the residency coordinator keeping track of which residents have attended, and scheduling the reps during times that residents, who have not had the opportunity to attend, will be present.
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Evaluation: at the completion of each session, the faculty member will review what was discussed with residents in attendance. Residents will fill out the pharm rep interaction form, which will be reviewed by the faculty member present and will then be placed in the residents file by the residency coordinator.
For additional information about this best practice, contact Aron Rogers, D.O.
GME Notes
Residents play soccer
For those who like to play soccer, Harinder Singh, M.D., one of the internal medicine chief residents, has arranged weekly (sometimes twice weekly) tournaments between interested residents (all departments) and faculty since January 2008. On average 10–12 residents play on two teams of 5–6 members. Soccer balls are provided by the internal medicine residents.
Tournaments are usually Saturday or Sunday at 5:30 p.m., the day decided in advance and played at the soccer field between Desert Inn and Spring Mountain Roads at Durango. Games last between 2.5–3 hours. This location is subject to availability and field conditions. All are welcome and invited to participate. For more information, contact Dr. Singh.
Current players include Ahmad Noman, Alireza Farabishahadel, Chima Osuoha, Cuong Nguyen, Deepak Wahi, Devinder Kumar, Ermias Gebre, Harinder Singh, Hesham Mohamed, Joaquim Tavares (ICU attending), Joseph El Youssef, Kartik Shetty, Martin Gallacher (RAT team), Naveen Gande, Prabhjot Dhanju, Rajendra Narla (ER), Reza Mojtabavi, Sujay Patel and Yuri Reznik (FM).
Residents present research at national and international meetings
Psychiatry, Las Vegas
Co Morbidity of Pathological Gambling with Other Psychiatric Disorders in Two Las Vegas Hospitals. Z Hafeez, C Kalinowski. Zeba Hafeez, M.D. and her mentors presented at an issue workshop on pathological gambling at the American Psychiatric Association in Washington, D.C.
Mind mapping software in resident training. T Goodson, B Goodson, GP Brown. Presented in a session on innovative use of technology in teaching residents at the Association of Directors of Psychiatry Residency Training meeting in New Orleans. Tina Goodson, M.D. and Bradley Goodson, M.D. along with Gregory Brown, M.D. reprised this presentation at interdisciplinary grand rounds in May.
Pediatrics
Feasibility and acceptability of routine human immunodeficiency screening: experience in an urban outpatient setting. O. Ekeh, A. Palacoc, D. Hemrajani, K. Kornswad, N. Gande, A. Norman, J. Lising, S. Satya, C. Nguyen, E. Ellis, J. Butt, A. Greenberg, R. Reich, E. Ezeanoule. Obe Ekeh, M.D. presented her work as a poster at the Pediatric Academic Societies Meeting in Honolulu.
Impact of an integrated maternal-child HIV program on outcome among infants perinatally exposed to HIV in Nevada: 2005-2007. Echezona E. Ezeanolue, Salome Kapella, Kanayo Ezeanolue, Ineada Jack, Uzma Farmanali, Joyce Dobard, Lorraine Noonan. This work was presented at a poster session on HIV disease in infants at the Pediatric Academic Societies Meeting in Hololulu.
Obstetrics and Gynecology
Asymptomatic Colonization by Methicillin Resistant Staphylococcus Aureus (MRSA) in Pregnancy May Lead to Serious Systemic Infection Postpartum. P Stumpf. M Zhou. This work was presented at the American College of Obstetricians and Gynecologists 2007 District III Annual Meeting in Santo Domingo, Dominican Republic.
The Use of Radiofrequency Ablation in Advanced Ovarian Cancer: Resection and Ablation of Liver Metastases. A Fleury. Aimee Fleury, M.D. presented her work at Charles University in Prague, Czech Republic.
Case Report: Consecutive declining hCG titers indicating loss of one sac in an otherwise viable early triplet pregnancy. M Zhou. Ming Zhou, M.D. presented at the 56th Annual Meeting of the Pacific Coast Reproductive Society in Rancho Mirage, California.
Perinatal outcomes in IVF patients with vanishing twin syndrome. M Zhou. Dr. Zhou will present her work at the International Society for Prenatal Diagnosis 14th International Conference in Vancouver in June.
Internal Medicine
Harinder Singh, M.D., chief resident in internal medicine, Las Vegas, gave a platform presentation on his study Vitamin D deficiency in patients with osteoporosis at the American Association of Clinical Endocrinologists 17th annual meeting in Orlando. Sathish Karmegan, a PGY1 in internal medicine, Las Vegas, was a co-author.
Naveen Gande, M.D., internal medicine, Las Vegas resident, presented his study Routine HIV screening in outpatient setting: is it feasible and acceptable at the American College of Physicians annual meeting in Washington, D.C. Co-authors included Jennifer Lising, M.D., Cuong Nguyen, M.D., and Sowmya Satya, M.D., all from the Department of Internal Medicine, Las Vegas.
Tatyana Reznik, M.D., internal medicine, Reno resident, presented her clinical vignette From encephalitis to fractures as part of the national resident competition at the American College of Physicians annual meeting in Washington, D. C.
In the Spotlight
Special distinctions
Six medical residents were recognized with the Humanism and Excellence in Teaching Awards from the Arnold P. Gold Foundation. These awardees include Julian Almeyda-Perez, M.D., internal medicine resident in Las Vegas; Richard Baynosa, M.D., plastic surgery resident in Las Vegas; Parker Fillmore, M.D., general surgery resident in Las Vegas; Brion Hill, M.D. and Noah Niufar, M.D., family medicine residents in Reno; and Shawn Rowles, M.D., pediatrics resident in Las Vegas.
Christian Kauffman, M.D., plastic surgery resident, was selected by the Class of 2008 to receive the outstanding resident award, Las Vegas.
Brion Hill, M.D., family medicine resident was selected by the Class of 2008 to receive the outstanding resident award, Reno.
Three graduating Las Vegas internal medicine residents will be pursuing fellowship training beginning in July. They include Prabjot Dhanju, M.D., The Kidney Institute, University of Kansas, nephrology; Joseph El Youssef, M.D., Oregon Health Sciences University, endocrinology; Cuong Nguyen, M.D., University of Utah, nephrology.
Joseph El Yousef, M.D., chief resident in internal medicine, Las Vegas, has been teaching a Microsoft Excel course for faculty, program directors and residency coordinators. Many thanks for this great opportunity.
The E.W. Richardson Excellence in Teaching Award was presented to Mark Broadhead, M.D., psychiatry program director, Reno, by Dean McDonald at the student and faculty awards ceremony in May.
Junior Faculty Issues, Junior Faculty Luncheon at the Society for Adolescent Medicine: R. Pasternak, M. Catallozzi, P. Kaul, C. Barangan. Society of Adolescent Medicine Annual Meeting, Greensboro, North Carolina. Caroline Barangan, M.D. is associate program director for pediatrics.
Changing the culture: Using interactive small groups to teach professionalism. C. Schenauer, C. Barangan. Presented as a workshop at the Association of Pediatric Program Directors annual meeting in Honolulu. Cynthia Schenauer, M.D. is director of hospitalist medicine for pediatrics.
Timothy Browder, M.D., was awarded an American Association for the Surgery of Trauma Research and Education Foundation Scholarship. To quote John Fildes, M.D., “This is a very big deal in the trauma world.” Dr. Browder is associate program director of the new acute care surgery fellowship.
Ross Berkeley, M.D. was named associate program director for emergency medicine. Prior to his naming, he was a member of the core emergency medicine faculty specializing in quality improvement.
Elissa J. Palmer, M.D. and her department offered the first Advanced Life Support in Obstetrics course in Nevada. The program was supported by a trust fund grant. Dr. Palmer is program director for the family medicine/obstetrics fellowship in Las Vegas and the rural residency program in Fallon.
Congratulations to Carol Allen, residency coordinator for obstetrics and gynecology, who has become TAGME certified (C-TAGME). She joins Tami Abu Hantash, C-TAGME as the other certified coordinator at the School of Medicine.
A warm welcome to Alison Netski, M.D. to the psychiatry department where she will serve as associate residency program director. Sandhya Wahi, MD., joins the Department of Internal Medicine as residency program director. Since starting she has made many changes and survived a residency review committee site visit for accreditation. Jennifer Michalski, joins the Department of Emergency Medicine as the new program coordinator. She comes from Buffalo where she had previous coordinator experience. Please welcome them all to the School of Medicine.
In This Edition
From the Desk of the Associate Dean
The Latest on Graduate Medical Education at the School of Medicine
From the ACGME
Information from the Accreditation Council for Graduate Medical Education
Best Practices
Las Vegas Family Medicine Practice Management Curriculum: Pharmaceutical Visits in the Clinic
GME Notes
Residents present at national and international meetings
In the Spotlight
Past Issues
GMEmail is a service of the Office of Health Science Communication, University of Nevada School of Medicine. Miriam Bar-on, M.D., Editor, Office of Graduate Medical Education. Copyright 2008 University of Nevada School of Medicine.