september 2008|Vol.1|no.3
From the Desk of the Associate Dean
The Latest on Graduate Medical Education at the School of Medicine
It is hard to believe that summer is almost over especially since in Las Vegas the temperatures still exceeds 100 degrees. At the beginning of the summer we welcomed 98 interns and fellows to the School of Medicine residency programs on both campuses. Orientation was filled with lots of required information to facilitate working at our partner institutions. However, for the Las Vegas residents and fellows, we introduced a workshop on professionalism presented by Melissa Piasecki, M.D., associate dean for faculty affairs and development. The workshop was interactive and well received. Evaluations from the workshop were almost uniformly excellent.
In addition to having new interns, we saw the advancement of the rest of the residents and fellows to new roles and positions of increased responsibility. In my travels around the hospital and in serving as inpatient attending, it appears that everyone is rising to the occasion and assuming their new roles seamlessly. I am delighted to see these changes and proud of your accomplishments.
I also have some very exciting news to share. For the residents in programs where boards are offered the final week of training, results have been streaming in. All of the OB/GYN graduates passed their written boards. For psychiatry– In Reno there was 100 percent pass (including the child psychiatry fellows) and in Las Vegas 75 percent. Also, the Las Vegas program has its first fully boarded psychiatrist graduate– who passed the oral part of the boards in May. For general surgery, all of the folks we have heard from so far have passed their boards. Congratulations to program directors Jon Hazen, M.D., John Fildes, M.D., Greg Brown, M.D., and Mark Broadhead, M.D.
In the last issue, I mentioned that we had seven ACGME residency review site visits. After the last site visitor left, I breathed a sigh of relief and thought we would be good for a while. That thought was short lived as we received notification just after she left that Family Medicine and Surgical Critical Care would be visited in mid-October. These two programs are actively putting together their documentation to prepare for their visits. We will also be visited in 2009 for at least two to three other programs.
This August also saw the first assembly of the University of Nevada, Reno Division of Health Sciences. This gathering began with talks by former School of Medicine dean, now vice president of health sciences, John McDonald, M.D., Ph.D., Provost Marc Johnson and Regent Dorothy Gallagher. Dr. McDonald spoke of his goals for the division and the opportunity for collaboration amongst everyone involved in the various aspects of healthcare. The School of Medicine was featured prominently with three posters, one devoted exclusively to graduate medical education (GME).
One of the goals of the School of Medicine is to expand our GME programs. I am pleased to announce that we have started a fellowship in hospice and palliative medicine. This fellowship is headquartered at the Reno VA hospital under the leadership of Neila Shumaker, M.D. She will work collaboratively with Diane Chau, M.D., the fellowship director of our geriatrics program. The two programs will complement each other. In June we submitted an application for this fellowship to become accredited. Review of our application will occur in January 2009. Our first fellow will begin her training in September following the completion of her geriatrics fellowship. Individuals who complete these fellowships are eligible to receive certificates of added qualification (CAQ) following board passage. Congratulations to the Department of Internal Medicine and the Division of Geriatrics for moving us forward.
Along the lines of expansion of GME, I have been tasked by the dean, Ole Thienhaus, M.D. and the executive vice chancellor for the Nevada System of Higher Education, Maurizio Trevisan, M.D., to formulate the school’s strategic plan. Toward that goal, I have been meeting with department chairs to hear about everyone’s goals. As we move forward with this plan, I will share it with you and seek your feedback.
Best to all for a great academic year,
m
Miriam Bar-on, M.D.
Associate Dean for Graduate Medical Education
Designated Institutional Official
From the ACGME
Systems-Based Practice Metric: An Objective Measure of the Village
Ginger Boyle, M.D., Robert McDonald, M.D., Anthony Geraci, M.D.
Systems-based practice (SBP) has been compared to the saying "It takes a village to raise a child." For this ACGME competency "it takes the residency program, hospital system and community to train a resident." ACGME standards for SBP state "residents are expected to work effectively in various health care delivery settings and systems, coordinate patient care within the health care system, incorporate considerations of cost-containment and risk-benefit analysis in patient care, advocate for quality patient care and optimal patient care systems, and work in inter-professional teams to enhance patient safety and care quality."
At the Spartanburg Family Medicine Residency Program in Spartanburg, South Carolina, one of the tools we have developed to evaluate and measure this competency is the "Systems-Based Practice Metric." This metric documents nine elements of SBP encountered throughout the three year residency training and the accumulated points for completion of each. Borrowing from the previously published work of Palermo we developed this scorecard method of tracking and thus evaluating our residents’ progress in SBP.1
The metric was developed initially as part of our program’s efforts to create a longitudinal SBP curriculum. Key elements of this curriculum were identified and prioritized during one of our semi-annual faculty retreats. The guidelines for completing each task were broken down by post-graduate year; relative weights were assigned to each task and minimum requirements and benchmark goals were set (Table 1).
Four times each year (July, October, January and April), our residents meet with their advisors. Documentation of the residents’ status with each element is provided by our program coordinator, associate program director’s assistant, and coordinator of the practice management rotation. Advisors complete the metric by tabulating the scores based on the relative weight of each element. The resident and their advisor discuss the score during the quarterly evaluation. Educational guidelines for completion of delinquent elements are set and monitored over the next quarter.
The scores are tallied during the April evaluation, and incorporated into both the annual performance review with the program director in May and the program’s annual competency retreat that follows. If a resident’s score falls below the benchmark for the year the resident must discuss this with the program director and it is included in their yearend letter. Residents whose scores remain below the benchmark at the end of three years are told they will receive a rating of unsatisfactory in SBP on the final verification of training form. The implications of this on eligibility to sit for the ABFP board certification examination are also discussed.
Since implementation of this tool, we have received feedback from both metric users and residents to improve the metric. These changes included moving one of the tools to the Practice-based Learning and Improvement advancement form and replacing another with an assessment of each resident’s coding audit, performed on outpatient continuity clinic visits. At least half of our systems-based practice curriculum occurs during the PMG rotation. Creating a longitudinal SBP curriculum expands the importance of this competency beyond the basic requirements for practice management education. This metric provides the program with objective criteria and scores for evaluating one of the more complex and subjective ACGME competencies throughout each resident’s training.
1 Palermo, Jefri, MA. Evaluating Professionalism and Practice-Based Learning and Improvement: An Example from the Field. ACGME Bulletin, December 2006:1–3.
Best Practices
Injecting Research into the Curriculum
Jack Lazerson, M.D., Pediatric Program Director; Echezona Ezeanolue, M.D., Scholarly Activity and Research Leadership Director
In 2005 the department’s residency program introduced a formal structured scholarly/research activity program in order to enhance the residents’ educational curriculum and comply with the ACGME Pediatric RRC recommendations that:
- the curriculum must advance residents' knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care;
- residents should participate in scholarly activity;
- the sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activity.
To this end
- once a month, a noon seminar is devoted to teaching research methodology, and the process of conducting research;
- individual residents are interviewed to delineate their specific areas of interest including detailing the availability of faculty scholarly and research interests;
- visiting professorship program throughout the year illustrates translational research;
- resident presentations at journal club, local and national meetings;
- the availability of a one month research elective.
Introduction
At the beginning of the academic year, at a noon conference, the faculty research leader introduces all first year residents to this program with a through description of its components. Individual meetings, with the program director, are then scheduled to discuss career plans, including scholarly activity.
Seminars
The seminar series includes the following topics: designing research projects, use of statistics, medical writing, presentation and manuscript preparation and submission, analytic methods in evaluating research, use of evidence based medicine methodology, identifying funding sources, literature searching, etc.
Process
- Step 1 At the beginning of the academic year, the program director meets, as a group, with all incoming residents in order to provide an overview of the scholarly activity/research program and its relevance to pediatric residency training;
- Step 2 The faculty leader responsible for the scholarly activity/research program describes in detail the goals and objectives and methodology for achieving competency in this area;
- Step 3 Department faculty projects and interests are presented and contact information is provided to those residents interested in specific areas;
- Step 4 All residents are asked to meet with the residency program director to discuss their career plans as well as to consider the scholarly activity/research program for enhancing their education and ultimately their career;
- Step 5 Once the resident has selected a mentor and faculty for their project a schedule is established to monitor the research/scholarly activity;
- Step 6 After the activity or study has been completed, the faculty leader will continue to monitor the resident’s preparation of presentations and publications, assisting where needed.
The key to the success of this program has been the commitment of one faculty leader along with the support of the program director to assume responsibility for formalizing the program from its initial inception through completion of the projects. Analysis of the quality and quantity of completed projects and report of these data to the department is another significant responsibility of the program leader.
Results
Using the above methodology, here are the results of the program’s efforts (Table 1). The publications include abstracts and the presentations include oral and poster at regional or national meetings. For additional information, contact Dr. Jack Lazerson.
GME Notes
First Graduating Classes
This year two of our new training programs saw the graduation of their first trainees. In Reno, our child psychiatry fellowship graduated Dana Arlien, M.D. who will be starting at Willow Springs Center one of the sites training sites for our fellowship program. In her new position, she will be developing their new intensive outpatient program. The other graduate, Andrea Sorensen, M.D, after taking some time off will be getting involved in a brand new multidisciplinary clinic for children with fetal alcohol syndrome. This program is under the direction of Erika Ryst, M.D.
In Las Vegas, Peter Letourneau, M.D. was the first graduate of the plastic surgery program. He has gone on to pursue a fellowship in microvascular reconstructive surgery at the University of Pittsburgh Medical Center in Pennsylvania. William Zamboni, M.D. is the program director of this residency, as well as chair of the Department of Surgery.
Congratulations to these groundbreaking trainees and the faculty who helped them achieve these accomplishments.
New Initiatives
With the development of several fellowship programs in Reno, there is now a critical mass to have a combined research seminar series to help meet the research requirements of all the programs. A new collaborative research seminar between child psychiatry, sports medicine, geriatrics, hospice and palliative care and family medicine obstetrics will begin with the new academic year. This model has been used nationally to not only provide everyone with their necessary classes, but also to facilitate interaction and cross pollination amongst the disciplines. With the integration of the School of Medicine into the Division of Health Sciences, many additional potential resources are available to enrich this initiative.
In Las Vegas the Department of Obstetrics and Gynecology has initiated a required research rotation for the first and second year residents. This rotation will focus on research basics such as study design, statistics, data gathering and analysis, as well as development of abstracts and manuscript preparation. Residents will have the opportunity to participate in this research boot-camp in Reno or Las Vegas or both. This program is being supported by Iain Buxton, Pharm.D. and David Lupan, Ph.D. in Reno and Paul Stumpf, M.D. and Rajeev Gala, M.D. in Las Vegas. It is anticipated that this program will have a positive impact on the scholarly productivity of the OB/GYN residents.
The Department of Obstetrics and Gynecology has also developed a visiting professor program for their residents and faculty. Nationally known speakers in women’s health have been engaged to provide grand rounds formated talks followed by a question and answer session. These sessions are open to all departments and usually occur on the third Friday morning of the month. Additional information can be obtained from Carol Allen, residency coordinator.
In the Spotlight
Special distinctions
Congratulations to Catherine McCarthy, M.D., associate program director in the family medicine department in Reno, on the birth of her son. Mother and baby are doing well.
Congratulations to Richard Williams, M.D., program director in the family medicine department in Reno, on the birth of his daughter. Mother, father and big brother are doing well.
Winners of the Las Vegas Resident Research Day Competition were:
- First Place, Clinical Science: Ming Zhou, M.D.– Perinatal outcomes in IVF patients with vanishing twin syndrome;
- Second Place, Clinical Science: Naveen Gande, M.D. and Obi Ekeh, M.D.– Routine HIV screening in outpatient setting: Is it feasible and acceptable?;
- First Place, Basic Science: Michael Benassi, M.D.– Comparison of a new fluid warming devise to existing military devices;
- First Place, Poster: Naveen Gande, M.D.– Successful treatment of severe refractory lupus with rituximab;
- Second Place, Poster: Benjamin Cousins, M.D.– Reevaluating the role of invasive biopsy for the diagnosis of systemic necrotizing vasculitis: Is the benefit worth the costs?;
- Third Place, Poster: Aditi Singh, M.D.– Fever of unknown origin and Castleman’s disease
Welcome to Larry Nussbaum, M.D. who joined the Department of Psychiatry as chief of the Division of Child Psychiatry in Reno. He has been an active member of the clinical faculty in the child psychiatry fellowship prior to joining the department full time.
Welcome to Jodi Greene, the new internal medicine residency coordinator. Ms. Greene is not new to the School of Medicine as she served as residency coordinator for the family medicine department.
In This Edition
From the Desk of the Associate Dean
The Latest on Graduate Medical Education at the School of Medicine
From the ACGME
Systems-Based Practice Metric: An Objective Measure of the Village
Best Practices
Injecting Research into the Curriculum
GME Notes
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.