Practical Info for New TYPDs or TYPD 101

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Practical Info for New TYPDs or TYPD 101!

• Cathy Nace, MD
• CTYPD Annual Meeting
• 18 Apr 2009

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Introduction

• The Language Acronyms and Terminology
• Where to start? First things first
• Whats next?
• Where to get help?
• Site visit coming up?
• Words of wisdom?

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The Challenges

• 1 yr program
• Tough to make progress on competencies
• Challenging to do outcomes after a short time
• Interface with multiple programs/people
• Dont see residents on a daily basis
• Communication issues and barriers
• Faculty
• Residents

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Acronyms and Terms

• Basic lingo
• ACGME
• Accreditation Council for Grad Med Ed
• GMEC
• Graduate Med Ed Committee
• At your own institution
• DIO/DME
• Designated Institutional Official/Dir Med Ed

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Acronyms and Terms

• TYEC Transitional Year Education Committee
• TYRC Transitional Year Review Committee
• Trans Yr RRC
• TYPD Transitional Year Program Director
• WebADS
• ACGME web-based data system

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Acronyms and Terms

• Internal Review
• Program site visit done by institution
  (internal)
• Institutional Review
• ACGME Review of sponsoring institution
• ERAS Electronic Residency Application Service
• For 4th yr students to apply to internships
• Under AAMC

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Acronyms and Terms

• FCS Fundamental Clinical Skills
• Required areas for TY residents
• EmerMd, FamMd, IntMd, ObGyn, Ped, (Gen)Surg
• PIF Program Information Form
• Forms for review for accreditation
• Completed for submission to TYRC and site visitor
• Available on ACGME web site

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First Things First

• Notify the ACGME of new PD
• Letter (through GMEC/DIO)
• Your address, e-mail, phone, CV
• Know whos who in ACGME
• Linda Thorsen, Exec Director, TYRC
• Stephen Moore, Accred Administrator, TYRC
• ACGME Website
• Home page check out latest scoop
• Click Review Committees on the left, drop down
  to Transitional Year (at the bottom)

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First Things First

• Define your job/role
• Discuss with previous PD
• Look at program requirements
• Look at the Institution handbook, talk with DIO
• Ensure adequate time allocation
• Consider 20 hrs/week
• Look at administrative support
• Is there a dedicated administrator?

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• You dont know how much authority you have until
  you exceed it then, they will tell you

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First Things First

• Meet with DME/DIO
• Establish rapport
• Learn organizational structure
• Institutional handbook/policies
• GMEC meetings
• Institutional support
• Time
• Budget
• Admin

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First Things First

• What to review and study
• Program Requirements!
• Include common requirements
• Institutional Requirements
• PIF (Program Information Form)
• ACGME website
• Review Committees - TY
• FAQs

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First Things First

• Critical Documents
• Latest program accreditation letter
• Latest institutional accreditation letter
• Last internal review document
• MOUs/LOAs with other facilities/institutions
• ?need updating (every 5 years at least)
• Resident contracts
• ?cover all appropriate areas

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First Things First

• Other documents to review
• Program handbook (?needs updating)
• Institutional handbook
• GME Directory Green Book
• Last years annual program evaluation
• Goals and objectives for rotations
• Updating ?

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Whats Next?

• Other items for review
• Last years rotation and program evaluations
• Time lines
• When is next internal review or site visit
• Objective look at the program
• Work environment
• Call rooms, resident comfort, areas to improve
• Scholarly activity
• Faculty CVs, resident involvement in SA

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Whats Next?

• Meetings
• TYEC at least quarterly (by academic yr)
• GMEC per your institution
• TY Resident
• Group meetings - ?monthly
• TY Resident
• Individual meetings at least 3x/yr

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TYEC

• Transitional Year Education Committee
• Freestanding vs subcommittee of GMEC
• Membership
• TYPD (?chair)
• PD/reps of required rotations
• PD/reps of sponsoring programs
• Reps from specialties regularly included (esp ER)
• Resident member (TY resident)
• CEO or designee (cannot be TYPD)

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TYEC

• 7 critical areas of responsibility
• Ensure adequate resources for curriculum
• Ensure residents educated in high-quality medical
  care, EBM, by qualified educators
• Ensure equivalent educational opportunities as
  categoricals
• Review TYR evals and their evals of rotations and
  faculty 2x/yr

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TYEC

• 10 areas (cont)
• Review curriculum each year
• Maintain record of attendance at TYEC and actions
  taken (minutes) responsibilities of TYEC
  reviewed at least 1X/yr
• Review ACGME letters to sponsor programs and
  monitor areas of noncompliance

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TYEC - Hints

• Keep accurate minutes
• Put member attendance into minutes
• Identify members by specialty, role in TYEC
• Regular attendance by members?
• Review old minutes for compliance with 7
  responsibilities
• Can annotate 7 responsibilities in margins or
  note in the minutes
• Meet at least quarterly

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Internal Review

• Follow institutional policies
• Know approximate date to be done
• Keep track in TYEC
• Have all (most) residents available
• Have adequate number faculty available
• Consider all TYEC members
• Get honest, constructive critique
• Report not visible to site visitor, but

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Competencies

• Know these!
• Make sure residents know these!
• How are you addressing them?
• Goals and objectives in appropriate format?
• Evaluations and feedback
• Competency based
• 360,mini-CEX, OSCE
• Consider workshop/small groups

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Curriculum

• FCS Fundamental Clinical Skills
• EmerMd, FamMd, IntMd, ObGyn, Ped, (Gen)Surg
• 24 weeks
• Emergency Medicine
• 140 hours
• Didactics can be a challenge

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Curriculum

• Ambulatory Care
• 140 hours
• Fam Med, Int Med, ObGyn, Peds, (Gen)Surg
• Electives
• At least 8 weeks
• Consider 3 blocks/months to cover for vacation
  time

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Goals and Objectives

• Competency format
• Make sure they exist for each rotation
• Update annually
• Accessibility to resident to review prior to
  rotation?
• Handbook/CD-Rom
• Web-site

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Evaluations Resident

• Competency based
• For each/every rotation
• Consider web-based
• Availability for resident review
• Forward evals to specialty PD at least twice/yr
  (4X/yr for anesthesia)

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Evaluations Resident

• Final Evaluation
• Review of performance in last several months
• Completion of requirements
• Professional ability

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Evaluations Faculty and Program

• Annually of faculty
• Consider eval by rotation
• Must be confidential
• Annual program evaluation
• By residents
• Confidential and in writing
• By ICC/faculty
• Review of GO, and effectiveness
• Outcome assessment
• USMLE
• f/u from residency PDs

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Conferences

• Expected attendance
• Percentage for residents to attend?
• MM, Journal Club, Ethics, etc
• Documentation of attendance
• Pen/paper
• Web-based
• Computerized system ie card swipe

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Duty Hours

• Know requirements!
• How is information provided and stressed to
  residents
• No exceptions for TY residents
• Documentation of hours worked
• Pen/paper
• Web-based
• ACGME Resident Survey

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Duty Hours (cont)

• Sleep and fatigue education
• Institutional/orientation education
• Life curriculum
• www.lifecurriculum.info
• CD-Roms with educational discussion
• Free to a PD
• Burnout, impairment, stress and depression,
  disruptive behavior
• Provider Health Committee awareness
• Patient Safety education

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Due Process

• Check institutional procedures
• Due process
• Grievance procedures for residents
• Resident awareness of policies and procedures
• Discuss at orientation/handbook

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Handbook Considerations

• Review and revise
• Hard copy vs internet/web-based
• Requirements/expectations
• Goals and objectives for each/every rotation
• Vacation/absence policies
• Duty hour policies
• Due process/grievance procedures

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Handbook Considerations

• Resident supervision
• Evaluation process
• On resident
• By resident
• Electives/research policies
• Ethics education
• Stress management/resources
• Sleep/fatigue information

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Handbook Considerations

• Professionalism
• Expectations
• Consequences
• Other hospital policies
• Restraints
• Documentation/annual training requirements
• Needed phone numbers/Points of contact
• Have resident sign a receipt for handbook!

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Resident Files

• Evaluations
• Communications
• Email
• Other feedback from students, faculty, peers
• Conference attendance documentation
• Letters of recommendation
• Other accomplishments
• Consider separate portfolios

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Other Issues

• USMLE/COMLEX
• Licensure
• Other resident responsibilities
• Institution specific
• Communication with future program director
• Moonlighting usually not an issue with TYRs

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Problem Residents

• Its not the mountain that wears you out, its
  the grain of sand in your shoe!
• No question, this can be a challenge, but is
  ALWAYS a learning experience!

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Problem Residents

• Early ID and documentation critical
• Counseling and remediation plan
• Stress management
• Academic remediation
• Involve DME/DIO for questions
• Probation as necessary
• Awareness of physician health committee

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Later Considerations

• Marketing your program
• Web site
• On-line purple book
• Recruiting
• Personal PD development
• Goals
• Attend appropriate CME meetings

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Where to get help?

• ACGME Website
• ACGME newsletters and e-mails
• Take a look at least
• TYRC Staff
• Ms. Linda Thorsen, Exec Dir
• CTYPD
• Bulletin Board ask questions
• Network at meetings

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When to contact ACGME?

• Request for change in resident number
• Permanent or temporary
• PD change
• Change in accreditation status of sponsoring
  program
• Change in sponsoring program

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When to contact ACGME?

• Addition or deletion of major participating
  institution
• Other major change in the program
• Other questions for Linda
• Questions on accreditation letter

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Prep for the Site Visit

• The things you do today that you dont have to
  do will determine who, what, and where you are
  when it is too late to do anything about what you
  should have done.
• Helen Keller

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Site Visit Pointers

• Start preparing early
• Its an open book test!
• Allocate adequate time to prepare
• Make a to-do list
• Look at your last ACGME letter

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Site Visit Pointers

• Ask questions/network if problems arise
• Know the requirements!
• Know your PIF!
• Plan to attend preparatory meetings
• ACGME annual workshop (early March)
• AHME/CTYPD

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Sage Advice

• Talk with other program directors
• No need to reinvent the wheel!
• Stay involved in your GMEC
• Keep up with work/meetings/files
• Prepare ahead of time for site visit
• Know the requirements!

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The Rewards

• Significant impact if only for 1 year
• Great introduction to medical education
• Good for long-term involvement
• Not quite as intense as 3 yr program
• Opens doors in medical education field
• Great meetings!
• FUN!