Professionalism and Redefining the Role of the Program Coordinator

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Professionalism andRe-defining the Role of the
Program Coordinator
UCSF Program Coordinators Quarterly Meeting

• Ruth H. Nawotniak MS, C-TAGME
• UB SUNY General Surgery Program Coordinator
• August 24, 2007

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Perception and Reality
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How is the Coordinator Seen By Others?
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Who are those Others?

• Program Directors
• Department Chairs
• Residents
• Attendings
• Department Staff

• GME Office Personnel
• ACGME

• Medical Students
• Hospital Staff

• Peers

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The Perception of Others
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How does the Coordinator See Him/Herself?
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Perception of Self

• Wonder Woman/Superman
• Always the
• Go to person
• One having to meet multiple deadlines
• Protector of the program, program director,
  faculty, and residents from the bad guy
  whomever that may be at any given moment
• One having to solve constant space problems
• Usually the glue
• Never has enough time and often not enough staff
• Often performs magic

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Perception of Self

• Intelligent
• Capable
• Skilled
• Flexible
• Enthusiastic
• Informed

• Accountable
• Take Charge
• Advocate
• Leader
• Team Player

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F lexible A dvocate C apable I
ntelligent L eader I nformed T eam
Player A ccountable T akes
Charge E nthusiastic S killed
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Where does the perception of Othersand the
perception of Self meet?
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Traditional Role of the Coordinator

• Den mother (father)
• Cheerleader
• Liaison between residents and the program
  director
• Contact between faculty and program director

• Data entry person
• Information resource
• Social/event planner
• Scheduler
• Support staff

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To the Resident

• The coordinator is
• den parent
• counselor
• liaison between them and the PD
• human resource person
• information resource
• cheerleader
• social event planner
• file manager

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To the Program Director

• The coordinator is
• support staff
• file manager
• scheduler
• social and event planner
• data entry person
• liasion between them and the residents and the
  faculty

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• In the traditional perception of the role, what
  was often not acknowledged was that the
  coordinator is counselor, advocate, resource and
  advisor to both.

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The Reality of the Role
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Support graduate medical education andthe
efforts and duties of our program director
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What did the ACGME Outcome Project do in regards
to managing training programs?
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• For the Program Director
• Changed expectations
• Increased
• the scope and depth of the function of the
  program director
• responsibility for the development of program and
  curriculum to meet accreditation standards,
  requiring substantial time, effort, and
  commitment
• expertise in medical education and adult learning
  processes and concepts

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• For the Program Coordinator
• Increased the scope and depth of the function of
  the program coordinator
• Resulted in a change in expectations
• Established the importance of the administrative
  management of the training program the
  coordinator
• Required
• a higher level of skills, ability and knowledge
  that elevated the position from
  clerical/secretarial to manager/administrator
• a closer working relationship with the PD

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• For the GME Administrator/Staff Person
• Resulted in a change in expectations
• Increased
• the scope and depth of the oversight
  responsibilities to meet accreditation standards
• expertise in medical education and knowledge of
  adult learning processes and concepts
• Resulted in a change in the institutional site
  visit process

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Expanded Role of the Coordinator

• Liaison between residents and the program
  director
• Liaison between faculty and program director
  (Contact)
• Manager/Administrator (Staff Support)
• Data Analyst for Program Improvement(Data Entry)

• Information Resource for Requirements for all
  Regulatory Agencies
• Monitor Track Duty Hours/Competencies
  (Scheduler)
• Human Resources medical/legal issues
• Arbitrator

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• Tasks of a Manager/Administrator
• Manage and coordinate the crucial interview
  season pre-screen applicants we are often the
  face of the program
• Monitor and document evaluation processes
• Manage process for adverse evaluations and
  potential subsequent actions
• Understand accreditation, board, and institution
  requirements, including state and federal
  regulations
• Manage resident activities and schedules

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• Tasks of a Manager/Administrator
• Identify the competencies, understand their
  implementation and monitor resident and program
  compliance
• Understand work hour regulations and monitor
  compliance
• Provide reports, summaries, and reviews of all
  training program activities
• Understand legal issues with regards to
  employment, visas, discipline, health care

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• Tasks of a Manager/Administrator
• Have knowledge of personnel and human resources
  issues
• Access the resources and Web sites involved in
  medical education
• Utilize networking and Internet opportunities
  efficiently and effectively
• Active involvement in site visit
• Provide solutions for data management issues
• Understand budgeting issues

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How Successful is the Individual Coordinator?

• How the program director views the position
• How much credibility s/he has with the residents

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The Program Director

• Must support the coordinators activities
• Must value the skills, knowledge, abilities, and
  opinions of the coordinator
• Must see the position as a mid-level manager or
  administrator who is professionally responsible

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The Residents

• Must see the coordinator as an advocate and
  resource for them
• Must see the coordinator as professionally
  responsible
• Must respect the knowledge, skills, and
  abilities of the coordinator
• Must see the coordinator as an extension of the
  program director

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• These are powerful concepts.

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• Both
• promote the well-being and
• success of the resident.
• promote compliance with all aspects of
  accreditation and program requirements.

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• Both
• support the efforts and duties of the program
  director.
• support graduate medical education.

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• When these perceptions come together, the
  coordinator is given the opportunity to be an
  active, productive participant, involved in
  achieving all the goals and objectives of the
  training program.

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What is the Basis for Success for the GME
Administrator or Staff Person?

• How the program directors and hospital
  administrators view the activities of the GME
  office
• How much credibility the GME office has with the
  program directors, hospital administrators and
  residents

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• The Program Directors and Coordinators must see
  the GME as a resource of knowledge that can be
  relied upon
• GME activities must be done in a timely and
  reasonable manner
• Meeting activities for the Program Directors must
  be efficient, effective and timely
• The GME is timely in their response to program
  directors and hospital administrators

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• Processes and procedures that the Program
  Coordinators need to follow and comply with are
  well defined, clear and concise
• Program Coordinators are offered a venue in which
  to network

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Personal Inventory Time

• How do others perceive you in your role as
  coordinator, or as GME personnel?
• How do you perceive yourself in your role?
• How are you growing in your role?
• How supportive are you of your program, your
  program director or your GME office?
• How supportive is your program director or GME
  office of you?

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If you are not successful, how do you get
there? If you are already successful - how do
you maintain that success?
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The six (6) competencies lead to a successful
graduate medical education program coordinator.
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1st Competency

• Training Program Management that is
  compassionate, appropriate, and effective for the
  treatment of accreditation issues and the
  promotion of the well-being of the training
  program.

• Patient Care that is compassionate, appropriate,
  and effective for the treatment of health
  problems and the promotion of health.1

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For the Professional Coordinator

• Competency 1 Resident, Program Director,
  Residency Program Care
• The Professional Coordinator needs to
• Be compassionate
• Effectively handle accreditation issues for the
  health of the program
• Appropriately care for all aspects of the
  residency program to keep it viable
• Be sensitive to and supportive of the needs of
  the Program Director

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2nd Competency

• Job Experience and Knowledge about established
  and evolving accreditation and board standards
  and processes and the application of this
  knowledge to the care of the training program.

• Medical Knowledge about established and evolving
  biomedical, clinical, and cognate (e.g.,
  epidemiological and social-behavioral) sciences
  and the application of this knowledge to patient
  care.2

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For the Professional Coordinator

• Competency 2 GME Knowledge
• The Professional Coordinator needs to know
• Common, Institutional and Clinical Specialty
  Program Requirements
• Evolving Board and accreditation processes and
  standards
• How to apply knowledge to care for the residency
  training program and keep it healthy

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3rd Competency

• Practice-Based Learning and Improvement that
  involves investigation and evaluation of their
  own patient care, appraisal and assimilation of
  scientific evidence, and improvements in patient
  care.3

• Practice-Based Learning and Improvement that
  involves networking and evaluation of the
  programs well being, appraisal and assimilation
  of the trends in graduate medical education and
  improvements in the care of the training program.

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For the Professional Coordinator

• Competency 3 Practice-Based Learning and
  Improvement
• The Professional Coordinator needs to
• Network about and evaluate the program
• Appraise the residency looking at trends in
  graduate medical education
• Improve the residency by applying information
  learned through networking and evaluation

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4th Competency

• Interpersonal and Communication Skills that
  result in effective information exchange and
  teaming with patients, their families, and other
  health professionals.4

• Interpersonal Communication Skills that result
  in effective information exchange and teaming
  with the programs residents, attendings, and
  administrative staff as well as networking on a
  national basis with other graduate medical
  education programs and organizations, and the
  accreditation bodies.

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For the Professional Coordinator

• Competency 4 Interpersonal and Communication
  Skills
• The Professional Coordinator must
• Communicate effectively with PD, residents,
  ACGME, the Board, GME office, and applicants
• Network with appropriate institutions and
  individuals for sharing information to enhance
  the residency
• Take a role as counselor, liaison, and advocate
  to heart, being able to listen, as well as being
  able to speak

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5th Competency

• Resource management, as manifested by actions
  that demonstrate an awareness of and
  responsiveness to the larger context and system
  of graduate medical education and the ability to
  effectively call on people or website resources
  to provide education and/or direction that is of
  optimal value.

• Systems-Based Practice, as manifested by actions
  that demonstrate an awareness of and
  responsiveness to the larger context and system
  of health care and the ability to effectively
  call on system resources to provide care that is
  of optimal value.5

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For the Professional Coordinator

• Competency 5 Resource Management
• The Professional Coordinator must
• Demonstrate an awareness of and an understanding
  of the larger context of graduate medical
  education
• Know not only where to go, but also how to access
  websites and resources to find answers for the
  needs of the residency program
• Apply this knowledge for the improvement of the
  residency program

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6th Competency

• Professionalism, as manifested through a
  commitment to carrying out professional
  responsibilities, adherence to ethical
  principles, and sensitivity to a diverse patient
  population.6

• Professionalism, as manifested through a
  commitment to carrying out professional
  responsibilities, adherence to ethical principles
  and sensitivity to a diverse graduate medical
  education population.

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For the Professional Coordinator

• Competency 6 Professionalism
• The Professional Coordinator is
• Understanding and respectful of the confidential
  nature of our jobs
• Committed
• to doing the job in a responsible manner
• to presenting a professional appearance

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Professionalismand beingProfessionally
Responsible
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Professionalismand beingProfessionally
ResponsibleWe Know It When We See It
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Professionalismand beingProfessionally
Responsible

• Appearance

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Appearance Communications

• Body Language
• Direct (speaking)
• on phone
• in person
• In-Direct (writing)
• email
• letters / signature

• Appropriate Terminology

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Appearance - Organization

• Files / Office
• Interview day
• Incoming resident activities
• Employment paperwork
• Department orientation
• Other program functions

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Appearance - Dress

• Whats fashionable?
• Whats professional?
• Is there a difference?
• Whats reasonable?
• Who are your role models?
• What are others in your profession wearing?

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Appearance Actions

• What is your role?
• How do you manage stress?
• What is reasonable?
• Who are your role models?
• Is there a difference between how you act and
  speak at work and how you act and speak at home?
• Do you have a game face?

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Program Coordinators Professional and Successful

• Perception
• Others Residents, PDs, Department Personnel,
  GME
• Self
• Roles
• Professional and other
• Applying competencies
• Appearances count
• Oral, Written, Visual

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• Whats Next?

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• Certification
• One Form of Acknowledgement and Recognition

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How did this start?

• 20 years ago Internal Medicine
• 9 years ago SUNY Syracuse
• Unintended consequence of the Outcome Project
• 5 years ago ARCS Conference
• Question posted in AMA E-Letter
• APCR, EMARC, AFPA Discussions
• Grassroots Interest
• Why reinvent the wheel?

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How did this start?

• Meeting in Baltimore
• Job analysis survey tool
• Formed National Board 3 specialties
• Open Forum in Chicago
• www.tagme.org
• Communication lines and updates printed in AMA
  E-Letter
• Established working board with 9 organized
  specialties represented

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Terminology

• Credentialing is the process of granting a
  credential, that is, a designation which
  indicates competence in a subject or area
• High Risk vs Low Risk

(NOCA)
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Terminology

• Credentialing
• Licensure most restrictive, mandatory
  governmental requirement to practice in a
  particular profession or occupation
• Registration title protection, mandatory
  through government or private agency
• Certification VOLUNTARY, non-governmental,
  individuals are recognized for advanced knowledge
  and skill

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Terminology

• Job title is institution/department specific
• Task is global Manage the day-to-day activities
  of a training program
• Administrator is most encompassing term used in
  certification title
• Coordinator is most common term used in
  conversation, in most association titles and in
  most institutions

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Mission Statement

• Mission Statement to assure a comprehensive
  level of services, training, knowledge and
  leadership through certification of the
  administrators of graduate medical education
  programs for physicians-in-training.

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Vision Statement

• Vision Statement The National Board of
  Certification for Training Administrators of
  Graduate Medical Education Programs has been
  created to establish standards for the
  profession, to acknowledge the expertise needed
  to successfully manage graduate medical education
  programs and to recognize those training program
  administrators who have achieved competence in
  all fields related to their profession.

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Criteria for Certification

• Years of On-the-Job Experience
• 3 contiguous years in the same clinical
  specialty
• National Meeting Attendance
• 1 in 3 years
• Focus of meeting must be graduate medical
  education
• Site Visit / Internal Review
• At least one experience

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Criteria for Certification

• Personal Professional Development
• 2 professional development experiences in 3 years
• Oral/poster presentations
• Abstracts and/or publications
• Participation/leadership in national
  organizations within the profession
• Participation/leadership in sponsoring
  institutional/GME committees
• Department presentations such as orientation and
  in-service training sessions on program
  procedures for attendings and/or residents
• Assessment

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Assessment

• Assessment versus Test
• Monitored Site
• Core Components Focus
• Clinical Specialty Focus
• Work Effort Product
• Core Components Focus
• Clinical Specialty Focus

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Core Components - Global

• ACGME - Common Program Requirements
• ACGME - Institutional Requirements
• ACGME - Policies Procedures
• ECFMG Basic Overview

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Core Components - Specialty

• Clinical Specialty Program Requirements
• Work Hours
• Core Competencies
• Governing Bodies, Navigation of Web sites
• Recruitment and Recruitment Tools

• Evaluations
• Pertinent Acronyms and Definitions
• Procedural Logs 
• Continuity of Care
• Academic Curriculum
• Required Annual Surveys GMETrack ADS Frieda

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Clinical Specialties and TAGME

• Clinical Specialty initiates task force
• Clinical Specialty requests TAGMEs approval to
  use the core components in the development of
  their assessment tools
• Confidentiality Statements
• TAGME releases core component

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Clinical Specialties and TAGME

• Clinical Specialty works with TAGME to develop
  tools
• Clinical Specialty submits tools and petitions
  TAGME for membership on the board
• TAGME reviews the petition and the tools and
  takes action
• Clinical Specialty responds to action

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Current Structure of TAGME

• Board of Directors 8 Permanent Members
• Neurology, OB/GYN, Orthopedics, Pediatrics,
  Preventative Medicine Rehabilitation,
  Psychiatry, Surgery, Thoracic Surgery
• Approved Task Forces 5 Core Specialties
• Diagnostic Radiology, Neurosurgery, Emergency
  Medicine, Internal Medicine, Family Medicine
• Approved Task Forces 2 Sub-specialties
• Psychiatry Child Psychiatry Pediatrics
  Neonatology

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Continuing Certification

• A 5 year period from the date of certification.
  
• Application includes continuation of initial
  criteria
• Attainment of CEUs from a pre-established
  software package that focuses on managerial
  skills.
• A national initiative in graduate medical
  education a new or revised measurement tool for
  continuing certification

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The Future

• Expand the constituency of the National
• Board to include other medical education
• personnel
• Program Coordinators Division (current)
• GME Division (interest level)
• Osteopathic Division (interest level)
• Dental Division (interest level)
• Program Directors ???

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The Future

• Establishment of the
• Journal for the Management of
• Physician-In-Training Programs

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What Certification Will Do

• It will
• standardize the knowledge base
• enhance the career
• acknowledge expertise and skills
• establish the coordinator position as a
  profession
• facilitate career advancement and movement

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What Certification Will NOT Do

• It will not get you a raise. Pay is determined,
  in part, by the structure of the employment
  agency and geographic area.
• It is not intended to be a requirement for the
  job as experience on the job is a criteria for
  certification.
• It is a VOLUNTARY process.

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New Formulas in Graduate Medical Education

• PC C(P SKA Ex) EPM

Program Coordinator Certification
(Professionalism Skills, Knowledge, Ability
Experience) Exceptional Program Management
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Thank you

• Thanks to
• Lorenzo Woo
• Helen Shui

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Thank you

• Ruth H. Nawotniak MS, C-TAGME
• General Surgery Program Coordinator
• University at Buffalo SUNY
• Immediate Past President - TAGME
• Director, New Specialty Development Committee -
  TAGME
• rhn_at_buffalo.edu

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Bibliography

• 1,2,3,4,5,6 www.acgme.org
• Nawotniak R, Grey E. Program Coordinators
  Professional and Successful. Association of
  Residency Coordinators in Surgery Spring
  Conference, Tucson, AZ, 2006.
• www.tagme.org
• Browning, Anne, Sr. Ed, Certification A NOCA
  Handbook, 1996, pg. 2-3.

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Whats New from the ACGME
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Whats New from the ACGME

• New Institutional Requirements
• Internal Review Timeline
• New Common PIF watch for it
• Web-based portfolio 2010
• www.acgme.org The ACGME Learning Portfolio

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Whats New from the ACGME

• New Common Program Requirements
• Institution
• ensure protected time and financial support for
  each PD to meet educational and administrative
  responsibilities
• The Program Letters of Agreement must be renewed
  every 5 years.

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Whats New from the ACGME

• New Common Program Requirements
• Program Personnel and Resources
• More PD responsibilities
• Regular participation by faculty in clinical
  discussions, conferences, rounds, journal clubs
• Some Faculty should participate in scholarly
  activity journal publications, publications or
  presentations at local and/or national meetings

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Whats New from the ACGME

• New Common Program Requirements
• Resident Appointment
• Transferring resident verification of training
  and summative competency based evaluation
• PD must notify DIO and GMEC of other learners
  in the program

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Whats New from the ACGME

• New Common Program Requirements
• Education Program
• Goals and objectives for each assignment at each
  PGY level must be distributed annually
• Curriculum must include delineation of resident
  progressive responsibilities and delineation of
  resident supervision over the whole program
• Curriculum must include the teaching of the basic
  principles of research
• Residents should participate in scholarly activity

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Whats New from the ACGME

• New Common Program Requirements
• Evaluation
• Resident Formative Evaluations are expanded
• 1 - Faculty evaluation of residents for each
  rotation
• 2 - Objective assessments of competence in the 6
  areas
• 3 - Use of multiple evaluators for resident
  evaluations

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Whats New from the ACGME

• New Common Program Requirements
• Evaluation
• Annual faculty performance evaluations are
  expanded
• 1 clinical teaching abilities
• 2 commitment to education
• 3 clinical knowledge, professionalism and
  scholarly activities
• 4 results of confidential written evaluations
  by residents

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Whats New from the ACGME

• New Common Program Requirements
• Evaluation
• Annual Program Evaluation is expanded
• 1 formal, systematic evaluation of curriculum
• 2 monitor resident performace, faculty
  development, graduate performance and program
  quality
• 3 documentation of resulting plans of action
  for appropriate program improvements