Jeff Wiese, MD Associate Dean for GME Program Director Tulane Internal Medicine

1
Graduate Medical Education In the Wake of A
Disaster

• Jeff Wiese, MDAssociate Dean for GMEProgram
  DirectorTulane Internal Medicine

2

• The Four Certainties
• Medicine is about teams
• Where there are teams, there must be leaders
• Following crisis, the success or failure of the
  team depends upon the character of the team and
  the leadership abilities of the leader.
• Life is what happens to you while you are making
  plans. Crisis is a part of life

3
Leadership Lesson 1 Preparation is Everything
4
Leadership Lesson 2 Get Control of Yourself
First
5
Leadership Lesson 3 Establish a Communication
Network
6
Components of a Successful Communication Network

• Emergency contact forms should include
  non-university email accounts
• Establishment of a central chat room
• Establishment of a proxy server
• Resident emergency contact information should be
  stored in each residents internet-based
  portfolio
• X
• Y

7
Leadership Lesson 4 Design Your Own Vision
8
The Ten Point Plan

• 1. The short-term emphasis is on providing
  disaster relief
• 2. I will assure that you will continue to get
  paid
• 3. You contract will be honored
• 4. Resident temporary transfers
• 5. Procedure for re-calling residents in three
  phases over the next four months
• 6. We will proceed with recruitment
• 7. A better disaster response will be prepared
  for subsequent years
• 8. Time-line of exactly what will happen
• Sept 3rd to Sept 15th- Disaster relief efforts.
• Sept. 15th- Notification of short term residency
  assignments.
• October 1st- Begin short term residency
  assignment. I will deal with the accreditation
  issues when we return. Everyone will graduate on
  time.
• November 1st- First wave of residents are called
  back. Recruitment Begins
• December 1st- Second wave of residents are called
  back..
• January 1st- Final wave of residents are called
  back.
• 9. There will be formal recognition for the
  heroism displayed during Katrina in the next
  few months

9
Act on best available data. Do not wait for
certainty or directives from on-high.
10
Set a plan early. Plans can change, but the
longer people are made to tread water, the
greater the number of people who drown.
Announce the plan early. It is easier to steer
a moving ship.
11
DISASTER POLICIES
Institution
GME
12
DISASTER POLICIES
Institution
GME
13
DISASTER POLICIES
GME
Institution
14
DISASTER POLICIES
Program
GME
Institution
15
Components of a Disaster Policy

• The residents will be paid and contracts will be
  honored.
• If this cant be done, then the program will
  assist in transferring the resident to another
  program
• Educational requirements will be ensured.
• If this cant be done, then the resident will be
  transferred to another program
• Refer to institutional disaster policy

16
The Ten Point Plan

• 1. The short-term emphasis is on providing
  disaster relief
• 2. I will assure that you will continue to get
  paid
• 3. You contract will be honored
• 4. Resident temporary transfers
• 5. Procedure for re-calling residents in three
  phases over the next four months
• 6. We will proceed with recruitment
• 7. A better disaster response will be prepared
  for subsequent years
• 8. Time-line of exactly what will happen
• Sept 3rd to Sept 15th- Disaster relief efforts.
• Sept. 15th- Notification of short term residency
  assignments.
• October 1st- Begin short term residency
  assignment. I will deal with the accreditation
  issues when we return. Everyone will graduate on
  time.
• November 1st- First wave of residents are called
  back. Recruitment Begins
• December 1st- Second wave of residents are called
  back..
• January 1st- Final wave of residents are called
  back.
• 9. There will be formal recognition for the
  heroism displayed during Katrina in the next
  few months

17
Eight Components of a Re-Design Vision

• The immediate focus
• Insure pay, contracts, and transfers
• Establish commitment to education requirements
  (transfers)
• Commitment to succeed as a team
• Time-lines
• Rewards for those who commit
• The end point
• The glue

18
Leadership Lesson 5 Enact Successful Resident
Transfers
19
Components to Making Successful Transfers
Assignments

• Focus on each resident one at a time.
• Identify what each resident wants.
• Integrate residents social, psychological and
  professional needs into this decision.
• Be aware of the financial implications.
• Have the necessary information to fulfill
  credentialing and licensing (Y)
• Begin with the end in mind.

20
The First Priority is Taking Care of Each
Individual Team Member First
21
When the team needs its team members devotion
the most, is exactly the time when the team must
show each team member the most devotion.
22
Attention to small comforts goes a long way in
showing the teams devotion and value of each
resident.
23
5. Resident Transfers Assignments

• Focus on each resident one at a time.
• Identify what each resident wants.
• Integrate residents social, psychological and
  professional needs into this decision.
• Be aware of the financial implications.
• Begin with the end in mind.

24
Five Components of Emergency Transfers

• 1. Identify the Destination
• 2. Identify ACGME Cap Space
• - If there is Cap space proceed with Step 3
• - If there is no Cap space, work with the
  receiving program to petition the ACGME for
  extension
• 3. Identify CMS Cap Space
• - If there is Cap space proceed with 4
• - If there is no Cap space apply to CMS for
  emergency transfer
• 4. Establish the Master Affiliation Agreement
• 5. Establish the Program Letter of Affiliation

25
Leadership Lesson 6

• Identify the Leaders and the Mavens.
• Inform the leaders Speak to the Mavens.
• Leaders People put in positions within the
  hierarchy based upon their perceived aptitude to
  lead.
• Mavens People whom other people follow,
  regardless of their position in the hierarchy.
  Opinion leaders.

26
Leadership Lesson 6 Re-establish a routine as
soon as possible
27

• In the face of a crisis, people will crave
  security and certainty.
• Without security, there can be no focus.
• Without focus, the teams mission statement
  (education and patient care) is compromised.

28
Leadership Lesson 7 Identify Support Networks
Early

• APDIM
• AAMC
• APM
• SGIM
• AAIM
• AMA
• ACP
• SHM

29
Leadership Lesson 8 Lead by walking around. Be
as visible as possible
30

• Gross Statistics Cell phone minutes 15736Ga
  llons of Gas 1534Gallons of
  Coffee 157Nights in a hotel 85Hours of
  sleep 1155Hours of work 3549Driving
  miles 36,007Dollars Spent on All of
  This 57,479
• Value of keeping a residency, a department a
  medical school course(s) together.
• Priceless

31
Leadership Lesson 9 Re-Entry
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
The Original Problem
39
(No Transcript)
40
(No Transcript)
41
What You Can Expect

• IME amounts will drop faculty costs will remain
  the same.
• DME amounts will drop institutional costs will
  remain the same.
• Not all populations will recover at the same rate
  
• Some programs will take a bigger hit than others.
• Quality is as important as Quantity

42
Quality Index Procedure-Based
43
Quality Index Non-Procedure Based
44
THE ECG(The Elite Code Grey Team)
45
The Old Method
Mon. Tues. Wed. Thurs. Fri. Sat. Sun.
Team 1
Team 2
Team 3
Team 4
Team 4
Team 4
Team 4
Team 1
Team 1
Team 1
Team 1
46
The New Method
Mon. Tues. Wed. Thurs. Fri. Sat. Sun.
Evacuation
ECG 1
ECG 1
ECG 1
Team 1
Team 2
Team 3
Team 4
ECG 2
ECG 2
ECG 2
47
The Elite Code Grey

• Not all people are equally suited for crisis
  situations.
• Preparation includes more than a call bag
• Team-based training is the most important skill.

48
The Elite Code Grey Team

• Team members are carefully selected

Volunteers
Peer Selection
Profiling
49
The Elite Code Grey Team

• ECG team members are selected
• ECG team members undergo year-long training
• - Team skills/ development
• - Disaster protocols
• - Disaster medicine
• - Crisis/stress management
• - Crisis preparation Personal lockers

50
The Elite Code Grey Team

• 3. Upon activation of the code grey, all
  residents sign out to the code grey team. Each
  sub-team of the ECG is assigned a hospital and a
  service.
• 4. All other residents prepare for evacuation
• 5. Code Grey Units work in shifts through the
  crisis.

51
Leadership Lesson 10 You Reap What You Sow
52

• At the end of the day, there is no full
  preparation for crisis thats what makes it a
  crisis.
• Only preparing yourself your leadership
  abilities will save your team.

53
Leadership Lesson 11

• Constantly Remind Yourself
• Institutions are comprised of people, not bricks
  and mortar. The politicians can control the
  bricks, but if you can maintain your team, you
  will control the future of your institution.

54
(No Transcript)