UCF

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UCF
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Jay L. Falk, MD, FACEP, FCCMChief Academic
Medical Officer Medical EducationOrlando Health

• Professor of Medicine and Emergency Medicine
• University of Central Florida College of Medicine
• Assistant Dean for Clinical UME
• _at_ OH, UCF COM
• Professor of Medicine and Emergency Medicine, FSU
  COM, UF COM and
• USF COM

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Lisette Whitman
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Jay Falk, MD
John Hillenmeyer, President/CEO
Im looking for a position where I can slowly
lose sight of
what I originally set out to do with my life,
with benefits.
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John Hillenmeyer, President/CEO
Jay Falk, MD
Youll be a perfect addition to our expendable
workforce.
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MEDICAL EDUCATION

• Pre-med BS / BA
• Medical school MD / DO
• GME (Graduate Medical Education)
• Residency training
• 3 7 years
• Diplomat status
• CME (Continuing Medical Education)

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ACCREDITATION,
CERTIFICATION, LICENSURE

• Medical Student Education
• 125 US med schools
• LCME AMA, AAMC

• GME
• ACGME
• 26 RRCs

Certification (voluntary)
Licensure (mandatory)

• ABMS
• 24 specialty boards
• Recertification

• USMLE 3 part exam
• NBME
• Fed State Med Boards

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Graduate Medical Education

• ACGME

Corporate Sponsor
Corporate Sponsor
DIO Designated Institutional Officer
IRC
Program Directors
RRC
Faculty
Residents
1º Specialties
Fellows
Subspecialties
JF ORMC 2011
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MEDICAL EDUCATION HEALTHCARE

• Societal contract
• History
• Current challenges
• Opportunities

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MEDICAL EDUCATION HEALTHCARE

• Its important to recognize that the
  caliber of doctors we have represents a
  negotiation between medical education and
  society. Our physicians reflect the type of
  people and society we are, not just the efforts
  of academic health centers. It would not be an
  exaggeration to say that as a nation we
  ultimately get the doctors we deserve.
• Kenneth Ludmerer Time to Heal 1999

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MEDICAL EDUCATION IN AMERICA

• Civil War 1920 Medical Education in US worst
  best in industrialized world.
• 1893 Johns Hopkins Medical School opens
  becomes model
• 1910 Flexner report Medical Education in
  the US and Canada Carnegie Foundation for
  the Advancement of Teaching
• 1920s Flexnerian Revolution
• Proprietary schools University Schools
• Public/Private Funding
• State licensing laws
• Proprietary schools loose accreditation
• 1920s 1970s Progressive education Golden
  Era
• Hands on Academic medical centers (teaching
  hospitals)
• GME develops
• Medicare/Medicaid (1965)
• 1980s Managed Care Wall Street
• 1990s present Second Revolution

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THE FIRST REVOLUTION

• William Welch, 1st Dean, Johns Hopkins
• The advancement and development of medicine in
  itself required an improvement in the methods of
  teaching medicine
• Johns Hopkins University Press 1920

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FUNDRAISING

• keep in mind that we are a public service
  institution and see to it that you do not fail to
  help the public
• President Nicholas Butler, Columbia
  Universityaddress to the medical faculty 1919

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UNIVERSITY AND TEACHING HOSPITAL

• There are few influences that exert as elevating
  an effect on the standard of professional work in
  a hospital as the presence in it of medical
  teaching
• This is so true that the phrase teaching
  hospital is almost synonymous with a good
  hospital
• Francis W. Peabody..1923

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RESTORING THE SOCIAL
CONTRACT

• The first step toward getting an endowment was
  to deserve one
• Charles Eliot, The Success of the Harvard Medical
  School. Boston Medical and Surgical Journal
  187388632

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MEDICAL SCHOOL CURRICULA

• Flexner report 1910
• 2 years basic sciences
• Anatomy
• Biochemistry
• Physiology
• Microbiology
• 2 years Clinical Clerkships
• Internal Medicine
• Surgery
• OB-GYN
• Pediatrics
• Psychiatry
• Electives (home/away)

• Pharmacology
• Pathology
• Introduction to Clinical Medicine

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RECENT INOVATIONS IN MEDICAL SCHOOL CURRICULA

• Content
• Geriatrics / end of life care
• Cultural competence / nutrition / family violence
• Genetics / molecular biology
• Medical decision making
• Medical ethics
• Teaching/Learning Methods
• Organ system approach
• Problem based learning
• Small groups
• Interactive
• Earlier patient contact
• Information Technologies
• Using databases
• Multimedia
• Simulation

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MEDICAL STUDENT ASSESSMENT

• OSCEs
• Objective structured clinical exams
• Trained actors
• Standardized patients
• Direct (remote) faculty observers
• Communication skills
• Professionalism
• NBME Clinical Skills Component 2004
• National Board of Medical Examiners
• 3 part exam
• 12 interactions standardized patients

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MEDICAL STUDENT CLINICAL EDUCATION

• Inpatient services challenges
• Narrower scope of illnesses in hospital
• Complex, specialized problems in hospital
• Short length of stay
• Outpatient pre and post stay
• Early stages not seen in-hospital
• Outpatient teaching challenges
• Clinics / offices away from campus
• Decreased efficiency (throughput)
• Consistency
• Faculty models (private practice)

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GME TEACHING /ASSESSING THE
NEW COMPETENCIES

• Patient care
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• Systems based practice

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RESIDENT SUPERVISION

• Graded responsibility
• Meaningful responsibility
• Patient safety
• ED
• Trauma
• CCM
• OR
• Resident credentialing

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GME SPONSORSHIP, OVERSIGHT, ACCOUNTABILITY

• Decentralized system
• 2003 713 institutions, 7954 specialty programs
• Over 100,000 residents
• Sponsoring institution responsibility
• Must have a DIO
  (designated institutional official)
• Associate dean for GME
• VP med-ed, DME, CAMO
• Governing board ultimately responsible

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TEACHING HOSPITALS

• 1100 Hospitals involved in Med Ed
• 400 AAMC COTH Hospitals
• Council of Teaching Hospitals
• 281 Non-federal acute care
• 19 Childrens hospitals
• 12 Specialty hospitals
• 64/116 VA medical centers
• COTH Categories
• Integrated Academic Medical Center Hospital
  n 118 43 shared ownership 19
  were shared now split
• Independent Academic Medical Center Hospitals
  n 163

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COTH Members Provide Specialized Services
Short-Term, Nonfederal Hospitals
Admissions
Surgical Transplant Services
COTH Members
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Other Hospitals
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79
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Burn Intensive Care Units
Level 1 Regional Trauma Centers
Arthritis Treatment Centers
Source AAMC Analysis of 2002 AHA Survey Data
69
54
42
31
46
58
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and Contribute a Disproportionate Share of
Charity Care and Services to the Medicaid
Population
Short-Term, Nonfederal Hospitals
Charity Care
Medicaid Discharges
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6
94
54
74
COTH Members
Source AAMC Analysis of 2002 and 2003 AHA Survey
Data
Other Hospitals
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Hospital Total Margins by Teaching Status, 1996 -
2001
Major Teaching Hospitals
7.3
Other Teaching Hospitals
7.0
Other Hospitals
4.9
3.4
3.5
1.1
1996 1997 1998
1999 2000
2001
Source MedPAC June 204 Data Book
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PHYSICIAN MANPOWER SHORTAGE

• National problem
• 85,000 MDs short by 2020
• Drivers
• Aging population (boomers)
• Increasing demand-specialty services
• Earlier MD retirement
• Younger docs work fewer hours
• Worse in Florida
• Managed penetration
• Liability crisis
• Population growth

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FLORIDA LAGS BEHIND OTHER STATES

• 41st in medical school graduates
• 26th in physicians per 100,000 population
• 24 fewer physicians per 100,000 population
  compared to 10 highest income states
• Imports 80-90 of its new physicians
• 3rd highest importer of international medical
  graduates

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FLORIDA NEEDS MORE RESIDENCY
POSITIONS

• Florida ranks 45th in slots/population
• 3000 slots needed in 5 years to national average

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HISTORY OF GME AT OH

• First Interns 1926
• Orange General Hospital
• Designated teaching hospital 1951
• Programs based on service needs
• All voluntary faculty

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HISTORY OF GME AT OH

• Accreditation Council for Graduate Medical
  Education (ACGME) 1960s present
• Teaching not service
• Increasing regulation/documentation
• Due Process
• Duty Hour Restrictions
• Competencies
• Full time program directors/faculty
• Service/Teaching balance
• Town-Gown collaboration
• Programs unburden private Docs
• Stimulating environment
• Proud tradition

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GME at OH

• Large full time facultynearly 300
• Olando Health Physicians Group
• 100 in med-ed
• 65 MD Anderson
• Pediatric specialists (APH)
• Geographic full time..EM, Path, Colorectal
• 248 Trainees (residents/ fellows)
• 110 over the cap
• Continuing to expand core program size
• Developing new programs (fellowships)
• Annual budget exceeds 100 M

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OH BOD Commitment

• Service excellence
• (patient satisfaction)
• Patient Safety
• Physician communication
• Physician behavior
• Outcomes (measurable)
• Medical Education

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Patient First Strategy

• Transformational
• Long Journey
• Needs all of us
• Working together

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It is all about Quality!

• Quality of Medical Staff/Teachers
• Quality of Resident Education
• Quality of Patient Care
• Quality of Research
• Culture of Quality

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Strategic Vision Patient-First

• Orlando Health will create a Patient-First
  clinically integrated new model of care in
  collaboration with our medical staff to pursue
  seamless, quality outcome-driven extraordinary
  care.

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• What Patients Want
• 1. Dont Hurt Me
• 2. Help Me
• 3. Be Nice to Me

Patient safety
service
quality
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Educational Challenge

• Service versus Teaching
• Economic Impact to Institution
• Impact on Patient Care
• Patient satisfaction
• Patient Safety
• Simulation
• Supervision
• Resident credentialing
• competencies

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ACGME

• Quality management is the newest competency
• Didactic and experiential curriculum needed
• Required
• Part of pay for performance
• OH GME committed

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Role of GME in Quality Improvement

• Residents on the Front Line
• Residents as Team Members
• Residents as Teachers
• Residents as Students of Quality and Safety
  Learning

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GME and Quality at OH

• AIAMC National initiative participant
• Resident participation on medical staff
  committees
• Resident initiated QI projects
• Research fair 5/23/2011

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ACTUAL SENTENCES FOUND IN PATIENTS HOSPITAL
CHARTS
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On the second day
the knee was better,
and on the third day it
disappeared.
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The patient has been depressed since she
began seeing me in 1993.
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Between you and me, we ought to be able to get
this lady pregnant.
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Patient had waffles for breakfast and
anorexia for lunch.
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She stated that she had been constipated for most
of her life, until she got a divorce.
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The patient was to have a bowel resection.
However, he took a job as a
stockbroker instead.
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She has no rigors or shaking chills, but her
husband states she was very hot in bed
last night.
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Patient-First, Starts With YOU!
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