Post on 16-Sep-2020
Tips for Program Directors; navigating the changing tide in
resident education
Dr. Jonathan BathUniversity of Cincinnati
APDVS 2016
Disclosures
• No financial disclosures• No conflicts of interest
Introduction
• Shifts in residency training
• Program Directorship:– Increased assessment– ACGME duty hours– Changing paradigms– Different type of
trainee– Operative competence
Program Director duties
50%
5%
50%
50%
50%
50%
Factors driving changes
1. ACGME duty-hours
2. Integrated Residency
3. Endovascular treatment
Tips for Program Directors
1. Know your audience
• Motivated cohort• Different strengths• Meet > 6 monthly• Don’t wait to fail!
– Annual PEC too little too late
– ACGME Resident Survey
2. Know the requirements
• ACGME:– Common Program
Requirements– Vascular Surgery– Policies and
Procedures• Revisions every 1-2
years• Latest version online
3. ACGME Course for New PDs
• ACGME 1 day course• PD < 2 yrs experience• Accreditation process• ACGME framework
– Review Committees– Data Collection Systems
4. Shape resident education
• Avoid passivity!• Academic trials:
– FIRST– iCOMPARE– Simulation
• JT Lee et al. 2009• AVSSSAP• IAVS• Fundamental of
Vascular Surgery
5. Institute of Health Innovation
• CLER focus area:– Quality Improvement– Patient Safety
• IHI website:– Comprehensive
learning modules– Introduction to PDSA
cycles• Satisfies CLER ‘gap’ http://www.ihi.org/Pages/default.aspx
6. Participate in GME
• Institutional GME office:– Accreditation
Committee– Patient Safety
Committee• Improve own program
– Cross-pollination– Early adoption
7. Learn to speak in acronyms
• The Match…• Simple enough, right?
– All-In Policy– Couples matching– Out-of-Match positions– International Medical
Graduates– SOAP– R3 system
• You need to register with:
• www.nrmp.org• www.aamc.org• www.acgme.org
New PD will need an NRMP token for The Match
8. ACS Surgeons as Educators
• ACS Division of Education
• 6 day intensive course:– Teaching methodology– Curriculum development– Education administration– Performance and
program evaluation https://www.facs.org/education/division-of-education/courses/surgeons-as-educators
Education research…
• Dr. Eric Warm– Internal Medicine PD– @CincyIM
• Surgery entrustment project
• Self-assessment of competence
• Interview process
Surgery Entrustment Project
• Plot all evaluations over time
• Same global ratings• Identify trends in
competence• Enough residents =
identify a ‘standard progression’
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Surgery Entrustment Project
• ‘Ideal’ vs. actual performance
• Relies heavily upon:– Lots of data points– External validation
• But…– objective data of
poorer performance– milestone mapping
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
‘Ideal’ performance
Actual performance
Modeled Best Fit Curves
Competence Project
• Dunning-Kruger effect– “ignorant of one’s own
ignorant”– Very difficult to change
behavior– Lack of insight into
problem
Self-assessment of competence
• Self-assessment vs. performance evals.
• Understands strengths
• Performs well– Ideal resident??– Room for
improvement?
-3
2
7
12
17
22Patient Care
Team Work
Professionalism
Efficiency
Patient Evaluations
Total Quality
Process Quality
Outcome Quality GIM Board Review
In -Tranining Exam
Self Patient Care
Self Medical Knowledge
Self Problem Based Learning
SelfCommunication
Self Professionalism
Self Systems Based Practice
High Self Assessment/High Performance
Self-assessment of competence
• Understands weaknesses
• Low performance– Self-identified
problems– Can they be
motivated??– Okay initially; obvious
issues if continues
-3
2
7
12
17
22Patient Care
Team Work
Professionalism
Efficiency
Patient Evaluations
Total Quality
Process Quality
Outcome Quality GIM Board Review
In -Tranining Exam
Self Patient Care
Self Medical Know-ledge
Self Problem Based Learning
SelfCommunication
Self Professionalism
SelfSystems Based Practice
Low Self Assessment/Low Performance
Self-assessment of competence
• Self-assessed highly• Performs poorly• Lack of insight
– Most troubling curve– Very difficult to
rehabilitate– Needs to gain
insight…how??
-3
2
7
12
17
22Patient Care
Team Work
Professionalism
Efficiency
Patient Evaluations
Total Quality
Process Quality
Outcome Quality GIM Board Review
In -Tranining Exam
Self Patient Care
Self Medical Knowledge
Self Problem Based Learning
SelfCommunication
Self Professionalism
Self Systems Based Practice
High Self Assessment/LowPerformance
Self-assessment of competence
• Low assessment• High performance• Ideal resident?
– Driven to improve??– Lack of confidence in
ability?? -3
2
7
12
17
22Patient Care
Team Work
Professionalism
Efficiency
Patient Evaluations
Total Quality
Process Quality
Outcome Quality GIM Board Review
In -Tranining Exam
Self Patient Care
Self Medical Knowledge
Self Problem Based Learning
SelfCommunication
Self Professionalism
Self Systems Based Practice
Low Self Assessment/High Performance
Interview process
• Can the interview be analyzed?
• Predictors of ‘good’ residents?– Personal statement?– USMLE scores??
• Word cloud for PS
A B
C D
References1. Philibert I, Friedman P, Williams WT. ACGME Work Group on Resident Duty hours. Accreditation Council for Graduate
Medical Education. New requirements for resident duty hours. JAMA 2002;288;1112-42. Scally CP, Ryan AM, Thuma JR, Gauger PG, Dimick JB. Early impact of the 2011 ACGME duty hour regulations on surgical
outcomes. Surgery 2015;158:1453-613. Babu R, Thomas S, Hazzard MA, Friedman AH, Sampson JH, Adamson C, Zomorodi AR, Haglund MM, Patil CG, Boakye M,
Lad SP. Worse outcomes for patients undergoing brain tumor and cerebrovascular procedures following the ACGME resident duty-hour restrictions. J Neurosurg 2014;121(2):262-76
4. Drolet BC, Sangisetty S, Tracy TF, Cioffi WG. Surgical residents’ perceptions of 2011 Accreditation Council for Graduate medical Education duty hour regulations. JAMA Surg 2013;148(5):427-33
5. Schumacher DJ, Frintner MP, Jain A, Cull W. The 2011 ACGME standards: impact reported by graduating residents on the working and learning environment. Acad Pediatr 2014;14(2):149-54
6. Vargehese TK Jr, Mokadam NA, Verrier ED, Wallyce D, Wood DE. Motivations and demographics of I-6 and traditional 5+2 cardiothoracic surgery resident applicants: insights from an academic training program. Ann Thorac Surg 2014;98(3):877-83
7. Aziz A, Sicard GA. Surgical management of abdominal aortic aneurysms: a lost art? Prog Cardiovasc Dis 2013;56(1):13-88. https://www.acgme.org/acgmeweb/tabid/195/MeetingsandConferences/AnnualEducationalConference/IntroductoryCourseforN
ewProgramDirectors.aspx9. https://www.acgme.org/acgmeweb/tabid/328/GraduateMedicalEducation/ProgramDirectorsandCoordinators.aspx10. https://clnicaltrials.gov/ct2/show/NCT0205078911. http://www.nrmp.org/match-a-to-z/12. http://www.ihi.org/topics/patientsafety/pages/default.aspx13. https://www.facs.org/education/division-of-education/courses/surgeons-as-educators
Thank you