2016-2017

Annual Report Carol M. Rumack, MD Associate Dean for Graduate Medical Education ACGME Designated Institutional Official (DIO)

1

GRADUATE MEDICAL EDUCATION 2016-17 ANNUAL REPORT

The Graduate Medical Education (GME) Office is under the leadership and direction of Carol M. Rumack, M.D., Associate Dean for GME at the University of Colorado School of Medicine (CUSOM) and Designated Institutional Official (DIO) for the Accreditation Council for Graduate Medical Education (ACGME). Ashley Walter, BA, is the new Director of Finance and Administration. Dr. Rumack and staff are responsible for the oversight of ACGME accreditation and educational environment as well as payroll, benefits and administrative issues for all residency and fellowship training programs. Mission: The GME Office will achieve the highest level of accreditation for the CUSOM institution and residency and fellowship programs, and provide leadership, education, and support to its residency and fellowship programs to educate residents and fellows to be outstanding physicians. The GME Office implements policies of the Graduate Medical Education Committee (GMEC) of the School of Medicine. The ACGME charges the GMEC with responsibility for monitoring and advising on all aspects of residency education including compliance with ACGME work hours, patient safety and quality improvement requirements, and in maintaining a strong learning environment. The GMEC is composed of program directors, designated representatives of the major teaching hospitals and officers of the Housestaff Association. GMEC reports to the Dean of the School of Medicine through the Associate Dean for GME and Senior Associate Dean for Education. The website is: www.medschool.ucdenver.edu/gme

2016-17 GME HIGHLIGHTS

The University of Colorado School of Medicine GME:

Trains 77% of the total residents and fellows in CO

Is the largest of 13 sponsoring institutions in the state of Colorado

Is the 19th largest institution of 792 nationally

Oversees and provides support to approximately 140 Program Directors, 90 Program Coordinators, and 1500 Faculty

Has no ACGME institutional citations

Anticipates its ACGME Institutional Self-Study Date in October, 2025

2

5th Annual GME Outstanding Program Coordinator Awards The Graduate Medical Education Committee, in collaboration with the Program Coordinator Council (PCC), recognized three outstanding program coordinators.

Kristine Smith was the CUSOM GME Nominee for the ACGME 2018 National Program Coordinator Award. Beth Musser was the recipient of the first Program Coordinator Special DIO Award. DIO Great Teaching Awards In collaboration with Undergraduate Medical Education and the Housestaff Association, the first DIO Great Teaching Awards were created to recognize Residents and Fellows for their strengths in teaching medical students based upon medical student evaluations. The following Residents were recognized:

2016-17 ACGME CUSOM RESIDENT & FACULTY SURVEY RESULTS

Residents and Faculty of all ACGME accredited programs are required to complete this annual survey. Results of the surveys are utilized by ACGME as a key performance indicator for program quality and compliance with work and training environment requirements and for CUSOM institutional performance. 97 programs were surveyed.

RESIDENT SURVEY RESULTS: 92% response rate Duty Hours Faculty Evaluation Educational Content Resources Patient Safety/Teamwork

FACULTY SURVEY RESULTS: 87% response rate Faculty Supervision & Teaching Educational Content Teamwork Resources Patient Safety

INSTITUTION IS AT OR ABOVE NATIONAL MEAN FOR ALL SURVEY QUESTIONS AND CATEGORIES

Kristine Smith Neonatal-Perinatal

Medicine

Jeanette Starkey Pediatric Cardiology

Beth Musser Urology

Jenna Bodmer, MD Pathology Residency

Jeremy Hua, MD Internal Medicine Residency

3

GMEC – OVERSIGHT & EDUCATION

NEW ACGME PROGRAMS APPROVED

Programs Positions Length of Training (years)

Site Visit

Scheduled Citations

Gynecologic Oncology 3 3 4/1/2019 1

Interventional Radiology - Independent 4 2 7/1/2019 0

Maternal-Fetal Medicine 6 3 4/1/2019 0

Orthopedic Sports Medicine – Steadman Hawkins (previously own institution) 2 1 7/1/2019 0

Pediatric Rheumatology 6 3 7/1/2019 0

Pediatric Transplant Hepatology 1 1 7/1/2019 0

Reproductive Endocrinology 3 3 4/1/2019 1

Surgical Critical Care – Pediatric 1 1 1/1/2019 0

ACGME PROGRAM SITE VISITS

Programs Site Visit Date

Citations Programs Site Visit Date

Citations

Adult Epilepsy 9/13/2016 0 Internal Medicine – Pediatrics 10/4/2016 0

Pediatric Epilepsy 9/15/2016 0 Critical Care Medicine (Anesthesiology) 10/5/2016 0

GMEC APPROVED NEW NON-ACGME PROGRAMS

Addiction Psychiatry Research Fetal Surgery Preventive Medicine – Occupational Medicine ABPN Pathway

Clinical Neuromuscular Pathology International Pediatric Surgery Stereotactic Radiosurgery

Endourology Pathology Research Vascular Medicine

GMEC Program Actions – GME Special Reviews

Programs Review Date Programs Review Date

Pediatric Cardiology 9/2016 Orthopedic Surgery 10/2016

Neurology 9/2016 Radiation Oncology 11/2016

Medical Genetics & Genomics 9/2016 Adult Congenital Heart Disease 3/2017

Infectious Disease 10/2016 Nephrology 6/2017

Pathology – Anatomic & Clinical 10/2016 Pediatric Anesthesiology 6/2017

Cardiovascular Disease 10/2016 Pulmonary Disease & Critical Care Medicine 6/2017

Pediatric Emergency Medicine 10/2016 Sleep Medicine 6/2017

4

New Program Directors (PDs) & Program Coordinators (PCs)

ACGME Programs 2012/13 2013/14 2014/15 2015/16 2016/17

New PDs 9 6 13 12 10

New PCs (and/or transferred to another program) 14 12 18 14 20

2016-17 average turn-over rate: PDs = 7% PCs = 22%

Clinical Learning Environment Review (CLER) Visit – November 2016 Resident/Fellow Learning and Working Environment

Patient Safety

Intern & Resident Orientations include experiential learning in the following QI/PS categories o Practiced safety event reporting o Focused learning regarding safe & effective patient hand-offs

GME Quality & Safety Bonus Program o 2017 Safety Event Reporting and Hand Hygiene in place o Residents earned Tier 2 ($250) of the hand hygiene metric (achieved 8 months at or above 85.6% compliance). Safety event

reporting metric was not met (see graphs below) o Total bonus paid out ~ $176,650 o Hospitals continue to support increase of bonus potential to $1000

5

Quality Improvement

GME & CU Institute for Healthcare Quality, Safety & Efficiency (IHQSE) are partnering to develop QI/PS fellow curriculum

Faculty development provided for faculty members who mentor residents in QI projects

UCH Clinical Effectiveness Patient Safety (CEPS) Small Grants funded 5 resident-led teams conducting UCH quality or safety projects with over $786,000 return on investment

UCH Clinical Effectiveness Patient Safety (CEPS) Small Grants CEPS Impact 2016-2017

6 CEPS Small Grants funded for 2017/18 o Reduce Inappropriate Line Usage o Institute DOT as Diagnostic Approach for CKD Clinic

Patients with Uncontrolled Hypertension o Improve Care for Hospitalized Elderly Adults with

Delirium o Establish Neurosurgical Quality Improvement Project o Add Azithromycin for Preoperative C-Section Antibiotic

Prophylaxis o Improve Safety During Transport from OR to ICU

UCH Clinical Effectiveness Patient Safety (CEPS) Small Grants CEPS Return on Investment 2016-2017

6

Transitions of Care (TOC)

Intern & Resident Orientations – All residents receive specific education about effective patient hand-offs

Transition of Care Policies for all programs are reviewed annually and must include how the program: o Minimizes the number of transitions in patient care o Monitors effective, structured hand-over process o Ensures residents are competent in communicating to

team members in the hand-over process o Ensures availability of schedules that inform all

members of the health care team of physicians and residents currently responsible for each patient’s care

Supervision

Resident supervision policies are provided to the four key hospitals for their use to inform hospital staff of supervision levels required for defined procedures

Supervision Policies for all programs are reviewed annually and must include how the program defines: o Progressive authority & responsibility, conditional

independence, supervisory role in patient care

o Guidelines for when residents must communicate with

the attending

o Clinical responsibilities by PGY levels for supervision

Work Hours, Fatigue Management & Mitigation

Continue monitoring work hours with program action plans for GMEC review are required when a trend in violations is noted

Program policies must address continuity of patient care in the event that a resident may be unable to perform patient care responsibilities

Professionalism

Intern & Resident Orientations – Professionalism interactive lectures given by behavior/legal experts

Office of Professionalism outreach to programs

2017-2018 GME ENROLLMENT DATA & TRENDS (Numbers reflect enrollment as of August 1, 2017.)

Figure 1 Number of GME Programs

191 residency and fellowship programs with 1173 residents and fellows:

31 ACGME residency programs - (829 residents)

74 ACGME fellowship programs - (297 fellows)

86 Non-ACGME fellowship programs - (47 fellows)

7

Figure 2 GME Total Enrollment

Figure 3

International Medical Graduate Enrollment

8

Figure 4 2017-18 Primary Care Enrollment = 340

Family Medicine, Internal Medicine, IM/Peds, Pediatrics

Figure 5

Primary Care vs. Specialty Enrollment

9

Figure 6

Under-Represented Minority Enrollment % of Total Enrollment (N=1173)

GRADUATE SATISFACTION – GME 2017 GRADUATE SURVEY

Plastic & Reconstructive Surgery Residency

For the 2016-17 academic year 363 residents and fellows graduated from ACGME and Non-ACGME approved programs. All graduates completed the 2017 GME Graduate Survey. Figure 7

2017 GME Graduate Survey Overall Satisfaction with Training Program

10

Figure 8 Graduates Who Would Recommend Program

Figure 9

What are the Professional Plans of ALL 2017 Exiting Housestaff?

11

Figure 10 Professional Plans – ALL 2017 GME Graduates

Figure 11

Practice in Colorado After Completion of Training – All 2017 GME Graduates

12

Figure 12

2017 Graduates Planning to Practice In Colorado

Figure 13

Reasons for Leaving CO

13

Figure 14 2017 Graduates Staying in Colorado Will Serve:

Figure 15 2017 Primary Care Graduates Professional Plans

(104/363) FM, IM, IM/Peds, Peds

14

Figure 16 Where Will 2017 Primary Care Graduates Practice?

(104/363)

Figure 17

2017 Specialty Graduates Professional Plans (259/363)

15

Figure 18 Where will 2017 Specialty Graduates Practice?

(259/363)

Figure 19

Resident/Fellow Financial Debt