December 11, 2010

Resident SurveyDidactic Education The Research RotationRotation Plans: Seventh Year Plans

and INOVA New Duty Hour Rules and Resident

Supervision

ACGME cracks down on Duty Hour Violations using the Resident Survey.

Morbidity and Mortality Neurosurgery Boot Camp Lecture Series Evidence Based Neurosurgery CPC Clinical Pathology Correlation Textbook Conference Journal Club Board Review Conference Saturday Case Conference UVA Conference Brain Tumor Conference Epilepsy Conference GME Conference

1. Would faculty be willing to participate and rotate leading Friday morning conference?

2. Should we consider a dedicated conference day?

3. Should we add other conferences; i.e. Neurovascular/Endovascular or Movement Disorders conference?

4. Provide suggestion on how to increase the attendance at these conferences (for both Residents and Faculty).

PGY-2 Residents identify a Research Mentor and area of interest during the PGY-2 year. This will be

presented to the faculty in a brief presentation at the June faculty meeting in their PGY-2 year.

PGY-3 & PGY-4 Residents develop a specific research plan with the assistance of the faculty mentor during the

PGY-3 year. A detailed plan will be presented to the faculty at the January faculty meeting during their PGY-4 year. Following acceptance of the research plan, regulatory documentation must be completed to allow a timely start to the project in July of the PGY-5 year. For resident interested in taking a clinical fellowship during the seventh year of the residency, the faculty will provide specific goals that must be met prior to making applications for fellowship positions.

PGY-5 Residents will provide updates to the faculty on the progress of their research at the June (actually

PGY-4) and January faculty meetings during the PGY-5 year. Residents will provide a detailed presentation of their research results and status of publications at

the June faculty meeting during their PGY-5 year. For resident interested in taking a clinical fellowship during the seventh year of the residency, the faculty will determine whether the specific goals previous outlined were met at this time.

PGY-7 Residents will provide research update and plan for the upcoming year at the June PGY-6 faculty

meeting. Residents will provide updates to the faculty on the progress of their research at the January

faculty meeting. Residents will provide a detailed presentation of their research results and status of publications at

the June faculty meeting during their PGY-7 year. Following the presentation, the faculty will determine whether or not the research requirement has been met.

A satisfactory research experience with publications is a prerequisite for graduation from the residency training program.

1. What are the minimum accomplishments to fulfill this requirement?

2. How can the previous research plan and schedule be revised to improve the Research Rotation and Productivity (What will need to be done each year in preparation for the actual PGY5 Research year?).

3. What milestone would need to be put into place to monitor resident progress and what should done in cases of resident underperformance in the research rotation?

4. What will be the responsibilities of Research Mentors?

5. Should exceptions be made for Residents completing enfolded training?

6. Should there be a requirement for publication of a clinical research project?

7. Should an outline be developed for the clinical research project?

1. What are the pros and cons of the TTP vs. One-on-One?

2. Could the TTP resident be permanently assigned to the VAMC? Is it possible to split the current 7/8th between 2 TTP residents?

3. Is there enough clinical material for 2 TTP residents?

4. If we decided to go with the 1-on-1 would this be better in the 6th year with Chief resident moved to the 7th year?

5. What is the recommendation for the 7th year?

1. Currently we have 3 residents in the PGY1 year and will have 3 PGY1 starting July 2011, should we proceed with setting this up to start on a trial basis in July 2012?

2. Would 4 month rotations in the PGY3 and PGY4 years be ideal?

The main impact of the recent duty hour rule is to our PGY1 residents and their ability to take in-house call.

The new requirements limit their hours to a maximum of 16 per shift

Stipulate that they should be supervised directly or indirectly with direct supervision immediately available

These changes will make it difficult for them to participate in the call schedule.

Options for call coverage include:1. Have the PGY1 resident report for duty on-call days at 4 PM

and work until 8 AM the following morning. Additionally, we would need to explore having the in-house intensivists as the designated supervisor for this rotation since there is a requirement for direct supervision immediately available. It would also be difficult for PGY1s to cover weekend calls since the duration is 24 hours except for Friday nights.

2. Involve upper-level residence in the coverage of call duties. Unfortunately, due to gaps in the program this schedule would most likely involved residents up to the PGY4 level taking and in house call. PGY3 and PGY4 residents are routinely covering ORs so their involvement in in-house call and subsequent absence post call will disrupt the OR coverage.

3. Reinstitute a night float system.

1. Can you think of other alternatives?

2. Should we consider applying for an increase in compliment?

3. Should we seek funding for mid-level support for in house call coverage?

4. Which scheme is preferred?