GRADUATE MEDICAL EDUCATION COMMITTEE
GMEC Responsibilities Legend
CC 3
Greenville Memorial Hospital
8:09 AM – 10:20 AM, Thursday, 1/23/2014
Minutes
ATTENDANCE:
GME Admin:
Family Medicine:
Internal Medicine:
Med/Peds:
OB/GYN:
Ortho:
Peds:
Psychiatry:
Surgery:
MIS:
Vascular:
Dev Peds:
Sports Medicine:
Emergency:
House Staff:
Quality:
Academic Development:
Guest:
☒Edward W. Bray III, MD
☒Bruce Hanlin, MD
☒J. Michael Fuller, MD
☒Russell Kolarik, MD
☒David Forstein, DO
☒Scott Porter, MD
☒Kerry Sease, MD
☒Julius Earle Jr., MD
☒Dane Smith, MD
☐William Cobb IV, MD
☒Chris Carsten, MD
☒Desmond Kelly, MD
☒Kyle Cassas, MD
☐Melissa Janse, MD
☐Lyle Jackson, MD
☐Robert Mobley Jr, MD
☐Brenda Thames
☒Karin Matheson
☒Tom Blackwell, MD
☒Erik Buzby, MD
☒Jim Freeman
☐Sean Bryan, MD
☒Ann Griffith
☐Sharon Keiser, MD
☒Kyle Jeray, MD
☒Kenneth Rogers, MD
☒David Cull, MD
☒Alfie Carbonell, MD
☐Joshua Knott, MD
☐Lauren Leffler, MD
☒Jay Crockett, MD
☐James Davis, MD
☒Kitty Wolcott
☒Marty Lutz, MD
☒Charles Marguet, MD
DIALOGUE
Welcome & Review Minutes
Dr. Edward Bray
AO - Accreditation Oversight of Programs
C&E – Curriculum and Evaluation
Com – Communication with Medical Staff
C/PD – Communication w/Program Directors
DH – Duty Hours and Related Issues
IA Mgmt –Institutional Accreditation Mgmt.
Inno – Innovative Projects/Experimentation
IRP – Internal Review Process & Reporting
PC – Program Changes prior to ACGME
PQ – Patient Safety and Quality
R & C - Reductions & Closures
RC/B – Resident Compensation/Benefits
RS – Resident Supervision
R Stats – Resident Status
VI – Vendor Interactions
Dr. Edward Bray called the meeting to order and minutes were approved.
OUTCOME/
ASSIGNMENTS
Minutes were approved
GMEC
CODE
IA Mgmt
AO
ACGME Communications
CLER Moment
Dr. Edward Bray
GME Expansion Reviews
Dr. Edward Bray
CLER Debrief & Oral Report
Dr. Bray reported that the CLER field officers gave us “significant kudos” and were very
impressed with our faculty, nursing staff, residents & PDs. The meeting went better than
he expected, based on the field officer’s statement that “CEO types don’t accept what
we have to say.” The final meeting went very well. They had a number of suggestions
and reminded us that they weren’t here to tell us what to do but rather to look at our
information, observe facts as they saw them, and compare them to what we said. Dr.
Bray said that he has every reason to believe the written report will match the oral
report, which was read to us from their computer. Field Officers commented that the
Clinical University was very unique, it was notable that senior leadership used clinical
learning environment beyond GME, and they planned to put that in report. They liked
the Academic Council. Residents were very positive overall about their education and
nurses were very supportive. 80-90% of residents reported safety. Most residents were
not familiar with safety/quality terminology. Reporting for safety was consistent, but they
noted that residents submitted very few event reports. Expectation going forward is
documentation that residents and attendings are participating in event reporting. It was
notable that M&M processes with VC of Quality. They commented that hand hygiene
was priority. Most residents participate in QI projects. Most residents, PDs and faculty
reported access to quality data. TOC 90% reported participating in hand off sessions
and there is a culture of close supervision. On floors, there is no document for nurses
to identify competency of residents. They work with residents based on familiarity with
them. The same issue exists with attendings on floors. Dr. Hanlin noted that there is a
list of privileges for attendings online. 30% of PD have seen problems with supervision
in regard to patient care. No difficulty with duty hours. Professionalism – nearly all
residents reported positive culture. Most nurses were very positive regarding professional
interaction. FO reported that this was a very rewarding visit. They gave us an A+ for
the logistics of the visit.
Proposal Presentation / Q&A
IA Mgmt
AO
IRP
AO
IA Mgmt
2
Kenneth Rogers, MD
Child Psychiatry
In SC there is critical need of child psychiatrists & adult psychiatrists. There should be
twice the number in Greenville for the population. Having a fellowship makes a much more
competitive general psychiatry program.
Q: (Sease) Does it make it more attractive to have triple board option w/pediatrics?
A: Only way to get triple board is to have all three in place first.
Q: (Porter) How long after starting program would it take to be triple board certified,
because that is very attractive?
A: At least one class cycled through both programs.
A. (Kelly) It would bring synergy with developmental peds fellowship. Faculty resources
would be shared.
Q: (Jeray) Is there an issue regarding accreditation with how long we’ve had the general
psychiatry program?
A: They function independently.
Q: (Bray) How would you see this program progressing? Would you expect 50% of general
psychiatry residents to transition to child psychiatry? Do they usually go into child
psychiatry after 3rd year or do all four years of general and then move into fellowship?
A: In Columbia, about 30% of residents have gone into child psych, which filled about half
of their spots. I would expect 1-2 per year to go into child psych. Most will start
child psych as PGY4. Department of Mental Health will fund half of the PGY5 spots
each year.
Q: (Forstein) How do you anticipate having time to be PD of this program along with other
responsibilities?
A: Goal is by 2017 we will have recruited someone in to be PD. Dr. Earle can assist with
those duties.
Q: (Freeman) Regarding accrediting an additional residency program when you’re halfway
finished with the first year of another residency program: is that typical across the
country? How dependent are you on the timeline that was projected? Are you as a
chair comfortable and are you aware of other programs that have started a second
residency program halfway through the first year of another program? Are there any
significant physical facility adjustments that would need to be made to add the child
psych program?
A: No. The issue for us/timeline is how do you begin to prepare a system for population
health management. There is no way of taking care of the number of kids out there.
Without having a program in place to take care of. If we wait 4 years when we
graduate first class, we’ll be behind the eight ball with regard to turning out more child
psychiatrists to meet needs in area. We’ve expanded current facilities to W. Georgia
Rd, so most second years wouldn’t be on GMMC. In renovation of MIP, there is
additional space allocated for additional residents.
Q: (Sease) Would anciliary providers need to be expanded (e.g. child psychologist, etc).
Can be partnered with Developmental Peds.
A: (Kelly) We’ve had those for years funded out of the psychology budget.
Q: (Jeray) If child psychiatrists are in demand, why are most in practice focused on
adults?
A: Most see adults as well as children because treating children is a grueling process,
so they want variety. Most programs around country are closing because psych
reimbursements aren’t adequate so the system decides to discontinue the program.
3
Q: (Cull) Is there no operational challenge with adding a second accredited program?
A: That is correct.
4
Jay Crockett, MD
Colorectal Surgery
The hospital’s mission is to teach innovatively. The community expects it. We need
to keep focused on teaching in this institution. Our community is growing & aging.
There are no colorectal training program in the Carolinas. There is one in Atlanta, a
few in Florida, and none in Alabama. Why do we need to train more? Data supports
that colorectal surgeons do surgery at lower cost with better mortality than general
surgeons. There are only 56 programs in the country (approx. 100 positions/year).
Patients want specialists and residents want specialized training. Residents look
forward to being on colorectal service, and they have a history of keeping up with
paperwork, etc.
Why should we have a colorectal program over other programs? It’s our turn; we’ve
been working on adding this program for three years. The program would be cheap –
we only need one resident; everything else is already in place (no staff, no call rooms,
etc). We already have two general surgery residents who want to start in the
colorectal program.
Q: (Freeman) Would you be required to have a PD & PC?
A: Yes, I’ve been Associate PD for two years.
Q: (Forstein) What is the impact of having residents working under fellows?
A: We have the approval of the Department of General Surgery.
Cull – When you bring a fellow onboard, it raises the quality of the General
Surgery residency and the applicant pool.
Q: (Forstein) Regarding academic productivity, how much is coming out of the
colorectal division?
A: Some members are more active than others (2-3 papers per year). A colorectal
resident would be expected to add at least one paper per year.
Q: In your application, several questions were answered with “TBD.”
A: The comleted application is due in August.
Q: (Porter) How many residents are on your service? Will the format be a mentorship
model?
A: We have two residents and six attendings. There will be no specific rotation; the
resident will go to colorectal clinic and will be free to choose the cases that he
wants each week. The resident will rotate through each faculty member a month
at a time.
Q: (Freeman) What percentage of time will you allot to Program Director’s duties?
Reimbursement will come from teaching buy-back?
A: I’ll set aside one afternoon a week for administrative duties.
(Bray) If we add another resident to any department, it will change the balance
from other departments.
Cull – Regarding questions answered with “TBD,” the process of submitting the
application has been going on for over two years. During that time, the process
changed within hospital and residency requirements. The final modifications have
been put on hold pending approval.
Carbonell – This is exactly how they started their fellowship. There have been missed
opportunity for trainees to have 1 in 7 cases covered and not have the ability to
train someone.
5
Tom Blackwell, MD
Marty Lutz, MD
Erik Busby, MD
Dates to Remember
Dr. Edward Bray
Adjourn
Emergency Medicine
Q: (Sease) I have concerns about space; we’re already limiting the number of peds
residents rotating in the ER. Peds volume decreases after 2 AM. Are there enough
cases to support overnight peds rotation?
A: The current renovations will take out a wall to provide more space.
Q: (Forstein) You have 28 hours/week for core faculty?
A:
Q: (Cull) – The case you’ve made is to add a residency program to add to the quality of
the ER. That is the reverse of what seems typical.
A:
Q: (Jeray) How do you fund this? Why go for 10 at once? Residents slow down
treatment.
A: Residents aren’t in Emergency Department all year; they’re rotating on other services.
They’re 24/7; not on call. In my years of experience, having residents in the ER does
improve efficiency. They’re looking at volume and acuity in this geographic area.
Q: (Cull) Could this program be based centrally in Greer so it’s not counted in our
numbers/budget?
A: It’s been part of the consideration.
Urology
Q: (Freeman) Where would program be located? What are physical facility needs?
A: The program would be located in the Department of Surgery.
Closed GMEC Review / Next Steps
February 5, 2014, 7:00 PM – 8:00 PM Enhancing Your Medical Career with a Public
Health Experience (location TBD) AAMC-CDC Cooperative Agreement Webinar Series
http://tinyurl.com/orhrgfm

February 3-5, 2014, 8:30 AM – 4:30 PM Professional Grant Development Workshop:
CU/Fee $595 (866-704-7268)

February 24, 2014 – Writing Your Specific Aims Workshop (866-704-7268)

March 7, 2014, 12:00 PM – 2:00 PM - Ethics Faculty Training (HSEB Learning
Studio 105)
There being no further business, the meeting adjourned at 10:20 AM.

Next Meeting:
2/27/2014; 8:00 AM in CC3.
C/PD
AO
IA Mgmt
wider
or/Near
Miss
Reporting
AO
IA Mgmt
C/PD
6