GRADUATE MEDICAL EDUCATION COMMITTEE
CC 3
Greenville Health System
8:15 AM – 10:00 AM, Thursday, 12/18/2014
GMEC Responsibilities Legend
AO- Accreditation Oversight of Programs
C&E- Curriculum and Evaluation
Minutes
ATTENDANCE:
GME Admin:
House Staff:
Family Medicine:
Sports Medicine:
Surgery:
MIS:
Colorectal:
Vascular
Internal Medicine:
Med/Peds:
OB/GYN:
Ortho:
OSM/Total Joint:
Peds:
Dev Peds:
Psychiatry:
Child Psych.:
Emergency:
Quality:
Education Assessment:
Academic Develop:
Guests:
☒Edward W. Bray III, MD
☒Laura Copeland, MD
☒R. Bruce Hanlin, MD
☐Kyle Cassas, MD
☒Dane Smith
☐Alfredo Carbonell, DO
☐Jay Crockett, MD
☒Chris Carsten, MD
☐J Michael Fuller, MD
☒Russ Kolarik, MD
☒Sharon Keiser
☒Scott Porter, MD
☒Richard Hawkins, MD
☐Kerry Sease, MD
☒Desmond Kelly, MD
☒Julius Earle, MD
☐Kenneth Rogers, MD
☒Melissa Janse, MD
☒Robert Mobley Jr, MD
☒Ryan Otto,
☐Brenda Thames
☒Latonya Garrett
☐Ann Griffith
☐Shannon Burgess, MD
☐Jeffrey Swartz, MD
☐Franklin Sease, MD
☒David Cull, MD
COM- Communication with Medical Staff
☒Derek Payne
☐Richard Gurich, MD
☒Irfan Asif, MD
C/PD- Communication w/Program Directors
DH - Duty Hours & 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 & Quality
☐Mark Call, MD
☐William Schmidt, MD
☒Jeffrey Elder, MD
☐Kyle Jeray, MD
☐Brian Burnikel, MD
☐Jennifer Hudson, MD
☐John Williams, MD
☐Ben Griffeth, MD
☐Peter Tilkemeier, MD
R&C- Reductions & Closures
RC/B- Resident Compensation/Benefits
☐Thomas Wheeler III, MD
RS- Resident Supervision
R Stats- Resident Status
☐Jon Lucas, MD
VI- Vendor Interactions
CLE- Clinical Learning Environment
☐Greg Hawkins
☒Mark Wess, MD
☒Kitty Wilcott
DIALOGUE
Welcome & Review Minutes
Dr. Edward Bray
Duty Hours Report Review
Dr. Edward Bray
Dr. Edward Bray called the meeting to order. November minutes were approved.
OUTCOME/
ASSIGNMENTS
Minutes were approved
Dr. Bray introduced and welcomed Dr. Richard Hawkins who is the Program Director for the
Orthopaedic Sports Medicine Fellowship previously facilitated by the Steadman-Hawkins
Foundation but is now under the GMEC oversight.
Introduction of Richard
Hawkins, MD;
Orthopaedic Sports
Medicine
Dr. Bray stated that all departments are continuing to do well with Duty Hour Reporting.
Documentation by the Program Directors is 100% compliant. No problems/issues were
reported.
Duty Hour Reports
monitored
GMEC
CODE
IA Mgmt
AO
C/PD
DH
House Senate Report
Dr. Laura Copeland
Dr. Laura Copeland reported that the resident food drive was successful. A competition that
involved residents from each department raised 1400lbs of food that was donated to
charity. Dr. Copeland also stated that the residents are looking to start more projects in
the future.
IA Mgmt
AO
C/PD
PQ
Dr. Copeland reported that during the last House Staff meeting the GHS Lab Department’s
Dr. Knight and Ginger Smith attended to discuss dropped or missed lab orders. Various
lab processing improvements were discussed and the lab was very supportive of improving
processes and the residents’ concern regarding patient safety.
Dr. Bray stated that he would like for the financial consultant regarding a specialty
disability insurance proposal to present their information to the House Senate Leadership.
Dr. Bray stated that this is the best unisex policy rate that he has seen offered and that it
is highly competitive in the market. Dr. Bray reported that HR has approved the proposal
and other institutions have taken part in this program, (i.e. MUSC and Wake Forrest).
ACGME Communications
Dr. Edward Bray
PQ
HR approved offering
the specialty disability
insurance policy.
Information will be
presented to the
House Senate.
RC/B
Dr. Scott Porter stated that this policy is attractive and agrees that the proposal should be
presented to the House Senate. In addition, he adds that the company also has a desire
to address the House Staff as a whole with unbiased financial planning as part of the
Business in Medicine curriculum. Dr. Julius Earle agreed with Dr. Porter regarding the need
to provide these topics to graduating residents within the business in medicine curriculum.
C&E
Dr. Bray asked if any department had any direct communication with ACGME that need to
be reported. No one reported any communications. Dr. Bray stated that there was an ecommunication sent out on December 1st regarding Phase I Site delay. The communication
is noted on the GMEC SharePoint.
IA Mgmt
AO
Dr. Bray also reminded the Program Directors of the deadline to update contact
information with in the ADS system. Dr. Bray reiterated that the accounts in ADS are how
the ACGME contacts a specific department.
C/PD
Dr. Julius Earle reported one resident has been placed on remediation to address
professionalism competencies and inappropriate communication. A medical student
reported that the resident had used nicknames in addressing them and did not stop in
spite of being asked to discontinue the behavior. It was also reported that a medical
student felt the resident did not monitor or intervene appropriately during an interview with
a hypersexual. The School of Medicine and GHS Human Resources have been notified. The
PGYIII resident will be assigned to additional training on professionalism and appropriate
communication. Dr. Earle reported that the residents have rapport and a level of comfort
with each other but this behavior should not have been assumed appropriate for any
concerned. Dr. Earle reported that he does not think there was any egregious intent and
that the incident has been taken seriously and has been addressed.
PGY III Psychiatry
resident being
remediated on
professionalism and
appropriate
interpersonal
communication/
teaching
RS
R Stats
2
ACGME CommunicationsCont’d.
Dr. Edward Bray
EPIC and eCW Orientation
Training Needs
Dr. Mark Wess
Dr. Asif reported a PGYII female was placed on remediation for rotation standards not
being met. Despite continued improvement efforts and feedback this PGYII was still not
meeting standards. The CCC met after her semi-annual evaluation and a decision was
made put her on probation. A meeting was held with the resident and all of her
options/appeal process was discussed. The next day the resident decided to resign.
Dr. Bray introduced and welcomed Dr. Mark Wess, Chief Medical Information Officer. Dr.
Bray stated that Dr. Wess will further explain what the needs are regarding eCW and
upcoming EPIC training and responsibilities. Dr. Bray stated that the system change from
eCW to EPIC is slated for July 16th. The residents start on July 1st which presents a
problematic training issue. The question posed was, “How much time do we spend during
orientation with these trainings when eCW will be used only 2 weeks prior to the go live
date for EPIC?”
Family Medicine PGY II
resignation
R Stats
Dr. Wess discussed
resident EMR training
needs for new
residents with the go
live implementation of
EPIC
C&E
C/PD
Dr. Wess stated that EPIC training will roll out in many phases. Dr. Wess reported a go live
pilot for EPIC on June 4th which includes 33 providers/practice sites. Ambulatory users go
live is scheduled for July 16th. Other hospital satellite facilities will go live in 2016. Dr.
Wess further stated that there is an EPIC Center link on GHS website that detail the go live
dates. EPIC training requires 4-7 hours of Computer Based Training (CBT) and 1 full ½ day
of instructor-led training. Dr. Wess stated that there is an inpatient component as well that
some departments will also have to complete that will take place in January/February
2016. Dr. Wess stated that for the 10 business days prior to go live a determining factor
could be whether or not a resident is scheduled for clinic. Dr. Wess reiterated that access
to EPIC will not be granted to residents who do not complete the training and pass a test.
Dr. Wess opened the discussion for questions.
Dr. Scott Porter questioned why they chose to implement the go live during a time of high
turnover with residents. Dr. Wess answered that the dates are flexible; however, moving the
date back has a cost involved. Dr. Wess also stated that upper management felt this
timeframe was the best.
Dr. Irfan Asif asked how much time an intern will need to be proficient. Dr. Wess answered
stating that 4-7 hours of CBT could be completed in during clinical service downtime in 30
minute increments. In addition, residents would have to attend a full ½ day (4 ½ hour) of
instructor-led hands-on training and pass a test. In summary, Dr. Wess stated that an intern
could complete the training and test in 2-3 days.
Dr. Chris Carson asked about the class size capacity.
in the class were ideal with 30 being the maximum.
Dr. Wess stated that 15-30 people
Dr. Sharon Keiser asked if this training could be added into the Orientation schedule for
incoming house staff? Dr. Wess stated that he has spoken with Ann Griffith, Manager of the
Graduate Medical Education (GME) Program, whom stated that the Orientation schedule was
already full and the addition was probably not possible.
3
EPIC and eCW Orientation
Training Needs-Cont’d.
Dr. Mark Wess
Dr. Russ Kolarik inquired if existing house staff could complete training in June and the
new house staff complete in July? Dr. Wess answered yes existing house staff will be
scheduled.
C&E
C/PD
Dr. Scott Porter asked if the training counts against the 80 hour work week. Dr. Wess
answered yes. Dr. Wess stated that acute facilities will go live in February 2016.
Dr. Bray asked that each residency department to report back to Dr. Wess regarding their
need for eCW training during orientation and to contact Margaret Durham who is the
training coordinator for the EPIC training schedule for the existing residents?
Dr. Scott Porter asked how we are to know as to whether a resident can omit eCW
training. Dr. Wess answered if you expect an incoming resident to document in eCW
previous to July then they will need training.
If they are just utilizing view print,
shadowing or learning the process then no training is required. In addition, Dr. Wess
stated that omitting the use of eCW could cause data integrity problems. Dr. Wess stated
that if the expectation is for an intern/resident to document in eCW within the first 2
weeks in July then they would need eCW training.
Dr. Sharon Keiser inquired about a new resident or intern that already had training in EPIC.
Dr. Wess stated that they would have a fast track available but some training would be
necessary.
Dr. Bray stated that some residents must have eCW but not all. He further understands
that problems arise when they transfer into other departments where eCW is being utilized.
Dr. Bray asked that the Program Directors report their resident training needs to Dr. Wess
and Ms. Durham.
3-Year GME Expansion Plans
Dr. Edward Bray
Program Directors are
to report back to Dr.
Wess regarding their
need for eCW training
during orientation and
to contact Margaret
Durham who is the
training coordinator for
the EPIC training
schedule for the
existing residents
training.
Dr. Bray reminded Program Directors that the 3-Year Expansion Plans are due by the end
of the month.
Dr. Bray stated that GME Expansion Reviews are scheduled for the January GMEC
Meeting. 4 new residency/fellowships (Joint Peds Genetic, Maternal-Fetal Medicine,
Internal Medicine Fellowships-Gastroenterology, Infectious Disease and Cardiology) have
been submitted. Dr. Bray stated that Emergency Medicine had previously been
approved by GMEC; but, the Resource Council (RC) has requested revision in the
financial plan. The EM revised 3-year projected budget has been submitted for AC
review. In addition, EM needed a Department Chair in place. They have now met all
of those requirements and will not have to re-visited by GMEC until funding approval
by AC. Dr. Bray added that the remaining proposals are on SharePoint and should be
read prior to GMEC presentations. Program Directors are asked to ensure familiarity
of each proposal in preparation for voting during the next meeting.
IA Mgmt
AO
Program Directors must
review proposed new
residency/fellowship
programs applications
prior to the next GMEC
Meeting.
4
Academic Council Update
Derek Payne
Derek Payne stated that the Academic Council discussed scholarly publications during
it meeting earlier this morning and reported that the council is looking at quality and
not quantity goals when it comes to publications and how they are chosen. Mr.
Payne stated that a press conference earlier stated GHS was starting a Physician
Assistant (PA) program. The council is still reviewing the financials around this
implementation and is close to making a decision within the next few weeks. In
addition, the number of students’ experiences at the organization is starting to strain
the institution. As a result Dr. Youkey is putting a group together to review the
capacity issues.
Due to the
implementation of EPIC
in July, budgetary
questions and
deadlines will begin in
February or March
IA Mgmt
C/PD
Com
Mr. Payne stated that those with Clemson appointments will have access to Clemson
resources. An email will be sent out with specific instructions at a later date.
Dates for EPIC happen in the summer and because that is typically when budgeting
occurs, finance has been asked to have the budget process completed by June 1 st. As
a result or the rescheduling, the budget process will begin in February or March;
communications will forthcoming for budgetary questions and deadlines.
Resident Salary Comparison
Kitty Wilcott
Kitty Wilcott presented recommended raises for PGYI, PGYII and PGYIII. Ms. Wilcott
stated that according to the national compensation rates from AHEC that GHS salaries
are lower than average. As a result, a 1.35% pay increase is proposed. Dr. Scott
Porter asked if the total benefit package was taken into consideration in comparison
(i.e. free food, iPhone, iPad etc.). Dr. Bray answered stating that the residents look at
pay, other benefits are important but that everyone has an array of benefits and that
but this information is not available to us. Dr. Bray further explained that the
information provided is salary. If GMEC doesn’t feel we need to have a cost of living
increase, then we do not have to approve.
Kitty Wilcott will
provide Program
Directors with the
Resident/Faculty
Benefit Survey which
includes more benefit
information in addition
to salary.
IA Mgmt
AO
C/PD
RC/B
Dr. Robert Hanlin stated that this will affect Family Medicine existing residents as well.
Mr. Payne interjected that from a budget standpoint this proposal would align within
the 2015-2016 budget. Mr. Payne stated typically they do 2% range when setting the
budget. Dr. Spence Taylor, Senior Assoc. Dean for Academic Affairs and President, GHS
Clinical University is in support of the increase. Dr. Bray asked if there was a motion
to approve.
Dr. Porter asked if we could get the other benefit information he previously mentioned.
Mrs. Wilcott stated that she did pull a Resident/Faculty Benefits Survey and it does
list some of the benefits offered by other institutions and would forward the
information to Program Directors. GMEC deferred voting to next month and after
review of the additional information.
GMEC deferred
voting to next
month and after
review of the
additional
information.
5
CLER Moment: Subcommittee
Update:
Dr. David Cull
Dr. David Cull presented an update regarding the CLER Sub-committee on Professionalism
and Supervision and how they have addressed the reported CLER issues. The
committee has reviewed:
a)
b)
c)
d)
IA Mgmt
AO
Current professionalism and supervision policies and their importance
What are we doing to promote professionalism and good supervision
What is the ideal Clinical Learning Environment regarding supervision and
professionalism
How are we doing as it relates to ACGME site survey and what should we do next
Dr. Cull stated that he had reviewed all of the program’s PIFs (Program Information Form)
and was pleased that most include policies regarding professionalism and supervision. He
stated that there is no need to write more policies. Dr. Cull stated that Family Medicine
and Peds had good examples of best practice pertaining to professionalism. Dr. Cull stated
that Surgery and Orthopaedics have good supervision policies in place. He gave an
example of their procedure log used to ensure residents had documented experience
before practice through simulation. Dr. Cull stated that his presentation and surveys were
located in SharePoint for review.
Dr. Cull addressed some of the vulnerabilities identified by CLER survey, specific instances
to be targeted by GMEC and improved:
1. Does Leadership periodically assess/monitor for the culture of professionalism of
medical staff/residency? Dr. Cull interpreted this to mean does the institution have
monitoring in place to promote a culture of professionalism. Proper supervision will
be addressed by the program directors implementing change over time.
2. The hospital does not have a procedure/policy in place for nursing staff to identify
resident’s competency. Dr. Bray is currently working on this issue.
3. Patient awareness as it relates to their care. Dr. Cull explained that they wanted to
know if the patient was aware of the roles of those who were directly providing
care.
4. Residents polled 11-16% felt pressured to compromise their integrity to do what
the attending asked them to do or document. Dr. Bray responded in the scope of
how many patient interactions they have over the course of 1 month (thousands)
the percentage isn’t as bad as it would appear. Also the resident may not
understand the reasoning behind the attending’s decision. Dr. Bray stated that he
had presented the end-of-the-year report (AIR) to the Board of Trustees and that it
was well received but one of the board members did question the 11% integrity.
Dr. Cull stated that GMEC needs to make some recommendations for monitoring.
Dr. Cull stated in summary that there were no serious red flags for professionalism and
supervision. Dr. Cull stated that the committee recommends that the GME Office should
utilize a targeted annual survey of faculty, residents and patients to show if we are
establishing a culture of professionalism. The committee also recommended that IT is
monitored to ensure proper usage.
Recommendation: GME
Office annually survey
faculty, residents and
patients and monitor
each departments
training activities to
assess the culture of
professionalism and
supervision.
C/PD
C&E
6
CLER Moment: Subcommittee
Update- Cont’d.:
Dr. David Cull
It was also suggested that the GME Office obtain information from program directors
regarding specific activities/training that are being done for professionalism and supervision.
Dr. Bray stated that the ACGME doesn’t recognize the title fellow, they say PGYVI or PGYVII
resident thus all of the consent forms use resident.
Annual Reports
Dr. Desmond Kelly
Dr. Russ Kolarik
Dr. Desmond Kelly presented the Pediatrics Annual Report stating that the board pass rate
was 100%. One third of the graduates are going into fellowship training. Scholarly activity
has been successful with 19 Peer reviews, 21 book/book chapter published, 10 poster
presentations presented and one of which the National Meeting is publishing.
Dr. Desmond Kelly presented the Developmental Pediatrics Annual Report stating that they
have a new program coordinator - Melinda Lavallee-Turner (1.6 FTE shared with the
residency program). Did not have board exams last year as they are every other year, but
have been above average. Dr. Kelly reported the program ranked number one in the Match
and the caliber of applicants has improved tremendously.
Dr. Kelly will provide a
response to CLER at a
later time.
Dr. Fuller was absent
and his portion of the
CLER is postponed as
well.
GMEC approved the
Annual Reports for the
following programs:
Pediatrics
Developmental Peds
Combined Med/Peds
IA Mgmt
IRP
AO
Dr. Russ Kolarik presented the Combined Internal Medicine/Pediatrics Annual Report stating
that the program was operating at full capacity of 5 residents. Dr. Kolarik reported that the
program has received national exposure due to their website; especially, in response to
resident testimonials. This attention has caused applicant interest to improve. This year 50
candidates are on the Med Peds waiting list. Dr. Kolarik reported all of their graduates
stayed in the area of primary care and 2 were faculty hires. He reported that board pass
rates are slightly above average. The goal is to improve board pass rates even more. The
next site visit is scheduled for 2018. In addition, the residents have done well in AAP/ACP
awards for scholarly activity.
Dates to Remember
Dr. Edward Bray
3-Year Plans and Expansion Requests are Due Dec. 30th
ACGME Milestone Evaluations Due: January 9, 2015 - to date the DIO has received
notice of any program milestones have been submitted. The following programs
reports are due to ADS:
(Internal Medicine, Ob/Gyn, Family Medicine, Orthopaedic Surgery, Surgery, Peds, Dev.
Peds and Psychiatry)
Program Directors
are to submit
milestone reports
to ADS in a
timely manner.
C/PD
AO
IA Mgmt
Match Deadlines: Jan 31 11:59 pm Quota Change/Rank Order List Feb. 25
ACGME Annual Mtg: Feb 26- March 1, 2015 held in San Diego, CA
AHME Institute National Meeting: May 13-15, 2015
7
Other Business
Dr. Edward Bray
Dr. Bray asked if there were other business items.
IA Mgmt
R Stats
Dr. Irfan Asif questioned the group regarding fatigue issues. Dr. Asif explained that a
resident has been complaining of fatigue due to rotation schedules. Drs. Scott Porter and
Chris Carsten stated that the resident should be urged to utilize the 5 weeks of
vacation/PTO. Dr. Elder stated to have good communication to ensure there are no other
issues like depression.
Adjourn
Dr. Edward Bray
There being no further business, the meeting adjourned at 9:45 AM.
Next Meeting:
1/22/2015; 8:00 AM in CC3.
AO
IA Mgmt
C/PD
8