Mount Auburn Hospital
Medical Education Annual Report
June 28, 2011
Charles J. Hatem, MD
Director of Medical Education/Designated Institutional Official
Accreditation Council for Graduate Medical Education
Institutional Organization and Responsibilities (Section I.B.4.b)
“The Designated Institutional Official (DIO)… must present an annual report to the
Organized Medical Staff…and the governing body of the Sponsoring Institution…This
annual report will review the activities of the Graduate Medical Education Committee
(GMEC) during the past year with attention to, at a minimum, resident supervision,
resident responsibilities, resident evaluation, compliance with duty-hour standards, and
resident participation in patient safety and quality of care education.”
The Graduate Medical Education Committee (at Mt. Auburn the GMEC= the Medical
Staff Education Committee/members listed in Appendix 1) meets monthly to review the
spectrum of medical education issues within Mt. Auburn Hospital. Typically, issues
pertaining to undergraduate, graduate and continuing medical education are discussed,
but this report will focus on the training of interns and residents (=housestaff) at MAH.
The previous Medical Education Annual Report to the Mt. Auburn Board of Trustees was
presented on March 23, 2010.
Overview:
1. The Committee is well acquainted with ACGME residency requirements:
“Minimum Program Requirements Language Approved by the ACGME, September
28, 1999
Educational Program: The residency program must require its residents to obtain
competencies in the 6 areas below to the level expected of a new practitioner. Toward
this end, programs must define the specific knowledge, skills, and attitudes required and
provide educational experiences as needed in order for their residents to demonstrate:
a. Patient Care that is compassionate, appropriate, and effective for the treatment of
health problems and the promotion of health
b. Medical Knowledge about established and evolving biomedical, clinical, and
cognate (e.g. epidemiological and social-behavioral) sciences and the application
of this knowledge to patient care
c. Practice-Based Learning and Improvement that involves investigation and
evaluation of their own patient care, appraisal and assimilation of scientific
evidence, and improvements in patient care
d. Interpersonal and Communication Skills that result in effective information
exchange and teaming with patients, their families, and other health professionals
e. Professionalism, as manifested through a commitment to carrying out
professional responsibilities, adherence to ethical principles, and sensitivity to a
diverse patient population
f. Systems-Based Practice, as manifested by actions that demonstrate an awareness
of and responsiveness to the larger context and system of health care and the
ability to effectively call on system resources to provide care that is of optimal
value.”
2. Current background information dealing with MAH Graduate Medical
Education (GME) follows:

There are 68.74 FTE residents who are/will train at MAH this current academic
year. These include residents in Medicine, Radiology, Surgery, Emergency
Medicine, OB/Gyn, Pediatrics, and Podiatry (A MAH-base Podiatry Residency is
slated to begin in the Fall, 2011). Within the Internal Medicine training program
there are 50 residents and 2 chief residents, and within the Diagnostic Radiology
program there are 13 residents.

The Internal Medicine and Diagnostic Radiology Programs are MAH-based
residencies for which we are reviewed by separate program and institutional
mechanisms on a regular basis.

Regarding Accreditation Status by the Resident Review Committees:
o Medicine: Program Director/Dr. Eric Flint; Associate Program
Directors: Drs. Cherie Noe and Patrick Gordan.


effective 5/15/10 – Next site visit – 5/1/15 – Cycle
length – 5 years.
Last internal review – 8/3/09 – next internal review due
– 11/6/12
o Radiology: Program Director/Dr. Pierre Sasson; Associate Program
Director: Dr. Edward Marianacci.

Effective 4/7/2010 – next site visit 4/1/15 – Cycle
length 5 years.
o Last internal review – 9/20/07 – next internal review due 10/3/12.
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Report Details:
Resident Supervision
Supervision with the MAH graduate training programs is the responsibility of all the
faculty who practice within inpatient and outpatient arenas of the institution. The basic
process issue within medical education here and elsewhere is the graduated assumption of
responsibility, under supervision, as the key element in the development of professional
independence.
Within the Department of Medicine there is broad matrix of supervision beginning with
close assessment by the hierarchy within the resident training program. As well, the
MAH hospitalist program as well as the Intensivists/Critical Care physicians provide 24/7
on-site supervision of the housestaff in the provision of care. Similarly, the availability of
24/7 Emergency Medicine Faculty and access to the full complement of subspecialists are
essential resources for the care of patients as well as being crucial to our training
programs.
Programmatically, the Internal Medicine (IM) Residency program meets regularly as the
Educational Council , a construct within the Department of Medicine devoted to weekly
reviews of the Internal Medicine Residency. This Council is comprised of the Chair of
Medicine, Program and Associate Program Directors of the IM Residency, Chair of the
Clinical Competence Committee, Head of the MAH Hospitalist Program, Chair of
Cardiology, Intensivist/Critical Care physician, Community Primary Care practitioner
and the Chief Residents in Medicine. The sole purpose of this Council is the ongoing
surveillance of the IM Residency program and assuring that residents are being trained
properly and progressing on an individual basis as required. There is also a weekly
conference of the Program Director of Internal Medicine and Associate Program
Directors along with the Chief Residents in Medicine devoted to a review of housestaff
functioning and program operations.
Within the Diagnostic Radiology Program there are also substantial efforts directed at the
supervision of residents. The key elements of that supervision are:
Faculty supervision is available at all sites of training. All radiologic studies performed
and interpreted by radiology residents between 7am and 9pm on weekdays and between
6am and 6pm on weekends are checked by a staff radiologist within one hour. All studies
performed after hours while the resident is on-duty are checked by the staff radiologist
within 14 hours. Residents must have a minimum of 12 months of training in diagnostic
radiology prior to independent in-house responsibilities.
Faculty back up by phone is immediately available to the night float resident. All faculty
have online access to the department PACS (Picture Archiving and Communications
System) system from home. On-call faculty are available to come into the hospital,
generally within 15 minutes if needed.
Faculty call assignments with home phone and pager numbers are available to the
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residents. Available on-call faculty includes one staff member on-call for general
radiology, one on-call for interventional radiology and one on-call for MRI and acute
stroke.
All percutaneous interventional invasive procedures performed by residents are done so
with direct faculty supervision.
Resident clinical training provides for progressive, supervised responsibility for patient
care. The responsibility or independence given to an individual resident depends on that
residents’ skill, experience and knowledge base.
Residents begin taking in-house independent call after they have successfully completed
12 months of training in diagnostic radiology and have passed the on-call certification
examination. All radiologic images are reviewed and all reports are signed by faculty
within 14 hours.
Programmatically, within Radiology, the Radiology Education Committee meets
quarterly to discuss active residency issues. This Committee is comprised of the Chair of
Radiology, Program Director and Assistant Director, Program Coordinator,
Administration Representative and all of the Radiology Residents;
Additional programmatic oversight is secured by:

Quarterly meetings among the Program Directors and the DIO to review
challenges and strategies the have evolved within each program that might be
applied in a different residency.

As noted, there are annual meetings between the Program Director of the
Diagnostic Radiology Program and his counterparts at Participating Institutions
(Massachusetts General Hospital and Boston Children’s Hospital), and lastly, the

Medical Staff Educational Committee monthly meetings reviews the gamut of
medical education offerings at the hospital, which includes specific reporting by
the Program Directors of the Medical and Radiology Residency programs, as well
as input from residents in attendance;
Resident Responsibilities
The educational objectives for the various training rotations within the Internal Medicine
and Diagnostic Radiology Programs are listed on the CareGroup Portal under the heading
‘New Innovations’. This site contains various administrative details pertaining to the
housestaff as well as detailed curriculum definitions for the various residency rotations.
On line evaluation instruments are here as well as the mechanism for logging duty hours,
which will be discussed below. Here the educational responsibilities are well outlined and
joined with those clearly articulated at orientation and throughout the year pertaining to
pertinent infectious disease recommendations (notably hospital policies on handwashing),
confidentiality and record keeping. Issues of responsibilities for self, significant others
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and patients are reviewed with emphasis at orientation. Annual copies of the document,
Compact Between Resident Physicians and Their Teachers, are distributed and further
defined the mutual responsibilities between residents and faculty.
The Internal Medicine Residency program sponsors a yearly retreat for all medical
housestaff. Each of the last 6 annual retreats has been devoted to the exploration of a
different ACGME competency domain. These programs are conducted under the
sponsorship of the competency committee of the Internal Medicine residency and directly
under the leadership of the Chair of the Competency Committee and the Director of
Faculty Development at MAH. These programs have utilized a variety of techniques to
meet the different educational goals presented by the exposition of each ACGME
competency domain.
Resident Evaluation
As oft said, assessment drives the system, and a variety of approaches are used for the
evaluation of housestaff at MAH. After monthly rotations in the IM residency, input by
faculty about the housestaff along with input by the housestaff about the faculty are
reviewed by the Program Director. Housestaff receive as copy of their evaluations as
does their faculty advisor (assigned to all IM housestaff and with whom they meet every
3 months.) Housestaff performance is monitored regularly throughout the year in weekly
meetings of Drs. Flint, Noe and Gordan along with the chief residents. Housestaff also
meet with the Program Director(s) every 6 months. At year’s end, the Clinical
Competence Committee evaluates each houseofficer to judge their ability to
advance/graduate. Similarly, with the Radiology training program, evaluation forms are
distributed at rotations’ end and copies of completed evaluation are sent to the resident
directly and to the Program Director (PD) for review. The PD meets with each resident
every 6 months to review the evaluations.
An additional project that was undertaken in academic year 2010-2011 was the
development of a resident evaluation form to be used for clinical care assessment at the
bedside. This form was designed for use by the MAH hospitalists as they concomitantly
care for patients with the housestaff.
Required external in-training written exams give to the residents and the programs an
additional sense of accomplishment of training objectives and an ability to advise
modification of an educational plan for each resident.
Compliance with Duty-Hour Standards
The Internal Medicine and Diagnostic Radiology Residencies consistently average 50-60
hours/week for each resident, well within the 80 hour maximum. Internal Medicine tracks
duty hours on the New Innovations web-site noted above, and Radiology uses ‘GoogleDocs’. In both instances, duty hours are monitored by the chief residents and Program
Directors.
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Resident Participation in Patient Safety and Quality
Two of the defined ACGME competency domains are those of Practice-based Learning
and Improvement and that of Systems-based Practice:
Practice-based Learning and Improvement
Residents must demonstrate the ability to investigate and evaluate their care of
patients, to appraise and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and life-long learning.
Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger
context and system of health care, as well as the ability to call effectively on other
resources in the system to provide optimal health care.
With these requirements in mind, residents have been able to participate in a number of
the robust initiatives with the MAH Department of Quality and Safety as well as their
respective Departments. Efforts in the past year have led to a variety of initiatives that
have positively impacted practice. Examples of projects by Medical residents that have
emerged include: safer protocols for the management of deep venous thromboses, the
safer use of anticoagulants and contributing to the development of a more efficient
discharge process.
The Radiology training program requires all of its residents to participate in a quality
improvement project during their training. Residents are supported by the Program
Director and faculty in the design and implementation of these projects. Examples of
such initiatives include:
a. reduction in the turn around time of abdominal CT examinations that are ordered
from the Emergency Department;
b. the use of metallic marker placement over the region of pain for all x-rays;
c. the development of a consent form for pregnant females in need of Chest CT
angiography;
d. development of a teaching file folder on the PACS (picture archiving and
communication systems) system to facilitate morning teaching and review
conference;
e. algorithms for the management of ovarian cystic lesions;
f. the reporting and follow up of small pulmonary nodules.
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Other developments of note:
Interpersonal/Communication Skills and Professionalism Projects
1. Diagnostic Radiology Training Program
A series of workshops have been conducted directed at radiology resident skill
development in how to obtain informed consent; how to communicate fetal demise in the
ultrasound suite; how to disclose medical error and how to communicate bad news in the
mammography suite. This latter domain has been the focus of extensive work by Dr. J.
Pierre Sasson, Program Director, Diagnostic Radiology, and Dr. Beth Lown, Director of
the Mount Auburn Faculty Fellowship in Medical Education and MAH Director of
Faculty Development. Data about communication training for Radiology residents was
gathered from a national survey of Radiology training programs. (Sasson J, Zand T,
Lown B. Communication in the Diagnostic Mammography Suite: Implications for
Practice and Training. Acad Radiol 2008;15:417-424). Subsequently, an innovative
program was designed and implemented that included patients as teachers and raters of
interpersonal and communication skills. A series of Objective Structured Clinical
Examinations (OSCE) were conducted, for both trainees and staff radiologists, which
enhanced skill development in this challenging domain of delivering ‘bad’ news,
particularly to patients undergoing diagnostic mammography with whom there typically
is no prior relationship. (Lown B, Sasson J, Hinrichs P. Patients as Partners in Radiology
Education: An Innovative Approach to Teaching and Assessing Patient-Centered
Communication. Acad Radiol. 2008;15:425-432.)
2. Internal Medicine Residency Program
For the past 25 years, we have conducted a weekly special version of bedside rounds.
These rounds are directed at the residents and involve the Chief of Medicine, Director of
Medical Education, Director of Faculty Development and a staff psychiatrist. A patient
has been selected by one of the residents and permission sought to participate in these
rounds. The patient is thus unknown to the rounding team and faculty. A resident is
allowed 10-15 minutes to elicit the reason as to why the patient has been hospitalized,
identify relevant psychosocial information, and if an emotional matter surfaces, to pursue
it. A pertinent limited exam follows. In the subsequent discussion, the team uses the
elicited primary data as the basis for discussion, and the identification of unanswered
questions. Residents subsequently provide a follow-up on the patients seen as well as a
brief literature review of any unanswered questions. These sessions permit direct
observation of interviewing, physical examination and diagnostic skills. They also focus
the discussion on the relevant psychosocial issues and are a stimulus for literature review.
(Hatem C. Teaching Approaches That Reflect and Promote Professionalism. Acad Med.
2003;78:709-713.)
In the past year, Drs. Lown and Carmody have completed a study of communication skill
development within the Ambulatory Care Center. Phase One of an IRB-approved study
sponsored by the Gold Foundation and the Department of Medicine (The Caring and
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Communication Initiative) has been completed. The goals of the study were to evaluate
an intervention designed to enhance the interpersonal and communication skills of Mt.
Auburn Housestaff and to explore the concept of concordance in healthcare
communication among patients and physicians. With appropriate approvals in place,
resident-patient communication was videotaped and reviewed with the houseofficer, their
advisor and the senior clinicians conducting the study.
Most recently, Dr. Lown has conducted a study dealing with communication and shared
decision-making in family meetings. The goals of this curriculum are to:
 Enhance residents’ abilities to support family members’ emotions, information
needs and capacity during meetings in which a patient’s critical or terminal illness
is discussed
 Recognize and utilize the expertise of team caregivers
 Engage families in shared decision making to integrate the patient’s values with
best medical practice
Teaching Skill Development
Year-long programs aimed at enhancing the teaching skills of medical residents
remain in place with an additional program for radiology residents being developed
for implementation in the new academic year. The Mt. Auburn Fellowship in
Medical Education has now graduated 42 faculty who have completed the year long
program. These faculty provide an important resource in the teaching of residents
as well as educational leadership within MAH.
Examples of Scholarly Work Done by MAH Housestaff
Medicine
Bhargavi Yalamarti, M.D. – Engraftment Syndrome in allogenic hematopoietic stem cell
transplants.
Laila Khalid, M.D. – Bridging Anticoagulation for Perioperative Patients
Sravan Jasti, M.D. – Racial disparities in Mortality of ESRD on Hemodialysis patients
from USRDS
Robert Spencer, M.D. – Circulating Levels of Soluble Endoglin Predict Presence of
Pulmonary Arterial Hypertension
Jeena Sandeep, M.D. – Iodine Content in Multivitamins
Weihong Yang, M.D. – ANA, PBC and Autoantigenomics
Smita Kohli, M.D. – Bleeding complications with PCI: Comparison of bivalirudin and
eptifibatide
Swetha Kommareddy – Drop in intraoperative PTM during minimally invasive
parathyroid surgery is predictor of post op Calcium and PTH in one year.
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Donald Misquitta, M.D. – Hypothyroidism and High Sensitivity CRP
Bibek Koirala – Pneumocystis Pneumonia: A Ten Year Retrospective Review of Mount
Auburn Hospital Cases
Examples of Scholarly Work Done by MAH Housestaff
Radiology
In addition to the projects noted previously, the following papers involving MAH
radiology resident authorship were published:
Lastly, the academic year culminated in the first MAH Scholarship Day during which
time various posters were presented that represented scholarly work done by the Medical
and Radiology Housestaff. A compendium of important cases seen on the medical service
was also compiled by Drs. Reitschuler-Cross and Nagaraja the medical chief residents.
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Future Directions MAH Housestaff
Medicine
Dr. Fatima Afridi
Curriculum Editor
InfectiousDiseases.org
Dr. Azadeh Assarpour
Geriatrics Fellowship
Beth Israel Deaconess Medical Center
Dr. Sravan Jasti
Nephrology Fellowship
Hospital of U. Penn.
Dr. Laila Khalid
Chief Medical Resident
Mount Auburn Hospital
Dr. Smita Kohli
Hospitalist
North Shore Medical Center
Dr. Bibek Koirala
Infectious Disease Fellowship
U. Mass. Memorial Medical Center
Dr. Swetha Kommareddy
Hospitalist
Mount Auburn Hospital
Dr. Donald Misquitta
Informatics Research Fellowship
Harvard Medical School/BMC
Dr. Jeena Sandeep
Hospitalist
Mount Auburn Hospital
Dr. Robert Spencer
Chief Medical Resident
Mount Auburn Hospital
Dr. Bhargavi Yalamarti
Hospitalist
Mount Auburn Hospital
Dr. Weihong Yang
Rheumatology Fellowship
Massachusetts General Hospital
Chief Medical Residents:
Dr. Archana Nagaraja
Endocrine Fellowship
U. Mass. Memorial Medical Center
Dr. Eva Reitschuler-Cross
Palliative Medicine Fellowship
Harvard Medical School
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Future Directions MAH Housestaff
Radiology
The graduating senior residents all passed the American Board of Radiology Oral
Examination and are board certified as of June 2011.
Dr. Christine Coolely Abdominal Imaging/Massachusetts General Hosp.l
Dr. Nidhi Kacholiya MRI/Baylor University Medical Center (Dallas)
Dr. Amy Oliveira
Musculoskeletal Imaging/Massachusetts General Hosp.
Primary Care Training At MAH
In the Residency Matching Program for AY 2011-2012, three additional primary care
interns were matched with MAH. This was made possible because of an earlier initiative
on the part of Department of Medicine and Medical Residency Leadership to secure
approval by the ACGME to approval the expansion of the MAH Medical Resident
Program to 56 housestaff. Subsequently, in response to an RFP for the training of
primary care residents (again Drs. Zinner, Flint and Mr. DiIeso were pivotal in securing
the grant) the MAH was successful in securing funding for these residents (3/year to a
total of 9; the extra residents will be funded by this grand and won’t be included in our
Medicare cap numbers.) Information about the grant:
Affordable Care Act: Primary Care Residency Expansion
AGENCY:
Department of Health and Human Services
Health Resources and Services Administration (HRSA)
AMOUNT:
$2,879.998.00;
GRANTEE NAME:
PROJECT PERIOD:
09/30/2010 -09/29/2015
Mount Auburn Hospital;
DIRECTOR: PROGRAM DIRECTOR/PRINCIPAL INVESTIGATOR: Eric Flint, M.D.
Podiatry Program
Historically, senior podiatry residents from Cambridge Health Alliance have gained
surgical experience at MAH, but new opportunities have lead to the initiation of a new
residency in Podiatric Medicine and Surgery at MAH. Thanks to the efforts of Drs. Basile,
Nauta, Cook and Mr. DiIeso new program application has been submitted and the MAH
was site-visited on 6/17/2011 by the Council on Podiatric Medical Education. Final
approval is pending review by their internal committee, but the preliminary assessment of
the MAH proposal and resources was extremely positive. The new Residency Director
will be Dr.Emily A. Cook, DPM, MPH, CPH, who will bring extensive training and a
passion for educational to this role. It is anticipated that the 3 year program when at full
size will train 6 residents (2 at each level). The expectation is to recruit the initial class of
residents for a September 2011 start.
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Appendix 1: Medical Staff Education Committee
Abookire, Susan, M.D, MPH
Carmody, Matthew, M.D.
Clough Jeanette
D’Afflitti, Joseph, M.D.
DiIeso, Nick
Evans, Jeffrey, M.D.
Flint, Eric, M.D.
Goldsmith, Gary, M.D.
Hatem, Charles, M.D. – (Chair)
Kamat, Brinda, M.D.
Khalid, Laila, M.D.
Kohli, Smita, M.D.
Lown, Beth, M.D.
Mackenzie, Malcolm, M.D.
McCaffrey, Anne, M.D.
Nagaraja, Archana, M.D.
Nauta, Russell, M.D.
Noe, Cherie, M.D.
Park, Brian, M.D.
Pronio-Stelluto, Valerie, M.D.
Sasson, Pierre, M.D.
Schuler, John, M.D.
Sehra, Shiv Tej, M.D.
Shortsleeve, Michael, M.D.
Walker, Xaviour, M.D.
Zinner, Stephen, M.D.
Chair, Quality and Safety
Primary Care Center
President and Chief Executive Officer
Chair, Department of Psychiatry
Chief Operating Officer
Department of Emergency Medicine
Program Director, Int. Med.
Assistant Chair of Medicine
Department of OBGYN
Director of Medical Education
Chair, Department of Pathology
Internal Med. Resident (was PGY3, now
Chief Res)
Internal Med. Resident (was PGY 3)
Director of Faculty Development, Dept. of
Med.
Dept. of OBGYN
Medical Director, The Marino Center for
Integrative Health
Chief Resident
Chair, Department of Surgery
Associate Program Director, Int. Med. Res.
Prog.
Radiology Resident (was PGY4)
Director of Med. Student Ed. – Dept. of
Med.
Program Director, Dept. of Radiology
Director of Surgical Education
Internal Med. Res. (Was PGY 2)
Chair, Dept. of Radiology
Internal Medicine Resident (was PGY 2)
Chair, Dept. of Medicine
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