Teimouraz Vassilidze, MD, PhD, DSc
David Tabagari, MD, PhD
Est. 2008
 In the US, there were 661,400
physicians and surgeons in 2008.
 22 MD per 10,000 population
In Georgia, there are approximately
25,000 physicians and surgeons
currently.

 55 MD per 10,000 population
Est. 2008
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
Country
Cuba
Greece
Belarus
Austria
Georgia
Russia
Italy
Norway
Switzerland
Niue
Iceland
Netherlands
Kazakhstan
Azerbaijan
Portugal
Uruguay
Andorra
Spain
Armenia
Lithuania
Bulgaria
Israel
Czech
Republic
Sweden
Lebanon
Germany
France
Denmark
Estonia
Physicians density (physicians/1,000
population)
6.4
6.04
4.87
4.75
4.54
4.31
4.24
4.08
4.07
4
3.93
3.92
3.88
3.79
3.76
3.74
3.72
3.7
3.7
3.66
3.63
3.63
3.63
3.58
3.54
3.53
3.5
3.42
3.41
Est. 2008
Healthcare improvement in Georgia
developing through:
 Opening of new and well-equipped
hospitals with good infrastructure.
 Increasing healthcare funding via state and
private medical insurance.
 Improving patient quality care through
physician competence, knowledge and
professionalism.
Est. 2008
Currently, there is neither standard postgraduate training, nor continuum of
medical education in Georgia.
As a consequence, there are no objective and
standardized evaluation of physician competencies
and professionalism.
Licensing and board certification are not feasible
without standard post-graduate training.
As a result, it leads to substandard quality
healthcare in spite of improved facilities and
funding.
Est. 2008
Our goal is, by using the American
model of medical residency and by
recruiting board certified American
physicians as consultants, to develop
the best training program for our
residents and students, and for the
generation of future leaders in medical
specialties in Georgia.
Est. 2008
Residency is an essential dimension of
the transformation of the medical
student to the independent practitioner
along the continuum of medical
education.

 Whereas, medical school teaches physicians a
broad range of medical knowledge, basic clinical
skills, and limited experience practicing medicine,
medical residency gives in-depth training within a
specific branch of medicine.
Est. 2008
The U.S. medical education system was
almost completely invented at Johns Hopkins
University: everything from the prerequisites
required to get into medical school to the 4year program, to the residency system that is
currently used today.
Est. 2008
In 1867, Johns Hopkins, merchant, banker, entrepreneur and
philanthropist, incorporated The Johns Hopkins University and
The Johns Hopkins Hospital, and appointed a 12-member
board of trustees for each. Upon his death in 1873, he left $7
million to be divided equally between the two institutions.
Est. 2008
The university was founded on January 22, 1876 and
named for its benefactor, the philanthropist Johns
Hopkins. Daniel Coit Gilman was inaugurated as first
president on February 22, 1876
Daniel Coit Gilman
1875-1901
Dr. Gilman consulted with all leading specialists in Europe,
USA and Canada, and within one decade developed a
system with full laboratory array in bio-medical science in
part by hiring the most reputable scientists. Gilman
believed that teaching and research are interdependent,
that success in one depends on success in the other.
Est. 2008
Johns Hopkins Hospital was completed in 1889 and
included, what was then, state-of-the art concepts in
heating and ventilation to check the spread of disease.
The services of four outstanding physicians, known as the
"Big Four,“ where instrumental as the founding staff of
the hospital. They were pathologist William Henry Welch,
surgeon William Stewart Halsted, internist William Osler,
and gynecologist Howard Atwood Kelly.
William Henry Welch
William Stewart Halsted
William Osler
Howard Atwood Kelly
Est. 2008
A munificent gift from Mary Elizabeth Garrett, heir to the
great Baltimore and Ohio Railroad fortune, enabled The
Johns Hopkins University School of Medicine to open and to
enroll its first class in October 1893. Her gift, however,
provided much more than financial assistance to this
fledgling institution. It carried conditions that led to the
transformation of American medical education.
Mary Elizabeth Garrett
Est. 2008
Mary E. Garrett’s stipulations brought about the greatest
educational changes.
Her three stipulations brought the greatest educational changes:
1) That women be admitted to the medical school on equal
terms as men to “all prizes, dignities or honors that are
awarded by competitive examination”.
2) “The Medical School of the university shall be exclusively a
graduate school and that it shall provide four years’ course,
leading to the degree of Doctor of Medicine”.
3) Applicants required to have a bachelor’s degree and proof
that they have satisfactorily completed courses in physics,
chemistry and biology and have a “good reading knowledge
of French and German”.
Est. 2008
 Equally important was William Osler’s greatest contribution to
medicine: the establishment of the medical residency program, an
idea that spread across the country and remains in place today in
most training hospitals. The success of his residency system
largely depended on its pyramidal structure with interns, fewer
assistant residents and a single chief resident. With time, the
system transformed to become rectangular instead of triangular to
accommodate modern demands.
 One of the most important aspects of the Halsted school of
surgery was the training of residents to be not only surgeons but
also teachers of surgery. Halsted fully trained 17 chief residents of
whom 11 became professors of surgery at medical schools and set
up residency training programs in their new posts according to the
Halsted’s model. The programs trained 168 surgeons thereby
spreading the residency training principles all over the country.
Currently, United States surgery is Halstedian surgery.
Est. 2008
JOHNS HOPKINS UNIVERSITY & MEDICAL SCHOOL:

Radically transformed medical education

Ushered new era marked by rigid entrance
requirements for medical students

Upgraded medical school curriculum with
emphasis on the scientific method

Incorporated bedside teaching and lab
research as part of instruction

Created standardized advanced training in
specialized field of medicine with the
creation of the first house staff fellowships
and post graduate internships
Est. 2008
 For the resident, the essential learning activity
is interaction with patients under the guidance
and supervision of faculty members who give
value, context, and meaning to those interactions.
As residents gain experience and demonstrate
growth in their ability to care for patients, they
assume roles that permit them to exercise those
skills with greater independence. This conceptgraded and progressive responsibility- is one of
the core tenets of American graduate medical
education.
-(ACGME requirements)
Est. 2008
A physician may choose a residency in:
RESIDENCY
CHOICES
• Anesthesiology
• Dermatology
• Emergency Medicine
• Family Practice
• Internal Medicine
• Neurology
• Obstetric and Gynecology
• Pathology
• Pediatrics
• Plastic and Reconstructive surgery
• Psychiatry
• Physicians Medicine and Rehabilitation
• Radiology
• Radiation Oncology
• Surgery
• and other specialties
Est. 2008
MEMBER
BOARDS
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
• American
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
Board
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
of
Allergy and Immunology (1971)
Anesthesiology (1941)
Colon and Rectal Surgery (1949)
Dermatology (ABMS Founding Member)
Emergency Medicine (1979)
Family Medicine (1969)
Internal Medicine (1936)
Medical Genetics (1991)
Neurological Surgery (1940)
Nuclear Medicine (1971)
Obstetrics and Gynecology (Founding Member)
Ophthalmology (Founding Member)
Orthopaedic Surgery (1935)
Otolaryngology (ABMS Founding Member)
Pathology (1936)
Pediatrics (1935)
Physical Medicine and Rehabilitation (1947)
Plastic Surgery (1941)
Preventive Medicine (1949)
Psychiatry and Neurology (1935)
Radiology (1935)
Surgery (1937)
Thoracic Surgery (1971)
Urology(1935)
Est. 2008
Est. 2008

All applicants for residencies participate in National Resident
Matching Program (NRMP)

NRMP is a United States-based non-profit, non-governmental
organization created in 1952 to help match medical school
students with residency programs. The NRMP is sponsored by:
i.
ii.
iii.
iv.
v.
The
The
The
The
The
American Board of Medical Specialties
American Medical Association
Association of American Medical Colleges
American Hospital Association
Council of Medical Specialty Societies
Applicants and 1st Year
Positions in the Match
Est. 2008

The 2012 Main
Residency
Match was the
largest in
NRMP. More
than 38,000
applicants vied
for 26,772 PGY1 and PGY-2
positions.
Est. 2008
PERCENT OF MATCHES BY CHOICE AND TYPE OF
APPLICANT, 2012
Est. 2008
UNMATCHED APPLICANTS:
For unmatched applicants during Match week 2012, NRMP launched the
Supplemental Offer and Acceptance Program (SOAP) that was designed to
automate, streamline and equilize the process for unmatched applicants
seeking unfiled positions to replace the Scramble.
Est. 2008
Est. 2008
 Graduation of residency leads to eligibility for
board certification and membership/fellowship of
several specialty colleges and academics
 In some states of USA, residents, after 1 year
residency, may obtain limited license to practice
medicine in settings such as urgent care centers
and rural hospitals. In order to obtain
unrestricted state license, it is required to
successfully complete the full residency program
ranging from 3 to 7 years.
Est. 2008
Est. 2008
Est. 2008
Est. 2008
FINANCING RESIDENCY PROGRAMS:
 The Department of Health and Human
Services, primarily Medicare, funds the vast
majority of residency training in the US. This
tax-based financing covers resident salaries and
benefits, as well as subsidies to teaching
hospitals through payments called DME and
IME payments.
 As a courtesy of the pharmaceutical industry,
private funding for dermatology residents is also
available for limited residency slots.
Est. 2008
REGULATING & MONITORING OF RESIDENCY
PROGRAMS:
ACGME- The Accreditation Council For Graduate Medical
Education is the non-profit, private council responsible for
evaluating and accrediting the majority of graduate medical
training programs for MDs in the US.

The ACGME’s member organizations are:
 American Board of Medical Specialties
 American Hospital Association
 American Medical Association
 Association of American Medical Colleges
 Council of Medical Specialties Societies
Each of these organizations appoints four members to the
ACGME’s board of directors.
Est. 2008
REGULATING & MONITORING OF RESIDENCY
PROGRAMS:
RRC- The Residency Review Committee, are councils that
approve new residencies in each specialty and limit the
number of specialists in their field.

COGME- The Committee on Graduate Medical Education,
was founded in 1989 as a forum for medical program directors,
department chairs and others. The COGME provides an
ongoing assessment of physician workforce trends, training
issues, financing policies, as well as:
 assures that programs in compliance with their
disciplinary requirements
 assures the educational appropriateness of program
design
 reviews proposed changes in residency programs
 monitors institutional agreements
 establishes and monitors program policies required by
the ACGME

Est. 2008
RESIDENCY CURRICULUM:
Each residency program has its own competencybased curriculum which was structured by the sixstep approach that included:
Problem Identification and General Needs Assessment
Needs Assessment of Targeted Learners
Competency-based Goals and Objectives
Educational Strategies
Implementation
Evaluation and Feedback
Est. 2008
ANESTHESIOLOGY:
CA-1 Year
CA-2 Year
•Introduction to Clinical Anesthesiology: 2
months
•Basic Anesthesiology Rotation: 5 months
•Surgical ICU: 1 month
•Advanced Airway Management: 1 month
•Cardiac Anesthesiology: 1 month
•Neurosurgical Anesthesiology
•Obstetric Anesthesiology: 1 month
•Vacation and Sick Time: 20 days
•Conference Time: 3 days
•Cardiac Anesthesiology: 1 month
•Obstetric Anesthesiology: 1 month
•Neurosurgical Anesthesiology: 1 month
•Pain Management: 1 month
•Non-Cardiac Thoracic Anesthesiology: 2
months
•Pediatric Anesthesiology: 1 month
•Regional Anesthesia: 1 month
•Acute Pain Management: 1 month
•Surgical ICU: 1 month
•Vascular Anesthesiology: 1 month
•Vacation and Sick Time: 20 days
•PACU: 2 weeks
•Pre-op Assessment Clinic: 2 weeks
•Conference Time: 3 days
CA-3 Year
Residents elect and design their final year
from the following choices:
Pain Management
Cardiothoracic Anesthesiology
Obstetric Anesthesiology
Research (limited to 6 months)
Clinical Anesthesiology with research
emphasis
Critical Care
Pediatric Anesthesiology
Regional Anesthesiology
Advanced OR Cases: The resident chooses
the most complex case on any day's
schedule (minimum 3 months)
In the CA-3 year there are 20 days
combined vacation/sick time and 5 days
conference time allowed
Est. 2008
INTERNAL MEDICINE:
Resident Year I – Categorical
•Continuity Clinic: 1/2 day/week
•Outpatient Medicine: 2 weeks
•Ward Medicine: 3-4 months
•Medical Intensive Care Unit: 1 month
•Cardiac Care Unit (CCU): 2 weeks (paired
with cardiology night medicine)
•Cardiology (Telemetry): 2 weeks (paired
with cardiology night medicine)
•Night Medicine/Night Cardiology: 8-10
weeks
•Hematology/Oncology: 0-1 month
•Emergency Room: 1 month
•Elective: 7-9 weeks
Resident Year II
Resident Year III
•Continuity Clinic: 1/2 day/week
•Ward Medicine: 2-3 months
•Night Medicine: 1-2 month
•Medical Intensive Care Unit: 4-8 weeks
•Telemetry or CCU: 1 month
•Outpatient Clinic: 1 month
•Renal: 0-4 weeks
•Electives/Selectives*: 7-11 weeks
•Continuity Clinic: 1/2 day/week
•Ward Medicine: 2-3 months
•Medical Intensive Care Unit: 1.5 months
•Telemetry or CCU: 1 month
•CCU Nights: 1 month
•Outpatient Clinic: 1 month
•Geriatrics and Palliative Care: 4 weeks
•Electives/Selectives: 7-13 weeks
Est. 2008
SURGERY:
PGY 1
General
Surgery : 4 6
months
Trauma
Surgery : 1
month
Burn Surgery :
1 month
Vascular
Surgery : 1
month
CT Surgery : 1
month
Neurosurgery :
1 month
Orthopedics : 1
month
Otolaryngology
: 1 month
Transplant : 1
month
Urology: 1
month
PGY 2
General
Surgery : 4
months
Surgical ICU :
1 month
Transplant : 1
month
CT Surgery : 1
month
Vascular
Surgery : 2
months
Thoracic/
General
Surgical
Oncology : 1-2
months
Burn Surgery :
1 month
Plastic Surgery
: 1 month
PGY 3
• General
Surgery: 4
months
• Trauma
Surgery: 2
months
• Vascular
Surgery: 1
month
• Surgical
Endoscopy: 1
month
• Children’s
Hospital: 2
months
PGY 4
• General
Surgery: 5
months
• Trauma
Surgery: 2
months
• General
Surgery: 4
months
• Vascular
Surgery: 1
month
PGY 5
• General
Surgery: 10
months
• Vascular
Surgery: 2
months
Est. 2008
INITIATING RESIDENCY PROGRAM IN GEORGIA:
Starting a residency program is a multi-year endeavor that requires both
program organization and cultivation of widespread support from
various groups within the specific practice site.
NECESSARY STEPS:







Inception and Initial Assessment
Resources
Recruiting
Program Design
Accreditation process
Funding
Residency regulations and standards
Est. 2008
INCEPTION & INITIAL ASSESSMENT:
Fundamental step in initiating residency program
is to determine if necessary elements for training
practitioners are in place.
 One of the most important concepts of our project
is that the residency program in Georgia be
designed following the standards and requirements
of the American residency system and that residents
be taught/ trained by board-certified American
MDs/consultants
Est. 2008
As part of initial assessment, specific questions must
be answered:
 How many resident positions should there be initially?
 Exact number of residents depends on factors such as the approved
curriculum and available facilities.
Should the program be affiliated with a medical school?
 There are substantial benefits to medical school affiliation.
Should the program be accredited? Who will accredit?
 The value of accreditation, through the Ministry of Health, is significant and
speaks highly of the commitment to excellence in residency training. The
accreditation process is a continuous quality improvement process that cannot
be reproduced internally.
What is the primary purpose of the residency program?
 The program purpose is to improve knowledge, skills and professionalism of
Georgian physicians leading to highest standards of patient quality care.
Which agency will regulate legal and logistical issues in the future?
 Creation of analog of ACGME/COGME- oversight committee responsible for
addressing and solving of legal, administrative and financial issues within
Georgia.
Est. 2008
RESOURCES:
 MD Staff:
 American board certified consultants in anesthesiology,
internal medicine and surgery will rotate for 2 to 4 weeks,
replacing each other to provide continuous teaching process.
Each consultant will train according to specified curriculum
segment.
 Selected Georgian specialists will participate on a full-time
basis in assisting American trainers.
 Medical facilities:
 Affiliated Medical school;
 Well-equipped hospitals willing to participate in the training
process;
 A medical center with multi-disciplinary departments;
 Ambulatory centers.
 Logistical question of whether to base the residency program
solely in Tbilisi or to encompass other target cities in Georgia.
Est. 2008
RECRUITING:
 Criteria for Finding Candidates:
Selection of residents will be based on submission of
application, followed by an interview of selected candidates
and subsequent final evaluation will be based on:
a) High academic achievements, including
matriculated scores and grade point averages;
b) Knowledge of English;
c) Strong faculty recommendation letters;
d) Prior research experience;
e) ECFMG certificate or high score on USMLE are
beneficial;
After acceptance to the program, residents will be required to
pass the test for Cardiac Life Support (ACLS) Certification
through the internet.
Est. 2008
PROGRAM DESIGN:
 Curriculum:
Curriculum will be based on rotational learning experience.
• 3-year program for internal medicine residency
• 3-year program for anesthesiology residency
• 5-year program for surgical residency
 Learning Objective:
 Daily face-to-face resident-faculty and junior-senior resident
teaching is critical to excellent patient care and successful
residency education.
 Didactic training will include:
• Clinical case conferences
• Introductory lecture series
• Core curriculum lectures
• Journal Clubs
• Keyword Phrase Mini Lectures
• Morbidity and Mortality Conferences.
Est. 2008
PROGRAM DESIGN continued:
 Evaluation
 In-training examinations will be administered semi-annually, and pertinent information will
be reviewed and compiled as part of the progress review by the Program director.
 Achievement of satisfactory performance levels for all seven competencies will be monitored
after completion of each rotation. Competencies based on ACGME criteria:
1. Patient Care
2. Medical Knowledge
3. Practice-based Learning and Improvement
4. Interpersonal and Communication Skills
5. Professionalism
6. Systems-based Practice
7. Technical Skills
 At the end of each training year, exams will be held to determine resident’s readiness for
proceeding to the next level of training.
 During the last year of the program, the best residents will be promoted to the Chief
Resident status and, contingent upon successful graduation, will remain in the program as
part of permanent staff.
 Training Manual
 “Road-map” of the residency program
 Specialty handbooks, journals, textbooks and web-based programs as educational
resources
Est. 2008
ACCREDITATION PROCESS:
 Accreditation of the proposed Residency Programs.
 One sponsoring institution must assume ultimate responsibility for the
program, and this responsibility extends to resident assignments at all
participating sites.
 Agreement contract between the Residency Program and each participating
site (Medical School, Hospitals, Ambulatory Centers).
 There must be a single program director with authority and accountability
for the operation of the program.
 Issuing Georgian licenses for American consultants in order to train in
Georgia.
 Certification and licensing of residency trainees after completion of program.
 Evaluation and approval of standardized specialty examination questions.
Est. 2008
FINANCIAL:
 Funding for residency program via grants, as well as public and
private channels.
 Expenditures:
 Travel and lodging expenses for teaching consultants;
 Salaries for full-time Georgian staff;
 Stipends for residents;
 Acquisition of necessary medical equipment to meet the
standards of care of the American Medical Association,
medical literature, payment for website library, etc.
Est. 2008
RESIDENCY REGULATIONS & STANDARDS:
 Contract between residents and program, outlining responsibilities,
relevant benefits, vacation and working schedule, etc.
 Resident compliance to rotational schedules and requirements of the
program as outlined in contract.
 Sponsoring organizations and practice sites must have contractual
arrangement(s) or signed agreement(s) that define clearly the responsibilities
for all aspects of the residency program.
The resident will be committed to attaining the program’s educational goals
and objectives.
 A residency is a full-time obligation. Residents must manage their activities,
external to the residency, so as not to interfere with the program.
 Residents must seek constructive verbal and documented feedback that
directs their learning. Residents must be committed to making active use of
the constructive feedback provided by residency program coordinators.
Est. 2008
LOOKING AHEAD:
 Work on creation of an American-Georgian Medical Center
staffed by the residency program graduates and by
American-Georgian MDs returning from United States.
 Development of fellowship programs in subspecialties for
graduates to continue further training.
Est. 2008
IN CONLUSION:
• Georgia must work collaboratively within, in order to
deliver the best medical care, equaling if not rivaling that
of the West. The acid-test for our success will be the
influx of foreign patients coming to Georgia for the
exceptional healthcare we have to offer.
• Starting a residency program is a significant
undertaking, requiring a lot of hard work. However, the
end result will be one of the most professionally
rewarding experiences achievable.
• Once the residency program is implemented, the staff
will find that the quality of, and the pride associated
with, the services they provide are irreversibly enhanced.
Est. 2008