The University of New Mexico
Graduate medical Education
GME Committee
13 February 2007
Chair: John C. Russell, MD, DIO
Present: Sterling, Hoffman, Pendergast, Gonzalez, Sparkman, Cleve, Bachofer, Bocklage, Russell, Phelps, Charlton, Harrison
Introductions
David Gonzalez, MD, Executive Medical Director of Patient Safety and Quality Improvement was welcomed as a new member of the committee. Dr. Gonzalez will serve to provide assistance in addressing quality assurance issues in which resident physicians can participate, as well as a University Hospital representative. Quality assurance activities need to be better attended by resident physicians. The Committee on Excellence at UNM meets the fourth Thursday of each month and could have participation from residents.
Action: The Resident Council will ask for resident participation in the Committee on Excellence at UNM and the Quality Management Committee.
GME Minutes12/12/06
The GME Committee minutes from 12 December 2006 were distributed, discussed and reviewed by the committee.
Action: The minutes of the GMEC from 12 December 2006 were accepted as presented to the committee.
Committee Reports
The following committee chairs provided reports to the GMEC:
-Operations Committee & the GME Forum meetings were combined on 30 January 2007. The committees heard reports from all the GME Committees, including the Rightsizing Committee. Quarterly duty hours were reviewed for the period of October to December 2006. Internal Medicine had a violation of thirty hours of continuous service at both the VA and UH. An action plan was submitted by the Department. Neurological Surgery had one violation of .6 tenths of an hour when averaged over a four week period. An action plan was requested from the department. Sara Morley of the HSC Library offered to provide departments with a system to track completion of resident learning modules. The system would allow programs to review which modules their trainees had completed.
-Program Review Committee met on 1 February 2007. The institutional most common citations were reviewed and discussed. Program reviews were conducted in Cardiovascular Disease, and Child and Adolescent Psychiatry. A program review follow-up on recommendations was overdue from Thoracic Surgery. ACGME letters of accreditation were reviewed and discussed for Forensic Pathology, Pediatrics, and Family Medicine Sports Medicine. Forensic Pathology and Pediatrics received full accreditation. Family Medicine Sports Medicine is a newly accredited program.
-Policy & Procedure Committee met on 18 January 2007. Minor wording modifications were made to the disabled callroom policy, background checks, and the sick leave policy. New policies were developed for the deficit reduction act. The lactation station was added under miscellaneous benefits. The duty hour protocol was reviewed by the committee and accepted.
-Resident Council met on 4 January 2007, and 6 February 2007. A task force is being formed to review a transfer of patient care system that is currently being used by the University of Washington. The committee was asked for volunteers. Discussion occurred around the CIR union election dates as well as the results of the election at the following meeting. Resident reports were heard from Medication Safety, Medical Executive Committee, and Tobacco Free Campus. The reorganization of the UH 6th Floor Callrooms which include accommodations for medical students was discussed.
-Coordinator Council meeting was held on 25 January 2007. A guest speaker from Guardian Insurance was present to discuss the resident’s disability insurance, and the conversion option. NRMP rank order entry dates are 13, 14 February 2007. Data entry will be through the Office of GME. Dates of intern orientation, transitional year educational conference, and upper level orientation were distributed.
Action: The GMEC approved the actions taken by the committees and task force as appropriate.
Old Business
-Unionization with the Committee of Interns and Residents was voted in with a majority vote on 31 January 2007. Approximately seventy percent of the residents voted with over two thirds of the voters in favor of unionization. The institution is composing leadership committees which will set at the negotiation table with the CIR.
-GME Systems Analyst position was strongly recommended by the GMEC to assist program with New Innovations, web design, converting the GME billing database to a database which would interact with banner, and managing the GME database. A job description was developed and the appropriate paperwork for a new position was approved by the University. However, due to budget limitations in the GME Office, the position was not approved by the SOM Executive Dean’s Office. A plan to piece mill out the responsibilities of the job is being developed by the HSC Library in conjunction with GME, and the SOM Executive Dean’s Office. Initial meeting reveal an HSC Library staff person should be able to work on the conversion of the GME billing system to one which interacts with Banner. Meetings are scheduled to see if a library staff person can be assigned to provide assistance with New Innovations and/or web design.
-Institutional Standards to Address Outcomes Project were discussed at the last meeting. Based upon those discussions, a list of items was presented to the committee as a minimum standard for addressing the ACGME outcomes project from an institutional position. Minimum tracking requirements are procedures (if not tracked by RRC website), in-service examination scores, GME curriculum completion, and board score rates. New Innovations short range plans are a down load from RRC procedure tracking databases to New Innovations. The guidelines should be developed to include who will review the data and how it will be used to address the ACGME outcomes project.
Action: A policy guideline should be developed which not only indicates minimum standards for tracking institutional data, but to indicate how it will be reviewed, evaluated, and by whom.
ACGME Citation in Common (Rev Jan 07)
The ACGME citations in common for the institution (attachment 8 IRD) was updated for the past six months and distributed to the committee for review. Program evaluations remain the most common citation with 23 programs having citations. New Innovations should be able to resolve the citation if properly used by each program. Inadequate scholarly activities were the second most common in fifteen programs. The institution has made efforts to increase tracking through annual scholarly activity reporting and the introduction of a web based modules on research design. Program letters were a common citation which has increased during the past six months. Instructions on when and how to prepare program letters was presented to the Operations Committee and Coordinator Council. The out dated VAMC affiliation agreement was cited in two programs. Since that time the institution has been able to negotiate updating the agreement.
Institutional Duty Hour Violation Report – Surgery – Action to Resolve
A duty hour violation from the Department of Surgery was reported on the institutional duty hour reporting web site. The rotation was mid December 2006 for a Surgery rotation at University Hospital. The person worked in excess of one hundred hours for the week. The Department of Surgery had submitted a response for the concern. However, the response did not correlate with the concern which was reported. The Department of Surgery will be asked for a response which correlates to the violation.
Action: The Department of Surgery will be asked to respond to the alleged duty hour violation for the week of 15 December 2006 at University Hospital.
Resident Salary & Benefit Recommendations 2007-08
Resident salaries based on the institutional six year plan to bring UNM to the mid point of the western region of the AAMC survey were presented to the committee for review. Paul Roth, Executive Vice President of the HSC assured resident physicians of no change in benefits for 2007-08. Salaries and benefits will be subject to negotiations between the University and the CIR.
Action: The committee accepted the proposal for resident salaries and benefits with the understanding benefits and salary are subject to CIR negotiations.
Rightsizing Request – 2007-08
The Department of Pathology and the Department of Radiology had funding requests which have occurred since the time of the Rightsizing Committee. The GMEC heard request for the following:
-Pathology requested 2 FTE funded by University Hospital for academic year 2007-08. The request was based on educational rationale, and increased service needs of UNMH. University Hospital and TriCore Labs provide better educational opportunities to meet ACGME accreditation standards than the VAMC. Pathology had received a three year allocation of financial support from UH which ended this academic year. If UH does not fund the two positions, the responsibility of support for service at UNMH would be with the Department of Pathology.
Action: The GMEC was supportive of the Department of Pathology request for University Hospital to fund 2 FTE. A recommendation from the GMEC will be forwarded to the Executive of the School of Medicine and University Hospital.
-Radiology requested 2 FTE funded by University Hospital for academic year 2007-08. The rational was based upon the increased service needs and educational opportunities that will be created by the Bill and Barbara Richardson Pavilion which opens in the Spring 2007. The Department of Radiology currently pays for these two positions and would like to transfer financial responsibility to University Hospital.
Action: The GMEC was supportive of the Department of Radiology request for University Hospital to fund 2 FTE. A recommendation from the GMEC will be forwarded to the Executive Dean of the School of Medicine and University Hospital Administration.
Administrative Fee for Funding GME/Budget
The administrative fee from University Hospital for the Office of GME is $750 per resident per year based on approximately 326 residents funded by UH. Efforts to increase the administrative fee to one which would cover the cost of GME administration continues. In order for the Office of GME to break even, it would require an administrative fee of approximately $3,100 per resident. The national average administrative fee for other GME Offices is approximately $3,500 per resident. The GME budget which was submitted for academic year 2007-08 was a deficit of approximately $1.3 million. The cost associated with the Human Simulation Lab had been removed from the Office of GME and placed under UME. However, that decision was reversed and the cost of the Human Simulation Lab, approximately $285,000, was added to the GME budget for 2007-08. With the added cost of the Human Simulation Lab the administrative fee per resident would increase to approximately $3,800 in order to break even.
Demonstration (U of WA) Transfer of Patient Care System
Ben Hoffman, MD is working with a task force to evaluate systems, which would work with the current Cerner and PowerChart system, which would provide greater information in patient charts to deliver a better standard of patient care. One system which is being considered is from the University of Washington. The standardized patient sign off system updates approximately every two hours. The system was demonstrated at the annual AAMC meeting and meets standards established by JCAHO. Notes, progress reports, and sign out sheets would be included in the system. The University of Washington has offered to provide use of the system to UNM SOM at an affordable cost. Individuals who are interested in the product should contact Dr. Hoffman for a demonstration.
Future Agendas
The following agenda items were established for future meetings:
Round Table
-The New Mexico legislature is considering a medical student loan repayment bill during the current session.
-Dr. Harrison reported a new residency program is being considered for funding by the state legislature for Silver City in Family Medicine. The program may be part of the Memorial Hospital program in Las Cruces. It has not been completely defined.
-The UNM Dental program has a request before the legislature for funding for a second year of training in Roswell.
-The National Health Service Corp has stopped offering the scholars program and is not accepting new enrollees.
The next meeting will be 13 March 2007
