University of Medicine and Dentistry of New Jersey-

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University of Medicine and Dentistry of New Jersey-

  1. 1. University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School Graduate Medical Education Annual Report for Academic Year 2008-2009 Marie C. Trontell, MD Associate Dean for Graduate Medical Education Chair, Graduate Medical Education Committee Designated Institutional Official University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (RWJMS) Approved by RWJMS Graduate Medical Education Committee on October 13th , 2009
  2. 2. University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School (RWJMS) Graduate Medical Education Annual Report Academic Year July 1st , 2008-June 30th , 2009 GRADUATE MEDICAL EDUCATION Graduate Medical Education (GME) is required training of medical school graduates which results in competence in a specialty/subspecialty of medicine and board eligibility in that field. The number of years required to complete training in a given specialty/subspecialty is determined by the respective Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) or Board of Medical Specialties. The ACGME is responsible for the accreditation of allopathic graduate medical education programs and has five member organizations: the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies. UMDNJ-Robert Wood Johnson Medical School (RWJMS) sponsors fifty residency and fellowship programs. Forty-four of the RWJMS programs are under the auspices of the ACGME, two are under the auspices of the American Board of Obstetrics-Gynecology, one is accredited by the Society of Surgical Oncology, and three are not governed by an accrediting body. The relationship of RWJMS with each hospital participating in RWJMS GME programs is described in an affiliation agreement. RWJMS is also affiliated with residency programs not sponsored by RWJMS at some hospital sites. UMDNJ-Robert Wood Johnson Medical School, through its Graduate Medical Education Committee (GMEC), and the Office of Graduate Medical Education (GME), has the ultimate responsibility for all of the GME programs sponsored by the school. This responsibility includes demonstrating an overall commitment to graduate medical education, maintaining affiliation agreements with other institutions participating in GME, monitoring the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) status of participating institutions, ensuring that formal quality assurance programs are conducted at participating institutions, monitoring eligibility and selection of residents, monitoring all aspects of resident appointment, monitoring resident participation in educational and professional activities, monitoring the residents’ work environment, and monitoring program compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements. The school examines program outcome measures, conducts extensive internal reviews of each GME program, and monitors program compliance with the ACGME duty hour standards. It also monitors that each program teaches and assesses the ACGME general competencies: Patient Care, Medical Knowledge, Practice-Based Learning, Interpersonal and Communication Skills, Professionalism, and Systems–Based Practice.
  3. 3. The GMEC, whose existence and activities are prescribed by the Accreditation Council for Graduate Medical Education (ACGME), is governed by the Bylaws of the Medical School. It is composed of program directors, peer-elected and appointed residents, the Associate Dean for Graduate Medical Education, and administrative representatives from each participating affiliated hospital. The Committee is charged with the responsibility of advising on all aspects of residency education. During academic year 2008-09, the GMEC met ten times. The GMEC meetings include discussions of: ACGME and Residency Review Committee (RRC) requirements; approval of all correspondence and requests before their submission to the ACGME; JCAHO regulations; patient care issues; hospital and resident issues; and state and federal legislation affecting GME. Working with the Office of Graduate Medical Education, the GMEC has developed and approved policies which govern all programs. These policies are gathered and filed in the GME Policy Manual, which is maintained on the RWJMS GME web site (http://rwjms.umdnj.edu/gme). The GMEC is supported by the Office of Graduate Medical Education. The Associate Dean for Graduate Medical Education is the Designated Institutional Official, whom the ACGME defines as having “the authority and responsibility for all the ACGME-accredited GME programs”. The Associate Dean reports to the Senior Associate Dean for Education, Stephen Lowry, MD. The Office of Graduate Medical Education conducts an annual Orientation Program for new residents, facilitates the registration and permit process required of all unlicensed physicians in New Jersey, and provides support for each residency and fellowship program. The office also maintains oversight of program-specific policies required by the ACGME and by UMDNJ-Robert Wood Johnson Medical School. OUTCOMES MEASURES Accreditation Status of Graduate Medical Education Programs at UMDNJ-RWJMS UMDNJ-Robert Wood Johnson Medical School is currently (November 2009) the sponsoring institution for fifty active Graduate Medical Education Programs, forty-four of which are eligible for ACGME accreditation and are fully accredited by the ACGME. RWJMS as an institution and all of its programs eligible for ACGME accreditation are fully accredited. Programs Accredited by the ACGME: Anesthesiology Residency Adult Cardiothoracic Anesthesia Fellowship Pain Medicine Fellowship Colon and Rectal Surgery Residency Dermatology Residency Emergency Medicine Residency(September 2009) Family Medicine (New Brunswick) Residency Geriatric Medicine Fellowship Sports Medicine Fellowship Family Medicine (Capital Health) Residency Family Medicine (CentraState) Residency Geriatric Medicine Fellowship
  4. 4. Internal Medicine Residency Cardiovascular Disease Fellowship Endocrinology Fellowship Gastroenterology Fellowship Infectious Disease Fellowship Nephrology Fellowship Rheumatology Fellowship Interventional Cardiology Fellowship Hematology/Oncology Fellowship Pulmonary/Critical Care Fellowship Neurology Obstetrics/Gynecology Residency Orthopedic Surgery Residency Pathology Residency Hematology/Pathology Fellowship Pediatrics Residency Pediatric Critical Care Fellowship Pediatric Hematology- Oncology Fellowship Pediatric Developmental-Behavioral Fellowship Neonatal-Perinatal Medicine Fellowship Physical Medicine and Rehabilitation Residency (at JFK) Preventive Medicine-Occupational Medicine Residency Psychiatry Residency Child and Adolescent Psychiatry Fellowship Forensic Psychiatry Fellowship Geriatric Psychiatry Fellowship Radiology – Diagnostic Residency Vascular Interventional Radiology Fellowship Surgery Residency Vascular Surgery Fellowship Thoracic Surgery Residency Urology Residency Programs Not Accredited by the ACGME: Advanced Heart Failure and Transplant Cardiology Fellowship (no accreditation available) Breast Surgery Fellowship (Approved by the Society of Surgical Oncology) EMS/Disaster Medicine – (no accreditation available) Family Medicine-Health Policy Fellowship (no accreditation available) Obstetrics/Gynecology Maternal Fetal Medicine Fellowship- Placed on probation by the American Board of Obstetrics/Gynecology Obstetrics-Gynecology Reproductive Endocrinology/Infertility Fellowship –Accredited by the American Board of Obstetrics-Gynecology National Resident Matching Program UMDNJ-RWJMS programs matched 100% of sought positions via the 2008-2009 National Resident Matching Program (NRMP); 92.6% of the matched positions were filled by US senior students. In the 2009 NRMP, the following programs filled all matched positions with US seniors: Dermatology, Family Medicine New Brunswick, Internal Medicine, Obstetrics-Gynecology, Orthopaedic Surgery, Pediatrics, Physical
  5. 5. Medicine and Rehabilitation, Psychiatry, Radiology, Radiation Oncology, and Categorical General Surgery. Performance on Certifying Examinations Performance on board certification examinations is carefully reviewed each year. During 2008, 88.1% of the 130 graduates who took the written board certification exam passed on the first attempt. The passing rate for all graduates taking written board certification exams in 2003 was 87.3%; in 2004 was 90.2%, in 2005 was 91.3%, in 2006 was 95.90%, and in 2007 was 93.40%. GMEC Program Reviews The GMEC is required by the ACGME to conduct internal reviews of each program at the midpoint of each program’s review cycle. In the 2008-2009 academic year the GMEC conducted Internal Reviews of eight programs, ensuring compliance with all the programmatic requirements. The protocol for the review process, mandated by the ACGME, was followed meticulously. Programs reviewed were: Pathology – 09/09/08 Dermatology – 09/09/08 Family Medicine-New Brunswick – 02/03/09 Anesthesiology - 02/03/09 Family Medicine- Sports Medicine – 04/14/09 Neurology – 04/14/09 Pediatrics-Hematology/Oncology – 04/14/09 Preventive-Occupational Medicine – 04/14/09 New Program Directors Approved by the RWJMS GMEC for ACGME approval Amy Church, MD, Program Director for Emergency Medicine Residency (proposed) Shelonitda Rose, MD, Program Director for Internal Medicine Hematology Oncology Fellowship Sung Kim, MD, Program Director for Radiation Oncology Residency New Programs Approved by RWJMS GMEC for Development The GMEC considers all proposed new GME programs prior to the program’s application for accreditation and/or inception. Four programs were evaluated and approved by the GMEC during the 2008-09 academic year; all four subsequently received initial accreditation from the ACGME. The four programs were: Adult Cardiothoracic Anesthesia Fellowship Pediatrics Developmental-Behavioral Fellowship Forensic Psychiatry Fellowship Emergency Medicine Residency ACGME Program Reviews Results of ACGME Accreditation Site Visits and Reviews conducted 7/1/08 to 6/30/09: Psychiatry – Child and Adolescent – 7/08/08 – Continued Accreditation Family Medicine – New Brunswick- Geriatrics – 12/17/08 – Continued Accreditation Orthopedic Surgery – 05/12/09 – Continued Accreditation Neurology – 05/13/09- Letter of Notification pending Family Medicine CSMC – Geriatrics – 05/14/09 – Continued Accreditation Colon Rectal Surgery – 06/09/09 – Continued Accreditation
  6. 6. Pain Medicine – 06/10/09 – Letter of Notification pending Emergency Medicine – 06/10/09 – Initial Accreditation Pathology- Hematology/Pathology – 06/11/09- Continued Accreditation PATIENT SAFETY Patient safety and the delivery of quality patient care are top priorities of the RWJMS residency programs, the office of Graduate Medical Education, and the GMEC. Resident education in patient safety and quality of care begins with all new residents during Resident Orientation and continues throughout the year in each program. Throughout the academic year, residents’ training includes: physician impairment, fatigue, recognizing and treating drug/alcohol abuse, stress/anxiety; work hour policies; universal precautions; and compliance with State and Federal Regulations. To prevent or reduce the transmission of vaccine-preventable and other communicable diseases between residents and their patients, the University’s Policy on “Resident Immunizations and Health Requirements” is strictly monitored by Employee Health Services. Efforts continue to fit test all residents with required respiratory equipment at each affiliated hospital. The GMEC also discusses quality of care and safety issues throughout the year. A representative from each hospital is a voting member of the GMEC and participates in committee meetings, Internal Reviews, and all activities of the GMEC. These hospital representatives facilitate communication between each hospital and the GMEC to ensure improved patient safety and the delivery of quality patient care. HOUSESTAFF ORIENTATION Each year an orientation session is held for residents and fellows new to UMDNJ- RWJMS to prepare them for their residency program at RWJMS. Faculty and guest speakers present sessions on the following topics: state regulations from the Board of Medical Examiners, University policies, blood banking, physician impairment, legal issues involving malpractice, the Employee Assistance Program, professional ethics, HBV/HIV prophylaxis, universal health precautions, and resident fatigue. Two workshops are provided as part of orientation: Residents as Teachers and Equal Opportunity and Diversity. RESIDENTS AS TEACHERS RWJMS recognizes the crucial role played by residents in the teaching of medical students, colleagues, and patients. The school offers institution-level and residency-level programs to enhance the skills of residents who teach, evaluate, or supervise medical students. Residents are involved in teaching and supervising medical students on core clerkships in Family Medicine, Internal Medicine, Pediatrics, Psychiatry, Obstetrics- Gynecology, and Surgery. The clerkship directors, residency program directors, and GME office have worked together to enhance the residents’ role in teaching and supervising medical students in many ways. The importance of the residents’ role in the teaching of medical students is discussed frequently at meetings of the RWJMS GMEC, whose membership includes program
  7. 7. directors, peer-elected residents, and hospital representatives. Residents receive written copies of the clerkship objectives and guidelines for student evaluation at the beginning of each clerkship rotation. Each residency program provides written materials, workshops, or other learning sessions to residents which are designed to improve the residents’ teaching and evaluating skills. The programs maintain records of these offerings and the residents’ participation in them; these records are shared with the Associate Dean for GME on a biannual basis. The Associate Dean for GME shares this report with the Senior Associate Dean for Education. The students’ evaluations of the residents with whom they work are submitted electronically. The Associate Dean for GME reviews these evaluations and provides feedback to program directors as necessary. These efforts ensure full awareness of medical student teaching and supervision issues and cooperation between Program Directors and Clerkship Directors. RWJMS and the GME Committee have created a “speaker’s bureau” composed of faculty and staff with expertise and interest in pedagogy which has been made available to all residency programs to supplement the department’s educational initiatives. The teaching skills of residents working with clerkship students are formally assessed by the students at the end of each clerkship rotation. These evaluations are part of the residents’ permanent file and are reviewed at least twice a year with the resident by the program director. “Best practices” developed by residency program faculty to enhance resident teaching of students are described and presented to all residency program directors. RESIDENT SPECIFIC ISSUES Work Requirements The GME Office and the GMEC maintain vigilance to be sure all programs comply with the ACGME-mandated limitations on resident duty hours. The ACGME duty hours standards state: 1) duty hours must not exceed 80 hours per week, averaged over a 4-week period, 2) residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, 3) there should be a period of at least 10 hours provided between all daily duty periods and after in-house call, 4) in-house call must not occur more frequently than every third night, averaged over a 4-week period, and 5) continuous on-site duty must not exceed 24 consecutive hours; residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. RWJMS residency programs remain compliant with the ACGME Requirements for Resident Work Hours, which went into effect July 1, 2003. Each program monitors its residents’ duty hours. Random quarterly resident surveys and focus group meetings conducted by the GME office and the ACGME resident survey summaries help to ensure that all requirements are being met. The request of any resident to work outside of their program (“Moonlighting”) must be submitted to RWJMS for consideration and possible approval. Approval must be obtained from the Program Director, the Department Chair, the GME Associate Dean,
  8. 8. and the UMDNJ Compliance Office before a resident is allowed to moonlight. Such permission is only granted if there is there is full assurance that the number of hours worked per week will not exceed 80 hours and that there is no conflict with any component of the residency or fellowship. Supervision Resident Supervision receives ongoing attention from the GMEC and the Medical School. Specific guidelines have been developed to assure adequate supervision for residents and fellows. Each program monitors the supervision of its trainees at all participating sites. Each trainee is assigned to a designated service. Back up is available at all times through more senior house officers, faculty, and other attending physicians. Each program director is responsible for establishing detailed written policies describing resident supervision at each level for each site involved in their individual residency program. The requirements for on-site supervision are established by each department in accordance with ACGME guidelines and are monitored through departmental reviews. A copy of each program’s supervision policy is on file in the GME Office. Resident supervision is also monitored through the GMEC Internal Review process and annual “focus group” meetings with the Associate Dean for GME and trainees in each program. Responsibility The general expectations of residents are listed in the GME policy manual and program- specific responsibilities are defined by each program for each post-graduate year level. Each program is required to attach a description of the role for each year of residency training to the resident’s contract. This contract is signed by the resident, the program director, the chair, and the dean’s designee (the Associate Dean for GME). The GMEC monitors common and program specific requirements of the ACGME to ensure compliance. Feedback Residents may communicate any concerns, without fear of reprisal, to the RWJMS Ombuds, the UMDNJ Ombuds, peer-elected residents on the GMEC, and to the Associate Dean for Graduate Medical Education. Residents are provided an open forum to discuss concerns at each meeting of the GMEC. At every GMEC meeting, the agenda includes a report from the Chair of the Resident Council and discussion of any resident concerns. A resident in any program may anonymously refer any issue to the GMEC by discussing it with one of the peer-elected resident members of the GMEC. Additionally, Focus Group meetings with residents and the GMEC Internal Reviews provide still another mechanism to monitor resident issues and the balance between education and service requirements.
  9. 9. During the 2008-09 academic year, the Associate Dean for GME conducted 37 focus group meetings with residents in RWJMS programs to obtain their feedback: A report of the results of each meeting was sent to the training program’s Program Director and Department Chair. Follow up meetings were scheduled if needed. Evaluation The GME Policy Manual describes guidelines for the residents’ performance evaluations. Each Program Director assumes responsibility for establishing the mechanism and frequency of performance evaluations in compliance with the ACGME essentials for the specific program. Formal evaluation sessions with each resident occur at least twice a year. The program’s compliance with evaluation standards is assessed in the GMEC Internal Reviews.
  10. 10. Distribution List: UMDNJ-Robert Wood Johnson Medical School Executive Council Dr. Peter S. Amenta, Dean, UMDNJ-RWJMS Dr. Stephen F. Lowry, Senior Associate Dean for Education, UMDNJ-RWJMS Dr. Al Maghazehe, President and Chief Executive Officer, Capital Health System Dr. Robert Remstein, Vice President for Medical Affairs and GMEC Representative, Capital Health Sys Mr. John T. Gribbin, President and Chief Executive Officer, CentraState Dr. Benjamin Weinstein, Sr. VP, Medical Director and GMEC Representative, CentraState Dr. Frank Castello, Medical Director, Children’s Specialized Hospital, New Brunswick Mr. John P. Sheridan, Jr, President and Chief Executive Officer, Cooper University Hospital Dr. Carolyn E. Bekes, Sr. VP for Acad & Med Affairs, Chief Compliance Officer & GMEC Rep, Cooper Mr. John R. Ernst, President and Chief Executive Officer, DH&LC Dr. Lynn B. McGrath, Vice President for Medical Affairs and GMEC Representative, DH&LC Mr. Scott Gebhard, Executive Vice President and Chief Operating Officer, JFKMC Dr. William Oser, Vice President for Medical Affairs and GMEC Representative, JFKMC Mr. Steven G. Littleson, President, JSUMC Dr. David Kountz, Senior VP of Medical and Academic Affairs and GMEC Representative, JSUMC Dr. Susan Rosenthal, Director of Medical Education and GMEC Rep, JSUMC Dr. Jeffrey Levine, Director, Division of Academic Affairs, Overlook Hospital Mr. Michael R. D’Agnes, President and Chief Executive Officer, RBMC Mr. Stephen Jones, President and Chief Executive Officer, RWJUH Mr. Kevin McTernan, VP Administrative Services, RWJUH Mr. Mark Rappaport, Senior VP for Operations GMEC representative RWJUH Mr. Carl O’Brien, Asst. VP Business Planning & Development and GMEC Representative, RWJUH Ms Claudia Pagani, Director of Nursing Education, GMEC representative, RWJUH Mr. Alfred Glover, President and Chief Executive Officer, SPUH Mr. Mahendra Solanki, Director of Medical Education & DIO and GMEC Representative, SPUH Mr. Christopher Kosseff, President and Chief Executive Officer, UMDNJ-UBHC Dr. Theresa Miskimen, VP for Medical Services and GMEC Representative, UMDNJ-UBHC Mr. Mark Jones, President, The University Medical Center at Princeton Dr. Kathryn Robinson, Associate Program Director, The University Medical Center at Princeton Dr. Dennis P. Quinlan, Sr., Chief of Medical Services, VANJHCS Dr. Marilyn Miller, Assoc. Chief of Staff for Education and GMEC Representative, VANJHCS

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