University of Medicine and Dentistry of New Jersey-
University of Medicine and Dentistry of New Jersey-
Robert Wood Johnson Medical School
Graduate Medical Education
Annual Report
for
Academic Year
2010-2011
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
Reviewed and approved by the UMDNJ- RWJMS Graduate Medical Education Committee at its November 8, 2011 meeting.
University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School (RWJMS)
Graduate Medical Education Annual Report
Academic Year July 1st, 2010-June 30th, 2011
I. INTRODUCTION AND OVERVIEW
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; it 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.
In 2010-2011, UMDNJ-Robert Wood Johnson Medical School (RWJMS) sponsored forty-eight residency and fellowship programs and has a close relationship with the Physical Medicine and Rehabilitation Residency program at John F Kennedy. Forty-five of the RWJMS programs are under the auspices of the ACGME, two are under the auspices of the American Board of Obstetrics-Gynecology and one is accredited by the Society of Surgical Oncology.
RWJMS has affiliation agreements with hospitals participating in required rotations for its GME programs: Atlantic Health System (Overlook), Capital Health Regional Medical Center, CentraState, Children’s Specialized Hospitals, Cooper University Medical Center, Deborah Heart and Lung Hospital, Jersey Shore University Medical Center, John F Kennedy Hospital, Raritan Bay Medical Center, Robert Wood Johnson University Hospital, Robert Wood Johnson University Hospital at Hamilton, Saint Peters University Hospital, University Behavioral Health Care, University Medical Center at Princeton, the Veterans Affairs New Jersey Health System, and the Philadelphia Veterans Affairs System. RWJMS is also affiliated with residency programs not sponsored by RWJMS at some hospital sites.
RWJMS, 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. The school’s responsibility for GME includes demonstrating an overall commitment to graduate medical education, maintaining affiliation agreements with 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 the institution and all programs’ 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 standards, especially limitations on duty hours. The school ensures 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. The Office of Graduate Medical Education facilitates the registration and permit process required of all unlicensed physicians in New Jersey and provides support for each residency and fellowship program and for the Graduate Medical Education Committee (GMEC).
The Associate Dean for Graduate Medical Education, Marie Trontell, MD, is the Designated Institutional Official (DIO), 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, Carol Terregino, MD.
The GMEC, whose existence and activities are prescribed by the RWJMS Bylaws and by the Accreditation Council for Graduate Medical Education (ACGME), met ten times during academic year 2010-11. There were 199 members, including program directors, chief residents, peer-elected residents, the Associate Dean for Graduate Medical Education (the Designated Institutional Official), and administrative representatives from each participating affiliated hospital. The membership of the GMEC elected the Associate Dean for GME to be the committee chair. The GMEC advises the Dean on all aspects of graduate medical education, conducts internal reviews of all residency and fellowship programs, oversees the accreditation status of all programs and all programmatic interactions with accrediting bodies, and discusses ACGME and Residency Review Committee (RRC) requirements, 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 ()
II. OUTCOME MEASURES
A. Accreditation Status of Programs at UMDNJ-RWJMS
UMDNJ-Robert Wood Johnson Medical School is the sponsoring institution for forty-nine active Graduate Medical Education Programs, forty-five of which are eligible for ACGME accreditation and are fully accredited by the ACGME. The following programs underwent ACGME site visits in the 2010-11 academic year:
1. Family Medicine Residency RWJ-New Brunswick – July 13, 2010 - Continued Accreditation
2. Pathology Residency– September 29, 2010 – Continued Accreditation
3. Adult Cardiothoracic Anesthesia Fellowship – September 30, 2010 – Continued Accreditation
4. Surgery Critical Care Fellowship – December 10, 2010 – Initial Accreditation
5. Forensic Psychiatry Fellowship April 14, 2011 – Continued Accreditation
6. Anesthesia – May 24, 2011 – Report pending
7. Pediatric Developmental –Behavioral – May 25, 2011 – Report pending
8. Family Medicine Sports Medicine – May 26, 2011 – Continued Accreditation
9. RWJMS as an institution and 25 of its programs eligible for ACGME accreditation currently have received the maximum possible number of years of continued accreditation after their most recent site visits. No programs received any citations concerning patient care or safety issues. The following table shows the current Accreditation Status of all residency and fellowship programs.
ACGME Accreditation Status Report as of June 30, 2011
|Programs & Subspecialties |Accreditation Status |Effective Dates | 1 year |2 years |
|Maternal Fetal Medicine |Amer. Board Obstetrics & Gyn |Probation |4/26/10 |2 years |
|Reproductive/Endocrin. and |Amer. Board Obstetrics & Gyn |Accredited |7/28/11 |4 years |
|Infertility | | | | |
|Surgery – Breast | Soc. Surgical Oncology |Accredited |11/4/07 |5 years |
B. Performance on Certifying Examinations
Performance on board certification examinations is carefully reviewed each year. During 2010, 132 graduates of 34 RWJMS programs took certifying board examinations; 110 passed on their first attempt (83.3%). The board passage rate was 100% for first time takers from 24 of the 34 programs. The average program percent passage rate on board examinations for first time takers in 2010 was 87.7%. The average percent passing rate for all RWJMS programs in 2004 was 90.2%, in 2005 was 91.3%, in 2006 was 95.90%, in 2007 was 93.40%, in 2008 was 88.1%, and in 2009 was 93%.
C. National Resident Matching Program
UMDNJ-RWJMS programs matched 95.8% of sought positions via the 2011 National Resident Matching Program (NRMP); 92.3% of the matched positions were filled by US senior students. In the 2011 NRMP, the following programs filled all matched positions with US seniors: Anesthesia, Dermatology, Internal Medicine Preliminary, Internal Medicine Categorical, Neurology, Obstetrics-Gynecology, Orthopedic Surgery, Pathology, Psychiatry, Radiology, Radiation Oncology, Surgery Preliminary, and Surgery Categorical.
III. ACTIVITIES OF THE GMEC DURING 2010-11
A. Resident Supervision
The GMEC made certain that all programs would be fully compliant with new ACGME policies on resident supervision, which became effective July 1, 2011. The new regulations require that each sponsored residency program develop a policy and procedure on resident supervision which specifies that residents are provided with progressively increasing responsibility for patient care according to their level of education, ability, and experience. These policies must specify the extent to which residents may undertake patient care without direct supervision. The classifications of supervision include: (1) Direct Supervision, in which the supervising physician is physically present with the resident and patient; (2) Indirect Supervision with direct supervision immediately available, in which the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide direct supervision; (3) Indirect supervision with direct supervision available, in which the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephone and/or electronic modalities, and is available to provide direct supervision; and (4) Oversight, in which the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. The new regulations also stipulate that PGY-1 residents should be supervised either directly or indirectly with direct supervision immediately available until the resident has demonstrated sufficient competence to progress to being supervised indirectly with direct supervision available. The new regulations also stipulate that each sponsored program must establish schedules which show the supervising physicians and guidelines for circumstances and events in which residents must communicate with appropriate supervising faculty members.
The GMEC reviews a yearly status report, collected by the GME Office, on each program’s policies governing resident and fellow supervision to ensure that each program monitors the supervision of its trainees at all participating sites. Each trainee is assigned to a designated service and back-up is available at all times through more senior house officers and attending physicians. Each program director is responsible for establishing detailed written policies describing resident supervision at each level for each site involved in the residency program. A copy of each program’s supervision policy is kept on file in the GME Office. Resident supervision is also monitored through the GMEC Internal Review process and annual “focus group” meetings held by the Associate Dean for GME with the trainees in each program.
B. Resident Responsibility
The GME office maintains a copy of each program’s descriptions of the roles for each year of residency training, which are required to be affixed to the resident’s contract. The contract is signed by the resident, the Program Director, the Department Chair, and the Associate Dean for GME.
The GMEC reviewed each program’s process for assessing their residents’ competence in specific procedures and documenting that competence for participating hospitals.
C. Resident Evaluation
The GMEC-approved GME Policy on resident evaluation requires that residents be evaluated after each rotation and that the Program Director meet with each resident at least twice a year to formally assess their progress. The program’s compliance with evaluation standards is assessed in the GMEC Internal Reviews and in the yearly focus group meetings held by the Associate Dean for GME with the trainees in each program.
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 and are described and presented to all residency program directors.
D. Compliance with Duty Hours Standards
The GMEC and the GME office monitor resident duty hours closely.
1. The GME office anonymously surveys all residents each year (in four “batches”) about learning environment issues and duty hours. A report of this survey is sent to the program director by the Associate Dean for GME.
2. The GMEC requires each program to have a formal policy regarding duty hours and a formal process by which compliance with duty hour limits is monitored.
3. The GMEC regularly discusses duty hours issues at committee meetings.
4. Duty hours are discussed with trainees in the annual focus group meetings held with the Associate Dean for GME.
5. “Moonlighting”. Any licensed resident wishing to work outside of their program (“Moonlight”) must submit a request to RWJMS for consideration and possible approval. Written approval must be obtained from the Program Director, the Department Chair, the GME Associate Dean, and the UMDNJ Compliance Office before a resident is allowed to moonlight. Such permission is only granted if 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.
E. Resident Participation in Safety and Quality of Care Education
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.
1. Resident education in patient safety and quality of care is included in the RWJMS Orientation Program for new residents and continues throughout the year in each program. The Orientation program is reviewed and approved by the GMEC. 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.
2. 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.
3. Programs require their residents to be involved in Patient Safety and Patient Quality of Care initiatives. The GMEC discusses resident participation in Safety and Quality of Care Education throughout the year at its regular meetings. 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. The Chair of the GMEC participates in the RWJUH Quality Improvement Committee.
4. Each program educates and assesses its residents in the six ACGME Competencies, which include Patient Care, Practice-Based Learning and Improvement, and Systems-Based Care. The program’s Internal Review assesses the completeness of these programs.
5. 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 and reported annually to the GMEC. Efforts continue to fit test all residents with required respiratory equipment at each affiliated hospital.
F. Internal Reviews of programs
The GMEC, as required by the ACGME, conducts internal reviews of each program at the midpoint of each program’s review cycle. These comprehensive reviews are conducted by program directors and residents according to a formal protocol and include faculty and resident interviews; a thorough review of curriculum, policies, assessment tools, outcomes measures, and program documents. In the 2010-2011 academic year, the GMEC conducted Internal Reviews of thirteen programs, ensuring compliance with all the programmatic requirements. The protocol for the review process, mandated by the ACGME, was followed meticulously. Programs reviewed were:
|Program |Internal Review Date |
|Radiology Diagnostic |9/14/10 |
|OB/GYN Reproductive, Endocrinology & Infertility |9/14/10 |
|Pain Medicine |11/16/10 |
|Vascular Surgery |12/14/10 |
|Neurology |12/14/10 |
|Emergency Medicine |1/11/11 |
|Radiation Oncology |1/11/11 |
|Family Medicine – CentraState |2/8/11 |
|Family Medicine – Capital Health |4/12/11 |
|Family Medicine Geriatrics – RWJ |4/12/11 |
|Psychiatry Child & Adolescent |5/10/11 |
|OB/GYN |6/14/11 |
|OB/GYN Maternal Fetal Medicine |6/14/11 |
IV. RWJMS Programs
A. Learning Environment Assessment Program (LEAP). The GMEC regularly discusses the school’s ongoing commitment to assessing and improving the learning environment of students and residents. The GMEC discussed and endorsed the system by which student feedback on residents is communicated to program directors.
B. Feedback
Residents may communicate any concerns, without fear of reprisal, to the RWJMS Ombuds, to 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; each month’s 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. During the 2010-11 academic year the Associate Dean for GME conducted 28 focus group meetings with residents in RWJMS programs to obtain their feedback. A confidential report of each meeting was sent to the training program’s Program Director and Department Chair. Follow up meetings were scheduled if needed.
C. 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 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.
V. SUMMARY
The Graduate Medical Education Residency and Fellowship programs at UMDNJ-Robert Wood Johnson Medical School continue to achieve excellent outcomes. The school’s Graduate Medical Education Committee and Graduate Medical Education office monitor, supervise, and support the school’s GME mission.
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