Annual Report Medical Education Resurrection Medical ...



Annual Report Medical Education Resurrection Medical Center 2006

Executive Summary:

• Resident work hour policies have been closely monitored

• Improved office volumes in the resident continuity clinics for Internal Medicine and Family Practice and opened a new continuity clinic for the IM. The Family Medicine residents now see the required number of continuity visits during their residency.

• Resident Competency Initiative implementation and refinement has continued.

• Residents and faculty continued scholarly activity including publications and presentations.

• Residents maintained active participation in community activities

• The AOA approved the Family Medicine PGY-2 and PGY-3 as an Osteopathic Family Medicine Residency.

• The Resurrection Medical Center Westlake Internal Medicine Residents received First, Second, and Third Place Awards in the IAMA clinical vignette competition.

• Dr. Chitra Sadasiwan, Resurrection Medical Center Westlake Internal Medicine Resident, won the first prize in the oral clinical vignette competition at the ACP Illinois State Conference in 2005, and presented the same at the national ACP conference in April 2006

• The Medical Education Department provided programs totaling 99 Category I CME Credits at RMC.

Introduction:

Resurrection Medical Center is the sponsor of the Emergency Medicine Residency, the Family Practice Residency , the Transitional Program, an Osteopathic Rotating Internship, a Primary Care Sports Medicine Fellowship within the Family Practice, and as of July 1, 2006 a Osteopathic Family Practice Residency. Resurrection Medical Center serves as the sponsor of the Internal Medicine Residency at Westlake Hospital. Resurrection Medical Center also serves as a site for clinically training for residents from within Resurrection Health Care and from our partner universities. Radiology Residents from Saint Francis Medical Center rotate in Radiology (1 FTE). At present five Surgical Residents and two OBGYN residents rotate at Resurrection Medical Center from Loyola (7 FTE). Midwestern University Residents in Emergency Medicine come to Resurrection Medical Center for Radiology, Neurology, Cardiology and Orthopedics (4 FTE). Internal Medicine Residents from Midwestern University do rotations in Nephrology, Infectious Diseases, Gastroenterology, and Neurology (1 FTE). One General Surgery Resident from Midwestern University rotates on General Surgery (1FTE). Midwestern University also sends a Radiology Resident for Invasive Radiology (1 FTE).

Graduate Medical Education Committee;

The GMEC for 2006was made of the following members:

Department of Medical Education Department Meeting Attendees

2006

|Kuznetsky, D., J.D. |

|Director Human Relations RMC |

|Bozek, S., M.D. |

|Pathology |

|Buckley, R., M.D. |

|Chair and Executive Director |

|DeOrio, A., M.D. |

|General Surgery |

|Emergency Medicine Chief Resident |

|Fahrenbach, Gary, M.D. |

|Internal Medicine |

|Family Practice Chief Resident |

|Dorfman, M. MD |

|EM Residency Director |

|Pillars J., M.D. |

|Radiology |

|IM Chief Resident |

|Malalis, L., M.D. |

|Pediatrics |

|Yeldandi, V. MD |

|Program Director Westlake Internal Medicine Program |

|McCurry, T., M.D |

|FP Program Director. |

|Meyer, P., D.O. |

|Osteopathic Internship Director/ DOME |

|Moran, W., D.O. |

|Osteopathic Family Practice Program Director |

|Yuska, C., R.N. |

|Vice President Patient and Oncology Services |

|Jaworski, C. MD |

|Program Director Primary Care Sports Medicine Fellowship |

|Rosenberg, M.S., M.D. |

|Transitional Program Director |

|Schneider, J. MD |

|Pulmonary/ Intensive Care |

|Shuber, S., M.D. |

|OBGYN |

|Sister Donna Marie, C.R. |

|Executive Vice President and CEO |

|Transitional Year Chief Resident |

The committee met on a monthly basis with the exception of October 2006.

Issues addressed include implementation of the Outcomes Project established by the ACGME; review of the academic progress of residents; review of the recruiting criteria used by each program; progress reports on addressing outstanding issues identified by the Residency Review Committees for each program; establishment of resident and procedure supervision policies; review of resident work hours; and review of resident salary and benefits.

In May 2004 the Institution underwent a site survey by the ACGME. The site surveyor met with the GMEC as well as residents form all the sponsored programs. As a result of that inspection Resurrection Medical Center was notified in November 2004 that we had received 5 years full accreditation. The following citations were received:

1. “While it is obvious that the GMEC is exercising good oversight of its programs, the institution’s system for ensuring program follow-up and correction of citations remains unclear.”

The Program Directors meet with Dr Buckley on a monthly basis to monitor compliance and correction of issues. Dr Buckley meets regularly with Sister Donna Marie and Patricia Shehorn and addresses any important institutional issues. It appears that this was not clearly communicated to the ACGME and will be corrected at the next site visit.

2. “Westlake is no longer requesting accreditation by JCAHO. It is accredited by the American Osteopathic Association Healthcare Facilities Program (HFAP). The DIO indicated at the time of the review that this is a nationally-recognized organization equivalent to JCAHO with respect to hospital accreditation status. Evidence of this equivalency is to be provided by the institution through provision of HFAP standards at the time of the next survey of the institution so that the IRC may determine its equivalency.”

HFAP is the equivalent of JCAHO, being recognized by CMS and having deeming authority. Rather than wait for the next site survey, we will submit a copy of the standards when notifying the IRC of Resurrection Medical Center’s accreditation by HFAP. The site surveyor for the Transitional Program was shown the HFAP standards at the review in June 2005. Subsequent to that review, the ACGME released a change in the institutional requirements recognizing HFAP as equivalent to JCAHO Accreditation.

3. “The internal review protocol does not adequately meet the standard regarding the residents who are interviewed. It does not state that they are to be peer-selected residents from each level of training in the program.”

The residents are peer selected but the policy was rewritten to reflect this.

Resident Work Hours

The work hour requirements were implemented in January 2003, ahead of the mandatory date of July 1 2003. Resident work hour issues have been reviewed at each meeting of the GMEC. In addition to verbal reports from the resident representatives, a one-month survey was performed in April 2006 and October 2006 to identify areas where there were compliance issues. Internal Medicine and the Transitional Program are providing these surveys on monthly basis. The Emergency Medicine Program monitors high risk rotations on a monthly basis. Several work-hour violations were identified and addressed.

Resident Supervision

Residents are supervised in their care of patients by more senior residents and the attending physician. There is a resident supervision policy that is given to all new residents at orientation and is provided in the information packets of all of the outside residents. The role of the senior resident for adult medicine was clarified by the GMEC and a written protocol added to the resident manual. Residents function purely under the privileges of the assigned attending physician. Prior to performing a procedure, residents are required to inform the supervising attending physician who then determines the level of supervision required.

Resident Evaluation

Evaluations have included questions aimed at the core competencies and have included the introduction of the 360( evaluations. The residency programs have also introduced direct observation to evaluate clinical and interpersonal skills. The Core Competencies have been incorporated into all resident evaluations. Residents are evaluated at the end of each rotation and reviewed at least quarterly with the resident.

Resident Responsibilities

Residents are involved in the care of patients both in the ambulatory and inpatient areas throughout Resurrection Medical Center. Core emergency privileges have been defined in consultation with the program directors by year group and program and have been provided to Nursing. Residents operate only under the auspices of the attending physician but can be called upon to provide emergent stabilizing care in the absence of the attending.

Patient Safety and Quality of Care

Committee A, the Medical Staff Patient Safety and Performance Improvement/ Performance Distinction Committee, established a subcommittee to review issues of quality of care and patient safety on the teaching services. The subcommittee is made up of resident and faculty representatives from the teaching programs. The subcommittee reviews cases referred by other committees and performs ongoing chart reviews. Recent reviews have included issues of medication orders, timing and dating of orders and the use of weight-based ordering on the pediatric floor. Dr Buckley, the Designated Institutional Official, was named Medical Director of Performance Improvement/ Performance Distinction. This has allowed more rapid identification of issues related to quality of care and safety issues on the teaching service and has further strengthened the connection between performance improvement and continuing medical education.

The presence of residents enhances the quality of care and patient safety by providing first responders in emergency settings. Family Practice residents provide coverage for in-house non-teaching emergencies during times when there is no House Physician coverage. The teaching services have 24 hours seven days per week in-house physician coverage for emergencies.

University Affiliations:

Loyola University

Resurrection Medical Center has a long-term relationship with Loyola School of Medicine Stritch School of Medicine. Residents in OBGYN and Surgery and students in Family Practice, Internal Medicine (ICU), Surgery, and OBGYN rotate at RMC. Loyola provides live teleconferencing of their Medicine Grand Rounds and Surgery Grand Rounds.

Midwestern University Chicago Osteopathic School of Medicine

In January of 2001, Resurrection Medical Center became an active member of the Midwestern University OPTI (the training consortium. Four Emergency Medicine residents from Midwestern rotate in Cardiology, ICU, Radiology, Neurology and Orthopedics. Along with the residents, RMC became a site for student rotations. Sister Donna Marie, C.R. and Dr Buckley remain active members of the Governing Board of the Midwestern OPTI.

We have a total of 1 FTE General Surgical Resident PGY 2-5 assigned. The addition of this upper level resident filled a void that was created by the loss of the Loyola Surgical Residents.

1 FTE Radiology Resident from Midwestern University comes to Resurrection Medical Center for a rotation in invasive radiology.

University of Illinois

The Emergency Medicine program has maintained their academic affiliation with the U of I. The program has combined lectures with U of I faculty and residents The Family Practice Program is a clinical site for the required Family Practice Clerkship and accepts 1 student per rotation from the U of I.

Rosalind Franklin University

The Family Practice Residency program serves as a clinical site for the required clinical clerkship in Family Practice. One student rotates in the Family Practice Center per rotation.

University of Chicago

In February 2001, Resurrection Medical Center, St Francis Hospital and the U of C entered into an agreement to allow anesthesia residents rotating at Saint Francis from the U of C to assist in proving cardiac anesthesia for heart cases at RMC. The resident comes to RMC with the cardiac anesthesia team 1-2 days per week.

Transitional Year Residency Program:

The Transitional Year Residency program received its site survey and received 5 years accreditation.  There were no citations noted.  One area of noncompliance was noted and acted upon:

1. The review committee stated that the review of the resident survey completed April/May 2004 indicated that 6 of twelve residents did not have at least one day in seven completely free from all educational and clinical responsibilities the 4 weeks prior to completing the survey. 

The curriculum was reviewed to ensure compliance with ACGME work rules. The work hour rules were clearly explained to the residents so there were no questions when they filled out future questionnaires. The resident work hours for the Transitional Program are evaluated by questionnaire on a monthly basis and reviewed with the Chair and Executive Director of Medical Education and presented to the Graduate Medical Education Committee.

 

1. Significant accomplishments:

a. The Transitional Year Residency successfully graduated 12 residents for the 2005-2006 academic year and recruited 14 residents for the 2006-2007 year. Current recruitment is going well with over 750 applications. As in the past, it is expected that 60 interviews will be done. 

b. The Transitional Program continues to implement the core competencies, as required by the ACGME and has modified its evaluation instruments to better measure the six competencies.

c. The ACGME put out new program requirements for TYR programs.  These requirements have been reviewed and all necessary changes will be incorporated starting with the 2006-2007 academic year.

 

2. Issues related to resident supervision:

a. To date, there have been no issues regarding resident supervision. At the monthly meetings, all residents feel that the level of supervision provided to them is adequate. The change in the ICU structure has been met with excellent reviews by the TYR residents. 

 

3. Work hour implementation and compliance:

a. The 80-hour workweek has been implemented and compliance has been met.  The residents are surveyed at the monthly GMEC meeting and semiannually to ensure compliance.

  

4. Scholarly activity:

a. Dr. Rosenberg successfully published a case report titled, "Vomiting Gravel".

 

b.  Dr. Dorfman published an article, "Hospital-Acquired Venous   Thromboembolism And Prophylaxis In An Integrated Hospital Delivery published in the Journal of Clinical Pharmacy and he also presented an abstract at the American College of Emergency Medicine conference regarding Urine Cultures in Emergency Department Patients with Renal Stones.

 

5. Progress in resolving areas identified in the site survey:

a. All issues identified as potentially problematic, from the site survey, have been addressed and rectified. 

 

6. Resident evaluation process and identification of academic probation issues:

a. Residents are evaluated on a monthly basis after each rotation by the attending with whom they worked.  These evaluations are competency based.  Furthermore, the residents meet with the Program Director on a quarterly basis to review their progress. To date, there have not been any current academic year issues.

 

7. Graded resident responsibilities:

Residents complete their year in accordance with RRC requirements.  The Transitional Year Resident responsibilities are consistent with other Resurrection intern responsibilities.  Since the TYR is a one-year program, graded responsibilities are not possible.

Emergency Medicine Residency:

Graduation

In June 2006 the program graduated 12 residents. Dr. Marcy Zirlin will be graduating in December secondary to a leave of absence. All have obtained the jobs of their choice. We were able to retain two, Drs. Scott Samlan, and Jarrod Wright, full time within RHC, and one other, Dr. Marcy Zirlin, was retained on a part time basis.

|Name of Graduate |Hospital |City/State |

|BECKETT, Adam H. |Univ. of Missouri Hospitals |Columbia, MO |

|BIELSKI, Michael A. | | |

|FITZSIMMONS, Kari |Swedish Medical Center |Seattle, Washington |

|GIBBONS, Donald |Med Center of Lewisville |Lewisville, Texas |

|HEDLUND, Kelly |United Hospital Systems |Kenosha, Wisconsin |

|JOHNSON, Randy |Wadsworth-Rittman Hospital |Wadsworth, Ohio |

|KOHLER, Lisa |Denton Regional Hospital |Denton, Texas |

|LE, Pha |Community Hospital of Ottawa |Ottawa, Illinois |

|LESTER, Joseph |Baptist Health |Montgomery, Alabama |

|NARUNATVANICH, David |Galesburg Cottage Hospital |Galesburg, Illinois |

|SAMLAN, Scott |Resurrection Medical Center |Chicago, Illinois |

|WRIGHT, Jarrod |St. Mary & St. Elizabeth Hospital |Chicago, Illinois |

|ZIRLIN, Marcy |Applications Pending | |

| |(Completing Residency December 2006) | |

Board Certification

Emergency Medicine Board Certification requires passage of a written and oral examination. Program graduates have a 100% passage rate for the previous three years. This November the class of 2006 became eligible to take the written exam and the class of 2005 became eligible for the oral exam. Of all RMC graduates who took the exams for the first time in 2005 (which may include graduates from earlier classes), 100% passed the written exam and all but one (Class of 2003) passed the oral exam. As of 12/8/06, data was not yet available for the 2006 exams.

Recruitment

The Emergency Medicine Program successfully recruited 13 new residents for July 2006. The residents are from all over the United States, including California, Indiana, Kentucky, Michigan, and Missouri. Locally, the Program recruited students from Rush Medical College, Southern Illinois University and Midwestern University. The residency has received well over 700 applications and is currently interviewing for the Class of 2010 to start July 2007.

|Name of Intern |Medical School |City/State |

|DESAI, Archana C. |Wayne State Univ. School of Med. |Detroit, MI |

|HARLAN, James C. |Michigan State Univ. Coll.-Human Med |East Lansing, MI |

|KLOPE, Jeremy L. |Southern Ill. Univ. School of Med. |Springfield, IL |

|KRIEG, Christopher L. |Univ. of Louisville School of Med. |Louisville, KY |

|LAYMAN, Jason A. |St. Louis Univ. Health Sciences Center |St. Louis, MO |

|OFFMAN, Ryan P. |Michigan State Univ. Coll.-Osteo Med |East Lansing, MI |

|OLIVER, Amy M. |Loma Linda Univ. School of Medicine |Loma Linda, CA |

|ORLIKOWSKI, Jill A. |Chicago College of Osteopathic Med. |Downers Grove, IL |

|PARKES, Steven W. |Rush Medical College |Chicago, IL |

|SHAH, Pratik P. |Indiana Univ. School of Medicine |Indianapolis, IN |

|SMITH-GARCIA, Jennifer |Wright State Univ. School of Medicine |Dayton, OH |

|SVANCAREK, Bridgette B. |Univ. of Missouri-Columbia SOM |Columbia, MO |

|VILLARI, Julie L. |Creighton Univ. School of Medicine |Omaha, NE |

Research Productivity

Emergency medicine is required by its RRC to demonstrate a high level of research activity. Our program has been successful in producing research and scholarly work. The Emergency Medicine Residency has presented at all of the National conferences including The American College of Emergency Physicians, the Society of Academic Emergency Medicine, and the American Academy of Emergency Medicine. The grids below summarize research over the last year.

Summary July 2005 – June 2006

All Faculty and Residents

|Scholarly Activity |Number of Projects |Publications |Publications |

| | |(Peer Reviewed) |(Non-Peer Reviewed) |

|Basic Science Research Projects |0 |0 |0 |

|Clinical Research Projects |18 (13 new) |2 (6 submitted) |0 |

|Textbook Chapters |1 |1 |0 |

|Collective Review Articles |0 |0 |0 |

|Case Reports/Letter to Editor |1 |1 |0 |

|Abstracts |32 (8 accepted) |1 |0 |

|Other (Specify) CPC |1 |0 |0 |

|SAEM photo session |1 (1 accepted) |0 |0 |

|Total |54 |5 |0 |

Summary July 2005 – June 2006

Residents Involvement

|Scholarly Activity |Number of Projects |Publications |Publications |

| | |(Peer Reviewed) |(Non-Peer Reviewed) |

|Basic Science Research Projects |0 |0 |0 |

|Clinical Research Projects |16 (11 new) |2 (3 submitted) |0 |

|Textbook Chapters |0 |0 |0 |

|Collective Review Articles |0 |0 |0 |

|Case Reports/Letter to Editor |0 |0 |0 |

|Abstracts |30 (7 accepted) |1 |0 |

|Other (Specify) CPC |1 |0 |0 |

|SAEM photo session |1 (1 accepted) |0 |0 |

|Total |47 |3 |0 |

Summary July 2005 – June 2006

Faculty Only

|Scholarly Activity |Number of Projects |Publications |Publications |

| | |(Peer Reviewed) |(Non-Peer Reviewed) |

|Basic Science Research Projects |0 |0 |0 |

|Clinical Research Projects |2 (2 new) |0 (3 submitted) |0 |

|Textbook Chapters |1 |1 |0 |

|Collective Review Articles |0 |0 |0 |

|Case Reports/Letter to Editor |1 |1 |0 |

|Abstracts |2 (1 accepted) |0 |0 |

|Other (Specify) |0 |0 |0 |

| | | | |

|Total |4 |2 |0 |

Detailed descriptions of these projects are available if needed. This includes title, principal investigator, faculty mentor, resident researcher and grant availability.

Resident Work Hours

The Emergency Medicine Residency is complying with resident work hour rules. The Residents are surveyed twice a year to ensure compliance. Any breach of the work hours is addressed immediately and corrected. Our most recent survey identified one rotation, Trauma at Mount Sinai, which was not in compliance with work hour rules. Dr. Dorfman will continue to monitor the off-site rotations to ensure compliance of the work hours and resident supervision. The ICU and Trauma rotations are surveyed on a monthly basis to ensure work hour compliance.

Resident Supervision

The Emergency Department uses real-time supervision of residents 24 hours a day, 7 days a week. The team concept utilizes a resident paired with an attending during the entire shift. Twice a year, an attending shadows the resident to critique the resident according to the ACGME competencies. If it is felt a resident needs clinical help, they may be scheduled for extra directed observation sessions

Community Service

The Emergency Medicine residents are very active in community service activities, with 100% of the program’s 39 residents participating in at least one project annually.

Summary July 2005 – June 2006

|Resident |Date or Frequency |Community Service Activity |Community Group |

|Name | | | |

|Breen, Marc |April 17, 2006 |Monetary Donation |National Ovarian Cancer Coalition |

|EM-1 | |(Boston Marathon) | |

|Burkard, Wade |April 2006 |Monetary Donation |Muscular Dystrophy |

|EM-1 | | |“Hop-A-Thon” |

|Colvig, Cameron |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-1 | | |(for Katrina Victims) |

|Colvig, Cameron |April 2006 |Monetary Donation |Muscular Dystrophy |

|EM-1 | | |“Hop-A-Thon” |

|Dorgan, Christopher |June 8, 2006 |Charity Golf Event |Ronald McDonald |

|EM-1 | | |House |

|Hamonko, Matthew |April 2006 |Monetary Donation |Muscular Dystrophy |

|EM-1 | | |“Hop-A-Thon” |

|Mangiardi, Sara |May 10, 2006 |Clothing Collections |Salvation Army |

|EM-1 | | | |

|Patacsil, Julie |July 2005 |Monetary Donation |Family of Jill Vasilakopoulas |

|EM-1 | | | |

|Schwieger, Jennifer |March 4, 2006 |Community Activity for |St. James Lutheran Church |

|EM-1 | |Homebound | |

|Shah, Meeta |May 10, 2006 |Clothing Collections |Salvation Army |

|EM-1 | | | |

|Swickhamer, Connie |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-1 | | | |

|Taher, Heather |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-1 | | | |

|Wallace, Brian |June 8, 2006 |Charity Golf Event |Ronald McDonald |

|EM-1 | | |House |

|Whapshare, Kristin |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-1 | | | |

|Brandstetter, Kevin |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-2 | | | |

|Donahue, Michael |July 2005 |Monetary Donation |Family of Jill Vasilakopoulas |

|EM-2 | | | |

|Dorow, Christina |April 11, 2006 |Monetary Donation |Children’s Memorial |

|EM-2 | | |“Friends for Steven” Cubs Event |

|Falk, Peter |August 5, 2005 |Medical/First Aid |Cardinal George Event |

|EM-2 | |Support | |

|Fister, Courtney |Sept. 8-9, 2005 |Medical Aid to Katrina |Organized by UIC |

|EM-2 | |Victims |(in Tinley Park) |

|Fister, Courtney |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-2 | | | |

|Goldberg, James |June 1, 2006 |Clothing Donation |Salvation Army |

|EM-2 | | | |

|Helderman, Trina |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-2 | | | |

|Magas, Ellen |01/30/06 |Career Day |Resurrection |

|EM-2 | |Participation |High School |

|Mancha, Nicole |8/05/05 |Medical/First Aid |Cardinal George Event |

|EM-2 | |Support | |

|Mancha, Nicole |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-2 | | | |

|Michalski, Matthew |Feb. 15, 2006 |Career Day Presentation |St. Maria Goretti School, PK-8 |

|EM-2 | | | |

|Moy, Ronald |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-2 | | | |

|Nguyen, Chi |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-2 | | | |

|Zarate, Amanda |November 2005 |Coordinator, Monetary |EMRA “Adopt a Resident” |

|EM-2 | |Donations | |

|Beckett, Adam |September 2005, ongoing |Mentor/Advisor to former |Marines for Life |

|EM-3 | |Marines |Project |

|Bielski, Michael |August 5, 2005 |Medical/First Aid |Cardinal George Event |

|EM-3 | |Support | |

|Fitzsimmons, Kari |December 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-3 | | | |

|Gibbons, Donald |July 2005 |Monetary Donation |Family of Jill Vasilakopoulas |

|EM-3 | | | |

|Gibbons, Donald |Sept. 8, 2005 |Medical Aid to Katrina |Organized by UIC |

|EM-3 | |Victims |(in Tinley Park) |

|Hedlund, Kelly |July 2005 |Monetary Donation |Family of Jill Vasilakopoulas |

|EM-3 | | | |

|Hedlund, Kelly |February 2006 |Monetary Donation |Gigi’s Playhouse Too |

|EM-3 | | | |

|Johnson, Randy |November 2005 |Monetary Donation |EMRA “Adopt a Resident” |

|EM-3 | | | |

|Johnson, Randy |February 2006 |Monetary Donation |Gigi’s Playhouse Too |

|EM-3 | | | |

|Kohler, Lisa |June 2006 |Monetary Donation |Gigi’s Playhouse Too |

|EM-3 | | | |

|Le, Pha |May 31, 2006 |Donation to Purchase Lab |Kirksville College of Medicine |

|EM-3 | |Coats | |

|Lester, Joseph |August 5, 2005 |Medical/First Aid |Cardinal George Event |

|EM-3 | |Support | |

|Lester, Joseph |Sept. 8, 2005 |Medical Aid to Katrina |Organized by UIC |

|EM-3 | |Victims |(in Tinley Park) |

|Narunatvanich, David |May 10, 2006 |Monetary Donation |American Cancer Society Walkathon |

|EM-3 | | | |

|Samlan, Scott |Sept. 8, 2005 |Medical Aid to Katrina |Organized by UIC |

|EM-3 | |Victims |(in Tinley Park) |

|Wright, Jarrod |May 2006 |Assist in Karate Benefit |Local Community Organization |

|EM-3 | | | |

|Zirlin, Marcy |Sept. 1, 2005 |Monetary |Komen Breast Cancer Foundation |

|EM-3 | |Donation | |

Residency Review Committee Site Survey

On September 24, 2002 the program was reviewed by the RRC. The program received full accreditation for five years. This is the maximum possible accreditation cycle. Five areas of improvement were identified. An action plan has been developed and submitted to the GMEC. The program is in compliance with all previous citations. Please refer to last years annual report for details.

Internal Review of RMC Emergency Medicine Residency

A review of the RMC Emergency Medicine Residency was conducted February 20, 2006. The review committee met with the program director, associate program director, two key faculty members, and representatives from each resident class.

The RMC Emergency Medicine Residency is a fully accredited, 3-year program training 39 residents. The main rotation sites are Resurrection Medical Center, St. Francis Hospital, and Our Lady of the Resurrection Hospital. It was established in 1996. The program is up for review in 2008. Before conducting the internal review, the committee was provided with documents including citations from the last Residency Review Committee (RRC) evaluation and the program’s corrective action plan.

Program Director Interview

The committee met with Drs. Dorfman and Uyenishi. It was noted that the curriculum is reviewed biannually. A notable curriculum change is the addition of more time in the intensive care unit now that an intensivist group staffs it. The residents give feedback regarding the curriculum in an open forum and through an anonymous questionnaire.

Historically, the residents have had a 90% pass rate for first-time board exam takers. Objective measurements of the residents’ performance include an in-service exam, an in-service exam practice test and exams given at the end of each rotation. It was felt that the addition of the in-service practice test had been beneficial.

The curriculum also includes presentations regarding evidence-based medicine every other month. Research seminars are required during the PGY-1 and PGY-2 years. Residents are required to write a scholarly research paper and do a picture or poster presentation.

The program works to meet ACGME core competencies through multiple methods. Didactic presentations are utilized to instruct residents regarding systems-based practice (practice management topics) and medical knowledge (supporting and expanding the residents’ knowledge base). Mentoring and written exams impart the competencies of patient care, practice-based learning, communication skills and professionalism.

Residents are evaluated and receive feedback through rotation evaluations and end-of-shift e-mail communication from preceptors. The e-mail communication is new and has been well received. In addition, each resident is assigned a mentor who provides feedback via a face-to-face meeting.

It was also noted that the employee assistance program has been utilized successfully several times for residents having difficulty. When used, it has been faculty members who have identified the resident and intervened.

The program had been cited during the last RRC evaluation for several issues regarding core faculty. To address those issues, the program now designates as core faculty those who devote most of their professional time to the program. In addition, research and scholarly activity are receiving increased emphasis. Of note, while reviewing the supporting documents, it is apparent that some faculty members are proceeding well with their research (articles published or ready for publication) while others may not be progressing as well (status of research project not known).

Response: By definition, a core faculty member has at least 12 hours a week of protected time, involved in the clinical arena, research, lecture, and other areas of the residency. The Emergency Medicine residency has 13 attending physicians that meet these criteria according to the RRC standards.

Another citation from the last RRC evaluation regarded resident moonlighting, specifically at OLR. To address this, the scheduler will ensure that no third year resident will moonlight at OLR while there for a rotation. The residents also sign an agreement stating that they will comply with the policy under penalty of dismissal.

Response: The residents need to be in good standing, have at least a 75% score on their in-service, and obtain a license. The resident signs a contract agreeing they will not moonlight at OLR when they are there on rotation. Violation of the contract includes dismissal as a possibility. Lastly, if the resident works at OLR as an attending while on service as resident, the shift will not be paid, therefore the shift will have been as a resident not as an attending.

Faculty Interviews

The committee met with Drs. Ambroz and Zonia. They stated that there is good communication amongst the faculty even though they are at different sites. The faculty members are evaluated by the program directors every six months. In addition, there are evaluations of the faculty made by the residents.

The program had been cited during the last RRC evaluation regarding faculty competency in ultrasonography. The faculty was of the impression that their fellow faculty members were progressing toward competency.

Drs. Ambroz and Zonia feel that they have adequate time for non-clinical duties.

Resident Interviews

The committee met with representatives from each class. Overall they were pleased with the residency. They felt that they had adequate supervision of procedures. They were pleased that resident input had resulted in curriculum changes, specifically to the ENT and ophthalmology rotations.

The residents reported one work hour rule violation several months ago at Mt. Sinai while on a surgery service. Dr. Dorfman has addressed the issue and continues to monitor the situation.

The residents were of the opinion that most of the faculty is not competent in ultrasonography. Their perception was that the residents as a group are more experienced.

The residents expressed concern regarding the NICU rotation at St. Alexius Hospital. Due to variations in patient volume, the residents felt that there was a lot of variability regarding the quality of the rotation.

With regard to didactic presentations, they felt that topics related to adult emergency medicine are good but that presentations regarding pediatric emergency medicine are only fair. The residents also reported that they have regular meetings with the research staff.

They appreciated the end-of-shift e-mail feedback but wish that it were available at St. Francis and OLR. The mentor program was discussed. Some residents reported regular meeting with their mentors. Others either did not know who their mentor was or reported infrequent meetings.

The residents were not familiar with the EAP program or how to get assistance for an impaired colleague. However, they were familiar with RMC’s annual program regarding the impaired physician.

Summary

The Emergency Medicine Residency was cited in five areas at the last RRC review. Three of the citations were regarding composition and duties of core faculty. The program has addressed these by redefining the roster of core faculty, ensuring time for non-clinical duties and promoting research and scholarly activity. It would appear that the effort has been largely successful although some core faculty members don’t have good documentation of their current research activities.

The fourth citation was regarding resident moonlighting at OLR. This has been addressed by improved schedule supervision and improved contractual agreement.

The fifth citation was regarding ultrasonography competence of residents and faculty. This area appears to be less than satisfactory. It does not appear that all faculty members are getting sufficient experience to demonstrate competence.

Response: Dr. Michael Lambert left for Christ Hospital and the Ultrasound program was taken over by Dr. Robert Rifenburg. The entire curriculum has been revamped. He has created a manual, test, and an expectation of 50 ultrasounds during the rotation and 150 ultrasounds prior to completion of the residency. I understand that the residents feel they are more qualified in ultrasound than the attendings, but that is simply not true. The attending’s ultrasound activity is tracked. It is an expectation that all will be credentialed in all body cavities over the next two years. Many attendings, including Drs. Christos, Chan and Ambroz are credentialed in several body areas. Of the graduating senior residents, only one, Joe Lester, had over 150 scans. Many residents did not have over 50. With Dr. Rifenburg taking over the program, all attendings will be given their numbers every other month. Furthermore, the residents will also be tracked to ensure they complete 150 scans. As attendings meet the criteria for credentialing, they will put through the necessary paperwork to be credentialed.

A separate issue of concern is the mentor program. Although there are many ways for the residents to receive feedback regarding their performance, a meeting with a faculty member is very important. Based on response from the residents, it seems that the mentor program has room for improvement.

Response: It is semantics, but important, that the Emergency Medicine program has an advisor program, more than a mentor program. Every new intern is assigned an attending as his or her advisor. The attending is supposed to meet with the resident at least every six months, and receives a letter reminding them of this. If the resident has an area of interest, i.e., EMS/Ultrasound, they may than choose a mentor from within the faculty who either shares the same interest, or the resident feels a bond with.

Further, the residents expressed a need for improved didactic instruction in pediatric emergency medicine.

Response: Dr. Linda Herman will now oversee the curriculum. The resident’s pediatric didactics consisted of PALS lectures, and case conferences. Dr. Herman is aware of the residents concern, and will integrate more pediatric lectures, as well as attending lectures into the curriculum.

In summary, we feel that the program is making strides to rectify areas cited in the last RRC evaluation and that further monitoring will be required.

Program Issues

The program continues to review all aspects of training. The faculty evaluations have been changed to reflect the competencies. The electronic end of shift format has been well received. The addition of the SICU rotation in the second year has also been well received. Starting next year (2007-08), the HEENT rotation, formerly in the second year, will be combined with the Administration rotation in the third year. The program has one resident who is not board eligible, and has not officially graduated from the program. One resident has not taken USMLE Step 3. Proof of passing USMLE Step 3 is required for graduation from the residency. As of 12/8/06, he has not responded to numerous e-mails, phone calls, and letters. The American Board of Emergency Medicine is aware of the situation.

Resident Evaluation Process

The residency program identifies residents in need of academic as well as clinical remediation. Dr. Bordo and Dr. Reilly have regularly scheduled extra reading sessions to assist residents didactically. Dr. Herman meets with identified individual residents to assist in clinical remediation. Currently, there are no residents on probation. The residency refers residents to the Employee Assistance Program (EAP) when necessary.

Resurrection Family Medicine Residency

Office Patient Volumes

The Family Practice Center has continued to see increase in volumes in 2006 with residents who are graduating exceeding all of the ACGME required office volumes. The scheduling of patients and volume restrictions were put in place to ensure adequate appointment availability and to stay within the RAP criteria of no more than 20% excess volume for residents.

Graduation

In June/July 2006 the program graduated another 6 residents. One went into a Sports Medicine Fellowship, one went into a Faculty Development Fellowship and the rest went into practice: one in Wisconsin, one in the Northwest Suburbs, one in the Western suburbs, and one in Louisville, KY.

Board Certification

Five residents took the boards and 4 passed. One is taking it in December 2006.

Recruitment of Medical Students

Resurrection Family Practice continues to draw qualified candidates from local and distant medical schools. Sports medicine has brought in interested candidates also for rotations. While many programs are seeing a drop-off in candidates we are experiencing an increase in numbers compared to last year. We have interviewed candidates who we have met at local and national recruitment fairs only who might not otherwise have interviewed. With a decreasing interest in primary care we are making sure we are interviewing more candidates this year. We matched 100% of our applicants in the two matches we participate in (NRMP and AOA.)

Osteopathic Internship and Residency

The Family Practice Residency obtained approval of the osteopathic internship in November of 2001, with our fifth class (5 residents) now in the program. This has been a positive in recruitment. With the AOA’s plans to eliminate free-standing internship programs, we submitted our application for a dual accredited 3 year residency with the AOA.

Our application was approved for a dual accredited program beginning July 2006. The AOA is now planning to follow the ACGME model of “residency only,” beginning in 2008, essentially eliminating our internship for a more unified model. We have the required faculty in place this program. We expect an onsite survey in Summer 2007 by the AOA because of our new program.

Publications, Outside Presentations and Research

The faculty and residents have participated in the following publications in the last year:

Griffith’s 5-Minute Clinical Consultant 2006 (5 chapters, 2 faculty and 4 residents)

Dr. Wolfe:

“Geriatrics Assessment,” Nursing Staff at Resurrection Medical Center, November 2006

Dr. Jaworski:

Clinical Abstracts Chair. Exercise and the Elderly. ACSM 53rd Annual

Meeting. June 2006.

Clinical Case Presenter. Midfoot Injury in a Pregnant Athlete. ACSM 53rd

Annual Meeting. June 2006.

Presenter. AMSSM Fellowship Fandango-Director’s Section. Use of

ERAS in the Sports Medicine Match. April 2006.

“Concussion Management Updates” Resurrection Medical Center’s Sports

Medicine Conference. March 2006.

“Exercise and Pregnancy” Resurrection Medical Center’s Sports Medicine

Conference. March 2006.

“The Female Athlete Triad” Resurrection Medical Center’s Sports Medicine

Conference. March 2006.

“Cervical Spine Issues in Athletes”. The University of Chicago’s 5th Annual

Current Concepts in Primary Care Sports Medicine. Invited Speaker.

March 2006.

“Physical Therapy Modalities for the Office”. ACSM Team Physician Course,

Part 1. Invited Speaker. February 2006.

“Sexual Activity and STDs in Athletes”. ACSM Team Physician Course, Part

1. Invited Speaker. February 2006.

“Abdominal Trauma in Athletes”. ACSM Team Physician Course, Part 1.

Invited Speaker. February 2006.

Dr. Moran:

“Diabetes Update,” Illinois Chapter of the American College of Osteopathic Family Physicians Annual Meeting, August 2006

Resident Work Hours

The Family Practice Residency is complying with resident work hour rules with frequent monitoring and education on fatigue and compliance strategies.

Resident Supervision and Medicare Billing Issues

In the Family Practice Center, we have excellent real time supervision of residents during all work hours. Medicare/Medicaid billing audits are on-going and showing required billing requirements to satisfy these payors.

Community Service and Outside Curricular Activities

The Family Practice Program has been actively involved in education of its residents as its prime mission. As an important part of the curriculum and social obligation, we are actively involved in the community and the maintenance of its health. All residents participate in community service during their residency.

The Family Practice Center supports the House of Good Shepard, woman’s shelter, by providing periodic visits to its clients to engage in healthy approaches to their disrupted families. (They had a fire last year which has decreased their census and reduced our involvement) The residents also provide support in the form of food, clothing and gift donations during the holiday season.

Our faculty and residents have helped the Indian American Medical Association by staffing the Pedersen Clinic on weekends in the winter. This is a free clinic at Petersen and Western. All residents and faculty participate.

The Family Practice Center has been involved in the following community screenings and education:

Monthly blood pressure screening, RRC (several hundred per session)

Flu Shots, Resurrection Retirement Community

Flu Shots, Resurrection High School

Flu Shots, Ridgewood High School

Periodic Health talks to School District 64 and Resurrection HS

Lectures to residents of Resurrection Retirement Community

The Family Practice Center has maintained connections with organized youth sports for both curricular elements and community service, and now for our Sports Medicine Fellowship.

Maine West HS Athletics, Football, Basketball and training room

Loyola Academy HS Athletics, Football, Basketball and training room

Resurrection HS, Volleyball

Park Ridge Charity Classic 5K race

Turkey Trot 5 K race

North Park College, Football and training room

Chicago Marathon, medical support

Chicago Triathlon, medical support

Extreme Volleyball, medical coverage

Chicago Storm, medical coverage

DeKalb MS150 Bicycle race, medical support

Martial Arts Competition Coverage

Mayor’s Fitness Council, “Chicago Works out”

The Family Practice Center has participated in the continuing education of its colleagues:

Monthly Lectures to Pediatric Nursing department by residents

Faculty outside involvement:

Rainbow Hospice, Dr. Wolfe (team leading and call coverage) and Dr. McCurry (advisory and call) – residents included

School District 64, Dr. McCurry (medical director) – residents included

Medical expert work, Dr. McCurry, experience shared with residents

North Park College Trainer Program Faculty, Dr. Jaworski, sports curriculum

Resurrection Health Preferred HO, Dr. McCurry (medical director) and residents involved

Ridgewood, Resurrection and Loyola Academy High School Medical Volunteer, Dr. Jaworski, sports curriculum

Ad hoc committee on Electronic Medical Records, co-chaired by Dr. McCurry and representatives from all programs, develop needs assessment for the specific new Family Medicine Requirements put in place in July 2006 for a medical record, made visits and agreed on a medical record. The CEO steering group approved the plan, but did not have a time line in place for funding the project.

Medical Student Programs

The Family Practice Center continues to take students on a regular basis from Loyola, Chicago Medical School, University of Illinois and Midwestern University. This helps our exposure to local medical schools.

ACGME Citations

1. Office Volumes. Please refer to the first heading above. Essentially by the time we received our 5-year accreditation this last January, we had resolved the volume issue.

2. The ACGME felt we didn’t document a didactic curriculum in Occupational medicine, which is not the case. We will need to show this to them at the next survey (2010)

Sports Medicine Fellowship

The fellowship is now in its second year. The clinical volumes have grown in the Sports Medicine Center, with the second year projections showing doubling of the volumes. Our second fellow was taken from our first participation in the national match. This year’s match list has already been submitted and we are awaiting results.

Many of the fellowship activities are integrated with the base program to insure resident exposure as well.

Dr. Jaworski maintains the following not mentioned above:

• Medical Director, Tour de Farms MS 150 Ride.

• Extreme Volleyball Professional Tour-Chicago, Medical Director.

• USPGA Nationwide Tour LaSalle Bank Open, Medical Director.

• Mayor’s Fitness Council Member

Internal Medicine Westlake Hospital:

Accomplishments

1. Successfully implemented and/or revised three clinical rotations:

Emergency Medicine at Westlake Hospital

Ambulatory Care Block Rotation

Rheumatology

2. Continued implementation of the University of Illinois Core Curriculum

13 Web based interactive modules based on the six ABIM Core Competencies

Practice Based Learning Patient Care

Communication and Interpersonal Skills Professionalism

Systems Based Practice Medical Knowledge

3. Graduated a total of 10 residents in 2006

9 out of the class of 10 took the ABIM examination and 100% of them passed.

4. Implemented the following Performance Improvement Modules (administered by

the American Board of Internal Medicine):

Bronchial asthma

Diabetes mellitus

Hypertension

Resident Responsibilities

First year residents implement care for approximately 8-12 patients on an in-patient service and 4-6 patients in the Intensive Care Unit. They initiate the diagnostic and therapeutic plan. They are responsible for the performance of bedside procedures under the supervision of the Senior Resident and Attending Physician. They are responsible for modifying patient care in keeping with advice from the Senior Resident, Attending Physician and consultants.

The Senior Resident directs patient care for approximately 20 patients on the inpatient service and 12 patients in the intensive care areas. He/She is responsible for the coordination of the patient care functions of the junior residents, medical students, attending physicians, nurses, consultants and allied services. The Senior Resident is responsible for the quality of care delivered by the service. This includes diagnostic and therapeutic orders as well as procedures performed by the junior residents or students. He/She addresses all problems (medical or otherwise) that arise on his/her service. The Senior Resident is also responsible for setting the scholarly and humanistic tone on the service. Ultimate responsibility for patient care rests with the Attending Physician.

Continued monitoring and supervision of the residents by the attending physicians occur on an on-going basis.

Work Hours

All rotations are in compliance with the ACGME work hour rules. Time study was performed for several of the rotations. The Chief Resident and faculty members monitor work hours on an ongoing informal basis.

Scholarly Activities

Resident Participants for the Illinois ACP Jeopardy Contest 2006

PGY1 Ajay Bhatia, M.D.

PGY2 Pranjal Shah, M.D.

PGY3 Deepika Kanupuru, M.D.

Resident Participants for the Illinois ACP Oral Clinical Vignette 2006

Preeti Modi, M.D., “An Unusual Cause of Pulmonary Cavitation”

Resident Participants for the Illinois ACP Clinical and Research Posters 2006

1. A VERY ANGRY PITUITARY.

V. Sethi, M.D., P. Modi, M.D., M. Abboud, M.D., B. Potaczek, M.D.

2. GENETIC MUTATION – NOW ACQUIRED

M. Ganne, M.D., V. Sethi, M.D., N. Salvador, M.D.

3. OSLER WEBER RENDU SYNDROME

P. Lorenzo, M.D., V. Sethi, M.D., S. Shaikh, M.D., K. Heydarpour, M.D.,

B. Potaczek, M.D.

4. OUTCOME OF CAPSULE ENDOSCOPY IN A COMMUNITY HOSPITAL

N. Madamala, M.D., R. Sreedhar. M.D., M.S., K. Heydarpour, M.D.

5. THE WORLDS SMALLEST SURGEONS

G. Tandon, M. D., R. Sreedhar, M.D., M.S.

6. THE MAGICALLY FALLING HGB A1C

M. Vicuna, M.D., P. Lorenzo, M.D., A. Sethi, M.D., B. Potaczek, M.D.

7. NESIRITIDE - A KIDNEY KILLER?

M. Ramalingam.M.D. R. Sreedhar, M.D., M.S.

8. THE CASE OF DISAPPEARING CORONARY STENOSIS

Sethi, M.D., P. Lorenzo, M.D., R. Sreedhar, M.D., M.S.

9. STAPHYLOCOCCAL PSOAS ABSCESS

Ajay Bhatia, M.D., Radhika Sreedhar, M.D.

10. CENTRAL HYPOVENTILATION

Vishesh Puri, M.D., Prabjit Singh, M.D., Barbara Potaczek, M.D.

Ved Yadava, MD, FACP, FCCP.

11. ALL THAT WHEEZES IS NOT ASTHMA.

F. Khasawneh M.D, R.Sreedhar M.D., M.S., V. Chundi M.D.

12. ORAL MUCOMYST – DEADLY ALLERGIC REACTION

S. Manchireddy M.D., N. Madamala M.D., N. Sunkara, M.D.,

R. Sreedhar, M.D, M.S.

13. RARE CONGENITAL SYNDROMES – They are not just seen by

Pediatricians anymore!

P. Radhakrishna, M.D, R. Sreedhar M.D, N. Salvador M.D.,

14. DETONATE THE BOMB BEFORE IT EXPLODES

P. Shah, M.D, V. Sethi, M.D., R. Sreedhar, M.D., M.S.

Publications by the residents/faculty.

(The names that are underlined are residents, and the names that are not underlined are faculty members)

• Asha Thomas, Faris Khasawneh, and Sajan Thomas. Hyothermia. Review article Due for publication for December 2006 in Hospital Physician.

• Anayochukwu Uche, and Sajan Thomas. Dysphagia Aortica. Case Report. Published in Resident and Staff Physician in March 2006.

• Sajan Thomas, and Deepika Kanupuru. Cluster Headache. Review Article. Published in Resident and Staff Physician in March 2006.

• Pia Lorenzo, Sajan Thomas, and Mylene Vicuna. Ludwig’s Angina. Case Report. Published in Resident and Staff Physician.in September 2006.

The residents in addition participated in the following:

• A.Bhatia, M.D. First prize winner at the IAMA clinical vignette competition held in November 2006

• P. Modi, M.D. 2nd prize winner at the IAMA clinical vignette competition held in November 2006

• M. Ramalingam, M.D. 3rd prize winner at the IAMA clinical vignette competition held in November 2006

.

• Dr. Pranjal Shah presented a poster at the ACGME Patient Care conference held in November 2006

• Pia Lorenzo’s poster “Osler Weber Rendu Syndrome” won the third prize at the ACP Annual Illinois State Conference in October 2006. She has been selected to present this poster at he National ACP conference in April 2007

• Dr. Chitra Sadasiwan won the first prize in the oral clinical vignette competition at the ACP Illinois State Conference in 2005, and presented the same at the national ACP conference in April 2006

Continuing Medical Education:

The Department of Medical Education is responsible for the coordination of all continuing medical education provided at Resurrection Medical Center. Resurrection Medical Center is accredited through the Illinois State Medical Society to award category 1 AMA credit for approved programs. During the past year Resurrection Medical Center offered programs for a total of 99 Category 1 credits with 1730 attendees.

Planning for Continuing Medical Education is performed by the Continuing Medical Education Committee, which is a subcommittee of the Graduate Medical Education Committee. The committee members include Dr R Buckley Chair; Dr Gary Fahrenbach; Dr Suad Shuber; Dr Sajjini Thomas; Dr Leonardo Malalis; Dr Marc Dorfman; and Dr Steve Bozek. The committee performs needs assessments, quality assurance data, and physician requests to identify and prioritize CME offerings. The committee is responsible for ensuring that all programs are compliant with the regulations promulgated by ISMS. A representative from Nursing Education, Carmen Hovanec was added to the committee to identify programs that would have interest to nursing staff and coordinate obtaining CEU credits for nurses that attend.

The CME committee this year reviewed and approved several olive presentations that were video-taped as enduring materials and had CD/ DVDs made and placed in the library for physicians who were unable to attend the live presentation. The initial demand for the presentations has been low but the committee elected to continue to offer these programs and promote them with the medical staff. Dr Buckley and Sister Donna Marie met in December with Mr. Chessum and Ms. Cunningham to review the possibility of putting presentations on-line for physician use and it was agreed to further pursue this in the up-coming year.

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