Embed Size (px)
Citation preview
The Programs Grade Book: Back to the Basics
Jennifer Shieck, MBA Afshin Molkara, MD
Arnold Tabuenca, MD University of California Riverside
Riverside County Regional Medical Center
Disclosure No conflicts of interest to report
Past
Present
Future
The Past
1990’s No Core Competencies
No common duty hour requirements
Paper Application Systems
Program Information Forms (PIF)
Limited use of technology – word processing
The Past Evaluation of Residents
Rotation evaluation
Program Director semi-annual evaluation
In-training scores
Difficult to track operative procedure numbers
Residents worked 100+ hours a week
Program resource
Graduate Medical Education Directory: The big green book
2000 ERAS
ACGME identifies and introduces 6 general competencies
51% of information flowing through the internet
2003 Common duty hours
The Present Webs Ads
Core Competencies
Milestones
Supervision Policies & Requirements
Learning Portfolios
Duty Hours Requirements
The basic questions: Who
What
Where
Why
Who do we collect data for?
ACGME
Institutions: GMEC
Programs / Resident
American Board of Surgery
What data do we collect
Core Competency information
Patient Care
Medical Knowledge
Professionalism
Practice-based Learning and Improvement
Interpersonal and Communication Skills
Systems-based Practice
Now lets take a break….
Where do we get the information / data
Operative Procedures logs
Evaluations
OSCE
In-training exam
Remediation programs
On line course work / program specific homework
Research
Conference attendance
Licensure / certification
Rotation check off sheets
PBLI assignments
Duty Hours
Why do we collect the data ACGME
Web Ads
Milestones
Operative Logs
American Board of Surgery
Resident Board application
Exam results for accreditation
Institutions: GMEC
Annual reports / internal reviews
Programs / Resident
Semi-annual evaluations
Resident advancement and final summary evaluations
Clinical Competency Committees
Resident capabilities
Tools To Help Massive use of technology
Networked computers
Internet
Cell Phones
ERAS
Residency Management Systems
Residency Management Systems Organize lots of information
Personal data
Procedures
Resident portfolio
Evaluations
Duty Hours
Conferences
Schedules
Life saver for program coordinators
Somewhat confusing for program directors & mentors
What Would Make Life Easier Program Director and Mentors
Up-to-date information
Concise information on each resident
Comparative data on all residents
Easy to use system
Easy to read reports
Introduction of Grade Book Program specific
Resident specific
Comparative data
Provides information for evaluation completion
Easy to use
One document vs. multiple reports
Information always available
Shared network folders
Dropbox
Grade Book = Multi Sheet Excel Document General Information
Milestones
ABSITE (tracked for all years)
ABSITE prep course
Skills Lab
Proficiencies
Defined Categories
Competency Information
Research
Certifications
Operative evaluation / CAMEO’s completed
Information Always Available Shared Network files
Drop Box
General Surgery Residency
July 1, 2015
ACS Test Percentage ABSITE % tile Conference Attendance Medical License Duty Hours Delinquent Op Logs Delinquent
PGY 1
BH 66 5 100 1 3
TL 77 16 100 0 1
NS 66 86 100 5 12
JO 77 79 100 1 1
SS 75 70 85 1 1
PGY 2
EA 83 56 92 1 2
MC 88 21 100 4 3
PE 88 13 100 05/31/16 0 0
FV 66 69 88 6/30/2016 2 1
PGY 3
CH 66 86 91 11/30/2015 5 12
VL 88 69 91 6/30/2015 1 0
AN 77 44 95 6/30/2016 1 1
JW 94 38 95 9/20/2015 1 1
PGY 4
AH 66 21 100 10/31/2016 2 1
KM 88 81 95 9/30/2016 3 5
MM 77 48 95 3/31/2017 3 2
SY 77 60 95 6/30/2016 1 0
ACGME Milestones July - December, 2014
PC 1 PC 2 PC 3 MK 1 MK 2 SBP 1 SBP 2 PBLI 1 PBLI 2 PBLI 3 Prof 1 Prof 2 Prof 3 ICS 1 ICS 2 ICS 3
AH 3 3 3.5 2.5 3.5 3 3 3 3 3 3 3 3 3.5 3.5 3
KM 3 3 3 3 3.5 3 3 3.5 3 3.5 3 3 3 3 3.5 3
MM 3 2.5 3 2.5 3 3 3 3 3.5 3 2.5 3 2.5 3 3 3
CK 2.5 2.5 2.5 3 3 2.5 2.5 2.5 2.5 3 3 2.5 2 2.5 2.5 2.5
BL 2.5 2.5 3 2.5 2.5 2.5 2.5 3 2 2.5 1.5 2.5 2 2.5 1 2.5
AS 2.5 2.5 2.5 2 2.5 2.5 2.5 2.5 2.5 2.5 3 2.5 2.5 2.5 2.5 2.5
JW 2.5 3 2.5 2.5 2.5 2.5 2.5 2.5 2.5 2.5 3 2.5 3 2.5 2.5 2.5
SY 2.5 2.5 2.5 1.5 2.5 2.5 2.5 2.5 1 2.5 2.5 2.5 2.5 2.5 2.5 2.5
EA 2 2 2 2 2 2 2 2 2 2 2 2 1.5 2 2 2
MC 2 2.5 2.5 1.5 2.5 2.5 2.5 2.5 2.5 2.5 2.5 2 2 2.5 2.5 2.5
PE 2 2 1.5 1.5 2 2 2 2 2 2 2.5 2 2 2 2 2
FV 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
BH 1 1.5 1 1 1 1 1 1 1 1 1.5 1.5 1.5 1 1 1
TL 1 1 1 1 0.5 1 1 1 1 1 1 1 1 1 1 0.5
SN 1 1.5 1 0.5 1 1 1 1 1 1 1.5 1 1 1.5 1 1
JO 1 1.5 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SS 1 1.5 1 1 1 1.5 1.5 1 1 1 1 1.5 1.5 1.5 1.5 1.5
AC+A1:P27S Weekly Test Scores
7/16 7/21 7/30 8/6 8/13 8/20 8/27 9/3 9/10 9/17 9/24 10/8 10/15 10/22 10/29
PGY 1
BH 5 5 5 5 5 5 5 5 5 5
TL 5 5 5 5 5 5 5 5 5 5 5 5 5
SN 5 5 5 5 5 5 5 5 5 5
JO 5 5 5 5 5 5 5 5 5 5 5 5 5
SS 5 5 5 5 5 5 5 5 5 5 5 5 5
PGY 2
AE 5 5 5 5 5 5 5 5 5 5 5 5 5 5
MC 5 5 5 5 5 5 5 5 5 5 5 5 5
PE 5 5 5 5 5 5 5 5 5 5 5 5 5
FV 5 5 5 5 5 5 5 5
PGY 3
KC 5 5 5 5 5 5 5 5 5 5 5
BL 5 5 5 5 5 5 5 5 5 5 5 5
AS 5 5 5 5 5 5 5 5 5 5 5 5 5
JW 5 5 5 5 5 5 5 5 5 5 5 5 5
PGY 4
AH 5 5 5 5 5 5 5 5 5 5
KM 5 5 5 5 5 5 5 5 5 5 5 5 5
MM 5 5 5 5 5 5 5 5 5 5 5 5
SY 5 5 5 5 5 5 5 5 5 5 5 5 5
ABSITE %tiles only
2012 2013 2014 2015 2016 Study Plan
AH 48 58 21 21 x
KM 73 84 53 81 x
MM 42 53 16 48 x
SY 42 18 21 60 x
KC 92 82 80
BL 49 56 69
AS 62 22 44 x
JY 32 42 38
AE 37 56 x
MC 33 21 x
EP 16 13 x
FV 53 57 69 x
BH 5
TL 16 x
NC 25 86 x
JO 79 x
SS 70 x
ABSITE Prep Course
Bre
ast,
Ap
py
, In
flam
mat
ion
Bili
ary
Cri
tica
l Car
e, S
ho
ck
Rev
iew
On
colo
gy, G
yn
Co
lon
& r
ectu
m, P
ed
iatr
ic
Sto
mac
h &
Du
od
enu
m, A
nu
s
Rep
eat
Sto
mac
h, d
uo
den
um
Rev
iew
Pan
crea
s, E
nd
ocr
ine
Pan
crea
s
Thyr
oid
, Hea
d &
Nec
k P
arat
hry
oid
Mo
ck A
bsi
te
Eso
ph
agu
s, P
itu
itar
y &
A
dre
nal
Rev
iew
Live
r, H
ern
ia
Smal
l Bo
wel
Surg
ical
infe
ctio
ns
Test
rev
iew
Tho
raci
c
rep
eat
mo
ck a
bsi
te
Trau
ma
Tran
spla
nt
& Im
mu
no
olo
gy
Rev
iew
Sple
en
Vas
cula
r
Nu
trit
ion
an
d M
etab
olis
m
Rev
iew
PGY 4:
AH 78 70 70 96 68 44 25 80 76 64 68 65 69 76 52 69 72 80 72 99 72 76 96 60 54 74 94
KM 74 72 6 80 60 36 54 66 65 60 60 59 62 60 80 68 71 92 57 43
MM 68 72 60 72 64 54 41 70 60 65 65 56 52 61 66 72 54 93 64 54 58 74 90
PGY 3
AS 72 62 60 64 52 40 41 48 54 57 48 100 78 88 87 89 82 86 72 89 100 86 75 60 95 80
SY 76 54 64 76 66 36 37 96 84 54 52 62 69 70 56 46 66 70 54 85 68 59 72 57 52 90
PGY 2:
EA 74 58 56 86 94 88 66 96 90 86 100 51 100 98 98 100 100 100 100 93 100 98 97 97 96
MC 72 80 74 92 76 46 41 76 76 58 2 67 62 82 60 93 100 98 88 96 79 59 92 48 80 72 76
EP 76 72 70 88 72 46 39 76 80 72 52 51 7 64 68 76 62 57 58 59 80 57 60 74 88
FV 76 56 74 54 38 50 42 78 65 58 84 49 72 56 63 60 73 80
PGY 1:
TL 28 * 66 54 28 37 42 41 20 34 43 71 58 33 54 63 68
NS 70 72 82 80 68 36 37 16 88 60 13 52 60 54 80 86 72 68 71 75 50 72
JO 46 48 62 58 42 29 44 60 42 39 50 51 54 61 41 66 68 39
SS 76 50 74 80 44 37 38 50 34 48 39 60 38 34 45 54 48 57 58 57
Resident Proficiency
Fundaments of
Surgery - FLS RCRMC
Basic knot tying &
suturing
Aseptic
techniques
Advanced Knot
Tying Instrument
Idenfification
Sutures &
suturing
techniques Wound care
Central Line Acceess II Tissue handling
PGY 1
Harris, Brad complete fail complete complete complete complete complete complete complete
Lu Tim complete complete complete Fail / complete complete complete complete complete
Nouri Sarvenaz complete 10/15/2014 complete complete complete complete complete complete complete
Ortiz Juan complete 11/28/2014 complete complete complete complete complete complete complete
Satey Sean complete 9/30/2014 complete complete complete complete complete complete
PGY 2 Ventilator
Management
Interpret EKG & Mgmt
of Dysrhythmia
Introduction of
Hemodynamic Monitoring
Alonso Emilio complete
Camelo Monica complete
Edpao Peter Joseph complete complete
Vega Francisco complete
PGY 3 Wound Care GI prep Airway mgmt
Chiang Kevin Complete complete
Love Bryan Complete Fail / complete
Son Andrew Complete complete
Wang Jerry Complete complete
PGY 4 Wound care Airway mgmt FLS Sages
Herrera Anthony complete
Mannoia Kristyn complete
Mitchell Mark complete
Yan Stephanie complete
SS&B H&N ALT AB LV PANC VASC ENDO TRAU MOP TRNO NOP THOR PED PLA
Resident 25 24 72 65 4 3 44 8 10 20 15 20 5
PGY3
KC 78 28 59 136 0 0 4 13 2 43 0 34 10
BL 87 6 67 119 1 1 10 1 1 83 0 27 18
AS 126 7 102 221 2 2 17 1 1 100 0 31 16
JW 63 42 63 106 1 0 15 9 6 98 4 31 22
PGY 4
AH 97 51 134 139 2 0 42 14 5 73 14 32 14
KM 90 64 109 161 2 1 67 24 11 134 30 43 24
MM 116 118 153 215 4 1 76 41 24 164 25 27 52
SY 95 78 110 184 3 3 38 25 16 24 25 28 23
Core Competencies
Practice Based Learning & Improvement
Blue Red Green PM Acute Care AM Actue Care / orange Surgical Education Transplant Anesthsia Self Eval
PGY 1
BH complete complete complete complete SICU - complete complete
TL complete complete complete complete complete
SN complete complete complete complete
JO complete complete complete complete complete complete
SS complete complete complete complete complete complete
PGY 2 SICU 1 SICU 2 Kaiser Plastics Ped Surg ACS AM Gen Surg self eval
EA complete complete complete complete
MC complete complete complete complete
PE complete complete complete complete complete
FV complete complete complete complete
PGY 3 Kaiser GS 1 Kaiser GS 2 GI ENT GS 1 GS 2 ACS AM ACS AM
Self Eval
KC complete complete complete complete
BL complete complete cmoplete complete complete complete
AS complete complete complete complete complete complete
YW complete complete complete complete complete complete
GI / Green Kaiser 1 Kaiser 2 Blue ACS PM 1 ACS PM 2 GS - Red Green
SY complete complete complete complete complete complete
PGY 4 Vasc 1 Vasc 2 ACS PM 1 ACS PM 2 Chest 1 Chest 2 GS 1 GS 2
Self Eval
AH complete complete complete complete complete complete
KM complete complete complete complete
MM complete complete complete complete complete
Surgery Residency Research Requirement
Pre-research
paperwork
Case report
Approval IRB approved
Case report
received
Case report
submitted for
publication
Case Report
accepted for
presentation
Research
Approval
Form
IRB
Approved
Research
Complete
Research
submitted for
Publication
PGY 3
KC complete complete complete complete Yes
BL complete YES
AS complete complete complete complete YES
JW complete complete complete No
Research Topics:
KC
Successful Initiative to Reduce Surgical Site Infections at a County Hospital. Silvia I
Gnass, MS, Arnold Tabuenca MD; Matias Gnass MD; Daniel Ludi MD; Kevin Chiang MD;
Ashfin Molkara MD. Abstract submitted to ACS clinical congress 2013
Successful Initiative to Reduce Surgical Site Infections at a County Hospital. Riverside
County Research Symposium, June 2013
Successful Initiative to Reduce Surgical Site Infections at a County Hospital. Silvia I
Gnass, MS, Arnold Tabuenca MD; Matias Gnass MD; Daniel Ludi MD; Kevin Chiang MD;
Ashfin Molkara MD. ACS - Clinical Congress Washington DC, October 8, 1013 . Podium
Presentation
General Surgery Residency
Duty Hours Report Per Rotation Block
Violations: Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7
7/1/11 - 7/27/11 7/28/11 - 8/24/11 8/25/11- 9/21/11 9/22/11 - 10/19/11 10/20/11 - 11/16/11 11/17/11 - 12/14/11 12/15/11 - 1/11/12
Maximum amount of hours worked per week = 80 hours
Maximum number of consecturive hours in one day: PGY 1 = 16
hours
Maximum number of consecutive hours in one day: PGY 2 and
above = 24 + 4
Days off: AOA programs 1 in 7 or 2 consecutive in 14
Days off: ACMGE program 1 in 7 averaged over 4 weeks
GS orange - 1
Maximum number of in house calls: no more frequntly than every
3rd night averaged over 4 weeks
Minimun number of hours off per shiff less than 24 hours = 10 Gen Surg = 9 Transplant = 3 Gen Surg = 2 GS - Blue 2 GS -
Red 1 GS - Orange 3
GS - Red 1
Minimun number of hours off per shift 24 hours or greater = 14
Maximum number of hours worked in the ER = 12 hours
Block 6 violations
KN(1) - only 9.5 hours off between duty periods. Managing critical issue with patients while on call for ICU over the weekend and returned to regular service on following day to prepare for rounds.
Block 5 violations
NO VIOLATIONS
Block 4 violations
SY(2)- on call resident during the day and needed to finish floor work, tuck in patients for the night before leaving
SY (1) Only had 9 hours off between duty periods. Came in early to attend surgery lecture
Block 3 violations
Short Break:
KN (2) - Misinformed about the rule, he thought it was 8 hours between shifts. Resident is now aware that even though he is in an ACGME program, he must follow RCRMC duty hours policy
AH - rounding with medical student and then resident. Carried out responsibilities after rounding with Resident
BLS ACLS ATLS
Critical Care
Support
Medical
License
Medical
License
Number DEA USMLE III USMLE II USMLE I CK exam
PGY 1
BH 6/30/2016 3/20/2016 Passed 198 230 pass
TL 4/30/2016 4/30/2016 Passed 233 229 pass
NS 5/30/2015 6/30/2015 Passed 224 214 pass
JO 6/30/2016 6/30/2016 218 225 pass
SS 6/30/2016 6/30/2016 Passed 227 231 pass
PGY 2
AE 11/30/2016 3/31/2017 Passed 211 221 pass
MC 4/30/2015 4/30/2015 1/31/2013 Passed 241 227 pass
PC 5/30/2015 5/30/2015 9/28/2018 1/31/2013 5/31/2016 A134595 Passed 227 215 pass
FV 1/31/2016 6/30/2015 9/28/2018 1/31/2013 6/30/2016 A130863 Passed 207 213 *pass
PGY 3
KC 5/30/2016 3/30/2016 10/15/2017 11/30/2015 A128996 Passed 252 227 Pass
BL 4/30/2015 4/30/2015 4/30/2017 6/30/2015 A126011 Passed 213 219 Pass
AS 4/30/2016 6/31/2016 10/15/2017 6/30/2016 A130893 Passed 217 202 pass
JW 4/30/2016 5/30/2016 4/30/2017 9/20/2015 A131054 Passed 216 213 pass
PGY 4
AH 4/30/2015 4/30/2015 11/13/2016 11/6/2012 10/31/2016 A124294 Passed* 195 221 Pass
KM 5/30/2016 6/30/2015 11/13/2016 11/6/2012 9/30/2016 A124962 Passed 236 218 pass
MM 6/30/2015 6/30/2015 4/24/2016 11/6/2012 3/31/2017 A124776 Passed* 201 216 *pass
SY 5/31/2015 5/31/2015 11/13/2016 6/30/2012 6/30/2016 A125106 Passed 208 188 pass
Open Inguinal
Heria
Partial Mastectomy / Excisional BX
Lap Appy Lap Chole Mastectomy
w/ Axilary Mgmt
Small Bowel resection / colectomy
Cameo 1 Cameo 2 Cameo 3 Cameo 4 Cameo 5 Cameo 6
PGY 1
BH 10/9/2014 3/12/2015
TL 8/14/2014 3/24/2015
SN 5/30/2014 8/8/2013 10/14/2013 8/14/2014
JO 8/14/2014
SS 11/17/2014 8/26/2014
PGY 2
AE 1/29/2014 5/14/2014 8/8/2013 8/12/2014
MC 6/6/2014 11/15/2013 11/12/2013 2/5/2015
EP 5/2/2014 5/9/2014 1/14/2014 5/1/2014 9/29/2014
FV 5/29/2013 4/20/2013 5/21/2013 10/9/2014
PGY 3
KC 4/12/2013 1/31/2014 3/15/14 Paper
Copy 3/21/2013 3/14/2014 3/19/2014 9/24/2014
BL 6/26/2013 4/24/2013 1/10/2014 9/28/13 Paper
Copy 5/23/2013 8/9/2013 9/30/2013 7/31/2014 3/18/2015
AS 4/10/2013 4/24/2014 1/30/2015 1/23/2015 3/19/2013 4/24/2014 6/9/2014
JY 7/3/2013 7/3/2013 5/16/2013 10/29/2013 9/25/2014 3/12/2015
PGY 4
AH 7/3/2013 3/24/13 Paper
copy
4/3/13 Paper copy
9/18/13 Paper copy 4/12/2013 4/23/2013 9/6/2013 9/27/2013 3/24/2015
KM 11/26/2014 5/16/2013 6/29/13 Paper
copy
5/22/13 Paper copy 5/15/2013 6/18/2013 12/4/2013 9/29/2014 3/18/2015
MM 3/7/2013 6/19/2014 9/1/2014 6/26/2014 9/16/2014 10/24/2014
SY 3/18/2014 4/19/2013 3/7/2013 3/21/2014 3/19/2014 8/14/2014 10/9/2014
Future Next Accreditation System (NAS)
More Documentation
Resident Supervision
Duty Hours
Core Competencies
Resident Capabilities
American Board of Surgery
Fundamentals of Laparoscopic Surgery
Fundamentals of Endoscopic Surgery
Summary Program Coordinator
Easy to use
Lots of information at my finger tips
Allows for advance notice of deficiencies
Easily adaptable
Residents
Can get information fast on what's due / past due
Faculty / Mentors
Easy to use
Information readily available
Program Director
Information readily available in one document
Easy to use
Adaptable
Semi-annual evaluations completed with ease
Web-ADS completed without extra data having to be gathered
Easy to determine where residents are deficient
Great document for Residency Review Committee
Great document for Clinical Competency Committee
Graduate Medical Education
Allows GME to track program compliance
The price is right!
Resident Ski Trip - 2015
