Hospital, residents adjust to new duty hoursby Cindy AbolePublic Relations In July, MUSC and more than 1,500 hospitals and institutions with accredited residency programs conformed to new duty hour regulations and program standards for graduate medical education. The change prompted GME programs across the country to redefine themselves and seek measurable methods to track hours and manage data which is the strength of medical residency programs today. Nine months later, the efforts introduced and guided by GME staff, the College of Medicine, and the Medical Center continue to make headway as residents, phy-sicians, and staff work collaboratively towards a level of compliance, accountability, and continuing excellence in residency education. “In terms of how well we’re doing, MUSC is successfully utilizing the E*Value system and we’re already ahead of the game,” said George Arana, M.D., associate dean and the designated institutional official for GME. These changes affect more than 500 physician residents and fellows in 45 medical residency programs at MUSC. Implementing E*Value
A major hurdle, testing the system, came last fall and yielded favorable results. A three-week visit by the Resident Review Committee for Internal Medicine evaluated the institution’s largest medical residency program, which includes subspecialities like cardiology, pulmonary, nephrology, and oncology. In November, the main hospital underwent its Joint Commission on Accreditation of Healthcare Organizations (JCAHO) review. Reviewers assessed how the hospital handled duty hour compliance. “They were very pleased with MUSC’s capacity of monitoring duty hours, resident and staff evaluations, and tracking other data,” Arana said. “They were impressed that we had a strong system in place that was easy to review and monitor.” More than a year prior to the compliance deadline, MUSC’s GME program was actively developing strategies to handle these changes. Known for its progressive approaches to the GME curriculum on a national level, the GME team formed a task force composed of physicians, hospital administrators, residents, and area practitioners. Guided by the ACGME’s six areas of competencies, the task force developed a strategic plan to redefine the program’s needs and goals for implementing the new standards. Its success with the strategic planning process led to more national recognition as a model for other residency programs, and has presented at both the American Association of Medical Colleges and the Association of Hospital Medical Education. As early as 2002, Afrin and the GME leaders began to look at tools like the E*Value system. They were considering a program that could handle duty hours tracking, plus other needs. Afrin contacted Quinn Montgomery, chief operations officer at Advanced Informatics. “We needed to design a Web-based evaluation, survey, and data collection program that was accessible, user-friendly and cost-effective,” said Afrin. In December 2002, Afrin conducted a three-month E*Value pilot study incorporating training and feedback from program coordinators, residents, physicians, and staff in the departments of Surgery, Psychiatry, OB/GYN, and Hematology/Oncology. By last July 1, all of MUSC’s 45 residency programs were online. A bumpy ride
“E*Value is very useful in the GME evaluation process because it makes the process more convenient for faculty and residents,” Afrin said. “It makes it easier for programs to track the status of the many evaluations that are always being sent out, filled out, and filed.” A newer, more challenging component to the system is education tracking and procedural approval, a requirement originally established by JCAHO to ensure quality care and patient safety within graduate residency programs. Only 40 percent in place, physician faculty and house staff can now electronically rate a resident’s ability to perform surgical or technical procedures. Alternatively, residents can evaluate faculty in their performances as teachers and provide effective feedback as programs improve or adjust in evaluations. Program directors and department chairmen can use E*Value as a measurable tool to review a resident’s procedure log or other GME data at anytime. “As residents demonstrate achieve-ment in medical procedure skills, their program director can extend resident privileges,” Afrin said. “We’ve needed a good, consistent method to help us manage this.” ACGME also requires some residents, like surgical trainees, to submit information for specific procedure-oriented programs into their national database or other systems sometimes double or triple logging data making it a time consuming effort. “E*Value brings some important new opportunities to managing the development of resident procedure competencies,” Afrin said. Staying ahead of the game
“MUSC is at the cutting edge of its thinking and work as they relate to GME,” said Montgomery, in a telephone interview. “Other medical institutions and programs may focus on duty hours, procedure tracking, and other features while MUSC is interested in the whole picture and how to get the most out of one system. It is certainly ahead of the game.” As the outlook for E*Value continues to brighten, Afrin, Arana, and GME associate dean Franklin Medio, Ph.D., are looking ahead and are not content with resting on their GME laurels. They are determining how state-of-the-art technology and newer efforts and strategies can improve graduate medical training. In January, Advanced Informatics announced updates to its duty hours tracking designed for wireless hand-held devices or other compatible program applications. Earlier this year, Advanced Inform-atics signed an agreement with MUSC’s College of Medicine to implement the E*Value system to monitor clerkship activities for third- and- fourth-year medical students. The system offers significant improvements to Advanced Informatics' electronic logbook that reports and monitors a student’s progress towards completed activities and manages clinical evaluations by faculty and residents. “E*Value offers a robust system for evaluation management, tracking, and other practical functions,” said Amy Blue, Ph.D., associate dean for curriculum and evaluation with the College of Medicine. “It also has some features that the college looks forward to incorporating in the future.” Staying focused on accountability
Arana wants to continue his focus on accountability. This fall, the program will host a program audit conducted by the same New York state auditing firm involved in New York state residency programs. Its aim is to conduct an independent audit of MUSC’s E*Value system to determine its overall accuracy and identify improvable processes to ensure the resident work effort is reliably captured. “Medicare reimbursement is directly dependent upon our report of residents work hours—the more accurately we do this, the more we receive from Medicare to pay resident and fellow stipends. We don’t want to overcharge because that’s fraudulent. We don’t want to under-charge because that’s dollars we leave on the table,” Arana said. “An external, impartial review by experienced auditors will help us
make accurate and meaningful adjustments in our process,” he said.
Friday, April 9, 2004
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