Overview of the Summa Health System / NEOMED Transitional Year

Overview of the Summa Health System / NEOMED Transitional Year residency Stephanie Zaugg, DO, PharmD Program Director starting 2023 October 1, 2022

Outline for PD Comments Welcome (overview of interview, thankyou for your interest) For Questions: Megan Baugher at baugherm.summahealth.org Pandemic: what we have done, how we have changed Hospital description: 10 ACGME residencies and 8 fellowships NEOMED Major teaching hospital Educational culture EIP: both traditional and progressive James Tan MD How supervised; med team rotations Med Teams: number of patients, direct jobs and feedback, day/night teams; follow all ACGME cap rules Duty hours: 16 hours longest scheduled call; ICU is 12.5-13 hours. Two teams: 3 seniors 4-5 PGY1s Electives and support for0research Ambulatory Block: PCMH, Pharmacist, Behavioralist and SW, APNs. Transitions; (PCMH, Business Curriculum, Population Health, Team skills) Other competencies QI methodology and practice Leading clinical teams Becoming a clinical teacher Business of medicine Wellness: Plan, Measure, Support, Resolution Relational learning culture

Basic Info – Summa Summa is a academic, medical school-Affiliated, Community program 653 staffed beds, 457 beds on Akron City campus All inpatient IM rotations are on the Akron City campus Level 1 Trauma Center Summa is the Sponsoring Institution for 10 ACGME-accredited residency programs and 8 ACGME certified fellowships

Summa sponsored ACGME programs Internal Medicine Cardiology Family Medicine – Akron City Sports Medicine Interventional Cardiology Family Medicine – Barberton Critical Care Medicine Geriatrics Hospice and Palliative Medicine General Surgery Plastic Surgery Psychiatry Addiction Medicine Transitional Year Emergency Medicine Preliminary Medicine is considered part of the Internal Medicine program Orthopedic Surgery Obstetrics and Gynecology Pathology

Basic Info – NEOMED NEOMED is a consortium medical school, bringing together 4 universities in NE Ohio & multiple hospitals More NEOMED grads come to Summa for residency than any other hospital More NEOMED grads entering IM residency come to Summa than any other IM program

How many residents and Fellows do we have? Internal Medicine – 20 residents per class (recently expanded) Preliminary Medicine – variable, plan for 2-3 in 2023-24 Transitional Year – 10 residents per class o Almost identical program to Preliminary Medicine Cardiology – 4 fellows per class Interventional Cardiology – 3 fellows Critical Care Medicine – 2 fellows per class Geriatrics – anticipate 2 fellows for 2023-24 Hospice and Palliative Medicine – anticipate 3 fellows for 2023-24

Gen Med 4 Gen Med Teams Admit q 4 days 2-3 seniors & 2-3 PGY 1s per team Admitting day o 1 senior & 1 PGY 1 during the day o Second senior and PGY 1 overnight & post admitting morning rounds Cross cover admitting on Sat night & some Fri nights Continuity Clinic in afternoon of Day 3 or Day 4 of the 4 day admitting cycle Residents eval patients for admission rather than just accept ER decision, discharge approx. 15% of ER evals

ICU & CCU 1 month each per year 12.5 – 13 hour shifts 3 seniors and 5-6 PGY 1s (including rotators) on ICU each month, split into 2 teams with some rotation between teams 3 seniors and 4 PGY 1s (including rotators) on CCU each month 1 senior & 1 PGY 1 in each unit per night – series of 5-6 night shifts 2 MICU attendings & 1 Cardiology fellow in house overnight Active interventional cardiology group including overnight

Continuity Clinic Continuity Clinic in office building connected to hospital by bridge, also houses core faculty offices Level 3 certified Patient Centered Medical Home Staff includes PharmD, Behavioral Health, Social Worker, NPs Half day per week Continuity Clinic, when on med team to see patients transitioning from the hospital to home Integrated with inpatient schedules to minimize stress associated with “going to clinic” Second half day per week during subspecialty and elective rotations Ambulatory focus for TY’s is to learn team-based care and systems-based practice, professionalism and communication competencies

Miscellaneous Duty hours o We follow all ACGME duty hours rules o Longest scheduled call is 16 hours o No one is here 24 consecutive hours o ICU/CCU shifts are 12.5 – 13 hours Census caps o We follow all ACGME cap rules for admissions and ongoing care Electronic Medical Record is EPIC

Prelim & Transitional Year Schedule Overview Rotation Gen Med Months 4 ICU 1 CCU 1 Night Float 1 Ambulatory Block 1 EM 1 Electives/Subspecialties 3

Sample Resident Schedule Gen Med 3 PGY3 PGY2 Gen Med 3 PGY1 Gen Med 3 PM/Trans 0 Gen Med 4 2 4 6 8 10 Months All rotations are 1 month in length unless noted otherwise NF Night Float Amb Ambulatory block HPM Hospice & Palliative Medicine PM/Trans Preliminary Medicine and Transitional Year * Gen Med Consult or specialty rotation depending on career focus 12

Additional Information We strive to stay on the forward leaning edge of medical education Charter program of the 10 year ACGME Educational Innovation Project, 2006-16 EIP goal was to find better ways to train residents and care for patients Programs included Ohio State, Cincinnati, UPMC, Indiana U, Duke, Mayo Clinic-Rochester, UC San Francisco & others EIP provided a testing ground for some revisions in ACGME Program Requirements

Summa EIP Our focus was on Patient and Resident Safety Quality Improvement Team-based approach to care

Future Directions In 2020-21 we allowed 10 PGY 1s (IM & Transitional) to start in May or early June; in 2021-22 and 2022-23 we allowed 5 PGY 1s to start on June 1 Goal was to improve transition to residency – this was NOT implemented to provide more care for COVID patients Subjectively results and resident perceptions have been very positive Anticipate making this available again for 2023-24