Program Coordinators’ Meeting November 8, 2018

Program Coordinators’ Meeting November 8, 2018

2 Agenda JAMAevidence Resource Intro to new GME Team Members Annual Institutional Review (AIR) MBC Update - New Licensing Requirements Job Descriptions Launch of the 12th Annual GME Survey Operations Updates Confidential – For Discussion Purposes Only

JAMAevidence Resource JAMAevidence is a rich collection of evidence based resources that includes detailed guides to critical appraisal of the literature. A powerful teaching/learning tool, JAMAevidence is an obvious adjunct to journal clubs or any course on evidence based medicine. NOTE: To try out the customizable appraisal worksheets under “Learning Tools” you’ll need to click “Sign in” and create a Free MyAccess Profile. Try JAMAevidence! 30 day trial (Nov 1 – 30) Send us your feedback! Your comments are key to the decision regarding a subscription to JAMAevidence. JAMAevidence Content Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice The Rational Clinical Examination: Evidence-Based Clinical Diagnosis Care at the Close of Life: Evidence and Experience Education Guides provide EBM-focused slide sets for teaching core concepts. Critical Appraisal Worksheets allow one to synthesize information from EBM readings. My Access Account enables fast access to recently reviewed content Confidential – For Discussion Purposes Only

New GME Team Members Trey Huynh-Ngo, MBA Project Coordinator Nancy Ruddy, PhD Program Manager/Education Specialist Allergy & Immunology Internal Medicine and Fellowships Family Medicine and Family Sports Medicine Medical Genetics and Genomics Pediatrics and Fellowships Ophthalmology Radiation Oncology Confidential – For Discussion Purposes Only

2018 Annual Institutional Review (AIR) Department of Graduate Medical Education Ann M. Dohn, MA, DIO, Director of GME Laurence Katznelson, MD, Associate Dean for GME

2018 Graduate Medical Education – Overall Summary Statistics Stanford Healthcare GME Programs 115 ACGME accredited Residency/Fellowship programs/Tracks (4% increase from 2017) All programs fully/initially accredited No programs on ACGME probation 69 non standard (non ACGME) programs Three (3) pending new ACGME programs (GU Pathology, Renal Pathology, Complex General Surgical Oncology) Trainees 1352 Residents/fellows ( (3% increase from 2017) 250 Visiting Residents/Fellows Confidential – For Discussion Purposes Only

GME Growth . 17% Growth in Trainees over the Past Five Years . Confidential – For Discussion Purposes Only

GME Growth Since 2000 134 % Growth in Trainees Confidential – For Discussion Purposes Only

2018 Graduate Medical Education – Summary of GME Actions 9 Programs Reviews Two (2) Programs on Internal GME Probation 1200 GME Educational Consultations GME delivered, aggregated and posted 3440 Program Evaluations for programs Four (4) Presentations/Workshops at the 2018 ACGME National Education Meeting in Orlando, FL One (1) ACGME Webinar Three (3) Presentations and one (1) Poster at the 2018 Group on Resident Affairs (GRA) Spring Meeting (AAMC) in Orlando, FL Confidential – For Discussion Purposes Only

2018 Graduate Medical Education – Quality and Patient Safety Resident Safety Council 60 members 4 projects for 2018: Voalte: optimize strategies to enhance MD-RN interactions Patient experience: systems-based interventions geared towards improving the experience Safety Culture: improve SAFE reporting Each team with nursing leadership Goals of Care: improve quality of end of life discussions and decisions Resident Safety Champions: embedded in each department 74 Posters at the 2018 Stanford Resident/Fellow Quality Improvement and Patient Safety Symposium - Included nurses and medical students Safety Education Rolled out Safety Quest for house staff onboarding, and resident education Confidential – For Discussion Purposes Only

Institutional Scorecard: 2010 - 2018 Confidential – For Discussion Purposes Only

2018 Program Wide Institutional Report Card 2015-16 Institution-Wide Program Report Card Pgm A Pgm B Pgm C Pgm D Pgm E Pgm F Pgm G Pgm H Pgm I Pgm J Pgm K Pgm L Survey ACGME %COMPLIANT 100% 100% 96% 89% 100% 100% 100% 100% 100% 100% 91% 95% 100% 100% 86% 83% 100% 100% 100% 100% 100% 100% 100% 85% SHC Balanced Report Card Key Measures SOURCE INT or EXT Data Source Sufficie nt Supe rvision RESIDENT EXT Sufficient Instruction RESIDENT EXT Survey ACGME %COMPLIANT Appropriate Balance for Education RESIDENT EXT Survey ACGME %COMPLIANT 100% 94% 78% 94% 86% 62% 100% 50% 100% 92% 100% 85% RESIDENT EXT Survey ACGME %COMPLIANT 100% 100% 88% 94% 86% 85% 100% 25% 100% 100% 100% 80% RESIDENT EXT Survey ACGME %COMPLIANT 100% 100% 79% 83% 95% 85% 100% 50% 100% 100% 100% 95% RESIDENT EXT Survey ACGME %COMPLIANT 100% 94% 82% 83% 86% 85% 80% 75% 100% 100% 100% 90% RESIDENT EXT Survey ACGME %COMPLIANT 94% 94% 87% 91% 94% 91% 93% 88% 100% 100% 100% 91% 0 0 0 0 (Resolved) 0 0 (Resolved) 0 (Resolved) 0 0 0 (Resolved) 0 (Resolved) 0 Faculty/Staff Create Environment of Inquiry Satisfied with Process for Problems and Concerns Climate Where Residents Can Raise Concerns Without Fear Overall Eval of the Program Total Number of ACGME PROGRAM Citations Board Pass PROGRAM Rate s Overall Satisfaction RESIDENT with Program Program Organized to Mee t RESIDENT Educational Needs Se rvice Over RESIDENT Education EXT ACGME EXT ABMS No Data 100% 96% 96% 100% 75% 83% 100% 89% 100% 100% No Data INT GME-Survey No Data 79% 99% 82% 88% 100% No Data 100% 100% No Data 100% 82% INT GME-Survey No Data 100% 93% 73% 88% 100% No Data 100% 100% No Data 100% 100% INT GME-Survey No Data 93% 92% 73% 84% 88% No Data 100% 100% No Data 100% 94% RESIDENT INT GME-Survey No Data 100% 97% 73% 96% 88% No Data 80% 100% No Data 100% 100% RESIDENT INT GME-Survey No Data 93% 97% 73% 84% 100% No Data 60% 100% No Data No Data 94% RESIDENT INT GME-Survey No Data 93% 99% 70% 92% 100% No Data 100% 100% No Data 100% 100% FACULTY INT Pgm Eval Mean Score/10 9.2 9.6 8.9 9.4 8.4 9.1 8.6 8.2 8.8 9.1 9.0 8.8 RESIDENT INT Pgm Eval Mean Score/10 9.5 9.4 8.8 9.7 7.9 9.5 7.9 8.2 9.2 9.9 9.2 9 PROGRAM INT 0 0 7 0 3 1 0 0 0 0 0 0 # Unreviewed Duty Hr PROGRAM Periods by PD / AY INT 0 0 12 3 3 0 0 0 0 0 0 1 Encouraged to Ask Questions on a Regular Basis Residents Can Be Ope n and Honest with Faculty Reside nts Would Recommend Program Faculty Overall Evaluation Program Resident Overall Program Evaluation 80 Hr Violations / AY Me dHub Institution Duty Hr Rpt MedHub De taile dRpt KEY Confidential – For Discussion Purposes Only STRENGTHS WEAKNESSES

Institutional Work Hours Confidential – For Discussion Purposes Only

ACGME Citations: 12 Total in 2017-18 93% Reduction in Citations Confidential – For Discussion Purposes Only

1 5 Meals Report Jan – Sept 2018 Confidential – For Discussion Purposes Only Totals YTD SHC 492,910 LPCH 152,740 Grand Total 645,650 Aug Average per FTE SHC – 138.78 LPCH - 100.17

1 6 Status of the Uber Account Uber Usage - Six months Total Expenditure 26,108.13 Uber Usage By Month 6,000.00 5,373.00 5,000.00 4,559.20 4,543.70 4,310.30 9,505.67 4,000.00 3,964.30 3,357.70 3,000.00 16,602.46 2,000.00 1,000.00 SHC Confidential – For Discussion Purposes Only LPCH 0.00 April May June July August September

2018-2019 SHC Salary & Benefit Information Confidential – For Discussion Purposes Only

AIR Action Plan - Outcomes from the 2017 Charge Charge from 2017 2018 Outcomes Faculty Development on Teaching Partnered with the Stanford Graduate School of Education Continue investigation of milestone feedback given to residents/fellows Pilot completed with six (6) programs Expanded Pilot to UCLA and Kaiser Presented results to ACGME National Conference and to the Group on Resident Affairs Enhance Program Coordinator Role Initiated interventions – Comment Quality, Central Tendency findings Innovative Mentoring Application Developed Completed Coordinator Education Monthly Seminar Series based on Annual Didactic Schedule and awarded 47 Certificates Expand QI Completed Program Coordinator Orientation 37 - 74 increase in QI Symposium Presentations Increased ACGME QI Scores Confidential – For Discussion Purposes Only

Graduate School of Education Milestone Project Summary of Findings 1. Milestone evaluations are unreliable across specialties and institutions 2. Evaluators are more predictive of milestone scores than the residents 3. Evaluators often rate milestone competencies along one dimension 4. Time and milestone score is a non-linear function (jump at PGY transition) 5. Evaluator characteristics do not appear to influence milestone scores 6. Monthly milestone evaluations directly impact CCC scores for residents Confidential – For Discussion Purposes Only

ConnectEd App Background & Highlights Moving Mentoring into the High Tech and the “Connected”Era www.bit.ly/SMSConnectEd Utilizes Stanford University (SUNet) login to maintain security and privacy. All data is stored on the Stanford server. Winter 2018: GME identifies an opportunity to utilize technology to foster mentorship and collaboration within Stanford School of Medicine Graduate Education. Imports pre-existing Stanford academic profiles ConnectEd team is formed, led by Thomas Caruso, MD and including Nicolas Prionas, MD (Radiation Oncology resident) and Tiffany Kung (medical student). Allows for searching across the academic spectrum – from medical students through faculty – to foster collaboration and mentorship. Summer 2018: Proof of concept mobile application is launched on the Apple iOs app store Filtering allows users to narrow their results to find those with shared interests. Fall 2018: Soft launch identified areas of opportunities needed to maximize potential Profile page allows users to supplement their profiles with additional information not on their preexisting Stanford profile. Confidential – For Discussion Purposes Only

2017-18 AIR SWOT Analysis To train physician leaders in clinical care, research and academics. Confidential – For Discussion Purposes Only

Questions Confidential – For Discussion Purposes Only

MBC Update MBC – April Alameda, Chief of Licensing was here – Oct 23rd to meet with Stanford GME stakeholders Confidential – For Discussion Purposes Only

Update on the Changes to Postgraduate Training Effective January 1, 2020 April Alameda, Chief of Licensing

What are the Changes? Minimum requirements for postgraduate training in California will require successful completion of thirty-six (36) months of a Board-approved program, for all applicants, regardless of whether the medical school attended was domestic or international An applicant must successfully complete 24 consecutive months of training in the same program, to be eligible for a California Physician’s and Surgeon’s Certificate Confidential – For Discussion Purposes Only

What are the Changes? A Postgraduate Training License (PTL) will be required for all residents who are participating in a California ACGME program A renewal of a PTL will not be required A Postgraduate Training Authorization Letter (PTAL) will no longer be required for international medical graduates Confidential – For Discussion Purposes Only

What are the Changes? The Board will no longer recognize international medical schools, rather the Board will recognize an international medical school as meeting the educational requirements for a PTL/licensure, if the school is listed on the World Federation for Medical Education (WFME) and the Foundation for Advancement of International Medical Education (FAIMER) and Research World Directory of Medical Schools joint directory or the World Directory of Medical Schools Confidential – For Discussion Purposes Only

PTL Requirements A trainee must obtain a PTL within 180 days after enrollment in a California ACGME program A PTL will be valid until 90 days after the trainee has successfully completed the required training A resident may apply for a PTL as soon as they have confirmation of acceptance into a California ACGME program Confidential – For Discussion Purposes Only

PTL Requirements A trainee will be issued a pocket card which will identify the holder of the PTL and the participating program A PTL will be displayed on the Board’s website Confidential – For Discussion Purposes Only

Moonlighting The holder of a PTL may engage in the practice of medicine only in connection with his or her duties as an intern or resident in a Board-approved postgraduate program, including its affiliated sites, or under those conditions as approved in writing and maintained in the file, by the director of his or her program. Accordingly, a holder of a PTL may moonlight with written authorization from the program director. Confidential – For Discussion Purposes Only

PTL to Licensure After successful completion of 36 months of training, the trainee will apply to transition their PTL to a Physician’s and Surgeon’s Certificate with the Board within 90 days to continue practicing medicine in California. Confidential – For Discussion Purposes Only

California Programs The program director -- GME is asking if this can be provided by GME -- will be required to submit the Postgraduate Training License Enrollment Form for each resident participating in their program. Confidential – For Discussion Purposes Only

California Programs The program must notify the Board if the trainee transfers to another Board-approved program, resigns, or is terminated. The Board must also be notified if the trainee’s program is extended for any reason(s), if the trainee takes a leave of absence and/or the trainee receives no credit for any rotation. Confidential – For Discussion Purposes Only

Implementation Timeline Confidential – For Discussion Purposes Only

Implementation Timeline Confidential – For Discussion Purposes Only

Implementation Timeline Confidential – For Discussion Purposes Only

Questions Confidential – For Discussion Purposes Only

Current Interns – PGY 1s Must be licensed by 1/1/2020 or face three year PTL So far we only have 11 applications submitted out of 182 GME has two (2) notaries Confidential – For Discussion Purposes Only

12th Annual GME House Staff Survey Launched November 7th – Runs through December 14th We’ll have overall results to you first week of January 2019 – prior to the start of the ACGME Survey 264 Responses so far Focus on Wellness this year Please encourage your trainees to take the survey Confidential – For Discussion Purposes Only

Job Descriptions - MedHub We will be building all job descriptions into MedHub CLER and Joint Commission Requirements Project Will be Completed by April We will need your help!! Confidential – For Discussion Purposes Only

GME Operations Updates A bit of housing/salary history Continuing Form Transfer Form New Hire Form Confidential – For Discussion Purposes Only

2 April 3, 1969 Letter from the GME Director to the President of the Board of Trustees Stanford University Confidential – For Discussion Purposes Only

3 April 3, 1969 Letter from the GME Director to the President of the Board of Trustees Stanford University Continued Confidential – For Discussion Purposes Only

Continuing Form – Due to GME by 12/13/2018 Confidential – For Discussion Purposes Only

Transfer Form – Due to GME by 12/13/2018 Confidential – For Discussion Purposes Only

New Hire Form – Due to GME by 12/13/2018 Confidential – For Discussion Purposes Only

Questions? Confidential – For Discussion Purposes Only