Graduate Medical Education

Annual Report for Academic Year 2011-12

Enclosed is the Partners HealthCare System Graduate Medical Education (GME) Annual Report for Academic Year (AY) 2011-2012. The activities and accomplishments are the result of a team effort by the dedicated indi-viduals listed below, and many others. We would like to thank the leadership of Partners (PHS), Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH) for their unwavering support, ongoing advice and advocacy of graduate medical education—in particular, Drs. Anne Klibanski (PHS Chief Academic Officer), Gary Gottlieb (PHS CEO) Elizabeth Nabel (BWH President), Peter Slavin (MGH President), Stanley Ashley (BWH CMO), and Britain Nicholson (MGH CMO). This annual report is intended to provide: a current overview of the size and scope of GME at Partners an inventory of PHS GME programs information regarding educational programs and other activities sponsored by PHS GME a snapshot summary of changes and key accomplishments in GME during this academic year. Special thanks go to Irina Knyshevski, Patti Salamone and Diane Sheehan for their efforts in producing this report. Comments, suggestions and/or corrections are most welcome, and we are happy to provide more detailed information upon request. Debra F. Weinstein, M.D. Partners Vice President, Graduate Medical Education John Patrick T. Co, M.D., M.P.H. Partners Director, Graduate Medical Education AY 2011-12 Partners Graduate Medical Education Staff Georgi Bland Sr. Accreditation Manager, APECS (through 2/2012) John Patrick T. Co, M.D., M.P.H. Partners Director Lisa DiPrizio-Monteiro Coordinator, Partners Office of Resources for Trainees (PORT) Carolyn Ellis Administrative Assistant, MGH Whittier Place Mary Ellen Goldhamer, M.D., M.P.H. Education Specialist Jennifer Goldsmith, M.P.H., M.ED. Project Director, Strategic Initiatives Irina Knyshevski Accreditation Manager, APECS Eric Nadel, M.D. Associate Director

Michelle Osborn Administrative Assistant, BWH Neville House Roy Phitayakorn, M.D. Education Specialist Cheryl Reif Program Manager, Program Quality, APECS Anne Rigg IT Project Specialist, GME Information Services Patricia Salamone Administrative Director Diane Sheehan Sr. Accreditation Manager, APECS (since 2/2012) Dempsey Springfield, M.D. Associate Director/Education Specialist Jean Tammaro Administrative Assistant, MGH Bulfinch Debra F. Weinstein, M.D. Partners Vice President

Partners Graduate Medical Education Annual Report: AY 2011-12

TABLE OF CONTENTS

AY 2011 – 2012 OVERVIEW……………………………………………………………………………………………… 5

AY 2011 - 2012 HIGHLIGHTS................................................................................................................................ 7

AY 2011 - 2012 GME ACTIVITIES………………………………………………………………………………………... 8 AY 2011 - 2012 SELECTED AREAS OF GME OVERSIGHT…………………………………………………………. 15 TABLE A: OVERVIEW OF PARTNERS GME: NUMBER & DISTRIBUTION OF PROGRAMS ……………………17 AY 2011 - 2012 INVENTORY OF PHS GME PROGRAMS……………………………………………………………..18

TABLE B: PHS-SPONSORED PROGRAMS INTEGRATED ACROSS TWO OR MORE PHS HOSPITALS……..25 TABLE C: RRC SITE VISITS …...………………………………………………………………………………………….26 TABLE D: ACGME ACCREDITATION ACTIONS ……………………………………………………………………….27 TABLE E: PROGRAM DIRECTOR TRANSITION APPROVALS…..…………………………………………………..28 TABLE F: INTERNAL REVIEWS…………………………………………………………………………………………...29 TABLE G: PROGRAM REVIEWS (non-ACGME programs) ……………………………………………………………30 APPENDIX A: GME COMMITTEES………………….. ………………………………………………………………….31

APPENDIX B: CENTERS OF EXPERTISE ………………………………………………………………………………35

AY 2011-2012 OVERVIEW Size and Scope The size and scope of GME at Partners continued to expand in AY 2011-2012. With the addition of six new fel-lowships, training programs numbered 234 at the end of the year, with a total of 2084 trainees. 106 of these pro-grams (36 residencies and 68 fellowships, including 1823 trainees) are accredited by the Accreditation Council on Graduate Medical Education (ACGME). 26 additional programs are accredited by other national organizations, such as the Council on Dental Accreditation and various specialty societies. (Table A provides a detailed inven-tory of programs.). GME Across the System Partners community and specialty hospitals remain important sites for resident education. Newton-Wellesley Hospital (NWH) sponsors Partners' only Transitional Year residency program, and Spaulding Rehabilitation Hos-pital (SRH) and Salem Hospital/North Shore Medical Center (NSMC) sponsor core residency programs in Physia-try and Internal Medicine, respectively. SRH also sponsors three ACGME-accredited fellowships and one non-accredited program, and McLean Hospital sponsors a nationally accredited interdepartmental GME fellowship program. In addition, a large number of Partners programs sponsored by BWH or MGH utilize one or more of the PHS community hospitals as important sites for training. DEB: I can't provide In AY 2011-12 38 GME programs were integrated across the Partners academic medical centers (13 residencies and 25 fellowships). 19 of these programs are accredited by the ACGME, and 7 by other national accrediting bodies (Table B). Leadership The GME physician leadership team (Vice President, Director and Associate Directors) remained stable as noted on the cover page. Dr. Ron Kleinman, MGH Chief of Pediatrics, was appointed Chair of the MGH Executive Committee on Teaching and Education (ECOTE) and Co-Chair of the Partners Education Committee (PEC). Dr. Ron Walls, BWH Chair of Emergency Medicine, continued to serve as Chair of the Brigham and Women’s Hospi-tal Education Committee (BWHEC) and Co-Chair of PEC. Representation on the three education committees continued to include residency and fellowship program directors (both ACGME-accredited and non-ACGME pro-grams), hospital and GME leadership, undergraduate medical education (UME) clerkship and/or HMS PCE (Harvard Medical School Principal Clinical Experience) directors, faculty designated as liaisons for patient care quality and safety and medical simulation, and residents elected by their peers. Education Committee Activities PEC, BWHEC and ECOTE has responsibility for the education mission beyond graduate medical education, but GME has represented the principle focus of these committees, based on the institutions’ direct responsibility for GME, the magnitude of this commitment, and the interdependence between GME and patient care delivery. Oversight of existing GME programs is provided by the hospital-based committees, while PEC approves sponsor-ship of new programs (and applications for national accreditation), develops educational policy, and addresses broader issues related to medical education. Representatives from each of the Partners teaching hospitals sit on PEC. For accreditation purposes, both the hospital-based education committees and PEC serve the function of “Graduate Medical Education Committee” (GMEC) as defined by the ACGME. Members of these committees are listed in Appendix A. 25 programs underwent ACGME site visits (Table C) during the year and 28 accreditation actions (Table D) by the ACGME Residency Review Committees (RRCs) were reviewed by BWHEC and ECOTE, including one pro-gram achieving initial accreditation. BWHEC and ECOTE approved the appointment of 10 new program direc-tors. (Table E)

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Trainee Recruitment Annual recruitment to BWH and MGH programs remained strong in AY 2011 - 2012. Partners programs matched all but two positions sought via the 2012 National Resident Matching Program (NRMP) Main Residency Match. Of these two positions, one was filled through the NRMP’s Supplemental Offer and Acceptance Program (SOAP) which replaced the NRMP scramble in 2012. The other position was filled outside the match. Child Neurology was a new specialty participating this academic year. Residencies matches in Urology, Oral and Maxillofacial Surgery, Child and Adolescent Psychiatry, and Thoracic Surgery occurred at various times during the year either through the NRMP or other national agencies. In addition to residency program matches, many Partners programs partici-pated in fellowship/sub-specialty matches through the NRMP. As in prior years, a survey of applicants who were ranked highly enough to have matched to programs sponsored by these hospitals—including those who chose to go elsewhere—revealed that each of these two institutions con-tinue to be each other’s strongest competitor, where residency training is not integrated. Personal/family consid-erations and the high cost of living in Boston continue to be cited as important factors by applicants who chose to train elsewhere. The GME Office provided detailed reports to programs participating in the NRMP (National Resident Matching Program) Main Residency Match, including collated anonymous program-specific survey responses from applicants and national specialty-specific benchmark data. Generalizable results from analysis of the nine-year “post-match survey” data collection will be submitted for publication. GME Office Activities Partners GME staff oversee accreditation-related activities; support ECOTE, BWHEC, and PEC; conduct internal program reviews; manage the “New Innovations” residency administrative platform; coordinate program participa-tion in the NRMP; produce a GME newsletter for program directors and coordinators; conduct, analyze and report surveys of GME applicants, residents and fellows; provide support and training for directors and coordinators of the individual training programs; develop and manage the Centers of Expertise for Residents and Fellows; and offer a variety of educational programs. Major annual events include the Trainee Orientation Programs which welcome residents and fellows matriculating to BWH and MGH programs, the Partners Housestaff Core Curricu-lum Retreat (for interns and first-year specialty residents), Clinical Fellow Retreat, Chief Resident Course, Program Director Workshops, and GME Coordinator Retreats. The GME Office also convenes periodic Resident/Fellow Town Meetings. The GME directors serve as liaisons to external organizations related to physi-cian education (such as the Association of American Medical Colleges Group on Resident Affairs and Group on Educational Affairs); Dr. Weinstein sits on the ACGME Board of Directors. In addition, the GME Directors help to identify appropriate solutions to conflicts that may arise between trainees and program leadership, and assist pro-gram directors in addressing concerns about the clinical competence or professionalism of individual trainees. During AY11-12, a few GME staff changes took place. Dempsey Springfield, MD, Associate Director of GME, expanded his role to assume the additional role of an Education Specialist at .25% effort. Georgi Bland, Senior Accreditation Manager, retired after more than 3 decades of service to the GME community. Diane Sheehan, former program coordinator for the Harvard Combined Orthopaedic Residency Program, assumed the Senior Accreditation Manager position.

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AY 2011-2012 HIGHLIGHTS ACGME institutional site visits were held on February 28, 2012 for BWH and on May 23, 2012 for the MGH.

The results of these visits were excellent, each institution received full accreditation with a five-year cycle (representing the maximum interval) and no citations.

The PHS Medical Education Awardees were selected by a PEC Subcommittee chaired by Trustee PEC

member Matina Horner, PhD. The awardees were celebrated at a dinner in February, 2012, where retiring program directors were also honored. Two new awards—the "Resident as Teacher" Award and a Mentoring Award—were presented.

The annual Partners Medical Education Grand Rounds series again brought a national figure in medical edu-

cation to PHS. In the spring of 2012, Mr. Edward Salsberg, Director of the National Center for Health Work-force Analysis in the Department of Health and Human Services, presented a Partners-wide Medical Educa-tion Grand Rounds on “Recent National Health Workforce Developments: Will we have enough practitioners to meet future health needs?”. Small group sessions entitled “Workforce Development Implications for Medi-cal Practice” and “Workforce Development Implications for Graduate Medical Education” were held with train-ees and faculty respectively.

The Partners Office of Resources for Trainees, in conjunction with various departments, oversaw several

improvements to the BWH and MGH Housestaff suites. At Brigham and Women’s Hospital, major renova-tions were made, including:

adding work stations; installing new lighting; cleaning or replacing carpets; painting the walls; and installing a new television and additional telephones. At Mass General Hospital, additional work stations and computers were provided.

Also at Mass General, lactation space was created in the female On-Call room on Bigelow 9. There is now a refrigerator in the room designated for lactation use, a privacy curtain, and signage to indicate when the room is being used for lactation.

A pilot OSCE (“objective structured clinical examination”) was conducted involving approximately 100 interns

matriculating for AY 2011-12. Analysis of data collected regarding intern experience is ongoing, and a study seeking to correlate OSCE results with subsequent performance (using de-identified data) is also underway.

The pilot Health Policy Certificate Course “graduated” it’s first two cohorts of resident/fellow participants, and

was extended to incorporate a third cohort of trainees in a block course format planned for the fall of 2012.

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2011-2012 GME ACTIVITIES

Residency/Fellowship Program Oversight Internal Reviews of ACGME-Accredited Programs During the 2011-2012 academic year, 28 ACGME-accredited programs sponsored by BWH and MGH underwent internal reviews and each of these was discussed at a GMEC meeting. (Table F) (For programs integrated across BWH and MGH, the findings and recommendations from these internal reviews were reported to both hospital-based GMECs.) Written responses submitted by the Program Directors were reviewed by one of the GME Direc-tors and presented to the education committee for discussion. Thirty-five trainees representing 28 programs and 39 faculty from 34 programs participated as members of Internal Review Committees. Revisions were made to the GME Internal Review Protocol to include a review by one of the GME Education Specialists of the program’s curriculum and evaluation templates. Occurring approximately 6 months prior to the review meeting, this document review affords the opportunity to work as necessary with the program director in developing curricula and evaluation tools that provide excellent training; meaningful evaluation of the trainees, faculty, and the program; and meet ACGME requirements. Also added to the protocol is a meeting between the GME Program Manager and the Program Coordinator to review administrative documents such as program let-ters of agreement, trainee contracts, and evidence of completion of evaluations. Internal Reviews Conducted: MGH Musculoskeletal Oncology PHS Radiation Oncology MGH Pediatric GI BWH Sleep Medicine BWH Selective Pathology BWH Cytopathology BWH Pathology, AP and CP PHS Neurology MGH Vascular and Interventional Radiology MGH Anesthesiology MGH Neuropathology MGH Transplant Hepatology MGH Nuclear Radiology BWH Thoracic Surgery MGH Clinical Cardiac Electrophysiology BWH Clinical Cardiac Electrophysiology MGH Allergy and Immunology BWH Internal Medicine/Pediatrics BWH Internal Medicine MGH Adult CT Anesthesiology BWH GI MGH Nuclear Medicine MGH Clinical Microbiology Laboratory MGH Radiology-Diagnostic MGH Vascular Surgery MGH Nuclear Radiology (modified review) BWH Hand Surgery MGH Neuroradiology Initial Reviews of New Programs and “Grandfathered” Non-ACGME Programs In an effort to ensure that all programs meet Partners educational standards, now all “grandfathered” (Table G) programs (i.e., those that had not been formally approved by any GMEC) must be reviewed and approved. This responsibility was delegated by the Partners Education Committee to its Program Review Subcommittee. The subcommittee, comprised of several program directors and the GME directors, was charged with reviewing pro-gram applications, curriculum, evaluation forms, and other pertinent documentation. Following a successful

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review, program leadership receives a decision letter specifying the committee’s recommendations, response due date, and the approximate cycle for the subsequent internal review. The Partners Education Committee itself con-tinues to carry out reviews of proposed new programs prior to recruitment. During the 2011-2012 academic year, the PEC Program Review Subcommittee had reviewed 4 BWH, 3 MGH, 1 SRH and 1 PHS non-ACGME programs: BWH Emergency Radiology BWH Global Women’s Health BWH International Emergency Medicine BWH Maternal Fetal Medicine MGH Acute Pain and Regional Anesthesia MGH OB Anesthesia MGH Thoracic Radiology SRH Neurological Rehabilitation PHS Neuroanesthesia Periodic Internal Reviews of Non-ACGME Programs In order to facilitate continuous program improvement, as of 2010-2011 academic year the process of periodic internal reviews was expanded to include non-ACGME programs. These internal reviews are conducted by the GME director assigned to the specialty/department under review, and include an interview with the training direc-tor and a discussion with current fellows. The assessment of the program includes a review of a questionnaire completed by the program director and other documents such as the curriculum, as well as the results of the most recent PHS non-ACGME fellow survey. The review cycle of each program is determined according to the findings. During the 2011-2012 academic year, internal reviews were carried out on 1 BWH, 4 MGH and 3 PHS non-ACGME programs: BWH Transplantation Nephrology MGH Academic General Neurology MGH Acute Care Surgery MGH Pediatric Orthopaedics MGH Transplantation Nephrology PHS Endocrine Surgery PHS Movement Disorders PHS Multiple Sclerosis Non-accredited Program Survey The Partners GME Office continued to conduct its annual survey of BWH and MGH fellows in programs not ac-credited by ACGME and thus not subject to national benchmarks, regulations or oversight. Survey questions focus on clinical experiences, the curriculum, research opportunities and overall perceptions of the program. The survey provides useful feedback to individual program directors while facilitating identification of hospital-wide or system-wide issues and trends. Program directors are provided with program-specific aggregated data where at least 4 responses are available (combining multiple years if necessary) to protect anonymity. In AY2012, 173 trainees responded (77% response rate), representing 77 of 98 programs. The variety of clinical experience drew the highest marks from trainees; closely behind were quality of clinical teaching and availability of faculty for clinical teaching, two areas that have been rated highly in past years as well. The didactic /confer-ence portion of programming again trailed other areas in resident satisfaction, with 26% of respondents rating this “fair” or “poor” (equal to last year). Trainees also expressed an uptick in dissatisfaction with the research compo-nent, with 23% of respondents rating this as “fair” or “poor,” as compared with 17% last year; survey comments also reflected this concern. Trainees also commented on the need for improved feedback quality and better access to career advice and mentorship.

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Partners Graduate Medical Education Annual Report: AY 2011-12

Educational Programs Intern/Specialty Resident/Fellow Orientation Programs Institutional orientations, coordinated by Partners GME, involve full day sessions for matriculating interns, resi-dents, and clinical fellows, providing an introduction to Partners and its institutions and values. In addition to pro-viding important information about patient care and education, these sessions also establish occupational health clearance and security access. Human Resources representatives verify employment eligibility and present bene-fits information. During orientation, trainees have access to select local vendors (e.g., health clubs and banks) and institutional resources such as the Employee Assistance Program. Orientation programs for incoming interns, first-year specialty residents, and clinical fellows were held on June 15 at BWH with 149 interns in attendance and on June 20 at MGH with 146 in attendance. There was also an Orien-tation on June 29 for both BWH and MGH incoming specialty residents and clinical fellows. BWH had 50 specialty residents and 123 clinical fellows and MGH had 46 specialty residents and 147 clinical fellows in atten-dance. Both orientations covered the following topics in-person or via HealthStream on-line training:

Introduction to Graduate Medical Education Benefits Centers of Expertise Core Competencies Credentialing, Licensure and Malpractice Duty Hours Employee Assistance Program Evaluations Handoffs Introduction to Professionalism IT Systems Overview JCAHO Medical Library Resources Medical Records and Physician Order Entry Needle Safety Occupational Health Patient Safety

Quality of Care Patient Safety Risk Management Supervision of Trainees TB Fit Testing Central Line Training Dictation Documentation ESA Training HIPAA Compliance Infection Control LMR Quality and Safety Safety Course Trainee Responsible Physician Fire, Safety and Security Tuberculosis Course

Clinical Fellows Retreat September 21, 2011 Approximately 103 fellows attended the annual Partners Clinical Fellows Retreat. The day began with a keynote address entitled “The Value Imperative” given by Dr. Elizabeth Mort, Vice President for Quality and Safety. There were multiple small-group breakout sessions led by an experienced faculty educator. Below is a list of topics presented:

Medico-Legal Issues for Trainees Sculpting a Career Choosing a Mentor The Transition to Practice Publishing Your Paper Teaching on the Run – Turning Clinical Discussions into Teaching Moments Patient and Physicians: Improving Healthcare Through Communication Centers of Expertise – Health Care Management Centers of Expertise - Global Health Carving out a Career in Medical Education Cultivating Mindful Practice: The Relationship Between Self Care and Patient Care Balancing Hope and Reality – Discussions of Prognosis

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Core Curriculum Retreat March 5 and 7, 2012 All Partners interns and first-year specialty residents are required to attend the full-day Core Curriculum Retreat. Approximately 323 participated over a two-day period in order to facilitate clinical coverage. Each day began with a keynote address, “Sleep and Fatigue: Impact on Trainee’s Learning and Performance”, given by Dr. Lawrence Epstein, Program Director for the BWH Sleep Medicine Fellowship and the Chief Medical Officer of the Sleep Health Centers. There were multiple small-group breakout sessions led by an experienced faculty educa-tor. Below is a list of topics presented:

Professionalism: Beyond Platitudes Patients and Physicians: Improving Healthcare through Communication Quality Improvement and Reducing Errors in the Medical Systems Balancing Hope and Reality – Discussions on Prognosis Enhancing EMPATHY in Healthcare Delivery

There were also informational round table discussions on the Centers of Expertise, led by Jennifer Goldsmith and on Harvard Catalyst led by Ann Schlesinger. Chief Residents Course May 7, 2012 There were 50 incoming Chief Residents that participated in the annual full-day Chief Resident Course, which focused on clinical and academic leadership skills. Plenary topics presented were “Challenging Communications” (Ron Walls, MD); “Supporting Residents with Personal and Professional Difficulties” (John Herman, MD and Eric Nadel, MD) and “Giving and Getting Feedback” (Jo Shapiro, MD). The day also included small group break-out sessions, a program director panel, and a panel of outgoing chief residents. Several faculty members partici-pated in leading a session or giving presentations.

Topics covered: Creating Change: Choosing a CR Project that will have a Positive Impact on the Program Time Management Conflict Management Integrating Quality in the Chief Resident Role

Housestaff Town Meetings Town meetings are an opportunity for residents and fellows to ask questions and make suggestions to hospital leadership. These meetings are referred to as “open house" meetings to which residents and fellows from all training programs are invited. The following meetings were held during the past academic year:

MGH March 2, 2011 BWH October 14, 2011 BWH March 27, 2012

The second MGH town meeting was postponed due to a scheduling conflict. Sessions for Medical Educators and Medical Education Researchers A varied series of weekly sessions for medical educators, organized and led by Drs. Jon Borus and Graham McMahon, continued at BWH. A monthly “Works in Progress” series led by Dr. Roy Phitayakorn contin-ued at MGH, allowing faculty to get input from colleagues about medical education research projects at an early stage of development. Faculty from across Partners have been welcome to attend any of these BWH and MGH sessions.

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Program Director Workshops The purpose of the Program Directors Workshops is to enhance the program directors effectiveness and satisfac-tion by providing relevant content and an opportunity to discuss challenging issues with colleagues. Six work-shops were held during the academic year. Each workshop was presented twice: once at Massachusetts General Hospital and once at Brigham and Women’s Hospital. Two hours of category 1 CME credits were pro-vided to attendees. Program Coordinators are usually welcome to attend, except in special situations. Presenters are required to have sufficient time for discussion as this is usually extremely productive. Attendance ranged from 11 to 27 with an average of 16. The evaluations were generally positive. Positive rating for faculty presentations, for the discussion, and the overall quality of the workshops consistently exceeded 69% and usually exceeded 80%. Attendance was about equal morning vs. evening and participants did not report a preference for one over the other. Our current plan is to continue the Program Director Workshops without change during the next academic year. Over a two-year cycle, four workshops will be repeated. Repeating work-shops are indicated in the following report. The September 2011 workshop was entitled “Simulation in Resident Education” and was co-directed by Jim Gordon, MD from MGH and Charles Pozner, MD from BWH. A total of 28 attended the two sessions. Drs. Gordon and Pozner discussed their use of simulation in resident education and offered examples of how simula-tion improves resident education. Dr. Gordon led a tour of the simulation facility at MGH (MGH Learning Labora-tory). The workshop at BWH was held in the Neil and Elise Wallace Stratus Center for Medical Simulation and Dr. Pozner led a tour of this facility. The participants learned about the opportunities for using simulation in the education of the residents. (This workshop is scheduled to be repeated on a two-year cycle.) The November 2011 workshop was entitled “Selecting the Right Resident” and was co-directed by Joel Katz, MD from BWH and John Mullen, MD from MGH. A total of 24 attended the two sessions. This workshop had numer-ous speakers. Robert Hasserjian, MD presented the results of a study comparing information on an application with the resident’s subsequent performance. Rachel Reynolds, MD presented her programs use of a structured interview process in the selection of residents. John Mullen, MD and Jennifer Doyle, MGH Department of Surgery’s Education Specialist, presented the method they use to screen applications before a thorough review. Joel Katz, MD showed the system he has used to make the information in an application more quantitative. The participants learned ways to improve the selection of residents from the applicant pool. (This workshop is sched-uled to be repeated on a two-year cycle.) The January 2012 workshop was entitled “GME Finance: From National Funding to Program Budgeting” and was co-directed by Debra Weinstein, MD and Anthony Santangelo from Partners HealthCare Finance. A total of 44 attended the two sessions. Mr. Santangelo, Director of Government Revenue for Partners HealthCare, gave an overview of graduate medical education reimbursement. He explained how Medicare determines the amount of money allocated to each hospital for graduate medical education. He described the changes over the past two decades and tried to predict the future of funding. Dr. Weinstein discussed hospital support, other funding sources, and program budgeting. Participants, some for the first time, were introduced to the sources of funds for resident education. The March 2012 workshop was entitled “Competency-based Assessment: Providing meaningful feedback and evaluation to achieve clinical competence” and was co-directed by and Keith Baker, MD, PhD and Mary Ellen Goldhamer, MD, MPH. A total of 38 attended the two sessions. Dr. Baker showed the extensive computer based system he uses to collect data from the faculty evaluations. He reported faculty are not down-graded by residents if they are critical evaluators. He showed his method of normalizing the evaluations of faculty to improve the accuracy of the evaluations. Dr. Goldhamer discussed the benefits of and how to provide mean-ingful feedback to residents. She used video clips so participants could role-play giving meaningful feedback. Participants learned how to improve the value of the resident evaluations and how to improve the faculty’s feed-back. (This workshop is scheduled to be repeated on a two-year cycle.) The May 2012 workshop was entitled “Teaching Systems Based Practice and Practice Based Learning” and was directed and presented by Dempsey Springfield, MD. A total of 31 attended the two sessions. Dr. Springfield

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discussed the reasons for competency based resident education and the importance of teaching systems-based practice and practice-based learning. He outlined the ACGME requirements, how these are reported in the Program Information Form (PIF), and gave examples of how these requirements can be met. He provided web sites with addition information. Participants learned the value of these two competencies in resident education and what activities can be used to teach them. (This workshop is scheduled to be repeated on a two-year cycle.) Program Coordinator Exchanges Two exchanges were held this year. In September, coordinators from the BWH and MGH Internal Medicine pro-grams presented updates to the Electronic Residency Application Service (ERAS) in preparation for this year’s recruitment season. A focus of the discussion was the process for creating individual fields for each program track to ease the management of applicants and expedite the download process for the post-match survey. Joining the discussions were the staffs from BWH’s Center for Faculty Development & Diversity and MGH’s Multicultural Affairs Office, who work with the individual programs and PHS GME to track the recruitment efforts for under-represented minority applicants. In January, representatives from the PHS International Office, BWH Physician Services, and MGH Medical Staff Office met with the program coordinators to review the requirements for visas, including types of visas, ECFMG eligibility, licensing board regulations, and timeline for processing. Program Coordinator Retreat In April, fifty-nine Program Coordinators from 24 residencies and 26 fellowships gathered at the Holiday Inn Boston at Beacon Hill to attend this year’s Annual Program Coordinator Retreat. Recognition and a special welcome were given to the nine coordinators who assumed their positions in the past year. Following breakfast and an opportunity to network with peers, Dr. John Co, GME Director, gave the keynote address on the ACGME’s Next Accreditation System (NAS). New Coordinator Retreat On October 3, 2011, the GME Office sponsored the first New Program Coordinator Retreat. Nineteen program coordinators with less than a year’s experience attended the retreat which focused on introductions of the GME staff, the basics of ACGME accreditation, the use of ERAS and the NRMP for recruitment and matching trainees, the functions of New Innovations, and a tour of the GME website. Based on feedback from a post-retreat survey, the attendees agreed that the retreat offered a good overview of their roles and responsibilities and acquainted them with available resources. Future new coordinator retreats will be held one to two times per year. GME Newsletter Three issues of the GME newsletter – Partners GME Focus – were published in AY 2011-12. The newsletter highlights changes in national and institutional requirements and policies, upcoming GME-sponsored events, reports of important actions taken by the educational committees, new programs and changes in current pro-grams and changes in GME program and GME Office staff. Program Directors and Program Coordinators are contacted regularly and asked to submit information about their programs, such as honors and awards received by faculty and trainees. Feature articles this year included Keith Baker, MD, Program Director of the MGH Anesthesia Residency Pro-gram, discussing his experience with trainee evaluation and feedback; the establishment of the new The Kraft Center Fellowship in Community Health Leadership; and the ACGME’s Next Accreditation System (NAS). The newsletters can be accessed through the following link: http://www.partners.org/Graduate-Medical-Education/GME-Office/GME-Newsletter.aspx

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New Innovations Advisory Committee The NI Advisory Committee met four times to suggest and prioritize enhancements to the software as well as view webinars from NI about new features. Many of these suggestions have been operationalized, and major enhancements have been made in the course of the academic year to the Personnel Data, Evaluations, and Duty Hours modules. The NI website has been optimized to work on mobile devices and now allows trainees to log their duty hours via their smart phones. New Innovations Training In addition to presentations at orientation and the spring Annual Coordinators Retreat, Anne Rigg provided 115 one-on-one training sessions to 71 program directors or coordinators, either in person or via teleconference and gave a brief presentation on NI to the MGH Pathology residents. During the course of the academic year, New Innovations provided two 1-hour webinars on major enhancements to the product. Centers of Expertise The Center of Expertise (CoE) concept was endorsed through the GME strategic planning process in 2008. Since then, six Centers have been launched with a pair of senior Partners leaders serving as co-Directors of each. (Appendix B).

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AY 2011 – 2012 SELECTED AREAS OF GME OVERSIGHT

Resident Supervision The Office of GME (OGME) maintains a database of current trainee supervision policies from each program to ensure that each clearly describes: o the achieved competencies (as defined by the respective RRC) under which PGY-1 residents (if applicable)

progress to indirect supervision with direct supervision available, if applicable o the limits of the residents' scope of authority, and the circumstances under which they are permitted to act

with conditional independence, using the following classification of supervision: o direct supervision: the supervising physician is physically present with the resident and patient o indirect supervision with direct supervision immediately available: the supervising physician is physi-

cally within the hospital or other site of patient care, and is immediately available to provide direct supervision

o indirect supervision with direct supervision available: the supervising physician is not physically pre-sent within the hospital or other site of patient care, but is immediately available by means of tele-phonic and/or electronic modalities, and is available to provide direct supervision

o oversight: the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

o circumstances and/or events that residents must communicate to appropriate supervising faculty members, such as the transfer of a patient to another or an intensive care unit or end-of-life decisions

o whom the resident should call for back-up in the event that a) patient volume or acuity becomes greater than s/he can appropriately handle, b) s/he becomes ill while on duty or experiences fatigue interfering with per-formance, or c) otherwise is unable to perform his/her patient care duties

As part of preparation for ACGME Institutional Site Visits that occurred at both BWH (February 2012) and MGH (May 2012), program supervision policies were reviewed, and program’s were given feedback in cases when im-provements were necessary. Supervision policies are now reviewed as part of a program’s internal review. The contract issued to each resident and fellow includes a copy of the Partners Resident Supervision Policy. The policy had been revised in April 2011 to incorporate extensive new requirements regarding attending supervision of residents by PGY level. Resident Responsibilities The trainee contract delineates resident responsibilities, including providing patient care with proper supervision, fully participating in the training program’s educational activities, submitting evaluations of faculty and the pro-gram, and abiding by institutional policies, including the resident duty hour policies which require residents to re-port their work hours honestly and accurately. Resident responsibilities are discussed at GME Committee meet-ings, as well as at program internal reviews. Resident Evaluation Initiative: The Evaluation and Feedback Subcommittee of the Partners Education Committee acts as the Steering Commit-tee for the design and implementation of an intensive effort aimed at elevating the quality and consistency of evaluation and feedback at Partners. Specific goals include:

1. Trainees should receive clear and accurate evaluations and effective feedback, consistently provided at defined intervals

2. Trainees should understand the basis on which they are being evaluated and the processes involved in conducting assessments and communicating the results

3. Evaluators, particularly program directors and teaching faculty, should be skilled in assessment and in providing feedback.

The committee met 6 times. Competency-based templates for 360-degree evaluation of residents and fellows were developed and include trainee evaluation by faculty, peers, patients, other healthcare providers, and a

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trainee self-assessment. A template Trainee Evaluation of Faculty is also available. Support for customiza-tion of evaluation templates is provided by Education Specialist, Dr. Mary Ellen Goldhamer. Faculty development workshops on Competency-based Evaluation and Feedback, train-the-trainer sessions, and one-on-one coaching are additional available resources. Fifteen faculty development workshops on evaluation and feedback were held in the form of grand rounds, retreats, and department-specific confer-ences. Goals for next year include development of the evaluation template, “Evaluation of the Program by Faculty and Trainee” and continued implementation of efforts to elevate the quality and consistency of evaluation and feedback in Partners programs.

Resident Duty Hours During AY 11-12 trainees in all ACGME-accredited programs were required to complete monthly anonymous duty hour evaluations to report on their experience with duty hour compliance, as well as record their duty hours daily, using the duty hours module in the New Innovations residency management suite during the months of August, November, February, and May. Program compliance was reviewed regularly at the education committee meet-ings, presented and discussed, at various hospital leadership meetings, and assessed during internal reviews. Dr. Co contacts Department Chairs and Program Directors directly when there are potential concerns, and when ne-cessary discusses plans for improving compliance. Resident Education: Patient Safety and Quality of Care At the BWH and MGH orientations for interns, first year specialty residents, and fellows, several presentations addressed various aspects of patient safety. Additional education was provided as part of the Annual Partners Housestaff Core Curriculum Retreat, the Clinical Fellows Retreat and the Chief Resident course. Topics ad-dressed included: communication skills patient safety reporting, including use of the electronic incident reporting tool that supports the collection of

data regarding systems-based issues affecting patient safety risk management career development in quality and safety In addition, the Partners GME Office Center of Expertise in Patient Care Quality and Safety provided additional opportunities for education, experience, and grant funding in this area.

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TABLE A: OVERVIEW OF PARTNERS GME, AY 11-12

NUMBER AND DISTRIBUTION OF PROGRAMS

NO. OF GME PROGRAMS SPONSORED BY PARTNERS HOSPTALS 232 No. of programs sponsored by MGH: 119 (54 accredited by the ACGME)

No. of programs sponsored by BWH: 101 (49 accredited by the ACGME) No. of programs sponsored by McLean: 4 (2 with national accreditation)

No. of programs sponsored by SRH: 4 (3 accredited by the ACGME) No. of programs sponsored by NWH: 3 (1 accredited by the ACGME) No. of programs sponsored by NSMC-Salem: 1 (accredited by the ACGME) NO. OF RESIDENCY PROGRAMS 45 No. of programs sponsored by MGH: 23 (16 accredited by the ACGME) No. of programs sponsored by BWH: 19 (18 accredited by the ACGME) No. of programs sponsored by NSMC-Salem: 1 (accredited by the ACGME) No. of programs sponsored by NWH: 1 (accredited by the ACGME) No. of programs sponsored by SRH: 1 (accredited by the ACGME) NO. OF FELLOWSHIPS 171 No. of programs sponsored by MGH: 94 (38 accredited by the ACGME; 10 with other national accreditation) No. of programs sponsored by BWH: 77 (31 accredited by the ACGME; 6 with other national accreditation)

No. of programs sponsored by McLean: 1 (with national accreditation), 3 clinical training programs (1 with national accreditation)

No. of programs sponsored by SRH: 3 (2 accredited by the ACGME) No. of programs sponsored by NWH: 2 (1 with national accreditation) NO. OF PARTNERS-INTEGRATED TRAINING PROGRAMS 47 No. of integrated residency programs: 19

No. of integrated fellowship programs: 28 No. accredited by the ACGME: 22 No. with other national accreditation: 7

NO. OF PARTNERS TRAINEES 2136 No. of Residents: 1454 (1409 accredited by the ACGME)

No. of Fellows: 639 (419 accredited by the ACGME) No. of Clinical Training Trainees: 43

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AY 2011 – 2012 INVENTORY OF PHS GME PROGRAMS

Key: residency programs are italicized

Specialty Trainees Accreditation Sponsor Program Director Anesthesia BWH Programs Anesthesiology 100 ACGME BWH Robert Lekowski, MD Adult Cardiothoracic Anesthesiology 6 ACGME BWH Douglas C. Shook, MD Ambulatory Anesthesia 0 BWH Beverly Philip, MD Critical Care Medicine 4 ACGME BWH Nicholas Sadovnikoff, MD Obstetric Anesthesiology 4 BWH Michaela Farber, MD Pain Medicine 8 ACGME BWH Srdjan Nedeljkovic, MD Regional Anesthesia 2 BWH Kamen Vlassakov, MD Integrated Programs Neuroanesthesia 1 BWH Gregory Crosby, MD MGH Programs Anesthesiology 80 ACGME MGH Keith Baker, MD, PhD Adult Cardiothoracic Anesthesiology 5 ACGME MGH Michael Andrawes, MD Critical Care Medicine 6 ACGME MGH Edward Bittner, MD Pain Medicine 6 ACGME MGH Gary Brenner, MD, PhD Perioperative Administration 1 MGH Peter Dunn, MD Dermatology BWH Programs Cutaneous Oncology 1 BWH Andrew Werchniak, MD Procedural Dermatology 0 ACGME BWH Chrysalyne Schmults, MD Integrated Programs Dermatology 19 ACGME MGH Rachel Reynolds, MD MGH Programs Dermatology Laser 2 MGH Mathew Avram, MD Melanoma 0 MGH Hensin Tsao, MD Emergency Medicine BWH Programs International Emergency Medicine 2 BWH Stephanie Kayden, MD, MPH Integrated Programs Emergency Medicine 59 ACGME BWH Eric Nadel, MD MGH Programs Emergency Ultrasound 1 MGH Andrew Liteplo, MD Wilderness Medicine 1 MGH N. Stuart Harris, MD

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Medicine BWH Programs Internal Medicine 176 ACGME BWH Joel Katz, MD Internal Medicine/Pediatrics 18 ACGME BWH Niraj Sharma, MD Internal Medicine/Medical Genetics 1 ABIM/ABMG BWH Michael F. Murray, MD Advanced Cardiac Electrophysiology 3 BWH Usha Tedrow, MD Advanced Heart Failure Transplant 2 BWH Lynne Warner Stevenson, MD Advanced Interventional Cardiovascular 0 BWH Pinak Shah, MD Allergy and Immunology 6 ACGME BWH Marianna Castells, MD Cardiovascular Disease 18 ACGME BWH Joshua A. Beckman, MD Clinical Cardiac Electrophysiology 5 ACGME BWH Usha Tedrow, MD Endocrinology, Diabetes & Metabolism 9 ACGME BWH Robert G. Dluhy, MD Gastroenterology 15 ACGME BWH Amir Qamar, MD Inflammatory Bowel Disease 0 BWH Joshua Korzenik, MD Interventional Cardiology 4 ACGME BWH Pinak Shah, MD Interventional Nephrology 1 BWH Dirk M. Hentschel, MD Rheumatology 9 ACGME BWH Simon M. Helfgott, MD Sleep Medicine 1 ACGME BWH Lawrence Epstein, MD Transplant Nephrology 1 BWH Edgar Louis Milford, MD Vascular Diagnostic and Interventional 2 BWH Andrew Craig Eisenhauer, MD Vascular Medicine 2 BWH Mark Creager, MD Integrated Programs Advanced Breast Oncology 2 DFCI Erica Mayer, MD, MPH Advanced GI Endoscopy 2 BWH John Saltzman, MD Advanced Hematologic Malignancies 1 DFCI Ann LaCasce, MD Early Drug Development 1 DFCI Geoffrey Shapiro, MD Hematology and Oncology 45 ACGME BWH Ann LaCasce, MD Hospice and Palliative Medicine 7 ACGME MGH Juliet Jacobsen, MD Infectious Disease 20 ACGME MGH Benjamin Davis, MD Nephrology 30 ACGME BWH J. Kevin Tucker, MD Pulmonary Disease Critical Care 30 ACGME MGH Peter Clardy, MD MGH Programs Internal Medicine 165 ACGME MGH Hasan Bazari, MD Internal Medicine/Pediatrics 16 ACGME MGH Evangeline Galvez, MD Allergy and Immunology 3 ACGME MGH Aidan Long, MD Cardiac Transplant/Heart Failure 1 MGH Stephanie Moore, MD Cardiovascular Disease 17 ACGME MGH Douglas E Drachman, MD Clinical Cardiac Electrophysiology 3 ACGME MGH Jeremy Ruskin, MD Clinical Vascular Medicine 1 MGH Michael R. Jaff, MD Echocardiography 7 MGH Michael Picard, MD Endocrinology, Diabetes & Metabolism 9 ACGME MGH Beverly Biller, MD Gastroenterology 10 ACGME MGH Andrew T Chan, MD Geriatric Medicine 2 ACGME MGH Fadi Ramadan, MD GI Motility 1 MGH Braden Kuo, MD Inflammatory Bowel Disease 1 MGH Vijay Yajnik, MD Interventional Cardiology 4 ACGME MGH Igor Palacios, MD Nuclear Cardiology 1 MGH Henry Gewirtz, MD Obesity Medicine and Nutrition 0 MGH Lee Kaplan, MD Rheumatology 4 ACGME MGH Robert Friday, MD Structural Heart Disease Intervention 1 MGH Igor Palacios, MD Transplant Hepatology 1 ACGME MGH Raymond T Chung, MD Transplant Infectious Disease 1 MGH Jay Fishman, MD Transplantation Nephrology 2 AST-ASN MGH Eliot Heher, MD Vascular Diagnostic and Interventional 3 MGH Kenneth Rosenfield, MD

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Salem-NSMC Programs Internal Medicine 21 ACGME NSMC Barrett Kitch, MD Neurology BWH Programs Behavioral Neurology & Neuropsychiatry 1 BWH Kirk Daffner, MD Clinical Neurophysiology 2 ACGME BWH Barbara Dworetzky, MD Multiple Sclerosis 1 BWH Tanuja Chitnis, MD Integrated Programs Neurology 51 ACGME BWH Tracey Milligan, MD Movement Disorders 1 MGH Alice Flaherty, MD Neurocritical Care 3 UCNS MGH Eric Rosenthal, MD Neuromuscular Medicine 6 ACGME BWH Anthony A. Amato, MD Neuro-oncology 1 UCNS MGH Scott Plotkin, MD Vascular Neurology 2 ACGME MGH Scott Silverman, MD MGH Programs Child Neurology 6 ACGME MGH Katherine Sims, MD Academic General Neurology 1 MGH Nagagopal Venna, MD Clinical Neurophysiology 5 ACGME MGH Andrew Cole, MD Neurosurgery BWH Programs Neurological Surgery 15 ACGME BWH Edward R Laws, MD MGH Programs Neurological Surgery 17 ACGME MGH Emad Eskandar, MD Obstetrics & Gynecology BWH Programs Family Planning 2 BWH Alisa Goldberg, MD Gynecologic Oncology 3 ABOG BWH Michael Mutov, MD Maternal Fetal Medicine 5 ABOG BWH Louise Wilkins-Haug, MD Minimally Invasive GYN Surgery 1 AAGL BWH Jon Einarsson, MD Reproductive Endocrinology & Infertility 4 ABOG BWH Elizabeth Ginsburg, MD Integrated Programs Obstetrics and Gynecology 44 ACGME BWH Ruth Tuomala, MD MGH Programs Female Pelvic & Reproductive Surgery 0 ABOG MGH Samantha Pulliam, MD Gynecologic Oncology 3 ABOG MGH Anne Goodman, MD Maternal Fetal Medicine 3 ABOG MGH Jeffrey Ecker, MD Reproductive Endocrinology 3 ABOG MGH Thomas Toth, MD NWH Programs Minimally Invasive GYN Surgery 1 AAGL NWH Keith Isaacson, MD Oral and Maxillofacial Surgery BWH Programs Oral Medicine 2 CODA BWH Nathaniel Treister, DMD Integrated Programs Dental 4 ADA MGH Agnes Lau, DMD Oral and Maxillofacial Surgery 16 CODA MGH Maria Troulis, MD

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MGH Programs Orofacial Pain 2 MGH Jeffry R. Shaefer, DMD Orthopaedic Surgery BWH Programs Arthroplasty 3 BWH Daniel Estok, MD Foot and Ankle 1 BWH Christopher Chiodo, MD Hand Surgery 3 ACGME BWH Philip Blazar, MD Orthopaedic Sports Medicine 2 ACGME BWH Scott D. Martin, MD Integrated Programs Orthopaedic Surgery 62 ACGME MGH George Dyer, MD Orthopaedic Trauma 2 MGH Mark Vrahas, MD Shoulder and Elbow 4 MGH John Warner, MD Spine Surgery 6 MGH Christopher Bono, MD MGH Programs Podiatric Medicine and Surgery 3 CPME MGH Robert Scardina, DPM Adult Reconstructive Surgery 4 MGH Young-Min Kwon, MD, PhD Hand Surgery 3 ACGME MGH Chaitanya Mudgal, MD Musculoskeletal Oncology 2 ACGME MGH Francis Hornicek, MD Orthopaedic Sports Medicine 4 ACGME MGH Thomas Gill, MD Pediatric Orthopaedics 1 MGH Brian Grottkau, MD NWH Programs Spine Surgery 1 NWH Louis Jenis, MD Pathology BWH Programs Pathology-Anatomic and Clinical 37 ACGME BWH Gayle L. Winters, MD Cytopathology 3 ACGME BWH Edmund S. Cibas, MD Hematology 4 ACGME BWH Scott Rodig, MD, PhD Neuropathology 3 ACGME BWH Rebecca Folkerth, MD Selective Pathology 2 ACGME BWH Christopher Crum, MD Subspecialty Surgical Pathology 9 BWH Amitabh Srivastava, MD Integrated Programs Blood Banking/Transfusion Medicine 3 ACGME BWH Richard M. Kaufman, MD Dermatopathology 3 ACGME BIDMC Steven Tahan, MD Molecular Genetic Pathology 3 ACGME BWH Neal Lindeman, MD Pathology Informatics 1 MGH John R. Gilbertson, MD MGH Programs Pathology-Anatomic and Clinical 35 ACGME MGH Stephen Black-Schaffer, MD

Cytopathology 1 ACGME MGH Rosemary Tambouret, MD Hematology 2 ACGME MGH Robert Hasserjian, MD Medical Microbiology 2 ACGME MGH Eric Rosenberg, MD Neuropathology 1 ACGME MGH Matthew Frosch, MD Subspecialty Surgical Pathology 6 MGH Gregory Lauwers, MD Pediatrics MGH Programs Pediatrics 49 ACGME MGH Shannon Scott-Vernaglia, MD Pediatric Critical Care Medicine 7 ACGME MGH Phoebe Yager, MD Pediatric Endocrinology 4 ACGME MGH Madhusmit Misra, MD Pediatric Gastroenterology 6 ACGME MGH Gary Russell, MD Pediatric Inflammatory Bowel Disease 2 MGH Harland Winter, MD

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Pediatric Pulmonology 3 ACGME MGH T. Benard Kinane, MD Physical Medicine and Rehabilitation SRH Programs Physical Medicine & Rehabilitation 20 ACGME SRH Kevin O'Connor, MD, MA Neurological Rehabilitation 2 SRH Randie Black-Schaffer, MD, MA Spinal Cord Injury Medicine 1 ACGME SRH Sunil Sabharwal, MD Sports Medicine (PM&R) 1 ACGME SRH Joanne Borg-Stein, MD Plastic Surgery Integrated Programs Plastic Surgery Independent 10 ACGME BWH Michael Yaremchuk, MD Plastic Surgery Integrated 17 ACGME BWH Michael Yaremchuk, MD MGH Programs Craniofacial Surgery 1 MGH Michael Yaremchuk, MD Reconstructive and Aesthetic Breast 1 MGH William G. Austen, Jr., MD Psychiatry BWH Programs Psychiatry 57 ACGME BWH Christie Sams, MD Psychosomatic Medicine 5 ACGME BWH David Gitlin, MD Women's Mental Health 1 BWH Laura Miller, MD Integrated Programs Psychiatry 62 ACGME MGH Kathy Sanders, MD Child and Adolescent Psychiatry 18 ACGME MGH Eugene Beresin, MD Addiction Psychiatry 2 ACGME MGH Roger Weiss, MD Clinical Neuropsychology 4 BWH Aaron Nelson, PhD Geriatric Psychiatry 1 ACGME MGH James Ellison, MD McLean Programs Adult/Geriatric Clinical Neuropsychology 2 McLean Allen Schiller, MD Behavioral Neurology & Neuropsychiatry 1 UCNS McLean Bruce Price, MD Child/Adolescent Clinical Neuropsychology 2 McLean Jennifer White, PhD Clinical Psychology Internship 7 APA McLean Philip Levendusky, PhD MGH Programs Behavioral Neurology & Neuropsychiatry 2 UCNS MGH Zeina El-Chemali, MD, MPH Clinical Psychology Internship 12 APA MGH Sheila O’Keefe, EdD Forensic Psychiatry 0 ACGME MGH Ronald Schouten, MD Psychosomatic Medicine 3 ACGME MGH Gregory Fricchione, MD Schizophrenia 1 MGH Oliver Freudenreic, MD Radiation Oncology BWH Programs Adult CNS Radiosurgery/Radiotherapy 1 BWH Nils Arvold, MD Integrated Programs Radiation Oncology 29 ACGME BWH Jay Harris, MD Medical Physics 6 CAMPEP MGH Lee Chin, D.Sc MGH Programs Head and Neck Radiation Oncology 0 MGH Paul Busse, MD Proton Radiation 1 MGH Annie W. Chan, MD

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Radiology BWH Programs Radiology-Diagnostic 40 ACGME BWH Barbara Weissman, MD Nuclear Medicine 4 ACGME BWH Frederick Grant, MD Abdominal Image Guided Therapy (R25) 3 BWH Fiona Fennessy, MD Abdominal Radiology 6 ACGME BWH Servet Tatli, MD Breast Imaging 2 BWH Sughra Raza, MD Emergency Radiology 2 BWH Bharti Khurana, MD Interventional Neuroradiology 1 BWH Kai Frerichs, MD MRI Clinical 2 BWH Hiroto Hatabu, MD Musculoskeletal Imaging & Intervention 6 BWH Glenn Gaviola, MD Neuroradiology 4 ACGME BWH Liangge Hsu, MD Thoracic Radiology 1 BWH Beatrice Trotman-

Dickenson,MBBS Vascular and Interventional Radiology 3 ACGME BWH Timothy Killoran, MD Women's Imaging 3 BWH Sughra Raza, MD Integrated Programs

Cancer Imaging 6 DFCI Fiona Fennessy, MD

MGH Programs Radiology-Diagnostic 38 ACGME MGH Theresa McLoud, MD Abdominal Imaging 6 MGH Raul Uppot, MD Abdominal Imaging and Intervention 3 MGH Ronald Arellano, MD Breast Imaging 3 MGH Elizabeth Rafferty, MD Cardiac Imaging 1 MGH Suhny Abbara, MD Emergency Radiology 2 MGH Robert Novelline, MD Interventional Neuroradiology & Endovascular Neurosurgery 2 MGH James Rabinov, MD Musculoskeletal Imaging & Intervention 4 MGH Martin Torriani, MD Neuroradiology 8 ACGME MGH Pamela Schaefer, MD Nuclear Radiology 1 ACGME MGH Edwin L. Palmer, MD Pediatric Radiology 1 ACGME MGH Katherine Nimkin, MD Thoracic and Cardiac Imaging 3 MGH Joanne Shepard, MD Vascular Imaging and Intervention 9 ACGME MGH Ronald Arellano, MD Surgery BWH Programs Surgery-General 53 ACGME BWH Douglas Smink, MD Thoracic Surgery 8 ACGME BWH R. Morton Bolman, MD Joint Thoracic-General Surgery 1 ACGME BWH R. Morton Bolman, MD, Douglas Smink, MD Acute Care Surgery 2 BWH Edward Kelly, MD Adult Cardiac Surgery 4 BWH R. Morton Bolman, MD Cardiac Surgery (Junior) 7 BWH James Rawn, MD Colon and Rectal Surgery 1 ACGME BWH Ronald Bleday, MD General Thoracic Surgery 2 BWH Raphael Bueno, MD Minimally Invasive Surgery 1 BWH David Brooks, MD Minimally Invasive Thoracic Surgery 3 BWH Raphael Bueno, MD Surgical Critical Care 4 ACGME BWH Edward Kelly, MD Thoracic Oncology 1 BWH David Sugarbaker, MD Vascular Surgery 2 ACGME BWH Matthew Menard, MD Integrated Programs Breast Surgery 1 SSO MGH Barbara Smith, MD, Endocrine Surgery 1 BWH Richard Hodin, MD Surgical Oncology 2 SSO BWH Chandrajit Raut, MD

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MGH Programs Surgery-General 46 ACGME MGH John T. Mullen, MD Thoracic Surgery 6 ACGME MGH Douglas Mathisen, MD Joint Thoracic-General Surgery 1 ACGME MGH Douglas Mathisen, MD, John T. Mullen, MD Acute Care Surgery 1 MGH Hasan Alam, MD Burn Surgery 1 MGH Shawn Fagan, MD Cardiac Surgery 2 MGH Thoralf Sundt, MD Laryngology and Phonosurgery 2 MGH Steven Zeitels, MD Minimally Invasive Surgery/Bariatric 1 MGH David Rattner, MD Surgical Critical Care 1 ACGME MGH Hasan Alam, MD Transplant Surgery 2 ASTS MGH James Markmann, MD Vascular Surgery 4 ACGME MGH Christopher Kwolek, MD Transitional Year NWH Programs Transitional Year 6 ACGME NWH Janet C. Larson, MD

Urology BWH Programs Urology 11 ACGME BWH Kevin Loughlin, MD Urologic Oncology 1 BWH Adam Kibel, MD MGH Programs Urology 12 ACGME MGH Dianne Sacco, MD Urologic Oncology 1 MGH Aria Olumi, MD

Multi-specialty BWH Programs Dermatology-Rheumatology 2 BWH RuthAnn Vleugels, MD Global Women’s Health 2 BWH Hilarie Cranmer, MD Medical Simulation 1 BWH Charles Pozner, MD Non-Invasive Cardiovascular Imaging 4 BWH Ron Blankstein, MD Justina C. Wu, MD, PhD Integrated Programs Internal Medicine-Dermatology (BIDMC) 4 MGH Rachel Reynolds, MD Internal Medicine-Dermatology (BWH) 6 MGH Rachel Reynolds, MD MGH Programs Internal Medicine-Dermatology (MGH) 5 MGH Rachel Reynolds, MD Health Policy and Management 1 MGH Timothy Ferris, MD Medical Simulation 1 MGH James Gordon, MD

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Partners Graduate Medical Education Annual Report: AY 2011-12

TABLE B: PHS-SPONSORED GME PROGRAMS INTEGRATED ACROSS

TWO OR MORE PARTNERS HOSPITALS

BWH*, MGH Neuroanesthesia

PHS Sponsors (Administrative

Sponsor*) Program Name Certification MGH*, BWH, McLean Addiction Psychiatry ACGME BWH*, MGH Advanced GI Endoscopy BWH*, MGH Blood Banking/Transfusion Medicine ACGME MGH*, BWH Breast Surgery SSO MGH*, McLean Child and Adolescent Psychiatry Residency ACGME MGH*, BWH Dental ADA MGH*, BWH Dermatology Residency ACGME BWH*, MGH Emergency Medicine Residency ACGME BWH*, MGH Endocrine Surgery MGH*, BWH, McLean Geriatric Psychiatry ACGME BWH*, MGH Hematology and Oncology ACGME MGH*, BWH Hospice and Palliative Medicine ACGME MGH*, BWH Infectious Disease ACGME MGH*, BWH Internal Medicine (BIDMC) - Dermatology Residency ABIM/ABD MGH*, BWH Internal Medicine (BWH) - Dermatology Residency ABIM/ABD Partners Com-munity Health Kraft Center Fellowship in Community Health MGH*, BWH Medical Physics BWH*, MGH Molecular Genetic Pathology ACGME MGH*, BWH Movement Disorders BWH*, MGH Nephrology ACGME

MGH*, BWH Neurocritical Care UCNS MGH*, BWH Neurology Residency ACGME BWH*, MGH Neuromuscular Medicine ACGME MGH*, BWH Neuro-oncology UCNS BWH*, MGH Obstetrics and Gynecology Residency ACGME MGH*, BWH Orthopaedic Surgery Residency ACGME MGH*, BWH Orthopaedic Trauma MGH*, BWH Pathology Informatics BWH*, Harvard Wide Patient Safety BWH*, MGH Plastic Surgery Residency – Integrated ACGME MGH*, McLean Psychiatry Residency ACGME MGH*, BWH Pulmonary Disease and Critical Care ACGME BWH*, MGH Radiation Oncology Residency ACGME MGH*, BWH Shoulder and Elbow MGH*, BWH Spine Surgery

Integrated Programs are those where two or more PHS hospitals share sponsorship and over-sight of the program; a primary administrative sponsor is identified for each (as is required by ACGME) Note:

1) Several of these programs are also integrated with other Harvard-affiliated hospitals; see PHS GME website for additional details.

2) Other integrated programs are co-sponsored by Partners hospitals and have a non-PHS hospital as “administrative sponsor”, such as Neurosurgery and Medical Genetics (spon-sored by Children’s Hospital).

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TABLE C: RRC SITE VISITS

ACGME SI Program Name SV Date MGH Neurological Surgery 7/26/11 MGH Child Neurology 7/28/11 MGH Surgery 8/16/11 BWH Anesthesia 8/17/11 BWH Radiology Diagnostic 8/23/11 BWH Abdominal Radiology 8/24/11 BWH Pain Medicine 8/24/11 BWH Neuroradiology 8/25/11 BWH* Obstetrics and Gynecology 9/27/12 BWH Hematology 10/25/11 MGH Internal Medicine 11/8/11 MGH Cardiovascular Disease 11/9/11 MGH Interventional Cardiology 11/10/11 MGH Internal Medicine-Pediatrics 11/15/11 MGH* Pulmonary Disease and Critical Care 11/16/11 MGH Rheumatology 11/17/11 MGH Endocrinology, Diabetes and Metabolism 11/18/11 MGH Pediatrics 11/29/11 MGH Pediatric Endocrinology 11/30/11 BWH Critical Care Medicine 12/1/11 BWH Psychiatry 1/10/12 BWH Psychosomatic Medicine 1/10/12 BWH Vascular Surgery 2/1/12 BWH Clinical Neurophysiology 2/2/12 BWH* Neuromuscular Medicine 2/29/12 *PHS Integrated Program: co-sponsored by two or more PHS hospitals

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TABLE D: ACGME ACCREDITATION ACTIONS

ACGME SI Program ACGME accreditation action

BWH Abdominal Radiology Continued Accreditation

BWH Anesthesia Continued Accreditation

BWH Critical Care Medicine (AN) Continued Accreditation

BWH Clinical Neurophysiology Continued Accreditation

BWH Hematology Continued Accreditation

BWH* Neuromuscular Medicine Continued Accreditation

BWH Neuropathology Continued Accreditation

BWH Neuroradiology Continued Accreditation

BWH* Obstetrics and Gynecology Continued Accreditation

BWH Pain Medicine (AN) Continued Accreditation

BWH Psychiatry Continued Accreditation

BWH Psychosomatic Medicine Continued Accreditation

BWH Vascular and Interventional Radiology Continued Accreditation

BWH Vascular Surgery Continued Accreditation

MGH Cardiovascular Disease Continued Accreditation

MGH Child Neurology Continued Accreditation

MGH Endocrinology, Diabetes, Metabolism Continued Accreditation

MGH Geriatric Medicine Continued Accreditation

MGH Internal Medicine Continued Accreditation

MGH Interventional Cardiology Continued Accreditation

MGH Internal Medicine-Pediatrics Continued Accreditation

MGH Medical Microbiology Initial Accreditation

MGH Neurological Surgery Continued Accreditation

MGH Pediatrics Continued Accreditation

MGH Pediatric Endocrinology Continued Accreditation

MGH* Pulmonary Disease and Critical Care Continued Accreditation

MGH Surgery Continued Accreditation

*PHS Integrated Program: co-sponsored by two or more PHS hospitals

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TABLE E: PROGRAM DIRECTOR TRANSITION APPROVALS

BWH Gastroenterology:

Retiring Program Director: Robert Burakoff, MD, serving since 2009 New Program Director: Amir Qamar, MD; appointment effective 10/1/11; Approved 9/26/2011

BWH Molecular Genetic Pathology*: Retiring Program Director: Janina Longtine, MD, serving since 1999

New Program Director: Neal Lindeman, MD; appointment effective 12/1/11; Approved 12/7/2011 BWH Surgery: Retiring Program Director: Stanley Ashley, MD, serving since 2000 New Program Director: Douglas Smink, MD; appointment effective 7/1/11; Approved 7/21/2011 BWH Surgical Critical Care:

Retiring Program Director: Selwyn Rogers, MD, serving since 2002 New Program Director: Edward Kelly, MD; appointment effective 7/1/12; Approved 9/26/2011

BWH Vascular and Interventional Radiology: Retiring Program Director: Chieh-Min Fan, MD, serving since 2006

New Program Director: Timothy Killoran; MD; appointment effective 10/1/11; Approved 9/26/2011

BWH Urology: Retiring Program Director: Jerome Richie, MD, serving since 1987

New Program Director: Kevin Loughlin, MD; appointment effective 7/1/12; Approved 6/4/2012

MGH Geriatric Medicine: Retiring Program Director: Claus Hamann, MD, serving since 2009 New Program Director: Fadi Ramadan, MD; appointment effective 12/1/11; Approved 12/5/2011

MGH Rheumatology:

Retiring Program Director: Margaret Seton, MD, serving since 2005 New Program Director: Robert Friday, MD; appointment effective 7/1/12; Approved 6/18/2012

MGH Orthopaedic Surgery*: Retiring Program Director: Dempsey Springfield, MD, serving since 2009

New Program Director: George Dyer, MD; appointment effective 7/1/12; Approved 6/18/2012

MGH Vascular Neurology*: Retiring Program Director: Jonathan Rosand, MD, serving since 2003 New Program Director: Scott Silverman, MD; appointment effective 9/19/11; Approved 9/19/2011

* PHS Integrated Program: co-sponsored by two or more PHS hospitals

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TABLE F: INTERNAL REVIEWS

Sponsor

Program

Program Director

Date of Internal Review

MGH Musculoskeletal Oncology Francis Hornicek, MD August 8, 2011 PHS Radiation Oncology Jay Harris, MD September 7, 2011 MGH Pediatric GI Gary Russell, MD September 8, 2011 BWH Sleep Medicine Laurence Epstein, MD September 30, 2011 BWH Selective Pathology Christopher Crum, MD October 12, 2011 BWH Cytopathology Edmund Cibas, MD October 17, 2011 BWH Pathology, AP and CP Gayle Winters, MD October 19, 2011 PHS Neurology Tracey Milligan, MD October 20, 2011 MGH Vascular and Interventional Radiology Ronald Arellano, MD November 2, 2011 MGH Anesthesiology Keith Baker, MD November 7, 2011 MGH Neuropathology Matthew Frosch, MD November 9, 2011 MGH Transplant Hepatology Raymond Chung, MD November 14, 2011 MGH Nuclear Radiology Edwin Palmer, MD November 16, 2011 BWH Thoracic Surgery R. Morton Bolman, MD November 18, 2011 MGH Clinical Cardiac Electrophysiology Jeremy Ruskin, MD November 21, 2011 BWH Clinical Cardiac Electrophysiology Usha Tedrow, MD January 18, 2012 MGH Allergy and Immunology Aidan Long, MD January 27, 2012 BWH Internal Medicine/Pediatrics Niraj Sharma, MD February 10, 2012 BWH Internal Medicine Joel Katz, MD February 15, 2012 MGH Adult CT Anesthesiology Michael Andrawes, MD February 21, 2012 BWH Gastrointestinal Amir Qamar, MD February 22, 2012 MGH Nuclear Medicine S. Ted Treves, MD April 25, 2012 MGH Clinical Microbiology Laboratory Eric Rosenberg, MD May 4, 2012 MGH Radiology – Diagnostic Theresa McLoud, MD May 14, 2012 MGH Vascular Surgery Christopher Kwolek, MD May 18, 2012 MGH Nuclear Radiology (modified review) Edwin Palmer, MD May 23, 2012 BWH Hand Surgery Philip Blazar, MD May 24, 2012 MGH Neuroradiology Pam Schaefer, MD June 6, 2012

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TABLE G: PROGRAM REVIEWS (NON-ACGME PROGRAMS)

Sponsor Program Program Director Certification DateBWH Emergency Radiology Bharti Khurana, MD 3/2/12BWH Global Women's Health Hilarie Cranmer, MD 4/5/12BWH International Emergency Medicine Stephanie Kayden, MD 12/14/11BWH Maternal Fetal Medicine Louise Wilkins-Haug,MD ABOG 12/14/11

BWH* Supportive and Palliative Radiation Oncol-ogy Nils Arvold, MD 6/25/12

DFCI Early Drug Development Geoffrey Shapiro, MD 12/12/11MGH Acute Pain and Regional Anesthesia Padma Gulur, MD 4/5/12MGH Behavioral Neurology & Neuropsychiatry Zeina El-Chemali, MD 12/12/11MGH* Neuroanesthesia Gregory Crosby, MD 3/2/12MGH Obstetric Anesthesia Rebecca Minehart, MD 4/5/12MGH Thoracic Radiology Joanne Shepard, MD 3/2/12

PHS* Kraft Center Fellowship in Community Health Derri Shtasel, MD 12/12/11

SRH Neurological Rehabilitation Randie Black-Schaffer, MD 4/5/12

*Integrated program

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APPENDIX A: GME COMMITTEES, AY 2011-12

Brigham and Women’s Hospital Education Committee

ROLE NAME DEPARTMENT Chair Ron Walls, MD Emergency Medicine Past Chair Jon Borus, MD Psychiatry Partners Vice President, GME Debra Weinstein, MD Graduate Medical Education Director, GME John Patrick Co, MD Graduate Medical Education Associate Director, GME Eric Nadel, MD Graduate Medical Education Associate Director, GME Dempsey Springfield, MD Graduate Medical Education Chief Medical Officer Stanley Ashley, MD Executive Administration Quality and Safety Rep. Allen Kachalia, MD Medical Dir, Quality and Safety Simulation Representatives Charles Pozner, MD Medical Director, Stratus Center HMS PCE Director Erik Alexander, MD Medicine Clerkship Director Residency Program Directors/Delegates Jay Harris, MD (alternate Tracy Balboni, MD) Radiation Oncology Joel Katz, MD (alternate Glen Kim, MD, MPH) Medicine Tracey Milligan, MD Neurology Eric Nadel, MD; Associate Director, GME Emergency Medicine A. John Popp, MD Neurosurgery Christie Sams, MD Psychiatry Niraj Sharma, MD Internal Medicine-Pediatrics Douglas Smink, MD Surgery Dempsey Springfield, MD; Associate Director GME Orthopaedic Surgery Ruth Tuomala, MD OB/GYN Barbara Weissman, MD Radiology Gayle Winters, MD Pathology Invited Residency Program Directors R. Morton Bolman, MD Cardiothoracic Surgery Robert Lekowski, MD Anesthesia Rachel Reynolds, MD Dermatology Jerome Richie, MD Urology S. Ted Treves, MD Nuclear Medicine Michael Yaremchuk, MD Plastic Surgery Fellowship Program Directors David Brooks, MD Minimally Invasive Surgery Edward Kelly, MD Acute Care Surgery Ann LaCasce, MD Hematology Oncology Scott Martin, MD Orthopaedic Sports Medicine Scott Rodig, MD, PhD Hematopathology Andrew Werchniak, MD Cutaneous Oncology Justina Wu, MD Non-invasive Cardiovascular Imaging Resident/Fellow Representatives Rebecca Lavelle, MD Urology, PGY4 Jennifer Lewey, MD Internal Medicine-Pediatrics, PGY4 Maulik Majmudar, MD Cardiovascular Disease, PGY9 Gearoid McMahon, MD Nephrology, PGY5 Jakob McSparron, MD Pulmonary & Critical Care, PGY5 Dominique Arce Moffitt, MD Anesthesiology, PGY3 Joseph Devin Roberts, MD Adult Cardiothoracic Anesthesia, PGY5 Ben Sandefur, MD Emergency Medicine, PGY4 Andrea Schwartz, MD, MPH Internal Medicine, PGY1 Alexander Sheng, MD Emergency Medicine, PGY2 Other Invited Guests Daniel Dedrick, MD Anesthesiology GME Staff Georgi Bland GME Irina Knyshevski GME

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MGH Executive Committee on Teaching and Education

ROLE NAME DEPARTMENT Chair Ron Kleinman, M.D., Chair, Department of Pediatrics Chief Medical Officer Britain Nicholson, M.D. Executive Administration MGH Trustee (Emeritus) Matina Horner, Ph.D. Partners Vice-President for GME Debra Weinstein, M.D. PHS Graduate Medical Education Director, Partners GME John Patrick T. Co, M.D., PHS Graduate Medical Education Associate Director, GME Eric Nadel, M.D. PHS Graduate Medical Education Associate Director, GME Dempsey Springfield, M.D. PHS Graduate Medical Education Chair, MGH Chiefs' Council W. Gerald Austen, M.D. Administration Chair and CEO, MGPO David Torchiana, M.D. Administration Institute of Health Professions Alex Johnson Provost, IHP Patient Care Services Gaurdia Banister, R.N., Ph.D. Exec. Dir., Institute for Patient Care Harvard Medical School (HMS) Principal Stephen Calderwood, M.D Clinical Experience Director Alberto Puig, M.D. Inpatient Clinician Education Service Marc DeMoya, M.D. Clerkship Director , Surgery Director, Office for Clinical Careers Theodore Stern, M.D. Office for Clinical Careers Simulation James Gordon, M.D. Emergency Services Quality and Safety Andrew Karson, M.D. Internal Medicine; Director, Clinical Decision Support Residency Program Directors Keith Baker, M.D. Anesthesiology Hasan Bazari, M.D. Internal Medicine W. Stephen Black-Schaffer, M.D. Pathology Tracey Cho, M.D., PHS Neurology Theresa McLoud, M.D. Radiology - Diagnostic John Mullen, M.D. Surgery - General Dianne Sacco, M.D. Urology Kathy Sanders, M.D. Psychiatry Maria Troulis, M.D. Oral and Maxillofacial Surgery Fellowship Program Director Representatives Benjamin Davis, M.D. PHS Infectious Disease Douglas Drachman, M.D. Cardiovascular Disease Matthew Frosch, M.D. Neuropathology Andrew Liteplo, M.D. Emergency Ultrasound Eric Rosenthal, M.D. Neurocritical Care Gary Russell, M.D. Pediatric Gastroenterology Rosemary Tambouret, M.D. Cytopathology Graduate Trainee Representatives Carson Campe, M.D., PG-3 Radiology Christopher Celano, M.D., PG-5 Psychosomatic Medicine Randall Craft, M.D., PG-3 PHS Plastic Surgery Areej El-Jawahri, M.D., PG-3 Internal Medicine Jairam Eswara, M.D., PG-4 Urology David Maduram, M.D., PG-2 Anesthesia Jennifer Munoz Pareja, M.D., PG-1 Pediatric Critical Care William Pendergraft, M.D., PG-2 PHS Nephrology Aparna Raj, M.D., PG-3 Internal Medicine Guests Kevin O’Connor, M.D., Program Director SRH Physical Medicine & Rehabilitation Stacey Gray, M.D., Program Director MEEI Otolaryngology Jeanette Ives-Erickson, R.N., Sr. VP for Patient Care Services, Chief Nurse Staff Georgi Bland PHS Graduate Medical Education Irina Knyshevski PHS Graduate Medical Education Diane Sheehan PHS Graduate Medical Education

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PARTNERS EDUCATION COMMITTEE: AY 2011-2012 ROLE NAME DEPARTMENT Co-Chair: Ron Kleinman, MD MGH Chief, Pediatrics, ECOTE Chair Co-Chair: Ron Walls, MD BWH Chair, Emergency Medicine, BWHEC Chair Partners Vice-President for GME Debra Weinstein, MD; PHS Graduate Medical Education Partners Director of GME John Patrick T. Co, MD, MPH, PHS Graduate Medical Education Associate GME Director Eric Nadel, MD Program Director, PHS Emer. Med. Associate GME Director Dempsey Springfield, MD Program Director, PHS Orthopedics BWH Chief Medical Officer Stanley Ashley, MD Executive Administration MGH Chief Medical Officer Britain Nicholson, MD Executive Administration Chair, MGH Joint Chiefs Council W. Gerald Austen, MD Executive Administration Board of Trustees (Emeritus) Matina Horner, PhD Faulkner Hospital Pardon Kenney, MD Chief of Surgery McLean Hospital Shelly Greenfield, MD Chief Academic Officer Newton-Wellesley Hospital Lawrence Friedman, MD Co-Chair, Education Review Board (alternate: Jodi Larson, MD PD, NWH Transitional Year Residency North Shore Medical Center Barrett Kitch, MD PD, Salem Hospital Internal Medicine Spaulding Rehabilitation Hospital Kevin O'Connor, MD PD, SRH Physical Med and Rehab (alternate: Ross Zafonte, DO SRH and MGH Chief of Physiatry) Dana-Farber Cancer Institute Robert Mayer, MD PD PHS Hematology-Oncology BWH Education Review Board Jonathan Borus, MD Director of Medical Education Evaluation and Feedback Subcommittee Keith Baker, MD Program Dir, MGH Anesthesiology HMS PCE, BWH Erik Alexander, MD Internal Medicine Clerkship and PCE Director HMS PCE, MGH Marc DeMoya, MD Surgery Clerkship Director(delegate, PCE Dir) Residency Program Director Reps Hasan Bazari, MD MGH Internal Medicine W. Stephen Black-Schaffer, MD MGH Pathology Joel Katz, MD BWH Internal Medicine (alternate: William Taylor, MD) BWH Internal Medicine Tracey Milligan, MD. PHS Neurology John Mullen, MD MGH Surgery Eric Nadel, MD PHS Emergency Medicine Kathy Sanders, MD MGH-McLean Psychiatry Niraj Sharma, MD BWH Internal Medicine-Pediatrics Douglas Smink, MD BWH General Surgery Dempsey Springfield, MD PHS Orthopedics Gayle Winters, MD BWH Pathology Fellowship Program Director Reps Benjamin Davis, MD PHS Infectious Disease Matthew Frosch, MD MGH Neuropathology Andrew Werchniak, MD BWH Cutaneous Oncology Trainee Representatives Carson Campe, MD MGH Radiology, PGY6 Randall Craft, MD PHS Plastic Surgery, PGY8 Bradford Lewis, MD MGH-McLean Child & Adolescent Psychiatry,PGY4 Gearoid McMahon, MD PHS Nephrology, PGY5 Aparna Raj, MD MGH Medicine, PGY3 Alexander Sheng, MD PHS Emergency Medicine, PGY2 Adjunct staff Roy Phitayakorn, MD GME Education Specialist Mary Ellen Goldhamer, MD GME Education Specialist Support staff Georgi Bland PHS Graduate Medical Education Irina Knyshevski PHS Graduate Medical Education Cheryl Reif PHS Graduate Medical Education Diane Sheehan PHS Graduate Medical Education

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PARTNERS EDUCATION COMMITTEE Program Review Subcommittee (PRS)

Members John Patrick T. Co, M.D. (Chair)

Partners Director of GME Marc DeMoya, M.D.

Clerkship Director, MGH Department of Surgery Fred Makrauer, M.D.

Program Director, BWH Inflammatory Bowel Disease Theresa McLoud, M.D.

Program Director, MGH Radiology - Diagnostic Eric Nadel, M.D.

Program Director, PHS Emergency Medicine and Associate Director, GME Samantha Pulliam, M.D.

Program Director, MGH Female Pelvic Medicine and Reconstructive Surgery Fred Schoen, M.D.

Executive Vice-Chair, BWH Department of Pathology Margaret (Maggie) Seton, M.D.

Program Director, MGH Rheumatology Dempsey Springfield, M.D.

Program Director, PHS Orthopedic Surgery and Associate Director, GME Usha Tedrow, M.D.

Program Director, BWH Clinical Cardiac Electrophysiology Staff: Georgi Bland, MGH Accreditation Manager; Irina Knyshevski, BWH Accreditation Manager PEC Evaluation and Feedback Sub-committee:

Keith Baker, MD, Co-chair; Vice Chair for Education, MGH Department of Anesthesia and Critical Care;

Program Director, Anesthesiology

Ron Arellano, MD, Program Director, MGH Vascular-Interventional Radiology

Gene Beresin, MD, Program Director, MGH-McLean Child and Adolescent Psychiatry

Stephen Black-Schaffer, MD, Associate Chief for Education, MGH Department of Pathology;

Program Director, Pathology

Fiona Fennessy, MBBCH, PhD, Program Director, DFCI Cancer Imaging; BWH Department of Radiology

Mary Ellen Goldhamer, MD, MPH, PHS GME Education Specialist; MGH Department of Medicine

Joel Katz, MD, Program Director, BWH Internal Medicine

James Gordon, MD, MPA, Director, MGH Learning Laboratory

Jodi Larson, MD, Assistant Chair, NWH Department of Medicine; Program Director, Transitional Year Program

John Popp, MD, Chair, BWH Department of Neurosurgery; Program Director, CHB-BWH Neurological Surgery

Doug Smink, MD, MPH, Program Director, BWH General Surgery; Associate Medical Director,

BWH STRATUS Center for Medical Simulation

Maria Troulis, MD, Program Director, MGH Oral and Maxillofacial Surgery

Kevin Tucker, MD, Program Director, PHS Nephrology

Ruth Tuomala, MD, Program Director, PHS Obstetrics and Gynecology

Debra Weinstein, MD, Co-chair; PHS VP for GME

Phoebe Yager, MD, Program Director, MGH Pediatric Critical Care Medicine

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APPENDIX B: CENTERS OF EXPERTISE Partners Centers of Expertise The Center of Expertise (CoE) program was developed through the GME strategic planning process in 2008 to offer enrichment to trainees outside the scope of their clinical training. The Centers are innovative cross-specialty educational opportunities that complement clinical training by providing residents and fellows with exposure to important areas of health care delivery. Six centers have been launched with a pair of senior Partners leaders serving as co-Directors for each. Academic Health Care Management Jean Elrick, MD, MGH Senior Vice President of Administration, and Michael Gustafson, MD, MBA, Chief Operat-ing Officer, Faulkner Hospital. (established in 2009) Global and Humanitarian Health David Bangsberg, MD, MPH, Dir. of MGH Center for Global Health, and Michael VanRooyen, MD, MPH, FACEP, BWH Dir. of the International Health and Humanitarian Programs Harvard Humanitarian Initiative. (established in 2009) Health Policy David Blumenthal, MD, MPP, Samuel O. Thier Professor of Medicine and Professor of Health Care Policy, Chief Health Information and Innovation Officer, Partners HealthCare, and Arnold Epstein, MD, John H. Foster Profes-sor and Chair of the Department of Health Policy and Management, Harvard School of Public Health and Internist, BWH Department of Medicine, serve as faculty co-chairs. Following the loss of Dr. James Mongan,, past Presi-dent, Partners HealthCare, Professor, Harvard School of Public Health, Drs. Blumenthal and Epstein accepted the leadership of the Center. (established in 2010) Medical Education Keith Baker, MD PhD., Program Director, Anesthesia, and MGH Graham McMahon, MD, BWH Department of Medicine, BWH, and Editor for Medical Education, NEJM. (established in 2011). Patient Care Quality and Safety Allen Kachalia, MD, JD, Associate Chief Quality Officer. BWH, and Gregg S. Meyer, MD,MSc., Senior Vice Presi-dent, Quality and Patient Safety, MGH. Dr. Kachalia was asked to co-lead the Center when founding director, Tejal K. Gandhi, MD, MPH, moved to the position of Partners Director of Patient Safety. In May 2012, Dr. Meyer left MGH, and Dr. Liz Mort assumed acting leadership of the Center. (established in 2008). Research Barbara Bierer, MD, BWH Senior Vice President, Research, and Rick Bringhurst, MD, MGH Senior Vice Presi-dent, Research. With Dr. Bringhurst’s departure in 2012, Ann Klibanski, MD assumed temporary co-leadership of the Center. In June 2012, David Fisher, MD, PhD, Chief of the MGH Department of Dermatology, Director of the MGH Cutaneous Biology Research Center and Director of the Melanoma Center at MGH, accepted the co-leadership of the Center.

AY11-12 Goals and Progress The 2011 – 2012 goals for Centers of Expertise (CoE) program included:

1. Establish measurable standards for program engagement, and evaluation and measurement stan-dards for programs and the Center model

2. Broaden content of the monthly lecture model and evaluate impact of the monthly lecture approach 3. Expand the range of trainee opportunities and increase the depth of engagement among trainees and

pilot program innovations 4. Develop collaborations within , and outside, Partners and Harvard, to create trainee opportunities

1. Establish measurable standards for program engagement, and evaluation and measurement stan-

dards for programs and the Center model Evolving over 4 years, the CoE program maintains a robust database tracking interest, engagement, and partici-pation of all trainees who have expressed interest in the CoE programs. The database is updated continually.

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Each year, a new table is created, purging trainees who have left their programs, and, adding new trainees who have expressed interest in one of the areas, allowing for a comparison of participation. In 2011-12, 343 individuals had contact with the Centers through applications, attendance, and/or mentoring re-quests (~17% of Partners trainee population). 48 didactic sessions were held from July 2011 through June 2012:

- 501 attendances were recorded. - 300 additional attendances were recorded for the Harvard Business School Value Based Health Care

Delivery course. The Centers facilitated 17 application processes resulting in:

- 206 applications reviewed - 72 grants awarded for research, travel or conference attendance - 78 positions awarded for participation in the HBS Value Based Health Care delivery course

In addition, 15 trainees met with the GME Project Director for 1-on-1 discussion/mentoring sessions. At year end, a survey was conducted to assess the impact and perceptions of the program and opportunities for program improvement.

Distributed to 334 trainees with CoE contact including: application, attendance, and direct mentored dis-cussion

161 responses (48%) Responses weighted toward active Health Policy participants, but distributed among all centers Respondents included 49 certificate or course participants, and 34 funded trainees. 69% of responses came from residents, and 29% from fellows. (2% other including admin fellows, med

students, faculty).

• 98% would recommend the program to others • 2/3 rated “4” (highest) and 1/3 “3” on 4-pt scale • 24% felt CoE will have had a significant impact on their careers; 59% moderate; 17% small • Only 6% learned of COE’s as applicants • Respondents offered positive feedback to content and to faculty/staff, and less favorable responses to lo-

gistics Trainees were asked to evaluate key attributes on a scale of 1-4. Survey results

Range 1-4 where 4 is excellent and 1 is poor

Knowledge of staff 3.76 Availability and helpfulness of staff 3.75 Range of lecture topics 3.72 Quality of communications 3.67 Shared experience among trainees with common interests 3.56 Range of funding opportunities 3.33 Convenience of programs 3.23

Please evaluate the following attributes of the Centers of Expertise program:

Key themes for follow up in survey comments were interest in additional funding opportunities, the challenge of logistics, location, and timing, as obstacles to program participation.

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2. Broaden content of the monthly lecture model and evaluate impact of the monthly lecture approach Each of five CoEs generally offered monthly lectures, while the Research Center met quarterly. In the AY11-12 year, the Centers offered a more expansive approach to content, expanding from the faculty to include:

added Group Mentored sessions (clinical effectiveness, translational research) added sequenced workshop sessions (research technique and survey design and teaching techniques) added early career panel (Health policy and management careers) added sessions with focus on immediate career steps (Global Primary Care and Global Health Service

Corps) added case based discussion (BRAC rural TB case and Value Based Health Care Delivery course) included Harvard faculty lectures (Clay Christiansen, Glenn Cohen, David Cutler, Rob Huckman,

Robert Kaplan, and Michael Porter). Included guest lecturers from government and industry (Jon Kingsdale and Ed Salzberg) added Keynote career lectures (Michael Jellinek and Michael Vanrooyen)

Continuing a practice begun in AY10-11, the CoE collected electronic evaluation of sessions to better understand perceptions of the programs, and to identify ways to improve quality, logistics, and overall effectiveness. While there were 501 attendances during the academic year, 471 trainees responded to the survey—this includes 386 who attended (77%), and 84 who did not. Typically, of rsvps, approximately 75% actually attend the sessions. 96% of those who attended rated sessions excellent (71%) or very good (25%). For those unable to attend sessions, clinical duties, personal commitments, and logistics were the barriers. 3. Expand the range of trainee opportunities and increase the depth of engagement among trainees

In prior years, trainees had access to conferences and travel funding. In the current year, the CoEs developed more specialized opportunities for residents and fellows, tapping external entities, and unique access of Partners leaders. In addition, with the expansion of the Medical Education Center, a number of new offerings were devel-oped.

In Health Policy, Dr. Weinstein, Jennifer Goldsmith, and Ryan Thompson continued the externally funded health policy certificate program for residents and fellows. Having received more than 80 applications for 40 positions, 36 trainees completed the program, with 25 of those trainees able to attend legislative visits to Washington, D.C.

Also in Health Policy, Dr. Blumenthal allowed a trainee to accompany him at each of three meetings of the Commonwealth Commission on a High Performance Health System, and to reflect on the Commis-sion’s work. The seven trainees who attended in New York, Washington, and Cambridge, described this experience as among the most influential aspects of their training experience.

In Global Health, trainees were invited to participate as moderators on Global Health Delivery On Line, an online platform of communities developed by the Global Health Delivery Project, where health care implementers share proven practices, connect with colleagues, and find resources they need to improve health outcomes in resource-limited settings.

In Medical Education, in addition to the chance to attend the ACGME and AAMC conferences, a trainee was selected to attend the National Board of Medical Examiners Center for Innovation Committee meet-ing with Dr. McMahon.

Also in Medical Education, trainees were availed of research funding opportunities for original research in a range of medical education pursuits.

In Academic Healthcare Management, trainees were invited to apply for a special Harvard Business School’s Value Based Healthcare Delivery course. This unique collaboration between HBS and PHS of-fered 78 trainees a rare chance to participate in this high sought course exclusively with Partners peers, faculty from HBS, and senior leaders from PHS.

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4. Develop collaborations within and outside Partners and Harvard to create trainee opportunities

A major benefit of the COE program has been relationship building within and beyond Partners. During this academic year, the CoEs benefited from reaching out across institutional lines, and beyond Partners. These ef-forts included:

distributed announcements of programs calls for papers, and funding opportunities of interest (i.e. Harvard

Humanitarian Initiative, Costs of Care, BWH Quality Grand Rounds, National Patient Safety Foundation, and Current Awareness News)

announced fellowship opportunities of particular relevance to the CoE areas. These included the Harvard Quality and Safety fellowship, the MGPO Health Policy and Management Fellowship, and the Global Women’s Health fellowship.

-coordinated discounted pricing for trainees attending the Institute for Healthcare Improvement's National Forum on Quality Improvement in Healthcare, the National Patient Safety Congress, and the Advisory Board Company.

Specific CoE collaborations include: Harvard Business School: Working with Professor Michael Porter and the Institute for Strategy and Competitive-ness, the Center of Academic Health Care Management advertised the annual course in Value based healthcare delivery. Through this work, together we deemed that there was an unmet need for this program among trainees who are not free for a full week of coursework. As a result, the Centers, jointly with the HBS team, established an onsite VBHD course to be offered at PHS in AY11-12. Global Health Delivery Online: This partnership, formed between the Division of Global Health Equity at BWH, HSPH, the Department of Global Health & Social Medicine at HMS, and Partners In Health, was designed to break the global health implementation bottlenecks. Partners trainees were invited to participate in, and lead, on line communities. Harvard Catalyst: Navigators at Harvard Catalyst sought out specific opportunities to support trainees, with inter-est in research, attending sessions, and offering targeted program invitations, to residents and fellows. NEHI: The Centers of Expertise built a partnership with NEHI, a national health policy entity with opportunities for trainee research and participation. Partners Healthcare International: During AY11-12, PHI began planning opportunities to engage residents and fellows in current consulting engagements, resulting in funded opportunities in AY11-12. 2011-12 Program Offerings Academic Health Care Management and Health Policy John Ayanian, History of Medicare David Bates, Primary Care Innovations David Blumenthal, Health Care IT Clay Christiansen, Disruptive Innovation Glen Cohen, Supreme Court arguments/ACA David Cutler, How Economists view Healthcare Arnie Epstein, Pay for Performance Tim Ferris, ACOs Amy Golbitz, Legislative Advocacy Michael Jellinek, Career Pathways Jon Kingsdale, Health reform- the Massachusetts Experience

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Liz Mort, Bundled Care Payment Joseph Kvedar, Connected Health Ed Salzberg, Physician Workforce Trends David Torchiana, System level strategy and health reform Kate Walsh, Leadership and Change in Health Care Policy Early Career Panel in Health Policy and Management Medical Education Keith Baker, Feedback and Medical Education Keith Baker and Graham McMahon, Evaluation across the Med Ed Spectrum Eric Campbell, Survey Design Dan Hunt, Teaching Techniques Graham McMahon, Med Ed Research Charles Pozner, Simulation in Education Jo Shapiro, Making a presentation Medical Education Research Reporting Global Health Vanessa Kerry, Global Health Service Corps Pat Lee, Global Primary Care Joe Rhatigan, BRAC Rural TB Case Rick Van Pelt, Quality in Global Health Michael Vanrooyen, Humanitarian Health Global Health Report back Session Quality/Safety Lela Holden, Error Reporting Lucien Leape, Culture of Safety Gregg Meyer, Just Culture Q&S Research Reporting Research Jose Baselga, Mentored Session on Translation Research Barbara Bierer, Research Opportunities for Partners Trainees Rick Bringhurst, Research Opportunities for Partners Trainees Sebastian Schneeweiss, Mentored Session Clinical Effectiveness VBHC Course: Michael Porter, Value Based Health Care Delivery; Tom Lee, UCLA Case and VBHD; Ryan Thompson, HBS CHOP Case; Rob Huckman, HBS Dartmouth Hitchcock case; Sachin Jain, Value Based Healthcare Delivery; Robert Kaplan, HBS Costing in healthcare; Gary Gottlieb, Commonwealth Care Alliance Case 2011-12 Funding Opportunities (funded participants/applicants) The Advisory Board Company National Meeting (11/11) AAMC conference (2/4)* Academy Health (3/5) ACGME conference (1/1) HBS Healthcare Club (3/3)

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Center for Connected Health Symposium (7/7) National Forum on Quality Improvement in Health Care (4/4) National Patient Safety Foundation (3/5) Mentored Conference Attendance Commonwealth Commission on a Higher Performance Health System with Dr. Blumenthal (7/10) NBME Innovation Committee with Dr. McMahon (1/3)

Courses Physician’s Foundation (40/74) HBS Institute for Strategy and Competitiveness (84/84) Research Funding Global and Humanitarian Travel Stipends (20/64) Partners Medical International Partnership (2/2) Quality and Safety Research (4/14) Medical Education Research Funding (4/8) Total Participants/Applicants 195/299 Collaborative Opportunities BWH Clinical and Research News trainee column Global Health Delivery On-Line NEHI National Health Policy Institute Distributions and Communications: Harvard Humanitarian Initiative, MGH Center for Global Health, Harvard Cata-lyst, BWH Quality Grand Rounds, HMS Center for Primary Care, MGH Quality and Patient Safety Forum. Funded Projects and Trainees

Global Health AY11-12 recipients and projects Cheri Blauwet, MD, Physical Medicine and Rehab, Spaulding Rehabilitation Hospital Implementation of a Comprehensive Rehabilitation Strategy in Post-Earthquake Haiti

Marjory Bravard, MD, MGH Internal Medicine Observing and integrating into the local ecosystem of global health technology development in Mbarara, Uganda Joan Camprodon, MD, MGH Psychiatry Cultural beliefs, attitudes and stigma in Epilepsy and Psychosis as determinants of treatment compliance, Mum-bai, India

Kyle Chambers, MD, Harvard Combined Program in Otolaryngology Mbarara-Harvard Otolaryngology Exchange

Brian T. Chan, MD, PHS Infectious Disease Trends in HIV care in southern India and implications for future practice

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Patrick J, Codd, MD, MGH Neurosurgery Improving Neurotrauma Outcomes through Ongoing Educational Outreach and Neurosurgical Capacity Building in Mbarara, Uganda

Sunshine Dwojak, MD, Harvard Combined Program in Otolaryngology Outcomes, HPV status, and Attitudes among American Indians in South Dakota with Head and Neck Cancer

Kevin Golden, BWH Pathology Rotating Fellowship in Surgical Pathology, Malawi

Alexander T. Hawkins, MD, MGH General Surgery Adaptation to Amputation in Tanzania

Brooke Lane Howett, BWH Anatomical Pathology Determination and prevalence of HPV types in cervical neoplasia in Malawi

Sudha Jayaraman, MD, BWH Trauma and Surgical Critical Care Trauma and Critical Care in Johannesburg, South Africa Academic Hospital

James Kelley, MD, PhD, BWH Clinical Pathology Providing Transfusion Medicine Educational Programs to Primary Care Physicians in Southern Africa

Paul J. Krezanoski , MGH Med Peds Objective Monitoring of Anti-malarial Bednet Adherence in Rural Uganda (SmartNet)

Jennifer Lewey, MD, BWH Med Peds Pediatric and adult cardiovascular cisease in India: a clinical and research elective

Jonathan Reisman, MD, MGH Internal Medicine Pneumococcal Colonization in Alaskan Native Children: Household Transmission and the Impact of Socioeco-nomic Factors and the PCV13 Vaccine Beth Riviello, MD, BWH Pulmonary and Critical Care Improving Surgical and Obstetric Outcomes in Rwanda: Implementation and Evaluation of a Surgical Safety Pro-gram

Radhika Sundararajan, MD, PHS Emergency Medicine Measuring “illness” and treatment-seeking behavior in rural India: a qualitative study of malarial infection among marginalized populations, Gadchiroli, Maharashtra, India

Anna Terry, MD, MGH Neurosurgery Improving head trauma and critical care capacity in a resource-poor setting: Mbarara University of Science and Technology, Southwestern Uganda

Oriana Vesga-Lopez, MD, MGH Psychiatry Assessing Mental Health and Psychosocial Status in Post-Conflict Liberia

Ana Weil, MD, MGH Internal Medicine Phenotypic characterization of T cell memory responses in acute V. cholerae infection, Bangladesh Anna Yuan, DDS, BWH Dentistry Implementation of basic oral health care delivery systems in Haiti

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Partners Graduate Medical Education Annual Report: AY 2011-12

Medical Education Research Funding Quality and Patient Safety Research Funding

Annop Rao, MGH Anesthesia Informatics Advance notification tool for relaying information in the mother's electronic medical record (EMR) that may impact the care in the neonate

Arjun Venkatesh, Partners Emergency Medicine Communication of Vital Signs at Emergency Department Handoffs: Defining the Performance Gap

Aditya Mandawat, BWH Medicine Protocol-Enhanced Dose Adjustment for Intravenous Heparin

Alice Watson, Partners Dermatology Design, implementation and evaluation of an electronic Triple Form: a novel approach to improving safety and reliability of the biopsy pathway in dermatology

Medical Education Research Funding George Alba and Daniel Kelmensen, MGH Medicine A Pilot Study of Formal Ultrasound Training of Internal Medicine Residents Luis Pernar, BWH Surgery Oral examinations in undergraduate surgical training Dana Telem, MGH Surgery A changing paradigm in medical education: Can endoscopic proficiency be attained prior to patient interaction?

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