supervision sunny g. yoder director, graduate medical education aamc vcu conference, december 7,...
TRANSCRIPT
Supervision
Sunny G. YoderDirector, Graduate Medical EducationAAMC VCU Conference, December 7, 2010
NOT JUST FOR DOCTORS:When you get anomalous data in a high-stakes environment, what do you do?
When do you call?
Deepwater Horizon, April 20, 2010
Concern in the Policy Sphere
IOM, “Crossing the Quality Chasm”, 2001- Safety is a system quality that patients should expect
IOM “To Err is Human”, 2000- 44,000 to 98,000 hospital deaths attributable to medical errors
Concern in the Policy Sphere
IOM “Resident Duty Hours”, 2009 -Supervision is key to balancing educational needs of residents and safety of patients
MedPAC Report, June 2010 -Redundant, team-based care; tie Medicare $ to competencies needed in 21st century medicine
Public Concern – July 1st Effect
- Public Release Date: June 2, 2010 - J Gen Intern Med. 2010 August; 25(8): 774–779
When news spreads like wildfire…
June 2, 2010
June 29, 2010
June 3, 2010
July 15, 2010
June 21, 2010
July 5, 2010
July 1st Effect Hits Legal Websites Too!June 4, 2010
July 17, 2010
ACGME 2010 Standards –A Response to Concerns
Objectives:
• the safety and quality of care of the patients under the care of residents today
• the safety and quality of care of the patients under the care of our graduates in their future practice
• the provision of a humanistic educational environment
ACGME 2010 Standards
Far more explicit about supervision than in the past
Default is ‘not ready’ – especially for PGY1 - resident must demonstrate competence
Supervision by more senior residents is recognized
JCAHO Addresses Supervision Too“The medical staff must have a defined process under which each resident is supervised in his or her patient care responsibilities by a LIP with appropriate privileges.”
AAMC Annual Meeting Sessions Sponsored by Group on Resident Affairs
Principles and tools
SUPERVISION: STORIES FROM THE FIELD
Mark Wilson, M.D., University of Iowahttps://www.aamc.org/download/161546/data/plenary_2_wilson.pdf
From Iowa
Supervision is the Next GME Frontier. To change the culture, we have to make it a conscious pursuit.
From IowaInclude assessment of supervisory practices as specific component of internal reviews
Grade how well programs address:
From IowaEstablish that direct supervision is the default mode
until milestone capability is ‘checked off’Develop a ‘supervision curriculum’ that drives
faculty & resident developmentDevise ways to assess how residents can
demonstrate:-‘when they need to ask for help’-ability to anticipate potential patient problems-ability to acknowledge/manage uncertainty
AAMC Annual Meeting Sessions Sponsored by Group on Resident Affairs
Principles and tools
SUPERVISION: STORIES FROM THE FIELD
Vineet Arora, M.D., University of Chicagohttps://www.aamc.org/download/161544/data/plenary_2_arora.pdf
From Southside Chicago
The barriers to good supervision are many; guidelines help.
From Southside Chicago
AAMC Annual Meeting Sessions Sponsored by Group on Resident Affairs
MONITORING COMPLIANCE: MEASURES AND METHODS
Linda M. Famiglio, M.D.Chief Academic Officer Academic Affairs, Geisinger Health System Associate Dean, Temple University School of Medicine
https://www.aamc.org/download/161556/data/plenary_3_famiglio.pdf
From Rural Pennsylvania
What data do you have to respond when the Joint Commission or the ACGME asks how do you know that the residents are supervised in caring for patients?
From Rural Pennsylvania
MONITOR…MONITOR…
Concluding Observations
SUPERVISION…SUPERVISION…
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