The GME CommitteeThe GME Committee

Lois L. Bready, M.D.Lois L. Bready, M.D.Associate Dean for GME and DIO Associate Dean for GME and DIO Chair, GME Committee, UTHSC San AntonioChair, GME Committee, UTHSC San Antonio

John D. Rybock, M.D. John D. Rybock, M.D. Assistant Dean and Compliance Officer for GME, Assistant Dean and Compliance Officer for GME, The Johns Hopkins University School of MedicineThe Johns Hopkins University School of Medicine

The GMECThe GMEC Why have a GMEC?Why have a GMEC? Requirements, ResponsibilitiesRequirements, Responsibilities ACGME IRC Citations involving the GMECACGME IRC Citations involving the GMEC Structure & FunctionStructure & Function

MembershipMembership Organizational ChartOrganizational Chart

Meetings and DocumentationMeetings and Documentation MinutesMinutes

Increasing Effectiveness Increasing Effectiveness

The GMECThe GMEC

Why have a GMEC?Why have a GMEC? ACGME Institutional Requirements (7/07) IIIACGME Institutional Requirements (7/07) III

Contains Contains 2626 separate references to GMEC! separate references to GMEC! Coordination of GME resourcesCoordination of GME resources Ensure compliance with lots of other entities Ensure compliance with lots of other entities

(JCAHO, NRMP, state medical boards, state (JCAHO, NRMP, state medical boards, state health depts, United Federation of Planets, etc.)health depts, United Federation of Planets, etc.)

Educational role – members, institutionEducational role – members, institutionVehicle to achieve the work of GMEVehicle to achieve the work of GME

The GMECThe GMEC

Why have a GMEC?Why have a GMEC?ACGME Institutional Requirements IIIACGME Institutional Requirements III “ “The Sponsoring Institution must The Sponsoring Institution must

have a GMEC.” have a GMEC.” Group - 13 specific areas of responsibilityGroup - 13 specific areas of responsibility Look at the IRD; keep it on your desktopLook at the IRD; keep it on your desktop

Other tasks – we’ll get to these . . . Other tasks – we’ll get to these . . .

The GMECThe GMEC

““GMEC must establish & GMEC must establish & implement policies and implement policies and procedures regarding procedures regarding

the quality of education &the quality of education & the work environment the work environment for the residents in all programs”for the residents in all programs”

The GMECThe GMEC1.1. Resident funding/ Resident funding/

benefitsbenefits2.2. Communication - PDsCommunication - PDs3.3. Duty HoursDuty Hours4.4. Resident supervisionResident supervision5.5. Communication - OMSCommunication - OMS6.6. Curriculum, evals: Curriculum, evals:

General CompetenciesGeneral Competencies7.7. Resident selection, Resident selection,

evaluation, promotion, evaluation, promotion, transfer, discipline & transfer, discipline & dismissaldismissal

8.8. Program Program accreditationaccreditation

9.9. Institutional Institutional accreditationaccreditation

10.10. ACGME ACGME correspondencecorrespondence

11.11. Experimentation & Experimentation & innovationinnovation

12.12. Reductions & Reductions & closuresclosures

13.13. Vendor interactionsVendor interactions

The 13 Specific Areas of ResponsibilityThe 13 Specific Areas of Responsibility

The GMECThe GMEC

The 13 Specific Areas of ResponsibilityThe 13 Specific Areas of Responsibility1.1. Resident stipends, benefits, position Resident stipends, benefits, position

allocationallocation**2.2. Communication – Communication –

a)a) GMEC with PDsGMEC with PDsb)b) PDs with Site Directors PDs with Site Directors at each participating siteat each participating site

3.3. Resident duty hoursResident duty hoursa)a) Written policies & proceduresWritten policies & proceduresb)b) Consider requests for exceptions to 80 hour limitConsider requests for exceptions to 80 hour limit

* At least annually

The GMECThe GMEC4.4. Resident supervision – monitor programs:Resident supervision – monitor programs:

a)a) Patient care safe & effectivePatient care safe & effectiveb)b) Educational needs of residentsEducational needs of residentsc)c) Progressive responsibilityProgressive responsibilityd)d) Compliance with CPRs, specialty-specific PRsCompliance with CPRs, specialty-specific PRs

5.5. Communication with Medical StaffCommunication with Medical Staffa)a) Annual report to OMSAnnual report to OMSb)b) Education – Pt Safety & Quality of careEducation – Pt Safety & Quality of carec)c) Accreditation status and patient care citationsAccreditation status and patient care citations

The GMECThe GMEC6.6. Curriculum & EvaluationCurriculum & Evaluation7.7. Resident status Resident status

a)a) SelectionSelectionb)b) EvaluationEvaluationc)c) PromotionPromotiond)d) TransferTransfere)e) DisciplineDisciplinef)f) DismissalDismissal

The GMECThe GMEC8.8. Oversight of program accreditation (Letters of Oversight of program accreditation (Letters of

Notification and Action Plans for Correction)Notification and Action Plans for Correction)9.9. Institutional accreditationInstitutional accreditation10.10. Oversight of program changes (11 items) – Oversight of program changes (11 items) –

essentially everythingessentially everything11.11. Oversight of educational experiments & Oversight of educational experiments &

innovationsinnovations12.12. Oversight of reductions & closuresOversight of reductions & closures13.13. Vendor interactionsVendor interactions

The GMECThe GMEC

Other GMEC responsibilities – IR IV.Other GMEC responsibilities – IR IV. Internal Review process, approved Internal Review process, approved

protocol GMEC minutes document Int Rev protocol GMEC minutes document Int Rev ‘in process at midpoint’‘in process at midpoint’

Monitor program responses to Int Rev Monitor program responses to Int Rev recommendationsrecommendations

The GMECThe GMEC Adult Cardiothoracic AnesthesiaAdult Cardiothoracic Anesthesia II.B: “There should be an institutional policy governing the

educational resources committed to the adult cardiothoracic anesthesiology program.”

Anesthesiology Critical CareAnesthesiology Critical Care II.B: “There should be an institutional policy governing the educational resources committed to critical care programs assuring cooperation of all involved disciplines.”

Surgery Critical CareSurgery Critical Care 1.A.2: 1.A.2: “There should be an institutional policy governing the educational resources committed to critical care programs and ensuring cooperation of all involved disciplines.”

Pediatric Critical CarePediatric Critical Care VIII: “ VIII: “If there is more than one ACGME program in critical care medicine in the sponsoring institution, there should be an institutional policy governing the educational resources committed to these programs and ensuring cooperation of all disciplines involved.”

Internal Medicine Critical CareInternal Medicine Critical Care – no longer addresses this

The GMECThe GMEC Anesthesiology Pain ManagementAnesthesiology Pain Management I.B.4: “There

must be an institutional policy governing the educational resources committed to pain medicine that ensures cooperation of all the involved disciplines.”

Physical Medicine & Rehab Pain MgmtPhysical Medicine & Rehab Pain Mgmt: Same as above

Neurology Pain MgmtNeurology Pain Mgmt: Same as above Psychiatry Pain MgmtPsychiatry Pain Mgmt: Same as above

The GMECThe GMECA major benefit of GMEC:Committee structure enhances effectiveness of the DIO

“I think/need/have decided . . .”vs.“The GMEC says/requests/decided . . .”

The GMECThe GMEC

Structure & Function – MembershipStructure & Function – Membership(Inst Reqs III.A.2) (Inst Reqs III.A.2) Voting membershipVoting membership

DIODIO residents nominated by their peersresidents nominated by their peers representative program directors representative program directors administratorsadministrators may include other members of the faculty or othersmay include other members of the faculty or others

The GMECThe GMEC

Structure & Function – MembershipStructure & Function – MembershipResidents nominated by their peersResidents nominated by their peers

Mechanism(s) for peer-selectionMechanism(s) for peer-selection electionelection resident organization’s (elected) officersresident organization’s (elected) officers othersothers

Roles in GMECRoles in GMEC involvement in GMEC, subcommittees, etc.involvement in GMEC, subcommittees, etc. internal reviews – internal reviews – essential!essential!

How to ensure meeting attendanceHow to ensure meeting attendance

The GMECThe GMEC

Structure & Function – MembershipStructure & Function – MembershipRepresentative program directorsRepresentative program directors

Which ones?Which ones? All vs. core programs vs. otherAll vs. core programs vs. other Mechanisms for rotating other PDs?Mechanisms for rotating other PDs? Other meetings with Other meetings with allall PDs? (IR III.B.2.a) PDs? (IR III.B.2.a)

Roles in GMECRoles in GMEC internal reviews internal reviews subcommittee worksubcommittee work

How to ensure meeting attendanceHow to ensure meeting attendance

The GMECThe GMEC

Structure & Function – MembershipStructure & Function – MembershipAdministratorsAdministrators

Which ones?Which ones? All participating institutions vs. primaryAll participating institutions vs. primary Who can add value to the process?Who can add value to the process? Reporting lines matter – incoming and outgoingReporting lines matter – incoming and outgoing

Roles in GMECRoles in GMEC internal reviews internal reviews subcommittee worksubcommittee work

How to ensure meeting attendanceHow to ensure meeting attendance

The GMEC*The GMEC*

Structure & Function – MembershipStructure & Function – MembershipProgram CoordinatorsProgram Coordinators

Which ones?Which ones? How selected?How selected?

Roles in GMECRoles in GMEC internal reviewsinternal reviews subcommittee worksubcommittee work

How to ensure meeting attendanceHow to ensure meeting attendance

The GMECThe GMEC

Structure & Function – MembershipStructure & Function – MembershipAnyone else who will add value to your GMEC*?Anyone else who will add value to your GMEC*?

Legal staffLegal staff Compliance officerCompliance officer Quality, risk managementQuality, risk management Public memberPublic member CME, UME, Clinical deansCME, UME, Clinical deans OthersOthers

Appointment vs. periodic reportingAppointment vs. periodic reporting

*likely to evolve over time

The GMECThe GMEC

Structure & Function – MembershipStructure & Function – MembershipVoting vs. Non-voting membersVoting vs. Non-voting members

ImplicationsImplications What will you be voting on?What will you be voting on?

The GMECThe GMEC

Structure & Function – MembershipStructure & Function – MembershipDocumentationDocumentation of attendance of attendance Institutional Site Visit – past 12 mo’ GMEC Institutional Site Visit – past 12 mo’ GMEC minutesminutes

attendance – have back-upsattendance – have back-ups residents’ attendance residents’ attendance

The GMECThe GMECStructure of the GMEC & its components Distributed Labor (Texas Style)Distributed Labor (Texas Style)

Subcommittees Subcommittees Quality & AccreditationQuality & AccreditationResident Duty HoursResident Duty HoursEducation & EvaluationEducation & EvaluationResident Funding & AllocationResident Funding & AllocationWorking EnvironmentWorking EnvironmentResident SupervisionResident SupervisionHouse Staff CouncilHouse Staff CouncilProgram CoordinatorsProgram Coordinators

Steering/Executive committeeSteering/Executive committee

Chairs

Structure of the GMEC & its components

Centralized Labor (Baltimore Style)Centralized Labor (Baltimore Style) SubcommitteesSubcommittees

Only for internal reviewOnly for internal review Executive CommitteeExecutive Committee

DIO, vice chair of GMEC, assistant dean for DIO, vice chair of GMEC, assistant dean for compliance, VPMA of primary hospital, compliance, VPMA of primary hospital, registrarregistrar

The GMEC*The GMEC*

The GMECThe GMEC

Structure of the GMEC & its components Lean and Mean GMECLean and Mean GMEC

Small group that does it allSmall group that does it all

The GMECThe GMEC

Structure & Function of the GMEC Frequency of meetings Frequency of meetings ““must meet at least quarterlymust meet at least quarterly” ”

common model = monthly meetingscommon model = monthly meetings Duration of meetingsDuration of meetings Location of meetings Location of meetings Format – round table, theater-styleFormat – round table, theater-style Videoconference?Videoconference? Food and drink?Food and drink? CME credit?CME credit?

minimize minimize barriersbarriers

The GMECThe GMEC

Structure & Function of the GMEC CalendarCalendar RemindersReminders Agenda - email vs. hardcopy vs. bothAgenda - email vs. hardcopy vs. both Projection vs. paper Projection vs. paper Standing agenda items Standing agenda items Best practices from your programsBest practices from your programs GME Visiting Professors GME Visiting Professors

share with program-level speakers who do GMEshare with program-level speakers who do GME

The GMECThe GMEC Approval of Minutes Reports from:

DIO/Executive Comm

Consent agenda* Best Practice(s) Reports from

Subcommittees Quality/Accred All others

Autopsies tracking

ACGME RRC correspondence

Each hospital – news & QI information

Announcements Next meeting Closed session

Residents in adverse status

Standing Agenda Items - GMEC

*action plans without controversy

Consent AgendaConsent Agenda Part of the regular agenda - one of the first itemsPart of the regular agenda - one of the first items Items for Items for information onlyinformation only, and do not require a , and do not require a

decision or action (e.g., committee reports)decision or action (e.g., committee reports) Allows all reports to be received with 1 motion & 1 Allows all reports to be received with 1 motion & 1

votevote Members can ask questions - once dealt with, the Members can ask questions - once dealt with, the

vote on the single motion addresses all the consent vote on the single motion addresses all the consent agenda reports.  agenda reports. 

Removing an item from the CA - if needs Removing an item from the CA - if needs actionaction or a or a decisiondecision, or if , or if significant further discussionsignificant further discussion is needed. is needed.

Any member can request that an item be removed Any member can request that an item be removed from the consent agenda, but the majority should from the consent agenda, but the majority should decide.decide.

The GMECThe GMEC

GMEC Minutes Must maintain written minutes (III.A.3)Must maintain written minutes (III.A.3) Format of minutesFormat of minutes Paper vs. electronic vs. both vs. email & link to websitePaper vs. electronic vs. both vs. email & link to website Distribution list – facilitate communication/QI issuesDistribution list – facilitate communication/QI issues Institutional site visit: Institutional site visit: need past 1 year’s GMEC need past 1 year’s GMEC minutesminutes“If it isn’t documented, it didn’t happen*”

*every organization whose rules you have to comply with

The GMECThe GMECCommon ACGME Citations - GMEC

1.1. IV.A.1 - GMEC composition & meetingsIV.A.1 - GMEC composition & meetings2.2. IV.B.4.a.1 – duty hours & call schedules IV.B.4.a.1 – duty hours & call schedules

monitored & adjustedmonitored & adjusted3.3. IV.B.4.b – procedures to monitor duty IV.B.4.b – procedures to monitor duty

hourshours4.4. IV.B.6 – curriculum/eval – gen’l IV.B.6 – curriculum/eval – gen’l

competenciescompetencies5.5. IV.B.8 – review accred letters and monitor IV.B.8 – review accred letters and monitor

action plansaction plans

The GMECThe GMEC

In your sponsoring institution: How is the GMEC appointed? By whom? To whom does it report?

The GMECThe GMEC

For your sponsoring institution: How do your GMEC minutes document that it fulfills its responsibilities?

The GMECThe GMEC

For your sponsoring institution: Where is the GMEC on the organizational chart?

The GMECThe GMEC

The GMECThe GMEC

Challenge to you: Review & revise:

GMEC membership list GMEC organizational chart GMEC minutes

After this meeting I plan to After this meeting I plan to make the following GMEC make the following GMEC

changes:changes:1.1.

2.2.

3.3.