Graduate Medical Education2015 End of Year Report

Elaine A. Donoghue, MD, FAACPACGME Designated Institutional Official

Graduate Medical Education National Perspective

■ CLER Pathways to Excellence■ AOA and ACGME single accreditation ■ Growth trends*

– Increasing number of medical students– Stable number of residency slots

■ In the news– Resident burnout & depression– GME funding uncertainty

*JGME March 2015-Weissbart et al.

Graduate Medical EducationLVHN Context

■ GME alignment with Triple Aim– Better Care-QI and patient safety work– Better Health-Reducing health disparities – Better Cost-Efficient care

■ Strategic Growth– Number of Residency Programs– Number of Fellowships

■ Lean administration & data management■ Epic implementation and optimization

GME Leadership

■ Elaine Donoghue, MD began as DIO in July 2014

■ Brian Costello, DO began as DME in October 2015

■ Valerie Holt, EdD, MBA began as GME Manager in July 2015

LVHN ResidenciesFor Academic Year Fall 2014-Spring 2015

+ACGME ^AOA >CODA

■ Dermatology 6^■ Dental Medicine 7>■ Emergency Med. 57^+■ Family Medicine 17 ^+■ General Surgery 28+■ Internal Medicine 37+

– Osteopathic Internship12^

■ Obstetrics/Gyn 21+■ Pediatrics 18+■ Plastic Surgery 6+■ Transitional Year 14+

LVHN Fellowships■ Cardiology 15+■ Colon and Rectal Surgery 2 +■ Gastroenterology new+- Starting in 2016■ Hematology-Oncology 4+■ Hospice and Palliative Medicine 3+■ Nephrology 4+■ Sports Medicine new + Started in 2015■ Surgical Critical Care 1+

LVHN Non-Medical Programs

■ Pharmacy- 2■ Clinical Pastoral Care- 6■ Administrative- 2

Overview Academic Years2010-2015

GME Demographics (Academic Year Ending June 30) AY11 AY12 AY13 AY14 AY15

# medical residents/fellows 215 228 235 243 252

# non-medical residents/fellows 10 10

# visiting residents 73 81 79 85 85

# total accredited residency programs 15 17 18 17 17

# allopathic (ACGME) accredited programs 10 12 13 14 15

# osteopathic (AOA) accredited programs 5 5 5 4 4

# dually (ACGME/AOA) accredited programs 2 2 2 2 2

# new program(s) applied for 3 2 0 1 2# of medical & non-medical graduates 81 87 94 102 114

Overview Academic Years2010-2015

GME Demographics (Academic Year Ending June 30) AY11 AY12 AY13 AY14 AY 15

Resident Recruitment and Match Data

# U.S. medical school applicants 1782 2360 2193 2718 2504

# applicant interviews conducted 658 879 816 954 972

# medical match positions available 79 81 84 86 95

% from allopathic accredited medical schools 49% 50% 41% 35% 42%

% from osteopathic medical schools 35% 33% 43% 43% 40%

% from international medical schools 16% 17% 16% 22% 18%

% from Pennsylvania medical schools 30% 33% 47% 37% 42%

AY 11-16 Approved Positions

214 217235 243

258 260

100

120

140

160

180

200

220

240

260

280

AY 11 AY 12 AY 13 AY 14 AY 15 (Current) AY 16 (Projected)

AY 11-16: Number of Residents and Fellows Approved Positions

AY 15 Recruiting Efforts & Yield ■ 2,504 applicants, 972 interviews, 95 match positions■ Summer 2015-Incoming

– Residents 77 – Fellows 18

■ Participation of LVHN residency programs at:– The Commonwealth Medical College– Philadelphia College of Osteopathic Medicine – Edward Via Virginia College of Osteopathic Medicine– American Association of Family Practice Conference– Family Medicine Educational Consortium

MS-4 Electives & RecruitingAY15■ 26% of matching residents & fellows (n=25)

completed at least one clerkship or elective at LVHN■ These 25 residents completed a total of 32 rotations■ 5 SELECT; 21 from other institutions■ AY15 first year for SELECT MS-4s

Resident and Fellows Match Summary

2,504

Applicants from U.S. medical

schools

972

Applicant interviews conducted

95

Positions filled including dental

and two outside of match

40%

Matches from osteopathic

accredited medical schools

42%

Matches from allopathic

accredited medical schools

18%

Matches from international

medical schools

Match SummaryCombined Allopathic, Osteopathic, & Sub-Specialties Match

Match from LCME Schools (All Matches)

U.S. Allopathic schools, 42%International medical schools, 18%U.S. Osteopathic schools, 40%

Non-PA schools, 62%Pennsylvania schools, 38%

Commonwealth Medical College, 1Drexel University School of Medicine, 2Thomas Jefferson Medical College, 1Penn State College of Medicine, 1University of Pennsylvania 2Temple University, 3University of Pittsburg 4

Resident Orientation 2015

■ 15 topics covering institutional and ACGME requirements

■ Streamlined for efficiency and minimizing pre-work

■ Included Epic training

ACGME Site Visits

■ Two fellowships with site visits in July 2015

– Nephrology– Hematology Oncology

■ First site visits since being approved ■ Expect Neurology program decision in

January 2016

CLER Visit■ Original occurred February 18, 2014■ Response submitted May 2014■ 6 CLER domains; 34 Pathways■ 2015 Preparation for Next Visit

– Ever ready

Faculty Evaluation Completion■ Cardiology 95%■ Colo-Rectal 95%■ Dermatology 100%■ Emergency 100%■ Family Med 100%■ Surgery 80%■ HemOnc 79%■ HPM 67%

■ Internal Med 100%■ Nephrology 79%■ OG/GYN 95%■ Pediatrics 92%■ Plastics 100%■ Surg CC 100%■ Transitional 100%

Resident Duty Hours Report

Department 80 HR CallDays Off

Night Float 24+

Short Break

Cardiology Fellowship 0 0 1 0 0 2

Dermatology 0 0 0 0 0 0

Emergency Medicine 0 0 1 0 10

Family Medicine 0 0 0 0 1 6

General Surgery 1 0 8 0 2 7

Hematology Oncology 0 0 0 0 0 1

Hospice/Palliative Medicine 0 0 0 0 0 0

Internal Medicine 3 0 4 0 1 25

Transitional Year 3 0 0 0 4 35

Nephrology 0 0 1 0 0 0

Obstetrics/Gynecology 2 0 10 0 33 14

Pediatrics 0 0 0 0 0 8

Plastic Surgery 0 0 0 0 0 0

Surgical Critical Care 0 0 0 0 1 0

QUALITY

■ 100% of residents participated in quality and/or safety case reviews.

■ 75/96 or 78% of senior residents participated in a PI project

IHI Open School Use

554Total lessons completed by

residents

72Residents who

completed at least one lesson

93%

Average score of the lessons

64%

357 Courses taken related to quality

improvement

29%

163 Courses taken related to patient

safety

Future Quality Improvement Activities

■ Transitions of Care– New TOC policy– Epic module optimization

■ Reducing resident sharps injuries– GMEC presentations– Video

■ Developing new QI elective

Resident Scholarly Work

Program# Resident Peer Reviewed Abstract/Poster/Oral Presentation

Resident Peer Reviewed Manuscripts Published

Pediatrics 1 0

Dermatology 19 6Emergency Medicine 29 16Internal Medicine 18 0Transitional 14 0General Surgery 2 0Plastic Surgery 2 0Colon/Rectal Surgery 2 0Surgical Critical Care 0 0Ob/Gyn 1 6Dental 14 0Family Medicine 2 1HPM 0 0Nephrology 3 0Cardiology 16 0Hematology/Oncology 3 6Totals 124 (previous year=99) 34 (previous year=22)

Resident Program Graduation, Fellowship, and Board Passage Rates

Residency ProgramTotal # of graduates

# of graduates who stayed at

LVHN

# of graduates progressing to

fellowships

Board passage rate

Family Medicine 5 2 1

Medical boards - 78% Osteopathic written &

practical 100%

Emergency Medicine 15 0 5 100%Internal Medicine (Categorical) 16 2 3 90%

Obstetrics/Gynecology 5 0 0 94%Pediatrics 6 1 3 N/A

General Surgery 8 0 187% qualification exam; 82% certification exam

Plastic Surgery 2 0 0 100%Dermatology 2 0 0 100%

Fellowship Program Graduation, Fellowship, and Board Passage Rates

Fellowship ProgramTotal # of graduates

# of graduates who stayed at

LVHN

# of graduates progressing to

Fellowships Board passage rate

Nephrology 2 2 0 100%

Hematology/Oncology 0 0 0 N/A

Hospice Palliative Medicine 3 1 0 75%

Cardiovascular Disease 5 0 5 98%

Surgical Critical Care 1 0 0 100%

Colon Rectal 2 0 0 75%

GME Finance From FY15 Cost Report - LVHTotal Dental Residents 3.85

Total Allopathic & Osteopathic Resident FTEs 173.10

1st Cap: 12/31/1996 91.22

1st Cap Adjustment (New Family Practice Program) 18.00

Section 5506 Adjustment 22.00

Total 1st Cap 131.22 131.22

Amount over Cap = 41.88

Section 422 Cap 25.00

Lesser of Amount over Cap or Section 422 Cap 25.00

Allowable FTEs:

1st Cap on Allopathic & Osteopathic FTEs 131.22

2nd Cap on Allopathic & Osteopathic FTEs 25.00

Dental Residents 3.85

Total Allowable and Funded 160.07

GME Finance From FY15 Cost Report - MHCTotal Dental Residents 2.94

Total Allopathic & Osteopathic Resident FTEs 63.13

1st Cap: 12/31/1996 0.00

1st Cap Adjustment (New Family Practice Program) 41.67

Section 5506 Adjustment 0.00

Total 1st Cap 41.67 41.67

Amount over Cap = 21.46

Section 422 Cap 16.00

Lesser of Amount over Cap or Section 422 Cap 16.00

Allowable FTEs:

1st Cap on Allopathic & Osteopathic FTEs 41.67

2nd Cap on Allopathic & Osteopathic FTEs 16.00

Dental Residents 2.94

Total Allowable and Funded 60.61

GMEC

■ GMEC restructured meetings to facilitate discussion

■ Policy Reviews Completed in AY15– GTA and Appendices– Eligibility, Selection, Recruitment, and

Appointment of Residents– Evaluation and Promotion– COMLEX Level III– USMLE Step III

AY15 Graduation Data

■ 105 Total Graduates■ 49 Stayed in PA■ 17 Stayed at LVHN■ 4 Continued to Fellowship with LVHN■ 22 Continued to Fellowship Elsewhere

AY 2016 Priorities■ Patient Safety and Quality Improvement

Activities■ Faculty Development ■ Transitions of Care■ CLER visit■ Epic Optimization■ GMEC dashboard

Priorities 2016 cont’d

■ New programs added and pending■ Preparation for Single accreditation■ Next Accreditation System

documentation■ Enhanced data management &

reporting ■ Redesign and renewal of RATL